Hospital Readmissions: Measuring for Improvement, Accountability, and Patients

The Commonwealth Fund and the Institute for Healthcare Improvement convened 15 experts in May 2013 to help address the current controversy over the measurement of hospital readmissions. Experts agreed that Medicare should, through payment and other means, be encouraging greater coordination of care, improvement in care transitions, and mitigation of risks that leave patients vulnerable to readmission. While the current readmissions metric is undoubtedly an imperfect proxy for broader health system failures, it also provides a valuable foundation on which to build a better policy -- one that is useful for improvement, fair for accountability, and above all, relevant to patients

The People's Republic of China administrative procedure law

The Administrative Procedure Law adopted some eighteen months ago by the National People's Congress became effective on October 1, 1990, the 41st anniversary of the founding of the PRC. The Law provides substance to Article 41 of the Constitution of the P RC ( 1982) which granted citizens "the right to criticize and make suggestions regarding any state organ or functionary'' and to make complaints or charges against state organs and their personnel for violation of the law or dereliction of duty. The Law establishes detailed procedures for challenges of administrative actions in the People's Courts but not of the administrative rules under which such actions were taken. Citizens, legal persons or other organizations may initiate proceedings in the courts. The Law is of special interest to foreigners and foreign businesses in that Chapter 10, 'Administrative Litigation Involving Foreign Entities', in Article 71, states that ''foreigners, stateless persons and foreign organizations ....... shall have litigation rights and obligations equal to those of citizens and organizations of the PRC''.peer-reviewe

Effects of the ACA on Health Care Cost Containment

This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to “bend the cost curve.” Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage. gains in the long term

Radiotherapy Dose–Volume Effects on Salivary Gland Function

Publications relating parotid dose-volume characteristics to radiotherapy-induced salivary toxicity were reviewed. Late salivary dysfunction has been correlated to the mean parotid gland dose, with recovery occurring with time. Severe xerostomia (defined as long-term salivary function of <25% of baseline) is usually avoided if at least one parotid gland is spared to a mean dose of less than ≈20 Gy or if both glands are spared to less than ≈25 Gy (mean dose). For complex, partial-volume RT patterns (e.g., intensity-modulated radiotherapy), each parotid mean dose should be kept as low as possible, consistent with the desired clinical target volume coverage. A lower parotid mean dose usually results in better function. Submandibular gland sparing also significantly decreases the risk of xerostomia. The currently available predictive models are imprecise, and additional study is required to identify more accurate models of xerostomia risk

Invasive crayfish as drivers of fine sediment dynamics in rivers: Field and laboratory evidence

Despite increasing recognition of the potential of aquatic biota to act as 'geomorphic agents', key knowledge gaps exist in relation to biotic drivers of fine sediment dynamics at microscales and particularly the role of invasive species. This study explores the impacts of invasive signal crayfish on suspended sediment dynamics at the patch scale through laboratory and field study. Three hypotheses are presented and tested: (1) that signal crayfish generate pulses of fine sediment mobilisation through burrowing and movement that are detectable in the flow field; (2) that such pulses may be more frequent during nocturnal periods when signal crayfish are known to be most active; and (3) that cumulatively the pulses would be sufficient to drive an overall increase in turbidity. Laboratory mesocosm experiments were used to explore crayfish impacts on suspended sediment concentrations for two treatments: clay banks and clay bed substrate. For the field study, high frequency near-bed and mid-flow turbidity time series from a lowland river with known high densities of signal crayfish were examined. Laboratory data demonstrate the direct influence of signal crayfish on mobilisation of pulses of fine sediment through burrowing into banks and fine bed material, with evidence of enhanced activity levels around the mid-point of the nocturnal period. Similar patterns of pulsed fine sediment mobilisation identified under field conditions follow a clear nocturnal trend and appear capable of driving an increase in ambient turbidity levels. The findings indicate that signal crayfish have the potential to influence suspended sediment yields, with implications for morphological change, physical habitat quality and the transfer of nutrients and contaminants. This is particularly important given the spread of signal crayfish across Europe and their presence in extremely high densities in many catchments. Further process-based studies are required to develop a full understanding of impacts across a range of river styles. © 2013 John Wiley & Sons, Ltd.The research was supported by a British Society for Geomorphology Research Grant (‘Field evidence for signal crayfish impacts on fine sediment dynamics in a lowland river’). Tom Moorhouse was funded by the Esmée Fairbairn Foundation

Drawing-writing culture: the truth-fiction spectrum of an ethno-graphic novel on the Sri Lankan civil war and migration

With our focus on an “ethno‐graphic novel” on the Sri Lankan civil war and the forcible displacement and migration of Tamil survivors, we make two main propositions while reflecting on the “graphic narrative turn” that has emerged in anthropology in recent years. First, we inscribe drawing into the “writing of cultures” where words have held a superior status in ethnographic representations. Rather than seeing drawings as perceptive tools for recording scenes in fieldwork alone, we extend them to a representational practice where they can have a deep, intricate, and equivalent entanglement with words to create synchronous affective intensities among a larger audience. Our second proposal follows Jean Rouch on cinéma vérité to interrogate assumptions about truth and fiction as portrayed by film representations. We propose a theory and practice for graphic novel production that we have termed vérités graphiques (literally, graphic realities). This describes the collaborative and interactive engagement with people's contributions and views, and their distillation and fictionalization through the ethno‐graphic form. We diverge from cinéma vérité, however, by highlighting a truth‐fiction spectrum that further challenges the presumed objectivity of what is seen, experienced, co‐created, and revealed

Risk Factors for SARS Transmission from Patients Requiring Intubation: A Multicentre Investigation in Toronto, Canada

In the 2003 Toronto SARS outbreak, SARS-CoV was transmitted in hospitals despite adherence to infection control procedures. Considerable controversy resulted regarding which procedures and behaviours were associated with the greatest risk of SARS-CoV transmission.A retrospective cohort study was conducted to identify risk factors for transmission of SARS-CoV during intubation from laboratory confirmed SARS patients to HCWs involved in their care. All SARS patients requiring intubation during the Toronto outbreak were identified. All HCWs who provided care to intubated SARS patients during treatment or transportation and who entered a patient room or had direct patient contact from 24 hours before to 4 hours after intubation were eligible for this study. Data was collected on patients by chart review and on HCWs by interviewer-administered questionnaire. Generalized estimating equation (GEE) logistic regression models and classification and regression trees (CART) were used to identify risk factors for SARS transmission. ratio ≤59 (OR = 8.65, p = .001) were associated with increased risk of transmission of SARS-CoV. In CART analyses, the four covariates which explained the greatest amount of variation in SARS-CoV transmission were covariates representing individual patients.Close contact with the airway of severely ill patients and failure of infection control practices to prevent exposure to respiratory secretions were associated with transmission of SARS-CoV. Rates of transmission of SARS-CoV varied widely among patients