Financial impact of introducing the Swiss-DRG reimbursement system on potentially avoidable readmissions at a university hospital.

QUESTION UNDER STUDY: Thirty-day readmissions can be classified as potentially avoidable (PARs) or not avoidable (NARs) by following a specific algorithm (SQLape®). We wanted to assess the financial impact of the Swiss-DRG system, which regroups some readmissions occurring within 18 days after discharge within the initial hospital stay, on PARs at our hospital. METHODS: First, PARs were identified from all hospitalisations recorded in 2011 at our university hospital. Second, 2012 Swiss-DRG readmission rules were applied, regrouped readmissions (RR) were identified, and their financial impact computed. Third, RRs were classified as potentially avoidable (PARRs), not avoidable (NARRs), and others causes (OCRRs). Characteristics of PARR patients and stays were retrieved, and the financial impact of PARRS was computed. RESULTS: A total of 36,777 hospitalisations were recorded in 2011, of which 3,140 were considered as readmissions (8.5%): 1,470 PARs (46.8%) and 1,733 NARs (53.2%). The 2012 Swiss-DRG rules would have resulted in 910 RRs (2.5% of hospitalisations, 29% of readmissions): 395 PARRs (43% of RR), 181 NARRs (20%), and 334 OCRRs (37%). Loss in reimbursement would have amounted to CHF 3.157 million (0.6% of total reimbursement). As many as 95% of the 395 PARR patients lived at home. In total, 28% of PARRs occurred within 3 days after discharge, and 58% lasted less than 5 days; 79% of the patients were discharged home again. Loss in reimbursement would amount to CHF 1.771 million. CONCLUSION: PARs represent a sizeable number of 30-day readmissions, as do PARRs of 18-day RRs in the 2012 Swiss DRG system. They should be the focus of attention, as the PARRs represent an avoidable loss in reimbursement

Performance of an automated multiplex immunofluorescence assay for detection of Chlamydia trachomatis immunoglobulin G.

Chlamydia serology is indicated to investigate etiology of miscarriage, infertility, pelvic inflammatory disease, and ectopic pregnancy. Here, we assessed the reliability of a new automated-multiplex immunofluorescence assay (InoDiag test) to detect specific anti-C. trachomatis immunoglobulin G. Considering immunofluorescence assay (IF) as gold standard, InoDiag tests exhibited similar sensitivities (65.5%) but better specificities (95.1%-98%) than enzyme-linked immunosorbent assays (ELISAs). InoDiag tests demonstrated similar or lower cross-reactivity rates when compared to ELISA or IF

Vers une anthropologie de la corruption : les histoires tragiques de Jean-Pierre Camus

La présente étude vise à montrer que, par la syntagmatique particulière qu’il confère à chaque récit, Jean-Pierre Camus réserve un traitement systématique aux nombreux cas de corruption qu’il met en scène dans ses nouvelles tragiques. L’analyse, menée dans une perspective linguistique, abordera plusieurs niveaux de la narrativité : la désignation des agents et son évolution au cours du récit, mais aussi l’expression de l’intentionnalité qui préside à l’action constituent les lieux discursifs par lesquels se distinguent des modes de corruption. L’agencement varié de ces composantes narratives donne lieu, dès lors qu’elles sont envisagées à l’échelle du recueil, à ce que nous appelons une anthropologie de la corruption

Challenges in control and autonomy of unmanned aerial-aquatic vehicles

Autonomous aquatic vehicles capable of flight can deploy more rapidly, access remote or constricted areas, overfly obstacles and transition easily between distinct bodies of water. This new class of vehicles can be referred as Unmanned Aerial-Aquatic Vehicles (UAAVs), and is capable of reaching distant locations rapidly, conducting measurements and returning to base. This greatly improves upon current solutions, which often involve integrating different types of vehicles (e.g. vessels releasing underwater vehicles), or rely on manpower (e.g. sensors dropped manually from ships). Thanks to recent research efforts, UAAVs are becoming more sophisticated and robust. Nonetheless numerous challenges remain to be addressed, and particularly dedicated control and sensing solutions are still scarce. This paper discusses challenges and opportunities in UAAV control, sensing and actuation. Following a brief overview of the state of the art, we elaborate on the requirements and challenges for the main types of robots and missions proposed in the literature to date, and highlight existing solutions where available. The concise but wide-ranging overview provided will constitute a useful starting point for researchers undertaking UAAV control work

Carbohydrate reserves in grapevine (Vitis vinifera L. 'Chasselas'): the influence of the leaf to fruit ratio

Seasonal dynamics of total non-structural carbohydrates (TNC) in relation to the leaf-fruit ratio were measured over five years at different grapevine phenological stages in one- and two-year-old canes, trunks and roots of the cultivar 'Chasselas' (Vitis vinifera L.). Carbohydrates were mainly stored as starch in different parts of the grapevine during the growing season. Soluble carbohydrates represented only a small part (< 7 % of dry weight, DW) of the TNC. In the roots and trunks, the starch content fluctuated during the growing season, reaching the lowest values between budbreak and flowering depending on the year, and the highest values between harvest and leaf fall. The soluble sugar content increased in the trunks and the two-year-old canes during the winter period with the decrease in temperatures. A negative correlation was established between the average air temperature recorded during the seven days before sample collection for carbohydrate analysis, and soluble carbohydrate content in the trunks and two-year-old canes. The leaffruit ratio (source-sink), expressed by the “light-exposed leaf area∙kg-1 fruit”, not only substantially influenced the soluble sugar content in berries but also the starch and TNC concentrations in the trunks and roots at harvest. Higher leaf-fruit ratios resulted in increased starch and TNC concentrations in the trunks and roots, which attained the maximum values when the leaf-fruit ratio neared 2.0 m2 of light-exposed leaf area∙kg-1 fruit. Canopy height and leaf area had no predominant influence on the soluble sugars, starch contents, or TNC in the permanent vine parts. 

Living with Gitelman disease: an insight into patients' daily experiences

Background Gitelman disease presents with musculoskeletal complaints and fatigue. Surprisingly, there is no clear-cut correlation between biochemical abnormalities and symptoms. Methods Starting from the hypothesis that the way patients comprehend their illness within their sociocultural frameworks reflects on their way of adapting to it, this study investigated how adult patients experience the disease in everyday life. We conducted a qualitative analysis based on interviews with 12 patients. Interviews were audio recorded, fully transcribed and analyzed using the constant comparative method described by Strauss and Corbin. Results A typology of the experiences emerged from the data and was tested on each transcript with an explicit search for disconfirming cases. Patients fell into four main groups: (i) those considering Gitelman disease a disabling illness, (ii) those considering it a normalized illness, (iii) those considering it a different normality and (iv) those considering it an episodic disability. Each pattern of experience was characterized by particular (i) ways of interpreting symptoms (ii) ways of managing Gitelman disease in everyday life, (iii) general lifestyles and (iv) risks for the patient's psychosocial life. Conclusions These findings suggest that health care providers should take advantage of considering patients' own perception of the disease in order to adjust the care and advice provide

Off-shore and underwater sampling of aquatic environments with the aerial-aquatic drone MEDUSA

Monitoring of aquatic habitats for water quality and biodiversity requires regular sampling, often in off-shore locations and underwater. Such sampling is commonly performed manually from research vessels, or if autonomous, is constrained to permanent installations. Consequentially, high frequency ecological monitoring, such as for harmful algal blooms, are limited to few sites and/or temporally infrequent. Here, we demonstrate the use of MEDUSA, an Unmanned Aerial-Aquatic Vehicle which is capable of performing underwater sampling and inspection at up to 10 m depth, and is composed of a multirotor platform, a tether management unit and a tethered micro Underwater Vehicle. The system is validated in the task of vertical profiling of Chlorophyll-a levels in freshwater systems by means of a custom solid sample filtering mechanism. This mechanism can collect up to two independent samples per mission by pumping water through a pair of glass-fibre GF/F filters. Chlorophyll levels measured from the solid deposits on the filters are consistent and on par with traditional sampling methods, highlighting the potential of using UAAVs to sample aquatic locations at high frequency and high spatial resolution