Importance Of Communication In Medicine: Views On Bedside Rounding And Readmissions

Objectives: To study communication in medicine within the context of readmission rates and patient satisfaction, by assessing 1) the perspectives of primary care physicians (PCPs) and home care nurses (HCNs) on why older adults are readmitted to the hospital within 30 days of discharge, and 2) patient perceptions regarding the implementation and value of bedside rounding. Design: Two studies were performed independently. 1) A qualitative study consisting of PCPs and HCNs of patients readmitted to the hospital within 30 days of discharge home. 2) A concurrent mixed methods study consisting of patients admitted to the inpatient medicine service who participated in bedside rounds. Materials and Methods: 1) Semi-structured open-ended qualitative phone interviews, and 2) qualitative in-person interviews followed by surveys including 5-item Likert scales and open-ended written responses. For qualitative analyses, interviews were repeated until thematic saturation was achieved. Results: 1) While PCPs and nurses both mentioned disease progression and multi-morbidity as contributors to readmissions, nurses further described other psychosocial factors like home environment and patient motivation. PCPs often ascribed responsibility for the readmissions to specialists, hospitalists, and emergency physicians. Nurses expressed frustration about the lack of both communication and working relationships between them and PCPs. 2) Patients described positive attributes of bedside rounds: meeting the medical team and understanding more about their illness. Although patients enjoyed undivided attention from physicians, distractions included too many participants in rounds, confusion about roles, and unclear expectations about the goal of rounds. Physicians sought to use patient-centered language, but 53% of patients stated that medical jargon was still used. Male patients reported a statistically significant improvement in their understanding about the plan for the day and borderline significance regarding knowing who was responsible for their care compared to female patients. Conclusion: Communication between HCNs and PCPs, and between patients and hospital teams can be improved. There should be an explicit agreement on roles, responsibilities, and coordination among all providers caring for a patient. Moreover, well-conducted, patient-centered bedside rounds greatly enhance patient-physician rapport and foster patient understanding and satisfaction

Massive thymic deletion results in systemic autoimmunity through elimination of CD4+ CD25+ T regulatory cells

Incomplete deletion of KRN T cells that recognize the ubiquitously expressed self-antigen glucose-6-phosphate-isomerase (GPI) initiates an anti-GPI autoimmune cascade in K/BxN mice resulting in a humorally mediated arthritis. Transgenic (Tg) expression of a KRN T cell receptor (TCR) agonist under the major histocompatibility complex class II promoter resulted in thymic deletion with loss of anti-GPI T and B cell responses and attenuated arthritis course. However, double Tg mice succumbed to systemic autoimmunity with multiorgan inflammation and autoantibody production. Extensive thymic deletion resulted in lymphopenia and elimination of CD4(+) CD25(+) regulatory T cells (Tregs), but spared some CD4(+) T cells expressing endogenous TCR, which oligoclonally expanded in the periphery. Disease was transferred by these T cells and prevented by cotransfer of CD4(+) CD25(+) Tregs. Moreover, we extended our findings to another TCR system (anti–hen egg lysozyme [HEL] TCR/HEL mice) where similarly extensive thymic deletion also resulted in disease. Thus, our studies demonstrated that central tolerance can paradoxically result in systemic autoimmunity through differential susceptibility of Tregs and autoreactive T cells to thymic deletion. Therefore, too little or too much negative selection to a self-antigen can result in systemic autoimmunity and disease

The Invisible Platform of E-Business: Trust

E-Business is the new business imperative in the age of Internet. With the features of Internet, business can extend their business activities across space and time. Without traditional fact-to-face interaction, most of the e-business activities can be done through networks. Since they do not have to see each other during e-business transaction, the levels of trust between members are pretty low. Mutual trust within a business, between suppliers and retailers, and between sellers and customers is the most important successful factors of e-business. Based on the review of literatures, we proposed that trust is the most important invisible platform for the e-business. In this article, we discuss the relationship between trust and three major components of e-business: (1) the trust for effective knowledge management (KM) within an organization; (2) the trust between organization and customer for effective customer relationship management (CRM); and (3) the trust between organizations for supply chain management (SCM)

Prototype digital weather laboratory at Colorado State University, The

Includes bibliographical references

The Spitzer c2d Survey of Large, Nearby, Interstellar Clouds. VIII. Serpens Observed with MIPS

We present maps of 1.5 deg^2 of the Serpens dark cloud at 24, 70, and 160 μm observed with the Spitzer Space Telescope MIPS camera. We describe the observations and briefly discuss the data processing carried out by the c2d team on these data. More than 2400 compact sources have been extracted at 24 μm, nearly 100 at 70 μm, and four at 160 μm. We estimate completeness limits for our 24 μm survey from Monte Carlo tests with artificial sources inserted into the Spitzer maps. We compare source counts, colors, and magnitudes in the Serpens cloud to two reference data sets: a 0.50 deg^2 set on a low-extinction region near the dark cloud, and a 5.3 deg^2 subset of the SWIRE ELAIS N1 data that was processed through our pipeline. These results show that there is an easily identifiable population of young stellar object candidates in the Serpens cloud that is not present in either of the reference data sets. We also show a comparison of visual extinction and cool dust emission illustrating a close correlation between the two and find that the most embedded YSO candidates are located in the areas of highest visual extinction

Trayectorias laborales de jóvenes trabajadores de la actividad vitivinícola : departamento Maipú, Mendoza

La presente investigación tuvo como eje los vínculos entre educación y trabajo en la vitivinicultura mendocina desde 1990 . El objetivo general fue comprender los procesos de incorporación de jóvenes de ambos sexos al mundo del trabajo y su vínculo con las estrategias de formación y los esquemas de percepción en el mercado vitivinícola mendocino desde los 90. Se analizaron e identificaron los tipos de trayectorias educativas, laborales y transiciones existentes en los jóvenes. También los condicionantes de género que operan desde la perspectiva de las mujeres jóvenes. Se buscó comprender las formas que adquieren, cómo se manifiestan y varían las perspectivas acerca del trabajo, de las exigencias laborales y las condiciones del mercado de trabajo a lo largo de las trayectorias educativas y laborales y cuáles son los principales elementos constitutivos de las trayectorias de inserción, qué factores están asociados a sus variaciones y cómo se vinculan con las expectativas y estrategias de formación de inserción laboral.Fil: Martín, María Eugenia. CONICET (Consejo Nacional de Investigaciones Científicas y Técnicas) - Universidad Nacional de CuyoFil: Zamarbide, Gabriela. Universidad Nacional de Cuy

The Spitzer c2d Survey of Large, Nearby, Interstellar Clouds. VII. Ophiuchus Observed with MIPS

We present maps of 14.4 deg^2 of the Ophiuchus dark clouds observed by the Spitzer Space Telescope Multiband Imaging Photometer for Spitzer (MIPS). These high-quality maps depict both numerous point sources and extended dust emission within the star-forming and non–star-forming portions of these clouds. Using PSF-fitting photometry, we detect 5779 sources at 24 μm and 81 sources at 70 μm at the 10 σ level of significance. Three hundred twenty-three candidate young stellar objects (YSOs) were identified according to their positions on the MIPS/2MASS K versus color-magnitude diagrams, as compared to 24 μm detections in the SWIRE extragalactic survey. We find that more than half of the YSO candidates, and almost all those with protostellar Class I spectral energy distributions, are confined to the known cluster and aggregates