The Impact of Medicare's Prospective Payment System on Psychiatric Patients Treated in Scatterbeds

Medicare's Prospective Payment System (PPS) for hospitals was phased-in during the 1884 Federal Fiscal Year. While many providers of psychiatric inpatient care were exempted from PPS patients treated in general hospital beds outside of psychiatric units (scatterbeds) were not. This allows for an initial assessment of the impact of PPS on psychiatric patients. We use a single equation model of hospital length of stay to estimate the impact of PPS. We allow for the possibility of both anticipating behavior and slow adjustment to the new payment scheme. The results indicate a substantial response to PPS over the first year of implementation. The estimated response includes sizable anticipatory and slow adjustment components. The findings suggest that policy discussions may be weighted too heavily in the direction of concern over hospital financial status given the ability of hospitals to change their behavior.

Effects of Dentifrices Differing in Fluoride Content on Remineralization Characteristics of Dentin in vitro

Objectives: The aim of this study was to compare the caries preventive effect of highly fluoridated dentifrices and gels on sound dentin as well as on artificial dentin caries-like lesions. Methods: Bovine dentin specimens (n = 240), with 2 different surfaces each (1 sound surface [sound treatment (ST)] and one caries lesion [demineralized treatment (DT)]), were prepared and randomly allocated to one highly (6 × 120 min demineralization/day [H]) and one lowly cariogenic (6 × 60 min demineralization/day [L]) pH-cycling model. Treatments during pH-cycling (28 days) were: brushing 2×/ day with: 0 ppm F [H0/L0], 1,450 ppm F [H1,450/L1,450], 2,800 ppm F [H2,800/L2,800], 5,000 ppm F [H5,000/L5,000], 5,000 ppm F plus TCP [H5,000+TCP/L5,000+TCP], and 12,500 ppm F [H12,500/ L12,500] containing dentifrices/gels. Dentifrice/gel slurries were prepared with deionized water (1: 2 wt/wt). Differences in integrated mineral loss (ΔΔZ) and Δ lesion depth were calculated between values before and after pH-cycling using transversal microradiography. Results: The correlation between ΔΔZDT and F– was strong for the highly (rH = 0.691; p < 0.001) and moderate (rL = 0.500; p < 0.001) for the lowly cariogenic model, indicating a fluoride dose-response for both. Significant differences for ΔΔZDT and ΔΔZST could be found between H0, H1,450, H5,000, and H12,500 as well as L0, L5,000, and L125,000 (p ≤ 0.046; analysis of covariance [ANCOVA]). Except for 0 ppm F–, no significant difference in ΔΔZST and ΔΔZDT could be found between the highly and lowly cariogenic model (p ≥ 0.056; ANCOVA). Conclusion: For both pH-cycling conditions a dose-response for fluoride could be revealed. For elderly people with exposed root surfaces, the use of gels containing 12,500 ppm F instead of regularly (1,450 ppm F) or highly (5,000 ppm F) fluoridated dentifrices should be further investigated, as it offered higher cariespreventive effects in vitro

Examining the restorative effects of casual video games

Individuals who work in highly stressful jobs (e.g. doctors, soldiers) struggle with the daily impact of stress-related cognitive fatigue. High-pressured job tasks and worry for job security can produce an unstable internal environment for the individual, where stress and cognitive workload can intensify. Stress-induced fatigue generates a multitude of overwhelming problems for the individual. Due to society’s growing demand of productivity and efficiency, there is an essential need for finding a cost effective way to reduce cognitive fatigue and stress for everyone. This study analyzed and compared three relaxation methods (break, meditation, & game) to determine the effectiveness of brief casual video game exposure as a method to reduce stress increase mood, and restore cognitive resources. Taking a short break or engaging in guided relaxation exercises are well-known methods for reducing stress and improving mood, but can be impractical, less motivating, and time-consuming in a high stress related job, where time-efficiency and productivity are critical. Casual Video Games (CVGs) may present an optimum opportunity to be a preferred method to reduce stress and improve mood, due to their short time requirements, better mobility, and convenience. Three experiments were conducted to examine the hypothesis that CVGs could be an efficacious method of reducing stress, improving mood and restoring fatigue induced cognitive decrements. Across all three experiments, the guided medication technique was found to be another effective method to reduce stress and improve mood; however, this method was found to be less effective than the casual video game condition, the break was found to be the least effective method of reducing stress and improving mood. However, none of the methods were able to improve cognitive functioning. Overall, the results indicated that briefly playing a casual video game (\u3c 10 minutes) can improve mood (increased positive affect & reduced negative affect), reduce stress with increased task engagement. Widespread use of Casual Video Games has the potential of improving employee productivity and efficiency and therefore improving a company’s profitability. Future research is needed to determine which aspects of casual video games may increase or reduce these effects

Preparing sparse solvers for exascale computing.

Sparse solvers provide essential functionality for a wide variety of scientific applications. Highly parallel sparse solvers are essential for continuing advances in high-fidelity, multi-physics and multi-scale simulations, especially as we target exascale platforms. This paper describes the challenges, strategies and progress of the US Department of Energy Exascale Computing project towards providing sparse solvers for exascale computing platforms. We address the demands of systems with thousands of high-performance node devices where exposing concurrency, hiding latency and creating alternative algorithms become essential. The efforts described here are works in progress, highlighting current success and upcoming challenges. This article is part of a discussion meeting issue 'Numerical algorithms for high-performance computational science'

Optimality in DNA repair

Peer reviewedPublisher PD

Development of an online teaching platform to improve access to postgraduate pathology training in sub-Saharan Africa

Background: Resource barriers to the provision of accessible training in cancer diagnosis in lower- and middle-income countries (LMICs) limit the potential of African health systems. Long-term provision via teaching visits from senior pathologists and trainee foreign placements is unsustainable due to the prohibitive costs of travel and subsistence. Emerging eLearning methods would allow pathologists to be trained by experts in a cheaper, more efficient, and more scalable way. Purpose: This study aimed to develop an online teaching platform, starting with hematopathology, for trainee pathologists in sub-Saharan Africa, initially in Nairobi, Kenya, and Lusaka, Zambia. Methods: Course materials were prepared for both Canvas and the Zoom eLearning platforms using digitally scanned slides of lymph nodes and bone marrow trephines. Initial in-person visits were made to each site to establish trainee rapport and maximize engagement, evaluate different methods and course content, and obtain feedback to develop the project. The knowledge of trainees before and after course completion was used to measure initial effectiveness. Online teaching with the preferred platform is to be continued for 1 year before re-evaluation for long-term effectiveness. Results: Canvas was selected as the preferred delivery platform as it is freely available and has good functionality to support all required tasks. Face-to-face teaching was considered optimal to establish the initial rapport necessary to maximize subsequent engagement with online teaching. Challenges have included sub-optimal internet speeds and connections and scheduling issues. Weekly online hematopathology teaching sessions using live image capture microscope sessions, Zoom, and Canvas have been delivered to students in Kenya and Zambia, with good attendance and interaction in case discussions. Conclusion: Our team has successfully designed and delivered an online training program in hematopathology to trainee pathologists in Kenya and Zambia, which has been ongoing for over a year. This project is now being scaled to other sub-Saharan countries and other sub-specialties

Time scale and intensity dependency in multiplicative cascades for temporal rainfall disaggregation

Multiplicative random cascades (MRCs) can parsimoniously generate highly intermittent patterns similar to those in rainfall. The elemental MRC model parameter is the cascade weight, which determines how rainfall at one scale is partitioned at the next smallest scale in the cascade. While it is known that the probability density of these weights may vary with both time scale and rainfall intensity, nearly all previous studies have considered either time scale or intensity separately. We examined the simultaneous dependency of the weights on both factors and assessed the impacts of explicitly including these dependencies in the MRC model. On the basis of the observed relationships between cascade weights and time scale and intensity, four progressively more “dependent” models were constructed to disaggregate a long time series of daily rainfall to hourly intervals. We found that inclusion of the intensity dependency on the model parameters that generate dry intervals greatly improved performance. For the relatively small range of time scales over which the rainfall was disaggregated, varying model parameters with time scale resulted in minor improvement.Keywords: dependent, multiplicative random cascade, intensity, time scale, rainfall, disaggregatio