Preventing 30-Day Readmissions of Clostridium difficile Patients Utilizing Targeted Discharge Instructions

The Patient Protection and Affordable Care Act of 2010 ushered in a new era of fiscal accountability for healthcare organizations. Healthcare organizations and providers are now jointly held responsible for the improved quality of patient care and sustained reductions in patient care events termed healthcare-acquired conditions. To ensure compliance with this newly enacted legislation, the Centers for Medicare and Medicaid Services (CMS) began penalizing hospitals for targeted conditions leading to 30-day readmissions beginning in October 2012. Annually, CMS has focused attention on conditions that endanger patient health and welfare while secondarily attempting to reduce the excessive financial expenditures in care related to 30-day readmissions. CMS penalizes hospitals by decreasing reimbursement for inpatient Medicare rates or by withholding payment through several programs that comprise the Inpatient Prospective Payment System (IPPS). Beginning in fiscal year 2017, Healthcare-acquired Clostridium difficile infection 30-day readmission penalties will commence under CMS quality programs. The aim of this quality improvement project was to decrease 30-day readmissions of healthcare-acquired Clostridium difficile infection in hospitalized patients. Following a targeted discharge education intervention focused on nursing providers and patients, a decrease in 30-day readmissions of healthcare-acquired Clostridium difficile infection was identified at a sustained rate of 14% for 30-day readmissions

A Turbine-powered UAV Controls Testbed

The latest version of the NASA Flying Controls Testbed (FLiC) integrates commercial-off-the-shelf components including airframe, autopilot, and a small turbine engine to provide a low cost experimental flight controls testbed capable of sustained speeds up to 200 mph. The series of flight tests leading up to the demonstrated performance of the vehicle in sustained, autopiloted 200 mph flight at NASA Wallops Flight Facility's UAV runway in August 2006 will be described. Earlier versions of the FLiC were based on a modified Army target drone, AN/FQM-117B, developed as part of a collaboration between the Aviation Applied Technology Directorate at Fort Eustis, Virginia and NASA Langley Research Center. The newer turbine powered platform (J-FLiC) builds on the successes using the relatively smaller, slower and less expensive unmanned aerial vehicle developed specifically to test highly experimental flight control approaches with the implementation of C-coded experimental controllers. Tracking video was taken during the test flights at Wallops and will be available for presentation at the conference. Analysis of flight data from both remotely piloted and autopiloted flights will be presented. Candidate experimental controllers for implementation will be discussed. It is anticipated that flight testing will resume in Spring 2007 and those results will be included, if possible

CD4 T Cell-Derived IFN-γ Plays a Minimal Role in Control of Pulmonary Mycobacterium tuberculosis Infection and Must Be Actively Repressed by PD-1 to Prevent Lethal Disease

IFN-γ–producing CD4 T cells are required for protection against Mycobacterium tuberculosis (Mtb) infection, but the extent to which IFN-γ contributes to overall CD4 T cell-mediated protection remains unclear. Furthermore, it is not known if increasing IFN-γ production by CD4 T cells is desirable in Mtb infection. Here we show that IFN-γ accounts for only ~30% of CD4 T cell-dependent cumulative bacterial control in the lungs over the first six weeks of infection, but \u3e80% of control in the spleen. Moreover, increasing the IFN-γ–producing capacity of CD4 T cells by ~2 fold exacerbates lung infection and leads to the early death of the host, despite enhancing control in the spleen. In addition, we show that the inhibitory receptor PD-1 facilitates host resistance to Mtb by preventing the detrimental over-production of IFN-γ by CD4 T cells. Specifically, PD-1 suppressed the parenchymal accumulation of and pathogenic IFN-γ production by the CXCR3+KLRG1-CX3CR1- subset of lung-homing CD4 T cells that otherwise mediates control of Mtb infection. Therefore, the primary role for T cell-derived IFN-γ in Mtb infection is at extra-pulmonary sites, and the host-protective subset of CD4 T cells requires negative regulation of IFN-γ production by PD-1 to prevent lethal immune-mediated pathology

Heavy Drinking in College Students Is Associated with Accelerated Gray Matter Volumetric Decline over a 2 Year Period

Background: Heavy and/or harmful alcohol use while in college is a perennial and significant public health issue. Despite the plethora of cross-sectional research suggesting deleterious effects of alcohol on the brain, there is a lack of literature investigating the longitudinal effects of alcohol consumption on the adolescent brain. We aim to probe the longitudinal effects of college drinking on gray matter change in students during this crucial neurodevelopmental period. Methods: Data were derived from the longitudinal Brain and Alcohol Research in College Students (BARCS) study of whom a subset underwent brain MRI scans at two time points 24 months apart. Students were young adults with a mean age at baseline of about 18.5 years. Based on drinking metrics assessed at both baseline and followup, subjects were classified as sustained abstainers/light drinkers (N = 45) or sustained heavy drinkers (N = 84) based on criteria established in prior literature. Gray matter volumetric change (GMV-c) maps were derived using the longitudinal DARTEL pipeline as implemented in SPM12. GMV-c maps were then subjected to a 1-sample and 2-sample t-test in SPM12 to determine within- and between-group GMV-c differences in drinking groups. Supplementary between-group differences were also computed at baseline only. Results: Within-group analysis revealed significant decline in GMV in both groups across the 2 year followup period. However, tissue loss in the sustained heavy drinking group was more significant, larger per region, and more widespread across regions compared to abstainers/light drinkers. Between-group analysis confirmed the above and showed a greater rate of GMV-c in the heavy drinking group in several brain regions encompassing inferior/medial frontal gyrus, parahippocampus, and anterior cingulate. Supplementary analyses suggest that some of the frontal differences existed at baseline and progressively worsened. Conclusion: Sustained heavy drinking while in college was associated with accelerated GMV decline in brain regions involved with executive functioning, emotional regulation, and memory, which are critical to everyday life functioning. Areas of significant GMV decreases also overlapped largely with brain reward and stress systems implicated in addictive behavior

The Grand Tour of the Ruby-East Humboldt Metamorphic Core Complex, Northeastern Nevada: Part 1-Introduction & Road Log

The purpose of this geological excursion is to provide an overview of the multiphase developmental history of the Ruby Mountains and East Humboldt Range, northeastern Nevada. Although these mountain ranges are commonly cited as a classic example of a Cordilleran metamorphic core complex developed through large-magnitude, mid-Tertiary crustal extension, a preceding polyphase Mesozoic contractional history is also well preserved in the ranges. An early phase of this history involved Late Jurassic two-mica granitic magmatism, high-temperature but relatively low-pressure metamorphism, and polyphase deformation in the central Ruby Mountains. In the northern Ruby Mountains and East Humboldt Range, a Late Cretaceous history of crustal shortening, metamorphism, and magmatism is manifested by fold-nappes (involving Archean basement rocks in the northern East Humboldt Range), widespread migmatization, injection of monzogranitic and leucogranitic magmas, all coupled with sillimanite-grade metamorphism. Following Late Cretaceous contraction, a protracted extensional deformation partially overprinted these areas during the Cenozoic. This extensional history may have begun as early as the Late Cretaceous or as late as the mid-Eocene. Late Eocene and Oligocene magmatism occurred at various levels in the crust yielding mafic to felsic orthogneisses in the deep crust, a composite granitic pluton in the upper crust, and volcanic rocks at the surface. Movement along a west-rooted, extensional shear zone in the Oligocene and early Miocene led to core-complex exhumation. The shear zone produced mylonitic rocks about 1 km thick at deep crustal levels, and an overprint of brittle detachment faulting at shallower levels as unroofing proceeded. Megabreccias and other synextensional sedimentary deposits are locally preserved in a tilted, upper Eocene through Miocene stratigraphic sequence. Neogene magmatism included the emplacement of basalt dikes and eruption of rhyolitic rocks. Subsequent Basin and Range normal faulting, as young as Holocene, records continued tectonic extension

Getting It on Record: Issues and Strategies for Ethnographic Practice in Recording Studios

The recording studio has been somewhat neglected as a site for ethnographic fieldwork in the field of ethno-musicology and, moreover, the majority of published studies tend to overlook the specific concerns faced by the researcher within these contexts. Music recording studios can be places of creativity, artistry, and collaboration, but they often also involve challenging, intimidating, and fractious relations. Given that recording studios are, first and foremost, concerned with documenting musicians’ performances, we discuss the concerns of getting studio interactions “on record” in terms of access, social relations, and methods of data collection. This article reflects on some of the issues we faced when conducting our fieldwork within British music recording facilities and makes suggestions based on strategies that we employed to address these issues

Familial Parkinson's Disease-associated L166P Mutation Disrupts DJ-1 Protein Folding and Function

Mutations in DJ-1, a protein of unknown function, were recently identified as the cause for an autosomal recessive, early onset form of familial Parkinson's disease. Here we report that DJ-1 is a dimeric protein that exhibits protease activity but no chaperone activity. The protease activity was abolished by mutation of Cys-106 to Ala, suggesting that DJ-1 functions as a cysteine protease. Our studies revealed that the Parkinson's disease-linked L166P mutation impaired the intrinsic folding propensity of DJ-1 protein, resulting in a spontaneously unfolded structure that was incapable of forming a homodimer with itself or a heterodimer with wild-type DJ-1. Correlating with the disruption of DJ-1 structure, the L166P mutation abolished the catalytic function of DJ-1. Furthermore, as a result of protein misfolding, the L166P mutant DJ-1 was selectively polyubiquitinated and rapidly degraded by the proteasome. Together these findings provide insights into the molecular mechanism by which loss-of-function mutations in DJ-1 lead to Parkinson's disease

Patterns of Clinical Response with Talimogene Laherparepvec (T-VEC) in Patients with Melanoma Treated in the OPTiM Phase III Clinical Trial

PURPOSE: Talimogene laherparepvec (T-VEC) is an oncolytic immunotherapy designed to induce tumor regression of injected lesions through direct lytic effects, and of uninjected lesions through induction of systemic antitumor immunity. In this study, we describe the patterns and time course of response to T-VEC from the phase III OPTiM trial of 436 patients with unresected stages IIIB-IV melanoma. METHODS: Lesion-level response analyses were performed based on the type of lesion (injected or uninjected cutaneous, subcutaneous, or nodal lesions; or visceral lesions [uninjected]), and the best percentage change from baseline of the sum of products of the longest diameters was calculated. Patients randomized to T-VEC (n = 295) who experienced a durable response (continuous partial or complete response for ≥6 months) were evaluated for progression prior to response (PPR), defined as the appearance of a new lesion or >25 % increase in total baseline tumor area. RESULTS: T-VEC resulted in a decrease in size by ≥50 % in 64 % of injected lesions (N = 2116), 34 % of uninjected non-visceral lesions (N = 981), and 15 % of visceral lesions (N = 177). Complete resolution of lesions occurred in 47 % of injected lesions, 22 % of uninjected non-visceral lesions, and 9 % of visceral lesions. Of 48 patients with durable responses, 23 (48 %) experienced PPR, including 14 who developed new lesions only. No difference in overall survival was observed, and median duration of response was not reached in patients with PPR versus those without PPR. CONCLUSIONS: Responses in uninjected lesions provide validation of T-VEC-induced systemic immunotherapeutic effects against melanoma. PPR did not negatively impact the clinical effectiveness of T-VEC