Cost of inpatient rehabilitation care in the Department of Veterans Affairs

Abstract—We investigated the determinants of inpatient rehabilitation costs in the Department of Veterans Affairs (VA) and examined the relationship between length of stay (LOS) and discharge costs using data from VA and community rehabilitation hospitals. We estimated regression models to identify patient characteristics associated with specialized inpatient rehabilitation costs. VA data included 3,535 patients discharged from 63 facilities in fiscal year 2001. We compared VA costs to community rehabilitation hospitals using a sample from the Uniform Data System for Medical Rehabilitation of 190,112 patients discharged in 1999 from 697 facilities. LOS was a strong predictor of cost for VA and non-VA hospitals. Functional status, measured by Functional Independence Measure (FIM) scores at admission, was statistically significant but added little explanatory value after controlling for LOS. Although FIM scores were associated with LOS, FIM scores accounted for little variance in cost after controlling for LOS. These results are most applicable to researchers conducting cost-effectiveness analyses.average costs, billing, charges, cost, health economics, micro-cost methods, reimbursement, rehabilitation, VA, veterans

Comparative Metabolomics of Early Development of the Parasitic Plants Phelipanche aegyptiaca and Triphysaria versicolor.

Parasitic weeds of the family Orobanchaceae attach to the roots of host plants via haustoria capable of drawing nutrients from host vascular tissue. The connection of the haustorium to the host marks a shift in parasite metabolism from autotrophy to at least partial heterotrophy, depending on the level of parasite dependence. Species within the family Orobanchaceae span the spectrum of host nutrient dependency, yet the diversity of parasitic plant metabolism remains poorly understood, particularly during the key metabolic shift surrounding haustorial attachment. Comparative profiling of major metabolites in the obligate holoparasite Phelipanche aegyptiaca and the facultative hemiparasite Triphysaria versicolor before and after attachment to the hosts revealed several metabolic shifts implicating remodeling of energy and amino acid metabolism. After attachment, both parasites showed metabolite profiles that were different from their respective hosts. In P. aegyptiaca, prominent changes in metabolite profiles were also associated with transitioning between different tissue types before and after attachment, with aspartate levels increasing significantly after the attachment. Based on the results from 15N labeling experiments, asparagine and/or aspartate-rich proteins were enriched in host-derived nitrogen in T. versicolor. These results point to the importance of aspartate and/or asparagine in the early stages of attachment in these plant parasites and provide a rationale for targeting aspartate-family amino acid biosynthesis for disrupting the growth of parasitic weeds

Simultaneous detection of Legionella species and L. anisa, L. bozemanii, L. longbeachae and L. micdadei using conserved primers and multiple probes in a multiplex real-time PCR assay

AbstractLegionnaires' disease is a severe respiratory disease that is estimated to cause between 8,000 and 18,000 hospitalizations each year, though the exact burden is unknown due to under-utilization of diagnostic testing. Although Legionella pneumophila is the most common species detected in clinical cases (80-90%), other species have also been reported to cause disease. However, little is known about Legionnaires' disease caused by these non-pneumophila species. We designed a multiplex real-time PCR assay for detection of all Legionella spp. and simultaneous specific identification of four clinically-relevant Legionella species, L. anisa, L. bozemanii, L. longbeachae, and L. micdadei, using 5′-hydrolysis probe real-time PCR. The analytical sensitivity for detection of nucleic acid from each target species was ≤50fg per reaction. We demonstrated the utility of this assay in spiked human sputum specimens. This assay could serve as a tool for understanding the scope and impact of non-pneumophila Legionella species in human disease

Longitudinal Predictors of Self-Reliance for Coping with Mental Health Problems in the Military

Military personnel encounter occupational hazards that make them vulnerable to developing mental health symptoms; however, many soldiers who experience a problem do not seek treatment. A major barrier to treatment is self-reliance, a preference to manage problems oneself rather than seek help from a professional. In the present study, we sought a more comprehensive understanding of factors that contribute to self-reliance. Active-duty soldiers (N = 485) were surveyed at two time points. The sample was 93% male, 67% Caucasian, and most were aged 20-24 (49%). The survey included: factors that affect treatment-seeking, deployment experiences, and mental health symptoms. Results indicated that stigmatizing beliefs about those who seek treatment and negative beliefs about treatment at Time 1 were related to higher preferences for self-reliance at Time 2, while positive beliefs about treatment at Time 1 were related to lower self-reliance. Combat exposure, mental health symptoms, social support for treatment-seeking, and stigma from others were not significant predictors. These results demonstrate that self-reliance may not be unique to combat soldiers and may not diminish as symptoms become severe. Instead one’s views of treatment and others who seek treatment may be more impactful, and should be the target of interventions to encourage treatment-seeking

Association of Injury History and Incident Injury in Cadet Basic Military Training

To determine the association between injury history at enrollment and incident lower extremity (LE) injury during cadet basic training among first-year military cadets

On the Cosmological Evolution of the Luminosity Function and the Accretion Rate of Quasars

We consider a class of models for the redshift evolution (between 0\lsim z \lsim 4) of the observed optical and X-ray quasar luminosity functions (LFs), with the following assumptions: (i) the mass-function of dark matter halos follows the Press-Schechter theory, (ii) the black hole (BH) mass scales linearly with the halo mass, (iii) quasars have a constant universal lifetime, and (iv) a thin accretion disk provides the optical luminosity of quasars, while the X-ray/optical flux ratio is calibrated from a sample of observed quasars. The mass accretion rate $\dot{M}$ onto quasar BHs is a free parameter of the models, that we constrain using the observed LFs. The accretion rate $\dot M$ inferred from either the optical or X-ray data under these assumptions generally decreases as a function of cosmic time from $z \simeq 4$ to $z \simeq 0$. We find that a comparable accretion rate is inferred from the X-ray and optical LF only if the X-ray/optical flux ratio decreases with BH mass. Near $z\simeq 0$, $\dot M$ drops to substantially sub-Eddington values at which advection-dominated accretion flows (ADAFs) exist. Such a decline of $\dot M$, possibly followed by a transition to radiatively inefficient ADAFs, could explain both the absence of bright quasars in the local universe and the faintness of accreting BHs at the centers of nearby galaxies. We argue that a decline of the accretion rate of the quasar population is indeed expected in cosmological structure formation models.Comment: Latex, 23 pages, 9 figures, accepted for publication in Ap

Chandra Observations of the Dwarf Nova WX Hyi in Quiescence

We report Chandra observations of the dwarf nova WX Hyi in quiescence. The X-ray spectrum displays strong and narrow emission lines of N, O, Mg, Ne, Si, S and Fe. The various ionization states implied by the lines suggest that the emission is produced within a flow spanning a wide temperature range, from T ~ 10^6 K to T >~ 10^8 K. Line diagnostics indicate that most of the radiation originates from a very dense region, with n ~ 10^{13}-10^{14} cm^{-3}. The Chandra data allow the first tests of specific models proposed in the literature for the X-ray emission in quiescent dwarf novae. We have computed the spectra for a set of models ranging from hot boundary layers, to hot settling flows solutions, to X-ray emitting coronae. WX Hyi differs from other dwarf novae observed at minimum in having much stronger low temperature lines, which prove difficult to fit with existing models, and possibly a very strong, broad O VII line, perhaps produced in a wind moving at a few x 10^3 km/s. The accretion rate inferred from the X-rays is lower than the value inferred from the UV. The presence of high-velocity mass ejection could account for this discrepancy while at the same time explaining the presence of the broad O VII line. If this interpretation is correct, it would provide the first detection of a wind from a dwarf nova in quiescence.Comment: accepted to ApJ; 19 pages, 3 figures, 1 tabl

Discovery of a Gas-Rich Companion to the Extremely Metal-Poor Galaxy DDO 68

We present HI spectral-line imaging of the extremely metal-poor galaxy DDO 68. This system has a nebular oxygen abundance of only 3% Z$_{\odot}$, making it one of the most metal-deficient galaxies known in the local volume. Surprisingly, DDO 68 is a relatively massive and luminous galaxy for its metal content, making it a significant outlier in the mass-metallicity and luminosity-metallicity relationships. The origin of such a low oxygen abundance in DDO 68 presents a challenge for models of the chemical evolution of galaxies. One possible solution to this problem is the infall of pristine neutral gas, potentially initiated during a gravitational interaction. Using archival HI spectral-line imaging obtained with the Karl G. Jansky Very Large Array, we have discovered a previously unknown companion of DDO 68. This low-mass (M$_{\rm HI}$ $=$ 2.8$\times$10$^{7}$ M$_{\odot}$), recently star-forming (SFR$_{\rm FUV}$ $=$ 1.4$\times$10$^{-3}$ M$_{\odot}$ yr$^{-1}$, SFR$_{\rm H\alpha}$ $<$ 7$\times$10$^{-5}$ M$_{\odot}$ yr$^{-1}$) companion has the same systemic velocity as DDO 68 (V$_{\rm sys}$ $=$ 506 km s$^{-1}$; D $=$ 12.74$\pm$0.27 Mpc) and is located at a projected distance of 42 kpc. New HI maps obtained with the 100m Robert C. Byrd Green Bank Telescope provide evidence that DDO 68 and this companion are gravitationally interacting at the present time. Low surface brightness HI gas forms a bridge between these objects.Comment: Accepted for publication in the Astrophysical Journal Letter

First-principles study of the phonon-limited mobility in n-type single-layer MoS2

In the present work we calculate the phonon-limited mobility in intrinsic n-type single-layer MoS2 as a function of carrier density and temperature for T > 100 K. Using a first-principles approach for the calculation of the electron-phonon interaction, the deformation potentials and Fr\"ohlich interaction in the isolated MoS2 layer are determined. We find that the calculated room-temperature mobility of ~410 cm^2 V^-1 s^-1 is dominated by optical phonon scattering via deformation potential couplings and the Fr\"ohlich interaction with the deformation potentials to the intravalley homopolar and intervalley longitudinal optical phonons given by 4.1 x 10^8 eV/cm and 2.6 x 10^8 eV/cm, respectively. The mobility is weakly dependent on the carrier density and follows a \mu ~ T^-1 temperature dependence with \gamma = 1.69 at room temperature. It is shown that a quenching of the characteristic homopolar mode which is likely to occur in top-gated samples, boosts the mobility with 70 cm^2 V^-1 s^-1 and can be observed as a decrease in the exponent to \gamma = 1.52. Our findings indicate that the intrinsic phonon-limited mobility is approached in samples where a high-kappa dielectric that effectively screens charge impurities is used as gate oxide.Comment: Submitted to Phys. Rev.