Associations between social risk factors and surgical site infections after colectomy and abdominal hysterectomy

Importance: Surgical site infection (SSI) is an important patient safety outcome. Although social risk factors have been linked to many adverse health outcomes, it is unknown whether such factors are associated with higher rates of SSI. Objectives: To determine whether social risk factors, including race/ethnicity, insurance status, and neighborhood income, are associated with higher rates of SSI after colectomy or abdominal hysterectomy, 2 surgical procedures for which SSI rates are publicly reported and included in pay-for-performance programs by Medicare and other groups. Design, Setting, and Participants: This cross-sectional study analyzed adults undergoing colectomy or abdominal hysterectomy, as captured in State Inpatient Databases for Arizona, Florida, Iowa, Massachusetts, Maryland, New York, and Vermont. Operations were performed in 2013 through 2014 at general acute care hospitals in the United States. Data analysis was conducted from October 2018 through June 2019. Exposures: Colectomy or hysterectomy. Main Outcomes and Measures: Postoperative complex SSI rates. Results: A total of 149 741 patients met the inclusion criteria, including 90 210 patients undergoing colectomies (mean [SD] age, 63.4 [15.6] years; 49 029 [54%] female; 74% white, 11% black, 9% Hispanic, and 5% other or unknown race/ethnicity) and 59 531 patients undergoing abdominal hysterectomies (mean [SD] age, 49.8 [11.8] years; 100% female; 52% white, 26% black, 14% Hispanic, and 8% other or unknown race/ethnicity). In the colectomy cohort, 34% had private insurance, 52% had Medicare, 9% had Medicaid, and 5% had other or unknown insurance or were uninsured; 24% were from the lowest quartile of median zip code income. In the hysterectomy cohort, 57% had private insurance, 16% had Medicare, 19% had Medicaid, and 3% had other or unknown insurance or were uninsured; 27% were from the lowest-income zip codes. Within 30 days of surgery, SSI rates were 2.55% for the colectomy cohort and 0.61% for the hysterectomy cohort. For colectomy, black race (adjusted odds ratio [AOR], 0.71; 95% CI, 0.61-0.82) was associated with lower odds of SSI, whereas Medicare (AOR, 1.25; 95% CI, 1.10-1.41), Medicaid (AOR, 1.23; 95% CI, 1.06-1.44), and low neighborhood income (AOR, 1.14; 95% CI, 1.01-1.29) were associated with higher odds of SSI. For hysterectomy, no social risk factors that were examined in this study had statistically significant associations with SSI after adjustment for clinical risk. Conclusions and Relevance: Inconsistent associations between social risk factors and SSIs were found. For colectomy, infection prevention programs targeting low-income groups may be important for reducing disparities in this postoperative outcome, and policy makers could consider taking social risk factors into account when evaluating hospital performance

Enhanced surface transfer doping of diamond by V2O5 with improved thermal stability

Surface transfer doping of hydrogen-terminated diamond has been achieved utilising V2O5 as a surface electron accepting material. Contact between the oxide and diamondsurface promotes the transfer of electrons from the diamond into the V2O5 as revealed by the synchrotron-based high resolution photoemission spectroscopy. Electrical characterization by Hall measurement performed before and after V2O5 deposition shows an increase in hole carrier concentration in the diamond from 3.0 × 1012 to 1.8 × 1013 cm−2 at room temperature. High temperature Hall measurements performed up to 300 °C in atmosphere reveal greatly enhanced thermal stability of the hole channel produced using V2O5 in comparison with an air-induced surface conduction channel. Transfer doping of hydrogen-terminated diamond using high electron affinity oxides such as V2O5 is a promising approach for achieving thermally stable, high performance diamond based devices in comparison with air-induced surface transfer dopin

Predicting and understanding spatio-temporal dynamics of species recovery : implications for Asian crested ibis Nipponia nippon conservation in China

Acknowledgements This work was supported by the National Natural Science Foundation of China (No. 31372218) and cofunded by the China Scholarship Council (CSC) and the ITC Research Fund, Enschede, the Netherlands. We thank Shaanxi Hanzhong Crested Ibis National Nature Reserve for sharing the data of nest site locations. We are grateful to Brendan Wintle, Justin Travis and two anonymous reviewers for helpful comments on a previous version of the manuscript.Peer reviewedPublisher PD

RNA Dynamics by Design: Biasing Ensembles Towards the Ligand-Bound State

No AbstractPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/77950/1/5731_ftp.pd

An explicit high-order single-stage single-step positivity-preserving finite difference WENO method for the compressible Euler equations

In this work we construct a high-order, single-stage, single-step positivity-preserving method for the compressible Euler equations. Space is discretized with the finite difference weighted essentially non-oscillatory (WENO) method. Time is discretized through a Lax-Wendroff procedure that is constructed from the Picard integral formulation (PIF) of the partial differential equation. The method can be viewed as a modified flux approach, where a linear combination of a low- and high-order flux defines the numerical flux used for a single-step update. The coefficients of the linear combination are constructed by solving a simple optimization problem at each time step. The high-order flux itself is constructed through the use of Taylor series and the Cauchy-Kowalewski procedure that incorporates higher-order terms. Numerical results in one- and two-dimensions are presented

A best online algorithm for scheduling on two parallel batch machines

AbstractWe consider the online scheduling on two parallel batch machines with infinite batch size to minimize makespan, where jobs arrive over time. That is, all information of a job is not available until it is released. For this online scheduling problem, Nong et al. [Q.Q. Nong, T.C.E. Cheng, C.T. Ng, An improved online algorithm for scheduling on two unrestrictive parallel batch processing machines, Operations Research Letters, 36 (2008) 584–588] have provided an online algorithm with competitive ratio no greater than 2. We show that this bound is tight for the problem. Furthermore we give a new best possible online algorithm with a tighter structure

Comparison of performance of psychiatrists vs other outpatient physicians in the 2020 US Medicare Merit-Based Incentive Payment System

Importance: Medicare\u27s Merit-Based Incentive Payment System (MIPS) is a new, mandatory, outpatient value-based payment program that ties reimbursement to performance on cost and quality measures for many US clinicians. However, it is currently unknown how the program measures the performance of psychiatrists, who often treat a different patient case mix with different clinical considerations than do other outpatient clinicians. Objective: To compare performance scores and value-based reimbursement for psychiatrists vs other outpatient physicians in the 2020 MIPS. Design Setting and Participants: In this cross-sectional study, the Centers for Medicare & Medicaid Services Provider Data Catalog was used to identify outpatient Medicare physicians listed in the National Downloadable File between January 1, 2018, and December 31, 2020, who participated in the 2020 MIPS and received a publicly reported final performance score. Data from the 593 863 clinicians participating in the 2020 MIPS were used to compare differences in the 2020 MIPS performance scores and value-based reimbursement (based on performance in 2018) for psychiatrists vs other physicians, adjusting for physician, patient, and practice area characteristics. Exposures: Participation in MIPS. Main Outcomes and Measures: Primary outcomes were final MIPS performance score and negative (penalty), positive, and exceptional performance bonus payment adjustments. Secondary outcomes were scores in the MIPS performance domains: quality, promoting interoperability, improvement activities, and cost. Results: This study included 9356 psychiatrists (3407 [36.4%] female and 5 949 [63.6%] male) and 196 306 other outpatient physicians (69 221 [35.3%] female and 127 085 [64.7%] male) (data on age and race are not available). Compared with other physicians, psychiatrists were less likely to be affiliated with a safety-net hospital (2119 [22.6%] vs 64 997 [33.1%]) or a major teaching hospital (2148 [23.0%] vs 53 321 [27.2%]) and had lower annual Medicare patient volume (181 vs 437 patients) and mean patient risk scores (1.65 vs 1.78) ( Conclusions and Relevance: In this cross-sectional study that compared US psychiatrists with other outpatient physicians, psychiatrists had significantly lower 2020 MIPS performance scores, were penalized more frequently, and received fewer bonuses. Policy makers should evaluate whether current MIPS performance measures appropriately assess the performance of psychiatrists

Comparison of Magnetic Resonance Imaging and Serum Biomarkers for Detection of Human Pluripotent Stem Cell-Derived Teratomas.

The use of cells derived from pluripotent stem cells (PSCs) for regenerative therapies confers a considerable risk for neoplastic growth and teratoma formation. Preclinical and clinical assessment of such therapies will require suitable monitoring strategies to understand and mitigate these risks. Here we generated human-induced pluripotent stem cells (iPSCs), selected clones that continued to express reprogramming factors after differentiation into cardiomyocytes, and transplanted these cardiomyocytes into immunocompromised rat hearts post-myocardial infarction. We compared magnetic resonance imaging (MRI), cardiac ultrasound, and serum biomarkers for their ability to delineate teratoma formation and growth. MRI enabled the detection of teratomas with a volume >8 mm(3). A combination of three plasma biomarkers (CEA, AFP, and HCG) was able to detect teratomas with a volume >17 mm(3) and with a sensitivity of more than 87%. Based on our findings, a combination of serum biomarkers with MRI screening may offer the highest sensitivity for teratoma detection and tracking