Transitions of Care: Raising Awareness and Improving Identification of the Social Determinants of Health

Problem: Hospital readmission rates have steadily climbed in the United States and the cost of unplanned readmissions can be detrimental. It has been identified that greater discharge preparation and quality care coordination greatly impacts the patient’s plan of care and reduces the risk of unplanned 30-day readmissions. Transition programs help reduce the psychosocial barriers that prevent patients from being able to self-manage their conditions outside the acute setting and help patients effectively navigate the through the continuum of care. Context: Research has shown that when the social determinants of health (SDOH) barriers are identified appropriately and early-on, this can decrease a patient’s risk of unplanned readmission. Audit results show opportunities for improvement in the program through development of a screening tool that will help clinicians appropriately identify psychosocial issues and increase educational awareness of the Transition Program (TP) as well as SDOH. Interventions: Several interventions were done to help increase low-elevated transitional support level referrals to TP: development of a psychosocial assessment tool, in-service meeting to review the referral process of the TP, and staff education to raise awareness and importance of identifying SDOH in patient care outcomes. Measures: Using HealthConnect and EPIC data to track weekly number of referral cases. Monitor if the development and implementation of the tool has increased the number of lowelevated TSL referrals to the Transition Program. Results: There was a 25% increase in low TSL referrals. Clinicians reported increased awareness and knowledge about SDOH and Transition Program interventions. Conclusions: Readmission and identifying SDOH barriers is a complex challenge to healthcare and requires interdisciplinary team collaboration and multimodal interventions

Dynamics in the centre manifold around equilibrium points in periodically perturbed three-body problems

A new application of the parameterization method is pre- sented to compute invariant manifolds about the equilib- rium points of Periodically Perturbed Three-Body Problems ( PPTBP ). These techniques are applied to obtain high-order semi-numerical approximations of the center manifolds abo ut the points L 1 , 2 of the Sun-perturbed Earth-Moon Quasi- Bicicular Problem ( QBCP ), which is a particular case of PPTBP . The quality of these approximations is compared with results obtained using equivalents of previous normal form procedures. Then, the parameterization is used to ini- tialize the computation of Poincaré maps, which allow to get a qualitative description of the periodically-perturb ed dynamics near the equilibrium pointsPostprint (published version

The Young Adult Chronic Patient: A Look Back

Editor's Note: In the commentary below, Francine Cournos, M.D., and Stephanie Le Melle, M.D., discuss the article on page 989, reprinted from the July 1981 issue of Hospital and Community Psychiatry. That article described a new group of chronic patients, young adults with poor social functioning who were draining the resources of public-sector programs. Drs. Cournos and Le Melle place the emergence of this patient group within a larger context of shifts in funding streams for social welfare programs and a lack of resources for community-based care. They describe studies published in this journal in the 1980s that examined many issues related to the treatment of young adult chronic patients—homelessness, outpatient commitment, and comorbid substance abuse—and they call on mental health professionals to advocate for more resources to improve patient care

Sustainability and oxidase biocatalysis – An overview

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The Absorption Signatures of Dwarf Galaxies: The z=1.04 Multicloud Weak MgII Absorber toward PG 1634+706

We analyze high resolution spectra of a multi--cloud weak [defined as W_r(MgII) < 0.3 A] absorbing system along the line of sight to PG 1634+706. This system gives rise to a partial Lyman limit break and absorption in MgII, SiII, CII, SiIII, SiIV, CIV, and OVI. The lower ionization transitions arise in two kinematic subsystems with a separation of ~150 km/s. Each subsystem is resolved into several narrow components, having Doppler widths of 3-10 kms. For both subsystems, the OVI absorption arises in a separate higher ionization phase, in regions dominated by bulk motions in the range of 30-40 km/s. The two OVI absorption profiles are kinematically offset by ~50 km/s with respect to each of the two lower ionization subsystem. In the stronger subsystem, the SiIII absorption is strong with a distinctive, smooth profile shape and may partially arise in shock heated gas. Moreover, the kinematic substructure of SiIV traces that of the lower ionization MgII, but may be offset by ~3 km/s. Based upon photoionization models, constrained by the partial Lyman limit break, we infer a low metallicity of ~0.03 solar for the low ionization gas in both subsystems. The broader OVI phases have a somewhat higher metallicity, and they are consistent with photoionization; the profiles are not broad enough to imply production of OVI through collisional ionization. Various models, including outer disks, dwarf galaxies, and superwinds, are discussed to account for the phase structure, metallicity, and kinematics of this absorption system. We favor an interpretation in which the two subsystems are produced by condensed clouds far out in the opposite extremes of a multi-layer dwarf galaxy superwind

Backscattered intensity profiles from horizontal Acoustic Doppler Current Profilers

River engineeringInnovative field and laboratory instrumentatio

A panel error correction approach to explore spatial correlation patterns of the dominant housing market in Australian capital cities

Purpose - A panel error correction model has been developed to investigate the spatial correlation patterns among house prices. This paper aims to identify a dominant housing market in the ripple down process. Design/methodology/approach - Seemingly unrelated regression estimators are adapted to deal with the contemporary correlations and heterogeneity across cities. Impulse response functions are subsequently implemented to simulate the spatial correlation patterns. The newly developed approach is then applied to the Australian capital city house price indices. Findings - The results suggest that Melbourne should be recognised as the dominant housing market. Four levels were classified within the Australian house price interconnections, namely: Melbourne; Adelaide, Canberra, Perth and Sydney; Brisbane and Hobart; and Darwin. Originality/value - This research develops a panel regression framework in addressing the spatial correlation patterns of house prices across cities. The ripple-down process of house price dynamics across cities was explored by capturing both the contemporary correlations and heterogeneity, and by identifying the dominant housing market

Exosomes in Ageing and Motor Neurone Disease: Biogenesis, Uptake Mechanisms, Modifications in Disease and Uses in the Development of Biomarkers and Therapeutics

Intercellular communication between neurons and their surrounding cells occurs through the secretion of soluble molecules or release of vesicles such as exosomes into the extracellular space, participating in brain homeostasis. Under neuro-degenerative conditions associated with ageing, such as amyotrophic lateral sclerosis (ALS), Alzheimer’s or Parkinson’s disease, exosomes are suspected to propagate toxic proteins. The topic of this review is the role of exosomes in ageing conditions and more specifically in ALS. Our current understanding of exosomes and exosome-related mechanisms is first summarized in a general sense, including their biogenesis and secretion, heterogeneity, cellular interaction and intracellular fate. Their role in the Central Nervous System (CNS) and ageing of the neuromotor system is then considered in the context of exosome-induced signaling. The review then focuses on exosomes in age-associated neurodegenerative disease. The role of exosomes in ALS is highlighted, and their use as potential biomarkers to diagnose and prognose ALS is presented. The therapeutic implications of exosomes for ALS are considered, whether as delivery vehicles, neurotoxic targets or as corrective drugs in and of themselves. A diverse set of mechanisms underpin the functional roles, both confirmed and potential, of exosomes, generally in ageing and specifically in motor neurone disease. Aspects of their contents, biogenesis, uptake and modifications offer many plausible routes towards the development of novel biomarkers and therapeutics