Head-to-head comparison of length of stay, patients' outcome and satisfaction in Switzerland before and after SwissDRG-Implementation in 2012 in 2012: an observational study in two tertiary university centers.

On 1 January 2012 Swiss Diagnosis Related Groups (DRG), a new uniform payment system for in-patients was introduced in Switzerland with the intention to replace a "cost-based" with a "case-based" reimbursement system to increase efficiency. With the introduction of the new payment system we aim to answer questions raised regarding length of stay as well as patients' outcome and satisfaction. This is a prospective, two-centre observational cohort study with data from University Hospital Basel and the Cantonal Hospital Aarau, Switzerland, from January to June 2011 and 2012, respectively. Consecutive in-patients with the main diagnosis of either community-acquired pneumonia, exacerbation of COPD, acute heart failure or hip fracture were included. A questionnaire survey was sent out after discharge investigating changes before and after SwissDRG implementation. Our primary endpoint was LOS. Of 1,983 eligible patients 841 returned the questionnaire and were included into the analysis (429 in 2011, 412 in 2012). The median age was 76.7 years (50.8% male). Patients in the two years were well balanced in regard to main diagnoses and co-morbidities. Mean LOS in the overall patient population was 10.0 days and comparable between the 2011 cohort and the 2012 cohort (9.7 vs 10.3; p = 0.43). Overall satisfaction with care changed only slightly after introduction of SwissDRG and remained high (89.0% vs 87.8%; p = 0.429). Investigating the influence of the implementation of SwissDRG in 2012 regarding LOS patients' outcome and satisfaction, we found no significant changes. However, we observed some noteworthy trends, which should be monitored closely

Next-to-leading-order temperature corrections to correlators in QCD

Corrections of order $T^4$ to vector and axial current correlators in QCD at a finite temperature $T<T_c$ are obtained using dispersion relations for the amplitudes of deep inelastic scattering on pions. Their relation with the operator product expansion is presented. An interpretation of the results in terms of $T$-dependent meson masses is given: masses of $\rho$ and $a_1$ start to move with temperature in order $T^4$.Comment: 13 pages, no figures, CERN-TH.7215/94, BUTP-94/

Temperature Dependence of Electric and Magnetic Gluon Condensates

The contribution of Lorentz non-scalar operators to finite temperature correlation functions is discussed. Using the local duality approach for the one-pion matrix element of a product of two vector currents, the temperature dependence of the average gluonic stress tensor is estimated in the chiral limit to be $\langle{\bf E}^2 +{\bf B}^2\rangle_{T}=\frac{\pi^2}{10}bT^4$. At a normalization point $\mu=0.5$ GeV we obtain $b\approx 1.1$. Together with the known temperature dependence of the Lorentz scalar gluon condensate we are able to infer $\langle{\bf E}^2\rangle_T$ and $\langle{\bf B}^2\rangle_T$ separately in the low-temperature hadronic phase.Comment: 11 pages, TPI-MINN-92/37-

QCD sum rule for nucleon in nuclear matter

We consider the two-point function of nucleon current in nuclear matter and write a QCD sum rule to analyse the residue of the nucleon pole as a function of nuclear density. The nucleon self-energy needed for the sum rule is taken as input from calculations using phenomenological NN potential. Our result shows a decrease in the residue with increasing nuclear density, as is known to be the case with similar quantities

Mitigation of methane and nitrous oxide emissions from animal operations: II. A review of manure management mitigation options

This review analyzes published data on manure management practices used to mitigate methane (CH4) and nitrous oxide (N2O) emissions from animal operations. Reducing excreted nitrogen (N) and degradable organic carbon (C) by diet manipulation to improve the balance of nutrient inputs with production is an effective practice to reduce CH4 and N2O emissions. Most CH4 is produced during manure storage; therefore, reducing storage time, lowering manure temperature by storing it outside during colder seasons, and capturing and combusting the CH4 produced during storage are effective practices to reduce CH4 emission. Anaerobic digestion with combustion of the gas produced is effective in reducing CH4 emission and organic C content of manure; this increases readily available C and N for microbial processes creating little CH4 and increased N2O emissions following land application. Nitrous oxide emission occurs following land application as a byproduct of nitrification and dentrification processes in the soil, but these processes may also occur in compost, biofilter materials, and permeable storage covers. These microbial processes depend on temperature, moisture content, availability of easily degradable organic C, and oxidation status of the environment, which make N2O emissions and mitigation results highly variable. Managing the fate of ammoniacal N is essential to the success of N2O and CH4 mitigation because ammonia is an important component in the cycling of N through manure, soil, crops, and animal feeds. Manure application techniques such as subsurface injection reduce ammonia and CH4 emissions but can result in increased N2O emissions. Injection works well when combined with anaerobic digestion and solids separation by improving infiltration. Additives such as urease and nitrification inhibitors that inhibit microbial processes have mixed results but are generally effective in controlling N2O emission from intensive grazing systems. Matching plant nutrient requirements with manure fertilization, managing grazing intensity, and using cover crops are effective practices to increase plant N uptake and reduce N2O emissions. Due to system interactions, mitigation practices that reduce emissions in one stage of the manure management process may increase emissions elsewhere, so mitigation practices must be evaluated at the whole farm level

Mitigation of methane and nitrous oxide emissions from animal operations: I. A review of enteric methane mitigation options

The goal of this review was to analyze published data related to mitigation of enteric methane (CH4) emissions from ruminant animals to document the most effective and sustainable strategies. Increasing forage digestibility and digestible forage intake was one of the major recommended CH4 mitigation practices. Although responses vary, CH4 emissions can be reduced when corn silage replaces grass silage in the diet. Feeding legume silages could also lower CH4 emissions compared to grass silage due to their lower fiber concentration. Dietary lipids can be effective in reducing CH4 emissions, but their applicability will depend on effects on feed intake, fiber digestibility, production, and milk composition. Inclusion of concentrate feeds in the diet of ruminants will likely decrease CH4 emission intensity (Ei; CH4 per unit animal product), particularly when inclusion is above 40% of dietary dry matter and rumen function is not impaired. Supplementation of diets containing medium to poor quality forages with small amounts of concentrate feed will typically decrease CH4 Ei. Nitrates show promise as CH4 mitigation agents, but more studies are needed to fully understand their impact on whole-farm greenhouse gas emissions, animal productivity, and animal health. Through their effect on feed efficiency and rumen stoichiometry, ionophores are likely to have a moderate CH4 mitigating effect in ruminants fed high-grain or mixed grain–forage diets. Tannins may also reduce CH4 emissions although in some situations intake and milk production may be compromised. Some direct-fed microbials, such as yeast-based products, might have a moderate CH4–mitigating effect through increasing animal productivity and feed efficiency, but the effect is likely to be inconsistent. Vaccines against rumen archaea may offer mitigation opportunities in the future although the extent of CH4 reduction is likely to be small and adaptation by ruminal microbes and persistence of the effect is unknown. Overall, improving forage quality and the overall efficiency of dietary nutrient use is an effective way of decreasing CH4 Ei. Several feed supplements have a potential to reduce CH4 emission from ruminants although their long-term effect has not been well established and some are toxic or may not be economically feasible

Tests of the Equivalence Principle with Neutral Kaons

We test the Principle of Equivalence for particles and antiparticles, using CPLEAR data on tagged K0 and K0bar decays into pi^+ pi^-. For the first time, we search for possible annual, monthly and diurnal modulations of the observables |eta_{+-}| and phi_{+-}, that could be correlated with variations in astrophysical potentials. Within the accuracy of CPLEAR, the measured values of |eta_{+-}| and phi_{+-} are found not to be correlated with changes of the gravitational potential. We analyze data assuming effective scalar, vector and tensor interactions, and we conclude that the Principle of Equivalence between particles and antiparticles holds to a level of 6.5, 4.3 and 1.8 x 10^{-9}, respectively, for scalar, vector and tensor potentials originating from the Sun with a range much greater than the distance Earth-Sun. We also study energy-dependent effects that might arise from vector or tensor interactions. Finally, we compile upper limits on the gravitational coupling difference between K0 and K0bar as a function of the scalar, vector and tensor interaction range.Comment: 15 pages latex 2e, five figures, one style file (cernart.csl) incorporate

Mitigation of methane and nitrous oxide emissions from animal operations: III. A review of animal management mitigation options

The goal of this review was to analyze published data on animal management practices that mitigate enteric methane (CH4) and nitrous oxide (N2O) emissions from animal operations. Increasing animal productivity can be a very effective strategy for reducing greenhouse gas (GHG) emissions per unit of livestock product. Improving the genetic potential of animals through planned cross-breeding or selection within breeds and achieving this genetic potential through proper nutrition and improvements in reproductive efficiency, animal health, and reproductive lifespan are effective approaches for improving animal productivity and reducing GHG emission intensity. In subsistence production systems, reduction of herd size would increase feed availability and productivity of individual animals and the total herd, thus lowering CH4 emission intensity. In these systems, improving the nutritive value of low-quality feeds for ruminant diets can have a considerable benefit on herd productivity while keeping the herd CH4 output constant or even decreasing it. Residual feed intake may be a tool for screening animals that are low CH4 emitters, but there is currently insufficient evidence that low residual feed intake animals have a lower CH4 yield per unit of feed intake or animal product. Reducing age at slaughter of finished cattle and the number of days that animals are on feed in the feedlot can significantly reduce GHG emissions in beef and other meat animal production systems. Improved animal health and reduced mortality and morbidity are expected to increase herd productivity and reduce GHG emission intensity in all livestock production systems. Pursuing a suite of intensive and extensive reproductive management technologies provides a significant opportunity to reduce GHG emissions. Recommended approaches will differ by region and species but should target increasing conception rates in dairy, beef, and buffalo, increasing fecundity in swine and small ruminants, and reducing embryo wastage in all species. Interactions among individual components of livestock production systems are complex but must be considered when recommending GHG mitigation practices

Test of CPT Symmetry and Quantum Mechanics with Experimental data from CPLEAR

We use fits to recent published CPLEAR data on neutral kaon decays to $\pi^+\pi^-$ and $\pi e\nu$ to constrain the CPT--violation parameters appearing in a formulation of the neutral kaon system as an open quantum-mechanical system. The obtained upper limits of the CPT--violation parameters are approaching the range suggested by certain ideas concerning quantum gravity.Comment: 9 pages of uuencoded postscript (includes 3 figures