Association between Post-Hospital Clinic and Telephone Follow-up Provider Visits with 30-Day Readmission Risk in an Integrated Health System

BACKGROUND: Follow-up visits with clinic providers after hospital discharge may not be feasible for some patients due to functional limitations, transportation challenges, need for physical distancing, or fear of exposure especially during the current COVID-19 pandemic. METHODS: The aim of the study was to determine the effects of post-hospital clinic (POSH) and telephone (TPOSH) follow-up provider visits versus no visit on 30-day readmission. We used a retrospective cohort design based on data from 1/1/2017 to 12/31/2019 on adult patients (n = 213,513) discharged home from 15 Kaiser Permanente Southern California hospitals. Completion of POSH or TPOSH provider visits within 7 days of discharge was the exposure and all-cause 30-day inpatient and observation stay readmission was the primary outcome. We used matching weights to balance the groups and Fine-Gray subdistribution hazard model to assess for readmission risk. RESULTS: Unweighted all-cause 30-day readmission rate was highest for patients who completed a TPOSH (17.3%) followed by no visit (14.2%), non-POSH (evaluation and management visits that were not focused on the hospitalization: 13.6%) and POSH (12.6%) visits. The matching weighted models showed that the effects of POSH and TPOSH visits varied across patient subgroups. For high risk (LACE 11+) medicine patients, both POSH (HR: 0.77, 95% CI: 0.71, 0.85, P \u3c .001) and TPOSH (HR: 0.91, 95% CI: 0.83, 0.99, P = .03) were associated with 23 and 9% lower risk of 30-day readmission, respectively, compared to no visit. For medium to low risk medicine patients (LACE\u3c 11) and all surgical patients regardless of LACE score or age, there were no significant associations for either visit type with risk of 30-day readmission. CONCLUSIONS: Post-hospital telephone follow-up provider visits had only modest effects on 30-day readmission in high-risk medicine patients compared to clinic visits. It remains to be determined if greater use and comfort with virtual visits by providers and patients as a result of the pandemic might improve the effectiveness of these encounters

The effects of a whey protein and guar gum-containing preload on gastric emptying, glycaemia, small intestinal absorption and blood pressure in healthy older subjects

A whey protein/guar gum preload reduces postprandial glycaemia in type 2 diabetes through slowing gastric emptying. However, gastric emptying has previously been assessed using a stable isotope breath test technique, which cannot discriminate between slowing of gastric emptying and small intestinal absorption. This preload also may be useful in the management of postprandial hypotension. We evaluated the effects of a whey protein/guar preload on gastric emptying, glucose absorption, glycaemic/insulinaemic and blood pressure (BP) responses to an oral glucose load. Eighteen healthy older participants underwent measurements of gastric emptying (scintigraphy), plasma glucose and insulin, glucose absorption, superior mesenteric artery (SMA) flow, BP and heart rate (HR) after ingesting a 50 g glucose drink, with or without the preload. The preload reduced plasma glucose (p = 0.02) and serum 3-O-methylglucose (3-OMG) (p = 0.003), and increased plasma insulin (p = 0.03). There was no difference in gastric emptying or BP between the two days. The reduction in plasma glucose on the preload day was related to the reduction in glucose absorption (r = 0.71, p = 0.002). In conclusion, the glucose-lowering effect of the preload may relate to delayed small intestinal glucose absorption and insulin stimulation, rather than slowing of gastric emptying.publishedVersio

The TIANSHAN Radio Experiment for Neutrino Detection

An antenna array devoted to the autonomous radio-detection of high energy cosmic rays is being deployed on the site of the 21 cm array radio telescope in XinJiang, China. Thanks in particular to the very good electromagnetic environment of this remote experimental site, self-triggering on extensive air showers induced by cosmic rays has been achieved with a small scale prototype of the foreseen antenna array. We give here a detailed description of the detector and present the first detection of extensive air showers with this prototype.Comment: 37 pages, 15 figures. Astroparticle Physics (in press

Sl-EDGE: Network Slicing at the Edge

Network slicing of multi-access edge computing (MEC) resources is expected to be a pivotal technology to the success of 5G networks and beyond. The key challenge that sets MEC slicing apart from traditional resource allocation problems is that edge nodes depend on tightly-intertwined and strictly-constrained networking, computation and storage resources. Therefore, instantiating MEC slices without incurring in resource over-provisioning is hardly addressable with existing slicing algorithms. The main innovation of this paper is Sl-EDGE, a unified MEC slicing framework that allows network operators to instantiate heterogeneous slice services (e.g., video streaming, caching, 5G network access) on edge devices. We first describe the architecture and operations of Sl-EDGE, and then show that the problem of optimally instantiating joint network-MEC slices is NP-hard. Thus, we propose near-optimal algorithms that leverage key similarities among edge nodes and resource virtualization to instantiate heterogeneous slices 7.5x faster and within 0.25 of the optimum. We first assess the performance of our algorithms through extensive numerical analysis, and show that Sl-EDGE instantiates slices 6x more efficiently then state-of-the-art MEC slicing algorithms. Furthermore, experimental results on a 24-radio testbed with 9 smartphones demonstrate that Sl-EDGE provides at once highly-efficient slicing of joint LTE connectivity, video streaming over WiFi, and ffmpeg video transcoding

3D characterization of CdSe nanoparticles attached to carbon nanotubes

The crystallographic structure of CdSe nanoparticles attached to carbon nanotubes has been elucidated by means of high resolution transmission electron microscopy and high angle annular dark field scanning transmission electron microscopy tomography. CdSe rod-like nanoparticles, grown in solution together with carbon nanotubes, undergo a morphological transformation and become attached to the carbon surface. Electron tomography reveals that the nanoparticles are hexagonal-based with the (001) planes epitaxially matched to the outer graphene layer.Comment: 7 pages, 8 figure

High-resolution observations of low-luminosity gigahertz-peaked spectrum and compact steep-spectrum sources

© 2018 The Author(s). Published by Oxford University Press on behalf of the Royal Astronomical Society. We present very long baseline interferometry observations of a faint and low-luminosity (L 1.4 GHz < 10 27 W Hz -1 ) gigahertz-peaked spectrum (GPS) and compact steep-spectrum (CSS) sample. We select eight sources from deep radio observations that have radio spectra characteristic of a GPS or CSS source and an angular size of Φ <~ 2 arcsec, and detect six of them with the Australian Long Baseline Array. We determine their linear sizes, and model their radio spectra using synchrotron self-absorption (SSA) and free-free absorption (FFA) models. We derive statistical model ages, based on a fitted scaling relation, and spectral ages, based on the radio spectrum, which are generally consistent with the hypothesis that GPS and CSS sources are young and evolving. We resolve the morphology of one CSS source with a radio luminosity of 10 2 5WHz -1 , and find what appear to be two hotspots spanning 1.7 kpc. We find that our sources follow the turnover-linear size relation, and that both homogeneous SSA and an inhomogeneous FFA model can account for the spectra with observable turnovers. All but one of the FFA models do not require a spectral break to account for the radio spectrum, while all but one of the alternative SSA and power-law models do require a spectral break to account for the radio spectrum. We conclude that our low-luminosity sample is similar to brighter samples in terms of their spectral shape, turnover frequencies, linear sizes, and ages, but cannot test for a difference in morphology

Lanthanide-doped inorganic nanoparticles turn molecular triplet excitons bright.

The generation, control and transfer of triplet excitons in molecular and hybrid systems is of great interest owing to their long lifetime and diffusion length in both solid-state and solution phase systems, and to their applications in light emission1, optoelectronics2,3, photon frequency conversion4,5 and photocatalysis6,7. Molecular triplet excitons (bound electron-hole pairs) are 'dark states' because of the forbidden nature of the direct optical transition between the spin-zero ground state and the spin-one triplet levels8. Hence, triplet dynamics are conventionally controlled through heavy-metal-based spin-orbit coupling9-11 or tuning of the singlet-triplet energy splitting12,13 via molecular design. Both these methods place constraints on the range of properties that can be modified and the molecular structures that can be used. Here we demonstrate that it is possible to control triplet dynamics by coupling organic molecules to lanthanide-doped inorganic insulating nanoparticles. This allows the classically forbidden transitions from the ground-state singlet to excited-state triplets to gain oscillator strength, enabling triplets to be directly generated on molecules via photon absorption. Photogenerated singlet excitons can be converted to triplet excitons on sub-10-picosecond timescales with unity efficiency by intersystem crossing. Triplet exciton states of the molecules can undergo energy transfer to the lanthanide ions with unity efficiency, which allows us to achieve luminescent harvesting of the dark triplet excitons. Furthermore, we demonstrate that the triplet excitons generated in the lanthanide nanoparticle-molecule hybrid systems by near-infrared photoexcitation can undergo efficient upconversion via a lanthanide-triplet excitation fusion process: this process enables endothermic upconversion and allows efficient upconversion from near-infrared to visible frequencies in the solid state. These results provide a new way to control triplet excitons, which is essential for many fields of optoelectronic and biomedical research

Calmodulin-like proteins localized to the conoid regulate motility and cell invasion by Toxoplasma gondii

Toxoplasma gondii contains an expanded number of calmodulin (CaM)-like proteins whose functions are poorly understood. Using a combination of CRISPR/Cas9-mediated gene editing and a plant-like auxin-induced degron (AID) system, we examined the roles of three apically localized CaMs. CaM1 and CaM2 were individually dispensable, but loss of both resulted in a synthetic lethal phenotype. CaM3 was refractory to deletion, suggesting it is essential. Consistent with this prediction auxin-induced degradation of CaM3 blocked growth. Phenotypic analysis revealed that all three CaMs contribute to parasite motility, invasion, and egress from host cells, and that they act downstream of microneme and rhoptry secretion. Super-resolution microscopy localized all three CaMs to the conoid where they overlap with myosin H (MyoH), a motor protein that is required for invasion. Biotinylation using BirA fusions with the CaMs labeled a number of apical proteins including MyoH and its light chain MLC7, suggesting they may interact. Consistent with this hypothesis, disruption of MyoH led to degradation of CaM3, or redistribution of CaM1 and CaM2. Collectively, our findings suggest these CaMs may interact with MyoH to control motility and cell invasion

CdSe Ring- and Tribulus-Shaped Nanocrystals: Controlled Synthesis, Growth Mechanism, and Photoluminescence Properties

With air-stable and generic reagents, CdSe nanocrystals with tunable morphologies were prepared by controlling the temperature in the solution reaction route. Thereinto, the lower reaction temperature facilitates the anisotropic growth of crystals to obtain high-yield CdSe ring- and tribulus-shaped nanocrystals with many branches on their surfaces. The photoluminescence properties are sensitive to the nature of particle and its surface. The products synthesized at room temperature, whose surfaces have many branches, show higher blue shift and narrower emission linewidths (FWHM) of photoluminescence than that of samples prepared at higher temperature, whose surfaces have no branches. Microstructural studies revealed that the products formed through self-assembly of primary crystallites. Nanorings formed through the nonlinear attachment of primary crystallites, and the branches on the surfaces grew by linear attachment at room temperature. And the structure of tribulus-shaped nanoparticle was realized via two steps of aggregation, i.e., random and linear oriented aggregation. Along with the elevation of temperature, the branches on nanocrystal surfaces shortened gradually because of the weakened linear attachment

Surgical Outcome of Children with a Malignant Liver Tumour in The Netherlands:A Retrospective Consecutive Cohort Study

INTRODUCTION: Six to eight children are diagnosed with a malignant liver tumour yearly in the Netherlands. The majority of these tumours are hepatoblastoma (HB) and hepatocellular carcinoma (HCC), for which radical resection, often in combination with chemotherapy, is the only curative treatment option. We investigated the surgical outcome of children with a malignant liver tumour in a consecutive cohort in the Netherlands. METHODS: In this nationwide, retrospective observational study, all patients (age &lt; 18 years) diagnosed with a malignant liver tumour, who underwent partial liver resection or orthotopic liver transplantation (OLT) between January 2014 and April 2021, were included. Children with a malignant liver tumour who were not eligible for surgery were excluded from the analysis. Data regarding tumour characteristics, diagnostics, treatment, complications and survival were collected. Outcomes included major complications (Clavien-Dindo ≥ 3a) within 90 days and disease-free survival. The results of the HB group were compared to those of a historical HB cohort. RESULTS: Twenty-six children were analysed, of whom fourteen (54%) with HB (median age 21.5 months), ten (38%) with HCC (median age 140 months) and one with sarcoma and a CNSET. Thirteen children with HB (93%) and three children with HCC (30%) received neoadjuvant chemotherapy. Partial hepatic resection was possible in 19 patients (12 HB, 6 HCC, and 1 sarcoma), whilst 7 children required OLT (2 HB, 4 HCC, and 1 CNSET). Radical resection (R0, margin ≥ 1.0 mm) was obtained in 24 out of 26 patients, with recurrence only in the patient with CNSET. The mean follow-up was 39.7 months (HB 40 months, HCC 40 months). Major complications occurred in 9 out of 26 patients (35% in all, 4 of 14, 29% for HB). There was no 30- or 90-day mortality, with disease-free survival after surgery of 100% for HB and 80% for HCC, respectively. Results showed a tendency towards a better outcome compared to the historic cohort, but numbers were too small to reach significance. CONCLUSION: Survival after surgical treatment for malignant liver tumours in the Netherlands is excellent. Severe surgical complications arise in one-third of patients, but most resolve without long-term sequelae and have no impact on long-term survival