Avoiding 30-day Readmissions of Acute MI Patients Utilizing Cardiac Rehabilitation

A significant number of Acute Myocardial Infarction (AMI) patients were readmitted to an urban San Francisco Medical Center within 5-7 days post discharge this year. Two of the main identified causes were symptom management issues and medication instructions, both of which are part of the discharge instructions. It’s not surprising that 80% of all discharge teaching is forgotten by patients by the time they hit the parking lot. With the recommended timeframe for post discharge follow up appointments at 48 to 72 hours post discharge and as those appointments are not typically available within the recommended timeframe, patients are more likely to be readmitted unless an alternative for post discharge follow up can be created. The intent of this project is to propose the implementation of a hospital based Cardiac Rehabilitation (CR) program that allows AMI patients to participate as early as 48 -72 hours post discharge. This first part, or intake to the CR program would reinforce discharge teaching inclusive of medication reconciliation, symptom management, and all other components taught at discharge. The evidence to be duplicated is that enrollment in a certified cardiac rehab program as early as 48 hours post discharge can prevent readmissions by enhancing the patient/family’s retention and understanding of discharge instructions that include symptom management and medicatio

New approaches for estimating risk from exposure to diethylstilbestrol.

A subgroup from a National Institute of Environmental Health Sciences, workshop concerned with characterizing the effects of endocrine disruptors on human health at environmental exposure levels considered the question, If diethylstilbestrol (DES) were introduced into the market for human use today and likely to result in low-dose exposure of the human fetus, what would be required to assess risk? On the basis of an analysis of the quality of data on human DES exposure, the critical times and doses for inducing genital tract malformations and cancer must be determined. This would be facilitated through analysis of the ontogeny of estrogen receptor expression in the developing human genital tract. Models of low-dose estrogenic effects will have to be developed for human and rodent genital tract development. Mouse models offer many advantages over other potential animal models because of the wealth of the earlier literature, the availability of sensitive end points, the availability of mutant lines, and the possibility of generating genetically engineered model systems. Through multidisciplinary approaches, it should be possible to elucidate the cellular and molecular mechanisms of endocrine disruption elicited by estrogens during development and facilitate an assessment of risk to humans

Underground reactor containments: An option for the future?

Changing world conditions and changing technologies suggest that serious consideration should be given to siting of nuclear power plants underground. Underground siting is not a new concept. Multiple research reactors, several weapons production reactors, and one power reactor have been built underground. What is new are the technologies and incentives that may now make underground siting a preferred option. The conditions and technologies, along with their implications, are discussed herein. Underground containments can be constructed in mined cavities or pits that are then backfilled with thick layers of rock and soil. Conventional above-ground containments resist assaults and accidents because of the strength of their construction materials and the effectiveness of their safety features that are engineered to reduce loads. However, underground containments can provide even more resistance to assaults and accidents because of the inertia of the mass of materials over the reactor. High-technology weapons or some internal accidents can cause existing strong-material containments to fail, but only very-high energy releases can move large inertial masses associated with underground containments. New methods of isolation may provide a higher confidence in isolation that is independent of operator action

Evaluation of non-chemical seed treatment methods for the control of Alternaria dauci and A. radicina on carrot seeds

The current study was initiated to evaluate the efficacy of physical methods (hot water, aerated steam, electron treatment) and agents of natural origin (resistance inducers, plant derived products, micro-organisms) as seed treatments of carrots for control of Alternaria dauci and A. radicina. Control of both Alternaria species by seed treatment with the resistance inducers was generally poor. Results were also not satisfactory with most of the formulated commercial micro-organism preparations. Based on the average of five field trials, one of these, BA 2552 (Pseudomonas chlororaphis), provided a low but significant increase in plant stand. Among the experimental micro-organisms, the best results were obtained with Pseudomonas sp. strain MF 416 and Clonostachys rosea strain IK726. A similar level of efficacy was provided by seed treatment with an emulsion (1%) of thyme oil in water. Good and consistent control was generally achieved with the physical methods aerated steam, hot water and electron treatment. Aerated steam treatment was, apart from the thiram-containing chemical standard, the best single treatment, and its performance may at least partially be due to extensive pre-testing, resulting in dosages optimally adapted to the respective seed lot. In some of the experiments the effect of the hot water treatment, which was tested at a fixed, not specifically adapted dosage, was significantly improved when combined with a Pseudomonas sp. MF 416 or C. rosea IK726 treatment. The results are discussed in relation to the outcome of experiments in which the same seed treatment methods and agents were tested in other seed-borne vegetable pathosystems

Mixed-data-model heterogeneous compilation and OpenMP offloading

Heterogeneous computers combine a general-purpose host processor with domain-specific programmable many-core accelerators, uniting high versatility with high performance and energy efficiency. While the host manages ever-more application memory, accelerators are designed to work mainly on their local memory. This difference in addressed memory leads to a discrepancy between the optimal address width of the host and the accelerator. Today 64-bit host processors are commonplace, but few accelerators exceed 32-bit addressable local memory, a difference expected to increase with 128-bit hosts in the exascale era. Managing this discrepancy requires support for multiple data models in heterogeneous compilers. So far, compiler support for multiple data models has not been explored, which hampers the programmability of such systems and inhibits their adoption. In this work, we perform the first exploration of the feasibility and performance of implementing a mixed-data-mode heterogeneous system. To support this, we present and evaluate the first mixed-data-model compiler, supporting arbitrary address widths on host and accelerator. To hide the inherent complexity and to enable high programmer productivity, we implement transparent offloading on top of OpenMP. The proposed compiler techniques are implemented in LLVM and evaluated on a 64+32-bit heterogeneous SoC. Results on benchmarks from the PolyBench-ACC suite show that memory can be transparently shared between host and accelerator at overheads below 0.7 % compared to 32-bit-only execution, enabling mixed-data-model computers to execute at near-native performance

STOVE: Seed treatments for organic vegetable production

The aim of the EU-financed research project „STOVE“ (Seed Treatments for Organic Vegetable Production) is to evaluate different methods potentially suited for seed treatment of vegetables in organic farming regarding their efficacy, to optimise these methods, and where feasible to combine them with each other. Scientists from seven European research institutions and a producer of organic vegetable seeds carry out the project

Clinician acquisition and retention of Motivational Interviewing skills: a two-and-a-half-year exploratory study

<p>Abstract</p> <p>Background</p> <p>Motivational interviewing (MI) is a collaborative, client-centred counselling style aimed at eliciting and strengthening clients' intrinsic motivation to change. There is strong research evidence supporting the efficacy of MI, notably in its application among alcohol and drug abuse populations. MI interventions in smoking cessation may yield modest but significant increases in quitting. The present study sought to assess the acquisition and retention of MI skills in counsellors at the Swedish National Tobacco Quitline.</p> <p>Methods</p> <p>Three audio-recorded sessions from each of three counsellors were assessed using the Motivational Interviewing Treatment Integrity (MITI) Code Version 3.0 over 11 assessment periods at fixed intervals in a two-and-a-half year period during which counsellors received ongoing supervision.</p> <p>Results</p> <p>The mean skill for all counsellors improved throughout the study period in most MITI variables. However, great variations in MI skill between counsellors were observed, as well as fluctuations in performance in counsellors over time.</p> <p>Conclusion</p> <p>The present exploratory study covers a longer time period than most evaluations of MI training, and has several advantages with regard to study design. It may provide a basis for (larger sample) replication to test MI skill (as measured by the MITI) in relation to behaviour change in clients, to evaluate MI training, and to assess the acquisition and retention of MI skill over time. Difficulties in acquiring and retaining MI skill may raise the issue of a selection policy for MI training. Moreover, fluctuations in MI skill over time emphasise the greater importance of continuous feedback and supervision over initial MI training, and the need for the use of validated treatment integrity assessment instruments in ordinary clinical implementations of MI.</p

A prospective study of asthma incidence and its predictors: the RHINE study.

To access publisher full text version of this article. Please click on the hyperlink in Additional LinkThe objective of this longitudinal study was to estimate the incidence rate of asthma, and to compare the incidence between subjects with or without baseline reporting of certain respiratory symptoms. A follow-up of the random population samples in the European Respiratory Health Survey (ECRHS) in Sweden, Norway, Denmark, Iceland and Estonia was conducted in 1999-2001, in a population aged 30-54 yrs at follow-up (n=14,731). Asthma was defined as reporting either asthma or physician-diagnosed asthma, and a reported year when asthma symptoms were first noticed. Incidence rates, incidence rate ratios and hazard ratios were calculated with 95% confidence intervals. The incidence rate of asthma was 2.2 cases per 1,000 person-yrs. The incidence was higher among females (2.9 cases.1,000 person-yrs(-1)) than among males (1.5 cases.1,000 person-yrs(-1)). When subjects with baseline reporting of wheezing were excluded, the incidence rate decreased to 1.7 cases.1,000 person-yrs(-1), with a further decrease to 1.5 cases.1,000 person-yrs(-1) after exclusion of subjects with wheezing, nocturnal dyspnoea, chest tightness and cough. There was a strong association between onset of asthma and wheezing at baseline. In this prospective, population-based study, the incidence rate of asthma in the whole population sample ranged 1.5-2.2.1,000 person-yrs(-1), with a higher incidence range among females. The incidence was dependent on the extent to which subjects with respiratory symptoms were excluded from follow-up. Hence, for comparability between studies, the exclusion criteria in the follow-up population must be stated