Implementating a Transitional Care Program to Reduce Hospital Readmissions in Medicare Recipients: A Research Translation Pilot Project

Patients discharged from hospital to home, especially the chronically ill and older adults, are too frequently readmitted within 30 days. The Centers for Medicare and Medicaid Services (n.d.; 2017) along with other interdisciplinary researchers have proposed, studied, and implemented strategies to decrease this excessive and expensive phenomenon. After the implementation of the Hospital Readmission Reduction Program in 2009, preventable readmissions have decreased but remain at unacceptable levels. Care transitions from hospital to home have been implicated as perilous and fraught with communication breakdown and lack of patient support and follow up. Strategies aimed at both the hospitalization phase and the 30-day transitional phase when the patient returns home have been developed and implemented. This research translation project implemented a program of transitional care management in a community clinic in Las Vegas, Nevada in accordance of the guidelines of the transitional care model (TCM). Five patients were referred to the clinic by two home health agencies. The project coordinator provided transitional care for these patients for the duration of their home health certification. All of the patients were high risk for rehospitalization according to evidence-based screening tools. At the end of 30 days, none of the five patients had been rehospitalized. Additionally, two patients were referred from another medical practice and the project coordinator evaluated them through chart review and saw them once. The sample size and non-randomized sampling method precluded generalization of the findings. However, the project revealed important qualitative data relative to risks and interventions impacting rehospitalization risk as well as issues, barriers, and facilitators related to the practice of transitional care in the community setting. Several of these findings were not specifically identified within the TCM. Themes were derived from findings and a causal network was developed. Patients received excellent and effective transitional care and the project added to the body of knowledge of transitional care implementation

Rehabilitation financing

Not Include

The experience of successful smoking cessation: A phenomenological inquiry

Cigarette smoking is a significant public health issue and despite efforts, prevalence of smoking has not decreased in accordance with national goals. This study utilized a phenomenological approach to describe women\u27s experience of successful smoking cessation. Pender\u27s Health Promotion Model (1996) and Prochaska and DiClementes\u27 Transtheoretical Model of Change (1996) were utilized. Twelve women who had successfully quit smoking were interviewed; Data analysis yielded a core theme of transformation to non-smoker. Sub-themes included motivational factors of image conflict and cues for action. Other themes included barriers to cessation and coping mechanisms. Interpersonal factors and unconditional resolve were influential. Activity-related affect included grief and loss during cessation and joy and fulfillment upon success; Both models and existing research were supported. New insight into smoking cessation was gained. The importance of advice to quit by health care providers was supported. Additional research was recommended

Not Like Me

This is a poem that looks through a child's lens as the child is desperately trying to find someone with whom she can identify in school, in the books she reads, and in the adults who make decisions about her education

Using Structure Indices for Efficient Approximation of Network Properties

Statistics on networks have become vital to the study of relational data drawn from areas including bibliometrics, fraud detection, bioinformatics, and the Internet. Calculating many of the most important measures—such as betweenness centrality, closeness centrality, and graph diameter—requires identifying short paths in these networks. However, finding these short paths can be intractable for even moderate-size networks. We introduce the concept of a network structure index (NSI), a composition of (1) a set of annotations on every node in the network and (2) a function that uses the annotations to estimate graph distance between pairs of nodes. We present several varieties of NSIs, examine their time and space complexity, and analyze their performance on synthetic and real data sets. We show that creating an NSI for a given network enables extremely efficient and accurate estimation of a wide variety of network statistics on that network

A Case of Isolated Elevated Copper Levels during Pregnancy

Introduction. Outside of Wilson's Disease, abnormal copper metabolism is a rare condition. In pregnancy, excess copper levels can be associated with intrauterine growth restriction, preeclampsia and neurological disease. Case Report. A 32 year old Gravida 4 para 2012 with an obstetrical history complicated by elevated copper levels presented for routine prenatal care. Her children had elevated copper levels at birth, with her firstborn child being diagnosed with autism and suffering three myocardial infarctions and being treated for elevated copper levels. During her prior pregnancies, she declined treatment for her elevated copper levels. During this pregnancy, she had declined chelation therapy and instead choose zinc therapy. She delivered a healthy infant with normal copper levels. Conclusion. Alterations in copper metabolism are rare, the consequences in pregnancy can be devastating. While isolated elevations of copper in pregnancy is exceedingly rare, it is treated the same as Wilson's disease. The goal is to prevent fetal growth restricting and neurological sequelae in the newborn and preeclampsia in the mother. Counseling, along with treatment options and timely delivery can greatly improve neonatal and maternal outcome

Thermal conductivity and conditioning of grey expanded polystyrene foams

This article focuses on the thermal conductivity of 50 mm thick silver grey (infrared absorbing) expanded polystyrene (EPS) foam boards blown with pentane. The effect of short-term ageing from the point of production, by ambient conditioning at 23°C/50% RH, is compared to conditioning at an elevated temperature of 70°C. The declared thermal properties of the product and CE certification are fulfilled by the requirements of the European EPS product standard and SG19 Guidance. Measured thermal conductivity levels within 1% of the final value are acceptable and considered representative throughout the economic life of the product. Levels within the criteria were determined for 50 mm silver EPS after conditioning for 5 days at an elevated temperature of 70°C, whereas for conditioning at 23°C/50% RH the time taken was 23 days. The latter time is in good accord with retesting retained grey EPS boards of similar density and up to 9 years old, after initial testing 22 days from production, and conditioning at 23°C/50% RH. Elevated temperature conditioning increases the rate of diffusion of the blowing agent, but there has been concern about EPS beads softening above 60°C. Although there is little evidence from scanning electron microscopy of significant increase in perforation of the cell membranes at elevated temperatures, there is some indication of a small increase in wrinkling of the walls and intercell skeletal strands at 60°C and 70°C. It takes longer to eliminate the pentane gas by conditioning at 23°C/50% RH but there is no risk of material change from heat conditioning

Metabolomic profiling of macrophages determines the discrete metabolomic signature and metabolomic interactome triggered by polarising immune stimuli

Priming and activating immune stimuli have profound effects on macrophages, however, studies generally evaluate stimuli in isolation rather than in combination. In this study we have investigated the effects of pro-inflammatory and anti-inflammatory stimuli either alone or in combination on macrophage metabolism. These stimuli include host factors such as IFNγ and ovalbumin-immunoglobulin immune complexes, or pathogen factors such as LPS. Untargeted LC-MS based metabolomics provided an in-depth profile of the macrophage metabolome, and revealed specific changes in metabolite abundance upon either individual stimuli or combined stimuli. Here, by factoring in an interaction term in the linear model, we define the metabolome interactome. This approach allowed us to determine whether stimuli interact in a synergistic or antagonistic manner. In conclusion this study demonstrates a robust approach to interrogate immune-metabolism, especially systems that model host-pathogen interactions

IMPLICATIONS OF NATIONAL TRENDS IN DIGITAL MEDIA USE FOR ART THERAPY PRACTICE

This paper presents an overview of national trends in visual art-making and art sharing using digital media, and, the authors’ reflections on the implications of these findings for art therapy practice. These findings were based on a secondary analysis of the 2012 Survey of Public Participation in the Arts administered by the National Endowment for the Arts. Survey findings indicated that increasing proportions of people in the United States are using digital media for creating, archiving, and sharing their art. Reflections by the authors on these findings include support for increase in use of digital media by art therapists for their own art and the need for research about, and, education on best practices for use of digital media

Learning from Struggling Readers: The Impact of a Community-based Service Learning Project on Teacher Preparation

With the growing number of diverse struggling readers in K-12 settings in the United States, it is critical to provide opportunities for students to enhance reading skills beyond classroom settings, for families to be involved in reading education, and for teachers to be better prepared to work with both students and their families. In this study, we described a community-based service learning project, the Village Project, that highlights the collaboration among the university, schools, and local community partners. Through reciprocal learning process, not only did struggling readers and families benefited from the program, preservice teacher candidates involved in the project also enhanced their understandings of reading instruction and family involvement. Following up with twenty teacher candidates who participated in the project during 2009-2012, we explored the long-term impact of the Village Project on their development as teachers, and provided discussions and implications for teacher education