Reduce Avoidable Hospitalisations: A Policy to Increase Value from Health Care Expenditures

An interdisciplinary examination of rates of avoidable hospitalizations in France and England to evaluate access to primary care and identify the extent to which these countries may be able to reduce hospital costs by investing in disease management and primary care

Serotonin and cholecystokinin synergistically stimulate rat vagal primary afferent neurones

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65669/1/jphysiol.2004.064816.pd

Cost-effectiveness of six strategies for Helicobacter pylori diagnosis and management in uninvestigated dyspepsia assuming a high resource intensity practice pattern

<p>Abstract</p> <p>Background</p> <p>Initial assessment of dyspepsia often includes noninvasive testing for <it>Helicobacter pylori </it>infection. Commercially available tests vary widely in cost and accuracy. Although there is extensive literature on the cost-effectiveness of <it>H. pylori </it>treatment, there is little information comparing the cost-effectiveness of various currently used, noninvasive testing strategies.</p> <p>Methods</p> <p>A Markov simulation was used to calculate cost per symptom-free year and cost per correct diagnosis. Uncertainty in outcomes was estimated using probabilistic sensitivity analysis.</p> <p>Results</p> <p>Under the baseline assumptions, cost per symptom-free year was $122 for empiric proton pump inhibitor (PPI) trial, and costs for the noninvasive test strategies ranged from$123 (stool antigen) to $129 (IgG/IgA combined serology). Confidence intervals had significant overlap.</p> <p>Conclusions</p> <p>Under our assumptions for how testing for <it>H. pylori </it>infection is employed in United States medical practice, the available noninvasive tests all have similar cost-effectiveness between one another as well as with empiric PPI trial.</p

Role of eddy forcing in the dynamics of multiple zonal jets in a model of the North Atlantic

Author Posting. © American Meteorological Society, 2009. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 39 (2009): 1361-1379, doi:10.1175/2008JPO4096.1.Multiple zonal jets are observed in satellite data–based estimates of oceanic velocities, float measurements, and high-resolution numerical simulations of the ocean circulation. This study makes a step toward understanding the dynamics of these jets in the real ocean by analyzing the vertical structure and dynamical balances within multiple zonal jets simulated in an eddy-resolving primitive equation model of the North Atlantic. In particular, the authors focus on the role of eddy flux convergences (“eddy forcing”) in supporting the buoyancy and relative/potential vorticity (PV) anomalies associated with the jets. The results suggest a central role of baroclinic eddies in the barotropic and baroclinic dynamics of the jets, and significant differences in the effects of eddy forcing between the subtropical and subpolar gyres. Additionally, diabatic potential vorticity sources and sinks, associated with vertical diffusion, are shown to play an important role in supporting the potential vorticity anomalies. The resulting potential vorticity profile does not resemble a “PV staircase”—a distinct meridional structure observed in some idealized studies of geostrophic turbulence.Funding for IK was provided by NSF Grants OCE 0346178 and 0749722. Funding for PB was provided by NSF Grants OCE 0344094 and OCE 0725796 and by the research grant from the Newton Trust of the University of Cambridge. For JP the acknowledgement is to NSF OCE-0451086

Aging and gastrointestinal neuromuscular function: insights from within and outside the gut

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86869/1/j.1365-2982.2011.01678.x.pd

Interventions to Influence Consulting and Antibiotic Use for Acute Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis

BACKGROUND: Respiratory tract infections (RTIs) are common in children and generally self-limiting, yet often result in consultations to primary care. Frequent consultations divert resources from care for potentially more serious conditions and increase the opportunity for antibiotic overuse. Overuse of antibiotics is associated with adverse effects and antimicrobial resistance, and has been shown to influence how patients seek care in ensuing illness episodes. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a systematic review and meta-analysis to assess the effectiveness of interventions directed towards parents or caregivers which were designed to influence consulting and antibiotic use for respiratory tract infections (RTIs) in children in primary care. Main outcomes were parental consulting rate, parental knowledge, and proportion of children subsequently consuming antibiotics. Of 5,714 references, 23 studies (representing 20 interventions) met inclusion criteria. Materials designed to engage children in addition to parents were effective in modifying parental knowledge and behaviour, resulting in reductions in consulting rates ranging from 13 to 40%. Providing parents with delayed prescriptions significantly decreased reported antibiotic use (Risk Ratio (RR) 0.46 (0.40, 0.54); moreover, a delayed or no prescribing approach did not diminish parental satisfaction. CONCLUSIONS: IN ORDER TO BE MOST EFFECTIVE, INTERVENTIONS TO INFLUENCE PARENTAL CONSULTING AND ANTIBIOTIC USE SHOULD: engage children, occur prior to an illness episode, employ delayed prescribing, and provide guidance on specific symptoms. These results support the wider implementation of interventions to reduce inappropriate antibiotic use in children

Open-ocean convection: observations, theory and models

We review what is known about the convective process in the open ocean, in which the properties of large volumes of water are changed by intermittent, deep-reaching convection, triggered by winter storms. Observational, laboratory, and modeling studies reveal a fascinating and complex interplay of convective and geostrophic scales, the large-scale circulation of the ocean, and the prevailing meteorology. Two aspects make ocean convection interesting from a theoretical point of view. First, the timescales of the convective process in the ocean are sufficiently long that it may be modified by the Earth's rotation; second, the convective process is localized in space so that vertical buoyancy transfer by upright convection can give way to slantwise transfer by baroclinic instability. Moreover, the convective and geostrophic scales are not very disparate from one another. Detailed observations of the process in the Labrador, Greenland, and Mediterranean Seas are described, which were made possible by new observing technology. When interpreted in terms of underlying dynamics and theory and the context provided by laboratory and numerical experiments of rotating convection, great progress in our description and understanding of the processes at work is being made