Regional data exchange to improve care for veterans after non-VA hospitalization: a randomized controlled trial

BACKGROUND: Coordination of care, especially after a patient experiences an acute care event, is a challenge for many health systems. Event notification is a form of health information exchange (HIE) which has the potential to support care coordination by alerting primary care providers when a patient experiences an acute care event. While promising, there exists little evidence on the impact of event notification in support of reengagement into primary care. The objectives of this study are to 1) examine the effectiveness of event notification on health outcomes for older adults who experience acute care events, and 2) compare approaches to how providers respond to event notifications. METHODS: In a cluster randomized trial conducted across two medical centers within the U.S. Veterans Health Administration (VHA) system, we plan to enroll older patients (≥ 65 years of age) who utilize both VHA and non-VHA providers. Patients will be enrolled into one of three arms: 1) usual care; 2) event notifications only; or 3) event notifications plus a care transitions intervention. In the event notification arms, following a non-VHA acute care encounter, an HIE-based intervention will send an event notification to VHA providers. Patients in the event notification plus care transitions arm will also receive 30 days of care transition support from a social worker. The primary outcome measure is 90-day readmission rate. Secondary outcomes will be high risk medication discrepancies as well as care transitions processes within the VHA health system. Qualitative assessments of the intervention will inform VHA system-wide implementation. DISCUSSION: While HIE has been evaluated in other contexts, little evidence exists on HIE-enabled event notification interventions. Furthermore, this trial offers the opportunity to examine the use of event notifications that trigger a care transitions intervention to further support coordination of care. TRIAL REGISTRATION: ClinicalTrials.gov NCT02689076. "Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization." Registered 23 February 2016

Effect of transport and rest stop duration on the welfare of conditioned cattle transported by road

The effects of providing rest on physiological and behavioural indicators of welfare of cattle being transported by road has not been well studied in North America. New revisions to Canada’s Health of Animals Regulations Part XII: Transportation of Animals indicate un-weaned and weaned calves can be transported a maximum of 12 and 36 h, respectively, before an 8 h rest is required. Therefore, the aim of this study was to assess the effects of rest duration, after 12 and 36 h of transport, on physiological and behavioural indicators of welfare in 7–8 mo-old beef calves. Three hundred and twenty conditioned calves (258 ± 23.9 kg BW) were randomly assigned to a 2 × 4 factorial design where the main factors included transport duration: 12 h (12; n = 160) and 36 h (36; n = 160) and rest stop duration: 0 h (R0; n = 80), 4 h (R4; n = 80), 8 h (R8; n = 80) and 12 h (R12; n = 80). After the resting period, animals were transported for an additional 4 h. Blood and hair samples were taken from 12 animals per treatment prior to and after the first and the 4 h transport; and then 7 h, 2 d and 28 d after the 4 h transport. The concentrations of haptoglobin, creatine kinase, non-esterified fatty acids (NEFA), lactate, and serum and hair cortisol were determined. Standing and lying behaviour was assessed for 14 d after transport, while feeding behaviour of calves in one pen per treatment were assessed for 28 d after transportation using an electronic feed bunk monitoring system. Body weight (BW), average daily gain (ADG) and shrink (%) was assessed for all calves. The data was modeled using generalized linear mixed methods (SAS PROC GLIMMIX), where transport and time (nested in rest) were considered fixed effects and animal and pen were considered random effects. Statistically significant (p < 0.05) effects of transport were observed on BW and shrink, where 36 h-transported calves had lower (p < 0.01) BW and greater (p < 0.01) shrink than 12 h-transported calves. A transport × time (nested in rest) interaction (p < 0.01) was observed for lying percentage where, 36-R8 calves had greater (p < 0.01) lying percentage than 12-R8 calves on d 1 after transportation. The area under the curve (AUC) for NEFA was greater (p < 0.01) for 36-R0 calves than 12-R0, 36-R4, and 36-R8 calves, and greater (p < 0.01) in 36-R12 calves than 12-R12 calves. Haptoglobin AUC was greater (p = 0.05) in 36-R12 than 12-R12 calves. Overall, physiological indicators of reduced welfare were greater in calves transported for 36 than 12 h, while no clear differences were observed between rest stop groups with the exception of NEFA. Based on these results, conditioned calves benefit from shorter transport durations but there was no clear evidence that calves rested 4, 8, and 12 h following transportation experienced reduced transport related stress compared to those that were not rested (0h).info:eu-repo/semantics/publishedVersio

Effect of rest, post-rest transport duration, and conditioning on performance, behavioural, and physiological welfare indicators of beef calves

The aim of this study was to assess the effects of conditioning, rest, and post-rest transport duration on welfare indicators of 6–7 mo old beef calves following a 20-h transport. Three hundred and twenty-eight weaned calves (237 ± 29.7 kg of BW) were randomly assigned to a 2 × 2 × 2 nested factorial design: conditioning, conditioned (C) or non-conditioned (N); rest, 0 (R0) or 8 (R8) h, and post-rest transport, 4 (T4) or 15 (T15) h. Calves were sampled before (LO1) and after (UN1) the initial 20-h journey, before (LO2) and after (UN2) the additional 4 or 15-h journey, and at 1, 2, 3, 5, 14, and 28 d after UN2. Data was analyzed using the GLIMMIX procedure of SAS. Fixed effects included conditioning, transport, and time nested within rest period, while random effects included animal and pen. Greater shrink (p < 0.01) was observed in C than N calves after the initial 20-h transport. During the first week after transportation, the mean ADG of N calves was greater than C calves (p < 0.01). From d 14 to d 28, however, the mean ADG of C calves was greater than N calves (p < 0.01). Flight speed, cortisol and L-lactate concentrations were greater (p ≤ 0.05) in C than N calves between LO1 and d 5, while greater (p ≤ 0.02) non-esterified fatty acids, creatine kinase, serum amyloid-A, and haptoglobin concentrations were observed in N than C calves between LO1 and d 3. The R8-T4 calves had greater (p < 0.01) ADG than R8-T15 calves between LO1 and d 5. The R0-T4 calves had greater L-lactate concentrations than R0-T15 and R8-T4 calves (both p = 0.02) on d 1. The R0 calves had greater (p < 0.01) ADG than R8 calves between 14 and 28 d. This study suggests that C calves are better fit for transport than N calves as evidenced by behavioural and physiological parameters. Fewer and inconsistent differences were observed for rest and post-rest transport treatments.info:eu-repo/semantics/publishedVersio

Characterizing the diagnostic sensitivity and specificity of pain biomarkers in cattle using receiver operating characteristic curves

Biomarkers are used to assess pain and analgesic drug efficacy in livestock. However, often the diagnostic sensitivity and specificity of these biomarkers for different painful conditions over time have not been described. Receiver operating characteristic (ROC) curves are graphical plots that illustrate the diagnostic ability of a test as its discrimination threshold is varied. The objective of this analysis was to use area under the curve (AUC) values derived from ROC analysis to characterize the predictive value of potential pain biomarkers at specific time points following a painful stimulus. The biomarkers included in the analysis were plasma cortisol, salivary cortisol, hair cortisol, infrared thermography (IRT), mechanical nociceptive threshold (MNT), substance P, kinematic gait analysis, and a visual analog scale for pain. A total of 7,992 biomarker outcomes collected from 7 pain studies involving pain associated with castration, dehorning, lameness, and abdominal surgery were included in the analysis. Each study consisted of 3 treatments: uncontrolled pain (tissue damage), no pain (handled controls), and analgesic use (tissue damage, administered a nonsteroidal anti-inflammatory drug). Results comparing analgesic effects to uncontrolled pain consistently yielded AUC values >0.7 (95% confidence interval: 0.40 to 0.99) for plasma cortisol (time points: 1.5, 2, 3, 4, 6, and 8 h), hair cortisol (time point: 62 d), and IRT (time point: 72 h). Results comparing analgesic effects to uncontrolled pain consistently yielded AUC values <0.7 (95% confidence interval: 0.28 to 0.90) for salivary cortisol (6, 13, 20, 34, 48, and 62 d); MNT (6, 25, and 49 h); substance P (1, 2, 3, 4, 6, 8, 12, 18, 24, 48, 72, 96, 120, 144, 312, 480, 816, 1,152, and 1,488 h); kinematic gait analysis including area (8, 16, 48, 72, 96, and 120 h), force (8, 16, 24, 48, 72, 96, and 120 h), and pressure (8, 16, 24, 48, 72, 96, and 120 h); and a visual analog scale for pain (1, 2, 3, 4, 5, and 6 d). These results indicate that ROC analysis can be used to characterize the predictive value of pain biomarkers and provide new knowledge on the diagnostic accuracy of pain biomarkers within this data set. This analysis, using data from 7 studies, was a preliminary approach to identify biomarkers and collection time points that could inform additional analytical approaches or meta-analyses with larger sample sizes, which are needed to further validate these hypotheses and conclusions.info:eu-repo/semantics/publishedVersio

Condensation and Clustering in the Driven Pair Exclusion Process

We investigate particle condensation in a driven pair exclusion process on one- and two- dimensional lattices under the periodic boundary condition. The model describes a biased hopping of particles subject to a pair exclusion constraint that each particle cannot stay at a same site with its pre-assigned partner. The pair exclusion causes a mesoscopic condensation characterized by the scaling of the condensate size $m_{\rm con}\sim N^\beta$ and the number of condensates $N_{\rm con}\sim N^\alpha$ with the total number of sites $N$. Those condensates are distributed randomly without hopping bias. We find that the hopping bias generates a spatial correlation among condensates so that a cluster of condensates appears. Especially, the cluster has an anisotropic shape in the two-dimensional system. The mesoscopic condensation and the clustering are studied by means of numerical simulations.Comment: 4 pages, 5 figure

Effects of confinement and surface enhancement on superconductivity

Within the Ginzburg-Landau approach a theoretical study is performed of the effects of confinement on the transition to superconductivity for type-I and type-II materials with surface enhancement. The superconducting order parameter is characterized by a negative surface extrapolation length $b$. This leads to an increase of the critical field $H_{c3}$ and to a surface critical temperature in zero field, $T_{cs}$, which exceeds the bulk $T_c$. When the sample is {\em mesoscopic} of linear size $L$ the surface induces superconductivity in the interior for $T T_{cs}$. In analogy with adsorbed fluids, superconductivity in thin films of type-I materials is akin to {\em capillary condensation} and competes with the interface delocalization or "wetting" transition. The finite-size scaling properties of capillary condensation in superconductors are scrutinized in the limit that the ratio of magnetic penetration depth to superconducting coherence length, $\kappa \equiv \lambda/\xi$, goes to zero, using analytic calculations. While standard finite-size scaling holds for the transition in non-zero magnetic field $H$, an anomalous critical-point shift is found for H=0. The increase of $T_c$ for H=0 is calculated for mesoscopic films, cylindrical wires, and spherical grains of type-I and type-II materials. Surface curvature is shown to induce a significant increase of $T_c$, characterized by a shift $T_c(R)-T_c(\infty)$ inversely proportional to the radius $R$.Comment: 37 pages, 5 figures, accepted for PR

Revealing structural evolution occurring from photo-initiated polymer network formation

Acomplete account of the structural evolution occurring during photopolymerisation is lacking. Here the physical changes occurring on the nanometer scale during photopolymerisation of acrylates are followed over time by FTIR, X-ray reflectometry, AFM, and GISAXS, offering insight into the mechanism by which initial composition influences the final morphology

Effect of a single subcutaneous injection of meloxicam on chronic indicators of pain and inflammatory responses in 2-month-old knife and band-castrated beef calves housed on pasture

One hundred and thirty-one 2 mo. old pasture housed Angus cross bull calves were evaluated for 62 d over two years (Year 1: n = 69, 134.1 ± 20.37 kg BW; Year 2: n = 62, 118.1 ± 15.49 kg BW) to determine 1) the effects of a subcutaneous (s.c) injection of meloxicam on indicators of long term pain after castration and 2) the potential use of cow-calf proximity and home range as indicators of pain. Calves were randomly assigned to treatments using a 3 × 2 factorial design including castration - sham (CT; n = 47), band (BA; n = 46) or knife (KN; n = 38) castration and medication – s.c. meloxicam (M; n = 66) or s.c. lactated ringers solution (NM; n = 65). Measurements included performance, scrotal temperature, swelling (WS) and healing (WH) scores, and pain sensitivity, collected on d -1, 6, 13, 20, 34, 48, and 62 post-castration. Suckling, lying, standing and walking duration, and head-turning, lesion-licking, foot-stamping and tail-flick frequencies were collected immediately following and up to 2-d after castration. Cow-calf proximity and home range were obtained from d 0 to 2 and from d 14 to 16. With the exception of suckling, no medication (P > 0.05) effects were found. Greater (P < 0.05) pain sensitivity was observed in KN from d 6 to 34 and on d 62, and in BA from d 6 to 62 compared to CT calves. Knife calves showed an earlier (d 20) absence of inflammatory responses (WS; P < 0.05) than BA (d 34) and overall, KN calves had greater (P < 0.05) standing, walking, and head turning than BA and CT. Knife and BA had greater (P < 0.05) foot stamping than CT for the first 2 h post-castration, but KN exhibited greater (P < 0.05) frequencies between 9 and 11 h (d 0) compared to BA and CT, and had greater (P < 0.05) tail flicks from d 0 to 2 than CT. Banded calves were closer to their dams on d 15 while KN calves and their dams had a reduced home range on d 0 than CT cow-calf pairs. Although meloxicam did not reduce indicators of pain (with exception of suckling behavior), our results suggest that knife castration causes greater acute pain, while band castration resulted in greater chronic-pain. Cow-calf proximity and home range have some potential to be used as pain indicators post-castration.info:eu-repo/semantics/publishedVersio