The Association Between Leapfrog\u27s Healthcare Organizational Grades and 30-Day Mortality Rates

U.S. healthcare consumers have access to various provider ratings from several organizations that are meant to assist in selecting their healthcare providers. Leapfrog Hospital Safety Grades is one such rating system that professes to allow consumers the ability to select the best hospital for their care. However, since consumers ranking mortality risk as their most important concern, it is essential to determine if Leapfrog grades align with consumer expectations. Andersen\u27s Phase-4 behavioral model of healthcare utilization was used as the foundation for understanding healthcare consumer preferences. This study was designed to determine if Leapfrog grades are predictive of CMS 30-day mortality rates for pneumonia, chronic heart failure, and acute myocardial infarction data, while also adjusting for selected organizational descriptors: state of residency, Medicare expansion, safety-net status, ownership type, teaching classification, and number of licensed beds. Linear regression demonstrated that Leapfrog grades are not reliable predictors of the 3 inpatient mortality rates analyzed. The study demonstrated that ownership type was a significant predictor for 2 of the 3 dependent variables. Furthermore, most of the covariates also provided some predictive value for at least 1 of the included outcomes; however, in most cases, the effect (β) was small. This study can help provide positive social change by elucidating that Leapfrog grades are not reliable predictors of patient outcomes for consumers, while also demonstrating that efforts to reduce 30-day mortality rates, especially for pneumonia, can be targeted by selected states, ownership type, and teaching status

Contrasting Inequalities: Comparing Correlates of Health in Canada and the United States

Comparative health studies consistently find that Canadians on average are healthier than Americans. Comparing health status within and between Canada and the United States provides key insights into the distribution of inequalities in these two countries. Canada’s universal health care insurance system contrasts with the mixed system of the United States: universal care for seniors, private health care insurance for many, and no or intermittent coverage for others. These countries are also notably different in the extent of income and racial/ethnic inequalities. It is within this context that this study compares the relative strength of the relationships between social, economic, and demographic factors (sex, age, marital status, income, education, country of birth, and race/ethnicity) and health status in Canada and the United States. Evidence drawn from the 2002-2003 Joint Canada/United States Survey of Health reveals that the correlations between these factors, above all country of birth and race/ethnicity, and health are relatively stronger in the United States, reflecting differences in health care access and racial/ethnic-based inequalities between the countries. The study findings are suggestive of the effects of universal access to health care and more equitable distribution of other social resources in protecting the health of the general population.self-reported health, United States, Canada, health insurance, income, race, ethnicity, age, sex

Refighting Pickett’s Charge: mathematical modeling of the Civil War battlefield

Objective. We model Pickett’s Charge at the Battle of Gettysburg to see whether the Confederates could have achieved victory by committing more infantry, executing a better barrage, or facing a weaker defense. Methods. Our mathematical modeling is based on Lanchester equations, calibrated using historical army strengths. We weight the Union artillery and infantry two different ways using two sources of data, and so have four versions of the model. Results. The models estimate that a successful Confederate charge would have required at least 1 to 3 additional brigades. An improved artillery barrage would have reduced these needs by about 1 brigade. A weaker Union defense could have allowed the charge to succeed as executed. Conclusions. The Confederates plausibly had enough troops to take the Union position and alter the battle’s outcome, but likely too few to further exploit such a success

Self-Assessment of Knowledge: a cognitive learning or affective measure? Perspectives from the management learning and education community

The article presents a response to the article "Self-Assessment of Knowledge: A Cognitive Learning or Affective Measure?," by Traci Sitzmann, Katherine Ely, Kenneth G. brown and Kristina N. Bauer. In the response the authors offer their opinions on the article, on self-assessment in education and on the role that self-assessment plays in the management learning and education communities. A discussion of research which has evaluated the psychology of learning and the psychology of personal growth is presented

A Recipe for Healthy Communities

In Grand Rapids’ urban areas the ability to gain access to nutritional food is difficult and in some cases, impossible. The purpose of the project is to work with a local non-profit organization be more successful in helping people living in areas known as food deserts. “Food deserts are defined by the USDA as parts of the country vapid of fresh fruit, vegetables, and other healthful whole foods, usually found in impoverished areas. This is due to a lack of grocery stores, farmers’ markets, and healthy food providers” (Gallagher, 2010). Having access to the produce is only the first obstacle. Rectifying this problem would also include access to fresh produce and the means to prepare the food in a healthy way. In a Liberal Studies course at Grand Valley State University called Food Matters, we partnered The Heartside Gleaning Initiative (HGI), which began to make a difference in the Heartside district of Grand Rapids. The initiative was set up to help bring extra produce, which would otherwise go to waste from the local farmers markets to supply food banks, soup kitchens and people in residential areas where fresh produce is not available. With hopes to help the organization our group put together a sample recipe book. The recipe book includes easy and low-maintenance recipes, which uses minimal ingredients that are focused around produce coming from the farmers’ markets. The recipe book was created as a tool to be used to help people learn about preparing produce in a healthy way. Some set backs occurred while compiling this project, it was brought to our attention that the recipients of the produce lacked kitchen equipment, which made recipes more difficult to construct. However, we were determined to help HGI in their efforts to encourage healthy eating in the Heartside community. The project, recipe book, and encouragement for the community have potential for growth in the future

Evaporation of sessile droplets on pinning-free surfaces

Contact-line pinning is a fundamental limitation of diffusion-limited evaporation of sessile droplets. Sessile droplet evaporation is pervasive in a wide range of situations from ink-jet printing, to pesticide sprays and spotted microarrays. Contact-line pinning drives, for example, stick-slip motion and non-uniform deposition of solute within the droplet. Moreover, contact-line pinning is problematic in a wide range of situations, such as droplet microfluidics where capillary forces dominate the motion of liquid fronts. Recently, Slippery Liquid-Infused Porous Surfaces (SLIPS) have shown excellent droplet shedding abilities by use of a lubricating liquid, imbibed into a porous structure, immiscible to droplets on the surface. However, the lubricating liquid removes the droplet-solid-interaction, can cloak the droplet, can be several microns in thickness and the porous structure can be fragile to external mechanical forces. Slippery Omniphobic Covalently Attached Liquid-Like (SOCAL) is a new type of liquid-like surface, which is an attached coating rather than a retained liquid. SOCAL promises pinning-free properties while being nanometres thick and demonstrating mechanical robustness. Few research groups have reported successful creation of SOCAL surfaces. This thesis shows an optimised methodology to make reliably, pinning-free low-hysteresis SOCAL surfaces. This is done by modifying the parameters to create SOCAL and measuring the contact-angle hysteresis. A low contact-angle hysteresis of < 1° is achieved. These surfaces then show, for the first time, constant contact angle mode evaporation of sessile water droplets from a solid surface. This allows for the accurate measurement of the diffusion coefficient of water. An unexpected feature of the evaporation sequences is a step change increase in contact angle reminiscent of a type V adsorption isotherm. Attempts are made to characterise this using Dynamic Vapour Sorption (DVS) and Quartz Crystal Microbalance (QCM) techniques. This thesis also shows voltage-programmable control of water droplets on SOCAL using electrowetting. The unexpected behaviour of droplets on SOCAL is investigated and the electrowetting device is optimised. This allows control of the constant contact angle evaporation on both SLIPS and SOCAL. This is used to study the effect on the contact angle during the evaporation of sessile water droplets. The results of this thesis will benefit the aforementioned applications overcoming contact-line pinning and introducing new methods of controlling sessile droplet evaporation

Metamorphosis of the Mushroom Bodies; Large-Scale Rearrangements of the Neural Substrates for Associative Learning and Memory in Drosophila

Paired brain centers known as mushroom bodies are key features of the circuitry for insect associative learning, especially when evoked by olfactory cues. Mushroom bodies have an embryonic origin, and unlike most other brain structures they exhibit developmental continuity, being prominent components of both the larval and the adult CNS. Here, we use cell-type-specific markers, provided by the P{GAL4} enhancer trap system, to follow specific subsets of mushroom body intrinsic and extrinsic neurons from the larval to the adult stage. We find marked structural differences between the larval and adult mushroom bodies, arising as the consequence of large-scale reorganization during metamorphosis. Extensive, though incomplete, degradation of the larval structure is followed by establishment of adult specific α and β lobes. Kenyon cells of embryonic origin, by contrast, were found to project selectively to the adult γ lobe. We propose that the γ lobe stores information of relevance to both developmental stages, whereas the α and β lobes have uniquely adult roles

Activation of lateral hypothalamus-projecting parabrachial neurons by intraorally delivered gustatory stimuli

The present study investigated a subpopulation of neurons in the mouse parabrachial nucleus (PbN), a gustatory and visceral relay area in the brainstem, that project to the lateral hypothalamus (LH). We made injections of the retrograde tracer Fluorogold (FG) into LH, resulting in fluorescent labeling of neurons located in different regions of the PbN. Mice were stimulated through an intraoral cannula with one of seven different taste stimuli, and PbN sections were processed for immunohistochemical detection of the immediate early gene c-Fos, which labels activated neurons. LH projection neurons were found in all PbN subnuclei, but in greater concentration in lateral subnuclei, including the dorsal lateral subnucleus (dl). Fos-like immunoreactivity (FLI) was observed in the PbN in a stimulus-dependent pattern, with the greatest differentiation between intraoral stimulation with sweet (0.5 M sucrose) and bitter (0.003 M quinine) compounds. In particular, sweet and umami-tasting stimuli evoked robust FLI in cells in the dl, whereas quinine evoked almost no FLI in cells in this subnucleus. Double-labeled cells were also found in the greatest quantity in the dl. Overall, these results support the hypothesis that the dl contains direct a projection to the LH that is activated preferentially by appetitive compounds; this projection may be mediated by taste and/or postingestive mechanisms