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

Local Moment Formation in the Periodic Anderson Model with Superconducting Correlations

We study local moment formation in the presence of superconducting correlations among the f-electrons in the periodic Anderson model. Local moments form if the Coulomb interaction U>U_cr. We find that U_cr is considerably stronger in the presence of superconducting correlations than in the non-superconducting system. Our study is done for various values of the f-level energy and electronic density. The smallest critical U_cr values occur for the case where the number of f- electrons per site is equal to one. In the presence of d-wave superconducting correlations we find that local moment formation presents a quantum phase transition as function of pressure. This quantum phase transition separates a region where local moments and d-wave superconductivity coexist from another region characterized by a superconducting ground state with no local moments. We discuss the possible relevance of these results to experimental studies of the competition between magnetic order and superconductivity in CeCu_2Si_2.Comment: 4 pages. accepted for publication in Phys. Rev.

Superconductivity in the SU(N) Anderson Lattice at U=\infty

We present a mean-field study of superconductivity in a generalized N-channel cubic Anderson lattice at U=\infty taking into account the effect of a nearest-neighbor attraction J. The condition U=\infty is implemented within the slave-boson formalism considering the slave bosons to be condensed. We consider the $f$-level occupancy ranging from the mixed valence regime to the Kondo limit and study the dependence of the critical temperature on the various model parameters for each of three possible Cooper pairing symmetries (extended s, d-wave and p-wave pairing) and find interesting crossovers. It is found that the d- and p- wave order parameters have, in general, very similar critical temperatures. The extended s-wave pairing seems to be relatively more stable for electronic densities per channel close to one and for large values of the superconducting interaction J.Comment: Seven Figures; one appendix. Accepted for publication in Phys. Rev.

Hyperacute Directional Hearing and Phonotactic Steering in the Cricket (Gryllus bimaculatus deGeer)

Background: Auditory mate or prey localisation is central to the lifestyle of many animals and requires precise directional hearing. However, when the incident angle of sound approaches 0u azimuth, interaural time and intensity differences gradually vanish. This poses a demanding challenge to animals especially when interaural distances are small. To cope with these limitations imposed by the laws of acoustics, crickets employ a frequency tuned peripheral hearing system. Although this enhances auditory directionality the actual precision of directional hearing and phonotactic steering has never been studied in the behaviourally important frontal range. Principal Findings: Here we analysed the directionality of phonotaxis in female crickets (Gryllus bimaculatus) walking on an open-loop trackball system by measuring their steering accuracy towards male calling song presented at frontal angles of incidence. Within the range of 630u, females reliably discriminated the side of acoustic stimulation, even when the sound source deviated by only 1u from the animal’s length axis. Moreover, for angles of sound incidence between 1u and 6u the females precisely walked towards the sound source. Measuring the tympanic membrane oscillations of the front leg ears with a laser vibrometer revealed between 0u and 30u a linear increasing function of interaural amplitude differences with a slope of 0.4 dB/u. Auditory nerve recordings closely reflected these bilateral differences in afferent response latency and intensity that provide the physiological basis for precise auditory steering

Divergent Immune Responses in Behaviorally-Inhibited vs. Non-Inhibited Male Rats

Stable behavioral traits (temperament, personality) often predict health outcomes. Temperament-specific differences in immune function could explain temperament-specific health outcomes, however, we have limited information on whether immune function varies by personality. In the present study, we examined the relationship between a basic behavioral trait (behavioral-inhibition vs. non-inhibition) and two immune responses (innate inflammation and delayed-type hypersensitivity, DTH) in a rodent model. In humans, behavioral inhibition (fearful temperament) is associated with altered stress physiology and allergies. In laboratory rats, the trait is associated with elevated glucocorticoid production. We hypothesized that behavioral inhibition is associated with glucocorticoid resistance and dampened T-helper 1 cell responses often associated with chronic stress and allergies. Further, this immune profile would predict poorly-regulated innate inflammation and dampened DTH. In male Sprague-Dawley rats, we quantified consistent behavioral phenotypes by measuring latency to contact two kinds of novelty (object vs. social), then measured lipopolysaccharide(LPS)-induced innate inflammation or keyhole limpet hemocyanin(KLH)-induced DTH. Behaviorally-inhibited rats had heightened glucocorticoid and interleukin-6 responses to a low/moderate dose of LPS and reduced DTH swelling to KLH re-exposure compared to non-inhibited rats. These results suggest that behavioral inhibition is associated with a glucocorticoid resistant state with poorly regulated innate inflammation and dampened cell-mediated immune responses. This immune profile may be associated with exaggerated T-helper 2 responses, which could set the stage for an allergic/asthmatic/atopic predisposition in inhibited individuals. Human and animal models of temperament-specific immune responses represent an area for further exploration of mechanisms involved in individual differences in health

Upper critical fields of the heavy-fermion superconductor UBe

We report high-precision measurements of the upper critical magnetic field of UBe13 as determined from the behavior of magnetic forces and torques acting on our samples. Our results suggest the presence of two sharp features or kinks in the upper critical field as a function of temperature in both single-crystal and polycrystalline samples. We discuss these results in light of recent theoretical and experimental work on the coexistence of heavy-fermion superconductivity with magnetic and/or additional superconducting states. © 1992 The American Physical Society