Case Mix, Costs, and Outcomes: Differences Between Faculty and Community Services in a University Hospital

In order to gain insight into the possible consequences of prospective payment for university hospitals, we studied 2,025 admissions to the faculty and community services of a university hospital, measuring differences in case mix, costs, and outcomes. The faculty service case mix was disproportionately weighted toward the more costly diagnoses, but even after adjustment for diagnosis-related groups (DRGs), costs were 11 percent higher on the faculty service. The differential was proportionately greater for diagnostic costs than for routine or treatment costs, and the differential was particularly large (70 percent) for patients with a predicted probability of death (DTHRISK) of .25 or greater.The in-hospital mortality rate was appreciably lower on the faculty service after adjustment for case mix and patient characteristics. The mortality differential between the two services was particularly large for patients in the high death risk category. Comparison of a matched sample of 51 pairs of admissions from the high death risk category confirmed the above results with respect to costs and in-hospital mortality, but follow-up revealed that the mortality rates were equal for the two services at nine months after discharge.

Nurses\u27 Alumnae Association Bulletin - Volume 16 Number 1

Alumnae Notes ANA Biennial Convention Cancer of the Cervix, Uterus and Ovaries Committee Reports Digest of Alumnae Association Meetings Greetings from Miss Childs Greetings from the President Graduation Awards - 1950 Isotopes and the Nurse - Dr. T.P. Eberhard Marriages Necrology New Arrivals Nursing Care in Heart Disease with Pulmonary Infarction Nursing Care of a Mitral Commissurotomy Physical Advances at Jefferson - 1950 Policies of the Private Duty Nurses\u27 Registry Staff Activities, 1950-1951 Students\u27 Corner The Department of Surgical Research - Drs. Templeton and Gibbon White Haven and Barton Memorial Division

Climate Quality Broadband and Narrowband Solar Reflected Radiance Calibration Between Sensors in Orbit

vAs the potential impacts of global climate change become more clear [1], the need to determine the accuracy of climate prediction over decade-to-century time scales has become an urgent and critical challenge. The most critical tests of climate model predictions will occur using observations of decadal changes in climate forcing, response, and feedback variables. Many of these key climate variables are observed by remotely sensing the global distribution of reflected solar spectral and broadband radiance. These "reflected solar" variables include aerosols, clouds, radiative fluxes, snow, ice, vegetation, ocean color, and land cover. Achieving sufficient satellite instrument accuracy, stability, and overlap to rigorously observe decadal change signals has proven very difficult in most cases and has not yet been achieved in others [2]. One of the earliest efforts to make climate quality observations was for Earth Radiation Budget: Nimbus 6/7 in the late 1970s, ERBE in the 1980s/90s, and CERES in 2000s are examples of the most complete global records. The recent CERES data products have carried out the most extensive intercomparisons because if the need to merge data from up to 11 instruments (CERES, MODIS, geostationary imagers) on 7 spacecraft (Terra, Aqua, and 5 geostationary) for any given month. In order to achieve climate calibration for cloud feedbacks, the radiative effect of clear-sky, all-sky, and cloud radiative effect must all be made with very high stability and accuracy. For shortwave solar reflected flux, even the 1% CERES broadband absolute accuracy (1-sigma confidence bound) is not sufficient to allow gaps in the radiation record for decadal climate change. Typical absolute accuracy for the best narrowband sensors like SeaWiFS, MISR, and MODIS range from 2 to 4% (1-sigma). IPCC greenhouse gas radiative forcing is approx. 0.6 W/sq m per decade or 0.6% of the global mean shortwave reflected flux, so that a 50% cloud feedback would change the global reflected flux by approx. 0.3 W/sq m or 0.3% per decade in broadband SW calibration change. Recent results comparing CERES reflected flux changes with MODIS, MISR, and SeaWiFS narrowband changes concluded that only SeaWiFS and CERES were approaching sufficient stability in calibration for decadal climate change [3]. Results using deep convective clouds in the optically thick limit as a stability target may prove very effective for improving past data sets like ISCCP. Results for intercalibration of geostationary imagers to CERES using an entire month of regional nearly coincident data demonstrates new approaches to constraining the calibration of current geostationary imagers. The new Decadal Survey Mission CLARREO is examining future approaches to a "NIST-in-Orbit" approach of very high absolute accuracy reference radiometers that cover the full solar and infrared spectrum at high spectral resolution but at low spatial resolution. Sampling studies have shown that a precessing CLARREO mission could calibrate other geo and leo reflected solar radiation and thermal infrared sensors

Case mix, costs, and outcomes — differences between faculty and community services in a university hospital

To gain insight into the possible consequences of prospective payment for university hospitals, we studied 2025 admissions to the faculty and community services of a university hospital, measuring differences in case mix, costs, and mortality in the hospital. The faculty service had more of the patients with costly diagnoses, but even after adjustment for diagnosis-related groups (DRGs), costs were 11 per cent higher on the faculty service (95 per cent confidence limits, 4 to 18 per cent). The percentage differential was greatest for diagnostic costs. The differential was particularly large — 70 per cent (95 per cent confidence limits, 33 to 107 per cent) — for patients with a predicted probability of death of 0.25 or greater. The in-hospital mortality rate was significantly lower on the faculty service after adjustment for case mix and patient characteristics (P<0.05); the difference was particularly large for patients in the high-death-risk category. Comparision of a matched sample of 51 pairs of admissions from the high-death-risk category confirmed the above results with respect to costs and in-hospital mortality, but follow-up revealed that the survival rates were equal for the two services at nine months after discharge. The effect of prospective payment on the cost of care will be closely watched; we conclude that it will also be important to monitor the effect on outcomes, including hospital mortality rates

Linguistic incompetence: giving an account of researching multilingually

This paper considers the place of linguistic competence and incompetence in the context of researching multilingually. It offers a critique of the concept of competence and explores the performative dimensions of multilingual research and its narration, through the philosophy of Judith Butler, and in particular her study Giving an account of oneself. It explores aspects of risk, justice, narrative limit and a morality of multilingualism in emergent multilingual research frameworks. These theoretical dimensions are explored through consideration of ‘linguistically incompetent’ ethnographic work with refugees and asylum seekers, in contexts of hospitality and in life long learning research in the Gaza Strip, and of early attempts to learn new languages. The paper offers a prospect of a relational approach to researching multilingually and affirms the vulnerability at the heart of linguistic hospitality

Evaluating the effects of bilingual traffic signs on driver performance and safety

Variable Message Signs (VMS) can provide immediate and relevant information to road users and bilingual VMS can provide great flexibility in countries where a significant proportion of the population speak an alternative language to the majority. The study reported here evaluates the effect of various bilingual VMS configurations on driver behaviour and safety. The aim of the study was to determine whether or not the visual distraction associated with bilingual VMS signs of different configurations (length, complexity) impacted on driving performance. A driving simulator was used to allow full control over the scenarios, road environment and sign configuration and both longitudinal and lateral driver performance was assessed. Drivers were able to read one and two-line monolingual signs and two-line bilingual signs without disruption to their driving behaviour. However, drivers significantly reduced their speed in order to read four-line monolingual and four-line bilingual signs, accompanied by an increase in headway to the vehicle in front. This implies that drivers are possibly reading the irrelevant text on the bilingual sign and various methods for reducing this effect are discussed

Gesture analysis for physics education researchers

Systematic observations of student gestures can not only fill in gaps in students' verbal expressions, but can also offer valuable information about student ideas, including their source, their novelty to the speaker, and their construction in real time. This paper provides a review of the research in gesture analysis that is most relevant to physics education researchers and illustrates gesture analysis for the purpose of better understanding student thinking about physics.Comment: 14 page

A 5 item version of the Compliance Questionnaire for Rheumatology (CQR5) successfully identifies low adherence to DMARDs

© 2013 Hughes et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedTaking DMARDs as prescribed is an essential part of self-management for patients with Rheumatoid Arthritis. To date, the Compliance Questionnaire for Rheumatology (CQR) is the only self-report adherence measure created specifically for and validated in rheumatic diseases. However, the factor structure of the CQR has not been reported and it can be considered lengthy at 19 items. The aim of this study was to test the factor structure of the CQR and reduce the number of items whilst retaining robust explanation of non-adherence to DMARDs. Such a reduction would increase the clinical utility of the scale, to identify patients with sub-optimal adherence to DMARDs in the clinic as well as for research purposes.Peer reviewe

Teleology and Realism in Leibniz's Philosophy of Science

This paper argues for an interpretation of Leibniz’s claim that physics requires both mechanical and teleological principles as a view regarding the interpretation of physical theories. Granting that Leibniz’s fundamental ontology remains non-physical, or mentalistic, it argues that teleological principles nevertheless ground a realist commitment about mechanical descriptions of phenomena. The empirical results of the new sciences, according to Leibniz, have genuine truth conditions: there is a fact of the matter about the regularities observed in experience. Taking this stance, however, requires bringing non-empirical reasons to bear upon mechanical causal claims. This paper first evaluates extant interpretations of Leibniz’s thesis that there are two realms in physics as describing parallel, self-sufficient sets of laws. It then examines Leibniz’s use of teleological principles to interpret scientific results in the context of his interventions in debates in seventeenth-century kinematic theory, and in the teaching of Copernicanism. Leibniz’s use of the principle of continuity and the principle of simplicity, for instance, reveal an underlying commitment to the truth-aptness, or approximate truth-aptness, of the new natural sciences. The paper concludes with a brief remark on the relation between metaphysics, theology, and physics in Leibniz

Epstein-barr virus latent membrane protein 1 genetic variability in peripheral blood B cells and oropharyngeal fluids

We report the diversity of latent membrane protein 1 (LMP1) gene founder sequences and the level of Epstein-Barr virus (EBV) genome variability over time and across anatomic compartments by using virus genomes amplified directly from oropharyngeal wash specimens and peripheral blood B cells during acute infection and convalescence. The intrahost nucleotide variability of the founder virus was 0.02% across the region sequences, and diversity increased significantly over time in the oropharyngeal compartment (P = 0.004). The LMP1 region showing the greatest level of variability in both compartments, and over time, was concentrated within the functional carboxyl-terminal activating regions 2 and 3 (CTAR2 and CTAR3). Interestingly, a deletion in a proline-rich repeat region (amino acids 274 to 289) of EBV commonly reported in EBV sequenced from cancer specimens was not observed in acute infectious mononucleosis (AIM) patients. Taken together, these data highlight the diversity in circulating EBV genomes and its potential importance in disease pathogenesis and vaccine design. IMPORTANCE: This study is among the first to leverage an improved high-throughput deep-sequencing methodology to investigate directly from patient samples the degree of diversity in Epstein-Barr virus (EBV) populations and the extent to which viral genome diversity develops over time in the infected host. Significant variability of circulating EBV latent membrane protein 1 (LMP1) gene sequences was observed between cellular and oral wash samples, and this variability increased over time in oral wash samples. The significance of EBV genetic diversity in transmission and disease pathogenesis are discussed