The Revolving Door: A Report on U.S. Hospital Readmissions

The U.S. health care system suffers from a chronic malady -- the revolving door syndrome at its hospitals. It is so bad that the federal government says one in five elderly patients is back in the hospital within 30 days of leaving.Some return trips are predictable elements of a treatment plan. Others are unplanned but difficult to prevent: patients go home, new and unexpected problems arise, and they require an immediate trip back to the hospital.But many of these readmissions can and should be prevented. They are the result of a fragmented system of care that too often leaves discharged patients to their own devices, unable to follow instructions they didn't understand, and not taking medications or getting the necessary follow-up care.The federal government has pegged the cost of readmissions for Medicare patients alone at $26 billion annually, and says more than$17 billion of it pays for return trips that need not happen if patients get the right care. This is one reason the Centers for Medicare & Medicaid Services has identified avoidable readmissions as one of the leading problems facing the U.S. health care system and now penalizes hospitals with high rates of readmissions for their heart failure, heart attack, and pneumonia patients. This report is being released in conjunction with the Robert Wood John Foundation's Care About Your Care initiative, which is devoted to improving care transitions when people leave the hospital. It looks at the issue of readmissions in two ways: by the numbers and through the eyes of the people who live them

Negotiating greenhouse abatement and the theory of public goods

In this paper, the problem of negotiating an abatement agreement is approached from the perspective of the theory of public goods in a general equilibrium context. Such an approach has the appeal of simultaneously dealing with both equity and efficiency issues. Three major difficulties in negotiating an agreement under such an approach are discussed. First, there is the problem of obtaining some measure of agreement about the welfare impacts of abatement on different economies. Second, there is the problem of obtaining agreement about the likely need to allocate side payments to address differential welfare impacts. Finally, in a partial abatement agreement, there is the problem of dealing with impacts on non-abating countries and the possible response of such countries. In a general equilibrium context, it is unlikely that there is a simple rule that could be used to approximate the appropriate public goods solution concept. Nevertheless, negotiations based on the use of indicator variables may provide a rough approximation

The Balance Between Mutators and Nonmutators in Asexual Populations

Mutator alleles, which elevate an individual’s mutation rate from 10 to 10,000-fold, have been found at high frequencies in many natural and ex- perimental populations. Mutators are continually produced from nonmu- tators, often due to mutations in mismatch-repair genes. These mutators gradually accumulate deleterious mutations, limiting their spread. How- ever, they can occasionally hitchhike to high frequencies with beneficial mutations. We study the interplay between these effects. We first analyze the dynamics of the balance between the production of mutator alleles and their elimination due to deleterious mutations. We find that when deleteri- ous mutation rates are high in mutators, there will often be many “young”, recently produced mutators in the population, and the fact that deleteri- ous mutations only gradually eliminate individuals from a population is important. We then consider how this mutator-nonmutator balance can be disrupted by beneficial mutations, and analyze the circumstances under which fixation of mutator alleles is likely. We find that dynamics is crucial: even in situations where selection on average acts against mutators, so they cannot stably invade, the mutators can still occasionally generate beneficial mutations and hence be important to the evolution of the population.Organismic and Evolutionary Biolog

Improving Patient Decision-Making in Health Care

Outlines regional variations within Minnesota in rates of patients with similar conditions receiving elective surgery, the concept of shared decision making, treatment choices for eight conditions, and steps for ensuring patients make informed decisions

Critical Dynamics in a Binary Fluid: Simulations and Finite-size Scaling

We report comprehensive simulations of the critical dynamics of a symmetric binary Lennard-Jones mixture near its consolute point. The self-diffusion coefficient exhibits no detectable anomaly. The data for the shear viscosity and the mutual-diffusion coefficient are fully consistent with the asymptotic power laws and amplitudes predicted by renormalization-group and mode-coupling theories {\it provided} finite-size effects and the background contribution to the relevant Onsager coefficient are suitably accounted for. This resolves a controversy raised by recent molecular simulations.Comment: 4 pages, 4 figure

Evidence-Based Use of Cold for Plantar Fasciitis

Objective The purpose of this study was to examine the effect of cold applied the night before or in the morning on pain and symptoms of plantar fasciitis. Design Experimental study. Methods Thirty subjects with plantar fasciitis were recruited for this study. Subjects with plantar fasciitis either had no intervention, cold applied (20 minutes) at night before bed, or 20 minutes in the morning upon wakening. Plantar fascia tenderness and pain were evaluated. There were ten subjects in each group. Measures included visual analog scale, plantar facial thickness via high resolution ultrasound, algometer measure, and range of motion of the ankle and foot. There were 3 groups of 10 subjects, control (no intervention), cold the night before bed, and cold in the morning before rising. Results The greatest relief of symptoms was cold used at bedtime the night before the measurements. Cold used in the morning was not as effective as cold used in the evening before bed. Cold use reduced the thickness of the plantar fascia and irritation. There was a 13% reduction in plantar fascia thickness with cold the night before (p\u3c0.05), a 44% reduction in pain and an 86 % increase in the force that could be applied to the bottom of the foot without pain (p\u3c0.05). Conclusions Cold applied for 20 minutes prior bedtime is effective for reduced symptomology caused by plantar fascia inflammation