Quality Measurement in Wonderland: The Curious Case of a Dialysis Readmissions Measure

The standardized readmission ratio is a new quality measure for dialysis facilities that will affect public reporting and payment beginning in 2017. Like all quality measures affecting public reporting and payment, the standardized readmission ratio was vetted by a process that included a technical expert panel convened by the US Centers for Medicare and Medicaid Services, and, then, the National Quality Forum. Unlike previous measures, standardized readmission ratio followed a tortuous path that exposed problems in the development and endorsement process. Although it is acknowledged that processes in the dialysis facility can be improved to decrease readmissions, multiple objections to the implementation of the standardized readmission ratio measure existed. This review discusses the standardized readmission ratio measure and issues related to quality metric development that are important for the nephrology community to consider

Update on Membranoproliferative GN

Membranoproliferative GN represents a pattern of injury seen on light microscopy. Historically, findings on electron microscopy have been used to further subclassify this pathologic entity. Recent advances in understanding of the underlying pathobiology have led to a proposed classification scheme based on immunofluorescence findings. Dysregulation of the complement system has been shown to be a major risk factor for the development of a membranoproliferative GN pattern of injury on kidney biopsy. Evaluation and treatment of this complex disorder rest on defining the underlying mechanisms

Neutrino oscillations in matter of varying density

We consider two-family neutrino oscillations in a medium of continuously-varying density as a limit of the process in a series of constant-density layers. We construct analytic expressions for the conversion amplitude at high energies within a medium with a density profile that is piecewise linear. We compare some cases to understand the type of effects that depend on the order of the material traversed by a neutrino beam.Comment: 10 page

Challenges and opportunities in late-stage chronic kidney disease

There is increasing recognition that chronic diseases are a major challenge for health delivery systems and treasuries. These are highly prevalent and costly diseases and frequency is expected to increase greatly as the population of many countries ages. Chronic kidney disease (CKD) has not received the same attention as other chronic diseases such as congestive heart failure; yet, the prevalence and costs of CKD are substantial. Greater recognition and support for CKD may require that the disease no longer be viewed as one continuous disease state. Early CKD stages require less complex care and generate lower costs. In contrast, late-stage CKD is every bit as complex and costly as other major chronic diseases. Health authorities may not recognize and fund CKD care appropriately until late-stage CKD is defined clearly as separate and distinct from earlier stages of disease. In this review, we describe the burden of chronic diseases, consider the challenges and barriers and propose processes to improve late-stage CKD care. In particular, we recommend the need for improved continuity of care, enhanced use of information technology, multidisciplinary care, timely referral to nephrologists, protocol use and improved patient engagement

Resolution of the Klein Paradox

We present a resolution of the Klein paradox within the framework of one-particle relativistic quantum mechanics. Not only reflection becomes total but the vacuum remains neutral as well. This is accomplished by replacing the pair production process with virtual negative energy "incidence" within the barrier in a similar manner to what is done with image charges in electrostatic and virtual sources in optics.Comment: 9 pages, 8 figure