Time From Booking Until Appointment and Healthcare Utilization in Hand Surgery Patients With Discretionary Conditions

Delaying medical therapy for benign musculoskeletal conditions may allow patients to develop coping strategies, resulting in less need for medical intervention and reduced cost. Our primary question was whether time from booking until appointment is associated with healthcare costs. Our secondary question was whether time from booking to appointment is associated with healthcare utilizations, including imaging, injections, nerve conduction studies, occupational therapy visits, surgery, referrals, and second opinions. We identified 16,750 patients making a first clinic visit to a hand surgery practice from 2003 through 2012. Utilizations were determined until the patient’s second visit. Costs were determined in Relative Value Units. In multivariable models, duration between booking and office visit was not associated with higher cost. Duration between booking and office visit was associated with a higher rate of nerve conduction studies (P < 0.001) and a lower rate of occupational therapy (P < 0.001). We observed substantial variation in cost and utilization based on treating surgeon. In a setting with relatively short wait times, greater wait time was not therapeutic, but is associated with different diagnostic and treatment measures. The variations by surgeon may make variations based on other factors including time between booking and appointment difficult to discern

THE STRUCTURE OF THE LOCAL HOT BUBBLE

Diffuse X-rays from the Local Galaxy (DXL) is a sounding rocket mission designed to quantify and characterize the contribution of Solar Wind Charge eXchange (SWCX) to the Diffuse X-ray Background and study the properties of the Local Hot Bubble (LHB). Based on the results from the DXL mission, we quantified and removed the contribution of SWCX to the diffuse X-ray background measured by the ROSAT All Sky Survey. The "cleaned" maps were used to investigate the physical properties of the LHB. Assuming thermal ionization equilibrium, we measured a highly uniform temperature distributed around kT = 0.097 keV ± 0.013 keV (FWHM) ± 0.006 keV (systematic). We also generated a thermal emission measure map and used it to characterize the three-dimensional (3D) structure of the LHB, which we found to be in good agreement with the structure of the local cavity measured from dust and gas

THE STRUCTURE OF THE LOCAL HOT BUBBLE

Diffuse X-rays from the Local Galaxy (DXL) is a sounding rocket mission designed to quantify and characterize the contribution of Solar Wind Charge eXchange (SWCX) to the Diffuse X-ray Background and study the properties of the Local Hot Bubble (LHB). Based on the results from the DXL mission, we quantified and removed the contribution of SWCX to the diffuse X-ray background measured by the ROSAT All Sky Survey. The "cleaned" maps were used to investigate the physical properties of the LHB. Assuming thermal ionization equilibrium, we measured a highly uniform temperature distributed around kT = 0.097 keV ± 0.013 keV (FWHM) ± 0.006 keV (systematic). We also generated a thermal emission measure map and used it to characterize the three-dimensional (3D) structure of the LHB, which we found to be in good agreement with the structure of the local cavity measured from dust and gas

Pressure Equilibrium Between The Local Interstellar Clouds And The Local Hot Bubble

This is the published version. Copyright © 2014. The American Astronomical Society. All rights reserved.Three recent results related to the heliosphere and the local interstellar medium (ISM) have provided an improved insight into the distribution and conditions of material in the solar neighborhood. These are the measurement of the magnetic field outside of the heliosphere by Voyager 1, the improved mapping of the three-dimensional structure of neutral material surrounding the Local Cavity using extensive ISM absorption line and reddening data, and a sounding rocket flight which observed the heliospheric helium focusing cone in X-rays and provided a robust estimate of the contribution of solar wind charge exchange emission to the ROSAT All-Sky Survey 1/4 keV band data. Combining these disparate results, we show that the thermal pressure of the plasma in the Local Hot Bubble (LHB) is P/k = 10,700 cm−3 K. If the LHB is relatively free of a global magnetic field, it can easily be in pressure (thermal plus magnetic field) equilibrium with the local interstellar clouds, eliminating a long-standing discrepancy in models of the local ISM

NASA SpaceCube Next-Generation Artificial-Intelligence Computing for STP-H9-SCENIC on ISS

Recently, Artificial Intelligence (AI) and Machine Learning (ML) capabilities have seen an exponential increase in interest from academia and industry that can be a disruptive, transformative development for future missions. Specifically, AI/ML concepts for edge computing can be integrated into future missions for autonomous operation, constellation missions, and onboard data analysis. However, using commercial AI software frameworks onboard spacecraft is challenging because traditional radiation-hardened processors and common spacecraft processors cannot provide the necessary onboard processing capability to effectively deploy complex AI models. Advantageously, embedded AI microchips being developed for the mobile market demonstrate remarkable capability and follow similar size, weight, and power constraints that could be imposed on a space-based system. Unfortunately, many of these devices have not been qualified for use in space. Therefore, Space Test Program - Houston 9 - SpaceCube Edge-Node Intelligent Collaboration (STP-H9-SCENIC) will demonstrate inflight, cutting-edge AI applications on multiple space-based devices for next-generation onboard intelligence. SCENIC will characterize several embedded AI devices in a relevant space environment and will provide NASA and DoD with flight heritage data and lessons learned for developers seeking to enable AI/ML on future missions. Finally, SCENIC also includes new CubeSat form-factor GPS and SDR cards for guidance and navigation

Pretreatment HLADQA1-HLADRB1 Testing for the Prevention of Azathioprine-Induced Pancreatitis in Inflammatory Bowel Disease: A Prospective Cohort Study

INTRODUCTION:Azathioprine-induced pancreatitis is an idiosyncratic and unpredictable response, occurring in up to 7% of azathioprine-exposed patients with inflammatory bowel disease (IBD). The haplotype HLADQA1-HLADRB1*07:01A\u3eC is strongly associated with azathioprine-induced pancreatitis in IBD. We aimed to evaluate whether pretreatment HLADQA1-HLADRB1*07:01A\u3eC screening will reduce the risk of azathioprine-induced pancreatitis.METHODS:Participants with IBD were screened for HLADQA1-HLADRB1*07:01A\u3eC, and participants with a variant genotype were excluded from azathioprine treatment. Wild-type participants were started on azathioprine and followed for 3 months. The incidence of pancreatitis was compared with unscreened historical controls.RESULTS:HLADQA1-HLADRB1*07:01A\u3eC screening resulted in an 11-fold reduction in the incidence of azathioprine-induced pancreatitis (n = 1/328 or 0.30% vs n = 13/373 or 3.4%). In propensity score-matched cohorts (age and sex), HLA DQA1-HLADRB1*07:01A\u3eC screening was significantly associated with a reduction in the incidence of AZA-induced pancreatitis independent of weight, glucocorticoid exposure, and smoking status (adjusted odds ratio = 0.075, 95% confidence interval = 0.01-0.58, P = 0.01). Up to 45% (n = 271/599) of participants were excluded from azathioprine therapy based on the haplotype in the HLADQA1-HLADRB1*07:01A\u3eC-screened cohort.DISCUSSION:HLADQA1-HLADRB1*07:01A\u3eC screening reduced the risk of azathioprine-induced pancreatitis; however, using this strategy to guide the use of azathioprine therapy in IBD may eliminate a large proportion of patients from being eligible for treatment with azathioprine. In regions where there is access to other IBD therapies, and given the short-term and long-term toxicities associated with azathioprine, HLADQA1-HLADRB1*07:01A\u3eC-screening may be a clinically relevant strategy for enhancing the safe use of azathioprine in IBD. In addition, cost-effectiveness analyses are needed to further solidify the utility of HLADQA1-HLADRB1*07:01A\u3eC screening in IBD populations

Initial evaluation of the Robert Wood Johnson Foundation Nurse Faculty Scholars program

The Robert Wood Johnson Foundation Nurse Faculty Scholars (RWJF NFS) program was developed to enhance the career trajectory of young nursing faculty and to train the next generation of nurse scholars. Although there are publications that describe the RWJF NFS, no evaluative reports have been published. The purpose of this study was to evaluate the first three cohorts (n = 42 scholars) of the RWJF NFS program

ROSAT Observations of Solar Wind Charge Exchange with the Lunar Exosphere

We analyze the ROSAT PSPC soft X-ray image of the Moon taken on 29 June 1990 by examining the radial profile of the count rate in three wedges, two wedges (one north and one south) 13-32 degrees off (19 degrees wide) the terminator towards the dark side and one wedge 38 degrees wide centered on the anti-solar direction. The radial profiles of both the north and the south wedges show substantial limb brightening that is absent in the 38 degree wide antisolar wedge. An analysis of the count rate increase associated with the limb brightening shows that its magnitude is consistent with that expected due to solar wind charge exchange (SWCX) with the tenuous lunar atmosphere. Along with Mars, Venus, and Earth, the Moon represents another solar system body at which solar wind charge exchange has been observed. This technique can be used to explore the solar wind-lunar interaction