A Systems Thinking Approach to Redesigning the Patient Experience to Reduce 30 Day Hospital Readmission

INTRODUCTION The cost of medical care is spiraling out of control, and one of the many reasons is lack of preventative care, poor communication to the patient and primary caregiver(s) both in an inpatient and outpatient setting. There are potentially many reasons for this cost escalation, one of the drivers of this cost is 30 day readmission after a hospitalization and this is what was examined in this analysis. The purpose of this paper in particular is to share what has been learned using a systems thinking approach to hospital readmissions and the patient experience. It is critical to understand the problems that occurred in the past. In addition, we will explain the methodology utilized and bring awareness to the iterative process. We will also demonstrate a suggested redesigned model

An ENU-induced mutation of miR-96 associated with progressive hearing loss in mice.

Progressive hearing loss is common in the human population, but little is known about the molecular basis. We report a new N-ethyl-N-nitrosurea (ENU)-induced mouse mutant, diminuendo, with a single base change in the seed region of Mirn96. Heterozygotes show progressive loss of hearing and hair cell anomalies, whereas homozygotes have no cochlear responses. Most microRNAs are believed to downregulate target genes by binding to specific sites on their mRNAs, so mutation of the seed should lead to target gene upregulation. Microarray analysis revealed 96 transcripts with significantly altered expression in homozygotes; notably, Slc26a5, Ocm, Gfi1, Ptprq and Pitpnm1 were downregulated. Hypergeometric P-value analysis showed that hundreds of genes were upregulated in mutants. Different genes, with target sites complementary to the mutant seed, were downregulated. This is the first microRNA found associated with deafness, and diminuendo represents a model for understanding and potentially moderating progressive hair cell degeneration in hearing loss more generally

Toward a theory‐based specification of non‐pharmacological treatments in aging and dementia: Focused reviews and methodological recommendations

Introduction: Non‐pharmacological treatments (NPTs) have the potential to improve meaningful outcomes for older people at risk of, or living with dementia, but research often lacks methodological rigor and continues to produce mixed results. Methods: In the current position paper, experts in NPT research have specified treatment targets, aims, and ingredients using an umbrella framework, the Rehabilitation Treatment Specification System. Results: Experts provided a snapshot and an authoritative summary of the evidence for different NPTs based on the best synthesis efforts, identified main gaps in knowledge and relevant barriers, and provided directions for future research. Experts in trial methodology provide best practice principles and recommendations for those working in this area, underscoring the importance of prespecified protocols. Discussion: We conclude that the evidence strongly supports various NPTs in relation to their primary targets, and discuss opportunities and challenges associated with a unifying theoretical framework to guide future efforts in this area

A meta-analysis of long-term effects of conservation agriculture on maize grain yield under rain-fed conditions

Conservation agriculture involves reduced tillage, permanent soil cover and crop rotations to enhance soil fertility and to supply food from a dwindling land resource. Recently, conservation agriculture has been promoted in Southern Africa, mainly for maize-based farming systems. However, maize yields under rain-fed conditions are often variable. There is therefore a need to identify factors that influence crop yield under conservation agriculture and rain-fed conditions. Here, we studied maize grain yield data from experiments lasting 5 years and more under rain-fed conditions. We assessed the effect of long-term tillage and residue retention on maize grain yield under contrasting soil textures, nitrogen input and climate. Yield variability was measured by stability analysis. Our results show an increase in maize yield over time with conservation agriculture practices that include rotation and high input use in low rainfall areas. But we observed no difference in system stability under those conditions. We observed a strong relationship between maize grain yield and annual rainfall. Our meta-analysis gave the following findings: (1) 92% of the data show that mulch cover in high rainfall areas leads to lower yields due to waterlogging; (2) 85% of data show that soil texture is important in the temporal development of conservation agriculture effects, improved yields are likely on well-drained soils; (3) 73% of the data show that conservation agriculture practices require high inputs especially N for improved yield; (4) 63% of data show that increased yields are obtained with rotation but calculations often do not include the variations in rainfall within and between seasons; (5) 56% of the data show that reduced tillage with no mulch cover leads to lower yields in semi-arid areas; and (6) when adequate fertiliser is available, rainfall is the most important determinant of yield in southern Africa. It is clear from our results that conservation agriculture needs to be targeted and adapted to specific biophysical conditions for improved impact

Work Zone Speed Limits and Motorist Compliance

This study sought to identify best practices for setting work zone speed limits by state departments of transportation (DOTs) and to evaluate select strategies for improving compliance with work zone speed limits. This was achieved by synthesizing information from a literature review, a state DOT survey, and field evaluations of select speed management strategies. The state DOT survey found that work zone speed limits are typically established based on the characteristics and conditions of the site, including permanent speed limit, facility type, worker presence, positive protection, work duration, and type and location of work activity. Work zone speed limit reductions of 10 mph are most frequently utilized on high-speed facility types, with further reductions provided based on worker presence in the absence of positive protection (e.g., concrete barrier). While the 10 mph speed limit reduction is often viewed as effective, the use of a 45 mph work zone speed limit when workers are present may require the use of additional speed reduction countermeasures to be effective. Research studies have generally shown several types of work zone speed management strategies, such as speed display signs, law enforcement, variable (dynamic) speed limits, temporary rumble strips, and portable changeable message sign (PCMS) messages, to be effective in reducing vehicle speeds in work zones. The work zone speed management strategies most frequently implemented by state DOTs include higher fines for speeding in work zones and lights on contractor or maintenance vehicles. While DOTs generally view law enforcement with an officer present as the most effective strategy for managing work zone speeds, they also perceive the availability of law enforcement as the greatest challenge to managing work zone speeds, followed by driver indifference and distracted drivers. Based on the findings from the literature review and DOT survey, a field study was performed to assess the effectiveness of two work zone speed management strategies, which included a speed feedback trailer (SFT) and law enforcement. In general, the magnitude of the speed reduction effects were greatest in the general proximity of the SFT. A second field evaluation assessed the effectiveness of a specialized work zone enforcement strategy. The visible presence of law enforcement activities at this location reduced work zone speeds by approximately 5 to 7 mph