WorldWideScience

Sample records for intraseasonal 30-50 day

  1. 20-50-day oscillation of summer Yangtze rainfall in response to intraseasonal variations in the subtropical high over the western North Pacific and South China Sea

    Energy Technology Data Exchange (ETDEWEB)

    Mao, Jiangyu; Wu, Guoxiong [Institute of Atmospheric Physics, Chinese Academy of Sciences, State Key Laboratory of Numerical Modeling for Atmospheric Sciences and Geophysical Fluid Dynamics (LASG), P.O. Box 9804, Beijing (China); Sun, Zhang [Institute of Atmospheric Physics, Chinese Academy of Sciences, State Key Laboratory of Numerical Modeling for Atmospheric Sciences and Geophysical Fluid Dynamics (LASG), P.O. Box 9804, Beijing (China); Zhejiang Meteorological Observatory, Hangzhou (China)

    2010-04-15

    The spatio-temporal variability in summer rainfall within eastern China is identified based on empirical orthogonal function (EOF) analysis of daily rain-gauge precipitation data for the period 1979-2003. Spatial coherence of rainfall is found in the Yangtze Basin, and a wavelet transform is applied to the corresponding principal component to capture the intraseasonal oscillation (ISO) of Yangtze rainfall. The ensemble mean wavelet spectrum, representing statistically significant intraseasonal variability, shows a predominant oscillation in summer Yangtze rainfall with a period of 20-50 days; a 10-20-day oscillation is pronounced during June and July. This finding suggests that the 20-50-day oscillation is a major agent in regulating summer Yangtze rainfall. Composite analyses reveal that the 20-50-day oscillation of summer Yangtze rainfall arises in response to intraseasonal variations in the western North Pacific subtropical high (WNPSH), which in turn is modulated by a Rossby wave-like coupled circulation-convection system that propagates northward and northwestward from the equatorial western Pacific. When an anomalous cyclone associated with this Rossby wave-like system reaches the South China Sea (SCS) and Philippine Sea, the WNPSH retreats northeastward due to a reduction in local pressure. Under these conditions, strong monsoonal southwesterlies blow mainly toward the SCS-Philippine Sea, while dry conditions form in the Yangtze Basin, with a pronounced divergent flow pattern. In contrast, the movement of an anomalous anticyclone over the SCS-Philippine Sea results in the southwestward extension of the WNPSH; consequently, the tropical monsoonal southwesterlies veer to the northeast over the SCS and then converge toward the Yangtze Basin, producing wet conditions. Therefore, the 20-50-day oscillation of Yangtze rainfall is also manifest as a seesaw pattern in convective anomalies between the Yangtze Basin and the SCS-Philippine Sea. A considerable zonal

  2. Origins and interrelationship of Intraseasonal rainfall variations around the Maritime Continent during boreal winter

    Science.gov (United States)

    Cao, Xi; Wu, Renguang

    2018-04-01

    Large intraseasonal rainfall variations are identified over the southern South China Sea (SSCS), tropical southeastern Indian Ocean (SEIO), and east coast of the Philippines (EPHI) in boreal winter. The present study contrasts origins and propagations and investigates interrelations of intraseasonal rainfall variations on the 10-20- and 30-60-day time scales in these regions. Different origins are identified for intraseasonal rainfall anomalies over the SSCS, SEIO, and EPHI on both time scales. On the 10-20-day time scale, strong northerly or northeasterly wind anomalies related to the East Asian winter monsoon (EAWM) play a major role in intraseasonal rainfall variations over the SSCS and EPHI. On the 30-60-day time scale, both the intraseasonal signal from the tropical Indian Ocean and the EAWM-related wind anomalies contribute to intraseasonal rainfall variations over the SSCS, whereas the EAWM-related wind anomalies have a major contribution to the intraseasonal rainfall variations over the EPHI. No relation is detected between the intraseasonal rainfall variations over the SEIO and the EAWM on both the 10-20-day and 30-60-day time scales. The anomalies associated with intraseasonal rainfall variations over the SSCS and EPHI propagate northwestward and northeastward, respectively, on the 10-20- and 30-60-day time scales. The intraseasonal rainfall anomalies display northwestward and northward propagation over the Bay of Bengal, respectively, on the 10-20- and 30-60-day time scales.

  3. Factors controlling the interannual variation of 30-60-day boreal summer intraseasonal oscillation over the Asian summer monsoon region

    Science.gov (United States)

    Li, Jianying; Mao, Jiangyu

    2018-04-01

    The 30-60-day boreal summer intraseasonal oscillation (BSISO) is a dominant variability of the Asian summer monsoon (ASM), with its intensity being quantified by intraseasonal standard deviations based on OLR data. The spatial and interannual variations of the BSISO intensity are identified via empirical orthogonal function (EOF) analysis for the period 1981-2014. The first EOF mode (EOF1) shows a spatially coherent enhancement or suppression of BSISO activity over the entire ASM region, and the interannual variability of this mode is related to the sea surface temperature anomaly (SSTA) contrast between the central-eastern North Pacific (CNP) and tropical Indian Ocean. In contrast, the second mode (EOF2) exhibits a seesaw pattern between the southeastern equatorial Indian Ocean (EIO) and equatorial western Pacific (EWP), with the interannual fluctuation linked with developing ENSO events. During strong years of EOF1 mode, the enhanced low-level westerlies induced by the summer-mean SSTA contrast between the warmer CNP and cooler tropical Indian Ocean tend to form a wetter moisture background over the eastern EIO, which interacts with intraseasonal low-level convergent flows, leading to stronger equatorial eastward propagation. The intensified easterly shear favors stronger northward propagation over the South Asian and Eastern Asian/Western North Pacific sectors, respectively. Opposite situation is for weak years. For interannual variations of EOF2 mode, the seesaw patterns with enhanced BSISO activity over the southeastern EIO while weakened activity over the EWP mostly occur in the La Niña developing summers, but inverse patterns appear in the El Niño developing summers.

  4. The 30-60-day Intraseasonal Variability of Sea Surface Temperature in the South China Sea dur1ing May-September

    Science.gov (United States)

    Mao, Jiangyu; Wang, Ming

    2018-05-01

    This study investigates the structure and propagation of intraseasonal sea surface temperature (SST) variability in the South China Sea (SCS) on the 30-60-day timescale during boreal summer (May-September). TRMM-based SST, GODAS oceanic reanalysis and ERA-Interim atmospheric reanalysis datasets from 1998 to 2013 are used to examine quantitatively the atmospheric thermodynamic and oceanic dynamic mechanisms responsible for its formation. Power spectra show that the 30-60-day SST variability is predominant, accounting for 60% of the variance of the 10-90-day variability over most of the SCS. Composite analyses demonstrate that the 30-60-day SST variability is characterized by the alternate occurrence of basin-wide positive and negative SST anomalies in the SCS, with positive (negative) SST anomalies accompanied by anomalous northeasterlies (southwesterlies). The transition and expansion of SST anomalies are driven by the monsoonal trough-ridge seesaw pattern that migrates northward from the equator to the northern SCS. Quantitative diagnosis of the composite mixed-layer heat budgets shows that, within a strong 30-60-day cycle, the atmospheric thermal forcing is indeed a dominant factor, with the mixed-layer net heat flux (MNHF) contributing around 60% of the total SST tendency, while vertical entrainment contributes more than 30%. However, the entrainment-induced SST tendency is sometimes as large as the MNHF-induced component, implying that ocean processes are sometimes as important as surface fluxes in generating the 30-60-day SST variability in the SCS.

  5. Relationship of boreal summer 10-20-day and 30-60-day intraseasonal oscillation intensity over the tropical western North Pacific to tropical Indo-Pacific SST

    Science.gov (United States)

    Wu, Renguang; Cao, Xi

    2017-06-01

    The present study contrasts interannual variations in the intensity of boreal summer 10-20-day and 30-60-day intraseasonal oscillations (ISOs) over the tropical western North Pacific and their factors. A pronounced difference is found in the relationship of the two ISOs to El Niño-Southern Oscillation. The 10-20-day ISO intensity is enhanced during El Niño developing summer, whereas the 30-60-day ISO intensity is enhanced during La Niña decaying summer. The above different relationship is interpreted as follows. The equatorial central and eastern Pacific SST anomalies modify vertical wind shear, lower-level moisture, and vertical motion in a southeast-northwest oriented band from the equatorial western Pacific to the tropical western North Pacific where the 10-20-day ISOs originate and propagate. These background field changes modulate the amplitude of 10-20-day ISOs. Preceding equatorial central and eastern Pacific SST anomalies induce SST anomalies in the North Indian Ocean in summer, which in turn modify vertical wind shear and vertical motion over the tropical western North Pacific. The modified background fields influence the amplitude of the 30-60-day ISOs when they reach the tropical western North Pacific from the equatorial region. A feedback of ISO intensity on local SST change is identified in the tropical western North Pacific likely due to a net effect of ISOs on surface heat flux anomalies. This feedback is more prominent from the 10-20-day than the 30-60-day ISO intensity change.

  6. Aspects Of 40- to 50-Day Oscillations In LOD And AAM

    Science.gov (United States)

    Dickey, Jean O.; Marcus, Steven L.; Ghil, Michael

    1992-01-01

    Report presents study of fluctuations in rotation of Earth, focusing on irregular intraseasonal oscillations in length of day (LOD) and atmospheric angular momentum (AAM) with periods varying from 40 to 50 days. Study draws upon and extends results of prior research.

  7. Evaluation of the NCEP CFSv2 45-day Forecasts for Predictability of Intraseasonal Tropical Storm Activities

    Science.gov (United States)

    Schemm, J. E.; Long, L.; Baxter, S.

    2013-12-01

    Evaluation of the NCEP CFSv2 45-day Forecasts for Predictability of Intraseasonal Tropical Storm Activities Jae-Kyung E. Schemm, Lindsey Long and Stephen Baxter Climate Prediction Center, NCEP/NWS/NOAA Predictability of intraseasonal tropical storm (TS) activities is assessed using the 1999-2010 CFSv2 hindcast suite. Weekly TS activities in the CFSv2 45-day forecasts were determined using the TS detection and tracking method devised by Carmago and Zebiak (2002). The forecast periods are divided into weekly intervals for Week 1 through Week 6, and also the 30-day mean. The TS activities in those intervals are compared to the observed activities based on the NHC HURDAT and JTWC Best Track datasets. The CFSv2 45-day hindcast suite is made of forecast runs initialized at 00, 06, 12 and 18Z every day during the 1999 - 2010 period. For predictability evaluation, forecast TS activities are analyzed based on 20-member ensemble forecasts comprised of 45-day runs made during the most recent 5 days prior to the verification period. The forecast TS activities are evaluated in terms of the number of storms, genesis locations and storm tracks during the weekly periods. The CFSv2 forecasts are shown to have a fair level of skill in predicting the number of storms over the Atlantic Basin with the temporal correlation scores ranging from 0.73 for Week 1 forecasts to 0.63 for Week 6, and the average RMS errors ranging from 0.86 to 1.07 during the 1999-2010 hurricane season. Also, the forecast track density distribution and false alarm statistics are compiled using the hindcast analyses. In real-time applications of the intraseasonal TS activity forecasts, the climatological TS forecast statistics will be used to make the model bias corrections in terms of the storm counts, track distribution and removal of false alarms. An operational implementation of the weekly TS activity prediction is planned for early 2014 to provide an objective input for the CPC's Global Tropical Hazards

  8. Intraseasonal relationships between tropical heating and extratropical jets

    OpenAIRE

    Neith, Michael T.

    1992-01-01

    Approved for public release; distribution is unlimited Intraseasonal variations of the northern midlatitude circulation and their relationships with the global tropical heating field are investigated using climate model fields. The greatest intraseasonal variance in the midlatitude flow is found in the vicinity of the time mean jets, and in the areas immediately downstream of these jet exits. The model kinetic energy field associated with these jets shows a clear 30-60 day variation and ...

  9. Intraseasonal oscillations and their predictability in a hemispheric barotropic model with seasonal forcing

    International Nuclear Information System (INIS)

    Strong, C.; Jin, F.; Ghil, M.

    1994-01-01

    Intraseasonal oscillations with a period of 40-50 days were discovered in zonal winds over the tropical Pacific by Madden and Julian in the 1970s. Since that time, considerable modeling and observational literature on intraseasonal tropical variability has emerged. Links have been established between such fluctuations and those in global atmospheric angular momentum (AAM). This study sheds further light on the seasonal dependence of intraseasonal variability. Floquet theory is used to study the stability of the large-scale, midlatitude atmospheric system's periodic basic state

  10. Processes of 30-90 days sea surface temperature variability in the northern Indian Ocean during boreal summer

    Science.gov (United States)

    Vialard, J.; Jayakumar, A.; Gnanaseelan, C.; Lengaigne, M.; Sengupta, D.; Goswami, B. N.

    2012-05-01

    During summer, the northern Indian Ocean exhibits significant atmospheric intraseasonal variability associated with active and break phases of the monsoon in the 30-90 days band. In this paper, we investigate mechanisms of the Sea Surface Temperature (SST) signature of this atmospheric variability, using a combination of observational datasets and Ocean General Circulation Model sensitivity experiments. In addition to the previously-reported intraseasonal SST signature in the Bay of Bengal, observations show clear SST signals in the Arabian Sea related to the active/break cycle of the monsoon. As the atmospheric intraseasonal oscillation moves northward, SST variations appear first at the southern tip of India (day 0), then in the Somali upwelling region (day 10), northern Bay of Bengal (day 19) and finally in the Oman upwelling region (day 23). The Bay of Bengal and Oman signals are most clearly associated with the monsoon active/break index, whereas the relationship with signals near Somali upwelling and the southern tip of India is weaker. In agreement with previous studies, we find that heat flux variations drive most of the intraseasonal SST variability in the Bay of Bengal, both in our model (regression coefficient, 0.9, against ~0.25 for wind stress) and in observations (0.8 regression coefficient); ~60% of the heat flux variation is due do shortwave radiation and ~40% due to latent heat flux. On the other hand, both observations and model results indicate a prominent role of dynamical oceanic processes in the Arabian Sea. Wind-stress variations force about 70-100% of SST intraseasonal variations in the Arabian Sea, through modulation of oceanic processes (entrainment, mixing, Ekman pumping, lateral advection). Our ~100 km resolution model suggests that internal oceanic variability (i.e. eddies) contributes substantially to intraseasonal variability at small-scale in the Somali upwelling region, but does not contribute to large-scale intraseasonal SST

  11. Dynamical linkage of tropical and subtropical weather systems to the intraseasonal oscillations of the Indian summer monsoon rainfall. Part II: Simulations in the ENSEMBLES project

    Energy Technology Data Exchange (ETDEWEB)

    Ma, Shujie [Institut Catala de Ciencies del Clima (IC3), Barcelona, Catalonia (Spain); Rodo, Xavier [Institut Catala de Ciencies del Clima (IC3), Barcelona, Catalonia (Spain); Institut Catala de Recerca i Estudis Avancats (ICREA), Barcelona, Catalonia (Spain); Song, Yongjia [Georgia Institute of Technology, School of Earth and Atmospheric Sciences, Atlanta, GA (United States); Cash, Benjamin A. [Center for Ocean-Land-Atmosphere Studies, Calverton, MD (United States)

    2012-09-15

    We assess the ability of individual models (single-model ensembles) and the multi-model ensemble (MME) in the European Union-funded ENSEMBLES project to simulate the intraseasonal oscillations (ISOs; specifically in 10-20-day and 30-50-day frequency bands) of the Indian summer monsoon rainfall (ISMR) over the Western Ghats (WG) and the Bay of Bengal (BoB), respectively. This assessment is made on the basis of the dynamical linkages identified from the analysis of observations in a companion study to this work. In general, all models show reasonable skill in simulating the active and break cycles of the 30-50-day ISOs over the Indian summer monsoon region. This skill is closely associated with the proper reproduction of both the northward propagation of the intertropical convergence zone (ITCZ) and the variations of monsoon circulation in this band. However, the models do not manage to correctly simulate the eastward propagation of the 30-50-day ISOs in the western/central tropical Pacific and the eastward extension of the ITCZ in a northwest to southeast tilt. This limitation is closely associated with a limited capacity of models to accurately reproduce the magnitudes of intraseasonal anomalies of both the ITCZ in the Asian tropical summer monsoon regions and trade winds in the tropical Pacific. Poor reproduction of the activity of the western Pacific subtropical high on intraseasonal time scales also amplify this limitation. Conversely, the models make good reproduction of the WG 10-20-day ISOs. This success is closely related to good performance of the models in the representation of the northward propagation of the ITCZ, which is partially promoted by local air-sea interactions in the Indian Ocean in this higher-frequency band. Although the feature of westward propagation is generally represented in the simulated BoB 10-20-day ISOs, the air-sea interactions in the Indian Ocean are spuriously active in the models. This leads to active WG rainfall, which is not

  12. The intraseasonal variability of winter semester surface air temperature in Antarctica

    Directory of Open Access Journals (Sweden)

    Lejiang Yu

    2011-02-01

    Full Text Available This study investigates systematically the intraseasonal variability of surface air temperature over Antarctica by applying empirical orthogonal function (EOF analysis to the National Centers for Environmental Prediction, US Department of Energy, Reanalysis 2 data set for the period of 1979 through 2007. The results reveal the existence of two major intraseasonal oscillations of surface temperature with periods of 26–30 days and 14 days during the Antarctic winter season in the region south of 60°S. The first EOF mode shows a nearly uniform spatial pattern in Antarctica and the Southern Ocean associated with the Antarctic Oscillation. The mode-1 intraseasonal variability of the surface temperature leads that of upper atmosphere by one day with the largest correlation at 300-hPa level geopotential heights. The intraseasonal variability of the mode-1 EOF is closely related to the variations of surface net longwave radiation the total cloud cover over Antarctica. The other major EOF modes reveal the existence of eastward propagating phases over the Southern Ocean and marginal region in Antarctica. The leading two propagating modes respond to Pacific–South American modes. Meridional winds induced by the wave train from the tropics have a direct influence on the surface air temperature over the Southern Ocean and the marginal region of the Antarctic continent.

  13. Processes of 30-90 days sea surface temperature variability in the northern Indian Ocean during boreal summer

    Energy Technology Data Exchange (ETDEWEB)

    Vialard, J. [Univerite P. et M. Curie, Laboratoire d' Oceanographie Experimentation et Approches Numeriques (LOCEAN), Case 100, CNRS, IRD, Paris Cedex 05 (France); Jayakumar, A.; Gnanaseelan, C.; Goswami, B.N. [Indian Institute of Tropical Meteorology, Pune (India); Lengaigne, M. [Univerite P. et M. Curie, Laboratoire d' Oceanographie Experimentation et Approches Numeriques (LOCEAN), Case 100, CNRS, IRD, Paris Cedex 05 (France); CSIR, National Institute of Oceanography, Goa (India); Sengupta, D. [Indian Institute of Sciences, Centre of Atmospheric and Oceanic Sciences, Bangalore (India)

    2012-05-15

    During summer, the northern Indian Ocean exhibits significant atmospheric intraseasonal variability associated with active and break phases of the monsoon in the 30-90 days band. In this paper, we investigate mechanisms of the Sea Surface Temperature (SST) signature of this atmospheric variability, using a combination of observational datasets and Ocean General Circulation Model sensitivity experiments. In addition to the previously-reported intraseasonal SST signature in the Bay of Bengal, observations show clear SST signals in the Arabian Sea related to the active/break cycle of the monsoon. As the atmospheric intraseasonal oscillation moves northward, SST variations appear first at the southern tip of India (day 0), then in the Somali upwelling region (day 10), northern Bay of Bengal (day 19) and finally in the Oman upwelling region (day 23). The Bay of Bengal and Oman signals are most clearly associated with the monsoon active/break index, whereas the relationship with signals near Somali upwelling and the southern tip of India is weaker. In agreement with previous studies, we find that heat flux variations drive most of the intraseasonal SST variability in the Bay of Bengal, both in our model (regression coefficient, 0.9, against {proportional_to}0.25 for wind stress) and in observations (0.8 regression coefficient); {proportional_to}60% of the heat flux variation is due do shortwave radiation and {proportional_to}40% due to latent heat flux. On the other hand, both observations and model results indicate a prominent role of dynamical oceanic processes in the Arabian Sea. Wind-stress variations force about 70-100% of SST intraseasonal variations in the Arabian Sea, through modulation of oceanic processes (entrainment, mixing, Ekman pumping, lateral advection). Our {proportional_to}100 km resolution model suggests that internal oceanic variability (i.e. eddies) contributes substantially to intraseasonal variability at small-scale in the Somali upwelling region

  14. Intraseasonal sea surface temperature variability in Indonesian seas

    Science.gov (United States)

    Napitu, A. M.; Gordon, A. L.; Yuan, X.

    2012-12-01

    The satellite-derived sea surface temperature (SST) data, 1998-mid 2012, are used to examine intraseasonal variability (ISV; 20-90 days) across the Indonesian seas. The most energetic ISV is observed in the Banda Sea and across the Indo-Australia basin with an The satellite-derived sea surface temperature (SST) data, 1998-mid 2012, are used to examine intraseasonal variability (ISV; 20-90 days) across the Indonesian seas. The most energetic ISV is observed in the Banda Sea and across the Indo-Australia basin with an average SST standard deviation (STD) between 0.4-0.5°C, with strongest signature during boreal winter. What physical processes force the SST ISV variability within the Indonesian seas? Ocean process, sea-air interaction, or both? To help identify the main forcing, the satellite derived outgoing longwave radiation (OLR) and wind stress data in the region are examined. The OLR shows robust intraseasonal variations and is significantly correlated with the SST, particularly for variability with periods of 30-60 days, with OLR accounting for ~60-70% of the SST variance. The OLR is also maximum during boreal winter. Conversely, the surface wind may play insignificant role in perturbing the SST at intraseasonal timescales as shown by weak correlation between wind stress and SST. We thus suspect that the surface solar flux (suggested by the OLR) is likely more dominant than the surface turbulent heat flux (indicated by the surface wind) as the main source for the ISV in the SST in Indonesian seas. Furthermore the maximum OLR phase, coupled with a period of minimum mixed layer depth, may explain the strong SST variation during boreal winter in Indonesian seas. The influence of the Madden-Julian Oscillation (MJO) on the OLR and SST variability is currently being evaluated.

  15. Intraseasonal patterns in coastal plankton biomass off central Chile derived from satellite observations and a biochemical model

    Science.gov (United States)

    Gomez, Fabian A.; Spitz, Yvette H.; Batchelder, Harold P.; Correa-Ramirez, Marco A.

    2017-10-01

    Subseasonal (5-130 days) environmental variability can strongly affect plankton dynamics, but is often overlooked in marine ecology studies. We documented the main subseasonal patterns of plankton biomass in the coastal upwelling system off central Chile, the southern part of the Humboldt System. Subseasonal variability was extracted from temporal patterns in satellite data of wind stress, sea surface temperature, and chlorophyll from the period 2003-2011, and from a realistically forced eddy-resolving physical-biochemical model from 2003 to 2008. Although most of the wind variability occurs at submonthly frequencies (< 30 days), we found that the dominant subseasonal pattern of phytoplankton biomass is within the intraseasonal band (30-90 days). The strongest intraseasonal coupling between wind and plankton is in spring-summer, when increased solar radiation enhances the phytoplankton response to upwelling. Biochemical model outputs show intraseasonal shifts in plankton community structure, mainly associated with the large fluctuations in diatom biomass. Diatom biomass peaks near surface during strong upwelling, whereas small phytoplankton biomass peaks at subsurface depths during relaxation or downwelling periods. Strong intraseasonally forced changes in biomass and species composition could strongly impact trophodynamics connections in the ecosystem, including the recruitment of commercially important fish species such as common sardine and anchovy. The wind-driven variability of chlorophyll concentration was connected to mid- and high-latitude atmospheric anomalies, which resemble disturbances with frequencies similar to the tropical Madden-Julian Oscillation.

  16. Intraseasonal variability and tides in Makassar Strait

    Science.gov (United States)

    Susanto, R. Dwi; Gordon, Arnold L.; Sprintall, Janet; Herunadi, Bambang

    2000-05-01

    Intraseasonal variability and tides along the Makassar Strait, the major route of Indonesian throughflow, are investigated using spectral and time-frequency analyses which are applied to sea level, wind and mooring data. Semidiurnal and diurnal tides are dominant features, with higher (lower) semidiurnal (diurnal) energy in the north compared to the south. Sea levels and mooring data display intraseasonal variability which are probably a response to remotely forced Kelvin waves from the Indian Ocean through Lombok Strait and to Rossby waves from the Pacific Ocean. Sea levels in Tarakan and Balikpapan and Makassar mooring velocities reveal intraseasonal features with periods of 48-62 days associated with Rossby waves from the Sulawesi Sea. Kelvin wave features with periods of 67-100 days are seen in Bali (Lombok Strait), at the mooring sites and in Balikpapan, however, they are not seen in Tarakan, which implies that these waves diminish after passing through the Makassar Strait.

  17. Representation of monsoon intraseasonal oscillations in regional climate model: sensitivity to convective physics

    KAUST Repository

    Umakanth, U.

    2015-11-07

    The aim of the study is to evaluate the performance of regional climate model (RegCM) version 4.4 over south Asian CORDEX domain to simulate seasonal mean and monsoon intraseasonal oscillations (MISOs) during Indian summer monsoon. Three combinations of Grell (G) and Emanuel (E) cumulus schemes namely, RegCM-EG, RegCM-EE and RegCM-GE have been used. The model is initialized at 1st January, 2000 for a 13-year continuous simulation at a spatial resolution of 50 km. The models reasonably simulate the seasonal mean low level wind pattern though they differ in simulating mean precipitation pattern. All models produce dry bias in precipitation over Indian land region except in RegCM-EG where relatively low value of dry bias is observed. On seasonal scale, the performance of RegCM-EG is more close to observation though it fails at intraseasonal time scales. In wave number-frequency spectrum, the observed peak in zonal wind (850 hPa) at 40–50 day scale is captured by all models with a slight change in amplitude, however, the 40–50 day peak in precipitation is completely absent in RegCM-EG. The space–time characteristics of MISOs are well captured by RegCM-EE over RegCM-GE, however it fails to show the eastward propagation of the convection across the Maritime Continent. Except RegCM-EE all other models completely underestimates the moisture advection from Equatorial Indian Ocean onto Indian land region during life-cycle of MISOs. The characteristics of MISOs are studied for strong (SM) and weak (WM) monsoon years and the differences in model performances are analyzed. The wavelet spectrum of rainfall over central India denotes that, the SM years are dominated by high frequency oscillations (period <20 days) whereas little higher periods (>30 days) along with dominated low periods (<20 days) observed during WM years. During SM, RegCM-EE is dominated with high frequency oscillations (period <20 days) whereas in WM, RegCM-EE is dominated with periods >20 days

  18. Predictability of tropical cyclone events on intraseasonal timescales with the ECMWF monthly forecast model

    Science.gov (United States)

    Elsberry, Russell L.; Jordan, Mary S.; Vitart, Frederic

    2010-05-01

    The objective of this study is to provide evidence of predictability on intraseasonal time scales (10-30 days) for western North Pacific tropical cyclone formation and subsequent tracks using the 51-member ECMWF 32-day forecasts made once a week from 5 June through 25 December 2008. Ensemble storms are defined by grouping ensemble member vortices whose positions are within a specified separation distance that is equal to 180 n mi at the initial forecast time t and increases linearly to 420 n mi at Day 14 and then is constant. The 12-h track segments are calculated with a Weighted-Mean Vector Motion technique in which the weighting factor is inversely proportional to the distance from the endpoint of the previous 12-h motion vector. Seventy-six percent of the ensemble storms had five or fewer member vortices. On average, the ensemble storms begin 2.5 days before the first entry of the Joint Typhoon Warning Center (JTWC) best-track file, tend to translate too slowly in the deep tropics, and persist for longer periods over land. A strict objective matching technique with the JTWC storms is combined with a second subjective procedure that is then applied to identify nearby ensemble storms that would indicate a greater likelihood of a tropical cyclone developing in that region with that track orientation. The ensemble storms identified in the ECMWF 32-day forecasts provided guidance on intraseasonal timescales of the formations and tracks of the three strongest typhoons and two other typhoons, but not for two early season typhoons and the late season Dolphin. Four strong tropical storms were predicted consistently over Week-1 through Week-4, as was one weak tropical storm. Two other weak tropical storms, three tropical cyclones that developed from precursor baroclinic systems, and three other tropical depressions were not predicted on intraseasonal timescales. At least for the strongest tropical cyclones during the peak season, the ECMWF 32-day ensemble provides

  19. Simulation of monsoon intraseasonal variability in NCEP CFSv2 and its role on systematic bias

    Science.gov (United States)

    Goswami, Bidyut B.; Deshpande, Medha; Mukhopadhyay, P.; Saha, Subodh K.; Rao, Suryachandra A.; Murthugudde, Raghu; Goswami, B. N.

    2014-11-01

    We have evaluated the simulation of Indian summer monsoon and its intraseasonal oscillations in the National Centers for Environmental Prediction climate forecast system model version 2 (CFSv2). The dry bias over the Indian landmass in the mean monsoon rainfall is one of the major concerns. In spite of this dry bias, CFSv2 shows a reasonable northward propagation of convection at intraseasonal (30-60 day) time scale. In order to document and understand this dry bias over the Indian landmass in CFSv2 simulations, a two pronged investigation is carried out on the two major facets of Indian summer monsoon: one, the air-sea interactions and two, the large scale vertical heating structure in the model. Our analysis shows a possible bias in the co-evolution of convection and sea surface temperature in CFSv2 over the equatorial Indian Ocean. It is also found that the simulated large scale vertical heat source (Q1) and moisture sink (Q2) over the Indian region are biased relative to observational estimates. Finally, this study provides a possible explanation for the dry precipitation bias over the Indian landmass in the simulated mean monsoon on the basis of the biases associated with the simulated ocean-atmospheric processes and the vertical heating structure. This study also throws some light on the puzzle of CFSv2 exhibiting a reasonable northward propagation at the intraseasonal time scale (30-60 day) despite a drier monsoon over the Indian land mass.

  20. Summer monsoon intraseasonal oscillation over eastern Arabian Sea

    Indian Academy of Sciences (India)

    Significant power is seen in the 8–15-day time scale in TWV during onset and retreat of the summer ... Intraseasonal oscillation; wavelet analysis; Indian summer monsoon. J. Earth .... be caused by synoptic scale systems, in conformity with the ...

  1. Maximum covariance analysis to identify intraseasonal oscillations over tropical Brazil

    Science.gov (United States)

    Barreto, Naurinete J. C.; Mesquita, Michel d. S.; Mendes, David; Spyrides, Maria H. C.; Pedra, George U.; Lucio, Paulo S.

    2017-09-01

    A reliable prognosis of extreme precipitation events in the tropics is arguably challenging to obtain due to the interaction of meteorological systems at various time scales. A pivotal component of the global climate variability is the so-called intraseasonal oscillations, phenomena that occur between 20 and 100 days. The Madden-Julian Oscillation (MJO), which is directly related to the modulation of convective precipitation in the equatorial belt, is considered the primary oscillation in the tropical region. The aim of this study is to diagnose the connection between the MJO signal and the regional intraseasonal rainfall variability over tropical Brazil. This is achieved through the development of an index called Multivariate Intraseasonal Index for Tropical Brazil (MITB). This index is based on Maximum Covariance Analysis (MCA) applied to the filtered daily anomalies of rainfall data over tropical Brazil against a group of covariates consisting of: outgoing longwave radiation and the zonal component u of the wind at 850 and 200 hPa. The first two MCA modes, which were used to create the { MITB}_1 and { MITB}_2 indices, represent 65 and 16 % of the explained variance, respectively. The combined multivariate index was able to satisfactorily represent the pattern of intraseasonal variability over tropical Brazil, showing that there are periods of activation and inhibition of precipitation connected with the pattern of MJO propagation. The MITB index could potentially be used as a diagnostic tool for intraseasonal forecasting.

  2. On the intra-seasonal variability within the extratropics in a general circulation model and observational data

    International Nuclear Information System (INIS)

    May, W.; Bengtsson, L.

    1994-01-01

    There are various phenomena on different spatial and temporal scales contributing to the intra-seasonal variability within the extratropics. One may notice higher-frequency baroclinic disturbances affecting the day-to-day variability of the atmosphere. But one finds also low-frequency fluctuations on a typical time scale of a few weeks. Blocking anticyclones are probably the most prominent example of such features. These fluctuations on different scales, however, are influencing each other, in particular the temporal evolution and spatial distribution. There has been observational work on various phenomena contributing to the intra-seasonal variability for a long time. In the last decade or so, however, with the increasing importance of General Circulation Models there have been some studies dealing with the intra-seasonal variability as simulated by these models

  3. Causes of intraseasonal diabatic heating variability over and near the Tibetan Plateau in boreal summer

    Science.gov (United States)

    Yang, Shuangyan; Li, Tim

    2017-10-01

    The structure and evolution features of the first two leading modes of the intraseasonal diabatic heating variability over the Tibetan Plateau (TP) during northern summer are investigated using reanalysis and observational data. Both of the leading modes present a dominant 10-30-day intraseasonal oscillation (ISO). The first mode is characterized by a perturbation center over the southern TP (STP), which remains quasi-stationary and is closely related to the low-latitude ISO. The associated low-latitude ISO is originated from the tropical western Pacific (WP) and propagates westward/northwestward toward northwestern India along the mean monsoon trough. The westward propagation near the South China Sea is mainly attributed to anomalous meridional vorticity advection and the advection of the planetary vorticity by ISO flow. The stationary feature of the perturbation over the STP is ascribed to the topographical features around the STP. The intraseasonal heating variability over the STP is attributed to the alternation of anticyclonic and cyclonic flow associated with the westward-propagating ISO perturbation originated from the tropical WP. The second leading mode is characterized by an east-west asymmetric structure over the TP. The intraseasonal diabatic heating anomaly propagates clockwise from the northwestern to eastern TP, while a heating anomaly with an opposite sign propagates from the southeastern to western TP. The mid-latitude Rossby wave trains play an essential role in forming the dipole structure. The wave trains propagate southeastward before reaching the TP and then eastward as they cross the TP. The source of anomalous water vapor over the TP is originated from lower latitudes. The upper- and lower-level wave trains are well coupled over the TP, exhibiting a baroclinic structure.

  4. Simulated Interannual Modulation of Intraseasonal Kelvin Waves in the Equatorial Indian Ocean

    Directory of Open Access Journals (Sweden)

    Iskhaq Iskandar

    2016-12-01

    Full Text Available Outputs from a high-resolution ocean general circulation model (OGCM for the period of 1990-2003 indicate an interannual modulation of intraseasonal Kelvin waves along the equatorial Indian Ocean. During normal conditions without IOD event, the first mode explains about 30-40% of the total variance in the western (60-65ºE and central (75-80ºE basin, while the second mode contributes up to 45% to the total variance in the central basin around the longitude of 82ºE. In contrast, during the 1997/98 IOD event, the fourth mode caused about 40% of the total variance in the central and eastern basin. During the 1994 IOD event, the contribution from the fourth baroclinic mode in the eastern basin caused 45% of the total variance. In the central basin, the second and the fourth baroclinic mode caused almost the same variance (~40%. The variations in the characteristics of the intraseasonal Kelvin waves are related to variations in the vertical stratification. During the IOD event, the pycnocline in the eastern basin was raised by about 50 m and the stratification at the upper level is strengthened, while it is weakened at lower levels. These changes lead to an increase in the contribution of higher-order baroclinic modes.

  5. On the intra-seasonal variability within the extratropics in the ECHAM3 general circulation model

    International Nuclear Information System (INIS)

    May, W.

    1994-01-01

    First we consider the GCM's capability to reproduce the midlatitude variability on intra-seasonal time scales by a comparison with observational data (ECMWF analyses). Secondly we assess the possible influence of Sea Surface Temperatures on the intra-seasonal variability by comparing estimates obtained from different simulations performed with ECHAM3 with varying and fixed SST as boundary forcing. The intra-seasonal variability as simulated by ECHAM3 is underestimated over most of the Northern Hemisphere. While the contributions of the high-frequency transient fluctuations are reasonably well captured by the model, ECHAM3 fails to reproduce the observed level of low-frequency intra-seasonal variability. This is mainly due to the underestimation of the variability caused by the ultra-long planetary waves in the Northern Hemisphere midlatitudes by the model. In the Southern Hemisphere midlatitudes, on the other hand, the intra-seasonal variability as simulated by ECHAM3 is generally underestimated in the area north of about 50 southern latitude, but overestimated at higher latitudes. This is the case for the contributions of the high-frequency and the low-frequency transient fluctuations as well. Further, the model indicates a strong tendency for zonal symmetry, in particular with respect to the high-frequency transient fluctuations. While the two sets of simulations with varying and fixed Sea Surface Temepratures as boundary forcing reveal only small regional differences in the Southern Hemisphere, there is a strong response to be found in the Northern Hemisphere. The contributions of the high-frequency transient fluctuations to the intra-seasonal variability are generally stronger in the simulations with fixed SST. Further, the Pacific storm track is shifted slightly poleward in this set of simulations. For the low-frequency intra-seasonal variability the model gives a strong, but regional response to the interannual variations of the SST. (orig.)

  6. Seasonal and Intraseasonal Variability of Mesoscale Convective Systems over the South Asian Monsoon Region

    Energy Technology Data Exchange (ETDEWEB)

    Virts, Katrina S.; Houze, Robert A.

    2016-12-01

    Seasonal and intraseasonal differences in mesoscale convective systems (MCSs) over South Asia are examined using A-Train satellites, a ground-based lightning network, and reanalysis fields. Pre-monsoon (April-May) MCSs occur primarily over Bangladesh and the eastern Bay of Bengal. During the monsoon (June-September), small MCSs occur over the Meghalaya Plateau and northeast Himalayan notch, while large and connected MCSs are most widespread over the Bay of Bengal. Monsoon MCSs produce less lightning and exhibit more extensive stratiform and anvil reflectivity structures in CloudSat observations than do pre-monsoon MCSs. During the monsoon season, Bay of Bengal and Meghalaya Plateau MCSs vary with the 30-60 day northward-propagating intraseasonal oscillation, while northeast Himalayan notch MCSs are associated with weak large-scale anomalies but locally enhanced CAPE. During intraseasonal active periods, a zone of enhanced large and connected MCSs, precipitation, and lightning extends from the northeastern Arabian Sea southeast over India and the Bay of Bengal, flanked by suppressed anomalies. Spatial variability is observed within this enhancement zone: lightning is most enhanced where MCSs are less enhanced, and vice versa. Reanalysis composites indicate that Bay of Bengal MCSs are associated with monsoon depressions, which are frequent during active monsoon periods, while Meghalaya Plateau MCSs are most frequent at the end of break periods, as anomalous southwesterly winds strengthen moist advection toward the terrain. Over both regions, MCSs exhibit more extensive stratiform and anvil regions and less lightning when the large-scale environment is moister, and vice versa.

  7. Tropical intraseasonal rainfall variability in the CFSR

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Jiande [I.M. System Group Inc. at NOAA/NCEP/EMC, Camp Springs, MD (United States); Wang, Wanqiu [NOAA/NCEP/CPC, Camp Springs, MD (United States); Fu, Xiouhua [University of Hawaii at Manoa, IPRC, SOEST, Honolulu, HI (United States); Seo, Kyong-Hwan [Pusan National University, Department of Atmospheric Sciences, Busan (Korea, Republic of)

    2012-06-15

    While large-scale circulation fields from atmospheric reanalyses have been widely used to study the tropical intraseasonal variability, rainfall variations from the reanalyses are less focused. Because of the sparseness of in situ observations available in the tropics and strong coupling between convection and large-scale circulation, the accuracy of tropical rainfall from the reanalyses not only measures the quality of reanalysis rainfall but is also to some extent indicative of the accuracy of the circulations fields. This study analyzes tropical intraseasonal rainfall variability in the recently completed NCEP Climate Forecast System Reanalysis (CFSR) and its comparison with the widely used NCEP/NCAR reanalysis (R1) and NCEP/DOE reanalysis (R2). The R1 produces too weak rainfall variability while the R2 generates too strong westward propagation. Compared with the R1 and R2, the CFSR produces greatly improved tropical intraseasonal rainfall variability with the dominance of eastward propagation and more realistic amplitude. An analysis of the relationship between rainfall and large-scale fields using composites based on Madden-Julian Oscillation (MJO) events shows that, in all three NCEP reanalyses, the moisture convergence leading the rainfall maximum is near the surface in the western Pacific but is above 925 hPa in the eastern Indian Ocean. However, the CFSR produces the strongest large-scale convergence and the rainfall from CFSR lags the column integrated precipitable water by 1 or 2 days while R1 and R2 rainfall tends to lead the respective precipitable water. Diabatic heating related to the MJO variability in the CFSR is analyzed and compared with that derived from large-scale fields. It is found that the amplitude of CFSR-produced total heating anomalies is smaller than that of the derived. Rainfall variability from the other two recently produced reanalyses, the ECMWF Re-Analysis Interim (ERAI), and the Modern Era Retrospective-analysis for Research and

  8. A case study of the intraseasonal oscillation traversing the TOGA-COARE LSD. [large-scale domain

    Science.gov (United States)

    Vincent, Dayton G.; Schrage, Jon M.; Sliwinski, L. D.

    1993-01-01

    The paper presents examination of tree intraseasonal (30-60 day) oscillations (ISOs) that occurred during the southern summer season (December 1, 1985 - February 28, 1986) traversing the Large-Scale Domain (LSD) TOGA-COARE, the region which also plays an important role in ENSO, Australian monsoon, and extratropical circulations. Data presented include Hovmoeller diagrams of 5-day running means of 250-mb velocity potential anomalies and OLR anomalies; graphs of five-day running means of OLR in precipitable water (W) per sq m, averaged over 10 x 10 deg boxes centered on 5 S and (1) 145 E, (2) 155 E, (3) 165 E, and (4) 165 D, indicating the midpoint of each ISO; and vertical profiles of zonal wind in m/s averaged over the time period that each ISO spends in the 10 x 10 deg box centered at 5 S, and 175 E and 145 E.

  9. Intraseasonal meridional current variability in the eastern equatorial Indian Ocean

    Digital Repository Service at National Institute of Oceanography (India)

    Ogata, T.; Sasaki, H.; Murty, V.S.N.; Sarma, M.S.S.; Masumoto, Y.

    . [2007] demonstrate the possibility of the air-sea interac- tion in the eastern Indian Ocean at the intraseasonal time- scale by analyzing observed and simulated data. Recent studies also reveal that multiscale air-sea interactions be- tween intraseasonal...

  10. Intraseasonal variability in the far-east pacific: investigation of the role of air-sea coupling in a regional coupled model

    Energy Technology Data Exchange (ETDEWEB)

    Small, R.J. [Naval Research Laboratory, Jacobs Technology, Stennis Space Center, MS (United States); University of Hawaii, International Pacific Research Center, POST 401, Honolulu, HI (United States); Xie, Shang-Ping [University of Hawaii, International Pacific Research Center, POST 401, Honolulu, HI (United States); University of Hawaii, Department of Meteorology, School of Ocean and Earth Science and Technology, Honolulu, HI (United States); Maloney, Eric D. [Colorado State University, Department of Atmospheric Science, Fort Collins, CO (United States); Szoeke, Simon P. de [Oregon State University, College of Oceanic and Atmospheric Sciences, Corvallis, OR (United States); Miyama, Toru [Frontier Research for Global Change, Yokohama (Japan)

    2011-03-15

    Intraseasonal variability in the eastern Pacific warm pool in summer is studied, using a regional ocean-atmosphere model, a linear baroclinic model (LBM), and satellite observations. The atmospheric component of the model is forced by lateral boundary conditions from reanalysis data. The aim is to quantify the importance to atmospheric deep convection of local air-sea coupling. In particular, the effect of sea surface temperature (SST) anomalies on surface heat fluxes is examined. Intraseasonal (20-90 day) east Pacific warm-pool zonal wind and outgoing longwave radiation (OLR) variability in the regional coupled model are correlated at 0.8 and 0.6 with observations, respectively, significant at the 99% confidence level. The strength of the intraseasonal variability in the coupled model, as measured by the variance of outgoing longwave radiation, is close in magnitude to that observed, but with a maximum located about 10 further west. East Pacific warm pool intraseasonal convection and winds agree in phase with those from observations, suggesting that remote forcing at the boundaries associated with the Madden-Julian oscillation determines the phase of intraseasonal convection in the east Pacific warm pool. When the ocean model component is replaced by weekly reanalysis SST in an atmosphere-only experiment, there is a slight improvement in the location of the highest OLR variance. Further sensitivity experiments with the regional atmosphere-only model in which intraseasonal SST variability is removed indicate that convective variability has only a weak dependence on the SST variability, but a stronger dependence on the climatological mean SST distribution. A scaling analysis confirms that wind speed anomalies give a much larger contribution to the intraseasonal evaporation signal than SST anomalies, in both model and observations. A LBM is used to show that local feedbacks would serve to amplify intraseasonal convection and the large-scale circulation. Further

  11. Intraseasonal Variability of the Indian Monsoon as Simulated by a Global Model

    Science.gov (United States)

    Joshi, Sneh; Kar, S. C.

    2018-01-01

    This study uses the global forecast system (GFS) model at T126 horizontal resolution to carry out seasonal simulations with prescribed sea-surface temperatures. Main objectives of the study are to evaluate the simulated Indian monsoon variability in intraseasonal timescales. The GFS model has been integrated for 29 monsoon seasons with 15 member ensembles forced with observed sea-surface temperatures (SSTs) and additional 16-member ensemble runs have been carried out using climatological SSTs. Northward propagation of intraseasonal rainfall anomalies over the Indian region from the model simulations has been examined. It is found that the model is unable to simulate the observed moisture pattern when the active zone of convection is over central India. However, the model simulates the observed pattern of specific humidity during the life cycle of northward propagation on day - 10 and day + 10 of maximum convection over central India. The space-time spectral analysis of the simulated equatorial waves shows that the ensemble members have varying amount of power in each band of wavenumbers and frequencies. However, variations among ensemble members are more in the antisymmetric component of westward moving waves and maximum difference in power is seen in the 8-20 day mode among ensemble members.

  12. A simple model of intraseasonal oscillations

    Science.gov (United States)

    Fuchs, Željka; Raymond, David J.

    2017-06-01

    The intraseasonal oscillations and in particular the MJO have been and still remain a "holy grail" of today's atmospheric science research. Why does the MJO propagate eastward? What makes it unstable? What is the scaling for the MJO, i.e., why does it prefer long wavelengths or planetary wave numbers 1-3? What is the westward moving component of the intraseasonal oscillation? Though linear WISHE has long been discounted as a plausible model for intraseasonal oscillations and the MJO, the version we have developed explains many of the observed features of those phenomena, in particular, the preference for large zonal scale. In this model version, the moisture budget and the increase of precipitation with tropospheric humidity lead to a "moisture mode." The destabilization of the large-scale moisture mode occurs via WISHE only and there is no need to postulate large-scale radiatively induced instability or negative effective gross moist stability. Our WISHE-moisture theory leads to a large-scale unstable eastward propagating mode in n = -1 case and a large-scale unstable westward propagating mode in n = 1 case. We suggest that the n = -1 case might be connected to the MJO and the observed westward moving disturbance to the observed equatorial Rossby mode.

  13. Intraseasonal variability of mixed layer depth in the tropical Indian Ocean

    Digital Repository Service at National Institute of Oceanography (India)

    Keerthi, M.G.; Lengaigne, M.; Drushka, K.; Vialard, J.; de Boyer, M.C.; Pous, S.; Levy, M.; Muraleedharan, P.M.

    that generally agrees well with those observed estimates is then used to investigate the mechanisms that drive MLD intraseasonal variations and to assess their potential impact on the related SST response. During summer, intraseasonal MLD variations in the Bay...

  14. Intraseasonal variations of the Yangtze rainfall and its related atmospheric circulation features during the 1991 summer

    Energy Technology Data Exchange (ETDEWEB)

    Mao, Jiangyu; Wu, Guoxiong [Chinese Academy of Sciences, State Key Laboratory of Numerical Modeling for Atmospheric Sciences and Geophysical Fluid Dynamics (LASG), Beijing (China); Institute of Atmospheric Physics, Beijing (China)

    2006-12-15

    The intraseasonal variations of the Yangtze rainfall over eastern China and its related atmospheric circulation characteristics during the 1991 summer are examined based on the gauge-observed rainfall and the NCEP/NCAR reanalysis data. Wavelet analysis shows that during the 1991 summer, the active and break sequences of rainfall over the middle and lower Yangtze Basin are mainly regulated by an oscillatory mode with a period of 15-35 days. An investigation of the circulation features suggests that the 15-35-day oscillation is associated with an anomalous low-level cyclone (anticyclone) appearing alternatively over the northern South China Sea (SCS) and the Philippine Sea, and related to a northeastward (southwestward) shift of the western Pacific subtropical anticyclone over the SCS, leading to a lower tropospheric divergence (convergence) over the Yangtze Basin. In the upper troposphere, the 15-35-day oscillation exhibits a dipole anomaly characterized by an anomalous cyclone (anticyclone) over eastern China and an anomalous anticyclone (cyclone) over the northern Tibetan Plateau, resulting in a southwestward shrinking (northeastward extending) of the South Asian anticyclone, and forming a convergence (divergence) over eastern China. Such a coupled anomalous flow pattern between the lower and upper troposphere favors large-scale descending (ascending) motion, and hence reduced (enhanced) rainfall over the Yangtze Basin. Dynamically, the intraseasonal variations in the Yangtze rainfall are mainly determined by the coupling between the low-level relative vorticity and the upper-level divergence. In the middle troposphere, the 15-35-day oscillation of the subtropical high is originated over the central North Pacific north of Hawaii, then propagates westward to the SCS-Philippine Sea, and finally modulates the intraseasonal variations of the Yangtze rainfall. (orig.)

  15. Diagnosing GCM errors over West Africa using relaxation experiments. Part II: intraseasonal variability and African easterly waves

    Science.gov (United States)

    Pohl, Benjamin; Douville, Hervé

    2011-10-01

    A near-global grid-point nudging of the Arpege-Climat atmospheric General Circulation Model towards ECMWF reanalyses is used to diagnose the regional versus remote origin of the summer model biases and variability over West Africa. First part of this study revealed a limited impact on the monsoon climatology compared to a control experiment without nudging, but a significant improvement of interannual variability, although the amplitude of the seasonal anomalies remained underestimated. Focus is given here on intraseasonal variability of monsoon rainfall and dynamics. The reproducible part of these signals is investigated through 30-member ensemble experiments computed for the 1994 rainy season, a year abnormally wet over the Sahel but representative of the model systematic biases. In the control experiment, Arpege-Climat simulates too few rainy days that are associated with too low rainfall amounts over the central and western Sahel, in line with the seasonal dry biases. Nudging the model outside Africa tends to slightly increase the number of rainy days over the Sahel, but has little effect on associated rainfall amounts. However, results do indicate that a significant part of the monsoon intraseasonal variability simulated by Arpege-Climat is controlled by lateral boundary conditions. Parts of the wet/dry spells over the Sahel occur in phase in the 30 members of the nudging experiment, and are therefore embedded in larger-scale variability patterns. Inter-member spread is however not constant across the selected summer season. It is partly controlled by African Easterly Waves, which show dissimilar amplitude from one member to another, but a coherent phasing in all members. A lowpass filtering of the nudging fields suggests that low frequency variations in the lateral boundary conditions can lead to eastward extensions of the African Easterly Jet, creating a favorable environment for easterly waves, while high frequency perturbations seem to control their

  16. Diagnosing GCM errors over West Africa using relaxation experiments. Part II: intraseasonal variability and African easterly waves

    Energy Technology Data Exchange (ETDEWEB)

    Pohl, Benjamin [CNRM-GAME, Meteo-France, CNRS, Toulouse (France); Centre de Recherches de Climatologie, CNRS, Universite de Bourgogne, Dijon (France); Douville, Herve [CNRM-GAME, Meteo-France, CNRS, Toulouse (France)

    2011-10-15

    A near-global grid-point nudging of the Arpege-Climat atmospheric General Circulation Model towards ECMWF reanalyses is used to diagnose the regional versus remote origin of the summer model biases and variability over West Africa. First part of this study revealed a limited impact on the monsoon climatology compared to a control experiment without nudging, but a significant improvement of interannual variability, although the amplitude of the seasonal anomalies remained underestimated. Focus is given here on intraseasonal variability of monsoon rainfall and dynamics. The reproducible part of these signals is investigated through 30-member ensemble experiments computed for the 1994 rainy season, a year abnormally wet over the Sahel but representative of the model systematic biases. In the control experiment, Arpege-Climat simulates too few rainy days that are associated with too low rainfall amounts over the central and western Sahel, in line with the seasonal dry biases. Nudging the model outside Africa tends to slightly increase the number of rainy days over the Sahel, but has little effect on associated rainfall amounts. However, results do indicate that a significant part of the monsoon intraseasonal variability simulated by Arpege-Climat is controlled by lateral boundary conditions. Parts of the wet/dry spells over the Sahel occur in phase in the 30 members of the nudging experiment, and are therefore embedded in larger-scale variability patterns. Inter-member spread is however not constant across the selected summer season. It is partly controlled by African Easterly Waves, which show dissimilar amplitude from one member to another, but a coherent phasing in all members. A lowpass filtering of the nudging fields suggests that low frequency variations in the lateral boundary conditions can lead to eastward extensions of the African Easterly Jet, creating a favorable environment for easterly waves, while high frequency perturbations seem to control their

  17. Complete and Voluntary Starvation of 50 Days

    Directory of Open Access Journals (Sweden)

    Bradley Elliott

    2016-09-01

    Full Text Available A 34-year-old obese male (96.8 kg; BMI, 30.2 kg m −1 volitionally undertook a 50-day fast with the stated goal of losing body mass. During this time, only tea, coffee, water, and a daily multivitamin were consumed. Severe and linear loss of body mass is recorded during these 50 days (final 75.4 kg; BMI, 23.5 kg mT 1 . A surprising resilience to effects of fasting on activity levels and physical function is noted. Plasma samples are suggestive of early impairment of liver function, and perturbations to cardiovascular dynamics are also noted. One month following resumption of feeding behavior, body weight was maintained (75.0 kg; BMI, 23.4 kg m −1 . Evidence-based decision-making with the fasting or hunger striking patient is limited by a lack of evidence. This case report suggests that total body mass, not mass lost, may be a key observation in clinical decision-making during fasting and starvation.

  18. The role of potential vorticity anomalies in the Somali Jet on Indian Summer Monsoon Intraseasonal Variability

    Science.gov (United States)

    Rai, P.; Joshi, M.; Dimri, A. P.; Turner, A. G.

    2018-06-01

    The climate of the Indian subcontinent is dominated by rainfall arising from the Indian summer monsoon (ISM) during June to September. Intraseasonal variability during the monsoon is characterized by periods of heavy rainfall interspersed by drier periods, known as active and break events respectively. Understanding and predicting such events is of vital importance for forecasting human impacts such as water resources. The Somali Jet is a key regional feature of the monsoon circulation. In the present study, we find that the spatial structure of Somali Jet potential vorticity (PV) anomalies varies considerably during active and break periods. Analysis of these anomalies shows a mechanism whereby sea surface temperature (SST) anomalies propagate north/northwestwards through the Arabian Sea, caused by a positive feedback loop joining anomalies in SST, convection, modification of PV by diabatic heating and mixing in the atmospheric boundary layer, wind-stress curl, and ocean upwelling processes. The feedback mechanism is consistent with observed variability in the coupled ocean-atmosphere system on timescales of approximately 20 days. This research suggests that better understanding and prediction of monsoon intraseasonal variability in the South Asian monsoon may be gained by analysis of the day-to-day dynamical evolution of PV in the Somali Jet.

  19. The role of potential vorticity anomalies in the Somali Jet on Indian Summer Monsoon Intraseasonal Variability

    Science.gov (United States)

    Rai, P.; Joshi, M.; Dimri, A. P.; Turner, A. G.

    2017-08-01

    The climate of the Indian subcontinent is dominated by rainfall arising from the Indian summer monsoon (ISM) during June to September. Intraseasonal variability during the monsoon is characterized by periods of heavy rainfall interspersed by drier periods, known as active and break events respectively. Understanding and predicting such events is of vital importance for forecasting human impacts such as water resources. The Somali Jet is a key regional feature of the monsoon circulation. In the present study, we find that the spatial structure of Somali Jet potential vorticity (PV) anomalies varies considerably during active and break periods. Analysis of these anomalies shows a mechanism whereby sea surface temperature (SST) anomalies propagate north/northwestwards through the Arabian Sea, caused by a positive feedback loop joining anomalies in SST, convection, modification of PV by diabatic heating and mixing in the atmospheric boundary layer, wind-stress curl, and ocean upwelling processes. The feedback mechanism is consistent with observed variability in the coupled ocean-atmosphere system on timescales of approximately 20 days. This research suggests that better understanding and prediction of monsoon intraseasonal variability in the South Asian monsoon may be gained by analysis of the day-to-day dynamical evolution of PV in the Somali Jet.

  20. Role of North Indian Ocean Air-Sea Interaction in Summer Monsoon Intraseasonal Oscillation

    Science.gov (United States)

    Zhang, L.; Han, W.; Li, Y.

    2017-12-01

    Air-sea coupling processes over the North Indian Ocean associated with Indian summer monsoon intraseasonal oscillation (MISO) are analyzed. Observations show that MISO convection anomalies affect underlying sea surface temperature (SST) through changes in surface shortwave radiation (via cloud cover change) and surface latent heat flux (associated with surface wind speed change). In turn, SST anomalies determine the changing rate of MISO precipitation (dP/dt): warm (cold) SST anomalies cause increasing (decreasing) precipitation rate through increasing (decreasing) surface convergence. Air-sea interaction gives rise to a quadrature relationship between MISO precipitation and SST anomalies. A local air-sea coupling model (LACM) is established based on these observed physical processes, which is a damped oscillatory system with no external forcing. The period of LACM is proportional to the square root of mean state mixed layer depth , assuming other physical parameters remain unchanged. Hence, LACM predicts a relatively short (long) MISO period over the North Indian Ocean during the May-June monsoon developing (July-August mature) phase when is shallow (deep). This result is consistent with observed MISO statistics. An oscillatory external forcing of a typical 30-day period is added to LACM, representing intraseasonal oscillations originated from the equatorial Indian Ocean and propagate into the North Indian Ocean. The period of LACM is then determined by both the inherent period associated with local air-sea coupling and the period of external forcing. It is found that resonance occurs when , amplifying the MISO in situ. This result explains the larger MISO amplitude during the monsoon developing phase compared to the mature phase, which is associated with seasonal cycle of . LACM, however, fails to predict the observed small MISO amplitude during the September-October monsoon decaying phase, when is also shallow. This deficiency might be associated with the

  1. Review of Tropical-Extratropical Teleconnections on Intraseasonal Time Scales

    Science.gov (United States)

    Stan, Cristiana; Straus, David M.; Frederiksen, Jorgen S.; Lin, Hai; Maloney, Eric D.; Schumacher, Courtney

    2017-12-01

    The interactions and teleconnections between the tropical and midlatitude regions on intraseasonal time scales are an important modulator of tropical and extratropical circulation anomalies and their associated weather patterns. These interactions arise due to the impact of the tropics on the extratropics, the impact of the midlatitudes on the tropics, and two-way interactions between the regions. Observational evidence, as well as theoretical studies with models of complexity ranging from the linear barotropic framework to intricate Earth system models, suggest the involvement of a myriad of processes and mechanisms in generating and maintaining these interconnections. At this stage, our understanding of these teleconnections is primarily a collection of concepts; a comprehensive theoretical framework has yet to be established. These intraseasonal teleconnections are increasingly recognized as an untapped source of potential subseasonal predictability. However, the complexity and diversity of mechanisms associated with these teleconnections, along with the lack of a conceptual framework to relate them, prevent this potential predictability from being translated into realized forecast skill. This review synthesizes our progress in understanding the observed characteristics of intraseasonal tropical-extratropical interactions and their associated mechanisms, identifies the significant gaps in this understanding, and recommends new research endeavors to address the remaining challenges.

  2. Intraseasonal SST-precipitation coupling during the Indian Summer Monsoon, and its modulation by the Indian Ocean Dipole

    Science.gov (United States)

    Jongaramrungruang, S.; Seo, H.; Ummenhofer, C.

    2016-02-01

    The Indian Summer Monsoon (ISM) plays a crucial role in shaping the large proportion of the total precipitation over the Indian subcontinent each year. The ISM rainfall exhibits a particularly strong intraseasonal variability, that has profound socioeconomic consequences, such as agricultural planning and flood preparation. However, our understanding of the variability on this time scale is still limited due to sparse data availability in the past. In this study, we used a combination of state-of-the-art high-resolution satellite estimate of rainfall, objectively analyzed surface flux, as well as atmospheric reanalysis product to investigate the nature of the ISM intraseasonal rainfall variability and how it varies year to year. The emphasis is placed on the Bay of Bengal (BoB) where the intraseasonal ocean-atmosphere coupling is most prominent. Results show that the maximum warming of SST leads the onset of heavy precipitation event by 3-5 days, and that surface heat flux and surface wind speed are weak prior to the rain but amplifies and peaks after the rain reaches its maximum. Furthermore, the Indian Ocean Dipole (IOD) significantly affects the observed intraseasonal SST-precipitation relationship. The pre-convection SST warming is stronger and more pronounced during the negative phase of the IOD, while the signal is weaker and less organized in the positive phase. This is explained by the column-integrated moisture budget analysis which reveals that, during the ISM heavy rainfall in the BoB, there is more moisture interchange in the form of enhanced vertical advection from the ocean to atmosphere in negative IOD years as compared to positive IOD years. Knowing the distinction of ISM variabilities during opposite phases of the IOD will help contribute to a more reliable prediction of ISM activities.

  3. 31 CFR 50.30 - General participation requirements.

    Science.gov (United States)

    2010-07-01

    .... 50.30 Section 50.30 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM State Residual Market Insurance Entities; Workers' Compensation Funds § 50.30 General participation requirements. (a) Insurers. As defined in § 50.5(f), all State residual market...

  4. Anomalous intraseasonal events in the thermocline ridge region of Southern Tropical Indian Ocean and their regional impacts

    Science.gov (United States)

    Jayakumar, A.; Gnanaseelan, C.

    2012-03-01

    The present study explores the mechanisms responsible for the strong intraseasonal cooling events in the Thermocline Ridge region of the southwestern Indian Ocean. Air sea interface and oceanic processes associated with Madden Julian Oscillation are studied using an Ocean General Circulation Model and satellite observations. Sensitivity experiments are designed to understand the ocean response to intraseasonal forcing with a special emphasis on 2002 cooling events, which recorded the strongest intraseasonal perturbations during the last well-observed decade. This event is characterized by anomalous Walker circulation over the tropical Indian Ocean and persistent intraseasonal heat flux anomaly for a longer duration than is typical for similar events (but without any favorable preconditioning of ocean basic state at the interannual timescale). The model heat budget analysis during 1996 to 2007 revealed an in-phase relationship between atmospheric fluxes associated with Madden Julian Oscillation and the subsurface oceanic processes during the intense cooling events of 2002. The strong convection, reduced shortwave radiation and increased evaporation have contributed to the upper ocean heat loss in addition to the slower propagation of active phase of convection, which supported the integration of longer duration of forcing. The sensitivity experiments revealed that dynamic response of ocean through entrainment at the intraseasonal timescale primarily controls the biological response during the event, with oceanic interannual variability playing a secondary role. This study further speculates the role of oceanic intraseasonal variability in the 2002 droughts over Indian subcontinent.

  5. Use of risk-adjusted CUSUM charts to monitor 30-day mortality in Danish hospitals

    Directory of Open Access Journals (Sweden)

    Rasmussen TB

    2018-04-01

    Full Text Available Thomas Bøjer Rasmussen, Sinna Pilgaard Ulrichsen, Mette Nørgaard Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark Background: Monitoring hospital outcomes and clinical processes as a measure of clinical performance is an integral part of modern health care. The risk-adjusted cumulative sum (CUSUM chart is a frequently used sequential analysis technique that can be implemented to monitor a wide range of different types of outcomes.Objective: The aim of this study was to describe how risk-adjusted CUSUM charts based on population-based nationwide medical registers were used to monitor 30-day mortality in Danish hospitals and to give an example on how alarms of increased hospital mortality from the charts can guide further in-depth analyses.Materials and methods: We used routinely collected administrative data from the Danish National Patient Registry and the Danish Civil Registration System to create risk-adjusted CUSUM charts. We monitored 30-day mortality after hospital admission with one of 77 selected diagnoses in 24 hospital units in Denmark in 2015. The charts were set to detect a 50% increase in 30-day mortality, and control limits were determined by simulations.Results: Among 1,085,576 hospital admissions, 441,352 admissions had one of the 77 selected diagnoses as their primary diagnosis and were included in the risk-adjusted CUSUM charts. The charts yielded a total of eight alarms of increased mortality. The median of the hospitals’ estimated average time to detect a 50% increase in 30-day mortality was 50 days (interquartile interval, 43;54. In the selected example of an alarm, descriptive analyses indicated performance problems with 30-day mortality following hip fracture surgery and diagnosis of chronic obstructive pulmonary disease.Conclusion: The presented implementation of risk-adjusted CUSUM charts can detect significant increases in 30-day mortality within 2 months, on average, in most

  6. 30-Day, 90-day and 1-year mortality after emergency colonic surgery

    DEFF Research Database (Denmark)

    Pedersen, T; Watt, S K; Tolstrup, M-B

    2017-01-01

    PURPOSE: Emergency surgery is an independent risk factor in colonic surgery resulting in high 30-day mortality. The primary aim of this study was to report 30-day, 90-day and 1-year mortality rates after emergency colonic surgery, and to report factors associated with 30-day, 90-day and 1-year...... mortality. Second, the aim was to report 30-day postoperative complications and their relation to in-hospital mortality. METHODS: All patients undergoing acute colonic surgery in the period from May 2009 to April 2013 at Copenhagen University Hospital Herlev, Denmark, were identified. Perioperative data...... postoperative deaths. CONCLUSION: Mortality and complication rates after emergency colonic surgery are high and associated with patient related risk factors that cannot be modified, but also treatment related outcomes that are modifiable. An increased focus on medical and other preventive measures should...

  7. Processes of India's offshore summer intraseasonal sea surface temperature variability

    Digital Repository Service at National Institute of Oceanography (India)

    Kurian, N.; Lengaigne, M.; Gopalakrishna, V.V.; Vialard, J.; Pous, S.; Peter, A-C.; Durand, F.; Naik, Shweta

    study, we use an eddy-permitting 0.25 degrees regional ocean model to investigate mechanisms of this offshore intraseasonal SST variability. Modelled climatological mixed layer and upper thermocline depth are in very good agreement with estimates from...

  8. EARLY PREDICTORS OF 30-DAY MORTALITY INNON-ST-ELEVATION ACUTE CORONARY SYNDROME PATIENTS

    Directory of Open Access Journals (Sweden)

    Suzana Rožič

    2008-09-01

    30-day mortality was 4.3 %. Between nonsurvivors and survivors there were significantdifferences in mean age, the incidence of arterial hypertension, positive family history ofcoronary artery disease, in mean admission systolic and diastolic blood pressure, pulse,mean admission troponin T, leukocyte count, CRP, creatinine and the incidence of admission heart failure. Multivariate logistic regression proved that most significant independent early predictor of 30-day mortality was admission heart failure (OR 41.21, 95 %CI 3.50 to 484.66, p = 0.003, followed by admission serum creatinine (OR 0.989, 95 %CI 0.981 to 0.997, p = 0.008 and troponin T (OR 0.263, 95 % CI 0.080 to 0.861.Conclusion Most significant independent predictor of 30-day mortality of patients with non-ST-elevation ACS, being 4.5 %, was heart failure on admission

  9. The role of low-frequency intraseasonal oscillations in the ...

    Indian Academy of Sciences (India)

    We analyze the dynamical features and responsible factors of the low-frequency intraseasonal time scales which influenced the nature of onset, intensity and duration of active/break phases and withdrawal of the monsoon during the anomalous Indian summer monsoon of 2002 – the most severe drought recorded in recent ...

  10. Intraseasonal variability of upper-ocean currents and photosynthetic primary production along the U.S. west coast associated with the Madden-Julian Oscillation

    Science.gov (United States)

    Barrett, B.; Davies, A. R.; Steppe, C. N.; Hackbarth, C.

    2017-12-01

    In the first part of this study, time-lagged composites of upper-ocean currents from February to May of 1993-2016 were binned by active phase of the leading atmospheric mode of intraseasonal variability, the Madden-Julian Oscillation (MJO). Seven days after the convectively active phase of the MJO enters the tropical Indian Ocean, anomalously strong south-southeastward upper-ocean currents are observed along the majority of U.S. west coast. Seven days after the convectively active phase enters the tropical western Pacific Ocean, upper-ocean current anomalies reverse along the U.S. west coast, with weaker southward flow. A physical pathway to the ocean was found for both of these: (a) tropical MJO convection modulates upper-tropospheric heights and circulation over the Pacific Ocean; (b) those anomalous atmospheric heights adjust the strength and position of the Aleutian Low and Hawaiian High; (c) surface winds change in response to the adjusted atmospheric pressure patterns; and (d) those surface winds project onto upper-ocean currents. In the second part of this study, we investigated if the MJO modulated intraseasonal variability of surface wind forcing and upper-ocean currents projected onto phytoplankton abundance along the U.S. west coast. Following a similar methodology, time-lagged, level 3 chlorophyll-a satellite products (a proxy for photosynthetic primary production) were binned by active MJO phase and analyzed for statistical significance using the Student's t test. Results suggest that intraseasonal variability of biological production along the U.S. west coast may be linked to the MJO, particularly since the time scale of the life cycle of phytoplankton is similar to the time scale of the MJO.

  11. 46 CFR 56.50-30 - Boiler feed piping.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false Boiler feed piping. 56.50-30 Section 56.50-30 Shipping... APPURTENANCES Design Requirements Pertaining to Specific Systems § 56.50-30 Boiler feed piping. (a) General... least two separate means of supplying feed water for the boilers. All feed pumps shall be fitted with...

  12. 50 CFR 32.30 - Hawaii.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Hawaii. 32.30 Section 32.30 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL... Hawaii. The following refuge units have been opened for hunting and/or fishing, and are listed in...

  13. Tropical intraseasonal oscillation simulated in an AMIP-type experiment by NICAM

    Science.gov (United States)

    Kikuchi, Kazuyoshi; Kodama, Chihiro; Nasuno, Tomoe; Nakano, Masuo; Miura, Hiroaki; Satoh, Masaki; Noda, Akira T.; Yamada, Yohei

    2017-04-01

    It is the first time for the non-hydrostatic icosahedral atmospheric model (NICAM), at a horizontal mesh size of approximately 14-km, to conduct a continuous long-term Atmospheric Model Intercomparison Project-type simulation. This study examines the performance of NICAM in simulating the tropical intraseasonal oscillation (ISO) from a statistical point of view using 30-year data (1979-2008) in the context of the bimodal ISO representation concept proposed by Kikuchi et al., which allows us to examine the seasonally varying behavior of the ISO in great detail, in addition to the MJO working group level 2 diagnostics. It is found that many of the fundamental features of the ISO are well captured by NICAM. The evolution of the ISO convection as well as large-scale circulation over the course of its life cycle is reasonably well reproduced throughout the year. As in the observation, the Madden-Julian oscillation (MJO) mode, characterized by prominent eastward propagation of convection, is predominant during boreal winter, whereas the boreal summer ISO (BSISO) mode, by a combination of pronounced eastward and northward propagation, during summer. The overall shape of the seasonal cycle as measured by the numbers of significant MJO and BSISO days in a month is relatively well captured. Two major biases, however, are also identified. The amplitude of the simulated ISO is weaker by a factor of 2. Significant BSISO events sometimes appear even during winter (December-April), amounting to 30 % of the total significant ISO days as opposed to 2 % in the observation. The results here warrant further studies using the simulation dataset to understand not only many aspects of the dynamics and physics of the ISO but also its role in weather and climate. It is also demonstrated that the concept of the bimodal ISO representation provides a useful framework for assessing model's capability to simulate, and illuminating model's deficiencies in reproducing, the ISO. The nature and

  14. The correlation between albumin levels with 30 days mortality in community acquired pneumonia patients

    Science.gov (United States)

    Damayanti, N.; Abidin, A.; Keliat, E. N.

    2018-03-01

    The assessment of level severity ofCommunity-Acquired Pneumonia (CAP) patient at the early admission to the hospital is critical because it will determine the severity of the disease and the subsequent management of the plan. Albumin can be used as a biomarker to assess the severity of CAP. To identify the correlation between albumin level at early admission in hospital with 30-day mortality in patients with CAP. It was a cohort study. We had examined of 50 CAP subject with theCURB-65 score (Confusion, Urea, Respiratory rate, Blood pressure, Age >65years), albumin, sputum culture at the early admission at Emergency Room (ER). Then, albumin levels associated with 30-day mortality was assessed using Chi-Square test. Analysis with chi-square test found a significant correlation between albumin level with 30-day mortality (p=0.001) and Relative Risk was 2.376 (95% CI 1.515-3.723). It means that patients with CAP who has severe hypoalbuminemia have a higher risk ofdying in 30 days with 2,376 times more significant than patients with mild to moderate hypoalbuminemia. In conclusion, albumin levels at early admission in the hospital correlate with 30-day mortality in CAP patients.

  15. Police Incident Blotter (30 Day)

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The 30 Day Police Blotter contains the most recent initial crime incident data, updated on a nightly basis. All data is reported at the block/intersection level,...

  16. Combined use of the National Early Warning Score and D-dimer levels to predict 30-day and 365-day mortality in medical patients

    DEFF Research Database (Denmark)

    Nickel, Christian H; Kellett, John; Cooksley, Tim

    2016-01-01

    AIM: To investigate the combined use of NEWS and D-dimer levels to predict the 30-day and 365-day mortality rates of a cohort of Danish patients with complete follow-up. METHODS: Post-hoc retrospective observational study of acutely admitted medical patients aged 18 years or older who had D...... with a NEWS on admission levels below 0.50mgL(-1) appears to identify patients of low risk...

  17. Spatiotemporal change of intraseasonal oscillation intensity over the tropical Indo-Pacific Ocean associated with El Niño and La Niña events

    Science.gov (United States)

    Wu, Renguang; Song, Lei

    2018-02-01

    The present study analyzes the intraseasonal oscillation (ISO) intensity change over the tropical Indo-Pacific associated with the El Niño-Southern Oscillation (ENSO) and compares the intensity change between El Niño and La Niña years and between the 10-20-day and 30-60-day ISOs. The ISO intensity change tends to be opposite between El Niño and La Niña years in the developing and mature phases. The intensity change features a contrast between the tropical southeastern Indian Ocean and the tropical western North Pacific (WNP) in the developing phases and between the Maritime Continent and the tropical central Pacific in the mature phase. In the decaying phases, the intensity change shows notable differences between El Niño and La Niña events and between fast and slow decaying El Niño events. Large intensity change is observed over the tropical WNP in the developing summer, over the tropical southeastern Indian Ocean in the developing fall, and over the tropical WNP in the fast decaying El Niño summer due to a combined effect of vertical shear, vertical motion, and lower-level moisture. In the ENSO developing summer and in the El Niño decaying summer, the 10-20-day ISO intensity change displays a northwest-southeast tilted distribution over the tropical WNP, whereas the large 30-60-day ISO intensity change is confined to the off-equatorial WNP. In the La Niña decaying summer, the 30-60-day ISO intensity change features a large zonal contrast across the Philippines, whereas the 10-20-day ISO intensity anomaly is characterized by a north-south contrast over the tropical WNP.

  18. Can intraseasonal to decadal forecasts benefit from from consideration of lunar forcing?

    CSIR Research Space (South Africa)

    Malherbe, J

    2014-10-01

    Full Text Available A possible forcing mechanism for intra-seasonal rainfall distribution to bi-decadal climate variability is explored. The atmospheric response to external forcing is demonstrated at a daily and annual time scale by noting variation in the Southern...

  19. Deep currents in the Gulf of Guinea: along slope propagation of intraseasonal waves

    Directory of Open Access Journals (Sweden)

    C. Guiavarc'h

    2009-05-01

    Full Text Available In the Gulf of Guinea, intraseasonal variability is large at the equator and along the coast. Current data on the continental slope near 7.5° S show very energetic biweekly oscillations at 1300 m depth. A high resolution primitive equation numerical model demonstrates that this deep variability is forced by equatorial winds, through the generation of equatorial Yanai waves that propagate eastward and at depth, and then poleward as coastally-trapped waves upon reaching the coast of Africa. Intraseasonal variability is intensified along the coast of the Gulf of Guinea, especially in the 10–20 day period range and at depths between 500 and 1500 m. The kinetic energy distribution is well explained at first order by linear theory. Along the equator, eastward intensification of energy and bottom intensification are in qualitative agreement with vertically propagating Yanai waves, although the signal is influenced by the details of the bathymetry. Along the coast, baroclinic modes 3 to 5 are important close to the equator, and the signal is dominated by lower vertical modes farther south. Additional current meter data on the continental slope near 3° N display an energy profile in the 10–20 day period band that is strikingly different from the one at 7.5° S, with surface intensification rather than bottom intensification and a secondary maximum near 800 m. The model reproduces these features and explains them: the surface intensification in the north is due to the regional wind forcing, and the north-south asymmetry of the deep signal is due to the presence of the zonal African coast near 5° N. A 4 years time series of current measurements at 7.5° S shows that the biweekly oscillations are intermittent and vary from year to year. This intermittency is not well correlated with fluctuations of the equatorial winds and does not seem to be a simple linear response to the wind forcing.

  20. Processes of 30–90 days sea surface temperature variability in the northern Indian Ocean during boreal summer

    Digital Repository Service at National Institute of Oceanography (India)

    Vialard, J.; Jayakumar, A; Gnanaseelan, C.; Lengaigne, M.; Sengupta, D.; Goswami, B.N.

    Temperature (SST) signature of this atmospheric variability, using a combination of observational datasets and Ocean General Circulation Model sensitivity experiments. In addition to the previously reported intraseasonal SST signature in the Bay of Bengal...

  1. Intraseasonal and Interannual Variability of the Quasi-Two Day Wave in the Northern Hemisphere Summer Mesosphere

    Science.gov (United States)

    McCormack, J. P.; Coy, L.; Singer, W.

    2013-01-01

    This study uses global synoptic meteorological fields from a high-altitude data assimilation system to investigate the spatial and temporal characteristics of the quasi-2 day wave (Q2DW) and migrating diurnal tide during the Northern Hemisphere summers of 2007, 2008, and 2009. By applying a 2-dimensional fast Fourier transform to meridional wind and temperature fields, we are able to identify Q2DW source regions and to diagnose propagation of Q2DW activity into the upper mesosphere and lower thermosphere. We find that Q2DW is comprised primarily of westward propagating zonal wavenumber 3 and wavenumber 4 components that originate from within baroclinically unstable regions along the equatorward flank of the summer midlatitude easterly jet. Amplitude variations of wavenumbers 3 and 4 tend to be anti-correlated throughout the summer, with wavenumber 3 maximizing in July and wavenumber 4 maximizing in late June and early August. Monthly mean Q2DW amplitudes between 30 50N latitude are largest when diurnal tidal amplitudes are smallest and vice versa. However, there is no evidence of any rapid amplification of the Q2DW via nonlinear interaction with the diurnal tide. Instead, variations of Q2DW amplitudes during July are closely linked to variations in the strength and location of the easterly jet core from one summer to the next, with a stronger jet producing larger Q2DW amplitudes. Linear instability model calculations based on the assimilated wind fields find fast growing zonal wavenumber 3 and 4 modes with periods near 2 days in the vicinity of the easterly jet.

  2. 50 CFR 30.1 - Surplus range animals.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Surplus range animals. 30.1 Section 30.1... NATIONAL WILDLIFE REFUGE SYSTEM RANGE AND FERAL ANIMAL MANAGEMENT Range Animals § 30.1 Surplus range animals. Range animals on fenced wildlife refuge areas, including buffalo and longhorn cattle, determined...

  3. The LDsub(50/30) and the survival time in whole-body gamma-irradiated conventional and germfree Minnesota miniature piglets

    International Nuclear Information System (INIS)

    Mandel, L.; Travnicek, J.; Talafantova, M.; Zahradnickova, M.

    1980-01-01

    The median lethal exposure causing the death in 30 days after single whole-body gamma-irradiation (the LD 50/30) was found to be 2731 MBq (73.8 mC/kg) for conventional piglets, but 3226 MBq (87.2 mC/kg) for germ-free piglets both irradiated 14 days after birth. After lethal exposures, the survival time in germ-free piglets was prolonged for 7 days in comparison with conventional piglets. (author)

  4. 30 CFR 256.50 - Dating of leases.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Dating of leases. 256.50 Section 256.50 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE LEASING OF SULPHUR OR OIL AND GAS IN THE OUTER CONTINENTAL SHELF Issuance of Leases § 256.50 Dating of leases. All leases issued under...

  5. Synoptic climatological analyses on the seasonal transition from winter to spring in Europe also with attention to the day-to-day variability (Comparing with that in East Asia)

    Science.gov (United States)

    Kato, Kuranoshin; Hamaki, Tatsuya; Haga, Yuichi; Otani, Kazuo; Kato, Haruko

    2016-04-01

    was found, although the extremely large day-to-day variation of SLP was found from the earlier season (October to March). It is interesting that the region where such large day-to-day amplitudes of TS and SLP were observed corresponded to the southeastern periphery zone of the Icelandic Low in the seasonal mean field. Besides, sub-monthly or about 30-day-period intraseasonal variation of the eastward intrusion of the Icelandic Low near the northwestern Europe was also clearly found in winter, as well as the short-period variation of the synoptic-scale disturbances to the southeast of the intraseasonal-scale Icelandic Low. In the seasonal mean field, relatively strong warm air advection in the lower layer was found to the southeast of the Icelandic Low due to combination of the strong westerly wind there and the cold air in the further eastern region. Such warm advection can be intermittently enhanced especially when the Icelandic Low intruded more closely to the northwestern Europe. These situations seem to result in the large day-to-day variation of TS around Germany and its northern region until the seasonal weakening of the Icelandic Low from March to April.

  6. Intra-Seasonal Monthly Oscillations in Stratospheric NCEP Data and Model Results

    Science.gov (United States)

    Mayr, H. G.; Mengel, J. G.; Huang, F. T.; Nash, E. R.

    2009-01-01

    Intra-seasonal oscillations (ISO) are observed in the zonal-mean of mesospheric wind and temperature measurements-and the numerical spectral model (NSM) generates such oscillations. Relatively large temperature ISO are evident also in stratospheric CPC (NCEP) data at high latitudes, where the NSM produces amplitudes around 3 K at 30 km. Analyzing the NCEP data for the years 1996-2006, we find in Fourier spectra signatures of oscillations with periods between 1.7 and 3 months. With statistical confidence levels exceeding 70%, the spectral features are induced by nonlinear interactions involving the annual and semi-annual variations. The synthesized data show for the 10-year average that the temperature ISO peak in winter, having amplitudes close to 4 K. The synthesized complete spectrum for periods around 2 months produces oscillations, varying from year to year, which can reach peak amplitudes of 15 and 5 K respectively at northern and southern polar latitudes.

  7. Evaluation of acute tacrine treatment on passive-avoidance response, open-field behavior, and toxicity in 17- and 30-day-old mice.

    Science.gov (United States)

    Pan, S Y; Han, Y F; Yu, Z L; Yang, R; Dong, H; Ko, K M

    2006-09-01

    The potential of tacrine in altering cognitive/behavioral function as well as in causing toxicity was evaluated in mice of 17 and 30 days of age. Cognitive and behavioral studies were performed using a step-through passive avoidance task and a habituation open-field test with a 24-h retention interval. Tacrine was subcutaneously injected (1.25-80 micro mol/kg) 30 min prior to the first session of both tests. During the training session in step-through task, tacrine treatment dose-dependently decreased the number of footshocks, with IC(50) values being 7.8 and 23.3 micro mol/kg in 17- and 30-day-old mice, respectively. Treatment with tacrine at a low dose (5 micro mol/kg) significantly prolonged the retention latency in 17-day-old mice only, but it shortened the retention latency at high doses of 20 and 40 micro mol/kg in 17- and 30-day-old, respectively. During the acquisition session in the open-field test, tacrine treatment dose-dependently decreased the locomotor activity in 17- and 30-day-old mice, with IC(50) values being 15.1 and 24.7 micro mol/kg, respectively. High doses of tacrine invariably increased the locomotor activity during the recall session. Tacrine treatment at a dose of 40 micro mol/kg caused a significant increase in serum alanine aminotransferase activity in 17- and 30-day-old mice at 6 h post-dosing, with the extent of stimulation in 30-day-old mice being more prominent. In conclusion, tacrine was more potent in enhancing/disrupting the cognitive function, inhibiting locomotor activity as well as in causing hepatotoxicity in 17-day-old than in 30-day-old mice.

  8. Incidence and cost analysis of hospital admission and 30day readmission among patients with cirrhosis

    Science.gov (United States)

    Chirapongsathorn, Sakkarin; Krittanawong, Chayakrit; Enders, Felicity T.; Pendegraft, Richard; Mara, Kristin C.; Borah, Bijan J.; Visscher, Sue L.; Loftus, Conor G.; Shah, Vijay H.; Talwalkar, Jayant A.

    2018-01-01

    We examined risks for first hospitalization and the rate, risk factors, costs, and 1‐year outcome of 30day readmission among patients admitted for complications of cirrhosis. Data were retrospectively analyzed for adult patients with cirrhosis residing in Minnesota, Iowa, or Wisconsin and admitted from 2010 through 2013 at both campuses of the Mayo Clinic Hospital in Rochester, MN. Readmission was captured at the two hospitals as well as at community hospitals in the tristate area within the Mayo Clinic Health System. The incidence of hospitalization for complications of cirrhosis was 100/100,000 population, with increasing age and male sex being the strongest risks for hospitalization. For the 2,048 hospitalized study patients, the overall 30day readmission rate was 32%; 498 (24.3%) patients were readmitted to Mayo Clinic hospitals and 157 (7.7%) to community hospitals, mainly for complications of portal hypertension (52%) and infections (30%). Readmission could not be predicted accurately. There were 146 deaths during readmission and an additional 105 deaths up to 1 year of follow‐up (50.4% total mortality). Annual postindex hospitalization costs for those with a 30day readmission were substantially higher ($73,252) than those readmitted beyond 30 days ($62,053) or those not readmitted ($5,719). At 1‐year follow‐up, only 20.4% of patients readmitted within 30 days were at home. In conclusion, patients with cirrhosis have high rates of hospitalization, especially among men over 65 years, and of unscheduled 30day readmission. Readmission cannot be accurately predicted. Postindex hospitalization costs are high; nationally, the annual costs are estimated to be more than $4.45 billion. Only 20% of patients readmitted within 30 days are home at 1 year. (Hepatology Communications 2018;2:188–198) PMID:29404526

  9. High dosages of sermion (30-60 mg per day) neuropsychiatric efficacy for encephalopathy monotherapy in irradiated patients

    International Nuclear Information System (INIS)

    Nyagu, A.I.; Loganovskij, K.N.; Yur'ev, K.L.; Petrova, I.V.; Bomko, M.A.

    1999-01-01

    Open randomised with parallel groups clinical trial was carried out for an assessment of neuropsychiatric efficacy of monotherapy by high dosages of Sermion (30-60 mg per day) in 57 liquidators at the age of 33-65 years irradiated by 50-900 mGy with organic mental disorders (encephalopathy) occurred following cleaning up works in the Chernobyl exclusion zone in 1986-1987. According to the obtained results Sermion 30-60 mg per day may be recommended for the treatment of patients with organic mental disorders (encephalopathy) exposed to ionising radiation

  10. Predicting 7-day, 30-day and 60-day all-cause unplanned readmission: a case study of a Sydney hospital.

    Science.gov (United States)

    Maali, Yashar; Perez-Concha, Oscar; Coiera, Enrico; Roffe, David; Day, Richard O; Gallego, Blanca

    2018-01-04

    The identification of patients at high risk of unplanned readmission is an important component of discharge planning strategies aimed at preventing unwanted returns to hospital. The aim of this study was to investigate the factors associated with unplanned readmission in a Sydney hospital. We developed and compared validated readmission risk scores using routinely collected hospital data to predict 7-day, 30-day and 60-day all-cause unplanned readmission. A combination of gradient boosted tree algorithms for variable selection and logistic regression models was used to build and validate readmission risk scores using medical records from 62,235 live discharges from a metropolitan hospital in Sydney, Australia. The scores had good calibration and fair discriminative performance with c-statistic of 0.71 for 7-day and for 30-day readmission, and 0.74 for 60-day. Previous history of healthcare utilization, urgency of the index admission, old age, comorbidities related to cancer, psychosis, and drug-abuse, abnormal pathology results at discharge, and being unmarried and a public patient were found to be important predictors in all models. Unplanned readmissions beyond 7 days were more strongly associated with longer hospital stays and older patients with higher number of comorbidities and higher use of acute care in the past year. This study demonstrates similar predictors and performance to previous risk scores of 30-day unplanned readmission. Shorter-term readmissions may have different causal pathways than 30-day readmission, and may, therefore, require different screening tools and interventions. This study also re-iterates the need to include more informative data elements to ensure the appropriateness of these risk scores in clinical practice.

  11. Role of wind forcing and eddy activity in the intraseasonal variability of the barrier layer in the South China Sea

    Science.gov (United States)

    Liang, Zhanlin; Xie, Qiang; Zeng, Lili; Wang, Dongxiao

    2018-03-01

    In addition to widely discussed seasonal variability, the barrier layer (BL) of the South China Sea (SCS) also exhibits significant intraseasonal variability (ISV) and plays an important role in the upper heat and salt balances. The characteristics and mechanisms of spatiotemporal variations in the BL are investigated using an eddy-resolving ocean model OFES (OGCM For the Earth Simulator) ouput and related atmospheric and oceanic processes. The active intraseasonal BL variability in the SCS occurs mainly during the late summer/autumn and winter and exhibits remarkable differences between these two periods. The BL ISV in late summer/autumn occurs in the southern basin, while in winter, it is limited to the northwestern basin. To further discuss the evolution and driving thermodynamic mechanisms, we quantify the processes that control the variability of intraseasonal BL. Different mechanisms for the intraseasonal BL variability for these two active periods are investigated based on the case study and composite analysis. During late summer/autumn, the active BL in the southern basin is generated by advected and local freshwater, and then decays rapidly with the enhanced wind. In winter, anticyclonic eddy activity is associated with the evolution of the BL by affecting the thermocline and halocline variations, while wind stress and wind stress curl have no obvious influence on BL.

  12. Parents or predators: Examining intraseasonal variation in nest survival for migratory passerine

    Science.gov (United States)

    Robin Hirsch-Jacobson; W. Andrew Cox; Emily E. Tewes; Frank R., III Thompson; John. Faaborg

    2012-01-01

    For birds, risk of nest predation can vary within a breeding season, but few data exist that explain why such variation occurs. We investigated intraseasonal variation of nest survival of the Acadian Flycatcher (Empidonax virescens) in Midwestern forests and tested whether four of the adults' reproductive strategies (clutch size, nest...

  13. Construction of tissue-engineered small-diameter vascular grafts in fibrin scaffolds in 30 days.

    Science.gov (United States)

    Gui, Liqiong; Boyle, Michael J; Kamin, Yishai M; Huang, Angela H; Starcher, Barry C; Miller, Cheryl A; Vishnevetsky, Michael J; Niklason, Laura E

    2014-05-01

    Tissue-engineered small-diameter vascular grafts have been developed as a promising alternative to native veins or arteries for replacement therapy. However, there is still a crucial need to improve the current approaches to render the tissue-engineered blood vessels more favorable for clinical applications. A completely biological blood vessel (3-mm inner diameter) was constructed by culturing a 50:50 mixture of bovine smooth muscle cells (SMCs) with neonatal human dermal fibroblasts in fibrin gels. After 30 days of culture under pulsatile stretching, the engineered blood vessels demonstrated an average burst pressure of 913.3±150.1 mmHg (n=6), a suture retention (53.3±15.4 g) that is suitable for implantation, and a compliance (3.1%±2.5% per 100 mmHg) that is comparable to native vessels. These engineered grafts contained circumferentially aligned collagen fibers, microfibrils and elastic fibers, and differentiated SMCs, mimicking a native artery. These promising mechanical and biochemical properties were achieved in a very short culture time of 30 days, suggesting the potential of co-culturing SMCs with fibroblasts in fibrin gels to generate functional small-diameter vascular grafts for vascular reconstruction surgery.

  14. Modulation of the intraseasonal Indo-western Pacific convection oscillation to tropical cyclogenesis location and frequency over the Indo-western North Pacific during boreal extended summer

    Science.gov (United States)

    Wang, Qiuyun; Li, Jianping; Li, Yanjie; Zhang, Jingwen

    2017-04-01

    The influence of the intraseasonal Indo-western Pacific convection oscillation (IPCO) on the tropical cyclone (TC) genesis location and frequency over the Indo-western North Pacific during the boreal extended summer (May-October) is explored in this paper. Observational analysis shows that the impacts of the intraseasonal IPCO on TCs over the Indo-western North Pacific features in evident "locational phase lock of TC genesis" and distinct differences in TC frequency. In term of the WNP, when the intraseasonal IPCO is positive phase, there tends to be much more TCs, especially in the South China Sea (SCS), and more TCs generate in the west of the WNP and lower latitude (around 5°-20°N); vice versa. At the positive intraseasonal IPCO phase, the atmosphere gains heat through both sea-air interaction and the latent heat release of cumulus convective condensation, and the anomalous cyclonic circulation weakens the western Pacific subtropical high (WPSH), these conditions do favor the TC genesis. Moreover, the shrinking WPSH, the enhanced heat transfer from sea to air at the lower latitude as well as the westward shifts of heating center and anomalous cyclonic circulation lock TC genesis locations in the west of the WNP and lower latitude. The opposite situation occurs at negative phase. As for the North Indian Ocean (NIO), the TC genesis locations at the positive intraseasonal IPCO phase mainly situate in 13°-20°N and distribute closer to Indian Peninsula, particularly in the Arabian Sea (ARB), in contrast, the spatial distribution is more dispersed at the negative intraseasonal IPCO phase. However, the total TC frequencies at two intraseasonal IPCO phases are similar. These features come largely from the differences in the area featuring conditions between the northern and southern regions of 13°N in the NIO: at the positive intraseasonal IPCO phase, to the northern region of 13°N, the environmental conditions are similar to the case of the WNP except without the

  15. Intra-seasonal Strategies Based on Energy Budgets in a Dynamic Predator-Prey Game

    NARCIS (Netherlands)

    Staňková, K.; Abate, A.; Sabelis, M.W.; Křivan, V.; Zaccour, G.

    2013-01-01

    We propose a game-theoretical model to describe intra-seasonal predator-prey interactions between predatory mites (Acari: Phytoseiidae) and prey mites (also called fruit-tree red spider mites) (Acari: Tetranychidae) that feed on leaves of apple trees. Its parameters have been instantiated based on

  16. PRISMA Analysis of 30 Day Readmissions to a Tertiary Cancer Hospital

    DEFF Research Database (Denmark)

    Cooksley, Tim; Merten, Hanneke; Kellett, John

    2015-01-01

    BACKGROUND: Hospital readmissions are increasingly used as a quality indicator. Patients with cancer have an increased risk of readmission. The purpose of this study was to develop an in depth understanding of the causes of readmissions in patients undergoing cancer treatment using PRISMA...... methodology and was subsequently used to identify any potentially preventable causes of readmission in this cohort. METHODS: 50 consecutive 30 day readmissions from the 1st November 2014 to the medical admissions unit (MAU) at a specialist tertiary cancer hospital in the Northwest of England were analysed...... retrospectively. RESULTS: Q25(50%) of the patients were male with a median age of 59 years (range 19-81). PRISMA analysis showed that active (human) factors contributed to the readmission of 4 (8%) of the readmissions, which may have been potentially preventable. All of the readmissions were driven by a medical...

  17. Nationwide Estimates of 30-Day Readmission in Patients With Ischemic Stroke.

    Science.gov (United States)

    Vahidy, Farhaan S; Donnelly, John P; McCullough, Louise D; Tyson, Jon E; Miller, Charles C; Boehme, Amelia K; Savitz, Sean I; Albright, Karen C

    2017-05-01

    Readmission within 30 days of hospital discharge for ischemic stroke is an important quality of care metric. We aimed to provide nationwide estimates of 30-day readmission in the United States, describe important reasons for readmission, and sought to explore factors associated with 30-day readmission, particularly the association with recanalization therapy. We conducted a weighted analysis of the 2013 Nationwide Readmission Database to represent all US hospitalizations. Adult patients with acute ischemic stroke including those who received intravenous tissue-type plasminogen activator and intra-arterial therapy were identified using International Classification of Diseases -Ninth Revision codes. Readmissions were defined as any readmission during the 30-day post-index hospitalization discharge period for the eligible patient population. Proportions and 95% confidence intervals for overall 30-day readmissions and for unplanned and potentially preventable readmissions are reported. Survey design logistic regression models were fit for determining crude and adjusted odds ratios and 95% confidence interval for association between recanalization therapy and 30-day readmission. Of the 319 317 patients with acute ischemic stroke, 12.1% (95% confidence interval, 11.9-12.3) were readmitted. Of these, 89.6% were unplanned and 12.9% were potentially preventable. More than 20% of all readmissions were attributable to acute cerebrovascular disease. Readmitted patients were older and had a higher comorbidity burden. After controlling for age, sex, insurance status, and comorbidities, patients who underwent recanalization therapy had significantly lower odds of 30-day readmission (odds ratio, 0.82; 95% confidence interval, 0.77-0.89). Up to 12% of patients with ischemic stroke get readmitted within 30 days post-discharge period, and recanalization therapy is associated with 11% to 23% lower odds of 30-day readmission. © 2017 American Heart Association, Inc.

  18. 50 CFR 30.11 - Control of feral animals.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Control of feral animals. 30.11 Section 30... (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM RANGE AND FERAL ANIMAL MANAGEMENT Feral Animals § 30.11 Control of feral animals. (a) Feral animals, including horses, burros, cattle, swine, sheep, goats...

  19. Heart failure rehospitalization of the Medicare FFS patient: a state-level analysis exploring 30-day readmission factors.

    Science.gov (United States)

    Schmeida, Mary; Savrin, Ronald A

    2012-01-01

    Heart failure readmission among the elderly is frequent and costly to both the patient and the Medicare trust fund. In this study, the authors explore the factors that are associated with states having heart failure readmission rates that are higher than the U.S. national rate. Acute inpatient hospital settings. 50 state-level data and multivariate regression analysis is used. The dependent variable Heart Failure 30-day Readmission Worse than U.S. Rate is based on adult Medicare Fee-for-Service patients hospitalized with a primary discharge diagnosis of heart failure and for which a subsequent inpatient readmission occurred within 30 days of their last discharge. One key variable found--states with a higher resident population speaking a primary language other than English at home--that is significantly associated with a decrease in probability in states ranking "worse" on heart failure 30-day readmission. Whereas, states with a higher median income, more total days of care per 1,000 Medicare enrollees, and a greater percentage of Medicare enrollees with prescription drug coverage have a greater probability for heart failure 30-day readmission to be "worse" than the U.S. national rate. Case management interventions targeting health literacy may be more effective than other factors to improve state-level hospital status on heart failure 30-day readmission. Factors such as total days of care per 1,000 Medicare enrollees and improving patient access to postdischarge medication(s) may not be as important as literacy. Interventions aimed to prevent disparities should consider higher income population groups as vulnerable for readmission.

  20. Medicare FFS 30 Day Readmission Rate PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — The hospital readmission rate PUF presents nation-wide information about inpatient hospital stays that occurred within 30 days of a previous inpatient hospital stay...

  1. 30 CFR 36.50 - Tests of fuel tank.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Tests of fuel tank. 36.50 Section 36.50 Mineral... Requirements § 36.50 Tests of fuel tank. The fuel tank shall be inspected and tested to determine whether: (a) It is fuel-tight, (b) the vent maintains atmospheric pressure within the tank, and (c) the vent and...

  2. Simulation of the intraseasonal variability over the Eastern Pacific ITCZ in climate models

    Energy Technology Data Exchange (ETDEWEB)

    Jiang, Xianan [Univ. of California, Los Angeles, CA (United States); Waliser, Duane E. [California Inst. of Technology (CalTech), La Canada Flintridge, CA (United States). Jet Propulsion Lab.; Kim, Daehyun [Columbia Univ., New York, NY (United States); Zhao, Ming [Princeton Univ., NJ (United States); Sperber, Kenneth R. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Stern, William F. [Princeton Univ., NJ (United States); Schubert, Siegfried D. [NASA Goddard Space Flight Center (GSFC), Greenbelt, MD (United States); Zhang, Guang J. [Scripps Institute of Oceanography. La Jolla, California (United States); Wang, Wanqiu [National Oceanic and Atmospheric Administration (NOAA), National Centers for Environmental Protection. Camp Springs, MD (United States); Khairoutdinov, Marat [Institute for Terrestrial and Planetary Atmospheres. Stony Brook Univ., NY (United States); Neale, Richard B. [National Center for Atmospheric Research. Boulder, CO (United States); Lee, Myong-In [Ulsan National Institute for Science and Technology. Seoul (Korea)

    2012-08-01

    During boreal summer, convective activity over the eastern Pacific (EPAC) inter-tropical convergence zone (ITCZ) exhibits vigorous intraseasonal variability (ISV). Previous observational studies identified two dominant ISV modes over the EPAC, i.e., a 40-day mode and a quasi-biweekly mode (QBM). The 40-day ISV mode is generally considered a local expression of the Madden-Julian Oscillation. However, in addition to the eastward propagation, northward propagation of the 40-day mode is also evident. The QBM mode bears a smaller spatial scale than the 40-day mode, and is largely characterized by northward propagation. While the ISV over the EPAC exerts significant influences on regional climate/weather systems, investigation of contemporary model capabilities in representing these ISV modes over the EPAC is limited. In this study, the model fidelity in representing these two dominant ISV modes over the EPAC is assessed by analyzing six atmospheric and three coupled general circulation models (GCMs), including one super-parameterized GCM (SPCAM) and one recently developed high-resolution GCM (GFDL HIRAM) with horizontal resolution of about 50 km. While it remains challenging for GCMs to faithfully represent these two ISV modes including their amplitude, evolution patterns, and periodicities, encouraging simulations are also noted. In general, SPCAM and HIRAM exhibit relatively superior skill in representing the two ISV modes over the EPAC. While the advantage of SPCAM is achieved through explicit representation of the cumulus process by the embedded 2-D cloud resolving models, the improved representation in HIRAM could be ascribed to the employment of a strongly entraining plume cumulus scheme, which inhibits the deep convection, and thus effectively enhances the stratiform rainfall. The sensitivity tests based on HIRAM also suggest that fine horizontal resolution could also be conducive to realistically capture the ISV over the EPAC, particularly for the QBM mode

  3. Simulation of the Intraseasonal Variability over the Eastern Pacific ITCZ in Climate Models

    Science.gov (United States)

    Jiang, Xianan; Waliser, Duane E.; Kim, Daehyun; Zhao, Ming; Sperber, Kenneth R.; Stern, W. F.; Schubert, Siegfried D.; Zhang, Guang J.; Wang, Wanqiu; Khairoutdinov, Marat; hide

    2012-01-01

    During boreal summer, convective activity over the eastern Pacific (EPAC) inter-tropical convergence zone (ITCZ) exhibits vigorous intraseasonal variability (ISV). Previous observational studies identified two dominant ISV modes over the EPAC, i.e., a 40-day mode and a quasi-biweekly mode (QBM). The 40-day ISV mode is generally considered a local expression of the Madden-Julian Oscillation. However, in addition to the eastward propagation, northward propagation of the 40-day mode is also evident. The QBM mode bears a smaller spatial scale than the 40-day mode, and is largely characterized by northward propagation. While the ISV over the EPAC exerts significant influences on regional climate/weather systems, investigation of contemporary model capabilities in representing these ISV modes over the EPAC is limited. In this study, the model fidelity in representing these two dominant ISV modes over the EPAC is assessed by analyzing six atmospheric and three coupled general circulation models (GCMs), including one super-parameterized GCM (SPCAM) and one recently developed high-resolution GCM (GFDL HIRAM) with horizontal resolution of about 50 km. While it remains challenging for GCMs to faithfully represent these two ISV modes including their amplitude, evolution patterns, and periodicities, encouraging simulations are also noted. In general, SPCAM and HIRAM exhibit relatively superior skill in representing the two ISV modes over the EPAC. While the advantage of SPCAM is achieved through explicit representation of the cumulus process by the embedded 2-D cloud resolving models, the improved representation in HIRAM could be ascribed to the employment of a strongly entraining plume cumulus scheme, which inhibits the deep convection, and thus effectively enhances the stratiform rainfall. The sensitivity tests based on HIRAM also suggest that fine horizontal resolution could also be conducive to realistically capture the ISV over the EPAC, particularly for the QBM mode

  4. Simulation of the intraseasonal variability over the Eastern Pacific ITCZ in climate models

    Energy Technology Data Exchange (ETDEWEB)

    Jiang, Xianan [University of California, Joint Institute for Regional Earth System Science and Engineering, Los Angeles, CA (United States); California Institute of Technology, Jet Propulsion Laboratory, Pasadena, CA (United States); Waliser, Duane E. [California Institute of Technology, Jet Propulsion Laboratory, Pasadena, CA (United States); Kim, Daehyun [Lamont-Doherty Earth Observatory of Columbia University, New York, NY (United States); Zhao, Ming; Stern, William F. [NOAA/Geophysical Fluid Dynamics Laboratory, Princeton, NJ (United States); Sperber, Kenneth R. [Lawrence Livermore National Laboratory, Livermore, CA (United States); Schubert, Siegfried D. [NASA Goddard Space Flight Center, Greenbelt, MD (United States); Zhang, Guang J. [Scripps Institution of Oceanography, La Jolla, CA (United States); Wang, Wanqiu [NOAA/National Centers for Environmental Prediction, Camp Springs, MD (United States); Khairoutdinov, Marat [Stony Brook University, Institute for Terrestrial and Planetary Atmospheres, Stony Brook, NY (United States); Neale, Richard B. [National Center for Atmospheric Research, Boulder, CO (United States); Lee, Myong-In [Ulsan National Institute of Science and Technology, Seoul (Korea, Republic of)

    2012-08-15

    During boreal summer, convective activity over the eastern Pacific (EPAC) inter-tropical convergence zone (ITCZ) exhibits vigorous intraseasonal variability (ISV). Previous observational studies identified two dominant ISV modes over the EPAC, i.e., a 40-day mode and a quasi-biweekly mode (QBM). The 40-day ISV mode is generally considered a local expression of the Madden-Julian Oscillation. However, in addition to the eastward propagation, northward propagation of the 40-day mode is also evident. The QBM mode bears a smaller spatial scale than the 40-day mode, and is largely characterized by northward propagation. While the ISV over the EPAC exerts significant influences on regional climate/weather systems, investigation of contemporary model capabilities in representing these ISV modes over the EPAC is limited. In this study, the model fidelity in representing these two dominant ISV modes over the EPAC is assessed by analyzing six atmospheric and three coupled general circulation models (GCMs), including one super-parameterized GCM (SPCAM) and one recently developed high-resolution GCM (GFDL HIRAM) with horizontal resolution of about 50 km. While it remains challenging for GCMs to faithfully represent these two ISV modes including their amplitude, evolution patterns, and periodicities, encouraging simulations are also noted. In general, SPCAM and HIRAM exhibit relatively superior skill in representing the two ISV modes over the EPAC. While the advantage of SPCAM is achieved through explicit representation of the cumulus process by the embedded 2-D cloud resolving models, the improved representation in HIRAM could be ascribed to the employment of a strongly entraining plume cumulus scheme, which inhibits the deep convection, and thus effectively enhances the stratiform rainfall. The sensitivity tests based on HIRAM also suggest that fine horizontal resolution could also be conducive to realistically capture the ISV over the EPAC, particularly for the QBM mode

  5. An observational study of the interaction between the synoptic-scale eddies and the intra-seasonal fluctuations in the atmosphere

    International Nuclear Information System (INIS)

    Derome, J.; Sheng, J.; Lin, H.; Klasa, M.

    1994-01-01

    It is clear from the kinetic energy spectrum published by Vinnichenko in 1970 that the atmospheric fluctuations with periods between about 10 and 100 days form a very important part of the atmospheric flow. These oscillations, often called low-frequency or intra-seasonal fluctuations, could result from an instability of the time-mean flow, from an interaction with the oceans, or from a nonlinear transfer of energy from the faster synoptic-scale eddies. In the present study we concentrate on this last possibility and examine, with the help of atmospheric data and general circulation model (GCM) output, the extent to which the synoptic-scale eddies affect the low-frequency fluctuations

  6. Magnitude of Anemia at Discharge Increases 30-Day Hospital Readmissions.

    Science.gov (United States)

    Koch, Colleen G; Li, Liang; Sun, Zhiyuan; Hixson, Eric D; Tang, Anne; Chagin, Kevin; Kattan, Michael; Phillips, Shannon C; Blackstone, Eugene H; Henderson, J Michael

    2017-12-01

    Anemia during hospitalization is associated with poor health outcomes. Does anemia at discharge place patients at risk for hospital readmission within 30 days of discharge? Our objectives were to examine the prevalence and magnitude of anemia at hospital discharge and determine whether anemia at discharge was associated with 30-day readmissions among a cohort of hospitalizations in a single health care system. From January 1, 2009, to August 31, 2011, there were 152,757 eligible hospitalizations within a single health care system. The endpoint was any hospitalization within 30 days of discharge. The University HealthSystem Consortium's clinical database was used for demographics and comorbidities; hemoglobin values are from the hospitals' electronic medical records, and readmission status was obtained from the University HealthSystem Consortium administrative data systems. Mild anemia was defined as hemoglobin of greater than 11 to less than 12 g/dl in women and greater than 11 to less than 13 g/dl in men; moderate, greater than 9 to less than or equal to 11 g/dl; and severe, less than or equal to 9 g/dl. Logistic regression was used to assess the association of anemia and 30-day readmissions adjusted for demographics, comorbidity, and hospitalization type. Among 152,757 hospitalizations, 72% of patients were discharged with anemia: 31,903 (21%), mild; 52,971 (35%), moderate; and 25,522 (17%), severe. Discharge anemia was associated with severity-dependent increased odds for 30-day hospital readmission compared with those without anemia: for mild anemia, 1.74 (1.65-1.82); moderate anemia, 2.76 (2.64-2.89); and severe anemia, 3.47 (3.30-3.65), P < 0.001. Anemia at discharge is associated with a severity-dependent increased risk for 30-day readmission. A strategy focusing on anemia treatment care paths during index hospitalization offers an opportunity to influence subsequent readmissions.

  7. Coated-platelets predict stroke at 30 days following TIA.

    Science.gov (United States)

    Kirkpatrick, Angelia C; Vincent, Andrea S; Dale, George L; Prodan, Calin I

    2017-07-11

    To examine the potential for coated-platelets, a subset of highly procoagulant platelets observed on dual agonist stimulation with collagen and thrombin, for predicting stroke at 30 days in patients with TIA. Consecutive patients with TIA were enrolled and followed up prospectively. ABCD2 scores were obtained for each patient. Coated-platelet levels, reported as percent of cells converted to coated-platelets, were determined at baseline. The primary endpoint was the occurrence of stroke at 30 days. Receiver operator characteristic (ROC) analysis was used to calculate area under the curve (AUC) values for a model including coated-platelets to predict incident stroke at 30 days. A total of 171 patients with TIA were enrolled, and 10 strokes were observed at 30 days. A cutoff of 51.1% for coated-platelet levels yielded a sensitivity of 0.80 (95% confidence interval [CI] 0.55-1.0), specificity of 0.73 (95% CI 0.66-0.80), positive predictive value of 0.16 (95% CI 0.06-0.26), and negative predictive value of 0.98 (95% CI 0.96-1.0). The adjusted hazard ratio of incident stroke in patients with coated-platelet levels ≥51.1% was 10.72 compared to those with levels TIA. © 2017 American Academy of Neurology.

  8. Predictors of 30-day readmission following pancreatic surgery: A retrospective review.

    Science.gov (United States)

    Amodu, Leo I; Alexis, Jamil; Soleiman, Aron; Akerman, Meredith; Addison, Poppy; Iurcotta, Toni; Rilo, Horacio L Rodriguez

    2018-04-22

    Pancreatectomies have been identified as procedures with an increased risk of readmission. In surgical patients, readmissions within 30 days of discharge are usually procedure-related. We sought to determine predictors of 30-day readmission following pancreatic resections in a large healthcare system. We retrospectively collected information from the records of 383 patients who underwent pancreatic resections from 2004-2013. To find the predictors of readmission in the 30 days after discharge, we performed a univariate screen of possible variables using the Fisher's exact test for categorical variables and the Mann-Whitney U test for continuous variables. Multivariate analysis was used to determine the independent factors. Fifty-eight (15.1%) patients were readmitted within 30 days of discharge. Of the patients readmitted, the most common diagnoses at readmission were sepsis (17.2%), and dehydration (8.6%). Multivariate logistic regression found that the development of intra-abdominal fluid collections (OR = 5.32, P readmission within 30 days of discharge. Our data demonstrate that factors predictive of 30-day readmission are a combination of patient characteristics and the development of post-operative complications. Targeted interventions may be used to reduce the risk of readmission. Copyright © 2018. Published by Elsevier B.V.

  9. Predictability experiments for the Asian summer monsoon: impact of SST anomalies on interannual and intraseasonal variability

    International Nuclear Information System (INIS)

    Molteni, Franco; Corti, Susanna; Ferranti, Laura; Slingo, Julia M.

    2003-07-01

    The effects of SST anomalies on the interannual and intraseasonal variability of the Asian summer monsoon have been studied by multivariate statistical analyses of 850-hPa wind and rainfall fields simulated in a set of ensemble integrations of the ECMWF atmospheric GCM, referred to as the PRISM experiments. The simulations used observed SSTs (PRISM-O), covering 9 years characterised by large variations of the ENSO phenomenon in the 1980's and the early 1990's. A parallel set of simulations was also performed with climatological SSTs (PRISM-C), thus enabling the influence of SST forcing on the modes of interannual and intraseasonal variability to be investigated. As in observations, the model's interannual variability is dominated by a zonally-oriented mode which describes the north-south movement of the tropical convergence zone (TCZ). This mode appears to be independent of SST forcing and its robustness between the PRISM-O and PRISM-C simulations suggests that it is driven by internal atmospheric dynamics. On the other hand, the second mode of variability, which again has a good correspondence with observed patterns, shows a clear relationship with the ENSO cycle. Since the mode related to ENSO accounts for only a small part of the total variance, the notion of a quasi-linear superposition of forced and unforced modes of variability may not provide an appropriate interpretation of monsoon interannual variability. Consequently, the possibility of a non-linear influence has been investigated by exploring the relationship between interannual and intraseasonal variability. As in other studies, a common mode of interannual and intraseasonal variability has been found, in this case describing the north-south transition of the TCZ associated with monsoon active/break cycles. Although seasonal-mean values of the Principal Component (PC) timeseries associated with the leading intraseasonal mode shows no significant correlation with ENSO, the 2-dimensional probability

  10. Predictability experiments for the Asian summer monsoon: Impact of SST anomalies on interannual and intraseasonal variability

    International Nuclear Information System (INIS)

    Molteni, F.; Corti, S.; Ferranti, L.; Slingo, J.M.

    2002-04-01

    The effects of SST anomalies on the interannual and intraseasonal variability of the Asian summer monsoon have been studied by multivariate statistical analyses of 850-hPa wind and rainfall yields simulated in a set of ensemble integrations of the ECMWF atmospheric GCM, referred to as the PRISM experiments. The simulations used observed SSTs (PRISM-O), covering 9 years characterised by large variations of the ENSO phenomenon in the 1980's and the early 1990's. A parallel set of simulations was also performed with climatological SSTs (PRISM-C), thus enabling the influence of SST forcing on the modes of interannual and intraseasonal variability to be investigated. As in observations, the model's interannual variability is dominated by a zonally-oriented mode which describes the north-south movement of the tropical convergence zone (TCZ). This mode appears to be independent of SST forcing and its robustness between the PRISM-O and PRISM-C simulations suggests that it is driven by internal atmospheric dynamics. On the other hand, the second mode of variability, which again has a good correspondence with observed patterns, shows a clear relationship with the ENSO cycle. Since the mode related to ENSO accounts for only a small part of the total variance, the notion of a quasi-linear superposition of forced and unforced modes of variability may not provide an appropriate interpretation of monsoon interannual variability. Consequently, the possibility of a non-linear influence has been investigated by exploring the relationship between interannual and intraseasonal variability. As in other studies, a common mode of interannual and intraseasonal variability has been found, in this case describing the north-south transition of the TCZ associated with monsoon active/break cycles. Although seasonal-mean values of the Principal Component (PC) timeseries associated with the leading intraseasonal mode shows no significant correlation with ENSO, the 2-dimensional probability

  11. Analysis of the nonlinearity of Asian summer monsoon intraseasonal variability using spherical PDFs

    Science.gov (United States)

    Jajcay, Nikola; Hannachi, Abdel

    2013-04-01

    The Asian summer monsoon (ASM) is a high-dimensional and highly complex phenomenon affecting more than one fifth of the world population. The intraseasonal component of the ASM undergoes periods of active and break phases associated respectively with enhanced and reduced rainfall over the Indian subcontinent and surroundings. In this paper the nonlinear nature of the intraseasonal monsoon variability is investigated using the leading EOFs of ERA-40 sea level pressure reanalyses field over the ASM region. The probability density function is then computed in spherical coordinates using a Epaneshnikov kernel method. Three significant modes are identified. They represent respectively (i) East - West mode with above normal sea level pressure over East China sea and below normal pressure over Himalayas, (ii) mode with above normal sea level pressure over East China sea (without compensating centre of opposite sign as in (i)) and (iii) mode with below normal sea level pressure over East China sea (same as (ii) but with opposite sign). Relationship to large scale flow are also investigated and discussed.

  12. Long-term (30 days toxicity of NiO nanoparticles for adult zebrafish Danio rerio

    Directory of Open Access Journals (Sweden)

    Kovrižnych Jevgenij A.

    2014-03-01

    Full Text Available Nickel oxide in the form of nanoparticles (NiO NPs is extensively used in different industrial branches. In a test on adult zebrafish, the acute toxicity of NiO NPs was shown to be low, however longlasting contact with this compound can lead to its accumulation in the tissues and to increased toxicity. In this work we determined the 30-day toxicity of NiO NPs using a static test for zebrafish Danio rerio. We found the 30-day LC50 value to be 45.0 mg/L, LC100 (minimum concentration causing 100% mortality was 100.0 mg/L, and LC0 (maximum concentration causing no mortality was 6.25 mg/L for adult individuals of zebrafish. Considering a broad use of Ni in the industry, NiO NPs chronic toxicity may have a negative impact on the population of aquatic organisms and on food web dynamics in aquatic systems.

  13. Worse Prognosis in Heart Failure Patients with 30-Day Readmission

    Science.gov (United States)

    Tung, Ying-Chang; Chou, Shing-Hsien; Liu, Kuan-Liang; Hsieh, I-Chang; Wu, Lung-Sheng; Lin, Chia-Pin; Wen, Ming-Shien; Chu, Pao-Hsien

    2016-01-01

    Background Heart failure (HF) readmission results in substantial expenditure on HF management. This study aimed to evaluate the readmission rate, outcome, and predictors of HF readmission. Methods Patients with reduced left ventricular ejection fraction (LVEF readmission rate, mortality and predictors of readmission. Results A total of 433 de novo HF patients with LVEF readmission rates were 10.9% and 27%, respectively. At the end of the 6-month follow-up, the readmission group had higher mortality than the non-readmission group (27.66% vs. 10.36%; p = 0.001). The survivors of the 30-day readmission had similar mortality rates at 6 months, regardless of the cause of readmission (cardiovascular vs. non-cardiovascular: 25% vs. 30.43%, p = 0.677). Among all the parameters, prescription of beta blockers independently reduced the risk of 30-day readmission (odds ratio 0.15; 95% confidence interval 0.02-0.99; p = 0.049). Conclusions Those HF patients who suffered from 30-day readmission had worse prognosis at the 6-month follow-up. Regardless of the readmission causes, the patients surviving the 30-day readmission had similar mortality rates at 6-month follow-up. These results underscored the importance of reducing readmission as a means to improve HF outcome. PMID:27899857

  14. 15 CFR 50.30 - Fee structure for foreign trade and shipping statistics.

    Science.gov (United States)

    2010-01-01

    ... shipping statistics. 50.30 Section 50.30 Commerce and Foreign Trade Regulations Relating to Commerce and... THE CENSUS § 50.30 Fee structure for foreign trade and shipping statistics. (a) The Bureau of the Census is willing to furnish on a cost basis foreign trade and shipping statistics provided there is no...

  15. 50 CFR 30.12 - Disposition of feral animals.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Disposition of feral animals. 30.12... (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM RANGE AND FERAL ANIMAL MANAGEMENT Feral Animals § 30.12 Disposition of feral animals. Feral animals taken on wildlife refuge areas may be disposed of by sale on the...

  16. 40 CFR 30.50 - Purpose of reports and records.

    Science.gov (United States)

    2010-07-01

    ... Purpose of reports and records. Sections 30.51 through 30.53 set forth the procedures for monitoring and reporting on the recipient's financial and program performance and the necessary standard reporting forms... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Purpose of reports and records. 30.50...

  17. Risk Factors for 30-Day Readmission Following Shoulder Arthroscopy.

    Science.gov (United States)

    Hill, J Ryan; McKnight, Braden; Pannell, William C; Heckmann, Nathanael; Sivasundaram, Lakshmanan; Mostofi, Amir; Omid, Reza; Rick Hatch, George F

    2017-01-01

    The purpose of this study was to evaluate a large population of shoulder arthroscopy cases in order to provide insight into the risk factors associated with readmission following this common orthopaedic procedure. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using current procedural terminology (CPT) billing codes to identify all patients older than 18 years of age who underwent shoulder arthroscopy between 2011 and 2013. Univariate and multivariate analyses were conducted to identify factors associated with 30-day readmission. We identified 15,015 patients who had undergone shoulder arthroscopy, with a 30-day readmission rate of 0.98%. The most common reason for readmission was pulmonary embolism (0.09%). On multivariate analysis, operative time > 1.5 hours (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.29 to 2.50), age 40 to 65 years (OR, 3.80; 95% CI, 1.37 to 10.59), age > 65 years (OR, 3.91; 95% CI, 1.35 to 11.35), American Society of Anesthesiologists (ASA) class 3 (OR, 4.53; 95% CI, 1.90 to 10.78), ASA class 4 (OR, 7.73; 95% CI, 2.91 to 27.25), chronic obstructive pulmonary disease (COPD; OR, 2.65; 95% CI, 1.54 to 4.55), and chronic steroid use (OR, 2.96; 95% CI, 1.46 to 6.01) were identified as independent risk factors for readmission. Operative time > 1.5 hours, age > 40 years, ASA classes 3 or 4, COPD, and chronic steroid use are independent risk factors for readmission following elective arthroscopic shoulder surgery, although the readmission rate following these procedures is low. Level III, retrospective comparative study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  18. Combined effect of MJO, ENSO and IOD on the intraseasonal variability of northeast monsoon rainfall over south peninsular India

    Science.gov (United States)

    Sreekala, P. P.; Rao, S. Vijaya Bhaskara; Rajeevan, K.; Arunachalam, M. S.

    2018-02-01

    The present study has examined the combined effect of MJO, ENSO and IOD on the intraseasonal and interannual variability of northeast monsoon rainfall over south peninsular India. The study has revealed that the intraseasonal variation of daily rainfall over south peninsular India during NEM season is associated with various phases of eastward propagating MJO life cycle. Positive rainfall anomaly over south peninsular India and surrounding Indian Ocean (IO) is observed during the strong MJO phases 2, 3 and 4; and negative rainfall anomaly during the strong MJO phases 5,6,7,8 and 1. Above normal (below normal) convection over south peninsular India and suppressed convection over east Indian and West Pacific Ocean, high pressure (low pressure) anomaly over West Pacific Ocean, Positive (negative) SST anomalies over equatorial East and Central Pacific Ocean and easterly wind anomaly (westerly anomaly) over equatorial Indian Ocean are the observed features during the first three MJO (5, 6, 7) phases and all these features are observed in the excess (drought) NEMR composite. This suggests that a similar mode of physical mechanism is responsible for the intraseasonal and interannual variability of northeast monsoon rainfall. The number of days during the first three phases (last four phases) of MJO, where the enhanced convection and positive rainfall anomaly is over Indian Ocean (East Indian ocean and West Pacific Ocean), is more (less) during El Nino and IOD years and less during La Nina and NIOD years and vice versa. The observed excess (deficit) rainfall anomaly over west IO and south peninsular India and deficit (excess) rainfall anomaly over east IO including Bay of Bengal and West Pacific Ocean suggest that the more (less) number of first three phases during El Nino and IOD (La Nina and Negative IOD) is due to the interaction between eastward moving MJO and strong easterlies over equatorial IO present during El Nino and IOD years. This interaction would inhibit the

  19. Effect of Ambulatory Transitional Care Management on 30-Day Readmission Rates.

    Science.gov (United States)

    Ballard, Jonathan; Rankin, Wade; Roper, Karen L; Weatherford, Sarah; Cardarelli, Roberto

    2018-05-01

    A process improvement initiative for transitional care management (TCM) was evaluated for effectiveness in reducing 30-day readmission rates in a retrospective cohort study. Regression models analyzed the association between level of TCM component implementation and readmission rates among patients discharged from a university medical center hospital. Of the 1884 patients meeting inclusion criteria, only 3.7% (70) experienced a 30-day readmission. Patients receiving the full complement of TCM had 86.6% decreased odds of readmission compared with patients who did not receive TCM ( P < .001). However, the complete package of TCM services under Medicare guidelines may not be essential. A postdischarge telephone call did not reduce readmission odds, provided a TCM office visit occurred. Important for risk assessment models targeting patients for TCM, the number of previous hospital admissions, not age, predicted 30-day readmission risk. This study provides evidence that primary care-based TCM can reduce 30-day readmissions even when overall rates are low.

  20. Health literacy and 30-day hospital readmission after acute myocardial infarction

    Science.gov (United States)

    Bailey, Stacy Cooper; Fang, Gang; Annis, Izabela E; O'Conor, Rachel; Paasche-Orlow, Michael K; Wolf, Michael S

    2015-01-01

    Objective To assess the validity of a predictive model of health literacy, and to examine the relationship between derived health literacy estimates and 30-day hospital readmissions for acute myocardial infarction (AMI). Design Retrospective cohort study. Setting and participants A National Institute of Aging (NIA) study cohort of 696 adult, English-speaking primary care patients, aged 55–74 years, was used to assess the validity of derived health literacy estimates. Claims from 7733 Medicare beneficiaries hospitalised for AMI in 2008 in North Carolina and Illinois were used to investigate the association between health literacy estimates and 30-day hospital readmissions. Measures The NIA cohort was administered 3 common health literacy assessments (Newest Vital Sign, Test of Functional Health Literacy in Adults, and Rapid Estimate of Adult Literacy in Medicine). Health literacy estimates at the census block group level were derived via a predictive model. 30-day readmissions were measured from Medicare claims data using a validated algorithm. Results Fair agreement was found between derived estimates and in-person literacy assessments (Pearson Correlation coefficients: 0.38–0.51; κ scores: 0.38–0.40). Medicare enrollees with above basic literacy according to derived health literacy estimates had an 18% lower risk of a 30-day readmission (RR=0.82, 95% CI 0.73 to 0.92) and 21% lower incidence rate of 30-day readmission (IRR=0.79, 95% CI 0.68 to 0.87) than patients with basic or below basic literacy. After adjusting for demographic and clinical characteristics, the risk of 30-day readmission was 12% lower (p=0.03), and the incidence rate 16% lower (pliteracy. Conclusions Health literacy, as measured by a predictive model, was found to be a significant, independent predictor of 30-day readmissions. As a modifiable risk factor with evidence-based solutions, health literacy should be considered in readmission reduction efforts. PMID:26068508

  1. Assessing Intraseasonal Variability Produced by Several Deep Convection Schemes in the NCAR CCM3.6

    Science.gov (United States)

    Maloney, E. D.

    2001-05-01

    The Hack, Zhang/McFarlane, and McRAS convection schemes produce very different simulations of intraseasonal variability in the NCAR CCM3.6. A robust analysis of simulation performance requires an expanded set of diagnostics. The use of only one criterion to analyze model Madden-Julian oscillation (MJO) variability, such as equatorial zonal wind variability, may give a misleading impression of model performance. Schemes that produce strong variability in zonal winds may sometimes lack a corresponding coherent signal in precipitation, suggesting that model convection and the large-scale circulation are not as strongly coupled as observed. The McRAS scheme, which includes a parametrization of unsaturated convective downdrafts, produces the best simulation of intraseasonal variability of the three schemes used. Downdrafts in McRAS create a moister equatorial troposphere, which increases equatorial convection. Composite analysis indicates a strong dependence of model intraseasonal variability on the frictional convergence mechanism, which may also be important in nature. The McRAS simulation has limitations, however. Indian Ocean variability is weak, and anomalous convection extends too far east across the Pacific. The dependence of convection on surface friction is too strong, and causes enhanced MJO convection to be associated with low-level easterly wind perturbations, unlike observed MJO convection. Anomalous vertical advection associated with surface convergence influences model convection by moistening the lower troposphere. Based on the work of Hendon (2000), coupling to an interactive ocean is unlikely to change the performance of the CCM3 with McRAS, due to the phase relationship between anomalous convection and zonal winds. Use of the analysis tools presented here indicates areas for improvement in the parametrization of deep convection by atmospheric GCMs.

  2. Remote ENSO forcing versus local air-sea interaction in QTCM: a sensitivity study to intraseasonal variability

    Directory of Open Access Journals (Sweden)

    D. Gushchina

    2006-01-01

    Full Text Available The skill of a newly designed global atmospheric model of intermediate complexity - QTCM (for quasi-equilibrium tropical circulation model in simulating the teleconnections is investigated. The role of the ENSO remote forcing over the Pacific surrounding regions is emphasized from sensitivity experiments to critical parameters of the model. The role of the tropical intraseasonal variability (ITV on the simulated ENSO teleconnection pattern is estimated using the methodology proposed by Lin et al. (2000 allowing to damp the energy of ITV in the model. The reduction of intraseasonal variability allows emphasizing the forced response of the atmosphere and eases the detection of local coupled atmosphere-ocean patterns. It was shown that the simulated ITV has an impact on the ENSO teleconnection pattern both in the mid-latitudes and in regions of ascending and descending branches of Walker circulation cells in the tropics.

  3. Drivers and Risk Factors of Unplanned 30-Day Readmission Following Spinal Cord Stimulator Implantation.

    Science.gov (United States)

    Elsamadicy, Aladine A; Sergesketter, Amanda; Ren, Xinru; Mohammed Qasim Hussaini, Syed; Laarakker, Avra; Rahimpour, Shervin; Ejikeme, Tiffany; Yang, Siyun; Pagadala, Promila; Parente, Beth; Xie, Jichun; Lad, Shivanand P

    2018-01-01

    Unplanned 30-day readmission rates contribute significantly to growing national healthcare expenditures. Drivers of unplanned 30-day readmission after spinal cord stimulator (SCS) implantation are relatively unknown. The aim of this study was to determine drivers of 30-day unplanned readmission following SCS implantation. The National Readmission Database was queried to identify all patients who underwent SCS implantation for the 2013 calendar year. Patients were grouped by readmission status, "No Readmission" and "Unplanned 30-day Readmission." Patient demographics and comorbidities were collected for each patient. The primary outcome of interest was the rate of unplanned 30-day readmissions and associated driving factors. A multivariate analysis was used to determine independent predictors of unplanned 30-day readmission after SCS implantation. We identified 1521 patients who underwent SCS implantation, with 113 (7.4%) experiencing an unplanned readmission within 30 days. Baseline patient demographics, comorbidities, and hospital characteristics were similar between both cohorts. The three main drivers for 30-day readmission after SCS implantation include: 1) infection (not related to SCS device), 2) infection due to device (limited to only hardware infection), and 3) mechanical complication of SCS device. Furthermore, obesity was found to be an independent predictor of 30-day readmission (OR: 1.86, p = 0.008). Our study suggests that infectious and mechanical complications are the primary drivers of unplanned 30-day readmission after SCS implantation, with obesity as an independent predictor of unplanned readmission. Given the technological advancements in SCS, repeated studies are necessary to identify factors associated with unplanned 30-day readmission rates after SCS implantation to improve patient outcomes and reduce associated costs. © 2017 International Neuromodulation Society.

  4. Risk Factors for 30-Day Readmission in Adults with Sickle Cell Disease.

    Science.gov (United States)

    Brodsky, Max A; Rodeghier, Mark; Sanger, Maureen; Byrd, Jeannie; McClain, Brandi; Covert, Brittany; Roberts, Dionna O; Wilkerson, Karina; DeBaun, Michael R; Kassim, Adetola A

    2017-05-01

    Readmission to the hospital within 30 days is a measure of quality care; however, only few modifiable risk factors for 30-day readmission in adults with sickle cell disease are known. We performed a retrospective review of the medical records of adults with sickle cell disease at a tertiary care center, to identify potentially modifiable risk factors for 30-day readmission due to vasoocclusive pain episodes. A total of 88 patients ≥18 years of age were followed for 3.5 years between 2010 and 2013, for 158 first admissions for vasoocclusive pain episodes. Of these, those subsequently readmitted (cases) or not readmitted (controls) within 30 days of their index admissions were identified. Seven risk factors were included in a multivariable model to predict readmission: age, sex, hemoglobin phenotype, median oxygen saturation level, listing of primary care provider, type of health insurance, and number of hospitalized vasoocclusive pain episodes in the prior year. Mean age at admission was 31.7 (18-59) years; median time to readmission was 11 days (interquartile range 20 days). Absence of a primary care provider listed in the electronic medical record (odds ratio 0.38; 95% confidence interval, 0.16-0.91; P = .030) and the number of vasoocclusive pain episodes requiring hospitalization in the prior year were significant risk factors for 30-day readmission (odds ratio 1.30; 95% confidence interval, 1.16-1.44; P readmission rate in adults with sickle cell disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Predictability experiments for the Asian summer monsoon impact of SST anomalies on interannual and intraseasonal variability

    CERN Document Server

    Molteni, F; Ferranti, L; Slingo, J M

    2003-01-01

    The effects of SST anomalies on the interannual and intraseasonal variability of the Asian summer monsoon have been studied by multivariate statistical analyses of 850-hPa wind and rainfall fields simulated in a set of ensemble integrations of the ECMWF atmospheric GCM, referred to as the PRISM experiments. The simulations used observed SSTs (PRISM-O), covering 9 years characterised by large variations of the ENSO phenomenon in the 1980's and the early 1990's. A parallel set of simulations was also performed with climatological SSTs (PRISM-C), thus enabling the influence of SST forcing on the modes of interannual and intraseasonal variability to be investigated. As in observations, the model's interannual variability is dominated by a zonally-oriented mode which describes the north-south movement of the tropical convergence zone (TCZ). This mode appears to be independent of SST forcing and its robustness between the PRISM-O and PRISM-C simulations suggests that it is driven by internal atmospheric dynamics. O...

  6. 50 CFR 30.2 - Disposition of surplus range animals.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Disposition of surplus range animals. 30.2... (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM RANGE AND FERAL ANIMAL MANAGEMENT Range Animals § 30.2 Disposition of surplus range animals. Disposition shall be made only during regularly scheduled disposal...

  7. Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Ki-Woong Nam

    Full Text Available Stroke in cancer patients is not rare but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer.In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer.We included 210 ischemic stroke patients with active cancer. The 30-day mortality data were collected by reviewing medical records. We also collected follow-up D-dimer levels in 106 (50% participants to evaluate the effects of treatment response on D-dimer levels.Of the 210 participants, 30-day mortality occurred in 28 (13% patients. Higher initial NIHSS scores, D-dimer levels, and CRP levels as well as frequent cryptogenic mechanism, systemic metastasis, multiple vascular territory lesion, hemorrhagic transformation, and larger infarct volume were related to 30-day mortality. In the multivariate analysis, D-dimer [adjusted OR (aOR = 2.19; 95% CI, 1.46-3.28, P < 0.001] predicted 30-day mortality after adjusting for confounders. The initial NIHSS score (aOR = 1.07; 95% CI, 1.00-1.14, P = 0.043 and hemorrhagic transformation (aOR = 3.02; 95% CI, 1.10-8.29, P = 0.032 were also significant independent of D-dimer levels. In the analysis of D-dimer changes after treatment, the mortality group showed no significant decrease in D-dimer levels, despite treatment, while the survivor group showed the opposite response.D-dimer levels may predict 30-day mortality in acute ischemic stroke patients with active cancer.

  8. Impacts and uses of seasonal and intraseasonal predictions in the business community with an emphasis on the energy and agricultural industries

    Science.gov (United States)

    Streit, D.; Murnane, R.

    2003-04-01

    Almost any industry can benefit financially from accurate seasonal and intraseasonal predictions by determining threats to profits and taking out derivative insurance. However, the energy and agricultural industries stand to gain from these forecasts in many more ways and are therefore already using them in their decision support systems. Earth Satellite Corporation is one of the leading companies providing seasonal and intraseasonal forecasts to customers in these communities. The end users in both can be broadly divided into producers and traders, each with specific needs and applications. In this presentation, we describe those needs and applications based on our 30 years of experience. The basic difference between traders and producers in both groups is that traders will use a long-range forecast to define their overall trading strategy for a season, while producers will use the forecast more in a tactical sense to either cut their losses or maximize their profits. For example, agricultural producers will change the crops to be planted if they know a dry growing season is expected. In the energy industry, the amount of natural gas or heating oil stored by producers for the upcoming heating season is driven by forecasts. Traders in both industries will apply a more aggressive or cautious approach to the positions they take based on the forecasts. The rest of the presentation will describe other several other applications in retail, transportation, and the housing industry.

  9. 30-Day Hospital Readmission Following Otolaryngology Surgery: Analysis of a State Inpatient Database

    Science.gov (United States)

    Graboyes, Evan M.; Kallogjeri, Dorina; Saeed, Mohammed J.; Olsen, Margaret A.; Nussenbaum, Brian

    2017-01-01

    Objectives For patients undergoing inpatient otolaryngologic surgery, determine patient and hospital-level risk factors associated with 30-day readmission. Study Design Retrospective cohort study Methods We analyzed the State Inpatient Database (SID) from California for patients who underwent otolaryngologic surgery between 2008 and 2010. Readmission rates, readmission diagnoses, and patient- and hospital-level risk factors for 30-day readmission were determined. Hierarchical logistic regression modeling was performed to identify procedure-, patient-, and hospital-level risk factors for 30-day readmission. Results The 30-day readmission rate following an inpatient otolaryngology procedure was 8.1%. The most common readmission diagnoses were nutrition, metabolic or electrolyte problems (44% of readmissions) and surgical complications (10% of readmissions). New complications after discharge were the major drivers of readmission. Variables associated with 30-day readmission in hierarchical logistic regression modeling were: type of otolaryngologic procedure, Medicare or Medicaid health insurance, chronic anemia, chronic lung disease, chronic renal failure, index admission via the emergency department, in-hospital complication during the index admission, and discharge destination other than home. Conclusions Approximately one out of twelve patients undergoing otolaryngologic surgery had a 30-day readmission. Readmissions occur across a variety of types of procedures and hospitals. Most of the variability was driven by patient-specific factors, not structural hospital characteristics. PMID:27098654

  10. Preadmission Use of Glucocorticoids and 30-Day Mortality After Stroke.

    Science.gov (United States)

    Sundbøll, Jens; Horváth-Puhó, Erzsébet; Schmidt, Morten; Dekkers, Olaf M; Christiansen, Christian F; Pedersen, Lars; Bøtker, Hans Erik; Sørensen, Henrik T

    2016-03-01

    The prognostic impact of glucocorticoids on stroke mortality remains uncertain. We, therefore, examined whether preadmission use of glucocorticoids is associated with short-term mortality after ischemic stroke, intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). We conducted a nationwide population-based cohort study using medical registries in Denmark. We identified all patients with a first-time inpatient diagnosis of stroke between 2004 and 2012. We categorized glucocorticoid use as current use (last prescription redemption ≤90 days before admission), former use, and nonuse. Current use was further classified as new or long-term use. We used Cox regression to compute 30-day mortality rate ratios with 95% confidence intervals (CIs), controlling for confounders. We identified 100 042 patients with a first-time stroke. Of these, 83 735 patients had ischemic stroke, 11 779 had ICH, and 4528 had SAH. Absolute mortality risk was higher for current users compared with nonusers for ischemic stroke (19.5% versus 10.2%), ICH (46.5% versus 34.4%), and SAH (35.0% versus 23.2%). For ischemic stroke, the adjusted 30-day mortality rate ratio was increased among current users compared with nonusers (1.58, 95% CI: 1.46-1.71), driven by the effect of glucocorticoids among new users (1.80, 95% CI: 1.62-1.99). Current users had a more modest increase in the adjusted 30-day mortality rate ratio for hemorrhagic stroke (1.26, 95% CI: 1.09-1.45 for ICH and 1.40, 95% CI: 1.01-1.93 for SAH) compared with nonusers. Former use was not substantially associated with mortality. Preadmission use of glucocorticoids was associated with increased 30-day mortality among patients with ischemic stroke, ICH, and SAH. © 2016 American Heart Association, Inc.

  11. Assessment of every day extremely low frequency (Elf) electromagnetic fields (50-60 Hz) exposure: which metrics?

    International Nuclear Information System (INIS)

    Verrier, A.; Magne, I.; Souqes, M.; Lambrozo, J.

    2006-01-01

    Because electricity is encountered at every moment of the day, at home with household appliances, or in every type of transportation, people are most of the time exposed to extremely low frequency (E.L.F.) electromagnetic fields (50-60 Hz) in a various way. Due to a lack of knowledge about the biological mechanisms of 50 Hz magnetic fields, studies seeking to identify health effects of exposure use central tendency metrics. The objective of our study is to provide better information about these exposure measurements from three categories of metrics. We calculated metrics of exposure measurements from data series (79 very day exposed subjects), made up approximately 20,000 recordings of magnetic fields, measured every 30 seconds for 7 days with an E.M.D.E.X. II dosimeter. These indicators were divided into three categories : central tendency metrics, dispersion metrics and variability metrics.We use Principal Component Analysis, a multidimensional technique to examine the relations between different exposure metrics for a group of subjects. Principal component Analysis (P.C.A.) enabled us to identify from the foreground 71.7% of the variance. The first component (42.7%) was characterized by central tendency; the second (29.0%) was composed of dispersion characteristics. The third component (17.2%) was composed of variability characteristics. This study confirm the need to improve exposure measurements by using at least two dimensions intensity and dispersion. (authors)

  12. 30-Day morbidity after augmentation enterocystoplasty and appendicovesicostomy: A NSQIP pediatric analysis.

    Science.gov (United States)

    McNamara, Erin R; Kurtz, Michael P; Schaeffer, Anthony J; Logvinenko, Tanya; Nelson, Caleb P

    2015-08-01

    Augmentation enterocystoplasty and appendicovesicostomy are complex pediatric urologic procedures. Although there is literature identifying long-term outcomes in these patients, the reporting of short-term postoperative outcomes has been limited by small numbers of cases and lack of prospective data collection. Here we report 30-day outcomes from the first nationally based, prospectively assembled cohort of pediatric patients undergoing these procedures. To determine 30-day complication, readmission and reoperation after augmentation enterocystoplasty and appendicovesicostomy in a large national sample of pediatric patients, and to explore the association between preoperative and intraoperative characteristics and occurrence of any 30-day event. We queried the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric database (ACS-NSQIPP) for all patients undergoing augmentation enterocystoplasty and/or appendicovesicostomy. Surgical risk score was classified on a linear scale using a validated pediatric-specific comorbidity score. Intraoperative characteristics and postoperative 30-day events were reported from prospectively collected data. A composite measure of complication, readmission and/or reoperation was used as primary outcome for the multivariate logistic regression. There were 461 patients included in the analysis: 245 had appendicovesicostomy, 97 had augmentation enterocystoplasty and 119 had both procedures. There were a total of 110 NSQIP complications seen in 87 patients. The most common complication was urinary tract infection (see Table for 30-day outcomes by patient). The composite measure of any 30-day event was seen in 27.8% of the cohort and this was associated with longer operative time, increased number of procedures done at time of primary surgical procedure and higher surgical risk score. The ACS-NSQIPP provides a tool to examine short-term outcomes for these complex urologic procedures that has not

  13. High Mortality among 30-Day Readmission after Stroke: Predictors and Etiologies of Readmission

    Directory of Open Access Journals (Sweden)

    Amre M. Nouh

    2017-12-01

    Full Text Available BackgroundAlthough some risk factors for stroke readmission have been reported, the mortality risk is unclear. We sought to evaluate etiologies and predictors of 30-day readmissions and determine the associated mortality risk.MethodsThis is a retrospective case–control study evaluating 1,544 patients admitted for stroke (hemorrhagic, ischemic, or TIA from January 2013 to December 2014. Of these, 134 patients readmitted within 30days were identified as cases; 1,418 other patients, with no readmissions were identified as controls. Patients readmitted for hospice or elective surgery were excluded. An additional 248 patients deceased on index admission were included for only a comparison of mortality rates. Factors explored included socio-demographic characteristics, clinical comorbidities, stroke characteristics, and length of stay. Chi-square test of proportions and multivariable logistic regression were used to identify independent predictors of 30-day stroke readmissions. Mortality rates were compared for index admission and readmission and among readmission diagnoses.ResultsAmong the 1,544 patients in the main analysis, 67% of index stroke admissions were ischemic, 22% hemorrhagic, and 11% TIA. The 30-day readmission rate was 8.7%. The most common etiologies for readmission were infection (30%, recurrent stroke and TIA (20%, and cardiac complications (14%. Significantly higher proportion of those readmitted for recurrent strokes and TIAs presented within the first week (p = 0.039 and had a shorter index admission length of stay (p = 0.027. Risk factors for 30-day readmission included age >75 (p = 0.02, living in a facility prior to index stroke (p = 0.01, history of prior stroke (p = 0.03, diabetes (p = 0.03, chronic heart failure (p ≤ 0.001, atrial fibrillation (p = 0.03, index admission to non-neurology service (p < 0.01, and discharge to other than home (p < 0.01. On multivariate analysis, index

  14. Intraseasonal sea surface warming in the western Indian Ocean by oceanic equatorial Rossby waves

    Science.gov (United States)

    2017-05-09

    USA, 2Naval Research Laboratory, Ocean Dynamics and Prediction Branch, Stennis Space Center, Hancock County, Mississippi, USA, 3Department of Physics ...IO and predominantly located south of the equator. The intraseasonal currents associated with downwelling ER waves act on the temperature gradient to...yield warm anomalies in the western IO, even in the presence of cooling by surface fluxes. The SST gradient is unique to the western IO and likely

  15. High Mortality among 30-Day Readmission after Stroke: Predictors and Etiologies of Readmission.

    Science.gov (United States)

    Nouh, Amre M; McCormick, Lauren; Modak, Janhavi; Fortunato, Gilbert; Staff, Ilene

    2017-01-01

    Although some risk factors for stroke readmission have been reported, the mortality risk is unclear. We sought to evaluate etiologies and predictors of 30-day readmissions and determine the associated mortality risk. This is a retrospective case-control study evaluating 1,544 patients admitted for stroke (hemorrhagic, ischemic, or TIA) from January 2013 to December 2014. Of these, 134 patients readmitted within 30days were identified as cases; 1,418 other patients, with no readmissions were identified as controls. Patients readmitted for hospice or elective surgery were excluded. An additional 248 patients deceased on index admission were included for only a comparison of mortality rates. Factors explored included socio-demographic characteristics, clinical comorbidities, stroke characteristics, and length of stay. Chi-square test of proportions and multivariable logistic regression were used to identify independent predictors of 30-day stroke readmissions. Mortality rates were compared for index admission and readmission and among readmission diagnoses. Among the 1,544 patients in the main analysis, 67% of index stroke admissions were ischemic, 22% hemorrhagic, and 11% TIA. The 30-day readmission rate was 8.7%. The most common etiologies for readmission were infection (30%), recurrent stroke and TIA (20%), and cardiac complications (14%). Significantly higher proportion of those readmitted for recurrent strokes and TIAs presented within the first week ( p  = 0.039) and had a shorter index admission length of stay ( p  = 0.027). Risk factors for 30-day readmission included age >75 ( p  = 0.02), living in a facility prior to index stroke ( p  = 0.01), history of prior stroke ( p  = 0.03), diabetes ( p  = 0.03), chronic heart failure ( p  ≤ 0.001), atrial fibrillation ( p  = 0.03), index admission to non-neurology service ( p  readmission ( p  ≤ 0.01). The mortality after a within 30-day readmission after stroke was higher

  16. Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke.

    Science.gov (United States)

    Nam, Ki-Woong; Kim, Chi Kyung; Kim, Tae Jung; An, Sang Joon; Oh, Kyungmi; Mo, Heejung; Kang, Min Kyoung; Han, Moon-Ku; Demchuk, Andrew M; Ko, Sang-Bae; Yoon, Byung-Woo

    2017-01-01

    Stroke in cancer patients is not rare but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer. In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer. We included 210 ischemic stroke patients with active cancer. The 30-day mortality data were collected by reviewing medical records. We also collected follow-up D-dimer levels in 106 (50%) participants to evaluate the effects of treatment response on D-dimer levels. Of the 210 participants, 30-day mortality occurred in 28 (13%) patients. Higher initial NIHSS scores, D-dimer levels, and CRP levels as well as frequent cryptogenic mechanism, systemic metastasis, multiple vascular territory lesion, hemorrhagic transformation, and larger infarct volume were related to 30-day mortality. In the multivariate analysis, D-dimer [adjusted OR (aOR) = 2.19; 95% CI, 1.46-3.28, P mortality after adjusting for confounders. The initial NIHSS score (aOR = 1.07; 95% CI, 1.00-1.14, P = 0.043) and hemorrhagic transformation (aOR = 3.02; 95% CI, 1.10-8.29, P = 0.032) were also significant independent of D-dimer levels. In the analysis of D-dimer changes after treatment, the mortality group showed no significant decrease in D-dimer levels, despite treatment, while the survivor group showed the opposite response. D-dimer levels may predict 30-day mortality in acute ischemic stroke patients with active cancer.

  17. 46 CFR 30.10-50 - Pilot boarding equipment and point of access.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Pilot boarding equipment and point of access. 30.10-50... Definitions § 30.10-50 Pilot boarding equipment and point of access. (a) Pilot boarding equipment means a... boarding equipment. [CGD 79-032, 49 FR 25455, June 21, 1984] ...

  18. US pediatric trauma patient unplanned 30-day readmissions.

    Science.gov (United States)

    Wheeler, Krista K; Shi, Junxin; Xiang, Henry; Thakkar, Rajan K; Groner, Jonathan I

    2018-04-01

    We sought to determine readmission rates and risk factors for acutely injured pediatric trauma patients. We produced 30-day unplanned readmission rates for pediatric trauma patients using the 2013 National Readmission Database (NRD). In US pediatric trauma patients, 1.7% had unplanned readmissions within 30days. The readmission rate for patients with index operating room procedures was no higher at 1.8%. Higher readmission rates were seen in patients with injury severity scores (ISS)=16-24 (3.4%) and ISS ≥25 (4.9%). Higher rates were also seen in patients with LOS beyond a week, severe abdominal and pelvic region injuries (3.0%), crushing (2.8%) and firearm injuries (4.5%), and in patients with fluid and electrolyte disorders (3.9%). The most common readmission principal diagnoses were injury, musculoskeletal/integumentary diagnoses and infection. Nearly 39% of readmitted patients required readmission operative procedures. Most common were operations on the musculoskeletal system (23.9% of all readmitted patients), the integumentary system (8.6%), the nervous system (6.6%), and digestive system (2.5%). Overall, the readmission rate for pediatric trauma patients was low. Measures of injury severity, specifically length of stay, were most useful in identifying those who would benefit from targeted care coordination resources. This is a Level III retrospective comparative study. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Examining 30-day COPD readmissions through the emergency department

    Directory of Open Access Journals (Sweden)

    Rezaee ME

    2017-12-01

    Full Text Available Michael E Rezaee,1 Charlotte E Ward,2,3 Bonita Nuanez,1 Daniel A Rezaee,4 Jeffrey Ditkoff,1,5 Alexandra Halalau1,6 1Oakland University William Beaumont School of Medicine, Rochester, MI, 2Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, 3Center for Health Statistics, University of Chicago, Chicago, IL, 4Primary Care, Brigham and Women’s Hospital, Boston, MA, 5Emergency Medicine, 6Internal Medicine, Beaumont Health, Royal Oak, MI, USA Background: Thirty-day readmission in COPD is common and costly, but potentially preventable. The emergency department (ED may be a setting for COPD readmission reduction efforts.Objective: To better understand COPD readmission through the ED, ascertain factors associated with 30-day readmission through the ED, and identify subgroups of patients with COPD for readmission reduction interventions.Patients and methods: A retrospective cohort study was conducted from January 2009 to September 2015 in patients with COPD of age ≥18 years. Electronic health record data were abstracted for information available to admitting providers in the ED. The primary outcome was readmission through the ED within 30 days of discharge from an index admission for COPD. Logistic regression was used to examine the relationship between potential risk factors and 30-day readmission.Results: The study involved 1,574 patients who presented to the ED within 30 days on an index admission for COPD. Of these, 82.2% were readmitted through the ED. Charlson score (odds ratio [OR]: 3.6; 95% CI: 2.9–4.4, a chief complaint of breathing difficulty (OR: 1.6; 95% CI: 1.1–2.6, outpatient utilization of albuterol (OR: 4.1; 95% CI: 2.6–6.4, fluticasone/salmeterol (OR: 2.3; 95% CI: 1.3–4.2, inhaled steroids (OR: 3.8; 95% CI: 1.3–10.7, and tiotropium (OR: 1.8; 95% CI: 1.0–3.2, as well as arterial blood gas (OR: 4.4; 95% CI: 1.3–15.1 and B-type natriuretic peptide (OR: 2.2; 95% CI: 1.4–3.5 testing in the

  20. Risk Factors for 30-Day Mortality in Patients with Methicillin-Resistant Staphylococcus aureus Bloodstream Infections

    Directory of Open Access Journals (Sweden)

    Pedro Ayau

    2017-08-01

    Conclusions: Our study identified significant risk factors for 30-day mortality in patients with MRSA BSI. Interestingly, diabetes mellitus, PVD and readmission were protective effects on 30-day mortality. There was no statistically significant variability in 30-day mortality over the 9-year study period.

  1. Impact of satellite data assimilation on the predictability of monsoon intraseasonal oscillations in a regional model

    KAUST Repository

    Parekh, Anant

    2017-04-07

    This study reports the improvement in the predictability of circulation and precipitation associated with monsoon intraseasonal oscillations (MISO) when the initial state is produced by assimilating Atmospheric Infrared Sounder (AIRS) retrieved temperature and water vapour profiles in Weather Research Forecast (WRF) model. Two separate simulations are carried out for nine years (2003 to 2011) . In the first simulation, forcing is from National Centers for Environmental Prediction (NCEP, CTRL) and in the second, apart from NCEP forcing, AIRS temperature and moisture profiles are assimilated (ASSIM). Ten active and break cases are identified from each simulation. Three dimensional temperature states of identified active and break cases are perturbed using twin perturbation method and carried out predictability tests. Analysis reveals that the limit of predictability of low level zonal wind is improved by four (three) days during active (break) phase. Similarly the predictability of upper level zonal wind (precipitation) is enhanced by four (two) and two (four) days respectively during active and break phases. This suggests that the initial state using AIRS observations could enhance predictability limit of MISOs in WRF. More realistic baroclinic response and better representation of vertical state of atmosphere associated with monsoon enhance the predictability of circulation and rainfall.

  2. Increased 30-day mortality in patients with diabetes undergoing surgery for colorectal cancer

    DEFF Research Database (Denmark)

    Fransgaard, T; Thygesen, L C; Gögenur, I

    2016-01-01

    with the use of antidiabetic drugs identified through the Danish National Prescription Registry and DCCG. The 30-day mortality was examined by the Kaplan-Meier method with the log-rank test and the Cox regression model used to test statistical significance. RESULTS: The study included 29 353 patients, of whom...... 3250 had preexisting diabetes. The 30-day mortality was significantly increased in patients with CRC and preexisting diabetes (adjusted hazard ratio 1.17, 95% CI 1.01-1.35, P = 0.03). The type of antidiabetic medication used was not associated with 30-day mortality. CONCLUSION: Preexisting diabetes...

  3. Multifaceted intra-seasonal modes over the East Asia-western North Pacific summer monsoon region

    Science.gov (United States)

    Ha, K. J.; Oh, H.

    2017-12-01

    Intra-seasonal monsoon prediction is the most imperative task due to high impact on 2/3 of world populations' daily life, but there remains an enduring challenge in climate science. The present study aims to provide a physical understanding of the sources for prediction of dominant intra-seasonal modes in the East Asian-western North Pacific summer monsoon (EA-WNPSM): preMeiyu&Baiu, Changma&Meiyu, WNPSM, and monsoon gyre modes classified by the self-organizing map analysis. The preMeiyu-Baiu mode is strongly linked to both the anomalous low-level convergence and vertical wind shear through baroclinic instability, and the Changma&Meiyu mode has a strengthened tropic-subtropics connection along the western north Pacific subtropical high, which induces vertical destabilization and strong convective instability. The WNPSM and monsoon gyre modes are characterized by anomalous southeasterly flow of warm and moist air from western north Pacific monsoon, and low-level easterly flow, respectively. Prominent difference in response to the ENSO leads to different effects of the Indian Ocean and western Pacific thermal state, and consequently, the distinct moisture supply and instability variations for the EASM intra-seasonal modes. We attempt to determine the predictability sources for the four modes in the EA-WNPSM using physical-empirical model. The selected predictors are based on the persistent and tendency signals of the SST/2m air temperature and sea level pressure fields, which reflect the asymmetric response to the ENSO and the ocean and land surface anomalous conditions. For the preMeiyu&Baiu mode, the SST cooling tendency over the WNP, which persists into summer, is the distinguishing contributor which is causative of north-south thermal contrast. Since the Changma&Meiyu mode is strongly related to the WNP subtropical high, a major precursor is the persistent SST difference between the Indian Ocean and the western Pacific. The WNPSM mode is mostly affected by the

  4. Predictive factors of mortality within 30 days in patients with nonvariceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Lee, Yoo Jin; Min, Bo Ram; Kim, Eun Soo; Park, Kyung Sik; Cho, Kwang Bum; Jang, Byoung Kuk; Chung, Woo Jin; Hwang, Jae Seok; Jeon, Seong Woo

    2016-01-01

    Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency that can be life threatening. This study evaluated predictive factors of 30-day mortality in patients with this condition. A prospective observational study was conducted at a single hospital between April 2010 and November 2012, and 336 patients with symptoms and signs of gastrointestinal bleeding were consecutively enrolled. Clinical characteristics and endoscopic findings were reviewed to identify potential factors associated with 30-day mortality. Overall, 184 patients were included in the study (men, 79.3%; mean age, 59.81 years), and 16 patients died within 30 days (8.7%). Multivariate analyses revealed that comorbidity of diabetes mellitus (DM) or metastatic malignancy, age ≥ 65 years, and hypotension (systolic pressure < 90 mmHg) during hospitalization were significant predictive factors of 30-day mortality. Comorbidity of DM or metastatic malignancy, age ≥ 65 years, and hemodynamic instability during hospitalization were predictors of 30-day mortality in patients with NVUGIB. These results will help guide the management of patients with this condition.

  5. Trends in Red Blood Cell Transfusion and 30-Day Mortality among Hospitalized Patients

    Science.gov (United States)

    Roubinian, Nareg H; Escobar, Gabriel J; Liu, Vincent; Swain, Bix E; Gardner, Marla N; Kipnis, Patricia; Triulzi, Darrell J; Gottschall, Jerome L; Wu, Yan; Carson, Jeffrey L; Kleinman, Steven H; Murphy, Edward L

    2014-01-01

    Background Blood conservation strategies have been shown to be effective in decreasing red blood cell (RBC) utilization in specific patient groups. However, few data exist describing the extent of RBC transfusion reduction or their impact on transfusion practice and mortality in a diverse inpatient population. Methods We conducted a retrospective cohort study using comprehensive electronic medical record data from 21 medical facilities in Kaiser Permanente Northern California (KPNC). We examined unadjusted and risk-adjusted RBC transfusion and 30-day mortality coincident with implementation of RBC conservation strategies. Findings The inpatient study cohort included 391,958 patients who experienced 685,753 hospitalizations. From 2009 to 2013, the incidence of RBC transfusion decreased from 14.0% to 10.8% of hospitalizations; this change coincided with a decline in pre-transfusion hemoglobin levels from 8.1 to 7.6 g/dL. Decreased RBC utilization affected broad groups of admission diagnoses and was most pronounced in patients with a nadir hemoglobin level between 8 and 9 g/dL (n=73,057; 50.8% to 19.3%). During the study period, the standard deviation of risk adjusted RBC transfusion incidence across hospitals decreased by 44% (p blood conservation strategies, RBC transfusion incidence and pre-transfusion hemoglobin levels decreased broadly across medical and surgical patients. Variation in RBC transfusion incidence across hospitals decreased from 2010 to 2013. Consistent with clinical trial data, more restrictive transfusion practice did not appear to impact 30-day mortality. PMID:25135770

  6. Modelling the day to day wind variability offshore central Chile at about 30 deg. south

    International Nuclear Information System (INIS)

    Rutllant, J.

    1994-07-01

    Cycles of strengthening and relaxation of the winds offshore 30 degrees S at central Chile, are related to the propagation of coastal-lows, a year-round phenomenon occurring with periodicities of about one in five days. Simple physical modelling of the day to day variability of the alongshore wind component at a coastal strip extending offshore up to the Rossby deformation radius of these wave perturbations, is presented in terms of the relevant horizontal pressure gradients and the ageostrophic components arising from the coastal-low propagation. The results of 5-day composites of 8 wind-events each, at the winter and summer halves of the annual cycle, respectively; lead to a good agreement between the observed phase-lag of the winds with respect to the pressure forcing field, stressing the importance of the ageostrophic wind components at the extremes of the pressure wave perturbation associated with the passage of coastal-lows over the Point Lengua de Vaca (30 15 S) area. A possible contribution of the upwelling-favorable wind enhancement at the time of the pressure rise and subsequent fall, ahead of the coastal-low, is postulated through an upwelling-front low-level jet, that would be carried onshore and closer to the surface by the combination of the enhanced coastal upwelling, the coastal depression of the subsidence inversion base and the coastal ageostrophic wind components during the passage of the leading edge of the coastal lows. (author). 26 refs, 5 figs, 1 tab

  7. Low and high frequency Madden-Julian oscillations in austral summer: interannual variations

    Energy Technology Data Exchange (ETDEWEB)

    Izumo, Takeshi [Research Institute For Global Change (JAMSTEC), Yokohama (Japan); LOCEAN, IRD-CNRS-UPMC, Paris (France); Masson, Sebastien; Vialard, Jerome; Madec, Gurvan [LOCEAN, IRD-CNRS-UPMC, Paris (France); Boyer Montegut, Clement de [IFREMER, Brest (France); Behera, Swadhin K. [Research Institute For Global Change (JAMSTEC), Yokohama (Japan); Takahashi, Keiko [Earth Simulator Center (JAMSTEC), Yokohama (Japan); Yamagata, Toshio [Research Institute For Global Change (JAMSTEC), Yokohama (Japan); University of Tokyo, Tokyo (Japan)

    2010-09-15

    The Madden-Julian oscillation (MJO) is the main component of intraseasonal variability of the tropical convection, with clear climatic impacts at an almost-global scale. Based on satellite observations, it is shown that there are two types of austral-summer MJO events (broadly defined as 30-120 days convective variability with eastward propagation of about 5 m/s). Equatorial MJO events have a period of 30-50 days and tend to be symmetric about the equator, whereas MJO events centered near 8 S tend to have a longer period of 55-100 days. The lower-frequency variability is associated with a strong upper-ocean response, having a clear signature in both sea surface temperature and its diurnal cycle. These two MJO types have different interannual variations, and are modulated by the Indian Ocean Dipole (IOD). Following a negative IOD event, the lower-frequency southern MJO variability increases, while the higher-frequency equatorial MJO strongly diminishes. We propose two possible explanations for this change in properties of the MJO. One possibility is that changes in the background atmospheric circulation after an IOD favour the development of the low-frequency MJO. The other possibility is that the shallower thermocline ridge and mixed layer depth, by enhancing SST intraseasonal variability and thus ocean-atmosphere coupling in the southwest Indian Ocean (the breeding ground of southern MJO onset), favour the lower-frequency southern MJO variability. (orig.)

  8. Comparison of in-hospital versus 30-day mortality assessments for selected medical conditions.

    Science.gov (United States)

    Borzecki, Ann M; Christiansen, Cindy L; Chew, Priscilla; Loveland, Susan; Rosen, Amy K

    2010-12-01

    In-hospital mortality measures such as the Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators (IQIs) are easily derived using hospital discharge abstracts and publicly available software. However, hospital assessments based on a 30-day postadmission interval might be more accurate given potential differences in facility discharge practices. To compare in-hospital and 30-day mortality rates for 6 medical conditions using the AHRQ IQI software. We used IQI software (v3.1) and 2004-2007 Veterans Health Administration (VA) discharge and Vital Status files to derive 4-year facility-level in-hospital and 30-day observed mortality rates and observed/expected ratios (O/Es) for admissions with a principal diagnosis of acute myocardial infarction, congestive heart failure, stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia. We standardized software-calculated O/Es to the VA population and compared O/Es and outlier status across sites using correlation, observed agreement, and kappas. Of 119 facilities, in-hospital versus 30-day mortality O/E correlations were generally high (median: r = 0.78; range: 0.31-0.86). Examining outlier status, observed agreement was high (median: 84.7%, 80.7%-89.1%). Kappas showed at least moderate agreement (k > 0.40) for all indicators except stroke and hip fracture (k ≤ 0.22). Across indicators, few sites changed from a high to nonoutlier or low outlier, or vice versa (median: 10, range: 7-13). The AHRQ IQI software can be easily adapted to generate 30-day mortality rates. Although 30-day mortality has better face validity as a hospital performance measure than in-hospital mortality, site assessments were similar despite the definition used. Thus, the measure selected for internal benchmarking should primarily depend on the healthcare system's data linkage capabilities.

  9. A systematic review of 30-day readmission after cranial neurosurgery.

    Science.gov (United States)

    Cusimano, Michael D; Pshonyak, Iryna; Lee, Michael Y; Ilie, Gabriela

    2017-08-01

    OBJECTIVE The 30-day readmission rate has emerged as an important marker of the quality of in-hospital care in several fields of medicine. This review aims to summarize available research reporting readmission rates after cranial procedures and to establish an association with demographic, clinical, and system-related factors and clinical outcomes. METHODS The authors conducted a systematic review of several databases; a manual search of the Journal of Neurosurgery, Neurosurgery, Acta Neurochirurgica, Canadian Journal of Neurological Sciences; and the cited references of the selected articles. Quality review was performed using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria. Findings are reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS A total of 1344 articles published between 1947 and 2015 were identified; 25 were considered potentially eligible, of which 12 met inclusion criteria. The 30-day readmission rates varied from 6.9% to 23.89%. Complications arising during or after neurosurgical procedures were a prime reason for readmission. Race, comorbidities, and longer hospital stay put patients at risk for readmission. CONCLUSIONS Although readmission may be an important indicator for good care for the subset of acutely declining patients, neurosurgery should aim to reduce 30-day readmission rates with improved quality of care through systemic changes in the care of neurosurgical patients that promote preventive measures.

  10. Hip Arthroscopy Surgical Volume Trends and 30-Day Postoperative Complications.

    Science.gov (United States)

    Cvetanovich, Gregory L; Chalmers, Peter N; Levy, David M; Mather, Richard C; Harris, Joshua D; Bush-Joseph, Charles A; Nho, Shane J

    2016-07-01

    To determine hip arthroscopy surgical volume trends from 2006 to 2013 using the National Surgical Quality Improvement Program (NSQIP) database, the incidence of 30-day complications of hip arthroscopy, and patient and surgical risk factors for complications. Patients who underwent hip arthroscopy from 2006 to 2013 were identified in the NSQIP database for the over 400 NSQIP participating hospitals from the United States using Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes. Trends in number of hip arthroscopy procedures per year were analyzed. Complications in the 30-day period after hip arthroscopy were identified. Univariate and multivariate regression analyses were performed to identify risk factors for complications. We identified 1,338 patients who underwent hip arthroscopy, with a mean age of 39.5 ± 13.0 years. Female patients comprised 59.6%. Hip arthroscopy procedures became 25 times more common in 2013 than 2006 (P arthroscopy. Hip arthroscopy is an increasingly common procedure, with a 25-fold increase from 2006 to 2013. There is a low incidence of 30-day postoperative complications (1.3%), most commonly bleeding requiring a transfusion, return to the operating room, and superficial infection. Regional/monitored anesthesia care and steroid use were independent risk factors for minor complications. Level III, retrospective comparative study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  11. Boreal Summer Intraseasonal Oscillation Impact on Western North Pacific Typhoons and Rainfall in Taiwan

    OpenAIRE

    Chih-wen Hung; Ho-Jiunn Lin; Pei-ken Kao; Ming-fu Shih; Wei-yi Fong

    2016-01-01

    This study discusses the boreal summer intraseasonal oscillation (BSISO) impact on the western North Pacific (WNP) typhoons and the summer rainfall in Taiwan. The real time BSISO1 and BISISO2 indices are created using the first two and the third and fourth principal components of the multivariate empirical orthogonal function analysis, based on outgoing long-wave radiation and zonal wind at 850 hPa from Lee et al. (2013). The results show that heavy rainfall in Taiwan and the associated WNP t...

  12. Powernext Day-AheadTM statistics April 30, 2005

    International Nuclear Information System (INIS)

    2005-04-01

    The introduction of a power exchange in France is a direct response to the opening up of the European electricity markets. Powernext SA is a Multilateral Trading Facility in charge of managing an optional and anonymous organised exchange offering: - Day-ahead contracts for the management of volume risk on Powernext Day-Ahead TM since 21 November 2001, - Medium term contracts for the management of price risk on Powernext Futures TM since 18 June 2004. This document presents in a series of tables and graphics the April 30, 2005 update of Powernext Day-Ahead TM statistics: traded volumes and average prices from November 2001 to April 2005, monthly overview from April 2004 to April 2005 (volumes, prices and price spreads), weekly overview from January to April 2005, daily and hourly overview and market resilience for April 2005, power consumption in March and April 2005 (average consumption, average forecasted consumption and average price on Powernext Day-Ahead TM ), power consumption on the French hub from January to April 2005 and Powernext Day-Ahead TM prices, transfer capacities in April 2005 (daily capacity allocations for France-Germany, France-Switzerland and France-Spain, daily and monthly capacity allocations for France-Belgium, auction on the France-UK Interconnector, daily and yearly capacity allocation for France-Italy), temperature variations in France from November 2004 to April 2005 and average prices on Powernext Day-Ahead TM , and balancing mechanism for March-April 2005 (half-hourly imbalance settlement prices). (J.S.)

  13. Powernext Day-AheadTM statistics - June 30, 2006

    International Nuclear Information System (INIS)

    2006-01-01

    The introduction of a power exchange in France is a direct response to the opening up of the European electricity markets. Powernext SA is a Multilateral Trading Facility in charge of managing an optional and anonymous organised exchange offering: - Day-ahead contracts for the management of volume risk on Powernext Day-Ahead TM since 21 November 2001, - Medium term contracts for the management of price risk on Powernext Futures TM since 18 June 2004. This document presents in a series of tables and graphics the June 30, 2006 update of Powernext Day-Ahead TM statistics: daily traded volumes and base-load prices from November 2001 to June 2006, monthly overview from June 2005 to June 2006 (volumes and prices), weekly overview from March to June 2006 (volumes and prices), daily and hourly overview and market resilience for June 2006, power consumption in May and June 2006 (average consumption, average forecasted consumption and average price on Powernext Day-Ahead TM ), power consumption on the French hub from July 2005 to May 2006 and Powernext Day-Ahead TM prices, transfer capacities in June 2006 (auction results for France-Germany, France-Belgium, France-UK, France-Spain and France-Italy, and daily capacity allocation for France-Switzerland), temperature variations in France from January 2005 to June 2006 and base-load Powernext Day-Ahead TM prices, and balancing mechanism for April, May and June 2006 (half-hourly imbalance settlement prices). (J.S.)

  14. Extent of Surgery Does Not Influence 30-Day Mortality in Surgery for Metastatic Bone Disease

    DEFF Research Database (Denmark)

    Sørensen, Michala Skovlund; Hindsø, Klaus; Hovgaard, Thea Bechmann

    2016-01-01

    describing the extent of the surgical trauma were found to be associated with 30-day mortality. The 30-day mortality in patients undergoing surgery for MBD is highly dependent on the general health status of the patients as measured by the ASA score and the Karnofsky performance status. The extent of surgery......, measured as duration of surgery, blood loss, and degree of bone resection were not associated with 30-day mortality....

  15. Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery

    Science.gov (United States)

    Sherrod, Brandon A.; Rocque, Brandon G.

    2017-01-01

    Objective Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. Methods The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) 2012–2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. Results A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p neurosurgery. Rates of SSI-associated complications are significantly lower in patients with superficial infection than in those with deep infection. There were no cases of SSI-related mortality within 30 days of the index procedure. PMID:28186474

  16. Comparison the effectiveness of pyruvic acid 50% and salicylic acid 30% in the treatment of acne.

    Science.gov (United States)

    Jaffary, Fariba; Faghihi, Gita; Saraeian, Sara; Hosseini, Sayed Mohsen

    2016-01-01

    Acne vulgaris is a chronic inflammatory disease of the pilosebaceous follicles and one of the most common skin diseases. The peeling method has been recently found to be effective for acne treatment. This study aimed to compare the efficacy of pyruvic acid 50% and salicylic acid 30% peeling in the treatment of mild to moderate acne. In a prospective single-blinded clinical trial, 86 patients with acne were randomly assigned into two groups. In both groups, the routine treatment of acne (topical solution of erythromycin 4%, triclorocarban soap, and sunscreen) were used twice a day for 8 weeks. In addition, salicylic acid 30% for the control group and pyruvic acid 50% for the case group were used. In both groups, acne severity index (ASI) was calculated before and at week 2, 4, 6, and 8 of the treatment. Patient satisfaction was assessed at the end of the treatment. Side effects were recorded using a checklist. In both groups, the reduction in the number of comedones, papules, and ASI were statistically significant ( P < 0.001) in the course of treatment. However, it was not significant regarding the number of pustules ( P = 0.09). None of the number of comedone, papules, pustules, and ASI was statistically different between study groups. Both treatment groups had similar side effects except for scaling in the fifth session, which was significantly lower in salicylic acid - treated patients ( P = 0.015). Both pyruvic acid 50% and salicylic acid 30% are effective in the improvement of mild to moderate acne with no significant difference in efficacy and side effects.

  17. Binaural Interaction Effects of 30-50 Hz Auditory Steady State Responses.

    Science.gov (United States)

    Gransier, Robin; van Wieringen, Astrid; Wouters, Jan

    Auditory stimuli modulated by modulation frequencies within the 30 to 50 Hz region evoke auditory steady state responses (ASSRs) with high signal to noise ratios in adults, and can be used to determine the frequency-specific hearing thresholds of adults who are unable to give behavioral feedback reliably. To measure ASSRs as efficiently as possible a multiple stimulus paradigm can be used, stimulating both ears simultaneously. The response strength of 30 to 50Hz ASSRs is, however, affected when both ears are stimulated simultaneously. The aim of the present study is to gain insight in the measurement efficiency of 30 to 50 Hz ASSRs evoked with a 2-ear stimulation paradigm, by systematically investigating the binaural interaction effects of 30 to 50 Hz ASSRs in normal-hearing adults. ASSRs were obtained with a 64-channel EEG system in 23 normal-hearing adults. All participants participated in one diotic, multiple dichotic, and multiple monaural conditions. Stimuli consisted of a modulated one-octave noise band, centered at 1 kHz, and presented at 70 dB SPL. The diotic condition contained 40 Hz modulated stimuli presented to both ears. In the dichotic conditions, the modulation frequency of the left ear stimulus was kept constant at 40 Hz, while the stimulus at the right ear was either the unmodulated or modulated carrier. In case of the modulated carrier, the modulation frequency varied between 30 and 50 Hz in steps of 2 Hz across conditions. The monaural conditions consisted of all stimuli included in the diotic and dichotic conditions. Modulation frequencies ≥36 Hz resulted in prominent ASSRs in all participants for the monaural conditions. A significant enhancement effect was observed (average: ~3 dB) in the diotic condition, whereas a significant reduction effect was observed in the dichotic conditions. There was no distinct effect of the temporal characteristics of the stimuli on the amount of reduction. The attenuation was in 33% of the cases >3 dB for

  18. Sex and racial/ethnic differences in the reason for 30-day readmission after COPD hospitalization.

    Science.gov (United States)

    Goto, Tadahiro; Faridi, Mohammad Kamal; Gibo, Koichiro; Camargo, Carlos A; Hasegawa, Kohei

    2017-10-01

    Reduction of 30-day readmissions in patients hospitalized for chronic obstructive pulmonary disease (COPD) is a national objective. However, there is a dearth of research on sex and racial/ethnic differences in the reason for 30-day readmission. We conducted a retrospective cohort study using 2006-2012 data from the State Inpatient Database of eight geographically-diverse US states (Arkansas, California, Florida, Iowa, Nebraska, New York, Utah, and Washington). After identifying all hospitalizations for COPD made by patients aged ≥40 years, we investigated the primary diagnostic code for all-cause readmissions within 30 days after the original COPD hospitalization, among the overall group and by sex and race/ethnicity strata. Between 2006 and 2012, there was a total of 845,465 COPD hospitalizations at risk for 30-day readmissions in the eight states. COPD was the leading diagnostic for 30-day readmission after COPD hospitalization, both overall (28%) and across all sex and race/ethnicity strata. The proportion of respiratory diseases (COPD, pneumonia, respiratory failure, and asthma) as the readmission diagnosis was higher in non-Hispanic black (55%), compared to non-Hispanic white (52%) and Hispanics (51%) (p reason for 30-day readmission in patients hospitalized for COPD. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Better Nurse Autonomy Decreases the Odds of 30-Day Mortality and Failure to Rescue

    Science.gov (United States)

    Rao, Aditi D.; Kumar, Aparna; McHugh, Matthew

    2017-01-01

    Research Purpose Autonomy is essential to professional nursing practice and is a core component of good nurse work environments. The primary objective of this study was to examine the relationship between nurse autonomy and 30-day mortality and failure to rescue (FTR) in a hospitalized surgical population. Study Design This study was a secondary analysis of cross-sectional data. It included data from three sources: patient discharge data from state administrative databases, a survey of nurses from four states, and the American Hospital Association annual survey from 2006–2007. Methods Survey responses from 20,684 staff nurses across 570 hospitals were aggregated to the hospital level to assess autonomy measured by a standardized scale. Logistic regression models were used to estimate the relationship between nurse autonomy and 30-day mortality and FTR. Patient comorbidities, surgery type, and other hospital characteristics were included as controls. Findings Greater nurse autonomy at the hospital level was significantly associated with lower odds of 30-day mortality and FTR for surgical patients even after accounting for patient risk and structural hospital characteristics. Each additional point on the nurse autonomy scale was associated with approximately 19% lower odds of 30-day mortality (p autonomy place their surgical patients at an increased risk for mortality and FTR. Clinical Relevance Patients receiving care within institutions that promote high levels of nurse autonomy have a lower risk for death within 30 days and complications leading to death within 30 days. Hospitals can actively take steps to encourage nurse autonomy to positively influence patient outcomes. PMID:28094907

  20. 46 CFR 50.20-30 - Alternative materials or methods of construction.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false Alternative materials or methods of construction. 50.20... ENGINEERING GENERAL PROVISIONS Plan Submittal and Approval § 50.20-30 Alternative materials or methods of construction. (a) When new or alternative procedures, designs, or methods of construction are submitted for...

  1. Intraseasonal response of the northern Indian Ocean coastal waveguide to the Madden-Julian Oscillation

    Digital Repository Service at National Institute of Oceanography (India)

    Vialard, J.; Shenoi, S.S.C.; Mc; Shankar, D.; Durand, F.; Fernando, V.; Shetye, S.R.

    Author version: Geophys. Res. Lett.: 36(14); 2009; doi:10.1029/2009GL038450; 5 pp Intraseasonal response of Northern Indian Ocean coastal waveguide to the Madden-Julian Oscillation J. Vialard 1 2 , S.S.C Shenoi 2 , J.P. McCreary 3 , D. Shankar 2... involving both equatorial wave dynamics and coastal wave propagation around the perimeter of the northern Indian Ocean [McCreary et al., 1993]. The East India Coastal Current (EICC), for example, is strongly influenced by remote wind forcing from...

  2. Liver stiffness and 30-day mortality in a cohort of patients admitted to hospital

    DEFF Research Database (Denmark)

    Lindvig, Kristoffer; Mössner, Belinda K; Pedersen, Court

    2012-01-01

    Eur J Clin Invest 2011 ABSTRACT: Background  Transient elastography (TE) is a new noninvasive method to assess the degree of liver fibrosis by measuring liver stiffness. The objective of this study was to determine whether increased liver stiffness in patients admitted to medical wards...... measure was 30-day mortality. Results  Among 568 patients admitted during 24 days, 289 (50·8%) were included in the study, 212 (73·4%) with valid TE measurement. Increased liver stiffness (TE value > 8 kPa) was found in 22·6% (48/212). This was independently associated with cirrhosis of the liver (P  8 k......Pa was 20·8% (10/48, 95%CI 10·5-35·0%) compared to patients with TE value ≤ 8 kPa 3·7% (6/164, 95%CI 1·3-7·8%) (P  8 kPa was an independent predictor of death. Conclusions  Elevated TE value at admission is associated with increased mortality, cirrhosis of the liver and CHF. This information may potentially...

  3. Predictors of 30-day readmission after aneurysmal subarachnoid hemorrhage: a case-control study.

    Science.gov (United States)

    Greenberg, Jacob K; Guniganti, Ridhima; Arias, Eric J; Desai, Kshitij; Washington, Chad W; Yan, Yan; Weng, Hua; Xiong, Chengjie; Fondahn, Emily; Cross, DeWitte T; Moran, Christopher J; Rich, Keith M; Chicoine, Michael R; Dhar, Rajat; Dacey, Ralph G; Derdeyn, Colin P; Zipfel, Gregory J

    2017-06-01

    OBJECTIVE Despite persisting questions regarding its appropriateness, 30-day readmission is an increasingly common quality metric used to influence hospital compensation in the United States. However, there is currently insufficient evidence to identify which patients are at highest risk for readmission after aneurysmal subarachnoid hemorrhage (SAH). The objective of this study was to identify predictors of 30-day readmission after SAH, to focus preventative efforts, and to provide guidance to funding agencies seeking to risk-adjust comparisons among hospitals. METHODS The authors performed a case-control study of 30-day readmission among aneurysmal SAH patients treated at a single center between 2003 and 2013. To control for geographic distance from the hospital and year of treatment, the authors randomly matched each case (30-day readmission) with approximately 2 SAH controls (no readmission) based on home ZIP code and treatment year. They evaluated variables related to patient demographics, socioeconomic characteristics, comorbidities, presentation severity (e.g., Hunt and Hess grade), and clinical course (e.g., need for gastrostomy or tracheostomy, length of stay). Conditional logistic regression was used to identify significant predictors, accounting for the matched design of the study. RESULTS Among 82 SAH patients with unplanned 30-day readmission, the authors matched 78 patients with 153 nonreadmitted controls. Age, demographics, and socioeconomic factors were not associated with readmission. In univariate analysis, multiple variables were significantly associated with readmission, including Hunt and Hess grade (OR 3.0 for Grade IV/V vs I/II), need for gastrostomy placement (OR 2.0), length of hospital stay (OR 1.03 per day), discharge disposition (OR 3.2 for skilled nursing vs other disposition), and Charlson Comorbidity Index (OR 2.3 for score ≥ 2 vs 0). However, the only significant predictor in the multivariate analysis was discharge to a skilled

  4. Predictors of 30-day mortality in patients admitted to ED for acute heart failure.

    Science.gov (United States)

    Marchetti, Matthieu; Benedetti, Antoine; Mimoz, Olivier; Lardeur, Jean-Yves; Guenezan, Jérémy; Marjanovic, Nicolas

    2017-03-01

    Acute heart failure (AHF) is a leading cause of admission in emergency departments (ED). It is associated with significant in-hospital mortality, suggesting that there is room for improvement of care. Our aims were to investigate clinical patterns, biological characteristics and determinants of 30-day mortality. We conducted a single site, retrospective review of adult patients (≥18years) admitted to ED for AHF over a 12-month period. Data collected included demographics, clinical, biological and outcomes data. Epidemiologic data were collected at baseline, and patients were followed up during a 30-day period. There were a total of 322 patients. Mean age was 83.9±9.1years, and 47% of the patients were men. Among them, 59 patients (18.3%) died within 30days of admission to the ED. The following three characteristics were associated with increased mortality: age>85years (OR=1.5[95%CI:0.8-2.7], p=0.01), creatinine clearance 5000pg/mL (OR=2.2[95%CI:1.2-4], p<0.001). The best Nt-proBNP cut-off value to predict first-day mortality was 9000pg/mL (area under the curve (AUC) [95%CI] of 0.790 [0.634-0.935], p<0.001). For 7-day mortality, it was 7900pg/mL (0.698 [0.578-0.819], p<0.001) and for 30-day mortality, 5000pg/mL (0.667 [0.576-0.758], p<0.001). Nt-proBNP level on admission, age and creatinine clearance, are predictive of 30-day mortality in adult patients admitted to ED for AHF. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. 30 CFR 50.20-2 - Criteria-“Transfer to another job.”

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Criteria-âTransfer to another job.â 50.20-2 Section 50.20-2 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR ACCIDENTS..., Injuries, and Illnesses § 50.20-2 Criteria—“Transfer to another job.” “Transfer to another job” means...

  6. Effect of spironolactone on 30-day death and heart failure rehospitalization (from the COACH Study).

    Science.gov (United States)

    Maisel, Alan; Xue, Yang; van Veldhuisen, Dirk J; Voors, Adriaan A; Jaarsma, Tiny; Pang, Peter S; Butler, Javed; Pitt, Bertram; Clopton, Paul; de Boer, Rudolf A

    2014-09-01

    The aim of our study is to investigate the effect of spironolactone on 30-day outcomes in patients with acute heart failure (AHF) and the association between treatment and outcomes stratified by biomarkers. We conducted a secondary analysis of the biomarker substudy of the multicenter COACH (Co-ordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure) trial involving 534 AHF patients for 30-day mortality and HF rehospitalizations. Spironolactone therapy was initiated and terminated at the discretion of the treating physician; 30-day outcomes were compared between patients who were treated with spironolactone and those who were not. Outcomes with spironolactone therapy were explored based on N-terminal pro-B-type natriuretic peptide, ST2, galectin-3, and creatinine levels. Spironolactone was prescribed to 297 (55.6%) patients at discharge (158 new and 139 continued). There were 19 deaths and 30 HF rehospitalizations among 46 patients by 30 days. Patients discharged on spironolactone had significantly less 30-day event (hazard ratio 0.538, p = 0.039) after adjustment for multiple risk factors. Initiation of spironolactone in patients who were not on spironolactone before admission was associated with a significant reduction in event rate (hazard ratio 0.362, p = 0.027). The survival benefit of spironolactone was more prominent in patient groups with elevations of creatinine, N-terminal pro-B-type natriuretic peptide, ST2, or galectin-3. In conclusion, AHF patients who received spironolactone during hospitalization had significantly fewer 30-day mortality and HF rehospitalizations, especially in high-risk patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Intraseasonal vertical velocity variation caused by the equatorial wave in the central equatorial Indian Ocean

    Digital Repository Service at National Institute of Oceanography (India)

    Horii, T.; Masumoto, Y.; Ueki, I.; PrasannaKumar, S.; Mizuno, K.

    to the theoretical solution of the equatorial waves [Matsuno, 1966] and the phase speed of the baroclinic mode, the wave that has meridional current on the equator with a quasi-biweekly period is the anti-symmetric mixed Rossby-gravity wave. In the wave... and conclusions are given in section 5. 2. Field Experiment, Data, and Methods 2.1. MISMO Ocean Observation [8] The goal of MISMO was to observe atmospheric conditions and variability associated with intraseasonal disturbances and resulting ocean responses...

  8. 20th century intraseasonal Asian monsoon dynamics viewed from Isomap

    Directory of Open Access Journals (Sweden)

    A. Hannachi

    2013-10-01

    Full Text Available The Asian summer monsoon is a high-dimensional and highly nonlinear phenomenon involving considerable moisture transport towards land from the ocean, and is critical for the whole region. We have used daily ECMWF reanalysis (ERA-40 sea-level pressure (SLP anomalies on the seasonal cycle, over the region 50–145° E, 20° S–35° N, to study the nonlinearity of the Asian monsoon using Isomap. We have focused on the two-dimensional embedding of the SLP anomalies for ease of interpretation. Unlike the unimodality obtained from tests performed in empirical orthogonal function space, the probability density function, within the two-dimensional Isomap space, turns out to be bimodal. But a clustering procedure applied to the SLP data reveals support for three clusters, which are identified using a three-component bivariate Gaussian mixture model. The modes are found to appear similar to active and break phases of the monsoon over South Asia in addition to a third phase, which shows active conditions over the western North Pacific. Using the low-level wind field anomalies, the active phase over South Asia is found to be characterised by a strengthening and an eastward extension of the Somali jet. However during the break phase, the Somali jet is weakened near southern India, while the monsoon trough in northern India also weakens. Interpretation is aided using the APHRODITE gridded land precipitation product for monsoon Asia. The effect of large-scale seasonal mean monsoon and lower boundary forcing, in the form of ENSO, is also investigated and discussed. The outcome here is that ENSO is shown to perturb the intraseasonal regimes, in agreement with conceptual ideas.

  9. Impact of boreal summer intraseasonal oscillation on heat wave occurrence in Asia and Europe during the summer of 2016

    Science.gov (United States)

    Lee, June-Yi; Hsu, Pang-Chi; ha, Kyung-Ja; Kim, Hae-Jeong; Jung, Yoo-Rim

    2017-04-01

    The summer of 2016 was the earth's hottest summer on record since 1880. Especially, in August, the global mean temperature was 1.66 degree higher than normal and heat waves set records across Asia, Europe, and North America. This study proposes that boreal summer intraseasonal oscillation (BSISO) played an important role in heat wave outbreaks over many regions of the Northern Hemisphere (NH) extratropics in the summer 2016 in addition to other factors including global warming, atmosphere-land interaction, and Africa-Pakistan heavy rainfall. By utilizing the real-time multivariate BSISO indices recently proposed, it has been demonstrated that the two dominant BSISO modes significantly modulate occurrence probability and spatial distributions of extreme rainfall and heat wave over Asia and Europe depending on their phases. The BSISO1 represents the canonical northward propagating variability that often occurs in conjunction with the eastward propagating Madden-Julian Oscillation with quasi-oscillating periods of 30-60 days. The BSISO2 represents the northward/northwestward propagating variability with periods of 10-30 days during primarily the pre-monsoon and monsoon-onset season. In August of 2016, BSISO1 was very active with amplitude up to 2 standard deviation and stayed at phase 7 state for about 20 days. During the phase 7 of BSISO1, extreme convective activity over the South China Sea and western North Pacific typically exerts significant global teleconnection leading to heat wave occurrence over East Asia including Korea and Japan, some part of Russia and Europe, and the western and eastern part of North America. In particular, anticyclonic circulation anomaly tends to be developed over East Asia inducing enhanced adiabatic and diabatic warming over Korea and Japan providing a favorable condition for extreme heat wave occurrence. The August of 2016 exhibited the typical global teleconnection pattern of BSISO1 associated with active convection over the western

  10. Pharmacokinetic and Genomic Effects of Arsenite in Drinking Water on Mouse Lung in a 30-Day Exposure

    Directory of Open Access Journals (Sweden)

    Jaya Chilakapati

    2015-06-01

    Full Text Available The 2 objectives of this subchronic study were to determine the arsenite drinking water exposure dependent increases in female C3H mouse liver and lung tissue arsenicals and to characterize the dose response (to 0, 0.05, 0.25, 1, 10, and 85 ppm arsenite in drinking water for 30 days and a purified AIN-93M diet for genomic mouse lung expression patterns. Mouse lungs were analyzed for inorganic arsenic, monomethylated, and dimethylated arsenicals by hydride generation atomic absorption spectroscopy. The total lung mean arsenical levels were 1.4, 22.5, 30.1, 50.9, 105.3, and 316.4 ng/g lung tissue after 0, 0.05, 0.25, 1, 10, and 85 ppm, respectively. At 85 ppm, the total mean lung arsenical levels increased 14-fold and 131-fold when compared to either the lowest noncontrol dose (0.05 ppm or the control dose, respectively. We found that arsenic exposure elicited minimal numbers of differentially expressed genes (DEGs; 77, 38, 90, 87, and 87 DEGs after 0.05, 0.25, 1, 10, and 85 ppm, respectively, which were associated with cardiovascular disease, development, differentiation, apoptosis, proliferation, and stress response. After 30 days of arsenite exposure, this study showed monotonic increases in mouse lung arsenical (total arsenic and dimethylarsinic acid concentrations but no clear dose-related increases in DEG numbers.

  11. Comparison the effectiveness of pyruvic acid 50% and salicylic acid 30% in the treatment of acne

    Directory of Open Access Journals (Sweden)

    Fariba Jaffary

    2016-01-01

    Full Text Available Background: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous follicles and one of the most common skin diseases. The peeling method has been recently found to be effective for acne treatment. This study aimed to compare the efficacy of pyruvic acid 50% and salicylic acid 30% peeling in the treatment of mild to moderate acne. Materials and Methods: In a prospective single-blinded clinical trial, 86 patients with acne were randomly assigned into two groups. In both groups, the routine treatment of acne (topical solution of erythromycin 4%, triclorocarban soap, and sunscreen were used twice a day for 8 weeks. In addition, salicylic acid 30% for the control group and pyruvic acid 50% for the case group were used. In both groups, acne severity index (ASI was calculated before and at week 2, 4, 6, and 8 of the treatment. Patient satisfaction was assessed at the end of the treatment. Side effects were recorded using a checklist. Results: In both groups, the reduction in the number of comedones, papules, and ASI were statistically significant (P < 0.001 in the course of treatment. However, it was not significant regarding the number of pustules (P = 0.09. None of the number of comedone, papules, pustules, and ASI was statistically different between study groups. Both treatment groups had similar side effects except for scaling in the fifth session, which was significantly lower in salicylic acid - treated patients (P = 0.015. Conclusion: Both pyruvic acid 50% and salicylic acid 30% are effective in the improvement of mild to moderate acne with no significant difference in efficacy and side effects.

  12. Origins of wind-driven intraseasonal sea level variations in the North Indian Ocean coastal waveguide

    Digital Repository Service at National Institute of Oceanography (India)

    Suresh, I.; Vialard, J.; Lengaigne, M.; Han, W.; Mc; Durand, F.; Muraleedharan, P.M.

    version: Geophys. Res. Lett., vol.40(21); 2013; 5740-5744 Origins of wind-driven intraseasonal sea level variations in the North Indian Ocean coastal waveguide I. Suresh1, J. Vialard2, M. Lengaigne2, W. Han3, J. McCreary4, F. Durand5, P.M. Muraleedharan1... reversing winds. These wind variations drive seasonal equatorial Kelvin and Rossby wave responses. The seasonal equatorial Kelvin waves propagate into the North Indian Ocean (hereafter NIO) as coastal Kelvin waves [McCreary et al., 1993]. As a result...

  13. Incidence and predictors of 30-day readmissions in patients hospitalized with chronic pancreatitis: A nationwide analysis.

    Science.gov (United States)

    Shah, Rushikesh; Haydek, Christopher; Mulki, Ramzi; Qayed, Emad

    2018-04-23

    Patients with chronic pancreatitis are prone to frequent readmissions. The aim of this study is to evaluate the rate and predictors of 30-day readmissions in patients with chronic pancreatitis using the Nationwide Readmission Database (NRD). We performed a retrospective analysis of all adult patients with the principal discharge diagnosis of chronic pancreatitis from 2010 through 2014. We excluded patients who died during the hospitalization. Multivariate Cox proportional hazard regression was performed to identify demographic, clinical, and hospital factors that associated with 30-day unplanned readmissions. During the study period, 25,259 patients had the principal discharge diagnosis of chronic pancreatitis and survived the index hospitalization. Of these, 6477 (26.7%) were readmitted within 30 days. Younger age group, males, length of stay >5 days, admission to a large, metropolitan hospital, and several comorbidities (renal failure, rheumatic disease, chronic anemia, heart failure, depression, drug abuse, psychosis, and diabetes) were independently associated with increased risk of 30-day readmission. ERCP, pancreatic surgery, and obesity were associated with lower risk. The most common reasons for readmissions were acute pancreatitis (30%), chronic pancreatitis (17%), pseudocyst (2%), and abdominal pain (6%). One in four patients with chronic pancreatitis is readmitted within 30 days (26.7%). Pancreatic disease accounts for at least half of all readmissions. Several baseline comorbidities and characteristics are associated with 30-day readmission risk after index admission. Knowledge of these predictors can help design interventions to target high-risk patients and reduce readmissions and costs of care. Copyright © 2018 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  14. Intra-Seasonal Flexibility in Avian Metabolic Performance Highlights the Uncoupling of Basal Metabolic Rate and Thermogenic Capacity

    Science.gov (United States)

    Petit, Magali; Lewden, Agnès; Vézina, François

    2013-01-01

    Stochastic winter weather events are predicted to increase in occurrence and amplitude at northern latitudes and organisms are expected to cope through phenotypic flexibility. Small avian species wintering in these environments show acclimatization where basal metabolic rate (BMR) and maximal thermogenic capacity (MSUM) are typically elevated. However, little is known on intra-seasonal variation in metabolic performance and on how population trends truly reflect individual flexibility. Here we report intra-seasonal variation in metabolic parameters measured at the population and individual levels in black-capped chickadees ( Poecile atricapillus ). Results confirmed that population patterns indeed reflect flexibility at the individual level. They showed the expected increase in BMR (6%) and MSUM (34%) in winter relative to summer but also, and most importantly, that these parameters changed differently through time. BMR began its seasonal increase in November, while MSUM had already achieved more than 20% of its inter-seasonal increase by October, and declined to its starting level by March, while MSUM remained high. Although both parameters co-vary on a yearly scale, this mismatch in the timing of variation in winter BMR and MSUM likely reflects different constraints acting on different physiological components and therefore suggests a lack of functional link between these parameters. PMID:23840843

  15. Relative contributions of synoptic and intraseasonal variations to strong cold events over eastern China

    Science.gov (United States)

    Song, Lei; Wu, Renguang; Jiao, Yang

    2018-06-01

    The present study investigates the relative roles of intraseasonal oscillations (ISOs) and synoptic variations in strong cold events over eastern China during the boreal winter. The ISOs and synoptic variations explain about 55% and 20% of the total area-mean temperature anomaly in eastern China, respectively. The advection of synoptic winds on synoptic temperature gradients has a leading contribution to the temperature decrease before the cold events and thus the synoptic variations are important in determining the time of peak cold anomalies. The ISOs have a larger role in sustaining the cold events. The height anomalies associated with ISOs and synoptic variations are manifested as Rossby wave trains propagating along the polar front jet over the Eurasian continent before the cold events. They both contribute to the deepening of the East Asian trough and the development of cold events. Compared to the ISO wave train, the synoptic wave train has a smaller spatial scale and moves faster. There are obvious intraseasonal signals in the stratosphere about 1 week before the cold events over eastern China. Large negative height anomalies associated with the weakening of the polar vortex are observed over the North Atlantic. These anomalies move eastwards and propagate downwards after reaching the west coast of Europe. The downward moving stratospheric signal triggers height anomalies in the troposphere over the entrance region of the polar front jet. Then the anomalies propagate towards East Asia along the wave train, contributing to the intensification of the Siberian high and the East Asian trough and the occurrence of cold events over eastern China.

  16. Is 30-Day Mortality after Admission for Heart Failure an Appropriate Metric for Quality?

    Science.gov (United States)

    Faillace, Robert T; Yost, Gregory W; Chugh, Yashasvi; Adams, Jeffrey; Verma, Beni R; Said, Zaid; Sayed, Ibrahim Ismail; Honushefsky, Ashley; Doddamani, Sanjay; Berger, Peter B

    2018-02-01

    The Centers for Medicare and Medicaid Services (CMS) model for publicly reporting national 30-day-risk-adjusted mortality rates for patients admitted with heart failure fails to include clinical variables known to impact total mortality or take into consideration the culture of end-of-life care. We sought to determine if those variables were related to the 30-day mortality of heart failure patients at Geisinger Medical Center. Electronic records were searched for patients with a diagnosis of heart failure who died from any cause during hospitalization or within 30 days of admission. There were 646 heart-failure-related admissions among 530 patients (1.2 admissions/patient). Sixty-seven of the 530 (13%) patients died: 35 (52%) died during their hospitalization and 32 (48%) died after discharge but within 30 days of admission; of these, 27 (40%) had been transferred in for higher-acuity care. Fifty-one (76%) died from heart failure, and 16 (24%) from other causes. Fifty-five (82%) patients were classified as American Heart Association Stage D, 58 (87%) as New York Heart Association Class IV, and 30 (45%) had right-ventricular systolic dysfunction. None of the 32 patients who died after discharge met recommendations for beta-blockers. Criteria for prescribing angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor blockers were not met by 33 of the 34 patients (97%) with heart failure with reduced ejection fraction not on one of those drugs. Fifty-seven patients (85%) had a do-not-resuscitate (DNR) status. A majority of heart failure-related mortality was among patients who opted for a DNR status with end-stage heart failure, limiting the appropriateness of administering evidence-based therapies. No care gaps were identified that contributed to mortality at our institution. The CMS 30-day model fails to take important variables into consideration. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. 38 CFR 10.50 - Section 601 and section 603 payments made on first day of calendar quarter.

    Science.gov (United States)

    2010-07-01

    ... section 603 payments made on first day of calendar quarter. Cash payments and the first installment of installment payments authorized in sections 601 and 603, respectively of title VI of the World War Adjusted... 603 payments made on first day of calendar quarter. 10.50 Section 10.50 Pensions, Bonuses, and...

  18. Daily modes of South Asian summer monsoon variability in the NCEP climate forecast system

    Energy Technology Data Exchange (ETDEWEB)

    Achuthavarier, Deepthi; Krishnamurthy, V. [George Mason University, Department of Atmospheric, Oceanic and Earth Sciences, Fairfax, VA (United States); Institute of Global Environment and Society, Center for Ocean-Land-Atmosphere Studies, Calverton, MD (United States)

    2011-05-15

    The leading modes of daily variability of the Indian summer monsoon in the climate forecast system (CFS), a coupled general circulation model, of the National Centers for Environmental Predictions (NCEP) are examined. The space-time structures of the daily modes are obtained by applying multi-channel singular spectrum analysis (MSSA) on the daily anomalies of rainfall. Relations of the daily modes to intraseasonal and interannual variability of the monsoon are investigated. The CFS has three intraseasonal oscillations with periods around 106, 57 and 30 days with a combined variance of 7%. The 106-day mode has spatial structure and propagation features similar to the northeastward propagating 45-day mode in the observations except for its longer period. The 57-day mode, despite being in the same time scale as of the observations has poor eastward propagation. The 30-day mode is northwestward propagating and is similar to its observational counterpart. The 106-day mode is specific to the model and should not be mistaken for a new scale of variability in observations. The dominant interannual signal is related to El Nino-Southern Oscillation (ENSO), and, unlike in the observations, has maximum variance in the eastern equatorial Indian Ocean. Although the Indian Ocean Dipole (IOD) mode was not obtained as a separate mode in the rainfall, the ENSO signal has good correlations with the dipole variability, which, therefore, indicates the dominance of ENSO in the model. The interannual variability is largely determined by the ENSO signal over the regions where it has maximum variance. The interannual variability of the intraseasonal oscillations is smaller in comparison. (orig.)

  19. Relative role of pre-monsoon conditions and intraseasonal oscillations in determining early-vs-late indian monsoon intensity in a GCM

    Science.gov (United States)

    Ghosh, Rohit; Chakraborty, Arindam; Nanjundiah, Ravi S.

    2018-01-01

    The aim of this paper is to identify relative roles of different land-atmospheric conditions, apart from sea surface temperature (SST), in determining early vs. late summer monsoon intensity over India in a high resolution general circulation model (GCM). We find that in its early phase (June-July; JJ), pre-monsoon land-atmospheric processes play major role to modulate the precipitation over Indian region. These effects of pre-monsoon conditions decrease substantially during its later phase (August-September; AS) for which the interannual variation is mainly governed by the low frequency northward propagating intraseasonal oscillations. This intraseasonal variability which is related to mean vertical wind shear has a significant role during the early phase of monsoon as well. Further, using multiple linear regression, we show that interannual variation of early and late monsoon rainfall over India is best explained when all these land-atmospheric parameters are taken together. Our study delineates the relative role of different processes affecting early versus later summer monsoon rainfall over India that can be used for determining its subseasonal predictability.

  20. Cholesterol Levels Are Associated with 30-day Mortality from Ischemic Stroke in Dialysis Patients.

    Science.gov (United States)

    Wang, I-Kuan; Liu, Chung-Hsiang; Yen, Tzung-Hai; Jeng, Jiann-Shing; Hsu, Shih-Pin; Chen, Chih-Hung; Lien, Li-Ming; Lin, Ruey-Tay; Chen, An-Chih; Lin, Huey-Juan; Chi, Hsin-Yi; Lai, Ta-Chang; Sun, Yu; Lee, Siu-Pak; Sung, Sheng-Feng; Chen, Po-Lin; Lee, Jiunn-Tay; Chiang, Tsuey-Ru; Lin, Shinn-Kuang; Muo, Chih-Hsin; Ma, Henry; Wen, Chi-Pang; Sung, Fung-Chang; Hsu, Chung Y

    2017-06-01

    We investigated the impact of serum cholesterol levels on 30-day mortality after ischemic stroke in dialysis patients. From the Taiwan Stroke Registry data, we identified 46,770 ischemic stroke cases, including 1101 dialysis patients and 45,669 nondialysis patients from 2006 to 2013. Overall, the 30-day mortality was 1.46-fold greater in the dialysis group than in the nondialysis group (1.75 versus 1.20 per 1000 person-days). The mortality rates were 1.64, .62, 2.82, and 2.23 per 1000 person-days in dialysis patients with serum total cholesterol levels of cholesterol levels of 120-159 mg/dL, the corresponding adjusted hazard ratios of mortality were 4.20 (95% confidence interval [CI] = 1.01-17.4), 8.06 (95% CI = 2.02-32.2), and 6.89 (95% CI = 1.59-29.8) for those with cholesterol levels of cholesterol levels of ≥160 mg/dL or <120 mg/dL on admission are at an elevated hazard of 30-day mortality after ischemic stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. Prediction and Monitoring of Monsoon Intraseasonal Oscillations over Indian Monsoon Region in an Ensemble Prediction System using CFSv2

    Science.gov (United States)

    Borah, Nabanita; Sukumarpillai, Abhilash; Sahai, Atul Kumar; Chattopadhyay, Rajib; Joseph, Susmitha; De, Soumyendu; Nath Goswami, Bhupendra; Kumar, Arun

    2014-05-01

    An ensemble prediction system (EPS) is devised for the extended range prediction (ERP) of monsoon intraseasonal oscillations (MISO) of Indian summer monsoon (ISM) using NCEP Climate Forecast System model version2 at T126 horizontal resolution. The EPS is formulated by producing 11 member ensembles through the perturbation of atmospheric initial conditions. The hindcast experiments were conducted at every 5-day interval for 45 days lead time starting from 16th May to 28th September during 2001-2012. The general simulation of ISM characteristics and the ERP skill of the proposed EPS at pentad mean scale are evaluated in the present study. Though the EPS underestimates both the mean and variability of ISM rainfall, it simulates the northward propagation of MISO reasonably well. It is found that the signal-to-noise ratio becomes unity by about18 days and the predictability error saturates by about 25 days. Though useful deterministic forecasts could be generated up to 2nd pentad lead, significant correlations are observed even up to 4th pentad lead. The skill in predicting large-scale MISO, which is assessed by comparing the predicted and observed MISO indices, is found to be ~17 days. It is noted that the prediction skill of actual rainfall is closely related to the prediction of amplitude of large scale MISO as well as the initial conditions related to the different phases of MISO. Categorical prediction skills reveals that break is more skillfully predicted, followed by active and then normal. The categorical probability skill scores suggest that useful probabilistic forecasts could be generated even up to 4th pentad lead.

  2. Prediction of 30-day morbidity after primary cytoreductive surgery for advanced stage ovarian cancer.

    Science.gov (United States)

    Gerestein, C G; Nieuwenhuyzen-de Boer, G M; Eijkemans, M J; Kooi, G S; Burger, C W

    2010-01-01

    Treatment in advanced stage epithelial ovarian cancer (EOC) is based on primary cytoreductive surgery followed by platinum-based chemotherapy. Successful cytoreduction to minimal residual tumour burden is the most important determinant of prognosis. However, extensive surgical procedures to achieve maximal debulking are inevitably associated with postoperative morbidity and mortality. The objective of this study is to determine predictors of 30-day morbidity after primary cytoreductive surgery for advanced stage EOC. All patients in the South Western part of the Netherlands who underwent primary cytoreductive surgery for advanced stage EOC between January 2004 and December 2007 were identified from the Rotterdam Cancer Registry database. All peri- and postoperative complications within 30 days after surgery were registered and classified according to the definitions of the National Surgical Quality Improvement Programme (NSQIP). To investigate independent predictors of 30-day morbidity, a Cox proportional hazards model with backward stepwise elimination was utilised. The identified predictors were entered into a nomogram. Two hundred and ninety-three patients entered the study protocol. Optimal cytoreduction was achieved in 136 (46%) patients. 30-day morbidity was seen in 99 (34%) patients. Postoperative morbidity could be predicted by age (P=0.007; odds ratio [OR] 1.034), WHO performance status (P=0.046; OR 1.757), extent of surgery (P=0.1308; OR=2.101), and operative time (P=0.017; OR 1.007) with an optimism corrected c-statistic of 0.68. 30-day morbidity could be predicted by age, WHO performance status, operative time and extent of surgery. The generated nomogram could be valuable for predicting operative risk in the individual patient.

  3. Clinical predictors of port infections within the first 30 days of placement.

    Science.gov (United States)

    Bamba, Ravinder; Lorenz, Jonathan M; Lale, Allison J; Funaki, Brian S; Zangan, Steven M

    2014-03-01

    To identify risk factors for port infections within 30 days of placement. A retrospective chart review of port placements from 2002-2009 was conducted. Patients who had port removals secondary to infection within the first 30 days of placement were included. This group of patients was compared with a control group of patients with ports with no evidence of infection. For every one patient with a port infection, two control subjects were chosen of the same gender and new port placement during the same month as the corresponding patient with an infected port. From 2002-2009, 4,404 ports were placed. Of the 4,404 patients, 33 (0.7%) were found to have a port infection within 30 days of placement. Compared with the control group, the early infection group had a higher prevalence of leukopenia (21.2% vs 6.1%, P = .039) and thrombocytopenia (33% vs 12%, P = .0158). There was also a higher prevalence of an inpatient hospital stay during port placement and high international normalized ratio in the early infection group. Low preoperative white blood cell and platelet counts were risk factors for early infection. Abnormal coagulation profiles and inpatient access of ports after placement could be additional risk factors. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  4. Influence of Sacubitril/Valsartan (LCZ696) on 30-Day Readmission After Heart Failure Hospitalization.

    Science.gov (United States)

    Desai, Akshay S; Claggett, Brian L; Packer, Milton; Zile, Michael R; Rouleau, Jean L; Swedberg, Karl; Shi, Victor; Lefkowitz, Martin; Starling, Randall; Teerlink, John; McMurray, John J V; Solomon, Scott D

    2016-07-19

    Patients with heart failure (HF) are at high risk for hospital readmission in the first 30 days following HF hospitalization. This study sought to determine if treatment with sacubitril/valsartan (LCZ696) reduces rates of hospital readmission at 30-days following HF hospitalization compared with enalapril. We assessed the risk of 30-day readmission for any cause following investigator-reported hospitalizations for HF in the PARADIGM-HF trial, which randomized 8,399 participants with HF and reduced ejection fraction to treatment with LCZ696 or enalapril. Accounting for multiple hospitalizations per patient, there were 2,383 investigator-reported HF hospitalizations, of which 1,076 (45.2%) occurred in subjects assigned to LCZ696 and 1,307 (54.8%) occurred in subjects assigned to enalapril. Rates of readmission for any cause at 30 days were 17.8% in LCZ696-assigned subjects and 21.0% in enalapril-assigned subjects (odds ratio: 0.74; 95% confidence interval: 0.56 to 0.97; p = 0.031). Rates of readmission for HF at 30-days were also lower in subjects assigned to LCZ696 (9.7% vs. 13.4%; odds ratio: 0.62; 95% confidence interval: 0.45 to 0.87; p = 0.006). The reduction in both all-cause and HF readmissions with LCZ696 was maintained when the time window from discharge was extended to 60 days and in sensitivity analyses restricted to adjudicated HF hospitalizations. Compared with enalapril, treatment with LCZ696 reduces 30-day readmissions for any cause following discharge from HF hospitalization. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  5. Comparing performance of 30-day readmission risk classifiers among hospitalized primary care patients.

    Science.gov (United States)

    Garrison, Gregory M; Robelia, Paul M; Pecina, Jennifer L; Dawson, Nancy L

    2017-06-01

    Hospital readmission within 30 days of discharge occurs in almost 20% of US Medicare patients and may be a marker of poor quality inpatient care, ineffective hospital to home transitions, or disease severity. Within a patient centered medical home, care transition interventions may only be practical from cost and staffing perspectives if targeted at patients with the greatest risk of readmission. Various scoring algorithms attempt to predict patients at risk for 30-day readmission, but head-to-head comparison of performance is lacking. Compare published scoring algorithms which use generally available electronic medical record data on the same set of hospitalized primary care patients. The LACE index, the LACE+ index, the HOSPITAL score, and the readmission risk score were computed on a consecutive cohort of 26,278 hospital admissions. Classifier performance was assessed by plotting receiver operating characteristic curves comparing the computed score with the actual outcome of death or readmission within 30 days. Statistical significance of differences in performance was assessed using bootstrapping techniques. Correct readmission classification on this cohort was moderate with the following c-statistics: Readmission risk score 0.666; LACE 0.680; LACE+ 0.662; and HOSPITAL 0.675. There was no statistically significant difference in performance between classifiers. Logistic regression based classifiers yield only moderate performance when utilized to predict 30-day readmissions. The task is difficult due to the variety of underlying causes for readmission, nonlinearity, and the arbitrary time period of concern. More sophisticated classification techniques may be necessary to increase performance and allow patient centered medical homes to effectively focus efforts to reduce readmissions. © 2016 John Wiley & Sons, Ltd.

  6. Risk factors for nonelective 30-day readmission in pediatric assault victims.

    Science.gov (United States)

    Buicko, Jessica L; Parreco, Joshua; Willobee, Brent A; Wagenaar, Amy E; Sola, Juan E

    2017-10-01

    Hospital readmission in trauma patients is associated with significant morbidity and increased healthcare costs. There is limited published data on early hospital readmission in pediatric trauma patients. As presently in healthcare outcomes and readmissions rates are increasingly used as hospital quality indicators, it is paramount to recognize risk factors for readmission. We sought to identify national readmission rates in pediatric assault victims and identify the most common readmission diagnoses among these patients. The Nationwide Readmission Database (NRD) for 2013 was queried for all patients under 18years of age with a non-elective admission with an E-code that is designed as assault using National Trauma Data Bank Standards. Multivariate logistic regression was implemented using 18 variables to determine the odds ratios (OR) for non-elective readmission within 30-days. There were 4050 pediatric victims of assault and 92 (2.27%) died during the initial admission. Of the surviving patients 128 (3.23%) were readmitted within 30days. Of these readmitted patients 24 (18.75%) were readmitted to a different hospital and 31 (24.22%) were readmitted for repeated assault. The variables associated with the highest risk for non-elective readmission within 30-days were: length of stay (LOS) >7days (OR 3.028, preadmission diagnosis groups were bipolar disorders (8.2%), post-operative, posttraumatic, or other device infections (6.2%), or major depressive disorders and other/unspecified psychoses (5.2%). Readmission after pediatric assault represents a significant resource burden and almost a quarter of those patients are readmitted after a repeated assault. Understanding risk factors and reasons for readmission in pediatric trauma assault victims can improve discharge planning, family education, and outpatient support, thereby decreasing overall costs and resource burden. Psychoses, weight loss, and prolonged hospitalization are independent prognostic indicators of

  7. Halloysite nanotubes-induced Al accumulation and oxidative damage in liver of mice after 30-day repeated oral administration.

    Science.gov (United States)

    Wang, Xue; Gong, Jiachun; Gui, Zongxiang; Hu, Tingting; Xu, Xiaolong

    2018-06-01

    Halloysite (Al 2 Si 2 O 5 (OH) 4 ·nH 2 O) nanotubes (HNTs) are natural clay materials and widely applied in many fields due to their natural hollow tubular structures. Many in vitro studies indicate that HNTs exhibit a high level of biocompatibility, however the in vivo toxicity of HNTs remains unclear. The objective of this study was to assess the hepatic toxicity of the purified HNTs in mice via oral route. The purified HNTs were orally administered to mice at 5, 50, and 300 mg/kg body weight (BW) every day for 30 days. Oral administration of HNTs stimulated the growth of the mice at the low dose (5 mg/kg BW) with no liver toxicity, but inhibited the growth of the mice at the middle (50 mg/kg BW) and high (300 mg/kg BW) doses. In addition, oral administration of HNTs at the high dose caused Al accumulation in the liver but had no marked effect on the Si content in the organ. The Al accumulation caused significant oxidative stress in the liver, which induced hepatic dysfunction and histopathologic changes. These findings demonstrated that Al accumulation-induced oxidative stress played an important role in the oral HNTs-caused liver injury. © 2018 Wiley Periodicals, Inc.

  8. Predictors of 30- and 90-day readmission following craniotomy for malignant brain tumors: analysis of nationwide data.

    Science.gov (United States)

    Donoho, Daniel A; Wen, Timothy; Babadjouni, Robin M; Schwartzman, William; Buchanan, Ian A; Cen, Steven Y; Zada, Gabriel; Mack, William J; Attenello, Frank J

    2018-01-01

    Hospital readmissions are a major contributor to increased health care costs and are associated with worse patient outcomes after neurosurgery. We used the newly released Nationwide Readmissions Database (NRD) to describe the association between patient, hospital and payer factors with 30- and 90-day readmission following craniotomy for malignant brain tumor. All adult inpatients undergoing craniotomy for primary and secondary malignant brain tumors in the NRD from 2013 to 2014 were included. We identified all cause readmissions within 30- and 90-days following craniotomy for tumor, excluding scheduled chemotherapeutic procedures. We used univariate and multivariate models to identify patient, hospital and administrative factors associated with readmission. We identified 27,717 admissions for brain tumor craniotomy in 2013-2014, with 3343 (13.2%) 30-day and 5271 (25.7%) 90-day readmissions. In multivariate analysis, patients with Medicaid and Medicare were more likely to be readmitted at 30- and 90-days compared to privately insured patients. Patients with two or more comorbidities were more likely to be readmitted at 30- and 90-days, and patients discharged to skilled nursing facilities or home health care were associated with increased 90-day readmission rates. Finally, hospital procedural volume above the 75th percentile was associated with decreased 90-day readmission rates. Patients treated at high volume hospitals are less likely to be readmitted at 90-days. Insurance type, non-routine discharge and patient comorbidities are predictors of postoperative non-scheduled readmission. Further studies may elucidate potentially modifiable risk factors when attempting to improve outcomes and reduce cost associated with brain tumor surgery.

  9. Multicentre clinical trial experience with the HeartMate 3 left ventricular assist device: 30-day outcomes.

    Science.gov (United States)

    Zimpfer, Daniel; Netuka, Ivan; Schmitto, Jan D; Pya, Yuriy; Garbade, Jens; Morshuis, Michiel; Beyersdorf, Friedhelm; Marasco, Silvana; Rao, Vivek; Damme, Laura; Sood, Poornima; Krabatsch, Thomas

    2016-09-01

    The objective of this study was to describe the operative experience and 30-day outcomes of patients implanted with the HeartMate 3 Left Ventricular Assist System (LVAS) during the Conformité Européenne (CE) Mark clinical trial. Adult patients met inclusion and exclusion criteria defining advanced-stage heart failure and included the indications of bridge to transplant and destination therapy. Operative parameters, outcomes, adverse events, physical status and quality-of-life parameters were assessed in the first 30 days after LVAS implant. Fifty patients were implanted with the HeartMate 3 at 10 centres in 6 countries. The 30-day survival rate was 98%. The median operative and cardiopulmonary bypass times were 200 (range: 95-585) min and 84 (range: 47-250) min, respectively. Patients required transfusion with packed red blood cells (3.6 ± 2.3 units), fresh frozen plasma (6.5 ± 5 units) and platelets (2 ± 1 units). Six patients (12%) required reoperation for postoperative bleeding and 10 patients (20%) did not require blood transfusion. The median intensive care time was 6 days (range: 1-112 days) and the total hospital stay was 28 days (range: 14-116 days). The most common adverse events were bleeding (15, 30%), arrhythmia (14, 28%) and infection (10, 20%). There were 2 (4%) strokes. The 30-day outcomes following implantation of the HeartMate 3 demonstrates excellent survival with low adverse event rates. The LVAD performed as intended with no haemolysis or device failure. NCT02170363. HeartMate 3™ CE Mark Clinical Investigation Plan (HM3 CE Mark). © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  10. Extended-range forecasting of Chinese summer surface air temperature and heat waves

    Science.gov (United States)

    Zhu, Zhiwei; Li, Tim

    2018-03-01

    Because of growing demand from agricultural planning, power management and activity scheduling, extended-range (5-30-day lead) forecasting of summer surface air temperature (SAT) and heat waves over China is carried out in the present study via spatial-temporal projection models (STPMs). Based on the training data during 1960-1999, the predictability sources are found to propagate from Europe, Northeast Asia, and the tropical Pacific, to influence the intraseasonal 10-80 day SAT over China. STPMs are therefore constructed using the projection domains, which are determined by these previous predictability sources. For the independent forecast period (2000-2013), the STPMs can reproduce EOF-filtered 30-80 day SAT at all lead times of 5-30 days over most part of China, and observed 30-80 and 10-80 day SAT at 25-30 days over eastern China. Significant pattern correlation coefficients account for more than 50% of total forecasts at all 5-30-day lead times against EOF-filtered and observed 30-80 day SAT, and at a 20-day lead time against observed 10-80 day SAT. The STPMs perform poorly in reproducing 10-30 day SAT. Forecasting for the first two modes of 10-30 day SAT only shows useful skill within a 15-day lead time. Forecasting for the third mode of 10-30 day SAT is useless after a 10-day lead time. The forecasted heat waves over China are determined by the reconstructed SAT which is the summation of the forecasted 10-80 day SAT and the lower frequency (longer than 80-day) climatological SAT. Over a large part of China, the STPMs can forecast more than 30% of heat waves within a 15-day lead time. In general, the STPMs demonstrate the promising skill for extended-range forecasting of Chinese summer SAT and heat waves.

  11. 76 FR 10035 - Agency Information Collection Request. 30-Day Public Comment Request, Grants.gov

    Science.gov (United States)

    2011-02-23

    ... updated to reflect changes in location within the United States Code. The ``Trafficking Victims Protection... DEPARTMENT OF HEALTH AND HUMAN SERVICES [30-day notice] Agency Information Collection Request. 30...), Department of Health and Human Services, is publishing the following summary of a proposed collection for...

  12. 76 FR 10034 - Agency Information Collection Request. 30-Day Public Comment Request, Grants.gov

    Science.gov (United States)

    2011-02-23

    ... citations located within the United States Code. The ``Trafficking Victims Protection Act of 2000'' (Section... DEPARTMENT OF HEALTH AND HUMAN SERVICES [30-day notice] Agency Information Collection Request. 30...), Department of Health and Human Services, is publishing the following summary of a proposed collection for...

  13. Prediction modelling for trauma using comorbidity and 'true' 30-day outcome.

    Science.gov (United States)

    Bouamra, Omar; Jacques, Richard; Edwards, Antoinette; Yates, David W; Lawrence, Thomas; Jenks, Tom; Woodford, Maralyn; Lecky, Fiona

    2015-12-01

    Prediction models for trauma outcome routinely control for age but there is uncertainty about the need to control for comorbidity and whether the two interact. This paper describes recent revisions to the Trauma Audit and Research Network (TARN) risk adjustment model designed to take account of age and comorbidities. In addition linkage between TARN and the Office of National Statistics (ONS) database allows patient's outcome to be accurately identified up to 30days after injury. Outcome at discharge within 30days was previously used. Prospectively collected data between 2010 and 2013 from the TARN database were analysed. The data for modelling consisted of 129 786 hospital trauma admissions. Three models were compared using the area under the receiver operating curve (AuROC) for assessing the ability of the models to predict outcome, the Akaike information criteria to measure the quality between models and test for goodness-of-fit and calibration. Model 1 is the current TARN model, Model 2 is Model 1 augmented by a modified Charlson comorbidity index and Model 3 is Model 2 with ONS data on 30day outcome. The values of the AuROC curve for Model 1 were 0.896 (95% CI 0.893 to 0.899), for Model 2 were 0.904 (0.900 to 0.907) and for Model 3 0.897 (0.896 to 0.902). No significant interaction was found between age and comorbidity in Model 2 or in Model 3. The new model includes comorbidity and this has improved outcome prediction. There was no interaction between age and comorbidity, suggesting that both independently increase vulnerability to mortality after injury. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. Nomogram for 30-day morbidity after primary cytoreductive surgery for advanced stage ovarian cancer.

    Science.gov (United States)

    Nieuwenhuyzen-de Boer, G M; Gerestein, C G; Eijkemans, M J C; Burger, C W; Kooi, G S

    2016-01-01

    Extensive surgical procedures to achieve maximal cytoreduction in patients with advanced stage epithelial ovarian cancer (EOC) are inevitably associated with postoperative morbidity and mortality. This study aimed to identify preoperative predictors of 30-day morbidity after primary cytoreductive surgery for advanced stage EOC and to develop a nomogram for individual risk assessment. Patients in The Netherlands who underwent primary cytoreductive surgery for advanced stage EOC between January 2004 and December 2007. All peri- and postoperative complications within 30 days after surgery were registered and classified. To investigate predictors of 30-day morbidity, a Cox proportional hazard model with backward stepwise elimination was utilized. The identified predictors were entered into a nomogram. The main outcome was to identify parameters that predict operative risk. 293 patients entered the study protocol. Optimal cytoreduction was achieved in 136 (46%) patients. Thirty-day morbidity was seen in 99 (34%) patients. Morbidity could be predicted by age (p = 0.033; OR 1.024), preoperative hemoglobin (p = 0.194; OR 0.843), and WHO performance status (p = 0.015; OR 1.821) with a optimism-corrected c-statistic of 0.62. Determinants co-morbidity status, serum CA125 level, platelet count, and presence of ascites were comparable in both groups. Thirty-day morbidity after primary cytoreductive surgery for advanced stage EOC could be predicted by age, hemoglobin, and WHO performance status. The generated nomogram could be valuable for predicting operative risk in the individual patient.

  15. Increased 30-Day Emergency Department Revisits Among Homeless Patients with Mental Health Conditions

    Directory of Open Access Journals (Sweden)

    Chun Nok Lam

    2016-09-01

    Full Text Available Introduction: Patients with mental health conditions frequently use emergency medical services. Many suffer from substance use and homelessness. If they use the emergency department (ED as their primary source of care, potentially preventable frequent ED revisits and hospital readmissions can worsen an already crowded healthcare system. However, the magnitude to which homelessness affects health service utilization among patients with mental health conditions remains unclear in the medical community. This study assessed the impact of homelessness on 30-day ED revisits and hospital readmissions among patients presenting with mental health conditions in an urban, safety-net hospital. Methods: We conducted a secondary analysis of administrative data on all adult ED visits in 2012 in an urban safety-net hospital. Patient demographics, mental health status, homelessness, insurance coverage, level of acuity, and ED disposition per ED visit were analyzed using multilevel modeling to control for multiple visits nested within patients. We performed multivariate logistic regressions to evaluate if homelessness moderated the likelihood of mental health patients’ 30-day ED revisits and hospital readmissions. Results: Study included 139,414 adult ED visits from 92,307 unique patients (43.5±15.1 years, 51.3% male, 68.2% Hispanic/Latino. Nearly 8% of patients presented with mental health conditions, while 4.6% were homeless at any time during the study period. Among patients with mental health conditions, being homeless contributed to an additional 28.0% increase in likelihood (4.28 to 5.48 odds of 30-day ED revisits and 38.2% increase in likelihood (2.04 to 2.82 odds of hospital readmission, compared to non-homeless, non-mental health (NHNM patients as the base category. Adjusted predicted probabilities showed that homeless patients presenting with mental health conditions have a 31.1% chance of returning to the ED within 30-day post discharge and a 3

  16. GYM score: 30-day mortality predictive model in elderly patients attended in the emergency department with infection.

    Science.gov (United States)

    González Del Castillo, Juan; Escobar-Curbelo, Luis; Martínez-Ortíz de Zárate, Mikel; Llopis-Roca, Ferrán; García-Lamberechts, Jorge; Moreno-Cuervo, Álvaro; Fernández, Cristina; Martín-Sánchez, Francisco Javier

    2017-06-01

    To determine the validity of the classic sepsis criteria or systemic inflammatory response syndrome (heart rate, respiratory rate, temperature, and leukocyte count) and the modified sepsis criteria (systemic inflammatory response syndrome criteria plus glycemia and altered mental status), and the validity of each of these variables individually to predict 30-day mortality, as well as develop a predictive model of 30-day mortality in elderly patients attended for infection in emergency departments (ED). A prospective cohort study including patients at least 75 years old attended in three Spanish university ED for infection during 2013 was carried out. Demographic variables and data on comorbidities, functional status, hemodynamic sepsis diagnosis variables, site of infection, and 30-day mortality were collected. A total of 293 patients were finally included, mean age 84.0 (SD 5.5) years, and 158 (53.9%) were men. Overall, 185 patients (64%) fulfilled the classic sepsis criteria and 224 patients (76.5%) fulfilled the modified sepsis criteria. The all-cause 30-day mortality was 13.0%. The area under the curve of the classic sepsis criteria was 0.585 [95% confidence interval (CI) 0.488-0.681; P=0.106], 0.594 for modified sepsis criteria (95% CI: 0.502-0.685; P=0.075), and 0.751 (95% CI: 0.660-0.841; P20 bpm; Morbidity-Charlson index ≥3) to predict 30-day mortality, with statistically significant differences (P=0.004 and Pcapacity than the classic and the modified sepsis criteria to predict 30-day mortality in elderly patients attended for infection in the ED.

  17. Microbial changes in conjunctival flora with 30-day continuous-wear silicone hydrogel contact lenses.

    Science.gov (United States)

    Iskeleli, Güzin; Bahar, Hrisi; Eroglu, Ebru; Torun, Muzeyyen Mamal; Ozkan, Sehirbay

    2005-05-01

    To determine the effect of 30-day continuous-wear silicone hydrogel contact lenses on the conjunctival flora in asymptomatic wearers. The authors studied 29 eyes of 15 patients wearing Focus NIGHT & DAY silicone hydrogel contact lenses for up to 30 nights of continuous wear. The average age of the patients was 25.54 +/- 8.98 years. Cultures of the inferior cul-de-sac were taken bilaterally from all eyes, before and after lens wear in asymptomatic patients. The isolation and identification of bacteria were made by standard clinical laboratory methods. The number of eyes whose conjunctival cultures were sterile before using the lenses significantly decreased (P = 0.0005), and the number of eyes with a growth of coagulase-negative staphylococci and diphtheroid rods in their conjunctival cultures significantly increased after using these lenses (P = 0.001 and P = 0.031, respectively). Conversely, a statistically significant difference was not found in the number of eyes that carried Propionibacterium acnes and Fusobacterium nucleatum in their conjunctival cultures before and after using the 30-day continuous-wear silicone hydrogel lenses (P = 0.998 and P = 0.488, respectively). The results suggest that the sterility of the conjunctiva significantly decreased after using 30-day continuous-wear silicone hydrogel contact lenses. In addition, the number of bacteria of the normal conjunctival flora significantly increased after the use of these lenses. Contamination by the bacteria of the eyelids may be a possible colonization factor in this study group. Therefore, it is appropriate to examine the patients who wear these lenses more frequently.

  18. CT pulmonary angiography findings that predict 30-day mortality in patients with acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Bach, Andreas Gunter, E-mail: mail@andreas-bach.de [Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany); Nansalmaa, Baasai; Kranz, Johanna [Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany); Taute, Bettina-Maria [Department of Internal Medicine, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany); Wienke, Andreas [Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger-Str. 8, 06112 Halle (Germany); Schramm, Dominik; Surov, Alexey [Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany)

    2015-02-15

    Highlights: • In patients with acute pulmonary embolism contrast reflux in inferior vena cava is significantly stronger in non-survivors (odds ratio 3.29; p < 0.001). • This finding is independent from the following comorbidities: heart insufficiency and pulmonary hypertension. • Measurement of contrast reflux is a new and robust radiologic method for predicting 30-day mortality in patients with acute pulmonary embolism. • Measurement of contrast reflux is a better predictor of 30-day mortality after acute pulmonary embolism than any other existing radiologic predictor. This includes thrombus distribution, and morphometric measurements of right ventricular dysfunction. - Abstract: Purpose: Standard computed tomography pulmonary angiography (CTPA) can be used to diagnose acute pulmonary embolism. In addition, multiple findings at CTPA have been proposed as potential tools for risk stratification. Therefore, the aim of the present study is to examine the prognostic value of (I) thrombus distribution, (II) morphometric parameters of right ventricular dysfunction, and (III) contrast reflux in inferior vena cava on 30-day mortality. Material and methods: In a retrospective, single-center study from 06/2005 to 01/2010 365 consecutive patients were included. Inclusion criteria were: presence of acute pulmonary embolism, and availability of 30-day follow-up. A review of patient charts and images was performed. Results: There were no significant differences between the group of 326 survivors and 39 non-survivors in (I) thrombus distribution, and (II) morphometric measurements of right ventricular dysfunction. However, (III) contrast reflux in inferior vena cava was significantly stronger in non-survivors (odds ratio 3.29; p < 0.001). Results were independent from comorbidities like heart insufficiency and pulmonary hypertension. Conclusion: Measurement of contrast reflux is a new and robust method for predicting 30-day mortality in patients with acute pulmonary

  19. Negative pion-nucleus elastic scattering at 30 and 50 MeV

    International Nuclear Information System (INIS)

    Seth, K.K.; Barlow, D.; Iversen, S.; Kaletka, M.; Nann, H.; Smith, D.; Artuso, M.; Burleson, G.; Blanpied, G.; Daw, G.; Burger, W.J.; Redwine, R.P.; Saghai, B.; Anderson, R.

    1990-01-01

    Differential cross sections for the elastic scattering of 30 and 50 MeV π - by nuclei ranging from 12 C to 208 Pb have been measured using a range spectrometer. Comparison is made with the predictions of a recent optical-model calculation and the general nature of discrepancies is discussed

  20. Predictors of premature clopidogrel discontinuation within 30 days of successful coronary artery stenting

    Directory of Open Access Journals (Sweden)

    Çayan Cakir

    2018-01-01

    Full Text Available Objective: We aimed to determine the prevalence, predictors, and mortality rate of premature clopidogrel discontinuation within 30 days of successful coronary stenting. Methods: All consecutive patients who underwent successful coronary stent implantation at our hospital between December 2006 and December 2007 were prospectively included in this study. Patients were interviewed by telephone 30 days after stent implantation. Premature clopidogrel discontinuation was defined as follows: patients who did not continue clopidogrel after discharge were defined as “never used” and patients who received clopidogrel for <20 days or interrupted therapy for at least 5 successive days within the first 30 days were defined as “partially used.” Results: Follow-up data were available for 381 patients and 58 (15.2% patients reported premature clopidogrel discontinuation. No mortality and only 1 (0.3% stent thrombosis occurred in adherent patients, whereas there were 2 (3.4% mortalities and 6 (10.3% stent thrombosis in the patients who prematurely discontinued clopidogrel. Those who discontinued clopidogrel therapy were older (P = 0.02, more likely to be female (P = 0.02, single (P = 0.03, of lower economic (P < 0.05 and educational status (P < 0.01, more likely to have chronic disease (P = 0.04, less likely to have undergone previous stenting (P = 0.01, and were more likely to be receiving a larger number of drugs (P < 0.05. In multivariate analysis, low- or intermediate-economic status, no history of previous stent implantation, and total number of prescribed drugs using were factors independently associated with premature clopidogrel discontinuation. Conclusion: This study demonstrates several predictors of premature clopidogrel discontinuation. This data may help clinicians pay particular attention to these patients in an attempt to improve the outcomes of coronary stenting.

  1. Risk prediction of emergency department revisit 30 days post discharge: a prospective study.

    Directory of Open Access Journals (Sweden)

    Shiying Hao

    Full Text Available Among patients who are discharged from the Emergency Department (ED, about 3% return within 30 days. Revisits can be related to the nature of the disease, medical errors, and/or inadequate diagnoses and treatment during their initial ED visit. Identification of high-risk patient population can help device new strategies for improved ED care with reduced ED utilization.A decision tree based model with discriminant Electronic Medical Record (EMR features was developed and validated, estimating patient ED 30 day revisit risk. A retrospective cohort of 293,461 ED encounters from HealthInfoNet (HIN, Maine's Health Information Exchange (HIE, between January 1, 2012 and December 31, 2012, was assembled with the associated patients' demographic information and one-year clinical histories before the discharge date as the inputs. To validate, a prospective cohort of 193,886 encounters between January 1, 2013 and June 30, 2013 was constructed. The c-statistics for the retrospective and prospective predictions were 0.710 and 0.704 respectively. Clinical resource utilization, including ED use, was analyzed as a function of the ED risk score. Cluster analysis of high-risk patients identified discrete sub-populations with distinctive demographic, clinical and resource utilization patterns.Our ED 30-day revisit model was prospectively validated on the Maine State HIN secure statewide data system. Future integration of our ED predictive analytics into the ED care work flow may lead to increased opportunities for targeted care intervention to reduce ED resource burden and overall healthcare expense, and improve outcomes.

  2. Application of a serial extended forecast experiment using the ECMWF model to interpret the predictive skill of tropical intraseasonal variability

    Energy Technology Data Exchange (ETDEWEB)

    Agudelo, P.A.; Hoyos, C.D.; Webster, P.J.; Curry, J.A. [Georgia Institute of Technology, School of Earth and Atmospheric Sciences, Atlanta, GA (United States)

    2009-05-15

    The extended-range forecast skill of the ECMWF operational forecast model is evaluated during tropical intraseasonal oscillation (ISO) events in the Indo-West Pacific warm pool. The experiment consists of ensemble extended serial forecasts including winter and summer ISO cases. The forecasts are compared with the ERA-40 analyses. The analysis focuses on understanding the origin of forecast errors by studying the vertical structure of relevant dynamical and moist convective features associated with the ISO. The useful forecast time scale for circulation anomalies is in average 13 days during winter compared to 7-8 days during summer. The forecast skill is not stationary and presents evidence of a flow-dependent nature, with states of the coupled system corresponding to long-lived convective envelopes associated with the ISO for which the skill is always low regardless of the starting date of the forecast. The model is not able to forecast skillfully the generation of specific humidity anomalies and results indicate that the convective processes in the model are associated with the erosion of the ISO forecast skill in the model. Circulation-associated anomalies are forecast better than moist convective associated anomalies. The model tends to generate a more stable atmosphere, limiting the model's capability to reproduce deep convective events, resulting in smaller humidity and circulation anomalies in the forecasts compared to those in ERA-40. (orig.)

  3. Rates, Causes, and Reduction of 30-Day Readmissions of Otolaryngology–Head and Neck Surgical Cases

    Directory of Open Access Journals (Sweden)

    Ali S. Al-Qahtani FKSU, FISQua

    2017-10-01

    Full Text Available Objectives The aim of this study was to determine risk factors associated with 30-day readmission for patients undergoing inpatient otolaryngologic head and neck surgery. Study Design Retrospective cohort study analysis. Setting Study at 2 tertiary hospitals. Methods A 10-year retrospective cohort analysis was performed for 30-day readmissions of otolaryngology surgical cases between July 1, 2006, and June 30, 2016, at Assir Central Hospital and Abha Private Hospital. Data included total number of patients, type of surgical procedure, number of and reasons for readmissions, and length of hospital stay. Results There were 32,662 discharges for otolaryngology operations over the 10-year period of the study, of which 364 patients were readmitted, giving a rate of 11.14 readmissions per 1000 operative procedures (95% CI, 10.1-12.3. The male:female ratio was 1.4:1. Period of postoperative stay ranged from 1 to 3 days and, after readmission, 2 to 5 days. The main reasons for readmission were bleeding in otolaryngologic cases and wound hematoma in head and neck surgical cases. Overall readmission rates dropped significantly from 12.72 per 1000 operative procedures in the first 5 years to 10.16 in the second 5 years. Conclusions This study helped to establish special policies and procedures to prevent readmission by utilizing best practices, including addressing quality care, using preadmission clinics, preventing surgical site infection, and improving communication with community physicians. Plans based on these results also include the development of national model for predicting readmission within 30 days of discharge.

  4. Predicting 30-Day Pneumonia Readmissions Using Electronic Health Record Data.

    Science.gov (United States)

    Makam, Anil N; Nguyen, Oanh Kieu; Clark, Christopher; Zhang, Song; Xie, Bin; Weinreich, Mark; Mortensen, Eric M; Halm, Ethan A

    2017-04-01

    Readmissions after hospitalization for pneumonia are common, but the few risk-prediction models have poor to modest predictive ability. Data routinely collected in the electronic health record (EHR) may improve prediction. To develop pneumonia-specific readmission risk-prediction models using EHR data from the first day and from the entire hospital stay ("full stay"). Observational cohort study using stepwise-backward selection and cross-validation. Consecutive pneumonia hospitalizations from 6 diverse hospitals in north Texas from 2009-2010. All-cause nonelective 30-day readmissions, ascertained from 75 regional hospitals. Of 1463 patients, 13.6% were readmitted. The first-day pneumonia-specific model included sociodemographic factors, prior hospitalizations, thrombocytosis, and a modified pneumonia severity index; the full-stay model included disposition status, vital sign instabilities on discharge, and an updated pneumonia severity index calculated using values from the day of discharge as additional predictors. The full-stay pneumonia-specific model outperformed the first-day model (C statistic 0.731 vs 0.695; P = 0.02; net reclassification index = 0.08). Compared to a validated multi-condition readmission model, the Centers for Medicare and Medicaid Services pneumonia model, and 2 commonly used pneumonia severity of illness scores, the full-stay pneumonia-specific model had better discrimination (C statistic range 0.604-0.681; P pneumonia. This approach outperforms a first-day pneumonia-specific model, the Centers for Medicare and Medicaid Services pneumonia model, and 2 commonly used pneumonia severity of illness scores. Journal of Hospital Medicine 2017;12:209-216. © 2017 Society of Hospital Medicine

  5. 77 FR 32639 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2012-06-01

    ... client insurance enrollment, benefits, and services; factors that influence variation in HIV care costs... quality care. Estimated Annualized Burden Table Number of Average Type of respondent Number of responses... Collection Request; 30-Day Public Comment Request AGENCY: Office of the Secretary, HHS. In compliance with...

  6. All-Cause, 30-Day Readmissions Among Persons With Intellectual and Developmental Disabilities and Mental Illness.

    Science.gov (United States)

    Balogh, Robert; Lin, Elizabeth; Dobranowski, Kristin; Selick, Avra; Wilton, Andrew S; Lunsky, Yona

    2018-03-01

    Early hospital readmissions within 30 days of discharge are common and costly. This research describes predictors of all-cause, 30-day hospital readmissions among persons with intellectual and developmental disabilities (IDD), a group known to experience high rates of hospitalization. A cohort of 66,484 adults with IDD from Ontario, Canada, was used to create two subgroups: individuals with IDD only and those with IDD and mental illness. The rates of hospital readmission were determined and contrasted with a comparison subgroup of people without IDD who have mental illness. Compared with those with mental illness only, individuals with IDD and mental illness were 1.7 times more likely to experience a hospital readmission within 30 days. Predictors of their readmission rates included being a young adult and having high morbidity levels. The high rate of hospital readmission suggests that individuals with IDD and mental illness need attention regarding discharge planning and outpatient follow-up.

  7. 50 CFR 18.30 - Polar bear sport-hunted trophy import permits.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Polar bear sport-hunted trophy import... IMPORTATION OF WILDLIFE AND PLANTS (CONTINUED) MARINE MAMMALS Special Exceptions § 18.30 Polar bear sport... estate, must submit an application for a permit to import a trophy of a polar bear taken in Canada to the...

  8. Comparing 30-day all-cause readmission rates between tibiotalar fusion and total ankle replacement.

    Science.gov (United States)

    Merrill, Robert K; Ferrandino, Rocco M; Hoffman, Ryan; Ndu, Anthony; Shaffer, Gene W

    2018-01-12

    End-stage ankle arthritis is a debilitating condition that negatively impacts patient quality of life. Tibiotalar fusion and total ankle replacement are treatment options for managing ankle arthritis. Few studies have examined short term readmission rates of these two procedures. The objective of this study was compare all-cause 30-day readmission rates between patients undergoing tibiotalar fusion vs. total ankle replacement. This study queried the Nationwide Readmission Database (NRD) from 2013-2014 and used international classification of disease, 9th revision (ICD-9) procedure codes to identify all patients who underwent a tibiotalar fusion or a total ankle replacement. Comorbidities, insurance status, hospital characteristics, and readmission rates were statistically compared between the two cohorts. Risk factors were then identified for 30-day readmission. A total of 5660 patients were analyzed with 2667 in the tibiotalar fusion cohort and 2993 in the total ankle replacement cohort. Univariate analysis revealed that the readmission rate after tibiotalar fusion (4.4%) was statistically greater than after total ankle replacement (1.4%). Multivariable regression analysis indicated that deficiency anemia (OR 2.18), coagulopathy (OR 3.51), renal failure (OR 2.83), other insurance relative to private (OR 3.40), and tibiotalar fusion (OR 2.51) were all statistically significant independent risk factors for having a readmission within 30-days. These findings suggest that during the short-term period following discharge from the hospital, patients who received a tibiotalar fusion are more likely to experience a 30-day readmission. These findings are important for decision making when a surgeon encounters a patient with end stage ankle arthritis. Level III, cohort study. Published by Elsevier Ltd.

  9. Complications and 30-day hospital readmission rates of patients undergoing tracheostomy: A prospective analysis.

    Science.gov (United States)

    Spataro, Emily; Durakovic, Nedim; Kallogjeri, Dorina; Nussenbaum, Brian

    2017-12-01

    To determine inpatient and outpatient tracheostomy complication rates and 30-day hospital readmission rates, and to assess patient and procedural risk factors associated with complications and readmissions. Prospective cohort study. Adult patients undergoing tracheostomy at a single academic hospital performed by any service, for any indication, were enrolled in this study over the course of 1 year. All patients had complete 30-day follow-up after discharge to determine complication and hospital readmission rates. Logistic regression was used to assess patient and procedural risk factors associated with these events. One hundred patients were enrolled in this study from June 1, 2015, to June 1, 2016. The overall inpatient tracheostomy complication rate was 47% (95% confidence interval [CI], 37%-57%). Inpatient complications were associated with location in the medical intensive care unit and increased length of hospitalization. The outpatient tracheostomy complication rate was 15% (95% CI, 8%-22%). Outpatient complications were associated with having a previous tracheostomy or an awake tracheostomy under local anesthesia. The all-cause 30-day hospital readmission rate was 33% (95% CI, 24%-42%), and the tracheostomy-specific readmission rate was 13% (95% CI, 6%-20%). All-cause readmissions were associated with diabetes, length of hospitalization after tracheostomy, and outpatient complications. The overall mortality rate during the study period was 11% (95% CI, 5%-17%), with one tracheostomy-related death. Patients undergoing tracheostomies are at high risk for both inpatient and outpatient complications, as well for 30-day hospital readmission. Understanding patient and procedural risk factors associated with these events will help guide interventions for quality improvement. 2b. Laryngoscope, 127:2746-2753, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  10. 77 FR 2297 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2012-01-17

    ... integrity or research ethics course for the treatment group. The control group will use the existing... DEPARTMENT OF HEALTH AND HUMAN SERVICES [Document Identifier: OS-0990-new; 30-Day Notice] Agency... of the Secretary (OS), Department of Health and Human Services, is publishing the following summary...

  11. 77 FR 9928 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2012-02-21

    ...: Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic Health Records and... permit us to better understand individuals' attitudes toward the privacy and security aspects of the use... DEPARTMENT OF HEALTH AND HUMAN SERVICES [Document Identifier: OS-0990-New; 30-day Notice] Agency...

  12. Income inequality and 30 day outcomes after acute myocardial infarction, heart failure, and pneumonia: retrospective cohort study.

    Science.gov (United States)

    Lindenauer, Peter K; Lagu, Tara; Rothberg, Michael B; Avrunin, Jill; Pekow, Penelope S; Wang, Yongfei; Krumholz, Harlan M

    2013-02-14

    To examine the association between income inequality and the risk of mortality and readmission within 30 days of hospitalization. Retrospective cohort study of Medicare beneficiaries in the United States. Hierarchical, logistic regression models were developed to estimate the association between income inequality (measured at the US state level) and a patient's risk of mortality and readmission, while sequentially controlling for patient, hospital, other state, and patient socioeconomic characteristics. We considered a 0.05 unit increase in the Gini coefficient as a measure of income inequality. US acute care hospitals. Patients aged 65 years and older, and hospitalized in 2006-08 with a principal diagnosis of acute myocardial infarction, heart failure, or pneumonia. Risk of death within 30 days of admission or rehospitalization for any cause within 30 days of discharge. The potential number of excess deaths and readmissions associated with higher levels of inequality in US states in the three highest quarters of income inequality were compared with corresponding data in US states in the lowest quarter. Mortality analyses included 555,962 admissions (4348 hospitals) for acute myocardial infarction, 1,092,285 (4484) for heart failure, and 1,146,414 (4520); readmission analyses included 553,037 (4262), 1,345,909 (4494), and 1,345,909 (4524) admissions, respectively. In 2006-08, income inequality in US states (as measured by the average Gini coefficient over three years) varied from 0.41 in Utah to 0.50 in New York. Multilevel models showed no significant association between income inequality and mortality within 30 days of admission for patients with acute myocardial infarction, heart failure, or pneumonia. By contrast, income inequality was associated with rehospitalization (acute myocardial infarction, risk ratio 1.09 (95% confidence interval 1.03 to 1.15), heart failure 1.07 (1.01 to 1.12), pneumonia 1.09 (1.03 to 1.15)). Further adjustment for individual income

  13. A novel risk classification system for 30-day mortality in children undergoing surgery

    Science.gov (United States)

    Walter, Arianne I.; Jones, Tamekia L.; Huang, Eunice Y.; Davis, Robert L.

    2018-01-01

    A simple, objective and accurate way of grouping children undergoing surgery into clinically relevant risk groups is needed. The purpose of this study, is to develop and validate a preoperative risk classification system for postsurgical 30-day mortality for children undergoing a wide variety of operations. The National Surgical Quality Improvement Project-Pediatric participant use file data for calendar years 2012–2014 was analyzed to determine preoperative variables most associated with death within 30 days of operation (D30). Risk groups were created using classification tree analysis based on these preoperative variables. The resulting risk groups were validated using 2015 data, and applied to neonates and higher risk CPT codes to determine validity in high-risk subpopulations. A five-level risk classification was found to be most accurate. The preoperative need for ventilation, oxygen support, inotropic support, sepsis, the need for emergent surgery and a do not resuscitate order defined non-overlapping groups with observed rates of D30 that vary from 0.075% (Very Low Risk) to 38.6% (Very High Risk). When CPT codes where death was never observed are eliminated or when the system is applied to neonates, the groupings remained predictive of death in an ordinal manner. PMID:29351327

  14. Risk model of thoracic aortic surgery in 4707 cases from a nationwide single-race population through a web-based data entry system: the first report of 30-day and 30-day operative outcome risk models for thoracic aortic surgery.

    Science.gov (United States)

    Motomura, Noboru; Miyata, Hiroaki; Tsukihara, Hiroyuki; Takamoto, Shinichi

    2008-09-30

    The objective of this study was to collect integrated data from nationwide hospitals using a web-based national database system to build up our own risk model for the outcome from thoracic aortic surgery. The Japan Adult Cardiovascular Surgery Database was used; this involved approximately 180 hospitals throughout Japan through a web-based data entry system. Variables and definitions are almost identical to the STS National Database. After data cleanup, 4707 records were analyzed from 97 hospitals (between January 1, 2000, and December 31, 2005). Mean age was 66.5 years. Preoperatively, the incidence of chronic lung disease was 11%, renal failure was 9%, and rupture or malperfusion was 10%. The incidence of the location along the aorta requiring replacement surgery (including overlapping areas) was: aortic root, 10%; ascending aorta, 47%; aortic arch, 44%; distal arch, 21%; descending aorta, 27%; and thoracoabdominal aorta, 8%. Raw 30-day and 30-day operative mortality rates were 6.7% and 8.6%, respectively. Postoperative incidence of permanent stroke was 6.1%, and renal failure requiring dialysis was 6.7%. OR for 30-day operative mortality was as follows: emergency or salvage, 3.7; creatinine >3.0 mg/dL, 3.0; and unexpected coronary artery bypass graft, 2.6. As a performance metric of the risk model, C-index of 30-day and 30-day operative mortality was 0.79 and 0.78, respectively. This is the first report of risk stratification on thoracic aortic surgery using a nationwide surgical database. Although condition of these patients undergoing thoracic aortic surgery was much more serious than other procedures, the result of this series was excellent.

  15. Poleward propagation of boreal summer intraseasonal oscillations in a coupled model: role of internal processes

    Energy Technology Data Exchange (ETDEWEB)

    Ajayamohan, R.S. [University of Victoria, Canadian Centre for Climate Modelling and Analysis, P.O. Box 3065, Victoria, BC (Canada); Annamalai, H.; Hafner, Jan [University of Hawaii, International Pacific Research Center, Honolulu (United States); Luo, Jing-Jia [Japan Agency for Marine-Earth Science and Technology, Frontier Research Centre for Global Change, Yokohama (Japan); Yamagata, Toshio [Japan Agency for Marine-Earth Science and Technology, Frontier Research Centre for Global Change, Yokohama (Japan); The University of Tokyo, Department of Earth and Planetary Science, Tokyo (Japan)

    2011-09-15

    The study compares the simulated poleward migration characteristics of boreal summer intraseasonal oscillations (BSISO) in a suite of coupled ocean-atmospheric model sensitivity integrations. The sensitivity experiments are designed in such a manner to allow full coupling in specific ocean basins but forced by temporally varying monthly climatological sea surface temperature (SST) adopted from the fully coupled model control runs (ES10). While the local air-sea interaction is suppressed in the tropical Indian Ocean and allowed in the other oceans in the ESdI run, it is suppressed in the tropical Pacific and allowed in the other oceans in the ESdP run. Our diagnostics show that the basic mean state in precipitation and easterly vertical shear as well as the BSISO properties remain unchanged due to either inclusion or exclusion of local air-sea interaction. In the presence of realistic easterly vertical shear, the continuous emanation of Rossby waves from the equatorial convection is trapped over the monsoon region that enables the poleward propagation of BSISO anomalies in all the model sensitivity experiments. To explore the internal processes that maintain the tropospheric moisture anomalies ahead of BSISO precipitation anomalies, moisture and moist static energy budgets are performed. In all model experiments, advection of anomalous moisture by climatological winds anchors the moisture anomalies that in turn promote the northward migration of BSISO precipitation. While the results indicate the need for realistic simulation of all aspects of the basic state, our model results need to be taken with caution because in the ECHAM family of coupled models the internal variance at intraseasonal timescales is indeed very high, and therefore local air-sea interactions may not play a pivotal role. (orig.)

  16. Vaccination and 30-Day Mortality Risk in Children, Adolescents, and Young Adults.

    Science.gov (United States)

    McCarthy, Natalie L; Gee, Julianne; Sukumaran, Lakshmi; Weintraub, Eric; Duffy, Jonathan; Kharbanda, Elyse O; Baxter, Roger; Irving, Stephanie; King, Jennifer; Daley, Matthew F; Hechter, Rulin; McNeil, Michael M

    2016-03-01

    This study evaluates the potential association of vaccination and death in the Vaccine Safety Datalink (VSD). The study cohort included individuals ages 9 to 26 years with deaths between January 1, 2005, and December 31, 2011. We implemented a case-centered method to estimate a relative risk (RR) for death in days 0 to 30 after vaccination.Deaths due to external causes (accidents, homicides, and suicides) were excluded from the primary analysis. In a secondary analysis, we included all deaths regardless of cause. A team of physicians reviewed available medical records and coroner's reports to confirm cause of death and assess the causal relationship between death and vaccination. Of the 1100 deaths identified during the study period, 76 (7%) occurred 0 to 30 days after vaccination. The relative risks for deaths after any vaccination and influenza vaccination were significantly lower for deaths due to nonexternal causes (RR 0.57, 95% confidence interval [CI] 0.38-0.83, and RR 0.44, 95% CI 0.24-0.80, respectively) and deaths due to all causes (RR 0.72, 95% CI 0.56-0.91, and RR 0.44, 95% CI 0.28-0.65). No other individual vaccines were significantly associated with death. Among deaths reviewed, 1 cause of death was unknown, 25 deaths were due to nonexternal causes, and 34 deaths were due to external causes. The causality assessment found no evidence of a causal association between vaccination and death. Risk of death was not increased during the 30 days after vaccination, and no deaths were found to be causally associated with vaccination. Copyright © 2016 by the American Academy of Pediatrics.

  17. Lipid paradox in acute myocardial infarction-the association with 30-day in-hospital mortality.

    Science.gov (United States)

    Cheng, Kai-Hung; Chu, Chih-Sheng; Lin, Tsung-Hsien; Lee, Kun-Tai; Sheu, Sheng-Hsiung; Lai, Wen-Ter

    2015-06-01

    Elevated low-density lipoprotein cholesterol and triglycerides are major risk factors for coronary artery disease. However, fatty acids from triglycerides are a major energy source, low-density lipoprotein cholesterol is critical for cell membrane synthesis, and both are critical for cell survival. This study was designed to clarify the relationship between lipid profile, morbidity as assessed by Killip classification, and 30-day mortality in patients with acute myocardial infarction. A noninterventional observational study. Coronary care unit in a university hospital. Seven hundred twenty-four patients with acute myocardial infarction in the coronary care program of the Bureau of Health Promotion were analyzed. None. Low-density lipoprotein cholesterol and triglyceride levels were significantly lower in high-Killip (III+IV) patients compared with low-Killip (I+II) patients and in those who died compared with those who survived beyond 30 days (both pvalues for predicting 30-day mortality and were associated with hazard ratios of 1.65 (95% CI, 1.18-2.30) and 5.05 (95% CI, 1.75-14.54), and the actual mortality rates were 23% in low low-density lipoprotein, 6% in high low-density lipoprotein, 14% in low triglycerides, and 3% in high triglycerides groups, respectively. To test the synergistic effect, high-Killip patients with triglycerides less than 62.5 mg/dL and low-density lipoprotein cholesterol less than 110 mg/dL had a 10.9-fold higher adjusted risk of mortality than low-Killip patients with triglycerides greater than or equal to 62.5 mg/dL and low-density lipoprotein cholesterol greater than or equal to 110 mg/dL (pparadox also improved acute myocardial infarction short-term outcomes prediction on original Killip and thrombolytic in myocardial infarction scores. Low low-density lipoprotein cholesterol, low triglycerides, and high Killip severity were associated with significantly higher 30-day in-hospital mortality in patients presenting with acute myocardial

  18. 30-day hospital readmission after robotic partial nephrectomy--are we prepared for Medicare readmission reduction program?

    Science.gov (United States)

    Brandao, Luis Felipe; Zargar, Homayoun; Laydner, Humberto; Akca, Oktay; Autorino, Riccardo; Ko, Oliver; Samarasekera, Dinesh; Li, Jianbo; Rabets, John; Krishnan, Jayram; Haber, Georges-Pascal; Kaouk, Jihad; Stein, Robert J

    2014-09-01

    After CMS introduced the concept of the Hospital Readmissions Reduction Program, hospitals and health care centers became financially penalized for exceeding specific readmission rates. We retrospectively reviewed our institutional review board approved database of patients undergoing robotic partial nephrectomy at our institution and included in our analysis patients who were readmitted to any hospital as an inpatient stay within 30 days from discharge home after robotic partial nephrectomy. From March 2006 to March 2013 a total of 627 patients underwent robotic partial nephrectomy at our center and 28 (4.46%) were readmitted within 30 days of surgery. Postoperative bleeding was responsible for 8 (28.5%) readmissions. Pulmonary embolism was reported in 3 cases and retroperitoneal abscess was diagnosed in 2. Urinary leak requiring surgical intervention developed in 2 patients, pneumonia was diagnosed in 2 and 2 patients were readmitted for chest pain. Overall 9 (32.1%) patients presented with major complications requiring intervention. On multivariable analysis Charlson comorbidity index score was the only factor significantly associated with a higher 30-day readmission rate (p = 0.03). If the Charlson score was 5 or greater the chance of hospital readmission would be 2.7 times higher. Increased comorbidity, specifically a Charlson score of 5 or greater, was the only significant predictor of a higher incidence of 30-day readmission. This information can be useful in counseling patients regarding robotic partial nephrectomy and in determining baseline rates if CMS expands the number of conditions they evaluate for excess 30-day readmissions. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  19. Diagnosing Air-Sea Interactions on Intraseasonal Timescales

    Science.gov (United States)

    DeMott, C. A.

    2014-12-01

    What is the role of ocean coupling in the Madden Julian Oscillation (MJO)? Consensus thinking holds that the essential physics of the MJO involve interactions between convection, atmospheric wave dynamics, and boundary layer and free troposphere moisture. However, many modeling studies demonstrate improved MJO simulation when an atmosphere-only general circulation model (AGCM) is coupled to an ocean model, so feedbacks from the ocean are probably not negligible. Assessing the importance and processes of these feedbacks is challenging for at least two reasons. First, observations of the MJO only sample the fully coupled ocean-atmosphere system; there is no "uncoupled" MJO in nature. Second, the practice of analyzing the MJO in uncoupled and coupled GCMs (CGCMs) involves using imperfect tools to study the problem. Although MJO simulation is improving in many models, shortcomings remain in both AGCMs and CGCMs, making it difficult to determine if changes brought about through coupling reflect critical air-sea interactions or are simply part of the collective idiosyncracies of a given model. For the atmosphere, ocean feedbacks from intraseasonal sea surface temperature (SST) variations are communicated through their effects on surface fluxes of heat and moisture. This presentation suggests a set of analysis tools for diagnosing the impact of an interactive ocean on surface latent and sensible heat fluxes, including their mean, variance, spectral characteristics, and phasing with respect to wind, SST, and MJO convection. The diagnostics are demonstrated with application to several CMIP5 models, and reveal a variety of responses to coupled ocean feedbacks.

  20. Association between Socioeconomic Status and 30-Day and One-Year All-Cause Mortality after Surgery in South Korea.

    Science.gov (United States)

    Oh, Tak Kyu; Kim, Kooknam; Do, Sang-Hwan; Hwang, Jung-Won; Jeon, Young-Tae

    2018-03-10

    Preoperative socioeconomic status (SES) is associated with outcomes after surgery, although the effect on mortality may vary according to region. This retrospective study evaluated patients who underwent elective surgery at a tertiary hospital from 2011 to 2015 in South Korea. Preoperative SES factors (education, religion, marital status, and occupation) were evaluated for their association with 30-day and one-year all-cause mortality. The final analysis included 80,969 patients who were ≥30 years old, with 30-day mortality detected in 339 cases (0.4%) and one-year mortality detected in 2687 cases (3.3%). As compared to never-married patients, those who were married or cohabitating (odds ratio (OR): 0.678, 95% confidence interval (CI): 0.462-0.995) and those divorced or separated (OR: 0.573, 95% CI: 0.359-0.917) had a lower risk of 30-day mortality after surgery. Similarly, the risk of one-year mortality after surgery was lower among married or cohabitating patients (OR: 0.857, 95% CI: 0.746-0.983) than it was for those who had never married. Moreover, as compared to nonreligious patients, Protestant patients had a decreased risk of 30-day mortality after surgery (OR: 0.642, 95% CI: 0.476-0.866). The present study revealed that marital status and religious affiliation are associated with risk of 30-day and one-year all-cause mortality after surgery.

  1. Monitoring Inter- and Intra-Seasonal Dynamics of Rapidly Degrading Ice-Rich Permafrost Riverbanks in the Lena Delta with TerraSAR-X Time Series

    Directory of Open Access Journals (Sweden)

    Samuel Stettner

    2017-12-01

    Full Text Available Arctic warming is leading to substantial changes to permafrost including rapid degradation of ice and ice-rich coasts and riverbanks. In this study, we present and evaluate a high spatiotemporal resolution three-year time series of X-Band microwave satellite data from the TerraSAR-X (TSX satellite to quantify cliff-top erosion (CTE of an ice-rich permafrost riverbank in the central Lena Delta. We apply a threshold on TSX backscatter images and automatically extract cliff-top lines to derive intra- and inter-annual CTE. In order to examine the drivers of erosion we statistically compare CTE with climatic baseline data using linear mixed models and analysis of variance (ANOVA. Our evaluation of TSX-derived CTE against annual optical-derived CTE and seasonal in situ measurements showed good agreement between all three datasets. We observed continuous erosion from June to September in 2014 and 2015 with no significant seasonality across the thawing season. We found the highest net annual cliff-top erosion of 6.9 m in 2014, in accordance with above-average mean temperatures and thawing degree days as well as low precipitation. We found high net annual erosion and erosion variability in 2015 associated with moderate mean temperatures but above average precipitation. According to linear mixed models, climate parameters alone could not explain intra-seasonal erosional patterns and additional factors such as ground ice content likely drive the observed erosion. Finally, mean backscatter intensity on the cliff surface decreased from −5.29 to −6.69 dB from 2013 to 2015, respectively, likely resulting from changes in surface geometry and properties that could be connected to partial slope stabilization. Overall, we conclude that X-Band backscatter time series can successfully be used to complement optical remote sensing and in situ monitoring of rapid tundra permafrost erosion at riverbanks and coasts by reliably providing information about intra-seasonal

  2. Are PCI Service Volumes Associated with 30-Day Mortality? A Population-Based Study from Taiwan.

    Science.gov (United States)

    Yu, Tsung-Hsien; Chou, Ying-Yi; Wei, Chung-Jen; Tung, Yu-Chi

    2017-11-09

    The volume-outcome relationship has been discussed for over 30 years; however, the findings are inconsistent. This might be due to the heterogeneity of service volume definitions and categorization methods. This study takes percutaneous coronary intervention (PCI) as an example to examine whether the service volume was associated with PCI 30-day mortality, given different service volume definitions and categorization methods. A population-based, cross-sectional multilevel study was conducted. Two definitions of physician and hospital volume were used: (1) the cumulative PCI volume in a previous year before each PCI; (2) the cumulative PCI volume within the study period. The volume was further treated in three ways: (1) a categorical variable based on the American Heart Association's recommendation; (2) a semi-data-driven categorical variable based on k-means clustering algorithm; and (3) a data-driven categorical variable based on the Generalized Additive Model. The results showed that, after adjusting the patient-, physician-, and hospital-level covariates, physician volume was associated inversely with PCI 30-day mortality, but hospital volume was not, no matter which definitions and categorization methods of service volume were applied. Physician volume is negatively associated with PCI 30-day mortality, but the results might vary because of definition and categorization method.

  3. 50 Div in Normandy: A Critical Analysis of the British 50th (Northumbrian) Division on D-Day and in the Battle of Normandy

    National Research Council Canada - National Science Library

    Williams, Ethan R

    2007-01-01

    In late 1943, the British Army ordered the veteran 7th Armored, 51st (Highland) and 50th (Northumbrian) Divisions to return to Great Britain to provide combat experienced troops for the D-Day invasion of northwest Europe...

  4. Preadmission use of nonaspirin nonsteroidal anti-inflammatory drugs and 30-day stroke mortality.

    Science.gov (United States)

    Schmidt, Morten; Hováth-Puhó, Erzsébet; Christiansen, Christian Fynbo; Petersen, Karin L; Bøtker, Hans Erik; Sørensen, Henrik Toft

    2014-11-25

    To examine whether preadmission use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) influenced 30-day stroke mortality. We conducted a nationwide population-based cohort study. Using medical databases, we identified all first-time stroke hospitalizations in Denmark between 2004 and 2012 (n = 100,043) and subsequent mortality. We categorized NSAID use as current (prescription redemption within 60 days before hospital admission), former, and nonuse. Current use was further classified as new or long-term use. Cox regression was used to compute hazard ratios (HRs) of death within 30 days, controlling for potential confounding through multivariable adjustment and propensity score matching. The adjusted HR of death for ischemic stroke was 1.19 (95% confidence interval [CI]: 1.02-1.38) for current users of selective cyclooxygenase (COX)-2 inhibitors compared with nonusers, driven by the effect among new users (1.42, 95% CI: 1.14-1.77). Comparing the different COX-2 inhibitors, the HR was driven by new use of older traditional COX-2 inhibitors (1.42, 95% CI: 1.14-1.78) among which it was 1.53 (95% CI: 1.02-2.28) for etodolac and 1.28 (95% CI: 0.98-1.68) for diclofenac. The propensity score-matched analysis supported the association between older COX-2 inhibitors and ischemic stroke mortality. There was no association for former users. Mortality from intracerebral hemorrhage was not associated with use of nonselective NSAIDs or COX-2 inhibitors. Preadmission use of COX-2 inhibitors was associated with increased 30-day mortality after ischemic stroke, but not hemorrhagic stroke. Use of nonselective NSAIDs at time of admission was not associated with mortality from ischemic stroke or intracerebral hemorrhage. © 2014 American Academy of Neurology.

  5. Major reduction in 30-day mortality after elective colorectal cancer surgery

    DEFF Research Database (Denmark)

    Iversen, Lene Hjerrild; Ingeholm, Peter; Gögenur, Ismail

    2014-01-01

    BACKGROUND: For years, the outcome of colorectal cancer (CRC) surgery has been inferior in Denmark compared to its neighbouring countries. Several strategies have been initiated in Denmark to improve CRC prognosis. We studied whether there has been any effect on postoperative mortality based...... on the information from a national database. METHODS: Patients who underwent elective major surgery for CRC in the period 2001-2011 were identified in the national Danish Colorectal Cancer Group database. Thirty-day mortality rates were calculated and factors with impact on mortality were identified using logistic...... the study period. CONCLUSION: The 30-day mortality rate after elective major surgery for CRC has decreased significantly in Denmark in the past decade. Laparoscopic surgical approach was associated with a reduction in mortality in colon cancer....

  6. Association between Socioeconomic Status and 30-Day and One-Year All-Cause Mortality after Surgery in South Korea

    Directory of Open Access Journals (Sweden)

    Tak Kyu Oh

    2018-03-01

    Full Text Available Preoperative socioeconomic status (SES is associated with outcomes after surgery, although the effect on mortality may vary according to region. This retrospective study evaluated patients who underwent elective surgery at a tertiary hospital from 2011 to 2015 in South Korea. Preoperative SES factors (education, religion, marital status, and occupation were evaluated for their association with 30-day and one-year all-cause mortality. The final analysis included 80,969 patients who were ≥30 years old, with 30-day mortality detected in 339 cases (0.4% and one-year mortality detected in 2687 cases (3.3%. As compared to never-married patients, those who were married or cohabitating (odds ratio (OR: 0.678, 95% confidence interval (CI: 0.462–0.995 and those divorced or separated (OR: 0.573, 95% CI: 0.359–0.917 had a lower risk of 30-day mortality after surgery. Similarly, the risk of one-year mortality after surgery was lower among married or cohabitating patients (OR: 0.857, 95% CI: 0.746–0.983 than it was for those who had never married. Moreover, as compared to nonreligious patients, Protestant patients had a decreased risk of 30-day mortality after surgery (OR: 0.642, 95% CI: 0.476–0.866. The present study revealed that marital status and religious affiliation are associated with risk of 30-day and one-year all-cause mortality after surgery.

  7. Preadmission use of SSRIs alone or in combination with NSAIDs and 30-day mortality after peptic ulcer bleeding

    DEFF Research Database (Denmark)

    Gasse, Christiane; Christensen, Steffen; Riis, Anders

    2009-01-01

    with NSAIDs on 30-day mortality after peptic ulcer bleeding (PUB). MATERIAL AND METHODS. A population-based cohort study of patients with a first hospitalization with PUB in three Danish counties was carried out between 1991 and 2005 using medical databases. We calculated 30-day mortality rate ratios (MRRs...

  8. 78 FR 66040 - 30-Day Notice of Proposed Information Collection: HUD-Owned Real Estate-Sales Contract and Addendums

    Science.gov (United States)

    2013-11-04

    ... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5683-N-91] 30-Day Notice of Proposed Information Collection: HUD-Owned Real Estate--Sales Contract and Addendums AGENCY: Office of the Chief... published a 30 day notice of proposed information collection entitled HUD-Owned Real Estate-Sales Contract...

  9. A propensity score analysis of the impact of surgical intervention on unexpected 30-day readmission following admission for subdural hematoma.

    Science.gov (United States)

    Franko, Lynze R; Sheehan, Kyle M; Roark, Christopher D; Joseph, Jacob R; Burke, James F; Rajajee, Venkatakrishna; Williamson, Craig A

    2017-12-22

    OBJECTIVE Subdural hematoma (SDH) is a common disease that is increasingly being managed nonoperatively. The all-cause readmission rate for SDH has not previously been described. This study seeks to describe the incidence of unexpected 30-day readmission in a cohort of patients admitted to an academic neurosurgical center. Additionally, the relationship between operative management, clinical outcome, and unexpected readmission is explored. METHODS This is an observational study of 200 consecutive adult patients with SDH admitted to the neurosurgical ICU of an academic medical center. Demographic information, clinical characteristics, and treatment strategies were compared between readmitted and nonreadmitted patients. Multivariable logistic regression, weighted by the inverse probability of receiving surgery using propensity scores, was used to evaluate the association between operative management and unexpected readmission. RESULTS Of 200 total patients, 18 (9%) died during hospitalization and were not included in the analysis. Overall, 48 patients (26%) were unexpectedly readmitted within 30 days. Sixteen patients (33.3%) underwent SDH evacuation during their readmission. Factors significantly associated with unexpected readmission were nonoperative management (72.9% vs 54.5%, p = 0.03) and female sex (50.0% vs 32.1%, p = 0.03). In logistic regression analysis weighted by the inverse probability of treatment and including likely confounders, surgical management was not associated with likelihood of a good outcome at hospital discharge, but was associated with significantly reduced odds of unexpected readmission (OR 0.19, 95% CI 0.08-0.49). CONCLUSIONS Over 25% of SDH patients admitted to an academic neurosurgical ICU were unexpectedly readmitted within 30 days. Nonoperative management does not affect outcome at hospital discharge but is significantly associated with readmission, even when accounting for the probability of treatment by propensity score weighted

  10. Event reporting guidelines 10 CFR 50.72 and 50.73. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Allison, D P; Harper, M R; Jones, W R; MacKinnon, J B; Sandin, S S

    1998-01-01

    Revision 1 to NUREG-1022 clarifies the immediate notification requirements of Title 10 of the Code of Federal Regulations, Part 50, Section 50.72 (10 CFR 50.72), and the 30-day written licensee event report (LER) requirements of 10 CFR 50.73 for nuclear power plants. This revision was initiated to improve the reporting guidelines related to 10 CFR 50.72 and 50.73 and to consolidate these guidelines into a single reference document. A first draft of this document was noticed for public comment in the Federal Register on october 7, 1991 (56 FR 50598). A second draft was noticed for comment in the Federal Register on February 7, 1994 (59 FR 5614). This document updates and supersedes NUREG-1022 and its Supplements 1 and 2 (published in September 1983, February 1984, and September 1985, respectively). It does not change the reporting requirements of 10 CFR 50.72 and 50.73.

  11. Event reporting guidelines 10 CFR 50.72 and 50.73. Revision 1

    International Nuclear Information System (INIS)

    Allison, D.P.; Harper, M.R.; Jones, W.R.; MacKinnon, J.B.; Sandin, S.S.

    1998-01-01

    Revision 1 to NUREG-1022 clarifies the immediate notification requirements of Title 10 of the Code of Federal Regulations, Part 50, Section 50.72 (10 CFR 50.72), and the 30-day written licensee event report (LER) requirements of 10 CFR 50.73 for nuclear power plants. This revision was initiated to improve the reporting guidelines related to 10 CFR 50.72 and 50.73 and to consolidate these guidelines into a single reference document. A first draft of this document was noticed for public comment in the Federal Register on october 7, 1991 (56 FR 50598). A second draft was noticed for comment in the Federal Register on February 7, 1994 (59 FR 5614). This document updates and supersedes NUREG-1022 and its Supplements 1 and 2 (published in September 1983, February 1984, and September 1985, respectively). It does not change the reporting requirements of 10 CFR 50.72 and 50.73

  12. Description of OPRA: A Danish database designed for the analyses of risk factors associated with 30-day hospital readmission of people aged 65+ years.

    Science.gov (United States)

    Pedersen, Mona K; Nielsen, Gunnar L; Uhrenfeldt, Lisbeth; Rasmussen, Ole S; Lundbye-Christensen, Søren

    2017-08-01

    To describe the construction of the Older Person at Risk Assessment (OPRA) database, the ability to link this database with existing data sources obtained from Danish nationwide population-based registries and to discuss its research potential for the analyses of risk factors associated with 30-day hospital readmission. We reviewed Danish nationwide registries to obtain information on demographic and social determinants as well as information on health and health care use in a population of hospitalised older people. The sample included all people aged 65+ years discharged from Danish public hospitals in the period from 1 January 2007 to 30 September 2010. We used personal identifiers to link and integrate the data from all events of interest with the outcome measures in the OPRA database. The database contained records of the patients, admissions and variables of interest. The cohort included 1,267,752 admissions for 479,854 unique people. The rate of 30-day all-cause acute readmission was 18.9% ( n=239,077) and the overall 30-day mortality was 5.0% ( n=63,116). The OPRA database provides the possibility of linking data on health and life events in a population of people moving into retirement and ageing. Construction of the database makes it possible to outline individual life and health trajectories over time, transcending organisational boundaries within health care systems. The OPRA database is multi-component and multi-disciplinary in orientation and has been prepared to be used in a wide range of subgroup analyses, including different outcome measures and statistical methods.

  13. Intra-seasonal and Inter-annual variability of Bowen Ratio over rain-shadow region of North peninsular India

    Science.gov (United States)

    Morwal, S. B.; Narkhedkar, S. G.; Padmakumari, B.; Maheskumar, R. S.; Deshpande, C. G.; Kulkarni, J. R.

    2017-05-01

    Intra-seasonal and inter-annual variability of Bowen Ratio (BR) have been studied over the rain-shadow region of north peninsular India during summer monsoon season. Daily grid point data of latent heat flux (LHF), sensible heat flux (SHF) from NCEP/NCAR Reanalysis for the period 1970-2014 have been used to compute daily area-mean BR. Daily grid point rainfall data at a resolution of 0.25° × 0.25° from APHRODITE's Water Resources for the available period 1970-2007 have been used to study the association between rainfall and BR. The study revealed that BR rapidly decreases from 4.1 to 0.29 in the month of June and then remains nearly constant at the same value (≤0.1) in the rest of the season. High values of BR in the first half of June are indicative of intense thermals and convective clouds with higher bases. Low values of BR from July to September period are indicative of weak thermals and convective clouds with lower bases. Intra-seasonal and inter-annual variability of BR is found to be inversely related to precipitation over the region. BR analysis indicates that the land surface characteristics of the study region during July-September are similar to that over oceanic regions as far as intensity of thermals and associated cloud microphysical properties are concerned. Similar variation of BR is found in El Nino and La Nina years. During June, an increasing trend is observed in SHF and BR and decreasing trend in LHF from 1976 to 2014. Increasing trend in the SHF is statistically significant.

  14. Impact of the intraseasonal variability of large-scale circulation over the Western North Pacific on the characteristics of tropical cyclone track

    OpenAIRE

    Chen, T. C.; Wang, Shih-Yu (Simon); Yen, M. C.; Clark, A. J.

    2009-01-01

    The life cycle of the Southeast Asian–western North Pacific monsoon circulation is established by the northward migrations of the monsoon trough and the western Pacific subtropical anticyclone, and is reflected by the intraseasonal variations of mo nsoon westerlies and trad e easterlies in the form of an east–west seesaw oscillation. In this paper, an effort is made to disclose the influence of this monsoon circulation on tropical cyclone tracks during its different ph ases using composite ch...

  15. Age-related differences in the rate and diagnosis of 30-day readmission after hospitalization for acute ischemic stroke.

    Science.gov (United States)

    Hirayama, Atsushi; Goto, Tadahiro; Faridi, Mohammad K; Camargo, Carlos A; Hasegawa, Kohei

    2018-01-01

    Background Little is known about the association between age and readmission within 30 days after hospitalization for acute ischemic stroke. Aim To examine the age-related differences in rate and principal reason of 30-day readmissions in patients hospitalized for acute ischemic stroke. Methods In this retrospective, population-based cohort study using State Inpatient Databases from eight US states, we identified all adults hospitalized for acute ischemic stroke. We grouped the patients into four age categories: readmission within 30 days of discharge from the index hospitalization for acute ischemic stroke and the principal diagnosis of 30-day readmission. Results We identified 620,788 hospitalizations for acute ischemic stroke. The overall 30-day readmission rate was 16.6% with an increase with advanced age. Compared to patients aged readmission rate was significantly higher in age 65-74 years (OR 1.19; 95% CI 1.16-1.21), in age 75-84 years (OR 1.29; 95% CI 1.27-1.31), and in ≥ 85 years (OR 1.24; 95% CI 1.22-1.27; all Preadmission rate association between men and women (P interaction  readmissions were assigned stroke-related conditions or rehabilitation care. Compared to younger adults, older adults were more likely to present with non-stroke-related conditions (46.1% in readmission rate after acute ischemic stroke. Compared with younger adults, older adults were more likely to be readmitted for non-stroke-related conditions.

  16. Software in 30 days how agile managers beat the odds, delight their customers, and leave competitors in the dust

    CERN Document Server

    Schwaber, Ken

    2012-01-01

    A radical approach to getting IT projects done faster and cheaper than anyone thinks possible Software in 30 Days summarizes the Agile and Scrum software development method, which allows creation of game-changing software, in just 30 days. Projects that use it are three times more successful than those that don't. Software in 30 Days is for the business manager, the entrepreneur, the product development manager, or IT manager who wants to develop software better and faster than they now believe possible. Learn how this unorthodox process works, how to get started, and how to succeed. Control r

  17. Hematoma Shape, Hematoma Size, Glasgow Coma Scale Score and ICH Score: Which Predicts the 30-Day Mortality Better for Intracerebral Hematoma?

    Science.gov (United States)

    Wang, Chih-Wei; Liu, Yi-Jui; Lee, Yi-Hsiung; Hueng, Dueng-Yuan; Fan, Hueng-Chuen; Yang, Fu-Chi; Hsueh, Chun-Jen; Kao, Hung-Wen; Juan, Chun-Jung; Hsu, Hsian-He

    2014-01-01

    Purpose To investigate the performance of hematoma shape, hematoma size, Glasgow coma scale (GCS) score, and intracerebral hematoma (ICH) score in predicting the 30-day mortality for ICH patients. To examine the influence of the estimation error of hematoma size on the prediction of 30-day mortality. Materials and Methods This retrospective study, approved by a local institutional review board with written informed consent waived, recruited 106 patients diagnosed as ICH by non-enhanced computed tomography study. The hemorrhagic shape, hematoma size measured by computer-assisted volumetric analysis (CAVA) and estimated by ABC/2 formula, ICH score and GCS score was examined. The predicting performance of 30-day mortality of the aforementioned variables was evaluated. Statistical analysis was performed using Kolmogorov-Smirnov tests, paired t test, nonparametric test, linear regression analysis, and binary logistic regression. The receiver operating characteristics curves were plotted and areas under curve (AUC) were calculated for 30-day mortality. A P value less than 0.05 was considered as statistically significant. Results The overall 30-day mortality rate was 15.1% of ICH patients. The hematoma shape, hematoma size, ICH score, and GCS score all significantly predict the 30-day mortality for ICH patients, with an AUC of 0.692 (P = 0.0018), 0.715 (P = 0.0008) (by ABC/2) to 0.738 (P = 0.0002) (by CAVA), 0.877 (Phematoma shape, hematoma size, ICH scores and GCS score all significantly predict the 30-day mortality in an increasing order of AUC. The effect of overestimation of hematoma size by ABC/2 formula in predicting the 30-day mortality could be remedied by using ICH score. PMID:25029592

  18. Recurrent epistaxis: predicting risk of 30-day readmission, derivation and validation of RHINO-ooze score.

    Science.gov (United States)

    Addison, A; Paul, C; Kuo, R; Lamyman, A; Martinez-Devesa, P; Hettige, R

    2017-06-01

    To derive and validate a predictive scoring tool (RHINO-ooze score) with good sensitivity and specificity in identifying patients with epistaxis at high risk of 30 day readmission and to enable risk stratification for possible definitive intervention. Using medical databases, we searched for factors influencing recurrent epistaxis. The information ascertained together with our analysis of retrospective data on patients admitted with epistaxis between October 2013 and September 2014, was used as the derivation cohort to develop the predictive scoring model (RHINO-ooze score). The tool was validated by performing statistical analysis on the validation cohort of patients admitted with epistaxis between October 2014 and October 2015. Multiple linear regressions with backwards elimination was used to derive the predictive model. The area under the curve (AUC), sensitivity and specificity were calculated. 834 admissions were encountered within the study period. Using the derivative cohort (n= 302) the RHINO-ooze score with a maximum score of 8 from five variables (Recent admission, Haemorrhage point unidentified, Increasing age over 70, posterior Nasal packing, Oral anticoagulant) was developed. The RHINO-ooze score had a chi-square value of 99.72 with a significance level of smaller than 0.0001 and hence an overall good model fit. Comparison between the derivative and validation groups revealed similar rates of 30-day readmission between the cohorts. The sensitivity and specificity of predicting 30-day readmission in high risk patients with recurrent epistaxis (RHINO-ooze score equal/larger than 6) was 81% and 84%, respectively. The RHINO-ooze scoring tool demonstrates good specificity and sensitivity in predicting the risk of 30 day readmission in patients with epistaxis and can be used as an adjunct to clinical decision making with regards to timing of operative intervention in order to reduce readmission rates.

  19. Vitamin D status predicts 30 day mortality in hospitalised cats.

    Directory of Open Access Journals (Sweden)

    Helen Titmarsh

    Full Text Available Vitamin D insufficiency, defined as low serum concentrations of the major circulating form of vitamin D, 25 hydroxyvitamin D (25(OHD, has been associated with the development of numerous infectious, inflammatory, and neoplastic disorders in humans. In addition, vitamin D insufficiency has been found to be predictive of mortality for many disorders. However, interpretation of human studies is difficult since vitamin D status is influenced by many factors, including diet, season, latitude, and exposure to UV radiation. In contrast, domesticated cats do not produce vitamin D cutaneously, and most cats are fed a commercial diet containing a relatively standard amount of vitamin D. Consequently, domesticated cats are an attractive model system in which to examine the relationship between serum 25(OHD and health outcomes. The hypothesis of this study was that vitamin D status would predict short term, all-cause mortality in domesticated cats. Serum concentrations of 25(OHD, together with a wide range of other clinical, hematological, and biochemical parameters, were measured in 99 consecutively hospitalised cats. Cats which died within 30 days of initial assessment had significantly lower serum 25(OHD concentrations than cats which survived. In a linear regression model including 12 clinical variables, serum 25(OHD concentration in the lower tertile was significantly predictive of mortality. The odds ratio of mortality within 30 days was 8.27 (95% confidence interval 2.54-31.52 for cats with a serum 25(OHD concentration in the lower tertile. In conclusion, this study demonstrates that low serum 25(OHD concentration status is an independent predictor of short term mortality in cats.

  20. 30 day mortality in adult palliative radiotherapy – A retrospective population based study of 14,972 treatment episodes

    International Nuclear Information System (INIS)

    Spencer, Katie; Morris, Eva; Dugdale, Emma; Newsham, Alexander; Sebag-Montefiore, David; Turner, Rob; Hall, Geoff; Crellin, Adrian

    2015-01-01

    Background: 30-day mortality (30DM) has been suggested as a clinical indicator of the avoidance of harm in palliative radiotherapy within the NHS, but no large-scale population-based studies exist. This large retrospective cohort study aims to investigate the factors that influence 30DM following palliative radiotherapy and consider its value as a clinical indicator. Methods: All radiotherapy episodes delivered in a large UK cancer centre between January 2004 and April 2011 were analysed. Patterns of palliative radiotherapy, 30DM and the variables affecting 30DM were assessed. The impact of these variables was assessed using logistic regression. Results: 14,972 palliative episodes were analysed. 6334 (42.3%) treatments were delivered to bone metastases, 2356 (15 7%) to the chest for lung cancer and 915 (5.7%) to the brain. Median treatment time was 1 day (IQR 1–7). Overall 30DM was 12.3%. Factors having a significant impact upon 30DM were sex, primary diagnosis, treatment site and fractionation schedule (p < 0.01). Conclusion: This is the first large-scale description of 30-day mortality for unselected adult palliative radiotherapy treatments. The observed differences in early mortality by fractionation support the use of this measure in assessing clinical decision making in palliative radiotherapy and require further study in other centres and health care systems

  1. [Prognostic factors of early 30-day mortality in elderly patients admitted to an emergency department].

    Science.gov (United States)

    Morales Erazo, Alexander; Cardona Arango, Doris

    The main aim of this study was to identify the variables related to early mortality in the elderly at the time of admission to the emergency department. Using probability sampling, the study included patients 60 years old or older of both genders who were admitted for observation to the emergency department of the University Hospital of Nariño, ¿Colombia? in 2015. Using a questionnaire designed for this study, some multidimensional features that affect the health of the elderly were collected (demographic, clinical, psychological, functional, and social variables). The patients were then followed-up for 30 days in order to determine the mortality rate during this time. Univariate and multivariate logistic regressions and survival analysis were performed. Data were collected from 246 patients, with a mean age of 75.27 years and the majority female. The 30-day mortality rate was 15%. The variables most associated with death were: being female, temperature problems, initial diagnosis of neoplasia, and unable to walk independently in the emergency department. It is possible to determine the multidimensional factors present in the older patient admitted to an emergency department that could affect their 30-day mortality prognosis. and which should be intervened. Copyright © 2017 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. The contribution of hospital nursing leadership styles to 30-day patient mortality.

    Science.gov (United States)

    Cummings, Greta G; Midodzi, William K; Wong, Carol A; Estabrooks, Carole A

    2010-01-01

    Nursing work environment characteristics, in particular nurse and physician staffing, have been linked to patient outcomes (adverse events and patient mortality). Researchers have stressed the need for nursing leadership to advance change in healthcare organizations to create safer practice environments for patients. The relationship between styles of nursing leadership in hospitals and patient outcomes has not been well examined. The purpose of this study was to examine the contribution of hospital nursing leadership styles to 30-day mortality after controlling for patient demographics, comorbidities, and hospital factors. Ninety acute care hospitals in Alberta, Canada, were categorized into five styles of nursing leadership: high resonant, moderately resonant, mixed, moderately dissonant, and high dissonant. In the secondary analysis, existing data from three sources (nurses, patients, and institutions) were used to test a hypothesis that the styles of nursing leadership at the hospital level contribute to patient mortality rates. Thirty-day mortality was 7.8% in the study sample of 21,570 medical patients; rates varied across hospital categories: high resonant (5.2%), moderately resonant (7.4%), mixed (8.1%), moderately dissonant (8.8%), and high dissonant (4.3%). After controlling for patient demographics, comorbidities, and institutional and hospital nursing characteristics, nursing leadership styles explained 5.1% of 72.2% of total variance in mortality across hospitals, and high-resonant leadership was related significantly to lower mortality. Hospital nursing leadership styles may contribute to 30-day mortality of patients. This relationship may be moderated by homogeneity of leadership styles, clarity of communication among leaders and healthcare providers, and work environment characteristics.

  3. Hematoma shape, hematoma size, Glasgow coma scale score and ICH score: which predicts the 30-day mortality better for intracerebral hematoma?

    Directory of Open Access Journals (Sweden)

    Chih-Wei Wang

    Full Text Available To investigate the performance of hematoma shape, hematoma size, Glasgow coma scale (GCS score, and intracerebral hematoma (ICH score in predicting the 30-day mortality for ICH patients. To examine the influence of the estimation error of hematoma size on the prediction of 30-day mortality.This retrospective study, approved by a local institutional review board with written informed consent waived, recruited 106 patients diagnosed as ICH by non-enhanced computed tomography study. The hemorrhagic shape, hematoma size measured by computer-assisted volumetric analysis (CAVA and estimated by ABC/2 formula, ICH score and GCS score was examined. The predicting performance of 30-day mortality of the aforementioned variables was evaluated. Statistical analysis was performed using Kolmogorov-Smirnov tests, paired t test, nonparametric test, linear regression analysis, and binary logistic regression. The receiver operating characteristics curves were plotted and areas under curve (AUC were calculated for 30-day mortality. A P value less than 0.05 was considered as statistically significant.The overall 30-day mortality rate was 15.1% of ICH patients. The hematoma shape, hematoma size, ICH score, and GCS score all significantly predict the 30-day mortality for ICH patients, with an AUC of 0.692 (P = 0.0018, 0.715 (P = 0.0008 (by ABC/2 to 0.738 (P = 0.0002 (by CAVA, 0.877 (P<0.0001 (by ABC/2 to 0.882 (P<0.0001 (by CAVA, and 0.912 (P<0.0001, respectively.Our study shows that hematoma shape, hematoma size, ICH scores and GCS score all significantly predict the 30-day mortality in an increasing order of AUC. The effect of overestimation of hematoma size by ABC/2 formula in predicting the 30-day mortality could be remedied by using ICH score.

  4. 78 FR 64143 - 30-Day Notice of Proposed Information Collection: Contractor's Requisition-Project Mortgages

    Science.gov (United States)

    2013-10-25

    ... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5683-N-88] 30-Day Notice of Proposed Information Collection: Contractor's Requisition--Project Mortgages AGENCY: Office of the Chief Information... Title of Information Collection: Contractor's Requisition--Project Mortgages. OMB Approval Number: 2502...

  5. Association Between Treatment by Locum Tenens Internal Medicine Physicians and 30-Day Mortality Among Hospitalized Medicare Beneficiaries.

    Science.gov (United States)

    Blumenthal, Daniel M; Olenski, Andrew R; Tsugawa, Yusuke; Jena, Anupam B

    2017-12-05

    Use of locum tenens physicians has increased in the United States, but information about their quality and costs of care is lacking. To evaluate quality and costs of care among hospitalized Medicare beneficiaries treated by locum tenens vs non-locum tenens physicians. A random sample of Medicare fee-for-service beneficiaries hospitalized during 2009-2014 was used to compare quality and costs of hospital care delivered by locum tenens and non-locum tenens internal medicine physicians. Treatment by locum tenens general internal medicine physicians. The primary outcome was 30-day mortality. Secondary outcomes included inpatient Medicare Part B spending, length of stay, and 30-day readmissions. Differences between locum tenens and non-locum tenens physicians were estimated using multivariable logistic regression models adjusted for beneficiary clinical and demographic characteristics and hospital fixed effects, which enabled comparisons of clinical outcomes between physicians practicing within the same hospital. In prespecified subgroup analyses, outcomes were reevaluated among hospitals with different levels of intensity of locum tenens physician use. Of 1 818 873 Medicare admissions treated by general internists, 38 475 (2.1%) received care from a locum tenens physician; 9.3% (4123/44 520) of general internists were temporarily covered by a locum tenens physician at some point. Differences in patient characteristics, demographics, comorbidities, and reason for admission between locum tenens and non-locum tenens physicians were not clinically relevant. Treatment by locum tenens physicians, compared with treatment by non-locum tenens physicians (n = 44 520 physicians), was not associated with a significant difference in 30-day mortality (8.83% vs 8.70%; adjusted difference, 0.14%; 95% CI, -0.18% to 0.45%). Patients treated by locum tenens physicians had significantly higher Part B spending ($1836 vs $1712; adjusted difference, $124; 95% CI, $93 to $154

  6. Machine learning-based Landsat-MODIS data fusion approach for 8-day 30m evapotranspiration monitoring

    Science.gov (United States)

    Im, J.; Ke, Y.; Park, S.

    2016-12-01

    Continuous monitoring of evapotranspiration (ET) is important for understanding of hydrological cycles and energy flux dynamics. At regional and local scales, routine ET estimation is a critical for efficient water management, drought impact assessment and ecosystem health monitoring, etc. Remote sensing has long been recognized to be able to provide ET monitoring over large areas. However, no single satellite could provide temporally continuous ET at relatively high spatial resolution due to the trade-off between the spatial and temporal resolution of current satellite sensors. Landsat-series satellites provide optical and thermal imagery at 30-100m resolution, whereas the 16-day revisit cycle hinders the observation of ET dynamics; MODIS provides sources of ET estimation at daily basis, but the 500-1000m ground sampling distance is too coarse for field level applications. In this study, we present a machine learning and STARFM based method for Landsat/MODIS ET fusion. The approach first downscales MODIS 8-day 1km ET (MOD16A2) to 30m based on eleven Landsat-derived indicators such as NDVI, EVI, NDWI etc on the cloud-free Landsat-available days using Random Forest approach. For the days when Landsat data are not available, downscaled ET is synthesized by MODIS and Landsat data fusion with STARFM and STI-FM approaches. The models are evaluated using in situ flux tower measurements at US-ARM and US-Twt AmeriFlux sites the United States. Results show that the downscaled 30m ET have good agreement with MODIS ET (RMSE=0.42-3.4mm/8days, rRMSE=3.2%-26%) and the downscaled ET have higher accuracy than MODIS ET when compared to in-situ measurements.

  7. A Retrospective Audit of In-Hospital 30-day Mortality from Acute Myocardial Infarction in Connolly Hospital Blanchardstown

    LENUS (Irish Health Repository)

    Hensey, M

    2017-09-01

    In 2015, The Department of Health published the first annual report of the “National Healthcare Quality Reporting System.” Connolly Hospital was reported to a mortality rate within 30 days post-Acute Myocardial Infarction (AMI) of 9.87 per 100 cases which was statistically significantly higher than the national rate. We carried out a retrospective audit of patients who were HIPE-coded as having died within 30 days of AMI from 2011-2013 and identified 42 patients. On review, only 23 patients (54.8%) were confirmed as having had an AMI. We identified 12 patients who had AMI included on death certificate without any evidence for same. If the 22 patients incorrectly coded were excluded, the mortality rate within 30 days post-AMI in CHB would fall to 4.14 deaths per 100 cases, well below the national average. Inaccuracies of data collection can lead to erroneous conclusions when examining healthcare data.

  8. Effects of high-frequency activity on latent heat flux of MJO

    Science.gov (United States)

    Gao, Yingxia; Hsu, Pang-Chi; Li, Tim

    2018-04-01

    The effect of high-frequency (HF) variability on latent heat flux (LHF) associated with the Madden-Julian Oscillation (MJO) during the boreal winter is investigated through diagnosis using two reanalysis datasets and numerical experiments of an atmospheric general circulation model (AGCM). The diagnostic results show that the HF activities exert an impact on the variability of MJO LHF mainly through their interactions with the longer than 90-day low-frequency background state (LFBS). The contribution of intraseasonal LHF induced by the interactions between LFBS and HF activities accounts for more than 20% of the total intraseasonal LHF over active MJO regions. The intraseasonal LHF induced by the LFBS-HF interaction is in phase with the MJO convection, while the total intraseasonal LHF appears at and to the west of the MJO convection center. This suggests that the intraseasonal LHF via the feedback of HF activity interacting with LFBS is conducive to the maintenance and eastward propagation of MJO convection. To confirm the role of HF disturbances in MJO convection activity, we carry out a series of experiments using the AGCM of ECHAM4, which captures well the general features of MJO. We select a number of MJO cases with enhanced convective signals and significant eastward propagation from a 30-year climatological simulation. Once the HF components of surface wind and moisture fields in LHF are excluded in model integration for each MJO case, most of the simulated MJO convection shows weakened activity and a slower propagation speed compared to the simulations containing all time-scale components. The outputs of these sensitivity experiments support the diagnostic results that HF activities contribute to the maintenance and propagation of MJO convection through the intraseasonal LHF induced by the scale interaction of HF activities with lower frequency variability.

  9. Relationships Between Tropical Deep Convection, Tropospheric Mean Temperature and Cloud-Induced Radiative Fluxes on Intraseasonal Time Scales

    Science.gov (United States)

    Ramey, Holly S.; Robertson, Franklin R.

    2010-01-01

    Intraseasonal variability of deep convection represents a fundamental mode of variability in the organization of tropical convection. While most studies of intraseasonal oscillations (ISOs) have focused on the spatial propagation and dynamics of convectively coupled circulations, we examine the projection of ISOs on the tropically-averaged temperature and energy budget. The area of interest is the global oceans between 20degN/S. Our analysis then focuses on these questions: (i) How is tropospheric temperature related to tropical deep convection and the associated ice cloud fractional amount (ICF) and ice water path (IWP)? (ii) What is the source of moisture sustaining the convection and what role does deep convection play in mediating the PBL - free atmospheric temperature equilibration? (iii) What affect do convectively generated upper-tropospheric clouds have on the TOA radiation budget? Our methodology is similar to that of Spencer et al., (2007) with some modifications and some additional diagnostics of both clouds and boundary layer thermodynamics. A composite ISO time series of cloud, precipitation and radiation quantities built from nearly 40 events during a six-year period is referenced to the atmospheric temperature signal. The increase of convective precipitation cannot be sustained by evaporation within the domain, implying strong moisture transports into the tropical ocean area. While there is a decrease in net TOA radiation that develops after the peak in deep convective rainfall, there seems little evidence that an "Infrared Iris"- like mechanism is dominant. Rather, the cloud-induced OLR increase seems largely produced by weakened convection with warmer cloud tops. Tropical ISO events offer an accessible target for studying ISOs not just in terms of propagation mechanisms, but on their global signals of heat, moisture and radiative flux feedback processes.

  10. Rates and risk factors of unplanned 30-day readmission following general and thoracic pediatric surgical procedures.

    Science.gov (United States)

    Polites, Stephanie F; Potter, Donald D; Glasgow, Amy E; Klinkner, Denise B; Moir, Christopher R; Ishitani, Michael B; Habermann, Elizabeth B

    2017-08-01

    Postoperative unplanned readmissions are costly and decrease patient satisfaction; however, little is known about this complication in pediatric surgery. The purpose of this study was to determine rates and predictors of unplanned readmission in a multi-institutional cohort of pediatric surgical patients. Unplanned 30-day readmissions following general and thoracic surgical procedures in children readmission per 30 person-days were determined to account for varied postoperative length of stay (pLOS). Patients were randomly divided into 70% derivation and 30% validation cohorts which were used for creation and validation of a risk model for readmission. Readmission occurred in 1948 (3.6%) of 54,870 children for a rate of 4.3% per 30 person-days. Adjusted predictors of readmission included hepatobiliary procedures, increased wound class, operative duration, complications, and pLOS. The predictive model discriminated well in the derivation and validation cohorts (AUROC 0.710 and 0.701) with good calibration between observed and expected readmission events in both cohorts (p>.05). Unplanned readmission occurs less frequently in pediatric surgery than what is described in adults, calling into question its use as a quality indicator in this population. Factors that predict readmission including type of procedure, complications, and pLOS can be used to identify at-risk children and develop prevention strategies. III. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. 78 FR 40310 - 30-Day Notice of Proposed Information Collection: Comprehensive Needs Assessment (CNA)

    Science.gov (United States)

    2013-07-03

    ...HUD has submitted the proposed information collection requirement described below to the Office of Management and Budget (OMB) for review, in accordance with the Paperwork Reduction Act. The purpose of this notice is to allow for an additional 30 days of public comment.

  12. World AIDS Day PSA (:30)

    Centers for Disease Control (CDC) Podcasts

    2011-11-16

    December 1 is World AIDS Day. In this PSA, communities are encouraged to get tested for HIV.  Created: 11/16/2011 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).   Date Released: 11/16/2011.

  13. Avoidable 30-day mortality analysis and failure to rescue in dysvascular lower extremity amputees

    DEFF Research Database (Denmark)

    Wied, Christian; Foss, Nicolai B; Tengberg, Peter T

    2018-01-01

    30 days after surgery. 4 deaths were classified as "definitely unavoidable," 4 as "probably unavoidable," and 23 as "FTR." Patients who died had a higher incidence of sepsis, pneumonia, and acute myocardial infarction compared with those alive. A log binominal regression analysis adjusted for age...

  14. Intraseasonal interaction between the Madden-Julian Oscillation and the North Atlantic Oscillation.

    Science.gov (United States)

    Cassou, Christophe

    2008-09-25

    Bridging the traditional gap between the spatio-temporal scales of weather and climate is a significant challenge facing the atmospheric community. In particular, progress in both medium-range and seasonal-to-interannual climate prediction relies on our understanding of recurrent weather patterns and the identification of specific causes responsible for their favoured occurrence, persistence or transition. Within this framework, I here present evidence that the main climate intra-seasonal oscillation in the tropics-the Madden-Julian Oscillation (MJO)-controls part of the distribution and sequences of the four daily weather regimes defined over the North Atlantic-European region in winter. North Atlantic Oscillation (NAO) regimes are the most affected, allowing for medium-range predictability of their phase far exceeding the limit of around one week that is usually quoted. The tropical-extratropical lagged relationship is asymmetrical. Positive NAO events mostly respond to a mid-latitude low-frequency wave train initiated by the MJO in the western-central tropical Pacific and propagating eastwards. Precursors for negative NAO events are found in the eastern tropical Pacific-western Atlantic, leading to changes along the North Atlantic storm track. Wave-breaking diagnostics tend to support the MJO preconditioning and the role of transient eddies in setting the phase of the NAO. I present a simple statistical model to quantitatively assess the potential predictability of the daily NAO index or the sign of the NAO regimes when they occur. Forecasts are successful in approximately 70 per cent of the cases based on the knowledge of the previous approximately 12-day MJO phase used as a predictor. This promising skill could be of importance considering the tight link between weather regimes and both mean conditions and the chances of extreme events occurring over Europe. These findings are useful for further stressing the need to better simulate and forecast the tropical

  15. Derivation and validation of a diagnostic score based on case-mix groups to predict 30-day death or urgent readmission.

    Science.gov (United States)

    van Walraven, Carl; Wong, Jenna; Forster, Alan J

    2012-01-01

    Between 5% and 10% of patients die or are urgently readmitted within 30 days of discharge from hospital. Readmission risk indexes have either excluded acute diagnoses or modelled them as multiple distinct variables. In this study, we derived and validated a score summarizing the influence of acute hospital diagnoses and procedures on death or urgent readmission within 30 days. From population-based hospital abstracts in Ontario, we randomly sampled 200 000 discharges between April 2003 and March 2009 and determined who had been readmitted urgently or died within 30 days of discharge. We used generalized estimating equation modelling, with a sample of 100 000 patients, to measure the adjusted association of various case-mix groups (CMGs-homogenous groups of acute care inpatients with similar clinical and resource-utilization characteristics) with 30-day death or urgent readmission. This final model was transformed into a scoring system that was validated in the remaining 100 000 patients. Patients in the derivation set belonged to 1 of 506 CMGs and had a 6.8% risk of 30-day death or urgent readmission. Forty-seven CMG codes (more than half of which were directly related to chronic diseases) were independently associated with this outcome, which led to a CMG score that ranged from -6 to 7 points. The CMG score was significantly associated with 30-day death or urgent readmission (unadjusted odds ratio for a 1-point increase in CMG score 1.52, 95% confidence interval [CI] 1.49-1.56). Alone, the CMG score was only moderately discriminative (C statistic 0.650, 95% CI 0.644-0.656). However, when the CMG score was added to a validated risk index for death or readmission, the C statistic increased to 0.759 (95% CI 0.753-0.765). The CMG score was well calibrated for 30-day death or readmission. In this study, we developed a scoring system for acute hospital diagnoses and procedures that could be used as part of a risk-adjustment methodology for analyses of postdischarge

  16. External validation of a multivariable claims-based rule for predicting in-hospital mortality and 30-day post-pulmonary embolism complications

    Directory of Open Access Journals (Sweden)

    Craig I. Coleman

    2016-10-01

    Full Text Available Abstract Background Low-risk pulmonary embolism (PE patients may be candidates for outpatient treatment or abbreviated hospital stay. There is a need for a claims-based prediction rule that payers/hospitals can use to risk stratify PE patients. We sought to validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT prediction rule for in-hospital and 30-day outcomes. Methods We used the Optum Research Database from 1/2008-3/2015 and included adults hospitalized for PE (415.1x in the primary position or secondary position when accompanied by a primary code for a PE complication and having continuous medical and prescription coverage for ≥6-months prior and 3-months post-inclusion or until death. In-hospital and 30-day mortality and 30-day complications (recurrent venous thromboembolism, rehospitalization or death were assessed and prognostic accuracies of IMPACT with 95 % confidence intervals (CIs were calculated. Results In total, 47,531 PE patients were included. In-hospital and 30-day mortality occurred in 7.9 and 9.4 % of patients and 20.8 % experienced any complication within 30-days. Of the 19.5 % of patients classified as low-risk by IMPACT, 2.0 % died in-hospital, resulting in a sensitivity and specificity of 95.2 % (95 % CI, 94.4–95.8 and 20.7 % (95 % CI, 20.4–21.1. Only 1 additional low-risk patient died within 30-days of admission and 12.2 % experienced a complication, translating into a sensitivity and specificity of 95.9 % (95 % CI, 95.3–96.5 and 21.1 % (95 % CI, 20.7–21.5 for mortality and 88.5 % (95 % CI, 87.9–89.2 and 21.6 % (95 % CI, 21.2–22.0 for any complication. Conclusion IMPACT had acceptable sensitivity for predicting in-hospital and 30-day mortality or complications and may be valuable for retrospective risk stratification of PE patients.

  17. External validation of a multivariable claims-based rule for predicting in-hospital mortality and 30-day post-pulmonary embolism complications.

    Science.gov (United States)

    Coleman, Craig I; Peacock, W Frank; Fermann, Gregory J; Crivera, Concetta; Weeda, Erin R; Hull, Michael; DuCharme, Mary; Becker, Laura; Schein, Jeff R

    2016-10-22

    Low-risk pulmonary embolism (PE) patients may be candidates for outpatient treatment or abbreviated hospital stay. There is a need for a claims-based prediction rule that payers/hospitals can use to risk stratify PE patients. We sought to validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) prediction rule for in-hospital and 30-day outcomes. We used the Optum Research Database from 1/2008-3/2015 and included adults hospitalized for PE (415.1x in the primary position or secondary position when accompanied by a primary code for a PE complication) and having continuous medical and prescription coverage for ≥6-months prior and 3-months post-inclusion or until death. In-hospital and 30-day mortality and 30-day complications (recurrent venous thromboembolism, rehospitalization or death) were assessed and prognostic accuracies of IMPACT with 95 % confidence intervals (CIs) were calculated. In total, 47,531 PE patients were included. In-hospital and 30-day mortality occurred in 7.9 and 9.4 % of patients and 20.8 % experienced any complication within 30-days. Of the 19.5 % of patients classified as low-risk by IMPACT, 2.0 % died in-hospital, resulting in a sensitivity and specificity of 95.2 % (95 % CI, 94.4-95.8) and 20.7 % (95 % CI, 20.4-21.1). Only 1 additional low-risk patient died within 30-days of admission and 12.2 % experienced a complication, translating into a sensitivity and specificity of 95.9 % (95 % CI, 95.3-96.5) and 21.1 % (95 % CI, 20.7-21.5) for mortality and 88.5 % (95 % CI, 87.9-89.2) and 21.6 % (95 % CI, 21.2-22.0) for any complication. IMPACT had acceptable sensitivity for predicting in-hospital and 30-day mortality or complications and may be valuable for retrospective risk stratification of PE patients.

  18. Hypoalbuminemia is a strong predictor of 30-day all-cause mortality in acutely admitted medical patients

    DEFF Research Database (Denmark)

    Jellinge, Marlene Ersgaard; Henriksen, Daniel Pilsgaard; Hallas, Peter

    2014-01-01

    (precision of predictions) for hypoalbuminemia was determined. RESULTS: We included 5,894 patients and albumin was available in 5,451 (92.5%). A total of 332 (5.6%) patients died within 30 days of admission. Median plasma albumin was 40 g/L (IQR 37-43). Crude 30-day mortality in patients with low albumin......OBJECTIVE: Emergency patients with hypoalbuminemia are known to have increased mortality. No previous studies have, however, assessed the predictive value of low albumin on mortality in unselected acutely admitted medical patients. We aimed at assessing the predictive power of hypoalbuminemia on 30...... follow-up. Patients were divided into three groups according to their plasma albumin levels (0-34, 35-44 and ≥45 g/L) and mortality was identified for each group using Kaplan-Meier survival plot. Discriminatory power (ability to discriminate patients at increased risk of mortality) and calibration...

  19. The readmission risk flag: using the electronic health record to automatically identify patients at risk for 30-day readmission.

    Science.gov (United States)

    Baillie, Charles A; VanZandbergen, Christine; Tait, Gordon; Hanish, Asaf; Leas, Brian; French, Benjamin; Hanson, C William; Behta, Maryam; Umscheid, Craig A

    2013-12-01

    Identification of patients at high risk for readmission is a crucial step toward improving care and reducing readmissions. The adoption of electronic health records (EHR) may prove important to strategies designed to risk stratify patients and introduce targeted interventions. To develop and implement an automated prediction model integrated into our health system's EHR that identifies on admission patients at high risk for readmission within 30 days of discharge. Retrospective and prospective cohort. Healthcare system consisting of 3 hospitals. All adult patients admitted from August 2009 to September 2012. An automated readmission risk flag integrated into the EHR. Thirty-day all-cause and 7-day unplanned healthcare system readmissions. Using retrospective data, a single risk factor, ≥ 2 inpatient admissions in the past 12 months, was found to have the best balance of sensitivity (40%), positive predictive value (31%), and proportion of patients flagged (18%), with a C statistic of 0.62. Sensitivity (39%), positive predictive value (30%), proportion of patients flagged (18%), and C statistic (0.61) during the 12-month period after implementation of the risk flag were similar. There was no evidence for an effect of the intervention on 30-day all-cause and 7-day unplanned readmission rates in the 12-month period after implementation. An automated prediction model was effectively integrated into an existing EHR and identified patients on admission who were at risk for readmission within 30 days of discharge. © 2013 Society of Hospital Medicine.

  20. Sex differences in 30-day and 5-year outcomes after endovascular repair of abdominal aortic aneurysms in the EUROSTAR study

    DEFF Research Database (Denmark)

    Grootenboer, Nathalie; Hunink, M G Myriam; Hendriks, Johanna M

    2013-01-01

    The purpose of this study was to determine the effect of sex on 30-day and long-term outcomes after elective endovascular aneurysm repair.......The purpose of this study was to determine the effect of sex on 30-day and long-term outcomes after elective endovascular aneurysm repair....

  1. Factors associated with readmission to the hospital within 30 days in patients with inflammatory bowel disease

    Science.gov (United States)

    Gaetano, John N.; Rubin, Jonah N.; Cohen, Russell D.; Sakuraba, Atsushi; Rubin, David T.; Pekow, Joel

    2017-01-01

    Background Management of inpatients with inflammatory bowel disease (IBD) requires increasing resources. We aimed to identify factors associated with hospital readmissions among individuals with IBD. Materials & methods We collected data from the Healthcare Cost and Utilization Project Nationwide Readmissions Database 2013. We identified individuals with index hospitalizations for IBD. Patient-specific factors, comorbidities and hospitalization characteristics were extracted for the index hospitalization. We performed logistic regression modeling to create adjusted odds ratios (ORs) for 30-day hospital readmission. Subgroup analysis was performed based on disease type and performance of surgery. Results We analyzed a total of 55,942 index hospital discharges; 3037 patients (7.0%) were readmitted to the hospital within 30 days. Increasing patient age (> 65: OR: 0.45; 95% CI 0.39–0.53) was associated with a decreased risk of readmission, while a diagnosis of Crohn’s disease (OR: 1.09; 95% CI 1.00–1.18) and male sex (OR: 1.16; 95% CI 1.07–1.25) were associated with an increased risk of readmission. The comorbidities of smoking (OR: 1.09; 95% CI 1.00–1.19), anxiety (OR: 1.17; 95% CI 1.01–1.36) and opioid dependence (OR: 1.40; 95% CI 1.06–1.86) were associated with an increased risk of 30-day readmission. Individual hospitalization characteristics and disease complications were significantly associated with readmission. Performance of a surgery during the index admission was associated with a decreased risk of readmission (OR: 0.57; 95% CI 0.33–0.96). Conclusion Analyzing data from a US publicly available all-payer inpatient healthcare database, we identified patient and hospitalization risk factors associated with 30-day readmission. Identifying patients at high risk for readmission may allow for interventions during or after the index hospitalization to decrease this risk. PMID:28837634

  2. Factors associated with readmission to the hospital within 30 days in patients with inflammatory bowel disease.

    Directory of Open Access Journals (Sweden)

    Dejan Micic

    Full Text Available Management of inpatients with inflammatory bowel disease (IBD requires increasing resources. We aimed to identify factors associated with hospital readmissions among individuals with IBD.We collected data from the Healthcare Cost and Utilization Project Nationwide Readmissions Database 2013. We identified individuals with index hospitalizations for IBD. Patient-specific factors, comorbidities and hospitalization characteristics were extracted for the index hospitalization. We performed logistic regression modeling to create adjusted odds ratios (ORs for 30-day hospital readmission. Subgroup analysis was performed based on disease type and performance of surgery.We analyzed a total of 55,942 index hospital discharges; 3037 patients (7.0% were readmitted to the hospital within 30 days. Increasing patient age (> 65: OR: 0.45; 95% CI 0.39-0.53 was associated with a decreased risk of readmission, while a diagnosis of Crohn's disease (OR: 1.09; 95% CI 1.00-1.18 and male sex (OR: 1.16; 95% CI 1.07-1.25 were associated with an increased risk of readmission. The comorbidities of smoking (OR: 1.09; 95% CI 1.00-1.19, anxiety (OR: 1.17; 95% CI 1.01-1.36 and opioid dependence (OR: 1.40; 95% CI 1.06-1.86 were associated with an increased risk of 30-day readmission. Individual hospitalization characteristics and disease complications were significantly associated with readmission. Performance of a surgery during the index admission was associated with a decreased risk of readmission (OR: 0.57; 95% CI 0.33-0.96.Analyzing data from a US publicly available all-payer inpatient healthcare database, we identified patient and hospitalization risk factors associated with 30-day readmission. Identifying patients at high risk for readmission may allow for interventions during or after the index hospitalization to decrease this risk.

  3. The New York risk score for in-hospital and 30-day mortality for coronary artery bypass graft surgery.

    Science.gov (United States)

    Hannan, Edward L; Farrell, Louise Szypulski; Wechsler, Andrew; Jordan, Desmond; Lahey, Stephen J; Culliford, Alfred T; Gold, Jeffrey P; Higgins, Robert S D; Smith, Craig R

    2013-01-01

    Simplified risk scores for coronary artery bypass graft surgery are frequently in lieu of more complicated statistical models and are valuable for informed consent and choice of intervention. Previous risk scores have been based on in-hospital mortality, but a substantial number of patients die within 30 days of the procedure. These deaths should also be accounted for, so we have developed a risk score based on in-hospital and 30-day mortality. New York's Cardiac Surgery Reporting System was used to develop an in-hospital and 30-day logistic regression model for patients undergoing coronary artery bypass graft surgery in 2009, and this model was converted into a simple linear risk score that provides estimated in-hospital and 30-day mortality rates for different values of the score. The accuracy of the risk score in predicting mortality was tested. This score was also validated by applying it to 2008 New York coronary artery bypass graft data. Subsequent analyses evaluated the ability of the risk score to predict complications and length of stay. The overall in-hospital and 30-day mortality rate for the 10,148 patients in the study was 1.79%. There are seven risk factors comprising the score, with risk factor scores ranging from 1 to 5, and the highest possible total score is 23. The score accurately predicted mortality in 2009 as well as in 2008, and was strongly correlated with complications and length of stay. The risk score is a simple way of estimating short-term mortality that accurately predicts mortality in the year the model was developed as well as in the previous year. Perioperative complications and length of stay are also well predicted by the risk score. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Causes and Temporal Patterns of 30-Day Readmission Among Older Adults Hospitalized With Heart Failure With Preserved or Reduced Ejection Fraction.

    Science.gov (United States)

    Goyal, Parag; Loop, Matthew; Chen, Ligong; Brown, Todd M; Durant, Raegan W; Safford, Monika M; Levitan, Emily B

    2018-04-23

    It is unknown whether causes and temporal patterns of 30-day readmission vary between heart failure (HF) with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). We sought to address this question by examining a 5% national sample of Medicare beneficiaries. We included individuals who experienced a hospitalization for HFpEF or HFrEF between 2007 and 2013. We identified causes of 30-day readmission based on primary discharge diagnosis and further classified causes of readmission as HF-related, non-HF cardiovascular-related, and non-cardiovascular-related. We calculated the cumulative incidence of these classifications for HFpEF and HFrEF in a competing risks model and calculated subdistribution hazard ratios of these classifications by comparing those with HFpEF and those with HFrEF. Among 60 640 Medicare beneficiaries, we identified 13 785 unique older adults hospitalized with HFpEF and 15 205 who were hospitalized with HFrEF. Noncardiovascular diagnoses represented the most common causes of 30-day readmission (HFpEF: 59%; HFrEF: 47%), a pattern that was observed for each week of the 30-day study period for both HFpEF and HFrEF participants. In comparing readmission diagnoses in an adjusted model, non-cardiovascular-related diagnoses were more common and HF-related diagnoses were less common in HFpEF participants. Non-cardiovascular-related diagnoses represented the most common causes of 30-day readmission following HF hospitalization for each week of the 30-day postdischarge period. HF diagnoses were less common among those with HFpEF compared with HFrEF. Future interventions aimed at reducing 30-day readmissions following an HF hospitalization would benefit from an increased focus on noncardiovascular comorbidity and interventions that target HFpEF and HFrEF separately. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  5. 30-days mortality in patients with perforated peptic ulcer: A national audit

    Science.gov (United States)

    Nakano, Anne; Bendix, Jørgen; Adamsen, Sven; Buck, Daniel; Mainz, Jan; Bartels, Paul; Nørgård, Bente

    2008-01-01

    Background In 2005, The Danish National Indicator Project (DNIP) reported findings on patients hospitalized with perforated ulcer. The indicator “30-days mortality” showed major discrepancy between the observed mortality of 28% and the chosen standard (10%). Rationale An audit committee was appointed to examine quality problems linked to the high mortality. The purpose was to (i) examine patient characteristics, (ii) evaluate the appropriateness of the standard, and (iii) audit all cases of deaths within 30 days after surgery. Methods Four hundred and twelve consecutive patients were included and used for the analyses of patient characteristics. The evaluation of the standard was based on a literature review, and a structured audit was performed according to the 115 deaths that occurred. Results The mean age was 69.1 years, 42.0% had one co-morbid disease and 17.7% had two co-morbid diseases. 45.9% had an American Association of Anaesthetists score of 3–4. We found no results on mortality in studies similar to ours. The audit process indicated that the postoperative observation of patients was insufficient. Discussion As a result of this study, the standard for mortality was increased to 20%, and the new indicators for postoperative monitoring were developed. The DNIP continues to evaluate if these initiatives will improve the results on mortality. PMID:22312201

  6. Development, Validation and Deployment of a Real Time 30 Day Hospital Readmission Risk Assessment Tool in the Maine Healthcare Information Exchange.

    Science.gov (United States)

    Hao, Shiying; Wang, Yue; Jin, Bo; Shin, Andrew Young; Zhu, Chunqing; Huang, Min; Zheng, Le; Luo, Jin; Hu, Zhongkai; Fu, Changlin; Dai, Dorothy; Wang, Yicheng; Culver, Devore S; Alfreds, Shaun T; Rogow, Todd; Stearns, Frank; Sylvester, Karl G; Widen, Eric; Ling, Xuefeng B

    2015-01-01

    Identifying patients at risk of a 30-day readmission can help providers design interventions, and provide targeted care to improve clinical effectiveness. This study developed a risk model to predict a 30-day inpatient hospital readmission for patients in Maine, across all payers, all diseases and all demographic groups. Our objective was to develop a model to determine the risk for inpatient hospital readmission within 30 days post discharge. All patients within the Maine Health Information Exchange (HIE) system were included. The model was retrospectively developed on inpatient encounters between January 1, 2012 to December 31, 2012 from 24 randomly chosen hospitals, and then prospectively validated on inpatient encounters from January 1, 2013 to December 31, 2013 using all HIE patients. A risk assessment tool partitioned the entire HIE population into subgroups that corresponded to probability of hospital readmission as determined by a corresponding positive predictive value (PPV). An overall model c-statistic of 0.72 was achieved. The total 30-day readmission rates in low (score of 0-30), intermediate (score of 30-70) and high (score of 70-100) risk groupings were 8.67%, 24.10% and 74.10%, respectively. A time to event analysis revealed the higher risk groups readmitted to a hospital earlier than the lower risk groups. Six high-risk patient subgroup patterns were revealed through unsupervised clustering. Our model was successfully integrated into the statewide HIE to identify patient readmission risk upon admission and daily during hospitalization or for 30 days subsequently, providing daily risk score updates. The risk model was validated as an effective tool for predicting 30-day readmissions for patients across all payer, disease and demographic groups within the Maine HIE. Exposing the key clinical, demographic and utilization profiles driving each patient's risk of readmission score may be useful to providers in developing individualized post discharge

  7. Early processing variations in selective attention to the color and direction of moving stimuli during 30 days head-down bed rest

    Science.gov (United States)

    Wang, Lin-Jie; He, Si-Yang; Niu, Dong-Bin; Guo, Jian-Ping; Xu, Yun-Long; Wang, De-Sheng; Cao, Yi; Zhao, Qi; Tan, Cheng; Li, Zhi-Li; Tang, Guo-Hua; Li, Yin-Hui; Bai, Yan-Qiang

    2013-11-01

    Dynamic variations in early selective attention to the color and direction of moving stimuli were explored during a 30 days period of head-down bed rest. Event-related potentials (ERPs) were recorded at F5, F6, P5, P6 scalp locations in seven male subjects who attended to pairs of bicolored light emitting diodes that flashed sequentially to produce a perception of movement. Subjects were required to attend selectively to a critical feature of the moving target, e.g., color or direction. The tasks included: a no response task, a color selective response task, a moving direction selective response task, and a combined color-direction selective response task. Subjects were asked to perform these four tasks on: the 3rd day before bed rest; the 3rd, 15th and 30th day during the bed rest; and the 5th day after bed rest. Subjects responded quickly to the color than moving direction and combined color-direction response. And they had a longer reaction time during bed rest on the 15th and 30th day during bed rest after a relatively quicker response on the 3rd day. Using brain event-related potentials technique, we found that in the color selective response task, the mean amplitudes of P1 and N1 for target ERPs decreased in the 3rd day during bed rest and 5th day after bed rest in comparison with pre-bed rest, 15th day and 30th day during bed rest. In the combined color-direction selective response task, the P1 latencies for target ERPs on the 3rd and 30th day during bed rest were longer than on the 15th day during bed rest. As 3rd day during bed rest was in the acute adaptation period and 30th day during bed rest was in the relatively adaptation stage of head-down bed rest, the results help to clarify the effects of bed rest on different task loads and patterns of attention. It was suggested that subjects expended more time to give correct decision in the head-down tilt bed rest state. A difficulty in the recruitment of brain resources was found in feature selection task

  8. Risk factors for 30-day reoperation and 3-month readmission: analysis from the Quality and Outcomes Database lumbar spine registry.

    Science.gov (United States)

    Wadhwa, Rishi K; Ohya, Junichi; Vogel, Todd D; Carreon, Leah Y; Asher, Anthony L; Knightly, John J; Shaffrey, Christopher I; Glassman, Steven D; Mummaneni, Praveen V

    2017-08-01

    OBJECTIVE The aim of this paper was to use a prospective, longitudinal, multicenter outcome registry of patients undergoing surgery for lumbar degenerative disease in order to assess the incidence and factors associated with 30-day reoperation and 90-day readmission. METHODS Prospectively collected data from 9853 patients from the Quality and Outcomes Database (QOD; formerly known as the N 2 QOD [National Neurosurgery Quality and Outcomes Database]) lumbar spine registry were retrospectively analyzed. Multivariate binomial regression analysis was performed to identify factors associated with 30-day reoperation and 90-day readmission after surgery for lumbar degenerative disease. A subgroup analysis of Medicare patients stratified by age (readmission rate was 6.3%. Multivariate analysis demonstrated that higher ASA class (OR 1.46 per class, 95% CI 1.25-1.70) and history of depression (OR 1.27, 95% CI 1.04-1.54) were factors associated with 90-day readmission. Medicare beneficiaries had a higher rate of 90-day readmissions compared with those who had private insurance (OR 1.43, 95% CI 1.17-1.76). Medicare patients readmission included higher ASA class and a history of depression. The 90-day readmission rates were higher for Medicare beneficiaries than for those who had private insurance. Medicare patients < 65 years of age were more likely to undergo reoperation within 30 days and to be readmitted within 90 days after their index surgery.

  9. The role of marshall and rotterdam score in predicting 30-day outcome of traumatic brain injury

    Science.gov (United States)

    Siahaan, A. M. P.; Akbar, T. Y. M.; Nasution, M. D.

    2018-03-01

    Traumatic brain injury (TBI) remains one of the leading causes of mortality and morbidity, especially in the young population. To predict the outcome of TBI, Marshall, and Rotterdam–CT Scan based scoring was mostly used. As many studies showed conflicting results regarding of the usage of both scoring, this study aims to determine the correlation between Rotterdam and Marshall scoring system with outcome in 30 days and found correlation among them. In 120 subjects with TBI that admitted to Adam Malik General Hospital, we found a significant association of both scorings with the 30-day Glasgow Outcome Score. Therefore, we recommend the use of Marshall and Rotterdam CT Score in initial assessment as a good predictor for patients with TBI.

  10. Halloysite Nanotubes-Induced Al Accumulation and Fibrotic Response in Lung of Mice after 30-Day Repeated Oral Administration.

    Science.gov (United States)

    Wang, Xue; Gong, Jiachun; Rong, Rui; Gui, Zongxiang; Hu, Tingting; Xu, Xiaolong

    2018-03-21

    Natural halloysite (Al 2 Si 2 O 5 (OH) 4 · nH 2 O) nanotubes (HNT) are clay materials with hollow tubular structure and are widely applied in many fields. Many in vitro studies indicate that HNTs exhibit a high level of biocompatibility; however, the in vivo toxicity of HNTs remains unclear. In this study, the biodistribution and pulmonary toxicity of the purified HNTs in mice were investigated after intragastric administration for 30 days. HNTs have high stability in biological conditions. Oral administration of HNTs caused significant Al accumulation predominantly in the lung with relative slight effects on Si biodistribution. Oral administration of HNTs stimulated the growth of the mice at low dose (5 mg/kg BW) with no pulmonary toxicity but inhibited the mouse growth and resulted in oxidative stress and inflammation in lung at high dose (50 mg/kg BW). In addition, oral HNTs at high dose could be absorbed from the gastrointestinal tract and deposited in lung and could also induce pulmonary fibrosis.

  11. The New York State risk score for predicting in-hospital/30-day mortality following percutaneous coronary intervention.

    Science.gov (United States)

    Hannan, Edward L; Farrell, Louise Szypulski; Walford, Gary; Jacobs, Alice K; Berger, Peter B; Holmes, David R; Stamato, Nicholas J; Sharma, Samin; King, Spencer B

    2013-06-01

    This study sought to develop a percutaneous coronary intervention (PCI) risk score for in-hospital/30-day mortality. Risk scores are simplified linear scores that provide clinicians with quick estimates of patients' short-term mortality rates for informed consent and to determine the appropriate intervention. Earlier PCI risk scores were based on in-hospital mortality. However, for PCI, a substantial percentage of patients die within 30 days of the procedure after discharge. New York's Percutaneous Coronary Interventions Reporting System was used to develop an in-hospital/30-day logistic regression model for patients undergoing PCI in 2010, and this model was converted into a simple linear risk score that estimates mortality rates. The score was validated by applying it to 2009 New York PCI data. Subsequent analyses evaluated the ability of the score to predict complications and length of stay. A total of 54,223 patients were used to develop the risk score. There are 11 risk factors that make up the score, with risk factor scores ranging from 1 to 9, and the highest total score is 34. The score was validated based on patients undergoing PCI in the previous year, and accurately predicted mortality for all patients as well as patients who recently suffered a myocardial infarction (MI). The PCI risk score developed here enables clinicians to estimate in-hospital/30-day mortality very quickly and quite accurately. It accurately predicts mortality for patients undergoing PCI in the previous year and for MI patients, and is also moderately related to perioperative complications and length of stay. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  12. A quality improvement plan to reduce 30-day readmissions of heart failure patients.

    Science.gov (United States)

    Simpson, Monica

    2014-01-01

    An evidence-based quality initiative to decrease heart failure 30-day readmissions was implemented at a hospital in Florida. Heart failure education and postdischarge telephone contact were provided to patients determined to be at high risk of readmission using risk stratification tools. The rate during the project decreased 13% as compared to the same time period in the previous year and 8.5% from the 2012 year to date rate.

  13. [Neurological deterioration within 30 days of ischemic stroke with spontaneous cervicocranial artery dissection].

    Science.gov (United States)

    Mori, Mayumi; Wakugawa, Yoshiyuki; Yasaka, Masahiro; Yasumori, Kotaro; Nagata, Shinji; Okada, Yasushi

    2014-01-01

    The objective of this study was to identify the clinical features associated with neurological deterioration within 30 days of ischemic stroke patients with spontaneous cevicocranial dissection (SCCD) and clarify the effect on outcomes. We retrospectively identified 18 patients with SCCD (1.6%, 3 women, 52 ± 16 years old) among 1,112 patients with acute ischemic stroke within 7 days after onset. Of the 18 patients, 13 (72%) had vertebrobasilar arterial dissection. Neurological deterioration was present in 4 patients (22%), and 2 patients (11%) died. All of them became worse within 3 days after onset. Their initial blood pressures were high. All of them had dominant side vertebral artery or basilar artery dissection. Subarachnoid hemorrahage (SAH) were not seen although the agressive anticoagulant therapy were performed except for a case who had aneurysmal change. The patients with neurological deterioration had poor outcome, but the patients without neurological deterioration had good outcome. Recurrent ischemic event or SAH did not occurred in 3 months if they had not neurological deterioration. When we see acute stroke patients with dissection at the dominant side vertebral artery or the basilar artery, we should observe carefully for neurological deterioration especially within three days of onset.

  14. 78 FR 31999 - 30-Day Notice of Proposed Information Collection: Iran Democracy Program Grants Vetting

    Science.gov (United States)

    2013-05-28

    ... DEPARTMENT OF STATE [Public Notice 8337] 30-Day Notice of Proposed Information Collection: Iran Democracy Program Grants Vetting ACTION: Notice of request for public comment and submission to OMB of proposed collection of information. SUMMARY: The Department of State has submitted the information...

  15. Hubungan Asupan Asam Lemak Omega-3 dan Omega-6 dengan Tekanan Darah Wanita Usia 3050 Tahun

    OpenAIRE

    Sari, Mega Lucyta; Probosari, Enny; Wijayanti, Hartanti Sandi

    2017-01-01

    Background: Hypertension is one of the major risk factors for cardiovascular disease. Decreased intake of omega-3 and increased intake of omega-6 can increase the risk of hypertension. Hypertension cases in Indonesia are highest in women especially aged 30 - 50 years. This study aimed to determine correlation of omega-3 and omega-6 intake with blood pressure in women aged 30-50 years.Method : This was an observational research with cross-sectional study design. Fifty four subjects were select...

  16. 75 FR 16139 - Request For Public Comment: 30-Day Proposed Information Collection: Indian Health Service Medical...

    Science.gov (United States)

    2010-03-31

    ... mins) 50 Optometry Privileges 21 1 0.33 (20 mins) 7 Psychology Privileges 30 1 0.17 (10 mins) 5..., Attention: Desk Officer for IHS, New Executive Office Building, Room 10235, Washington, DC 20503. Send...

  17. 78 FR 36198 - Request for Public Comment: 30-Day Proposed Information Collection: Indian Health Service Medical...

    Science.gov (United States)

    2013-06-17

    ... mins) 50 Psychology Privileges 30 1 0.17 (10 mins) 5 Audiology Privileges 7 1 0.08 (5 mins) 1 Podiatry..., Office of Regulatory Affairs, New Executive Office Building, Room 10235, Washington, DC 20503, Attention...

  18. Status and Results from DarkSide-50

    OpenAIRE

    Fan, Alden; Collaboration, for the DarkSide

    2015-01-01

    DarkSide-50 is the first physics detector of the DarkSide dark matter search program. The detector features a dual-phase underground-argon Time Projection Chamber (TPC) of 50 kg active mass surrounded by an organic liquid-scintillator neutron veto (30 tons) and a water-Cherenkov muon detector (1000 tons). The TPC is currently fully shielded and operating underground at Gran Sasso National Laboratory. A first run of 1422 kg-day exposure with atmospheric argon represents the most sensitive dark...

  19. Intra-seasonal Oscillations (ISO of zonal-mean meridional winds and temperatures as measured by UARS

    Directory of Open Access Journals (Sweden)

    F. T. Huang

    2005-06-01

    Full Text Available Based on an empirical analysis of measurements with the High Resolution Doppler Imager (HRDI on the UARS spacecraft in the upper mesosphere (95km, persistent and regular intra-seasonal oscillations (ISO with periods of about 2 to 4 months have recently been reported in the zonal-mean meridional winds. Similar oscillations have also been discussed independently in a modeling study, and they were attributed to wave-mean-flow interactions. The observed and modeled meridional wind ISOs were largely confined to low latitudes. We report here on an analysis of concurrent UARS temperature measurements, which produces oscillations similar to those seen in the meridional winds. Although the temperature oscillations are observed at lower altitudes (55km, their phase variations with latitude are qualitatively consistent with the inferred properties seen in the meridional winds and thus provide independent evidence for the existence of ISOs in the mesosphere.

  20. Trends in 30-day mortality rate and case mix for paediatric cardiac surgery in the UK between 2000 and 2010.

    Science.gov (United States)

    Brown, Katherine L; Crowe, Sonya; Franklin, Rodney; McLean, Andrew; Cunningham, David; Barron, David; Tsang, Victor; Pagel, Christina; Utley, Martin

    2015-01-01

    To explore changes over time in the 30-day mortality rate for paediatric cardiac surgery and to understand the role of attendant changes in the case mix. Included were: all mandatory submissions to the National Institute of Cardiovascular Outcomes Research (NICOR) relating to UK cardiac surgery in patients aged case mix indicators, in 10 consecutive time periods, from 2000 to 2010. Comparisons were made between two 5-year eras of: 30-day mortality, period prevalence and mean age for 30 groups of specific operations. 30-day mortality for an episode of surgical management. Our analysis includes 36 641 surgical episodes with an increase from 2283 episodes in 2000 to 3939 in 2009 (pcase mix became more complex in terms of the percentage of patients case mix complexity, and compares well with international benchmarks. Definitive repair is now more likely at a younger age for selected infants with congenital heart defects.

  1. Predictors associated with unplanned hospital readmission of medical and surgical intensive care unit survivors within 30 days of discharge.

    Science.gov (United States)

    Ohnuma, Tetsu; Shinjo, Daisuke; Brookhart, Alan M; Fushimi, Kiyohide

    2018-01-01

    Reducing the 30-day unplanned hospital readmission rate is a goal for physicians and policymakers in order to improve quality of care. However, data on the readmission rate of critically ill patients in Japan and knowledge of the predictors associated with readmission are lacking. We investigated predictors associated with 30-day rehospitalization for medical and surgical adult patients separately. Patient data from 502 acute care hospitals with intensive care unit (ICU) facilities in Japan were retrospectively extracted from the Japanese Diagnosis Procedure Combination (DPC) database between April 2012 and February 2014. Factors associated with unplanned hospital readmission within 30 days of hospital discharge among medical and surgical ICU survivors were identified using multivariable logistic regression analysis. Of 486,651 ICU survivors, we identified 5583 unplanned hospital readmissions within 30 days of discharge following 147,423 medical hospitalizations (3.8% readmitted) and 11,142 unplanned readmissions after 339,228 surgical hospitalizations (3.3% readmitted). The majority of unplanned hospital readmissions, 60.9% of medical and 63.1% of surgical case readmissions, occurred within 15 days of discharge. For both medical and surgical patients, the Charlson comorbidity index score; category of primary diagnosis during the index admission (respiratory, gastrointestinal, and metabolic and renal); hospital length of stay; discharge to skilled nursing facilities; and having received a packed red blood cell transfusion, low-dose steroids, or renal replacement therapy were significantly associated with higher unplanned hospital readmission rates. From patient data extracted from a large Japanese national database, the 30-day unplanned hospital readmission rate after ICU stay was 3.4%. Further studies are required to improve readmission prediction models and to develop targeted interventions for high-risk patients.

  2. 75 FR 27401 - Airworthiness Directives; McDonnell Douglas Corporation Model DC-9-30, DC-9-40, and DC-9-50...

    Science.gov (United States)

    2010-05-17

    ... Airworthiness Directives; McDonnell Douglas Corporation Model DC- 9-30, DC-9-40, and DC-9-50 Series Airplanes... airworthiness directive (AD) for certain Model DC-9-30, DC-9-40, and DC-9-50 series airplanes. This AD requires... this AD to detect and correct the potential for an arc/spark condition to occur within the fuel boost...

  3. Radiotoxicity of α-emitter 211At for testes and its LD50 in mice

    International Nuclear Information System (INIS)

    Lin Ning; Jin Jiannan; Xia Qingjie; Zhang Shuyuan

    1998-01-01

    The radiotoxicity of α-emitter 211 At for testes in NIH strain mice was investigated by a singular i.p. injection with 5.55 x 10 5 Bq of Na 211 At, and the histopathological change of testicular cells was observed. Testes mass decreased rapidly at 6∼30 days post-injection. Histopathological observation revealed that some cells of interstitial tissue are irradiated to death at 6 days, the seminiferous tubules become empty at 30 days post-injection, and there is no spermatogenesis any more at this time. Additionally, the lethal dose (LD 50 ) of 211 At in the mice was investigated also by i.p injection and a LD 50 /7 of 8.14 x 10 4 Bq/g was measured

  4. A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Gislason, Gunnar H; Hlatky, Mark A

    2014-01-01

    BACKGROUND: Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. METHODS AND RESULTS: All individuals...... with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n = 16 827). In total, 1787 (10.6%) died within 30days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute...... by bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P heart failure, this simple...

  5. Geospatial approach for assessment of biophysical vulnerability to agricultural drought and its intra-seasonal variations.

    Science.gov (United States)

    Sehgal, Vinay Kumar; Dhakar, Rajkumar

    2016-03-01

    The study presents a methodology to assess and map agricultural drought vulnerability during main kharif crop season at local scale and compare its intra-seasonal variations. A conceptual model of vulnerability based on variables of exposure, sensitivity, and adaptive capacity was adopted, and spatial datasets of key biophysical factors contributing to vulnerability were generated using remote sensing and GIS for Rajasthan State of India. Hazard exposure was based on frequency and intensity of gridded standardized precipitation index (SPI). Agricultural sensitivity was based on soil water holding capacity as well as on frequency and intensity of normalized difference vegetation index (NDVI)-derived trend adjusted vegetation condition index (VCITadj). Percent irrigated area was used as a measure of adaptive capacity. Agricultural drought vulnerability was derived separately for early, mid, late, and whole kharif seasons by composting rating of factors using linear weighting scheme and pairwise comparison of multi-criteria evaluation. The regions showing very low to extreme rating of hazard exposure, drought sensitivity, and agricultural vulnerability were identified at all four time scales. The results indicate that high to extreme vulnerability occurs in more than 50% of net sown area in the state and such areas mostly occur in western, central, and southern parts. The higher vulnerability is on account of non-irrigated croplands, moderate to low water holding capacity of sandy soils, resulting in higher sensitivity, and located in regions with high probability of rainfall deficiency. The mid and late season vulnerability has been found to be much higher than that during early and whole season. Significant correlation of vulnerability rating with food grain productivity, drought recurrence period, crop area damaged in year 2009 and socioeconomic indicator of human development index (HDI) proves the general soundness of methodology. Replication of this methodology

  6. Effect of Spironolactone on 30-Day Death and Heart Failure Rehospitalization (from the COACH Study)

    NARCIS (Netherlands)

    Maisel, Alan; Xue, Yang; van Veldhuisen, Dirk J.; Voors, Adriaan A.; Jaarsma, Tiny; Pang, Peter S.; Butler, Javed; Pitt, Bertram; Clopton, Paul; de Boer, Rudolf A.

    2014-01-01

    The aim of our study is to investigate the effect of spironolactone on 30-day outcomes in patients with acute heart failure (AHF) and the association between treatment and outcomes stratified by biomarkers. We conducted a secondary analysis of the biomarker substudy of the multicenter COACH

  7. Hospital variation in 30-day mortality after colorectal cancer surgery in denmark: the contribution of hospital volume and patient characteristics

    DEFF Research Database (Denmark)

    Osler, Merete; Iversen, Lene Hjerrild; Borglykke, Anders

    2011-01-01

    This study examines variation between hospitals in 30-day mortality after surgery for colorectal cancer (CRC) in Denmark and explores whether hospital volume and patient characteristics contribute to any variation between hospitals.......This study examines variation between hospitals in 30-day mortality after surgery for colorectal cancer (CRC) in Denmark and explores whether hospital volume and patient characteristics contribute to any variation between hospitals....

  8. Effect of Pharmacy-Supported Transition-of-Care Interventions on 30-Day Readmissions: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Rodrigues, Claire R; Harrington, Amanda R; Murdock, Nicole; Holmes, John T; Borzadek, Eliza Z; Calabro, Kristin; Martin, Jennifer; Slack, Marion K

    2017-10-01

    To describe pharmacy-supported transition-of-care (TOC) interventions and determine their effect on 30-day all-cause readmissions. MEDLINE/PubMed, EMBASE, International Pharmaceutical Abstracts, ABI Inform Complete, PsychINFO, Web of Science, Academic Search Complete, CINHAL, Cochrane library, OIASTER, ProQuest Dissertations & Theses, ClinicalTrials.gov , and relevant websites were searched from January 1, 1995, to December 31, 2015. PICOS+E criteria were utilized. Eligible studies reported pharmacy-supported TOC interventions compared with usual care in adult patients discharged to home within the United States. Studies were required to evaluate postdischarge outcomes (eg, rate of readmissions, hospital utilization). Randomized controlled trials, cohort studies, or controlled before-and-after studies were included. Two reviewers independently extracted data and evaluated study quality. A total of 56 articles were included in the systematic review (n = 61 858), of which 32 reported 30-day all-cause readmissions and were included in the meta-analysis. A taxonomy was developed to categorize targeted patients, intervention types, and pharmacy personnel as sole intervener. The meta-analysis demonstrated about a 32% reduction in the odds of readmission (odds ratio [OR] = 0.68; 95% CI = 0.61 to 0.75) observed for pharmacy-supported TOC interventions compared with usual care. Heterogeneity was identified ( I 2 = 55%; P < 0.001). A stratified meta-analysis showed that interventions with patient-centered follow-up reduced 30-day readmissions relative to studies without follow-up (OR = 0.70; CI = 0.63 to 0.78). Pharmacy-supported TOC programs were associated with a significant reduction in the odds of 30-day readmissions.

  9. Predictors of 30-day perioperative morbidity and mortality of unruptured intracranial aneurysm surgery.

    Science.gov (United States)

    Kerezoudis, Panagiotis; McCutcheon, Brandon A; Murphy, Meghan; Rayan, Tarek; Gilder, Hannah; Rinaldo, Lorenzo; Shepherd, Daniel; Maloney, Patrick R; Hirshman, Brian R; Carter, Bob S; Bydon, Mohamad; Meyer, Fredric; Lanzino, Giuseppe

    2016-10-01

    Large-scale studies examining the incidence and predictors of perioperative complications after surgical clipping of unruptured intracranial aneurysms (UIA) using nationally representative prospectively collected data are lacking in the literature. Using the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) dataset, we conducted a retrospective analysis of the complications experienced by patients that underwent surgical management of a UIA between the years of 2007 and 2013. The primary outcomes of interest were mortality within the 30-day perioperative period and adverse discharge disposition to a location other than home. Predictors of morbidity and mortality were elucidated using multivariable logistic regression analyses controlling for available patient demographic, comorbidity, and operative characteristics. 662 patients were identified in the ACS-NSQIP dataset for operative management of an unruptured aneurysm. The observed rates of 30-day mortality and adverse discharge disposition were 2.27% and 19.47%, respectively. A hundred and eight (16.31%) patients developed at least one major complication. On multivariable analysis, death within 30days was significantly associated with increased operative time (OR 1.005 per minute, 95% CI 1.002-1.008) and chronic preoperative corticosteroid use (OR 28.4, 95% CI 1.68-480.42), whereas major complication development was associated with increased operative time (OR 1.004 per minute, 95% CI 1.002-1.006), age (OR 1.017 per year, 95% CI 1-1.034), preoperative dependency (OR 3.3, 95% CI 1.16-9.40) and diabetes mellitus (OR 2.89, 95% CI 1.45-5.75). Lastly, increasing age (OR 1.017 per year, 95% CI 1-1.034) as well as ASA Class 3 (OR 1.73, 95% CI 1.08-2.77) and 4 (OR 2.28, 95% CI 1.1-4.72) were independent predictors of discharge to a location other than home. Our study yields morbidity and mortality benchmarks for UIA surgery in a representative, national surgical registry. It will

  10. Predicting psychiatric readmission: sex-specific models to predict 30-day readmission following acute psychiatric hospitalization.

    Science.gov (United States)

    Barker, Lucy Church; Gruneir, Andrea; Fung, Kinwah; Herrmann, Nathan; Kurdyak, Paul; Lin, Elizabeth; Rochon, Paula A; Seitz, Dallas; Taylor, Valerie H; Vigod, Simone N

    2018-02-01

    Psychiatric readmission is a common negative outcome. Predictors of readmission may differ by sex. This study aimed to derive and internally validate sex-specific models to predict 30-day psychiatric readmission. We used population-level health administrative data to identify predictors of 30-day psychiatric readmission among women (n = 33,353) and men (n = 32,436) discharged from all psychiatric units in Ontario, Canada (2008-2011). Predictor variables included sociodemographics, health service utilization, and clinical characteristics. Using derivation data sets, multivariable logistic regression models were fit to determine optimal predictive models for each sex separately. Results were presented as adjusted odds ratios (aORs) and 95% confidence intervals (CI). The multivariable models were then applied in the internal validation data sets. The 30-day readmission rates were 9.3% (women) and 9.1% (men). Many predictors were consistent between women and men. For women only, personality disorder (aOR 1.21, 95% CI 1.03-1.42) and positive symptom score (aOR 1.41, 95% CI 1.09-1.82 for score of 1 vs. 0; aOR 1.44, 95% CI 1.26-1.64 for ≥ 2 vs. 0) increased odds of readmission. For men only, self-care problems at admission (aOR 1.20, 95% CI 1.06-1.36) and discharge (aOR 1.44, 95% CI 1.26-1.64 for score of 1 vs. 0; aOR 1.79, 95% CI 1.17-2.74 for 2 vs. 0), and mild anxiety rating (score of 1 vs. 0: aOR 1.30, 95% CI 1.02-1.64, derivation model only) increased odds of readmission. Models had moderate discriminative ability in derivation and internal validation samples for both sexes (c-statistics 0.64-0.65). Certain key predictors of psychiatric readmission differ by sex. This knowledge may help to reduce psychiatric hospital readmission rates by focusing interventions.

  11. Impact of Inpatient Versus Outpatient Total Joint Arthroplasty on 30-Day Hospital Readmission Rates and Unplanned Episodes of Care.

    Science.gov (United States)

    Springer, Bryan D; Odum, Susan M; Vegari, David N; Mokris, Jeffrey G; Beaver, Walter B

    2017-01-01

    This article describes a study comparing 30-day readmission rates between patients undergoing outpatient versus inpatient total hip (THA) and knee (TKA) arthroplasty. A retrospective review of 137 patients undergoing outpatient total joint arthroplasty (TJA) and 106 patients undergoing inpatient (minimum 2-day hospital stay) TJA was conducted. Unplanned hospital readmissions and unplanned episodes of care were recorded. All patients completed a telephone survey. Seven inpatients and 16 outpatients required hospital readmission or an unplanned episode of care following hospital discharge. Readmission rates were higher for TKA than THA. The authors found no statistical differences in 30-day readmission or unplanned care episodes. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Effect of bystander CPR initiation prior to the emergency call on ROSC and 30day survival

    DEFF Research Database (Denmark)

    Viereck, Søren; Palsgaard Møller, Thea; Kjær Ersbøll, Annette

    2017-01-01

    BACKGROUND: This study aimed at evaluating if time for initiation of bystander cardiopulmonary resuscitation (CPR) - prior to the emergency call (CPRprior) versus during the emergency call following dispatcher-assisted CPR (CPRduring) - was associated with return of spontaneous circulation (ROSC...... and corresponding emergency calls were evaluated. Multivariable logistic regression analyses were applied to evaluate the association between time for initiation of bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of CPRprior. RESULTS: The study...... included 548 emergency calls for OHCA patients receiving bystander CPR, 34.9% (n=191) in the CPRpriorgroup and 65.1% (n=357) in the CPRduringgroup. Multivariable analyses showed no difference in ROSC (OR=0.88, 95% CI: 0.56-1.38) or 30-day survival (OR=1.14, 95% CI: 0.68-1.92) between CPRpriorand CPRduring...

  13. The National Surgical Quality Improvement Program 30-Day Challenge: Microsurgical Breast Reconstruction Outcomes Reporting Reliability

    Directory of Open Access Journals (Sweden)

    Austin D. Chen

    2018-03-01

    Conclusion:. For immediate, free-tissue breast reconstruction, the ACS-NSQIP may be reliable for monitoring and comparing SSI, WD, URO, and URA rates. However, clinicians may find it useful to understand limitations of the ACS-NSQIP for complications and risk factors, as it may underreport complications occurring beyond 30 days.

  14. Atrial fibrillation detected by external loop recording for seven days or two-day simultaneous Holter recording: A comparison in patients with ischemic stroke or transient ischemic attack.

    Science.gov (United States)

    Sejr, Michala Herskind; Nielsen, Jens Cosedis; Damgaard, Dorte; Sandal, Birgitte Forsom; May, Ole

    Atrial fibrillation (AF) is the most common cardiac cause of ischemic stroke and transient ischemic attack (IS/TIA). To compare the diagnostic value of seven-day external loop recording (ELR) and two-day Holter recording for detecting AF after IS/TIA. 191 IS/TIA patients without AF history. Endpoint was AF >30s. We started two-day Holter recording and seven-day ELR simultaneously. Seven-day ELR and two-day Holter recording detected the same three AF patients. ELR detected another six patients with AF adjudicated by cardiologists, four detections after Holter (3 vs. 7, p=0.125) and two false-positive detections during Holter. Seven-day ELR automatically classified 50/191 patients (26%) with AF, but only 7/50 (14%) were confirmed as AF by cardiologists. Seven-day ELR did not detect significantly more patients with AF than two-day Holter recording. 86% of patients with ELR-classified AF were false positives, indicating a poor performance of the automatic AF detection algorithm used. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Risk Factors for 30-day Unplanned Readmission following Infrainguinal Endovascular Interventions

    Science.gov (United States)

    Bodewes, Thomas C.F.; Soden, Peter A.; Ultee, Klaas H.J.; Zettervall, Sara L.; Pothof, Alexander B.; Deery, Sarah E.; Moll, Frans L.; Schermerhorn, Marc L.

    2016-01-01

    Objective Unplanned hospital readmissions following surgical interventions are associated with adverse events and contribute to increasing healthcare costs. Despite numerous studies defining risk factors following lower extremity bypass surgery, evidence regarding readmission after endovascular interventions is limited. This study aims to identify predictors of 30-day unplanned readmission following infrainguinal endovascular interventions. Methods We identified all patients undergoing an infrainguinal endovascular intervention in the Targeted Vascular module of the American College of Surgeons National Surgical Quality Improvement Program between 2012 and 2014. Perioperative outcomes were stratified by symptom status (chronic limb-threatening ischemia [CLI] vs. claudication). Patients who died during index admission, and those who remained in the hospital after 30 days, were excluded. Indications for unplanned readmission related to the index procedure were evaluated. Multivariable logistic regression was used to identify preoperative and in-hospital (during index admission) risk factors of 30-day unplanned readmission. Results 4449 patients underwent infrainguinal endovascular intervention, of which 2802 (63%) had CLI (66% tissue loss) and 1647 (37%) had claudication. The unplanned readmission rates for CLI and claudication patients were 16% (N=447) and 6.5% (N=107), respectively. Mortality after index admission was higher for readmitted patients compared to those not readmitted (CLI: 3.4% vs. 0.7%, P readmissions were related to the index procedure. Among CLI patients, the most common indication for readmission related to the index procedure was wound- or infection-related (42%), while patients with claudication were mainly readmitted for recurrent symptoms of peripheral vascular disease (28%). In patients with CLI, predictors of unplanned readmission included diabetes (OR: 1.3, 95% CI: 1.01–1.6), congestive heart failure (1.6, 1.1–2.5), renal insufficiency

  16. 78 FR 44134 - Submission for OMB Review; 30-day Comment Request: Financial Sustainability of Human Tissue...

    Science.gov (United States)

    2013-07-23

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Submission for OMB Review; 30-day Comment Request: Financial Sustainability of Human Tissue Biobanking (NCI) SUMMARY: Under the... Collection: Financial Sustainability of Human Tissue Biobanking, 0925-NEW, National Cancer Institute (NCI...

  17. Discharge Processes and 30-Day Readmission Rates of Patients Hospitalized for Heart Failure on General Medicine and Cardiology Services.

    Science.gov (United States)

    Salata, Brian M; Sterling, Madeline R; Beecy, Ashley N; Ullal, Ajayram V; Jones, Erica C; Horn, Evelyn M; Goyal, Parag

    2018-05-01

    Given high rates of heart failure (HF) hospitalizations and widespread adoption of the hospitalist model, patients with HF are often cared for on General Medicine (GM) services. Differences in discharge processes and 30-day readmission rates between patients on GM and those on Cardiology during the contemporary hospitalist era are unknown. The present study compared discharge processes and 30-day readmission rates of patients with HF admitted on GM services and those on Cardiology services. We retrospectively studied 926 patients discharged home after HF hospitalization. The primary outcome was 30-day all-cause readmission after discharge from index hospitalization. Although 60% of patients with HF were admitted to Cardiology services, 40% were admitted to GM services. Prevalence of cardiovascular and noncardiovascular co-morbidities were similar between patients admitted to GM services and Cardiology services. Discharge summaries for patients on GM services were less likely to have reassessments of ejection fraction, new study results, weights, discharge vital signs, discharge physical examinations, and scheduled follow-up cardiologist appointments. In a multivariable regression analysis, patients on GM services were more likely to experience 30-day readmissions compared with those on Cardiology services (odds ratio 1.43 95% confidence interval [1.05 to 1.96], p = 0.02). In conclusion, outcomes are better among those admitted to Cardiology services, signaling the need for studies and interventions focusing on noncardiology hospital providers that care for patients with HF. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. 78 FR 48178 - Submission for OMB Review; 30-day Comment Request: Autism Spectrum Disorder Research Portfolio...

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    2013-08-07

    ...; 30-day Comment Request: Autism Spectrum Disorder Research Portfolio Analysis SUMMARY: Under the... (ASD) Research Portfolio Analysis, 0925--NEW- National Institute of Mental Health (NIMH), National Institutes of Health (NIH). Need and Use of Information Collection: The purpose of the ASD portfolio analysis...

  19. 77 FR 47690 - 30-Day Notice of Proposed Information Collection: Civilian Response Corps Database In-Processing...

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    2012-08-09

    .... Title of Information Collection: Civilian Response Corps Database In-Processing Electronic Form. OMB... DEPARTMENT OF STATE [Public Notice 7976] 30-Day Notice of Proposed Information Collection: Civilian Response Corps Database In-Processing Electronic Form, OMB Control Number 1405-0168, Form DS-4096...

  20. Digoxin Use and Lower 30-day All-cause Readmission for Medicare Beneficiaries Hospitalized for Heart Failure

    NARCIS (Netherlands)

    Ahmed, Ali; Bourge, Robert C.; Fonarow, Gregg C.; Patel, Kanan; Morgan, Charity J.; Fleg, Jerome L.; Aban, Inmaculada B.; Love, Thomas E.; Yancy, Clyde W.; Deedwania, Prakash; van Veldhuisen, Dirk J.; Filippatos, Gerasimos S.; Anker, Stefan D.; Allman, Richard M.

    BACKGROUND: Heart failure is the leading cause for hospital readmission, the reduction of which is a priority under the Affordable Care Act. Digoxin reduces 30-day all-cause hospital admission in chronic systolic heart failure. Whether digoxin is effective in reducing readmission after

  1. Residents examine factors associated with 30-day, same-cause hospital readmissions on an internal medicine service.

    Science.gov (United States)

    Moran, Jennifer; Colbert, Colleen Y; Song, Juhee; Hull, Joshua; Rajan, Sabitha; Varghees, Sunita; Arroliga, Alejandro C; Reddy, Santosh P

    2013-01-01

    In recent years, there has been increased interest in stemming the tide of hospital readmissions in an attempt to improve quality of care. This study presents the Phase I results of a resident-led quality improvement initiative to determine the percentage of and risk factors for same-cause readmissions (SCRs; defined as hospital readmission within 30 days of hospital discharge for treatment of the same condition) to the internal medicine service of a multispecialty teaching hospital in central Texas. Results indicate that patients diagnosed with chronic obstructive pulmonary disease/asthma or anemia may be at increased risk for SCRs. Those patients who are insured by Medicaid and those who require assistance from social services also demonstrated an increased risk for SCRs. This study appears to be the first resident-led initiative in the field to examine 30-day SCRs to an internal medicine service for demographic and clinical risk factors.

  2. CERN Open Days The LHC demystified!

    CERN Multimedia

    2008-01-01

    Lots of surprises are being planned for the CERN Open Days scheduled for 5 and 6 April (see 21 January edition of the Bulletin). Fred’s itinerary on 6 April 20089.00 a.m\tDeparture from SM12 at CERN (the pit down which all the LHC magnets were lowered into the tunnel)9.15 a.m. Saint-Genis theatre10.00 a.m.\tRoussillon communal hall in Crozet 10.50 a.m. La Chenaille communal hall in Echenevex 11.40 a.m. CMS Building SX5 at Cessy 2.30 p.m. La Forge communal hall in Versonnex 3.30 p.m. Le Levant communal hall in Ferney Voltaire4.40 Forum in Meyrin 5.30 p.m. Main Auditorium at CERN For instance, Fred, who fronts the French television programme "C’est pas sorcier" on France 3 will be taking part in the Open Day for the general public on Sunday, 6 April. He will be on board a CERN lorry carrying a 35 tonne 15 m long dipole magnet and will make halts at eight Swiss and French communes around the LHC Ring to meet the local inhabitants (see...

  3. Evaluation of fungal burden of medicinal plants submitted to gamma radiation process after 30 days

    International Nuclear Information System (INIS)

    Aquino, Simone; Araujo, Michel M.; Villavicencio, A.L.C.H.; Goncalez, Edlayne; Reis, Tatiana A. dos; Correa, Benedito

    2007-01-01

    Forty samples of medicinal plants (Peumus boldus, Camellia sinensis, Maytenus ilicifolia and Cassia angustifolia), purchased from pharmacies and street market in the five cities of Sao Paulo State, were irradiated using a 60 Co gamma ray source (Gammacell) with a dose of 10.0 kGy, delivered at dose rate of 3.0 kGy/h. Nonirradiated samples were used as controls of fungal isolates. For fungal counts and identification in medicinal plants a serial dilutions from 10 -1 to 10 -6 of the samples were seeded in duplicates and plated using the method in Dichloran 18% Glycerol Agar (DG 18) and were counted after five days at 25 deg C. Mycological analysis of control samples revealed the presence of genera Aspergillus and Penicillium, which are known as toxigenic fungi. The process of gamma radiation was effective in reducing the number of colony forming units (cfu/g) in all irradiated samples of medicinal plants after 30 days, using the dose of 10.0 kGy and kept of veiled conditions. (author)

  4. Evaluation of fungal burden of medicinal plants submitted to gamma radiation process after 30 days

    Energy Technology Data Exchange (ETDEWEB)

    Aquino, Simone; Araujo, Michel M.; Villavicencio, A.L.C.H. [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil). Centro de Tecnologia das Radiacoes]. E-mail: siaq06@hotmail.com; Goncalez, Edlayne; Reis, Tatiana A. dos; Correa, Benedito [Universidade de Sao Paulo, SP (Brazil). Inst. de Ciencias Biomedicas. Dept. de Microbiologia]. E-mail: correabe@usp.br

    2007-07-01

    Forty samples of medicinal plants (Peumus boldus, Camellia sinensis, Maytenus ilicifolia and Cassia angustifolia), purchased from pharmacies and street market in the five cities of Sao Paulo State, were irradiated using a {sup 60}Co gamma ray source (Gammacell) with a dose of 10.0 kGy, delivered at dose rate of 3.0 kGy/h. Nonirradiated samples were used as controls of fungal isolates. For fungal counts and identification in medicinal plants a serial dilutions from 10{sup -1} to 10{sup -6} of the samples were seeded in duplicates and plated using the method in Dichloran 18% Glycerol Agar (DG 18) and were counted after five days at 25 deg C. Mycological analysis of control samples revealed the presence of genera Aspergillus and Penicillium, which are known as toxigenic fungi. The process of gamma radiation was effective in reducing the number of colony forming units (cfu/g) in all irradiated samples of medicinal plants after 30 days, using the dose of 10.0 kGy and kept of veiled conditions. (author)

  5. Outcome of slow pathway modulation for atrioventricular nodal reentrant tachycardia with 50 versus 30 watts-more power, more effect?

    Science.gov (United States)

    Dechering, Dirk G; Schleberger, Ruben; Greiser, Eva; Dickow, Jannis; Koebe, Julia; Frommeyer, Gerrit; Willems, Stephan; Eckardt, Lars; Hoffmann, Boris A; Wasmer, Kristina

    2018-03-19

    Slow pathway modulation is the treatment of choice in patients with atrioventricular nodal reentrant tachycardia (AVNRT). No comparative data on ablation strategies exist. Therefore, we sought to compare two common ablation approaches. We analyzed prospective ablation databases of two high-volume tertiary centers (> 1000 ablations/year) using either 30 or 50 W for slow pathway modulation from 2012 to 2013. We analyzed procedural characteristics as well as short- and long-term outcomes. Mean follow-up was 36 ± 9 months. Six hundred thirty-four patients (50 W center: n = 342, 30 W center: n = 292) were ablated. Slow pathway modulation was successful in 99% in both groups (p = ns). Periprocedural AV block occurred in nine patients (2.6%) in the 50 W and five patients (1.7%) in the 30 W group (p = 0.59), respectively. We documented no permanent higher-degree AV block. The number of RF lesions and seconds of RF delivery was significantly less in the 50 W group (p = 0.04 for number of lesions; p modulation are highly effective and safe. Significantly, fewer RF duration was necessary to modulate the slow pathway with higher power output (50 W). Our subgroup analysis suggests that males and females might benefit most from different modulation approaches.

  6. Upper parameters of toxicity (LDsub(50/30)) of some radioactive and chemical substances

    International Nuclear Information System (INIS)

    Rodionova, L.F.; Kupriyanova, V.M.; Zasedatelev, A.A.

    1978-01-01

    The toxicities of radioactive ( 90 Sr, 210 Po) and chemical (lead nitrate, mercuric chloride) substances were compared using equivalent procedures. Ninety six doses of toxic substances in various concentrations were tested on mice to which these substances were administered by intragastric intubation. The material was processed and analyzed by conventional methods used in toxicology. The upper limits of toxicity for the tested substances were determined from their LDsub(50/30) values by various methods of calculation

  7. The non Opec petroleum supply would get from 42 to 47 Mb/day from 1995 until 2000 but the call to Opec petroleum would reach 50 Mb/day in the year 2010

    International Nuclear Information System (INIS)

    Anon.

    1996-01-01

    The increase of non Opec petroleum supply is going to reach 47 Mb/d in 2000. This increase comes from the North sea production and that is the reason why the international Energy Agency estimates that the petroleum prices, except supply disruption, will not increase. An increase of international energy demand is predicted from 34% to 46% between 1995 and 2010. This demand will be satisfied by fossil fuels. The petroleum demand will become from 70 millions of barrels by day to 92 and 97 millions barrels by day in 2010. The dependence of OECD countries could reach 60% in 2010 against 50% nowadays. It is predicted that middle east Opec countries would supply 50% of the worldwide petroleum needs and the OECD energy consumption could represent 50% of the worldwide energy consumption. (N.C.). 3 tabs

  8. 78 FR 79703 - Submission for OMB Review; 30-Day Comment Request: Application Process for Clinical Research...

    Science.gov (United States)

    2013-12-31

    ...; 30-Day Comment Request: Application Process for Clinical Research Training and Medical Education at..., MD, Deputy Director, Office of Clinical Research Training and Medical Education, NIH Clinical Center... Clinical Research Training and Medical Education at the Clinical Center and its Impact on Course and...

  9. 77 FR 2601 - 30-Day Notice of Proposed Information Collection: DS-4164 OMB Control #1405-XXXX

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    2012-01-18

    ... DEPARTMENT OF STATE [Public Notice 7753] 30-Day Notice of Proposed Information Collection: DS-4164 OMB Control 1405-XXXX ACTION: Notice of request for public comment and submission to OMB of proposed collection of information. SUMMARY: The Department of State has submitted the following information...

  10. 76 FR 9849 - 30-Day Notice of Proposed Information Collection: Refugee Biographic Data, OMB Control Number...

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    2011-02-22

    ... DEPARTMENT OF STATE [Public Notice 7339] 30-Day Notice of Proposed Information Collection: Refugee... accordance with the Paperwork Reduction Act of 1995. Title of Information Collection: Refugee Biographic Data... Originating Office: Bureau of Population, Refugees, and Migration, PRM/A Form Number: N/A Respondents: Refugee...

  11. 77 FR 37706 - Agency Information Collection Activities: 30-Day Notice of Intention To Request Clearance of...

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    2012-06-22

    ... purchase price is attributable either directly or indirectly to such assets, the transaction may not be... DEPARTMENT OF THE INTERIOR National Park Service [NPS-BSD-CONC-10370; 2410-OYC] Agency Information Collection Activities: 30-Day Notice of Intention To Request Clearance of Collection of Information...

  12. 78 FR 78369 - Submission for OMB Review; 30-Day Comment Request: Early Career Reviewer Program Online...

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    2013-12-26

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Submission for OMB Review; 30-Day Comment Request: Early Career Reviewer Program Online Application System--Center for Scientific Review (CSR) SUMMARY: Under the provisions of Section 3507(a)(1)(D) of the Paperwork Reduction Act...

  13. WHipple-ABACUS, a simple, validated risk score for 30-day mortality after pancreaticoduodenectomy developed using the ACS-NSQIP database.

    Science.gov (United States)

    Gleeson, Elizabeth M; Shaikh, Mohammad F; Shewokis, Patricia A; Clarke, John R; Meyers, William C; Pitt, Henry A; Bowne, Wilbur B

    2016-11-01

    Pancreaticoduodenectomy needs simple, validated risk models to better identify 30-day mortality. The goal of this study is to develop a simple risk score to predict 30-day mortality after pancreaticoduodenectomy. We reviewed cases of pancreaticoduodenectomy from 2005-2012 in the American College of Surgeons-National Surgical Quality Improvement Program databases. Logistic regression was used to identify preoperative risk factors for morbidity and mortality from a development cohort. Scores were created using weighted beta coefficients, and predictive accuracy was assessed on the validation cohort using receiver operator characteristic curves and measuring area under the curve. The 30-day mortality rate was 2.7% for patients who underwent pancreaticoduodenectomy (n = 14,993). We identified 8 independent risk factors. The score created from weighted beta coefficients had an area under the curve of 0.71 (95% confidence interval, 0.66-0.77) on the validation cohort. Using the score WHipple-ABACUS (hypertension With medication + History of cardiac surgery + Age >62 + 2 × Bleeding disorder + Albumin procedure. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Increased in vivo glucose utilization in 30-day-old obese Zucker rat: Role of white adipose tissue

    International Nuclear Information System (INIS)

    Krief, S.; Bazin, R.; Dupuy, F.; Lavau, M.

    1988-01-01

    In vivo whole-body glucose utilization and uptake in multiple individual tissues were investigated in conscious 30-day-old Zucker rats, which when obese are hyperphagic, hyperinsulinemic, and normoglycemic. Whole-body glucose metabolism (assessed by [3- 3 H]glucose) was 40% higher in obese (fa/fa) than in lean (Fa/fa) rats, suggesting that obese rats were quite responsive to their hyperinsulinemia. In obese compared with lean rats, tissue glucose uptake was increased by 15, 12, and 6 times in dorsal, inguinal, perigonadal white depots, respectively; multiplied by 2.5 in brown adipose tissue; increased by 50% in skin from inguinal region but not in that from cranial, thoracic, or dorsal area; and increased twofold in diaphragm but similar in heart in proximal intestine, and in total muscular mass of limbs. The data establish that in young obese rats the hypertrophied white adipose tissue was a major glucose-utilizing tissue whose capacity for glucose disposal compared with that of half the muscular mass. Adipose tissue could therefore play an important role in the homeostasis of glucose in obese rats in the face of their increased carbohydrate intake

  15. 77 FR 43412 - 30-Day Notice of Proposed Information Collection: DS 7655, Iraqi Citizens and Nationals Employed...

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    2012-07-24

    ... to 30 days from July 24, 2012. ADDRESSES: You may submit comments by any of the following methods..., biographical information, to include employee name, date(s) of employment, biometric, and other data must be...

  16. Relationship between spending on electronic cigarettes, 30-day use, and disease symptoms among current adult cigarette smokers in the U.S.

    Directory of Open Access Journals (Sweden)

    Tingting Yao

    Full Text Available To examine the relationship between spending on electronic cigarettes (e-cigarettes and disease symptoms compared with the relationship between 30-day e-cigarette use and disease symptoms among adult cigarette smokers in the U.S.We analyzed data from the Tobacco and Attitudes Beliefs Survey which included 533 respondents aged 24+ who were current cigarette smokers and e-cigarette ever users. Fifteen self-reported disease symptoms were included as outcome variables. Separate multivariable logistic regression models were estimated for each disease symptom with total spending on e-cigarettes in the past 30 days and with reported 30-day e-cigarette use. All models controlled for cigarettes smoked per day (CPD and sociodemographic characteristics.We found that those who spent more on e-cigarettes were more likely to report chest pain (AOR = 1.25, 95% CI 1.02-1.52, to notice blood when brushing their teeth (AOR = 1.23, 95% CI 1.02-1.49, to have sores or ulcers in their mouth (AOR = 1.36, 95% CI 1.08-1.72, and to have more than one cold (AOR = 1.36, 95% CI 1.05-1.78 than those with no spending on e-cigarettes in the past 30 days in an adjusted analysis. After controlling for CPD and other covariates, there were no significant relationships between 30-day e-cigarette use and symptoms. Even after controlling for CPD, e-cigarette expenditures or use was associated with greater odds of wheezing and shortness of breath.E-cigarette expenditures might be a more useful measure of intensity of e-cigarette use. The additional health effect of e-cigarette use or expenditures among smokers independent of the effect of CPD suggests that e-cigarette use adds adverse health effects even among cigarette smokers.

  17. Relationship between spending on electronic cigarettes, 30-day use, and disease symptoms among current adult cigarette smokers in the U.S.

    Science.gov (United States)

    Yao, Tingting; Max, Wendy; Sung, Hai-Yen; Glantz, Stanton A; Goldberg, Rachel L; Wang, Julie B; Wang, Yingning; Lightwood, James; Cataldo, Janine

    2017-01-01

    To examine the relationship between spending on electronic cigarettes (e-cigarettes) and disease symptoms compared with the relationship between 30-day e-cigarette use and disease symptoms among adult cigarette smokers in the U.S. We analyzed data from the Tobacco and Attitudes Beliefs Survey which included 533 respondents aged 24+ who were current cigarette smokers and e-cigarette ever users. Fifteen self-reported disease symptoms were included as outcome variables. Separate multivariable logistic regression models were estimated for each disease symptom with total spending on e-cigarettes in the past 30 days and with reported 30-day e-cigarette use. All models controlled for cigarettes smoked per day (CPD) and sociodemographic characteristics. We found that those who spent more on e-cigarettes were more likely to report chest pain (AOR = 1.25, 95% CI 1.02-1.52), to notice blood when brushing their teeth (AOR = 1.23, 95% CI 1.02-1.49), to have sores or ulcers in their mouth (AOR = 1.36, 95% CI 1.08-1.72), and to have more than one cold (AOR = 1.36, 95% CI 1.05-1.78) than those with no spending on e-cigarettes in the past 30 days in an adjusted analysis. After controlling for CPD and other covariates, there were no significant relationships between 30-day e-cigarette use and symptoms. Even after controlling for CPD, e-cigarette expenditures or use was associated with greater odds of wheezing and shortness of breath. E-cigarette expenditures might be a more useful measure of intensity of e-cigarette use. The additional health effect of e-cigarette use or expenditures among smokers independent of the effect of CPD suggests that e-cigarette use adds adverse health effects even among cigarette smokers.

  18. SU-F-19A-07: Is a Day30 Scan Necessary to Evaluate Activity-Based Regulatory Compliance in Permanent Interstitial Brachytherapy for Prostate Cancer?

    Energy Technology Data Exchange (ETDEWEB)

    Kapur, P; Ford, J; Moghanaki, D; Datsang, R; Chang, M; Rosu, M [Virginia Commonwealth University, Richmond, Virginia (United States); Veterans Affairs Medical Center, Richmond, VA (United States); Hagan, M; Palta, J [Virginia Commonwealth University, Richmond, Virginia (United States); Veterans Affairs Medical Center, Richmond, VA (United States); National Radiation Oncology Program, Richmond, VA (United States)

    2014-06-15

    Purpose: To evaluate the Medical Event (ME) criteria for I-125 prostate implants based on the assessment of post implant dosimetry on “Day0”/“Day30” imaging. The new ME criteria do not mandate a timeframe for this assessment. The compliance criteria are: more than 80% of the activity from the written directive for treatment site (TS) must be implanted inside TS, and doses to 1cc of either uninvolved rectum (D1-UR) or uninvolved bladder (D1-UB), or 2cc of other non-specified tissue (D2-UT) must be less than 150% of the planned dose. Methods: “Day0”/“Day30” post-implant analyses for 25 patients were evaluated. Treatment plans had a peripheral loading pattern with 2 core needles placed at least 10 mm away from urethra, with several seeds planned outside of the prostate for adequate target coverage. TS were a uniform 5 mm expansion of the prostate, except posteriorly (no expansion). Results: “Day0”/“Day30”analyses found no MEs. The relative changes for D1-UR, D1-UB, and D2-UT were (ranges): [−37.0, 38.2]%, [−96.5, 74.7]%, and [−41.2, 37.7]%. Furthermore, changes did not correlate with prostate volume changes of −18.7% [σ:16.0%, range:−60.5%, +6.4%]. These unfavorable changes did not lead to ME at “Day30” because these values were generally well below 150% at “Day0”. However, D2-UT dose values exceeded those for D1-UR and D1-UB at both “Day0”/“Day30”. Conclusion: The total activity was relatively insensitive to changes in target volume from “Day0” to ”Day30”. The dose metrics of interest, albeit susceptible to large, often unfavorable changes, remained less than the 150% threshold. Data from this study suggest that “Day0” can be used for the regulatory compliance evaluation. However, further evaluation at “Day30” is advisable if D2-UT is 110% or above (based on the largest D2-UT increase of 37.7% observed in this patient population). Future rigorous statistical analysis of a larger cohort will afford a

  19. Predicting 30-Day Readmissions in an Asian Population: Building a Predictive Model by Incorporating Markers of Hospitalization Severity.

    Directory of Open Access Journals (Sweden)

    Lian Leng Low

    Full Text Available To reduce readmissions, it may be cost-effective to consider risk stratification, with targeting intervention programs to patients at high risk of readmissions. In this study, we aimed to derive and validate a prediction model including several novel markers of hospitalization severity, and compare the model with the LACE index (Length of stay, Acuity of admission, Charlson comorbidity index, Emergency department visits in past 6 months, an established risk stratification tool.This was a retrospective cohort study of all patients ≥ 21 years of age, who were admitted to a tertiary hospital in Singapore from January 1, 2013 through May 31, 2015. Data were extracted from the hospital's electronic health records. The outcome was defined as unplanned readmissions within 30 days of discharge from the index hospitalization. Candidate predictive variables were broadly grouped into five categories: Patient demographics, social determinants of health, past healthcare utilization, medical comorbidities, and markers of hospitalization severity. Multivariable logistic regression was used to predict the outcome, and receiver operating characteristic analysis was performed to compare our model with the LACE index.74,102 cases were enrolled for analysis. Of these, 11,492 patient cases (15.5% were readmitted within 30 days of discharge. A total of fifteen predictive variables were strongly associated with the risk of 30-day readmissions, including number of emergency department visits in the past 6 months, Charlson Comorbidity Index, markers of hospitalization severity such as 'requiring inpatient dialysis during index admission, and 'treatment with intravenous furosemide 40 milligrams or more' during index admission. Our predictive model outperformed the LACE index by achieving larger area under the curve values: 0.78 (95% confidence interval [CI]: 0.77-0.79 versus 0.70 (95% CI: 0.69-0.71.Several factors are important for the risk of 30-day readmissions

  20. Demographic, procedural and 30-day safety results from the WEB Intra-saccular Therapy Study (WEB-IT).

    Science.gov (United States)

    Fiorella, David; Molyneux, Andrew; Coon, Alexander; Szikora, Istvan; Saatci, Isil; Baltacioglu, Feyyaz; Sultan, Ali; Arthur, Adam

    2017-12-01

    The Woven EndoBridge (WEB) represents a novel intrasaccular therapeutic option for the treatment of intracranial wide-necked bifurcation aneurysms (WNBAs). The WEB-IT Study is a pivotal Investigational Device Exemption (IDE) study to determine the safety and effectiveness of the WEB device for the treatment of WNBAs located in the anterior and posterior intracranial circulations. We present the patient demographics, procedural characteristics, and 30-day adverse event data for the US WEB-IT study. WEB-IT is a prospective multicenter single-arm interventional study conducted at 25 US and 6 international centers. The study enrolled 150 adults with WNBAs of the anterior and posterior intracranial circulations. All patients were intended to receive a WEB device delivered via standard endovascular neurosurgical embolization techniques. The study was conducted under Good Clinical Practices and included independent adjudication effectiveness outcomes and all adverse events. One hundred and fifty patients enrolled at 27 investigational sites underwent attempted treatment with the WEB. Mean age was 59 years (range 29-79) and 110 (73.3%) of the patients were female. Treated aneurysms were located at the basilar apex (n=59, 39.3%), middle cerebral artery bifurcation (n=45, 30%), anterior communicating artery (n=40, 26.7%), and internal carotid artery terminus (n=6, 4%). Average aneurysm size was 6.4 mm (range 3.6-11.4) with a mean neck size of 4.8 mm (range 2.0-8.2, mean dome to neck ratio 1.34). Nine patients presented with ruptured aneurysms. Of the enrolled patients, 98.7% were treated successfully with WEB devices. Mean±SD fluoroscopy time was 30.2±15.7 min. One primary safety event (PSE) (0.7%)-a delayed parenchymal hemorrhage 22 days after treatment-occurred between the index procedure and 30-day follow-up. In addition to the single PSE, there were seven (4.7%) minor ischemic strokes (5 resolved without sequelae and 2 had a modified Rankin Scale score of 1

  1. Effects of 30-, 60-, and 90-Day Bed Rest on Postural Control in Men and Women

    Science.gov (United States)

    Esteves, Julie; Taylor, Laura C.; Vanya, Robert D.; Dean, S. Lance; Wood, Scott J.

    2011-01-01

    INTRODUCTION Head-down-tilt bed rest (HDT) has been used as a safe gr ound-based analog to mimic and develop countermeasures for the physiological effects of spaceflight, including decrements in postural stability. The purpose of this investigation was to characterize the effects of 30-, 60-, and 90-day bed rest on postural control in men and women. METHODS Twenty-nine subjects (18M,11F) underwent 13 days of ambula tory acclimatization and were placed in 6? HDT for 30 (n=12), 60 (n=8), or 90 (n=9) days, followed by 14 days of ambulatory recovery. Computerized dynamic posturography (CDP) was used to assess changes in sensory and motor components of postural control, and recovery after HDT. Sensory Organization Tests (SOTs) objectively evaluate one?s ability to effectively use or suppress visual, vestibular, and proprioceptive information for postural control. Stability during the SOTs was assessed using peak-to-peak sway and convergence toward stability limits to derive an equilibrium score. Motor Control Tests (MCTs) evaluate one?s ability to recover from unexpected support surface perturbations, with performance determined by center-of-pressure path length. Whole-body kinematic data were collected to determine body-sway strategy used to maintain stability during each condition. Baselines were determined pre-HDT. Recovery was tracked post-HDT on days 0, 1, 2, and 4. RESULTS Immediately after HDT, subjects showed decreased performance on most SOTs, primarily on sway-referenced support conditions, typically returning to baseline levels within 4 days. MCT performance was not significantly affected. There were no significant gender or duration differences in performance. Kinematic data revealed a tendency to use ankle strategy to maintain an upright stance during most SOT conditions. Interestingly, six subjects (2M,4F) experienced orthostatic intolerance and were unable to complete day 0 testing. CONCLUSION HDT mimics some un loading mechanisms of spaceflight and

  2. LD50 and inviably dose of gamma radiation for Musca domestica L., 1758 (diptera: muscidae) pupae aged 1, 2, 3 and 4 days

    International Nuclear Information System (INIS)

    Itepan, Natanael M.; Itepan, Sara E.D.Z.

    2013-01-01

    This experiment was carried out in Biological Control of Domestic Fly 'Eduardo Hiroshi Mizumoto' Laboratory at Entomology and Acarology Department (LEA/ESALQ/USP) and in Food Irradiation and Radioentomology Laboratory (LIARE/CENA/USP). The gamma radiation source that was used is a Co-60 irradiator model Gammabeam-650 of the Atomic Energy of Canada Ltd. whose activity in the beginning of the experiments was 9.8x10 13 Bq. (2,644 Ci). The lots of pupae of Musca domestica had been kept in acclimatized room with 25 ± 2 deg C of temperature and 70 ± 5% of relative humidity, until reaching the desired ages. Lots of pupae of M. domestica that had been used, gotten by the flotation process. They had been irradiated with the ages of 1, 2, 3 and 4 days. The used doses for 1 day pupae was 0 (control) 2.5, 5, 7.5, 10, 12.5, 15, 17.5 20, 22.5, 25, 27.5 and 30 Gy; for 2 days pupae: 0 (control), 20, 40, 60, 80, 100, 120, 140, 160, 180, 200, 220, 240, 260, 280 and 300 Gy; for 3 days pupae: 0 (control), 0, 40, 80, 120, 160, 200, 240, 280, 320 and 360 Gy; and for 4 days pupae: 0 (control), 40; 80; 120; 160, 200, 240, 280, 320, 360, 400 480 and 520 Gy. The dose rate was about 1,500Gy/hr. At these age intervals, the dose to prevent adult emergence was 25, 220, 360 and 520 Gy and the LD50 was 14.28, 128.04, 243.09 e 353.57 Gy, respectively. (author)

  3. LD50 and inviably dose of gamma radiation for Musca domestica L., 1758 (diptera: muscidae) pupae aged 1, 2, 3 and 4 days

    Energy Technology Data Exchange (ETDEWEB)

    Itepan, Natanael M., E-mail: nmitepan@ifsp.edu.br [Instituto Federal de Sao Paulo (IFSP), Piracicaba, SP (Brazil); Itepan, Sara E.D.Z., E-mail: sarazenitepan@ig.com.br [Universidade de Sao Paulo (FFCLRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Filosofia Ciencias e Letras; Arthur, Valter, E-mail: arthur@cena.usp.br [Centro de Energia Nuclear na Agricultura (CENA/USP), Piracicaba, SP (Brazil)

    2013-07-01

    This experiment was carried out in Biological Control of Domestic Fly 'Eduardo Hiroshi Mizumoto' Laboratory at Entomology and Acarology Department (LEA/ESALQ/USP) and in Food Irradiation and Radioentomology Laboratory (LIARE/CENA/USP). The gamma radiation source that was used is a Co-60 irradiator model Gammabeam-650 of the Atomic Energy of Canada Ltd. whose activity in the beginning of the experiments was 9.8x10{sup 13} Bq. (2,644 Ci). The lots of pupae of Musca domestica had been kept in acclimatized room with 25 ± 2 deg C of temperature and 70 ± 5% of relative humidity, until reaching the desired ages. Lots of pupae of M. domestica that had been used, gotten by the flotation process. They had been irradiated with the ages of 1, 2, 3 and 4 days. The used doses for 1 day pupae was 0 (control) 2.5, 5, 7.5, 10, 12.5, 15, 17.5 20, 22.5, 25, 27.5 and 30 Gy; for 2 days pupae: 0 (control), 20, 40, 60, 80, 100, 120, 140, 160, 180, 200, 220, 240, 260, 280 and 300 Gy; for 3 days pupae: 0 (control), 0, 40, 80, 120, 160, 200, 240, 280, 320 and 360 Gy; and for 4 days pupae: 0 (control), 40; 80; 120; 160, 200, 240, 280, 320, 360, 400 480 and 520 Gy. The dose rate was about 1,500Gy/hr. At these age intervals, the dose to prevent adult emergence was 25, 220, 360 and 520 Gy and the LD50 was 14.28, 128.04, 243.09 e 353.57 Gy, respectively. (author)

  4. The AFFORD clinical decision aid to identify emergency department patients with atrial fibrillation at low risk for 30-day adverse events.

    Science.gov (United States)

    Barrett, Tyler W; Storrow, Alan B; Jenkins, Cathy A; Abraham, Robert L; Liu, Dandan; Miller, Karen F; Moser, Kelly M; Russ, Stephan; Roden, Dan M; Harrell, Frank E; Darbar, Dawood

    2015-03-15

    There is wide variation in the management of patients with atrial fibrillation (AF) in the emergency department (ED). We aimed to derive and internally validate the first prospective, ED-based clinical decision aid to identify patients with AF at low risk for 30-day adverse events. We performed a prospective cohort study at a university-affiliated tertiary-care ED. Patients were enrolled from June 9, 2010, to February 28, 2013, and followed for 30 days. We enrolled a convenience sample of patients in ED presenting with symptomatic AF. Candidate predictors were based on ED data available in the first 2 hours. The decision aid was derived using model approximation (preconditioning) followed by strong bootstrap internal validation. We used an ordinal outcome hierarchy defined as the incidence of the most severe adverse event within 30 days of the ED evaluation. Of 497 patients enrolled, stroke and AF-related death occurred in 13 (3%) and 4 (aid included the following: age, triage vitals (systolic blood pressure, temperature, respiratory rate, oxygen saturation, supplemental oxygen requirement), medical history (heart failure, home sotalol use, previous percutaneous coronary intervention, electrical cardioversion, cardiac ablation, frequency of AF symptoms), and ED data (2 hours heart rate, chest radiograph results, hemoglobin, creatinine, and brain natriuretic peptide). The decision aid's c-statistic in predicting any 30-day adverse event was 0.7 (95% confidence interval 0.65, 0.76). In conclusion, in patients with AF in the ED, Atrial Fibrillation and Flutter Outcome Risk Determination provides the first evidence-based decision aid for identifying patients who are at low risk for 30-day adverse events and candidates for safe discharge. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Development of a diagnosis- and procedure-based risk model for 30-day outcome after pediatric cardiac surgery.

    Science.gov (United States)

    Crowe, Sonya; Brown, Kate L; Pagel, Christina; Muthialu, Nagarajan; Cunningham, David; Gibbs, John; Bull, Catherine; Franklin, Rodney; Utley, Martin; Tsang, Victor T

    2013-05-01

    The study objective was to develop a risk model incorporating diagnostic information to adjust for case-mix severity during routine monitoring of outcomes for pediatric cardiac surgery. Data from the Central Cardiac Audit Database for all pediatric cardiac surgery procedures performed in the United Kingdom between 2000 and 2010 were included: 70% for model development and 30% for validation. Units of analysis were 30-day episodes after the first surgical procedure. We used logistic regression for 30-day mortality. Risk factors considered included procedural information based on Central Cardiac Audit Database "specific procedures," diagnostic information defined by 24 "primary" cardiac diagnoses and "univentricular" status, and other patient characteristics. Of the 27,140 30-day episodes in the development set, 25,613 were survivals, 834 were deaths, and 693 were of unknown status (mortality, 3.2%). The risk model includes procedure, cardiac diagnosis, univentricular status, age band (neonate, infant, child), continuous age, continuous weight, presence of non-Down syndrome comorbidity, bypass, and year of operation 2007 or later (because of decreasing mortality). A risk score was calculated for 95% of cases in the validation set (weight missing in 5%). The model discriminated well; the C-index for validation set was 0.77 (0.81 for post-2007 data). Removal of all but procedural information gave a reduced C-index of 0.72. The model performed well across the spectrum of predicted risk, but there was evidence of underestimation of mortality risk in neonates undergoing operation from 2007. The risk model performs well. Diagnostic information added useful discriminatory power. A future application is risk adjustment during routine monitoring of outcomes in the United Kingdom to assist quality assurance. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  6. Predicting 30- to 120-Day Readmission Risk among Medicare Fee-for-Service Patients Using Nonmedical Workers and Mobile Technology.

    Science.gov (United States)

    Ostrovsky, Andrey; O'Connor, Lori; Marshall, Olivia; Angelo, Amanda; Barrett, Kelsy; Majeski, Emily; Handrus, Maxwell; Levy, Jeffrey

    2016-01-01

    Hospital readmissions are a large source of wasteful healthcare spending, and current care transition models are too expensive to be sustainable. One way to circumvent cost-prohibitive care transition programs is complement nurse-staffed care transition programs with those staffed by less expensive nonmedical workers. A major barrier to utilizing nonmedical workers is determining the appropriate time to escalate care to a clinician with a wider scope of practice. The objective of this study is to show how mobile technology can use the observations of nonmedical workers to stratify patients on the basis of their hospital readmission risk. An area agency on aging in Massachusetts implemented a quality improvement project with the aim of reducing 30-day hospital readmission rates using a modified care transition intervention supported by mobile predictive analytics technology. Proprietary readmission risk prediction algorithms were used to predict 30-, 60-, 90-, and 120-day readmission risk. The risk score derived from the nonmedical workers' observations had a significant association with 30-day readmission rate with an odds ratio (OR) of 1.12 (95 percent confidence interval [CI], 1 .09-1.15) compared to an OR of 1.25 (95 percent CI, 1.19-1.32) for the risk score using nurse observations. Risk scores using nurse interpretation of nonmedical workers' observations show that patients in the high-risk category had significantly higher readmission rates than patients in the baseline-risk and mild-risk categories at 30, 60, 90, and 120 days after discharge. Of the 1,064 elevated-risk alerts that were triaged, 1,049 (98.6 percent) involved the nurse care manager, 804 (75.6 percent) involved the patient, 768 (72.2 percent) involved the health coach, 461 (43.3 percent) involved skilled nursing, and 235 (22.1 percent) involved the outpatient physician in the coordination of care in response to the alert. The predictive nature of the 30-day readmission risk scores is influenced

  7. Readmission After COPD Exacerbation Scale: determining 30-day readmission risk for COPD patients.

    Science.gov (United States)

    Lau, Christine Sm; Siracuse, Brianna L; Chamberlain, Ronald S

    2017-01-01

    COPD affects over 13 million Americans, and accounts for over half a million hospitalizations annually. The Hospital Readmission Reduction Program, established by the Affordable Care Act requires the Centers for Medicare and Medicaid Services to reduce payments to hospitals with excess readmissions for COPD as of 2015. This study sought to develop a predictive readmission scale to identify COPD patients at higher readmission risk. Demographic and clinical data on 339,389 patients from New York and California (derivation cohort) and 258,113 patients from Washington and Florida (validation cohort) were abstracted from the State Inpatient Database (2006-2011), and the Readmission After COPD Exacerbation (RACE) Scale was developed to predict 30-day readmission risk. Thirty-day COPD readmission rates were 7.54% for the derivation cohort and 6.70% for the validation cohort. Factors including age 40-65 years (odds ratio [OR] 1.17; 95% CI, 1.12-1.21), male gender (OR 1.16; 95% CI, 1.13-1.19), African American (OR 1.11; 95% CI, 1.06-1.16), 1st income quartile (OR 1.10; 95% CI, 1.06-1.15), 2nd income quartile (OR 1.06; 95% CI, 1.02-1.10), Medicaid insured (OR 1.83; 95% CI, 1.73-1.93), Medicare insured (OR 1.45; 95% CI, 1.38-1.52), anemia (OR 1.05; 95% CI, 1.02-1.09), congestive heart failure (OR 1.06; 95% CI, 1.02-1.09), depression (OR 1.18; 95% CI, 1.14-1.23), drug abuse (OR 1.17; 95% CI, 1.09-1.25), and psychoses (OR 1.19; 95% CI, 1.13-1.25) were independently associated with increased readmission rates, P readmission variability. The RACE Scale reliably predicts an individual patient's 30-day COPD readmission risk based on specific factors present at initial admission. By identifying these patients at high risk of readmission with the RACE Scale, patient-specific readmission-reduction strategies can be implemented to improve patient care as well as reduce readmissions and health care expenditures.

  8. The daily risk of bacteremia during hospitalization and associated 30-day mortality evaluated in relation to the traditional classification of bacteremia

    DEFF Research Database (Denmark)

    Nielsen, Stig Lønberg; Lassen, Annmarie Touborg; Kolmos, Hans Jørn

    2016-01-01

    BACKGROUND: We investigated the overall and daily incidence of bacteremia among hospitalized patients and evaluated the traditional classification of bacteremia (community-onset vs nosocomial based on a 48-hour time window) by means of the daily incidence and associated 30-day mortality. METHODS:...... of bacteremia during the first 2 days followed by lower incidences that were constant beyond day 12. Thirty-day mortality was 18%-21% for patients with bacteremia on the first 2 days and 25%-35% thereafter. Our findings support the traditional classification of bacteremia.......BACKGROUND: We investigated the overall and daily incidence of bacteremia among hospitalized patients and evaluated the traditional classification of bacteremia (community-onset vs nosocomial based on a 48-hour time window) by means of the daily incidence and associated 30-day mortality. METHODS...... as the daily incidence of bacteremia per 10,000 bed-days and associated 30-day mortality. RESULTS: We included 724,339 admissions and 10,281 bacteremias for an overall incidence of 14.2 per 1,000 admissions and 23.6 per 10,000 bed-days. The daily incidence was highest on the first 2 days of admission followed...

  9. Independent risk factors of 30-day outcomes in 1264 patients with peptic ulcer bleeding in the USA - large ulcers do worse

    Science.gov (United States)

    Camus, Marine; Jensen, Dennis M.; Kovacs, Thomas O.; Jensen, Mary Ellen; Markovic, Daniela; Gornbein, Jeffrey

    2016-01-01

    Background Predictors of worse outcomes (rebleeding, surgery and death) of peptic ulcer bleeding (PUB’s) are essential indicators because of significant morbidity and mortality. rates of PUB’s. However those have been rarely infrequently reported since changes in medical therapy (proton poump inhibitors-PPI) and application of newer endoscopic hemostasis. Aim Our purposes were to determine: 1) independent risk factors of 30-day rebleeding, surgery, and death and 2) whether ulcer size is an independent predictor of major outcomes in patients with severe PUB’s after successful endoscopic hemostasis and treatment with optimal medical (high dose IV PPI) vs. prior treatment (high dose IV histamine 2 antagonists – H2RA’s). Methods A large prospectively followed population of patients hospitalized with severe PUB’s between 1993 and 2011 at two US tertiary care academic medical centers, stratified by stigmata of recent hemorrhage (SRH) was studied. Using multivariable logistic regression analyses, independent risk factors of each outcome (rebleeding, surgery, and death) up to 30 days were analyzed. Effects of medical treatment (H2RA patients 1993–2005 vs. PPI’s 2006–2011) were also analysed. Results 1264 patients were included. For ulcers ≥10mm, the odds of 30-day rebleeding increased 6% per each 10% increase in ulcer size (OR 1.06, 95%CI 1.02–1.10, p=0.0053). Other risk factors of 30-day rebleeding were major SRH, inpatient start of bleeding, and prior GI bleeding. Major SRH and ulcer size ≥10 mm were predictors of 30-day surgery. Risk factors of 30-day death were major SRH, inpatient bleeding, any initial platelet transfusion or fresh frozen plasma transfusion ≥2 units. Among patients with major SRH and outpatient start of bleeding, larger ulcer size was also a risk factor for death (OR 1.08 per 10% increase in ulcer size, 95%CI 1.02–1.14, p=0.0095). Ulcer size was a significant independent variable for both time periods. Conclusions Ulcer

  10. 41 CFR 301-52.19 - Will I receive a late payment fee if my agency fails to reimburse me within 30 calendar days...

    Science.gov (United States)

    2010-07-01

    ... payment fee if my agency fails to reimburse me within 30 calendar days after I submit a proper travel claim? 301-52.19 Section 301-52.19 Public Contracts and Property Management Federal Travel Regulation... fails to reimburse me within 30 calendar days after I submit a proper travel claim? Yes, your agency...

  11. 76 FR 6794 - 30-Day Submission Period for Requests for ONC-Approved Accreditor (ONC-AA) Status

    Science.gov (United States)

    2011-02-08

    ... Accreditor (ONC-AA) Status AGENCY: Office of the National Coordinator for Health Information Technology... submission of requests for ONC-Approved Accreditor (ONC-AA) status. Authority: 42 U.S.C. 300jj-11. DATES: The... for ONC-AA status may be submitted. The 30-day period for submission of requests for ONC-AA status...

  12. 78 FR 25091 - Submission for OMB Review; 30-Day Comment Request: Request for Human Embryonic Stem Cell Line To...

    Science.gov (United States)

    2013-04-29

    ...; 30-Day Comment Request: Request for Human Embryonic Stem Cell Line To Be Approved for Use in NIH... Embryonic Stem Cell Line to be Approved for Use in NIH-Funded Research, 0925-0601, Expiration Date 04/30... Information Collection: The form is used by applicants to request that human embryonic stem cell lines be...

  13. 77 FR 51041 - 30-Day Extension of Call for Nominations for the U.S. Extractive Industries Transparency...

    Science.gov (United States)

    2012-08-23

    ... DEPARTMENT OF THE INTERIOR Office of the Secretary [Docket No. ONRR-2012-0003] 30-Day Extension of Call for Nominations for the U.S. Extractive Industries Transparency Initiative Advisory Committee... the United States Extractive Industries Transparency Initiative (USEITI) Multi- Stakeholder Group (MSG...

  14. Structural, Nursing, and Physician Characteristics and 30-Day Mortality for Patients Undergoing Cardiac Surgery in Pennsylvania.

    Science.gov (United States)

    Lane-Fall, Meghan B; Ramaswamy, Tara S; Brown, Sydney E S; He, Xu; Gutsche, Jacob T; Fleisher, Lee A; Neuman, Mark D

    2017-09-01

    Cardiac surgery ICU characteristics and clinician staffing patterns have not been well characterized. We sought to describe Pennsylvania cardiac ICUs and to determine whether ICU characteristics are associated with mortality in the 30 days after cardiac surgery. From 2012 to 2013, we conducted a survey of cardiac surgery ICUs in Pennsylvania to assess ICU structure, care practices, and clinician staffing patterns. ICU data were linked to an administrative database of cardiac surgery patient discharges. We used logistic regression to measure the association between ICU variables and death in 30 days. Cardiac surgery ICUs in Pennsylvania. Patients having coronary artery bypass grafting and/or cardiac valve repair or replacement from 2009 to 2011. None. Of the 57 cardiac surgical ICUs in Pennsylvania, 43 (75.4%) responded to the facility survey. Rounds included respiratory therapists in 26 of 43 (60.5%) and pharmacists in 23 of 43 (53.5%). Eleven of 41 (26.8%) reported that at least 2/3 of their nurses had a bachelor's degree in nursing. Advanced practice providers were present in most of the ICUs (37/43; 86.0%) but residents (8/42; 18.6%) and fellows (7/43; 16.3%) were not. Daytime intensivists were present in 21 of 43 (48.8%) responding ICUs; eight of 43 (18.6%) had nighttime intensivists. Among 29,449 patients, there was no relationship between mortality and nurse ICU experience, presence of any intensivist, or absence of residents after risk adjustment. To exclude patients who may have undergone transcatheter aortic valve replacement, we conducted a subgroup analysis of patients undergoing only coronary artery bypass grafting, and results were similar. Pennsylvania cardiac surgery ICUs have variable structures, care practices, and clinician staffing, although none of these are statistically significantly associated with mortality in the 30 days following surgery after adjustment.

  15. Intraseasonal variability in the atmosphere-ocean climate system. 2. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Lau, William K.M. [NASA/Goddard Space Flight Center, Greenbelt, MD (United States). Lab. for Atmospheres; Waliser, Duane E. [California Institute of Technology, Pasadena, CA (United States). Earth Science and Technology Directorate, Jet Propulsion Laboratory

    2012-07-01

    This updated multi-author, comprehensive and authoritative review of intra-seasonal variability (ISV), has a balance of observation, theory and modeling and provides a single source of reference for all those interested in this important, multi-faceted natural phenomenon and its relation to major short-term climatic variations. All the original chapters are updated, where appropriate. The book opens with an overview of ISV and observations from an historical perspective. Successive chapters then deal with the role of ISV in monsoon variability in the South Asian, East Asian and South American monsoon regions, in North America and in the oceans. The coupling between ocean and atmosphere is considered, together with the function of angular momentum and Earth rotation. Later chapters deal with modeling ISV in the atmosphere and oceans, and the connection between the Madden and Julian Oscillation (MJO). Specifically updated in this second edition is the chapter on modeling with recent development in global high-resolution modeling of the fine structures of the MJO. The El Nino/Southern Oscillation with short-term climate change is also considered. The authors consider how knowledge of ISV may be harnessed into improving long range forecasts of severe weather, and a new chapter on substantial new development of ISV research is added. This includes five subject areas: a) new theories of the MJO; b) vertical structures of the MJO, including latent heating profile derived from satellite data; c) extratropical-tropical interaction associated with MJO; d) linkage of ISV to transport of biogeochemical species; and e) possible impact of ISV on West Africa and Middle East region. (orig.)

  16. Predictors of early dyspnoea relief in acute heart failure and the association with 30-day outcomes: findings from ASCEND-HF

    Science.gov (United States)

    Mentz, Robert J.; Hernandez, Adrian F.; Stebbins, Amanda; Ezekowitz, Justin A.; Felker, G. Michael; Heizer, Gretchen M.; Atar, Dan; Teerlink, John R.; Califf, Robert M.; Massie, Barry M.; Hasselblad, Vic; Starling, Randall C.; O'Connor, Christopher M.; Ponikowski, Piotr

    2013-01-01

    Aims To examine the characteristics associated with early dyspnoea relief during acute heart failure (HF) hospitalization, and its association with 30-day outcomes. Methods and results ASCEND-HF was a randomized trial of nesiritide vs. placebo in 7141 patients hospitalized with acute HF in which dyspnoea relief at 6 h was measured on a 7-point Likert scale. Patients were classified as having early dyspnoea relief if they experienced moderate or marked dyspnoea improvement at 6 h. We analysed the clinical characteristics, geographical variation, and outcomes (mortality, mortality/HF hospitalization, and mortality/hospitalization at 30 days) associated with early dyspnoea relief. Early dyspnoea relief occurred in 2984 patients (43%). In multivariable analyses, predictors of dyspnoea relief included older age and oedema on chest radiograph; higher systolic blood pressure, respiratory rate, and natriuretic peptide level; and lower serum blood urea nitrogen (BUN), sodium, and haemoglobin (model mean C index = 0.590). Dyspnoea relief varied markedly across countries, with patients enrolled from Central Europe having the lowest risk-adjusted likelihood of improvement. Early dyspnoea relief was associated with lower risk-adjusted 30-day mortality/HF hospitalization [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.68–0.96] and mortality/hospitalization (HR 0.85; 95% CI 0.74–0.99), but similar mortality. Conclusion Clinical characteristics such as respiratory rate, pulmonary oedema, renal function, and natriuretic peptide levels are associated with early dyspnoea relief, and moderate or marked improvement in dyspnoea was associated with a lower risk for 30-day outcomes. PMID:23159547

  17. 78 FR 55264 - Submission for OMB Review; 30-Day Comment Request: Awareness and Beliefs About Cancer Survey...

    Science.gov (United States)

    2013-09-10

    ...; 30-Day Comment Request: Awareness and Beliefs About Cancer Survey, National Cancer Institute (NCI.... Proposed Collection: Awareness and Beliefs about Cancer Survey, 0925-NEW, National Cancer Institute (NCI... gather data about American adults' awareness and beliefs about cancer. The ultimate goal is to determine...

  18. Age trends in 30 day hospital readmissions: US national retrospective analysis

    Science.gov (United States)

    Berry, Jay G; Gay, James C; Joynt Maddox, Karen; Coleman, Eric A; Bucholz, Emily M; O’Neill, Margaret R; Blaine, Kevin; Hall, Matthew

    2018-01-01

    Abstract Objective To assess trends in and risk factors for readmission to hospital across the age continuum. Design Retrospective analysis. Setting and participants 31 729 762 index hospital admissions for all conditions in 2013 from the US Agency for Healthcare Research and Quality Nationwide Readmissions Database. Main outcome measure 30 day, all cause, unplanned hospital readmissions. Odds of readmission were compared by patients’ age in one year epochs with logistic regression, accounting for sex, payer, length of stay, discharge disposition, number of chronic conditions, reason for and severity of admission, and data clustering by hospital. The middle (45 years) of the age range (0-90+ years) was selected as the age reference group. Results The 30 day unplanned readmission rate following all US index admissions was 11.6% (n=3 678 018). Referenced by patients aged 45 years, the adjusted odds ratio for readmission increased between ages 16 and 20 years (from 0.70 (95% confidence interval 0.68 to 0.71) to 1.04 (1.02 to 1.06)), remained elevated between ages 21 and 44 years (range 1.02 (1.00 to 1.03) to 1.12 (1.10 to 1.14)), steadily decreased between ages 46 and 64 years (range 1.02 (1.00 to 1.04) to 0.91 (0.90 to 0.93)), and decreased abruptly at age 65 years (0.78 (0.77 to 0.79)), after which the odds remained relatively constant with advancing age. Across all ages, multiple chronic conditions were associated with the highest adjusted odds of readmission (for example, 3.67 (3.64 to 3.69) for six or more versus no chronic conditions). Among children, young adults, and middle aged adults, mental health was one of the most common reasons for index admissions that had high adjusted readmission rates (≥75th centile). Conclusions The likelihood of readmission was elevated for children transitioning to adulthood, children and younger adults with mental health disorders, and patients of all ages with multiple chronic conditions. Further attention to the

  19. Three stops of fuel reloading with length of less 30 days in the Laguna Verde Central

    International Nuclear Information System (INIS)

    Lozano L, A.

    2007-01-01

    The Laguna Verde Central having established as mission 'With maximum priority in the safety, to generate electricity by nuclear means with quality and cost competitive, sustained in our personnel's continuous overcoming and deep respect to the environment' and respecting our values (safety, responsibility by results, professional integrity, continuous improving, team working, excellence in the acting, quality of service, protection to the environment) they thought about our strategic objectives of the power station being born this way one of them that it is the program of improvement 'Reduction of reload times' looking for to be improves every day comparing us with the best plants in the world efficient all the processes in the power station that allowed us to measure our acting with the same parameters that settle down at international level like they are nuclear safety, industrial safety, radiological safety, capacity factor, readiness factor, cleaning of the power station attachment to procedures, attention to the detail and certainly to be competitive in the economic aspect. After analyzing the acting record of the power station, evaluating our technical capacity, economic, the location of the installation besides revising the international experiences it was defined that one of the concepts that impact considerably so much to the capacity and readiness factors besides the dose and production cost is the duration of the reload periods, for this reason they were elaborated work strategies to be able to reach our goal of reload days considered in being able to carry out them in less than 30 days, here the actions carried out that they made us complete the three last reloads in less than 30 days are captured. (Author)

  20. 36 CFR 1254.50 - Does NARA consider reinstating research privileges?

    Science.gov (United States)

    2010-07-01

    ... Research Room Rules Other Conduct Rules § 1254.50 Does NARA consider reinstating research privileges? (a) You have 30 calendar days after the date of revocation to appeal the action in writing and seek... identification card, which we issue to you if your conduct during the probationary period follows the rules of...

  1. Predictors of Adverse Outcomes of Patients with Chest Pain and Primary Diagnosis of Non-Cardiac Pain at the Time of Discharge from Emergency Department: A 30-Days Prospective Study.

    Science.gov (United States)

    Soltani, Mohammadhossien; Mirzaei, Masoud; Amin, Ahmad; Emami, Mahmoud; Aryanpoor, Reza; Shamsi, Farimah; Sarebanhassanabadi, Mohammadtaghi

    2016-07-01

    Chest pain is a common symptom for referring patients to emergency departments (ED). Among those referred, some are admitted to hospitals with a definite or tentative diagnosis of acute coronary syndrome and some are discharged with primary diagnosis of non-cardiac chest pain. This study aimed at investigating 30 days' adverse outcomes of patients discharged from ED of a major heart center in Iran. Out of 1638 chest pain admissions to the centre during 2010-2011, 962 patients (mean age= 50.9±15.9 years) who were admitted to Afshar Heart Center's ED with chest pain as their chief complaint, and discharged with primary diagnosis of non-cardiac chest pain, were followed for any adverse cardiac events 30 days post discharge. The adverse events were: unstable angina, non-ST-elevated myocardial infarction (NSTEMI), ST elevated myocardial infarction (STEMI), coronary revascularization (percutaneous angioplasty, coronary artery bypass grafting) and death. Adverse cardiac events, including acute coronary syndrome (ACS), revascularization and death were observed in 30 patients (3.1%) including: acute MI n=5 (0.5%, sudden cardiac death inn=1 (0.1%, coronary revascularization in n=8 (0.8%) and hospitalization due to unstable angina/NSTEMI in n=16 (1-7%). Adverse events were seen more frequently in patients with history of hypertension, dyslipidemia and previous coronary artery disease. In univariate analysis, the chance of postdischarge adverse cardiac events was higher in patients with hypertension (OR=9.36, CI=3.24-27.03), previous coronary artery disease (OR= 3.8, CI=1.78-8.0), dyslipidemia (OR=3.5, CI=1.7-7.38) and discharge against medical advice (OR=2.85, CI= 1.37-5.91). The extent of adverse cardiac events in patients with a primary diagnosis of non-cardiac chest pain within 30 days of discharge was significant, mandating nation-wide registries to provide better care for these patients.

  2. Hypocoagulability, as evaluated by thrombelastography, at admission to the ICU is associated with increased 30-day mortality

    DEFF Research Database (Denmark)

    Johansson, Pär I; Stensballe, Jakob; Vindeløv, Nis

    2010-01-01

    Thrombelastography (TEG), a cell-based whole blood assay, may better reflect haemostatic competence than conventional coagulation assays and this was therefore evaluated including the clot forming parameters: R, angle and maximal amplitude in patients at ICU admission. This was a prospective...... were recorded. At ICU admission, 106 patients (42%) showed hypocoagulability as evaluated by TEG and these patients had higher first day SOFA score (P ... (P = 0.05), angle (P evaluated by TEG was an independent risk factor for 30-day mortality [adjusted odds ratio (OR) 3.5; 95% confidence interval (CI) 1...

  3. 30-day mortality and readmission after hemorrhagic stroke among Medicare beneficiaries in Joint Commission primary stroke center-certified and noncertified hospitals.

    Science.gov (United States)

    Lichtman, Judith H; Jones, Sara B; Leifheit-Limson, Erica C; Wang, Yun; Goldstein, Larry B

    2011-12-01

    Ischemic stroke patients treated at Joint Commission Primary Stroke Center (JC-PSC)-certified hospitals have better outcomes. Data reflecting the impact of JC-PSC status on outcomes after hemorrhagic stroke are limited. We determined whether 30-day mortality and readmission rates after hemorrhagic stroke differed for patients treated at JC-PSC-certified versus noncertified hospitals. The study included all fee-for-service Medicare beneficiaries aged 65 years or older with a primary discharge diagnosis of subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH) in 2006. Covariate-adjusted logistic and Cox proportional hazards regression assessed the effect of care at a JC-PSC-certified hospital on 30-day mortality and readmission. There were 2305 SAH and 8708 ICH discharges from JC-PSC-certified hospitals and 3892 SAH and 22 564 ICH discharges from noncertified hospitals. Unadjusted in-hospital mortality (SAH: 27.5% versus 33.2%, Pmortality (SAH: 35.1% versus 44.0%, Pmortality was 34% lower (odds ratio, 0.66; 95% confidence interval, 0.58-0.76) after SAH and 14% lower (odds ratio, 0.86; 95% confidence interval, 0.80-0.92) after ICH for patients discharged from JC-PSC-certified hospitals. There was no difference in 30-day risk-adjusted readmission rates for SAH or ICH based on JC-PSC status. Patients treated at JC-PSC-certified hospitals had lower risk-adjusted mortality rates for both SAH and ICH but similar 30-day readmission rates as compared with noncertified hospitals.

  4. Meteorologist saved D-Day 50 years ago

    Science.gov (United States)

    June 6, 1944, might have been remembered as doomsday instead of D-Day if General Dwight D. Eisenhower's chief weatherman had been wrong about his forecasts.When J. M. Stagg was appointed chief meteorological officer of the Allied Forces in October of 1943, he had no idea he would pay a crucial role in shaping world history. Little did he know it would be his analysis on which the U.S. Supreme Commander would base his decision to launch the Allied invasion on the beaches of Normandy.

  5. Low Levels of Hemoglobin at Admission Are Associated With Increased 30-Day Mortality in Patients With Hip Fracture

    DEFF Research Database (Denmark)

    Praetorius, Katrine; Madsen, Christian M; Abrahamsen, Bo

    2016-01-01

    INTRODUCTION: Previous smaller studies suggest that anemia is a risk factor for mortality in patients with hip fracture. The purpose of this investigation was to assess the correlation between hemoglobin at admission with 30-day mortality following a hip fracture in a large-scale study. PATIENTS...... AND METHODS: From January 1996 to December 2012, all patients with hip fracture (>60 years of age) admitted to Bispebjerg Hospital, Copenhagen, were identified from a local hip fracture database. We excluded conservatively treated patients and patients who died preoperatively. RESULTS: Seven thousand four...... hundred twenty-one consecutive patients with hip fracture were identified. Of those 7319 had a hemoglobin measurement on admission and were thus eligible for further analysis. Mean hemoglobin for patients alive at 30 days was 7.6 (standard deviation [SD]: 1.0) and for deceased patients 7.4 (SD: 1.1), P...

  6. A contemporary risk model for predicting 30-day mortality following percutaneous coronary intervention in England and Wales.

    Science.gov (United States)

    McAllister, Katherine S L; Ludman, Peter F; Hulme, William; de Belder, Mark A; Stables, Rodney; Chowdhary, Saqib; Mamas, Mamas A; Sperrin, Matthew; Buchan, Iain E

    2016-05-01

    The current risk model for percutaneous coronary intervention (PCI) in the UK is based on outcomes of patients treated in a different era of interventional cardiology. This study aimed to create a new model, based on a contemporary cohort of PCI treated patients, which would: predict 30 day mortality; provide good discrimination; and be well calibrated across a broad risk-spectrum. The model was derived from a training dataset of 336,433 PCI cases carried out between 2007 and 2011 in England and Wales, with 30 day mortality provided by record linkage. Candidate variables were selected on the basis of clinical consensus and data quality. Procedures in 2012 were used to perform temporal validation of the model. The strongest predictors of 30-day mortality were: cardiogenic shock; dialysis; and the indication for PCI and the degree of urgency with which it was performed. The model had an area under the receiver operator characteristic curve of 0.85 on the training data and 0.86 on validation. Calibration plots indicated a good model fit on development which was maintained on validation. We have created a contemporary model for PCI that encompasses a range of clinical risk, from stable elective PCI to emergency primary PCI and cardiogenic shock. The model is easy to apply and based on data reported in national registries. It has a high degree of discrimination and is well calibrated across the risk spectrum. The examination of key outcomes in PCI audit can be improved with this risk-adjusted model. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  7. 30-days mortality in patients with perforated peptic ulcer: A national audit

    Directory of Open Access Journals (Sweden)

    Anne Nakano

    2008-11-01

    Full Text Available Anne Nakano1,4, Jørgen Bendix2, Sven Adamsen3, Daniel Buck4, Jan Mainz5, Paul Bartels1, Bente Nørgård4,61The Danish National Indicator Project, Regionshuset Aarhus, Aarhus, Denmark; 2Department of Gastrointestinal Surgery L, Aarhus University Hospital, Denmark; 3Digestive Disease Center, Section for Gastrointestinal Surgery, Copenhagen, Denmark; University Hospital Herlev, Denmark; 4Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 5Department of Psychiatry Region North, Denmark and Institute of Public Health, University of Southern Denmark, Odense, Denmark; 6Center for National Clinical Databases, South, Odense University Hospital, and Epidemiology, Institute of Public Health, University of Southern Denmark, Odense, DenmarkBackground: In 2005, The Danish National Indicator Project (DNIP reported findings on patients hospitalized with perforated ulcer. The indicator “30-days mortality” showed major discrepancy between the observed mortality of 28% and the chosen standard (10%.Rationale: An audit committee was appointed to examine quality problems linked to the high mortality. The purpose was to (i examine patient characteristics, (ii evaluate the appropriateness of the standard, and (iii audit all cases of deaths within 30 days after surgery.Methods: Four hundred and twelve consecutive patients were included and used for the analyses of patient characteristics. The evaluation of the standard was based on a literature review, and a structured audit was performed according to the 115 deaths that occurred.Results: The mean age was 69.1 years, 42.0% had one co-morbid disease and 17.7% had two co-morbid diseases. 45.9% had an American Association of Anaesthetists score of 3–4. We found no results on mortality in studies similar to ours. The audit process indicated that the postoperative observation of patients was insufficient.Discussion: As a result of this study, the standard for mortality was increased to

  8. Unplanned emergency department consultations and readmissions within 30 and 90 days of bariatric surgery.

    Science.gov (United States)

    Iskra, María P; Ramón, José M; Martínez-Serrano, Andrés; Serra, Carmen; Goday, Albert; Trillo, Lourdes; Lanzarini, Enrique; Pera, Manuel; Grande, Luis

    2018-04-01

    Hospital readmission is used as a measure of quality healthcare. The aim of this study was to determine the incidence, causes, and risk factors related to emergency consultations and readmissions within 30 and 90 days in patients undergoing laparoscopic gastric bypass and laparoscopic sleeve gastrectomy. Retrospective study of 429 patients operated on from January 2004 to July 2015 from a prospectively maintained database and electronic medical records. Demographic data, type of intervention, postoperative complications, length of hospital stay and records of emergency visits and readmissions were analyzed. Within the first 90 days postoperative, a total of 117 (27%) patients consulted the Emergency Department and 24 (6%) were readmitted. The most common reasons for emergency consultation were noninfectious problems related to the surgical wound (n=40, 34%) and abdominal pain (n=28, 24%), which was also the first cause of readmission (n=9, 37%). Postoperative complications, reintervention, associated surgery in the same operation and depression were risk factors for emergency consultation within the first 90 days of the postoperative period. Despite the high number of patients who visit the Emergency Department in the first 90 days of the postoperative period, few require readmission and none surgical reoperation. It is important to know the reasons for emergency consultation to establish preventive measures and improve the quality of care. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Unplanned 30-Day Readmissions in a General Internal Medicine Hospitalist Service at a Comprehensive Cancer Center.

    Science.gov (United States)

    Manzano, Joanna-Grace M; Gadiraju, Sahitya; Hiremath, Adarsh; Lin, Heather Yan; Farroni, Jeff; Halm, Josiah

    2015-09-01

    Hospital readmissions are considered by the Centers for Medicare and Medicaid as a metric for quality of health care delivery. Robust data on the readmission profile of patients with cancer are currently insufficient to determine whether this measure is applicable to cancer hospitals as well. To address this knowledge gap, we estimated the unplanned readmission rate and identified factors influencing unplanned readmissions in a hospitalist service at a comprehensive cancer center. We retrospectively analyzed unplanned 30-day readmission of patients discharged from the General Internal Medicine Hospitalist Service at a comprehensive cancer center between April 1, 2012, and September 30, 2012. Multiple independent variables were studied using univariable and multivariable logistic regression models, with generalized estimating equations to identify risk factors associated with readmissions. We observed a readmission rate of 22.6% in our cohort. The median time to unplanned readmission was 10 days. Unplanned readmission was more likely in patients with metastatic cancer and those with three or more comorbidities. Patients discharged to hospice were less likely to be readmitted (all P values quality measures in cancer hospitals. Copyright © 2015 by American Society of Clinical Oncology.

  10. Incidence and predictors of 30-day readmission for patients discharged home after craniotomy for malignant supratentorial tumors in California (1995-2010).

    Science.gov (United States)

    Marcus, Logan P; McCutcheon, Brandon A; Noorbakhsh, Abraham; Parina, Ralitza P; Gonda, David D; Chen, Clark; Chang, David C; Carter, Bob S

    2014-05-01

    Hospital readmission within 30 days of discharge is a major contributor to the high cost of health care in the US and is also a major indicator of patient care quality. The purpose of this study was to investigate the incidence, causes, and predictors of 30-day readmission following craniotomy for malignant supratentorial tumor resection. The longitudinal California Office of Statewide Health Planning & Development inpatient-discharge administrative database is a data set that consists of 100% of all inpatient hospitalizations within the state of California and allows each patient to be followed throughout multiple inpatient hospital stays, across multiple institutions, and over multiple years (from 1995 to 2010). This database was used to identify patients who underwent a craniotomy for resection of primary malignant brain tumors. Causes for unplanned 30-day readmission were identified by principle ICD-9 diagnosis code and multivariate analysis was used to determine the independent effect of various patient factors on 30-day readmissions. A total of 18,506 patients received a craniotomy for the treatment of primary malignant brain tumors within the state of California between 1995 and 2010. Four hundred ten patients (2.2%) died during the index surgical admission, 13,586 patients (73.4%) were discharged home, and 4510 patients (24.4%) were transferred to another facility. Among patients discharged home, 1790 patients (13.2%) were readmitted at least once within 30 days of discharge, with 27% of readmissions occurring at a different hospital than the initial surgical institution. The most common reasons for readmission were new onset seizure and convulsive disorder (20.9%), surgical infection of the CNS (14.5%), and new onset of a motor deficit (12.8%). Medi-Cal beneficiaries were at increased odds for readmission relative to privately insured patients (OR 1.52, 95% CI 1.20-1.93). Patients with a history of prior myocardial infarction were at an increased risk of

  11. Is day surgery safe?

    DEFF Research Database (Denmark)

    Majholm, Birgitte; Engbæk, J; Bartholdy, Jens

    2012-01-01

    Day surgery is expanding in several countries, and it is important to collect information about quality. The aim of this study was to assess morbidity and unanticipated hospital visits 0-30 days post-operatively in a large cohort.......Day surgery is expanding in several countries, and it is important to collect information about quality. The aim of this study was to assess morbidity and unanticipated hospital visits 0-30 days post-operatively in a large cohort....

  12. Actigraph measures of sleep among female hospital employees working day or alternating day and night shifts.

    Science.gov (United States)

    Korsiak, Jill; Tranmer, Joan; Leung, Michael; Borghese, Michael M; Aronson, Kristan J

    2017-07-14

    Sleep disturbance is common among shift workers, and may be an important factor in the effect of shift work on chronic disease development. In this cross-sectional study, we described sleep patterns of 294 female hospital workers (142 alternating day-night shift workers, 152 day workers) and determined associations between shift work and sleep duration. Rest-activity cycles were recorded with the ActiGraph GT3X+ for 1 week. Analyses were stratified by chronotype of shift workers. Using all study days to calculate average sleep duration, shift workers slept approximately 13 min less than day workers during main sleep periods, while 24-h sleep duration did not differ between day workers and shift workers. Results from age-adjusted models demonstrated that all shift workers, regardless of chronotype, slept 20-30 min less than day workers on day shifts during main and total sleep. Early and intermediate chronotypes working night shifts slept between 114 and 125 min less than day workers, both with regard to the main sleep episode and 24-h sleep duration, while the difference was less pronounced among late chronotypes. When sleep duration on free days was compared between shift workers and day workers, only shift workers with late chronotypes slept less, by approximately 50 min, than day workers during main sleep. Results from this study demonstrate how an alternating day-night shift work schedule impacts sleep negatively among female hospital workers, and the importance of considering chronotype in sleep research among shift workers. © 2017 European Sleep Research Society.

  13. 4 km NODC/RSMAS AVHRR Pathfinder Version 5.0 and 5.1 5-day Harmonic Climatologies (1982-2008) (NODC Accession 0071182)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This accession contains a global, 4km 5-day sea surface temperature climatology derived from harmonic analysis of the AVHRR Pathfinder Version 5.0 and 5.1 sea...

  14. Predictors of all-cause 30day readmission among Medicare patients with type 2 diabetes.

    Science.gov (United States)

    Collins, Jenna; Abbass, Ibrahim M; Harvey, Raymond; Suehs, Brandon; Uribe, Claudia; Bouchard, Jonathan; Prewitt, Todd; DeLuzio, Tony; Allen, Elsie

    2017-08-01

    Readmission is costly among patients with type 2 diabetes (T2DM) in Medicare Advantage Prescription Drug Plans; identifying high-risk patients is necessary for targeting reduction programs. The objective of this study was to develop a claims-based algorithm to predict all-cause 30day readmission among patients with T2DM. This study used administrative data from 1 January 2012 through 31 January 2014. The cohort included hospitalized T2DM patients, aged 18-90 with ≥12 months' continuous enrollment before an unplanned hospital admission and ≥1 month of enrollment post-discharge, excluding patients in long-term care >30 days pre-index. Multivariate logistic regression predicted the likelihood of readmission following hospitalization in 2013. The analytic file was randomly split into training and test datasets to build and validate the model. Candidate variables included physician and patient demographics, baseline clinical conditions, and healthcare utilization metrics. Clinical conditions were classified using the Healthcare Cost and Utilization Project clinical classification system for ICD-9-CM. Of 63,237 individuals, 17.1% experienced a readmission. Of nearly 200 candidate variables, 14 were predictors of readmission, including total cumulative number of days for inpatient stays and the number of emergency department visits in the baseline period. Male gender, older age, and certain comorbidities were associated with higher likelihood of readmission. The final model demonstrated good discriminant ability (c-statistic = 0.82). This study provided evidence that certain patient characteristics and healthcare utilization are predictive of readmission. An algorithm with good discriminant ability was developed which could be used to target readmission reduction programs. Physician gender, specialty, and ownership status did not appear to influence the likelihood of readmission.

  15. BION-M 1: First continuous blood pressure monitoring in mice during a 30-day spaceflight

    Science.gov (United States)

    Andreev-Andrievskiy, Alexander; Popova, Anfisa; Lloret, Jean-Christophe; Aubry, Patrick; Borovik, Anatoliy; Tsvirkun, Daria; Vinogradova, Olga; Ilyin, Eugeniy; Gauquelin-Koch, Guillemette; Gharib, Claude; Custaud, Marc-Antoine

    2017-05-01

    Animals are an essential component of space exploration and have been used to demonstrate that weightlessness does not disrupt essential physiological functions. They can also contribute to space research as models of weightlessness-induced changes in humans. Animal research was an integral component of the 30-day automated Russian biosatellite Bion-M 1 space mission. The aim of the hemodynamic experiment was to estimate cardiovascular function in mice, a species roughly 3000 times smaller than humans, during prolonged spaceflight and post-flight recovery, particularly, to investigate if mice display signs of cardiovascular deconditioning. For the first time, heart rate (HR) and blood pressure (BP) were continuously monitored using implantable telemetry during spaceflight and recovery. Decreased HR and unchanged BP were observed during launch, whereas both HR and BP dropped dramatically during descent. During spaceflight, BP did not change from pre-flight values. However, HR increased, particularly during periods of activity. HR remained elevated after spaceflight and was accompanied by increased levels of exercise-induced tachycardia. Loss of three of the five mice during the flight as a result of the hardware malfunction (unrelated to the telemetry system) and thus the limited sample number constitute the major limitation of the study. For the first time BP and HR were continuously monitored in mice during the 30-day spaceflight and 7-days of post-flight recovery. Cardiovascular deconditioning in these tiny quadruped mammals was reminiscent of that in humans. Therefore, the loss of hydrostatic pressure in space, which is thought to be the initiating event for human cardiovascular adaptation in microgravity, might be of less importance than other physiological mechanisms. Further experiments with larger number of mice are needed to confirm these findings.

  16. The association of culling and death rate within 30 days after calving with productivity or reproductive performance in dairy herds in Fukuoka, Southern Japan.

    Science.gov (United States)

    Goto, Akira; Nakada, Ken; Katamoto, Hiromu

    2016-05-03

    The incidence of peripartum disorders in dairy herds negatively influences productivity and reproductive performance. Concrete data from local areas are helpful for explaining the importance of peripartum management to dairy farmers. This study was conducted to clarify the association of culling and death rate within 30 days after calving with productivity or reproductive performance in 179 dairy herds in Fukuoka, Southern Japan. A database was compiled from the records of the Livestock Improvement Association of Japan, the Dairy Cooperative Association and the Federation of Agricultural Mutual Relief Association. In this study, we created a comprehensive database of dairy farm production data for epidemiological analysis and used a general linear mixed model to analyze the association of culling and death rate within 30 days after calving with milk production or reproductive performance. The database can be used to describe, analyze and predict the risk of production. A cross-sectional analysis with contrasts was applied to investigate the association of cows served by AI/all cows, pregnant cows/cows served by AI, days open, milk yield and somatic cell counts with culling and death rate within 30 days after calving. The days open value significantly increased with increasing rate of culling and death within 30 days after calving (P for trend <0.001). No significant differences were found for the other comparisons. Our data suggest that proper feeding and management in the dry period may lead to improved postpartum reproductive performance in this dairy cow cohort.

  17. Predictive value of NT-proBNP for 30-day mortality in patients with non-ST-elevation acute coronary syndromes: a comparison with the GRACE and TIMI risk scores.

    Science.gov (United States)

    Schellings, Dirk Aam; Adiyaman, Ahmet; Dambrink, Jan-Henk E; Gosselink, At Marcel; Kedhi, Elvin; Roolvink, Vincent; Ottervanger, Jan Paul; Van't Hof, Arnoud Wj

    2016-01-01

    The biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts outcome in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). Whether NT-proBNP has incremental prognostic value beyond established risk strategies is still questionable. To evaluate the predictive value of NT-proBNP for 30-day mortality over and beyond the Global Registry of Acute Coronary Events (GRACE) and Thrombolysis In Myocardial Infarction (TIMI) risk scores in patients with NSTE-ACS. Patients included in our ACS registry were candidates. NT-proBNP levels on admission were measured and the GRACE and TIMI risk scores were assessed. We compared the predictive value of NT-proBNP to both risk scores and evaluated whether NT-proBNP improves prognostication by using receiver operator curves and measures of discrimination improvement. A total of 1324 patients were included and 50 patients died during follow-up. On logistic regression analysis NT-proBNP and the GRACE risk score (but not the TIMI risk score) both independently predicted mortality at 30 days. The predictive value of NT-proBNP did not differ significantly compared to the GRACE risk score (area under the curve [AUC]) 0.85 vs 0.87 p =0.67) but was considerably higher in comparison to the TIMI risk score (AUC 0.60 p risk score by adding NT-proBNP did not improve prognostication: AUC 0.86 ( p =0.57), integrated discrimination improvement 0.04 ( p =0.003), net reclassification improvement 0.12 ( p =0.21). In patients with NSTE-ACS, NT-proBNP and the GRACE risk score (but not the TIMI risk score) both have good and comparable predictive value for 30-day mortality. However, incremental prognostic value of NT-proBNP beyond the GRACE risk score could not be demonstrated.

  18. Day Care Centers

    Data.gov (United States)

    Department of Homeland Security — This database contains locations of day care centers for 50 states and Washington D.C. and Puerto Rico. The dataset only includes center based day care locations...

  19. Toxicidad oral a 60 días del aceite de sacha inchi (Plukenetia volubilis L. y linaza (Linum usitatissimum L. y determinación de la dosis letal 50 en roedores Oral toxicity at 60-days of sacha inchi oil (Plukenetia volubilis L. and linseed (Linum usitatissimum L., and determination of lethal dose 50 in rodents

    Directory of Open Access Journals (Sweden)

    Arilmi Gorriti

    2010-09-01

    Full Text Available Objetivos. Evaluar la toxicidad oral a 60 días y determinar la dosis letal 50 (DL 50 de los aceites crudos de sacha inchi (Plukenetia volubilis L. y linaza (Linum ussitatisimum en ratas Holtzman y en ratones cepa Balb C57, respectivamente. Materiales y métodos. Para la evaluación de la toxicidad oral a dosis repetida por 60 días se utilizó 24 ratas macho Holtzman divididos en tres grupos de ocho cada uno, los grupos fueron: solución salina fisiológica 4 mL/kg (SSF, aceite de sacha inchi 0,5 mL/kg (SI05 y aceite de linaza 0,5 mL/kg (L05, durante el experimento se controló semanalmente el peso corporal y signos de toxicidad en los grupos investigados, así como colesterol total, HDL, triglicéridos, glucosa, urea, TGP y fosfatasa alcalina a los 30 y 60 días de iniciado el experimento. Para la evaluación de la DL50 se usó ratones macho cepa Balb C57 en grupos de diez animales, se administró por vía oral dosis crecientes de aceites crudos hasta alcanzar 1 mL/kg (37 g/kg; Resultados. Los parámetros séricos en las ratas indican que no existe toxicidad alguna a los 60 días y que la administración de los aceites disminuyeron los niveles de colesterol, triglicéridos e incrementaron el HDL con respecto al grupo control. La DL50 muestra que los aceites crudos de sacha inchi y linaza presentan dosis por encima de los 37 g/kg de masa corporal. Conclusiones. Los aceites de sacha inchi y linaza son inocuos a 60 días y presentan una DL50 por encima de los 37 g/kg de animal.Objectives. To evaluate the oral toxicity at 60 days and to determine the lethal dose 50 (LD 50 of raw sacha inchi (Plukenetia volubilis L. and linseed (Linum ussitatisimum oils in Holtzman rats and mice of the strain Balb C57 respectively. Materials and methods. For the evaluation of the oral toxicity of repeated doses for 60 days, 24 male Holtzman rats were used, divided in three groups of 8 each, the groups were: physiologic saline solution 4 mL/kg (FSS, sacha inchi oil

  20. Impact of pre-existing or new-onset atrial fibrillation on 30-day clinical outcomes following transcatheter aortic valve replacement: Results from the BRAVO 3 randomized trial.

    Science.gov (United States)

    Hengstenberg, Christian; Chandrasekhar, Jaya; Sartori, Samantha; Lefevre, Thierry; Mikhail, Ghada; Meneveau, Nicolas; Tron, Christophe; Jeger, Raban; Kupatt, Christian; Vogel, Birgit; Farhan, Serdar; Sorrentino, Sabato; Sharma, Madhav; Snyder, Clayton; Husser, Oliver; Boekstegers, Peter; Hambrecht, Rainer; Widder, Julian; Hildick-Smith, David; De Carlo, Marco; Wijngaard, Peter; Deliargyris, Efthymios; Bernstein, Debra; Baber, Usman; Mehran, Roxana; Anthopoulos, Prodromos; Dangas, George

    2017-11-15

    Prior studies have suggested that patients with atrial fibrillation (AF) undergoing transcatheter aortic valve replacement (TAVR) are at higher risk for adverse cardiovascular events. Whether procedural bivalirudin compared with unfractionated heparin (UFH) has a beneficial effect on early outcomes in these patients is unknown. We examined for the effect of baseline or new-onset AF within 30 days of TAVR and explored for the effect of bivalirudin versus UFH by AF status, on 30-day outcomes from the BRAVO 3 trial. The BRAVO-3 trial multicenter randomized trial included 802 patients undergoing transfemoral TAVR randomized to bivalirudin or UFH. We compared AF and no-AF groups and examined for 30-day Bleeding Academic Research Consortium type ≥3b bleeding, major vascular complications and all ischemic endpoints. Adjusted outcomes were analyzed using logistic regression methods. Of the study population, 41.4% (n = 332) patients had baseline or new-onset AF within 30 days of TAVR, whereas 58.6% (n = 470) had no AF. Patients with AF had greater prevalence of renal dysfunction, lower left ventricular ejection fraction, and higher euroSCORE I compared with their counterparts without AF. Among AF and no-AF patients, there were no significant baseline differences between bivalirudin and UFH groups. At 30 days the incidence of death (6.0 vs. 4.5%, P = 0.324) and stroke (3.9 vs. 2.6%, P = 0.274) was similar in AF vs. no-AF patients. However, new-onset AF (n = 38) was associated with significantly greater crude risk of 30-day stroke compared with no AF (HR 4.49, 95% CI 1.37-14.67). Regardless of AF status, there were no differences in 30-day death (P-int = 0.652) or stroke (P-int = 0.066) by anticoagulation type. Prior or new-onset AF is noted in more than one-third of patients undergoing transfemoral TAVR. Despite greater baseline comorbidities than non-AF patients, AF was not associated with significantly higher risk of adjusted 30-day outcomes

  1. Low serum albumin and total lymphocyte count as predictors of 30 day hospital readmission in patients 65 years of age or older

    Directory of Open Access Journals (Sweden)

    Robert Robinson

    2015-08-01

    Full Text Available Introduction. Hospital readmission within 30 days of discharge is a target for health care cost savings through the medicare Value Based Purchasing initiative. Because of this focus, hospitals and health systems are investing considerable resources into the identification of patients at risk of hospital readmission and designing interventions to reduce the rate of hospital readmission. Malnutrition is a known risk factor for hospital readmission.Materials and Methods. All medical patients 65 years of age or older discharged from Memorial Medical Center from January 1, 2012 to March 31, 2012 who had a determination of serum albumin level and total lymphocyte count on hospital admission were studied retrospectively. Admission serum albumin levels and total lymphocyte counts were used to classify the nutritional status of all patients in the study. Patients with a serum albumin less than 3.5 grams/dL and/or a TLC less than 1,500 cells per mm3 were classified as having protein energy malnutrition. The primary outcome investigated in this study was hospital readmission for any reason within 30 days of discharge.Results. The study population included 1,683 hospital discharges with an average age of 79 years. The majority of the patients were female (55.9% and had a DRG weight of 1.22 (0.68. 219 patients (13% were readmitted within 30 days of hospital discharge. Protein energy malnutrition was common in this population. Low albumin was found in 973 (58% patients and a low TLC was found in 1,152 (68% patients. Low albumin and low TLC was found in 709 (42% of patients. Kaplan–Meier analysis shows any laboratory evidence of PEM is a significant (p < 0.001 predictor of hospital readmission. Low serum albumin (p < 0.001 and TLC (p = 0.018 show similar trends. Cox proportional-hazards regression analysis showed low serum albumin (Hazard Ratio 3.27, 95% CI [2.30–4.63] and higher DRG weight (Hazard Ratio 1.19, 95% CI [1.03–1.38] to be significant

  2. Four stops of fuel reloading with duration of less of 30 days in the Laguna Verde Central

    International Nuclear Information System (INIS)

    Lozano L, A.

    2008-01-01

    The Laguna Verde Central having established as mission 'With maximum priority in the safety, to generate electricity by nuclear means with competitive quality and cost, sustained in our personnel's continuous overcoming and deep respect to the environment' and respecting our values (safety, responsibility by results, professional integrity, continuous improvement, team work, excellence in the performance, quality of service, protection to the environment its thought about our strategic objectives of the power station being born by this way one of them that it is the improvement program 'reduction of reloading times' looking for to be improves every day comparing us with the best plants of the world effectiveness all the processes in the power station that allowed us to measure our performance with the same parameters that settle down at international level as its are nuclear safety, industrial safety, radiological safety, capacity factor, readiness factor, cleaning of the power station attachment to procedures, attention to the detail and certainly to be competitive in the economic aspect. After analyzing the performance record of the power station, evaluating our technical, economic capacity, the location of the installation besides revising the international experiences was defined that one of the concepts that impact considerably so much to the capacity factors and readiness besides the dose and production cost is the duration of the reloading periods, for this reason work strategies were elaborated to be able to reach our goals of reloading days in less than 30 days, here are formed the carried out actions that they made us complete the four last reloading in less than 30 days. (Author)

  3. Effects of air-sea coupling on the boreal summer intraseasonal oscillations over the tropical Indian Ocean

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Ailan [CMA, Key Open Laboratory for Tropical Monsoon, Institute of Tropical and Marine Meteorology, Guangzhou (China); Li, Tim [CMA, Key Open Laboratory for Tropical Monsoon, Institute of Tropical and Marine Meteorology, Guangzhou (China); University of Hawaii, IPRC, Honolulu, Hawaii (United States); University of Hawaii, Department of Meteorology, Honolulu, Hawaii (United States); Fu, Xiouhua [University of Hawaii, IPRC, Honolulu, Hawaii (United States); Luo, Jing-Jia; Masumoto, Yukio [Research Institute for Global Change, JAMSTEC, Yokohama (Japan)

    2011-12-15

    The effects of air-sea coupling over the tropical Indian Ocean (TIO) on the eastward- and northward-propagating boreal summer intraseasonal oscillation (BSISO) are investigated by comparing a fully coupled (CTL) and a partially decoupled Indian Ocean (pdIO) experiment using SINTEX-F coupled GCM. Air-sea coupling over the TIO significantly enhances the intensity of both the eastward and northward propagations of the BSISO. The maximum spectrum differences of the northward- (eastward-) propagating BSISO between the CTL and pdIO reach 30% (25%) of their respective climatological values. The enhanced eastward (northward) propagation is related to the zonal (meridional) asymmetry of sea surface temperature anomaly (SSTA). A positive SSTA appears to the east (north) of the BSISO convection, which may positively feed back to the BSISO convection. In addition, air-sea coupling may enhance the northward propagation through the changes of the mean vertical wind shear and low-level specific humidity. The interannual variations of the TIO regulate the air-sea interaction effect. Air-sea coupling enhances (reduces) the eastward-propagating spectrum during the negative Indian Ocean dipole (IOD) mode, positive Indian Ocean basin (IOB) mode and normal years (during positive IOD and negative IOB years). Such phase dependence is attributed to the role of the background mean westerly in affecting the wind-evaporation-SST feedback. A climatological weak westerly in the equatorial Indian Ocean can be readily reversed by anomalous zonal SST gradients during the positive IOD and negative IOB events. Although the SSTA is always positive to the northeast of the BSISO convection for all interannual modes, air-sea coupling reduces the zonal asymmetry of the low-level specific humidity and thus the eastward propagation spectrum during the positive IOD and negative IOB modes, while strengthening them during the other modes. Air-sea coupling enhances the northward propagation under all

  4. First-Ever Stroke and Transient Ischemic Attack Incidence and 30-Day Case-Fatality Rates in a Population-Based Study in Argentina

    DEFF Research Database (Denmark)

    Bahit, M Cecilia; Coppola, Mariano L; Riccio, Patricia M

    2016-01-01

    BACKGROUND AND PURPOSE: Epidemiological data about stroke are scarce in low- and middle-income Latin-American countries. We investigated annual incidence of first-ever stroke and transient ischemic attack (TIA) and 30-day case-fatality rates in a population-based setting in Tandil, Argentina....... METHODS: We prospectively identified all first-ever stroke and TIA cases from overlapping sources between January 5, 2013, and April 30, 2015, in Tandil, Argentina. We calculated crude and standardized incidence rates. We estimated 30-day case-fatality rates. RESULTS: We identified 334 first-ever strokes.......1% (95% CI, 14.2-36.6) for intracerebral hemorrhage, and 1.9% (95% CI, 0.4-5.8) for TIA. CONCLUSIONS: This study provides the first prospective population-based stroke and TIA incidence and case-fatality estimate in Argentina. First-ever stroke incidence was lower than that reported in previous Latin...

  5. 30-day mortality after coronary artery bypass grafting and valve surgery has greatly improved over the last decade, but the 1-year mortality remains constant

    Directory of Open Access Journals (Sweden)

    Laura Sommer Hansen

    2015-01-01

    Full Text Available Introduction: European system for cardiac operative risk evaluation (EuroSCORE is a valuable tool in control of the quality of cardiac surgery. However, the validity of the risk score for the individual patient may be questioned. The present study was carried out to investigate whether the continued fall in short-term mortality reflects an actual improvement in late mortality, and subsequently, to investigate EuroSCORE as predictor of 1-year mortality. Methods: A population-based cohort study of 25,602 patients from a 12-year period from three public university hospitals undergoing coronary artery bypass grafting (CABG or valve surgery. Analysis was carried out based on EuroSCORE, age and co-morbidity factors (residual EuroSCORE. Results: During the period the average age increased from 65.1 ± 10.0 years to 68.9 ± 10.7 years (P < 0.001, one-way ANOVA, and the number of females increased from 26.0% to 28.2% (P = 0.0012, Chi-square test. The total EuroSCORE increased from 4.67 to 5.68 while the residual EuroSCORE decreased from 2.64 to 1.83. Thirty-day mortality decreased from 4.07% in 1999-2000 to 2.44% in 2011-2012 (P = 0.0056; Chi-square test, while 1-year mortality was unchanged (6.50% in 1999-2000 vs. 6.25% in 2011-2012 [P = 0.8086; Chi-square test]. Discussion: The study demonstrates that both co-morbidity and age has a great impact on 30-day mortality. However, with time the impact of co-morbidity seems less. Thus, age is more important than co-morbidity in late mortality. The various developments in short and long-term mortality are not readily explained. Conclusion: Although 30-day mortality of CABG and valve surgery patients has decreased during the 12-year period, the 1-year mortality remains the same.

  6. Kansas City Cardiomyopathy Questionnaire Utility in Prediction of 30-Day Readmission Rate in Patients with Chronic Heart Failure

    Directory of Open Access Journals (Sweden)

    Shengchuan Dai

    2016-01-01

    Full Text Available Background. Heart failure (HF is one of the most common diagnoses associated with hospital readmission. We designed this prospective study to evaluate whether Kansas City Cardiomyopathy Questionnaire (KCCQ score is associated with 30-day readmission in patients hospitalized with decompensated HF. Methods and Results. We enrolled 240 patients who met the study criteria. Forty-eight (20% patients were readmitted for decompensated HF within thirty days of hospital discharge, and 192 (80% patients were not readmitted. Compared to readmitted patients, nonreadmitted patients had a higher average KCCQ score (40.8 versus 32.6, P = 0.019 before discharge. Multivariate analyses showed that a high KCCQ score was associated with low HF readmission rate (adjusted OR = 0.566, P = 0.022. The c-statistic for the base model (age + gender was 0.617. The combination of home medication and lab tests on the base model resulted in an integrated discrimination improvement (IDI increase of 3.9%. On that basis, the KCQQ further increased IDI of 2.7%. Conclusions. The KCCQ score determined before hospital discharge was significantly associated with 30-day readmission rate in patients with HF, which may provide a clinically useful measure and could significantly improve readmission prediction reliability when combined with other clinical components.

  7. Talampanel improves the functional deficit after transient focal cerebral ischemia in rats. A 30-day follow up study.

    Science.gov (United States)

    Erdo, Franciska; Berzsenyi, Pál; Német, László; Andrási, Ferenc

    2006-01-15

    The neuroprotective effect of talampanel, a negative allosteric modulator of alpha-amino-3-hydroxy-methyl-4-isoxazolyl-propionic acid (AMPA) receptors has been described previously. However, in these studies the histological changes and not the functional consequences of the brain damage were evaluated. The aim of present investigation was to analyze the sensorimotor function after stroke and to test the influence of talampanel (GYKI-53773, LY-300164) by 30-day monitoring in rats. After 1h middle cerebral artery occlusion (MCAO) general 'well-being', neurological status, spontaneous motor activity, rotation, motor coordination, balancing, muscle strength and reaction time were followed for 1 month. Talampanel (6 x 10 mg/kg i.p. given on the day of stroke) improved the motor coordination in rotarod (p beam walking (p tests, reduced the number of stroke-induced rotations (p < 0.05), shortened the reflex time on the forelimb contralateral to brain ischemia and improved the survival rate comparing with vehicle treated control. After stroke, serious sensorimotor deficits appeared in rats but they showed partial spontaneous recovery after 30 days. Talampanel treatment enhanced the rate of functional improvement without changing the morphology at the end of the experiment. Our results indicate that modulation of AMPA receptors by talampanel can be a promising therapeutic approach to the treatment of stroke.

  8. 78 FR 56901 - Submission for OMB Review; 30-day Comment Request: Family Life, Activity, Sun, Health, and Eating...

    Science.gov (United States)

    2013-09-16

    ...; 30-day Comment Request: Family Life, Activity, Sun, Health, and Eating (FLASHE) Study (NCI) SUMMARY... Collection: Family Life, Activity, Sun, Health, and Eating (FLASHE) Study (NCI), 0925-NEW, Expiration Date xx... behaviors (but also examining other behaviors such as sleep, sun-safety, and tobacco) in new ways not...

  9. Open Day: General Information

    CERN Multimedia

    2004-01-01

    http://www.cern.ch/cern50/ With 50 visit points, including theatre performances, debates and visits to installations that have never before been opened to the public, CERN's 50th anniversary Open Day is set to be a day to remember. Seven hundred volunteers have signed up to help for the day. The Open Day team truly appreciates this wonderful show of support! The Open Day would not be possible without their help. Car parking and Access Cars with a CERN sticker can access all CERN sites as normal. However, to avoid congestion on Meyrin site, we ask you to park in areas that will not be open to the public (see below) and to use the shuttle services wherever possible for your transport during the day. Private cars on the French side of the border without a CERN sticker will be diverted to a car park area in the Prévessin site. There is a shuttle service connecting the Meyrin and Prévessin sites via SM18 every 20 minutes. Private cars on the Swiss side of the border without a CERN sticker will be diverte...

  10. A unifying view of climate change in the Sahel linking intra-seasonal, interannual and longer time scales

    International Nuclear Information System (INIS)

    Giannini, A; Salack, S; Gaye, A T; Lodoun, T; Ali, A; Ndiaye, O

    2013-01-01

    We propose a re-interpretation of the oceanic influence on the climate of the African Sahel that is consistent across observations, 20th century simulations and 21st century projections, and that resolves the uncertainty in projections of precipitation change in this region: continued warming of the global tropical oceans increases the threshold for convection, potentially drying tropical land, but this ‘upped ante’ can be met if sufficient moisture is supplied in monsoon flow. In this framework, the reversal to warming of the subtropical North Atlantic, which is now out-pacing warming of the global tropical oceans, provides that moisture, and explains the partial recovery in precipitation since persistent drought in the 1970s and 1980s. We find this recovery to result from increases in daily rainfall intensity, rather than in frequency, most evidently so in Senegal, the westernmost among the three Sahelian countries analyzed. Continuation of these observed trends is consistent with projections for an overall wetter Sahel, but more variable precipitation on all time scales, from intra-seasonal to multi-decadal. (letter)

  11. Extraction and prediction of indices for monsoon intraseasonal oscillations: an approach based on nonlinear Laplacian spectral analysis

    Science.gov (United States)

    Sabeerali, C. T.; Ajayamohan, R. S.; Giannakis, Dimitrios; Majda, Andrew J.

    2017-11-01

    An improved index for real-time monitoring and forecast verification of monsoon intraseasonal oscillations (MISOs) is introduced using the recently developed nonlinear Laplacian spectral analysis (NLSA) technique. Using NLSA, a hierarchy of Laplace-Beltrami (LB) eigenfunctions are extracted from unfiltered daily rainfall data from the Global Precipitation Climatology Project over the south Asian monsoon region. Two modes representing the full life cycle of the northeastward-propagating boreal summer MISO are identified from the hierarchy of LB eigenfunctions. These modes have a number of advantages over MISO modes extracted via extended empirical orthogonal function analysis including higher memory and predictability, stronger amplitude and higher fractional explained variance over the western Pacific, Western Ghats, and adjoining Arabian Sea regions, and more realistic representation of the regional heat sources over the Indian and Pacific Oceans. Real-time prediction of NLSA-derived MISO indices is demonstrated via extended-range hindcasts based on NCEP Coupled Forecast System version 2 operational output. It is shown that in these hindcasts the NLSA MISO indices remain predictable out to ˜3 weeks.

  12. Randomised controlled pragmatic clinical trial evaluating the effectiveness of a discharge follow-up phone call on 30-day hospital readmissions: balancing pragmatic and explanatory design considerations

    Science.gov (United States)

    Yiadom, Maame Yaa A B; Domenico, Henry; Byrne, Daniel; Hasselblad, Michele Marie; Gatto, Cheryl L; Kripalani, Sunil; Choma, Neesha; Tucker, Sarah; Wang, Li; Bhatia, Monisha C; Morrison, Johnston; Harrell, Frank E; Hartert, Tina; Bernard, Gordon

    2018-01-01

    Introduction Hospital readmissions within 30days are a healthcare quality problem associated with increased costs and poor health outcomes. Identifying interventions to improve patients’ successful transition from inpatient to outpatient care is a continued challenge. Methods and analysis This is a single-centre pragmatic randomised and controlled clinical trial examining the effectiveness of a discharge follow-up phone call to reduce 30-day inpatient readmissions. Our primary endpoint is inpatient readmission within 30days of hospital discharge censored for death analysed with an intention-to-treat approach. Secondary endpoints included observation status readmission within 30days, time to readmission, all-cause emergency department revisits within 30days, patient satisfaction (measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems scores) and 30-day mortality. Exploratory endpoints include the need for assistance with discharge plan implementation among those randomised to the intervention arm and reached by the study nurse, and the number of call attempts to achieve successful intervention delivery. Consistent with the Learning Healthcare System model for clinical research, timeliness is a critical quality for studies to most effectively inform hospital clinical practice. We are challenged to apply pragmatic design elements in order to maintain a high-quality practicable study providing timely results. This type of prospective pragmatic trial empowers the advancement of hospital-wide evidence-based practice directly affecting patients. Ethics and dissemination Study results will inform the structure, objective and function of future iterations of the hospital’s discharge follow-up phone call programme and be submitted for publication in the literature. Trial registration number NCT03050918; Pre-results. PMID:29444787

  13. 30-Day Mortality and Readmission after Hemorrhagic Stroke among Medicare Beneficiaries in Joint Commission Primary Stroke Center Certified and Non-Certified Hospitals

    Science.gov (United States)

    Lichtman, Judith H.; Jones, Sara B.; Leifheit-Limson, Erica C.; Wang, Yun; Goldstein, Larry B.

    2012-01-01

    Background and Purpose Ischemic stroke patients treated at Joint Commission Primary Stroke Center (JC-PSC) certified hospitals have better outcomes. Data reflecting the impact of JC-PSC status on outcomes after hemorrhagic stroke are limited. We determined whether 30-day mortality and readmission rates after hemorrhagic stroke differed for patients treated at JC-PSC certified versus non-certified hospitals. Methods The study included all fee-for-service Medicare beneficiaries ≥65 years old with a primary discharge diagnosis of subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH) in 2006. Covariate-adjusted logistic and Cox proportional hazards regression assessed the effect of care at a JC-PSC certified hospital on 30-day mortality and readmission. Results There were 2,305 SAH and 8,708 ICH discharges from JC-PSC certified hospitals and 3,892 SAH and 22,564 ICH discharges from non-certified hospitals. Unadjusted in-hospital mortality (SAH: 27.5% vs. 33.2%, pmortality (SAH: 35.1% vs. 44.0%, pmortality was 34% lower (OR 0.66, 95% CI 0.58–0.76) after SAH and 14% lower (OR 0.86, 95% CI 0.80–0.92) after ICH for patients discharged from JC-PSC certified hospitals. There was no difference in 30-day risk-adjusted readmission rates for SAH or ICH based on JC-PSC status. Conclusions Patients treated at JC-PSC certified hospitals had lower risk-adjusted mortality rates for both SAH and ICH but similar 30-day readmission rates as compared with non-certified hospitals. PMID:22033986

  14. Regional simulation of Indian summer monsoon intraseasonal oscillations at gray-zone resolution

    Science.gov (United States)

    Chen, Xingchao; Pauluis, Olivier M.; Zhang, Fuqing

    2018-01-01

    Simulations of the Indian summer monsoon by the cloud-permitting Weather Research and Forecasting (WRF) model at gray-zone resolution are described in this study, with a particular emphasis on the model ability to capture the monsoon intraseasonal oscillations (MISOs). Five boreal summers are simulated from 2007 to 2011 using the ERA-Interim reanalysis as the lateral boundary forcing data. Our experimental setup relies on a horizontal grid spacing of 9 km to explicitly simulate deep convection without the use of cumulus parameterizations. When compared to simulations with coarser grid spacing (27 km) and using a cumulus scheme, the 9 km simulations reduce the biases in mean precipitation and produce more realistic low-frequency variability associated with MISOs. Results show that the model at the 9 km gray-zone resolution captures the salient features of the summer monsoon. The spatial distributions and temporal evolutions of monsoon rainfall in the WRF simulations verify qualitatively well against observations from the Tropical Rainfall Measurement Mission (TRMM), with regional maxima located over Western Ghats, central India, Himalaya foothills, and the west coast of Myanmar. The onset, breaks, and withdrawal of the summer monsoon in each year are also realistically captured by the model. The MISO-phase composites of monsoon rainfall, low-level wind, and precipitable water anomalies in the simulations also agree qualitatively with the observations. Both the simulations and observations show a northeastward propagation of the MISOs, with the intensification and weakening of the Somali Jet over the Arabian Sea during the active and break phases of the Indian summer monsoon.

  15. Association between use of pre-hospital ECG and 30-day mortality: A large cohort study of patients experiencing chest pain.

    Science.gov (United States)

    Rawshani, Nina; Rawshani, Araz; Gelang, Carita; Herlitz, Johan; Bång, Angela; Andersson, Jan-Otto; Gellerstedt, Martin

    2017-12-01

    In the assessment of patients with chest pain, there is support for the use of pre-hospital ECG in the literature and in the care guidelines. Using propensity score methods, we aim to examine whether the mere acquisition of a pre-hospital ECG among patients with chest pain affects the outcome (30-day mortality). The association between pre-hospital ECG and 30-day mortality was studied in the overall cohort (n=13151), as well as in the one-to-one matched cohort with 2524 patients not examined with pre-hospital ECG and 2524 patients examined with pre-hospital ECG. In the overall cohort, 21% (n=2809) did not undergo an ECG tracing in the pre-hospital setting. Among those who had pain during transport, 14% (n=1159) did not undergo a pre-hospital ECG while 32% (n=1135) of those who did not have pain underwent an ECG tracing. In the overall cohort, the OR for 30-day mortality in patients who had a pre-hospital ECG, as compared with those who did not, was 0.63 (95% CI 0.05-0.79; pECG was used. The PH-ECG is underused among patients with chest discomfort and the mere acquisition of a pre-hospital ECG may reduce mortality. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Sucralfate and Lidocain: Antacid 50:50 solution in Post Esophageal Variceal Band Ligation Pain.

    Science.gov (United States)

    Hafeez, Muhammad; Kadir, Ehsan; Aijaz, Anjum

    2016-01-01

    To compare the effectiveness of pain relief of Sucralfate and lidocain antacid 50:50 solution in post esophageal variceal band ligation pain. All patients who had under gone Esophageal Variceal Band Ligation (EVBL) were included in the study. Patients un-willing to be included in the study or those who didn't have post EVBL pain were excluded. Patients with post EVBL pains were divided into two groups: one group was given sucralfate and other was given lidocaine: antacid 50:50 solution. Both were inquired about the duration of the pain relief after the medication. The results were analyzed on SPSS 23. Independent samples T-test was performed to find out whether the difference in duration of pain relief was significantly different in the two groups. Out of 110 patients who have EVBL, 66(60.00%) had pain and 44(40.00%) were pain free. In the pain group 46 (69.7%) were given sucralfate and 20 (30.3%) were given lidocain: antacid 50:50 solution. Mean duration of pain relief in two groups was 2.78 (SD ± 2.096) and 2.5 days (SD ±. 0.76) respectively. Independent samples T-test results revealed that there was no statistically significant difference in the duration of pain relief between these two groups with p value 0.426. Both Sucralfate and Lidocain: antacid 50:50 solutions are effective in relieving the post EVBL pain. However, no statistically significant difference in duration of pain relief was detected in separate groups of patients treated with either treatment.

  17. Impact of high- versus low-dose neuromuscular blocking agent administration on unplanned 30-day readmission rates in retroperitoneal laparoscopic surgery.

    Directory of Open Access Journals (Sweden)

    Martijn Boon

    Full Text Available Recent data shows that a neuromuscular block (NMB induced by administration of high doses of rocuronium improves surgical conditions in certain procedures. However, there are limited data on the effect such practices on postoperative outcomes. We performed a retrospective analysis to compare unplanned 30-day readmissions in patients that received high-dose versus low-dose rocuronium administration during general anesthesia for laparoscopic retroperitoneal surgery. This retrospective cohort study was performed in the Netherlands in an academic hospital where routine high-dose rocuronium NMB has been practiced since July 2015. Charts of patients receiving anesthesia between January 2014 and December 2016 were searched for surgical cases receiving high-dose rocuronium and matched with respect to procedure, age, sex and ASA classification to patients receiving low-dose rocuronium. The primary post-operative outcome was unplanned 30-day readmission rate. There were 130 patients in each cohort. Patients in the high- and low-dose rocuronium cohorts received 217 ± 49 versus 37 ± 5 mg rocuronium, respectively. In the high-dose rocuronium group neuromuscular activity was consistently monitored; matched patients were unreliably monitored. All patients receiving high-dose rocuronium were reversed with sugammadex, while just 33% of matched patients were reversed with sugammadex and 20% with neostigmine; the remaining patients were not reversed. Unplanned 30-day readmission rate was significantly lower in the high-dose compared to the low-dose rocuronium cohort (3.8% vs. 12.7%; p = 0.03; odds ratio = 0.33, 95% C.I. 0.12-0.95. This small retrospective study demonstrates a lower incidence of unplanned readmissions within 30-days following laparoscopic retroperitoneal surgery with high-dose relaxant anesthesia and sugammadex reversal in comparison to low-dose relaxant anesthesia. Further prospective studies are needed in larger samples to corroborate our

  18. Impact of high- versus low-dose neuromuscular blocking agent administration on unplanned 30-day readmission rates in retroperitoneal laparoscopic surgery.

    Science.gov (United States)

    Boon, Martijn; Martini, Chris; Yang, H Keri; Sen, Shuvayu S; Bevers, Rob; Warlé, Michiel; Aarts, Leon; Niesters, Marieke; Dahan, Albert

    2018-01-01

    Recent data shows that a neuromuscular block (NMB) induced by administration of high doses of rocuronium improves surgical conditions in certain procedures. However, there are limited data on the effect such practices on postoperative outcomes. We performed a retrospective analysis to compare unplanned 30-day readmissions in patients that received high-dose versus low-dose rocuronium administration during general anesthesia for laparoscopic retroperitoneal surgery. This retrospective cohort study was performed in the Netherlands in an academic hospital where routine high-dose rocuronium NMB has been practiced since July 2015. Charts of patients receiving anesthesia between January 2014 and December 2016 were searched for surgical cases receiving high-dose rocuronium and matched with respect to procedure, age, sex and ASA classification to patients receiving low-dose rocuronium. The primary post-operative outcome was unplanned 30-day readmission rate. There were 130 patients in each cohort. Patients in the high- and low-dose rocuronium cohorts received 217 ± 49 versus 37 ± 5 mg rocuronium, respectively. In the high-dose rocuronium group neuromuscular activity was consistently monitored; matched patients were unreliably monitored. All patients receiving high-dose rocuronium were reversed with sugammadex, while just 33% of matched patients were reversed with sugammadex and 20% with neostigmine; the remaining patients were not reversed. Unplanned 30-day readmission rate was significantly lower in the high-dose compared to the low-dose rocuronium cohort (3.8% vs. 12.7%; p = 0.03; odds ratio = 0.33, 95% C.I. 0.12-0.95). This small retrospective study demonstrates a lower incidence of unplanned readmissions within 30-days following laparoscopic retroperitoneal surgery with high-dose relaxant anesthesia and sugammadex reversal in comparison to low-dose relaxant anesthesia. Further prospective studies are needed in larger samples to corroborate our findings and

  19. Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30 and 60 Day Hospitalization: The Depression CAREPATH Cluster-Randomized Trial

    Science.gov (United States)

    Bruce, Martha L.; Lohman, Matthew C.; Greenberg, Rebecca L.; Bao, Yuhua; Raue, Patrick J.

    2016-01-01

    OBJECTIVES To determine whether a depression care management intervention among Medicare home health recipients decreases risks of hospitalization. DESIGN Cluster-randomized trial. Nurse teams were randomized to Intervention (12 teams) or Enhanced Usual Care (EUC; 9 teams). SETTING Six home health agencies from distinct geographic regions. Patients were interviewed at home and by telephone. PARTICIPANTS Patients age>65 who screened positive for depression on nurse assessments (N=755), and a subset who consented to interviews (N=306). INTERVENTION The Depression CAREPATH (CARE for PATients at Home) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted biweekly telephone conferences with team supervisors. MEASUREMENTS The study examined acute-care hospitalization and days to hospitalization. H1 used data from the home health record to examine hospitalization over 30-day and 60-day periods while a home health patient. H2 used data from both home care record and research assessments to examine 30-day hospitalization from any setting. RESULTS The adjusted hazard ratio (HR) of being admitted to hospital directly from home health within 30 days of start of home health care was 0.65 (p=.013) for CAREPATH compared to EUC patients, and 0.72 (p=.027) within 60 days. In patients referred to home health directly from hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, p=.001) among CAREPATH patients. CONCLUSION Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk among older adults receiving Medicare home health nursing services. PMID:27739067

  20. Continued Inpatient Care After Primary Total Knee Arthroplasty Increases 30-Day Post-Discharge Complications: A Propensity Score-Adjusted Analysis.

    Science.gov (United States)

    McLawhorn, Alexander S; Fu, Michael C; Schairer, William W; Sculco, Peter K; MacLean, Catherine H; Padgett, Douglas E

    2017-09-01

    Discharge destination, either home or skilled care facility, after total knee arthroplasty (TKA) may be associated with significant variation in postacute care outcomes. The purpose of this study was to characterize the 30-day postdischarge outcomes after primary TKA relative to discharge destination. All primary unilateral TKAs performed for osteoarthritis from 2011-2014 were identified in the National Surgical Quality Improvement Program database. Propensity scores based on predischarge characteristics were used to adjust for selection bias in discharge destination. Propensity-adjusted multivariable logistic regressions were used to examine associations between discharge destination and postdischarge complications. Among 101,256 primary TKAs identified, 70,628 were discharged home and 30,628 to skilled care facilities. Patients discharged to facilities were more frequently were female, older, higher body mass index class, higher Charlson comorbidity index and American Society of Anesthesiologists scores, had predischarge complications, received general anesthesia, and classified as nonindependent preoperatively. Propensity adjustment accounted for this selection bias. Patients discharged to skilled care facilities after TKA had higher odds of any major complication (odds ratio = 1.25; 95% confidence interval, 1.13-1.37) and readmission (odds ratio = 1.81; 95% confidence interval, 1.50-2.18). Skilled care was associated with increased odds for respiratory, septic, thromboembolic, and urinary complications. Associations with death, cardiac, and wound complications were not significant. After controlling for predischarge characteristics, discharge to skilled care facilities vs home after primary TKA is associated with higher odds of numerous complications and unplanned readmission. These results support coordination of care pathways to facilitate home discharge after hospitalization for TKA whenever possible. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Registration Day-Camp 2016

    CERN Multimedia

    Nursery School

    2016-01-01

    Reminder Registration for the CERN Staff Association Day-camp are open for children from 4 to 6 years old More information on the website: http://nurseryschool.web.cern.ch/. The day-camp is open to all children. An inscription per week is proposed, cost 480.-CHF/week, lunch included The camp will be open weeks 27, 28, 29 and 30, from 8:30 am to 5:30 pm. For further questions, thanks you for contacting us by email at Summer.Camp@cern.ch.

  2. Epidemiological investigation of a food-borne gastroenteritis outbreak caused by Norwalk-like virus in 30 day-care centres.

    Science.gov (United States)

    Götz, Hannelore; de Jong, Birgitta; Lindbäck, Johan; Parment, Per Arne; Hedlund, Kjell Olof; Torvén, Maria; Ekdahl, Karl

    2002-01-01

    In March 1999, an outbreak of gastroenteritis occurred affecting 30 day-care centres served by the same caterer. A retrospective cohort study was performed in 13 randomly selected day-care centres to determine the source and mode of transmission. Electron microscopy and PCR were used to verify the diagnosis. The overall attack rate (AR) was 37% (195/524): 30% in children and 62% in adults. Modified by the age of the patient, eating pumpkin salad served on 1 March was associated with becoming an early case (odds ratio = 3.9; 95% confidence interval 1.8-8.8). No significant association was found between food consumption and becoming a late case. The primary food-borne AR was 27% and the secondary AR was 14%. The same genotype of Norwalk-like virus was found in 5 cases and in 1 ill and 1 asymptomatic food-handler. Contamination by 1 of the food-handlers seems the most likely route of spread of the virus and underlines the importance of strict hygienic routines.

  3. Effect of 30-day orbital flight BION M1 on excretion of expired endogenous CO in mice

    Science.gov (United States)

    Shulagin, Yury; Tatarkin, Sergey; Dyachenko, Alexander

    It is known that increased destruction of hem structures is accompanied by increase of the endogenous carbon monoxide excretion rate with respiration (VCO). Changes VCO preceded the observed changes in the blood composition [D’yachenko A. et al., 2010]. Changes in blood composition, i.e. rise of red blood cells content and reduction of reticulocytes content was detected after a 12-day orbital flight (OF) in mice C57BL/6 [Gridley D.et al., 2003]. The purpose of this study was to investigate the effect of 30-day OF on excretion of endogenous CO. The method and apparatus for simultaneous measurement of VCO, and O2 and CO2 exchange were developed. The research consisted of three parts: 1). Measurement of VCO in five C57BL/6 mice after 30-day OF on the Russian satellite BION M1. 2). Measurement of VCO in six C57BL/6 mice after 30-day ground-based experiment (GBE) with simulated flight telemetry environment of BION M1. 3). Measurement of VCO in seven C57BL/6 mice in vivarium The results: Mice weight after OF was 24.3+-3.3 (mean +-SD) with minimal weight 18.1 g, and maximal weight 29.9 g. Vivarium mice weight was 27.0+-1.8 g. KGE mice weight was 25.0+-1.3 g. Mice age in all three groups was the same. We measured and estimated VCO and total CO excretion (MCO) for two gas mixtures ventilated mouse camera: atmospheric CO-contained air and then CO-free air(30 min). The results showed that the average MCO allocated GBE and vivarium mice did not significantly differ. Average MCO in mice after OF was significantly higher then in vivarium group (T=-2,74; p=0.02). MCO after GBE was between the vivarium and OF groups. MCO in OF and KGE groups did not differ ( T=-1,93; p=0,085). Blood tests in mice after OF was not carried out, because the recovery after the OF was studied in this group. The largest excretion of CO was observed in a mouse N39 after the OF. The weight of this mouse was only 18.1 g, i.e. much less than mean weight. Increase of VCO in food-restricted animal is known

  4. The role of shallow convection in promoting the northward propagation of boreal summer intraseasonal oscillation

    Science.gov (United States)

    Liu, Fei; Zhao, Jiuwei; Fu, Xiouhua; Huang, Gang

    2018-02-01

    By conducting idealized experiments in a general circulation model (GCM) and in a toy theoretical model, we test the hypothesis that shallow convection (SC) is responsible for explaining why the boreal summer intraseasonal oscillation (BSISO) prefers propagating northward. Two simulations are performed using ECHAM4, with the control run using a standard detrainment rate of SC and the sensitivity run turning off the detrainment rate of SC. These two simulations display dramatically different BSISO characteristics. The control run simulates the realistic northward propagation (NP) of the BSISO, while the sensitivity run with little SC only simulates stationary signals. In the sensitivity run, the meridional asymmetries of vorticity and humidity fields are simulated under the monsoon vertical wind shear (VWS); thus, the frictional convergence can be excited to the north of the BSISO. However, the lack of SC makes the lower and middle troposphere very dry, which prohibits further development of deeper convection. A theoretical BSISO model is also constructed, and the result shows that SC is a key to convey the asymmetric vorticity effect to induce the BSISO to move northward. Thus, both the GCM and theoretical model results demonstrate the importance of SC in promoting the NP of the BSISO.

  5. Determining 30-day readmission risk for heart failure patients: the Readmission After Heart Failure scale.

    Science.gov (United States)

    Chamberlain, Ronald S; Sond, Jaswinder; Mahendraraj, Krishnaraj; Lau, Christine Sm; Siracuse, Brianna L

    2018-01-01

    Chronic heart failure (CHF), which affects >5 million Americans, accounts for >1 million hospitalizations annually. As a part of the Hospital Readmission Reduction Program, the Affordable Care Act requires that the Centers for Medicare and Medicaid Services reduce payments to hospitals with excess readmissions. This study sought to develop a scale that reliably predicts readmission rates among patients with CHF. The State Inpatient Database (2006-2011) was utilized, and discharge data including demographic and clinical characteristics on 642,448 patients with CHF from California and New York (derivation cohort) and 365,359 patients with CHF from Florida and Washington (validation cohort) were extracted. The Readmission After Heart Failure (RAHF) scale was developed to predict readmission risk. The 30-day readmission rates were 9.42 and 9.17% (derivation and validation cohorts, respectively). Age readmission risk after hospitalization for CHF. The RAHF scale was created and explained the 95% of readmission variability within the validation cohort. The RAHF scale was then used to define the following three levels of risk for readmission: low (RAHF score readmission rate), moderate (RAHF score 12-15; 9.78% readmission rate), and high (RAHF score >15; 12.04% readmission rate). The relative risk of readmission was 1.67 for the high-risk group compared with the low-risk group. The RAHF scale reliably predicts a patient's 30-day CHF readmission risk based on demographic and clinical factors present upon initial admission. By risk-stratifying patients, using models such as the RAHF scale, strategies tailored to each patient can be implemented to improve patient outcomes and reduce health care costs.

  6. Trends, causes and timing of 30-day readmissions after hospitalization for heart failure: 11-year population-based analysis with linked data.

    Science.gov (United States)

    Fernandez-Gasso, Lucía; Hernando-Arizaleta, Lauro; Palomar-Rodríguez, Joaquín A; Abellán-Pérez, M Victoria; Pascual-Figal, Domingo A

    2017-12-01

    Reliable data are necessary if the burden of early readmissions following hospitalization for heart failure (HF) is to be addressed. We studied unplanned 30-day readmissions, their causes and timing over an 11-year period, using population-based linked data. All hospitalizations from 2003 to 2013 were analyzed by using administrative linked data based on the Minimum Basic Set discharge registry of the Department of Health (Region of Murcia, Spain). Index hospitalizations with HF as principal diagnosis (n=27,581) were identified. Transfers between centers were merged into one discharge. Readmissions were defined as unplanned admissions to any hospital within 30-days after discharge. In the 2003-2013 period, 30-day readmission rates had a relative mean annual growth of +1.36%, increasing from 17.6% to 22.1%, with similar trends for cardiovascular and non-cardiovascular causes. The figure of 22.1% decreased to 19.8% when only same-hospital readmissions were considered. Most readmissions were due to cardiovascular causes (60%), HF being the most common single cause (34%). The timing of readmission shows an early peak on the fourth day post discharge (+13.29%) due to causes other than HF, followed by a gradual decline (-3.32%); readmission for HF decreased steadily from the first day (-2.22%). Readmission for HF (12.7%) or non-cardiovascular causes (13.3%) had higher in-hospital mortality rates than the index hospitalization (9.2%, p<0.001). Age and comorbidity burden were the main predictors of any readmission, but the performance of a predictive model was poor. These findings support the need for population-based strategies to reduce the burden of early-unplanned readmissions. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Extensive Loss of Islet Mass Beyond the First Day After Intraportal Human Islet Transplantation in a Mouse Model.

    Science.gov (United States)

    Liljebäck, Hanna; Grapensparr, Liza; Olerud, Johan; Carlsson, Per-Ola

    2016-01-01

    Clinical islet transplantation is characterized by a progressive deterioration of islet graft function, which renders many patients once again dependent on exogenous insulin administration within a couple of years. In this study, we aimed to investigate possible engraftment factors limiting the survival and viability of experimentally transplanted human islets beyond the first day after their transplantation to the liver. Human islets were transplanted into the liver of nude mice and characterized 1 or 30 days after transplantation by immunohistochemistry. The factors assessed were endocrine mass, cellular death, hypoxia, vascular density and amyloid formation in the transplanted islets. One day posttransplantation, necrotic cells, as well as apoptotic cells, were commonly observed. In contrast to necrotic death, apoptosis rates remained high 1 month posttransplantation, and the total islet mass was reduced by more than 50% between 1 and 30 days posttransplantation. Islet mass at 30 days posttransplantation correlated negatively to apoptotic death. Vascular density within the transplanted islets remained less than 30% of that in native human islets up to 30 days posttransplantation and was associated with prevailing hypoxia. Amyloid formation was rarely observed in the 1-day-old transplants, but was commonly observed in the 30-day-old islet transplants. We conclude that substantial islet cell death occurs beyond the immediate posttransplantation phase, particularly through apoptotic events. Concomitant low vascularization with prevailing hypoxia and progressive amyloid development was observed in the human islet grafts. Strategies to improve engraftment at the intraportal site or change of implantation site in the clinical setting are needed.

  8. Examining the Relationship Between Perceived Quality of Care and Actual Quality of Care as Measured by 30-Day Readmission Rates.

    Science.gov (United States)

    Salinas, Stanley R

    To test the relationship between patient experience, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and actual quality of care, as measured by 30-day readmission rates. Both HCAHPS data and outcome data reported to the Centers of Medicare & Medicaid Services (CMS). This secondary, nationwide (N = 4060), hospital-level study focused only on acute care hospitals. HCAHPS question 22 "Would you recommend this hospital to your friends and family?" was used to determine level of overall satisfaction, and 30-day readmission rates, as reported to the CMS, was used as a proxy for actual quality of care. A statistically significant relationship was found between patient experience and actual quality outcomes. The results of this study reinforce the inclusion of patient experience in Medicare's Value Based Purchasing program as a matter of good public policy.

  9. Clinical results of definitive-dose (50 Gy/25 fractions) preoperative chemoradiotherapy for unresectable esophageal cancer

    International Nuclear Information System (INIS)

    Ishikawa, Kazuki; Nakamatsu, Kiyoshi; Shiraishi, Osamu; Yasuda, Takushi; Nishimura, Yasumasa

    2015-01-01

    The clinical results of definitive-dose preoperative chemoradiotherapy (CRT) of 50 Gy/25 fractions/5 weeks for unresectable esophageal cancer were analyzed. Inclusion criteria were unresectable esophageal squamous cell carcinoma with T4b or mediastinal lymph nodes invading to the trachea or aorta. Radiation therapy of 50 Gy/25 fractions/5 weeks was combined concurrently with two courses of FP therapy (CDDP 70 mg/m 2 + 5-FU 700 mg/m 2 /d x 5 days: day 1-5, day 29-33). Tumor response was evaluated 4 weeks after completion of RT. Subtotal esophagectomy was planned 6-8 weeks after RT. Thirty patients (26 male and 4 female) aged from 50-78 years (median 66) were enrolled between 2008 and 2011. The clinical stages according to the 7th edition of UICC were stages II/III/IV, 1/23/6; T1/2/3/4, 1/1/4/24; and N0/1/2/3, 3/25/1/1. All 30 patients completed RT of 50 Gy/ 25 fractions. Initial tumor responses were 21 patients with resectable disease, 7 with unresectable disease, and 2 with progressive disease. Subtotal esophagectomy was performed in 18 (60%) of the 30 patients. Pathological complete response was obtained in five (28%) patients. There were two patients with hospitalization death after surgery (11%). Six of the 7 patients who still had unresectable disease were treated with 1-3 courses of docetaxel, CDDP and 5-FU. Three patients treated without surgery showed long-term survival. The 3-year locoregional control rate and the 3-year overall survival rate for the 30 patients were 70 and 49%, respectively. Definitive-dose preoperative CRT was feasible, and is a promising treatment strategy for unresectable esophageal cancer. (author)

  10. The effect of sesame oil consumption during pregnancy and lactation on the memory of rat offspring in 30 days after birth

    Directory of Open Access Journals (Sweden)

    Neda Asle Iranifam

    2013-06-01

    Full Text Available Background: According to positive effect of sesame oil on the nervous system and because that fatty acids are essential for evolution of nervous system during pregnancy and for growth of neurons during lactation, in this study, effect of diet containing 10% sesame oil was evaluated on learning of rats at 30 days after birth. Material and Methods: In present study, adult female and male rats were divided into 2 groups (9 female and 3 male rats in each group: control group with usual diet and test group with diet containing 10% sesame oil were fed during pregnancy and lactation. Then male and female offspring of groups was examined at 30 days after birth using shuttle box. The results were analyzed using two way analysis of variance. Results: The average of latent time in entering to black box in start of learning in test group was less than control group (P< 0/01. The average of latent time in entering to black box at 48 after learning in test group was higher than control group and the average of spend time in black box at 48 after learning in test group was less than control group P< 0.001. Conclusion: The results showed that diet containing 10% sesame oil during pregnancy and lactation increased passive avoidance memory learning after 48 hour in rats at 30 days after birth.

  11. Spatio-temporal characteristics of PM10 concentration across Malaysia

    Science.gov (United States)

    Juneng, Liew; Latif, Mohd Talib; Tangang, Fredolin T.; Mansor, Haslina

    The recurrence of forest fires in Southeast Asia and associated biomass burning, has contributed markedly to the problem of trans-boundary haze and the long-range movement of pollutants in the region. Air pollutants, specifically particulate matter in the atmosphere, have received extensive attention, mainly because of their adverse effect on people's health. In this study, the spatial and temporal variability of the PM10 concentration across Malaysia was analyzed by means of the rotated principal component analysis. The results suggest that the variability of the PM10 concentration can be decomposed into four dominant modes, each characterizing different spatial and temporal variations. The first mode characterizes the southwest coastal region of the Malaysian Peninsular with the PM10 showing a peak concentration during the summer monsoon i.e. when the winds are predominantly southerlies or southwesterlies, and a minimal concentration during the winter monsoon. The second mode features the region of western Borneo with the PM10 exhibiting a concentration surge in August-September, which is likely to be the result of the northward shift of the Inter Tropical Convergence Zone (ITCZ) and the subsequent rapid arrival of the rainy season. The third mode delineates the northern region of the Malaysian Peninsular with strong bimodality in the PM10 concentration. Seasonally, this component exhibits two concentration maxima during the late winter and summer monsoons, as well as two minima during the inter-monsoon periods. The fourth dominant mode characterizes the northern Borneo region which exhibits weaker seasonality of the PM10 concentration. Generally, the seasonal fluctuation of the PM10 concentration is largely associated with the seasonal variation of rainfall in the country. However, in addition to this, the PM10 concentration also fluctuates markedly in two timescale bands i.e. 10-20 days quasi-biweekly (QBW) and 30-60 days lower frequency (LF) band of the intra-seasonal

  12. Exposure to Pb, Cd, and As mixtures potentiates the production of oxidative stress precursors: 30-day, 90-day, and 180-day drinking water studies in rats.

    Science.gov (United States)

    Whittaker, Margaret H; Wang, Gensheng; Chen, Xue-Qing; Lipsky, Michael; Smith, Donald; Gwiazda, Roberto; Fowler, Bruce A

    2011-07-15

    Exposure to chemical mixtures is a common and important determinant of toxicity and is of particular concern due to their appearance in sources of drinking water. Despite this, few in vivo mixture studies have been conducted to date to understand the health impact of chemical mixtures compared to single chemicals. Interactive effects of lead (Pb), cadmium (Cd) and arsenic (As) were evaluated in 30-, 90-, and 180-day factorial design drinking water studies in rats designed to test the hypothesis that ingestion of such mixtures at individual component Lowest-Observed-Effect-Levels (LOELs) results in increased levels of the pro-oxidant delta aminolevulinic acid (ALA), iron, and copper. LOEL levels of Pb, Cd, and As mixtures resulted in the increased presence of mediators of oxidative stress such as ALA, copper, and iron. ALA increases were followed by statistically significant increases in kidney copper in the 90- and 180-day studies. Statistical evidence of interaction was identified for six biologically relevant variables: blood delta aminolevulinic acid dehydratase (ALAD), kidney ALAD, urinary ALA, urinary iron, kidney iron, and kidney copper. The current investigations underscore the importance of considering interactive effects that common toxic agents such as Pb, Cd, and As may have upon one another at low-dose levels. The interactions between known toxic trace elements at biologically relevant concentrations shown here demonstrate a clear need to rigorously review methods by which national/international agencies assess health risks of chemicals, since exposures may commonly occur as complex mixtures. Copyright © 2011. Published by Elsevier Inc.

  13. Effect of bystander CPR initiation prior to the emergency call on ROSC and 30day survival-An evaluation of 548 emergency calls.

    Science.gov (United States)

    Viereck, Søren; Palsgaard Møller, Thea; Kjær Ersbøll, Annette; Folke, Fredrik; Lippert, Freddy

    2017-02-01

    This study aimed at evaluating if time for initiation of bystander cardiopulmonary resuscitation (CPR) - prior to the emergency call (CPR prior ) versus during the emergency call following dispatcher-assisted CPR (CPR during ) - was associated with return of spontaneous circulation (ROSC) and 30-day survival. The secondary aim was to identify predictors of CPR prior . This observational study evaluated out-of-hospital cardiac arrests (OHCA) occurring in the Capital Region of Denmark from 01.01.2013 to 31.12.2013. OHCAs were linked to emergency medical dispatch centre records and corresponding emergency calls were evaluated. Multivariable logistic regression analyses were applied to evaluate the association between time for initiation of bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of CPR prior . The study included 548 emergency calls for OHCA patients receiving bystander CPR, 34.9% (n=191) in the CPR prior group and 65.1% (n=357) in the CPR during group. Multivariable analyses showed no difference in ROSC (OR=0.88, 95% CI: 0.56-1.38) or 30-day survival (OR=1.14, 95% CI: 0.68-1.92) between CPR prior and CPR during . Predictors positively associated with CPR prior included witnessed OHCA and healthcare professional bystanders. Predictors negatively associated with CPR prior included residential location, solitary bystanders, and bystanders related to the patient. The majority of bystander CPR (65%) was initiated during the emergency call, following dispatcher-assisted CPR instructions. Whether bystander CPR was initiated prior to emergency call versus during the emergency call following dispatcher-assisted CPR was not associated with ROSC or 30-day survival. Dispatcher-assisted CPR was especially beneficial for the initiation of bystander CPR in residential areas. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  14. Storage of nitroglycerin (NTG) admixed with HBOC-201 for 30 days in polyolefin plastic bags: a pilot study.

    Science.gov (United States)

    Nigam, Savita; McCarron, Richard; Arnaud, Francoise

    2017-10-01

    Hemorrhaged animals have benefited from resuscitation with the hemoglobin-based oxygen carrier (HBOC-201). Co-infusion of nitric oxide (NO) via separate intravascular lines is effective in attenuating HBOC-induced elevation of blood pressure. We tested whether nitroglycerin (NTG) and HBOC-201 can be packaged together as a single drug for resuscitation. Since NTG binds easily to plastics such as polyvinylchloride, we assessed the stability of this combination in oxygen barrier double-layer ethylene-vinyl alcohol/polyolefin bags over a 30-day period. Outcome measures indicative of the stability of HBOC/NTG were reported as changes in levels of hemoglobin (Hb), methemoglobin (MetHb), NTG, and nitrite over time. Individual tightly sealed small aliquots of HBOC/NTG were prepared under nitrogen and analyzed in a timely fashion from 0 to 30 days using hematology instruments, HPLC, FPLC, and chemiluminescence. The level of NTG in the HBOC/NTG mixture was reduced significantly over time whereas it was stable in control mixtures of NTG/saline. The level of total Hb in the HBOC/NTG and HBOC/saline mixtures remained stable over time. MetHb formed and increased to 6% up to day 1 and then slowly decreased in the HBOC/NTG mixture whereas it remained unchanged in the HBOC/saline mixture. Nitrite was produced in the HBOC/NTG group upon mixing, was increased at day 1, and then became undetectable. The reaction between HBOC-201 and NTG occurring upon mixing and developing over time in polyolefin bags makes the long-term storage of this mixed combination inappropriate.

  15. Evaluation of pre transplant T-cell activation status by soluble CD 30 determination.

    Science.gov (United States)

    Abbas, Khawar; Muzaffar, Rana; Zafar, Mirza Naqi; Mubarak, Muhammad; Naqvi, Syed Ali Anwar; Rizvi, Syed Adibul Hassan

    2009-04-01

    To evaluate the utility of serum CD30 (sCD30) levels as predictor of early acute graft rejection in live related renal transplant programme. This prospective study included 50 consecutive renal transplant recipients who received their first live related renal allograft at the Sindh Institute of Urology and Transplantation (SIUT) between October 2006 and March 2007. Blood samples were obtained one day before transplantation and on the third and fourteenth posttransplant days. Blood samples were also obtained from 50, age and sex matched healthy control individuals. Levels of serum sCD30 were measured by Enzyme Linked Immunosorbent Assay (ELISA). Donor-recipient blood group matching was identical in all patients. Pre-transplant lymphocyte crossmatch for T and B cells was negative, and panel reactive antibodies (PRA) were 0% for all recipients. The mean age of recipients was 31.6 +/- 10.23 years (range 5 to 55 years), while mean donor age was 32.74 +/- 8.48 years (range 21-50 years). Eleven (22%) recipients and donors were HLA identical while remaining (78%) were one haplotype match. Average serum sCD30 pre-transplant levels (37.8 +/- 4.97U/ml) were significantly higher than those of healthy individual's mean value of 8.48 +/- 4.97 U/ml, (P = 0.001). Eight (16%) patients developed acute rejection episode during this follow up period. Rejections were described and classified according to BANFF 97 classification. In this small single center study the serum levels of sCD30 did not show any significant difference between rejection and non rejection group in our transplant population.

  16. The Risk of Acute Kidney Injury and Its Impact on 30-Day and Long-Term Mortality after Transcatheter Aortic Valve Implantation

    Directory of Open Access Journals (Sweden)

    Katrin Gebauer

    2012-01-01

    Full Text Available Background. Transcatheter aortic valve implantation (TAVI is widely used in high risk patients (pts with aortic stenosis. Underlying chronic kidney disease implicates a high risk of postprocedural acute kidney injury (AKI. We analyzed its occurrence, impact on hospital stay, and mortality. Methods. 150 consecutive pts underwent TAVI in our institution (mean age 81 ± 7 years; logistic EuroSCORE 24 ± 15%. AKI definition was a creatinine rise of 26.5 μmol/L or more within 48 hours postprocedural. Ten patients on chronic hemodialysis were excluded. Results. AKI occurred in 28 pts (20%. Baseline creatinine was higher in AKI pts (126.4 ± 59.2 μmol/L versus 108.7 ± 45.1 μmol/L, P=0.09. Contrast media use was distributed evenly. Both, 30-day mortality (29% versus 7%, P<0.0001 and long-term mortality (43% versus 18%, P<0.0001 were higher; hospital stay was longer in AKI pts (20 ± 12 versus 15 ± 10 days, P=0.03. Predicted renal failure calculated STS Score was similar (8.0 ± 5.0% [AKI] versus 7.1 ± 4.0% [non-AKI], P=0.32 and estimated lower renal failure rates than observed. Conclusion. AKI remains a frequent complication with increased mortality in TAVI pts. Careful identification of risk factors and development of more suitable risk scores are essential.

  17. 5 A study analysing the diagnostic performance of ECG interpretation for 30-day major cardiac events in the emergency department.

    Science.gov (United States)

    Morris, Niall; Body, Rick

    2017-12-01

    This study evaluates the diagnostic accuracy of an Emergency Medicine (EM) clinician at identifying ischaemia on an ECG using 30-day major adverse cardiac events (MACE) as the primary outcome. This is a secondary analysis of a prospective, multi-centre, observational cohort at 14 centres: the Bedside Evaluation of Sensitive Troponin study. All fourteen Emergency Departments were based in the United Kingdom. Emergency physicians' assessments of the ECG were collected using a standardised form. Clinicians were asked to judge whether the ECG demonstrated ischaemia, the presence of ST depression (STD) and if there was abnormal T wave inversion (ATWI). Patients provided written informed consent and underwent serial high sensitivity troponin testing. 30 day follow-up was performed by research nurses using a standardised form via telephone. The primary outcome was 30-day major adverse cardiac events, defined as acute myocardial infarction, any cause of death and coronary revascularisation. In total, 756 patients were included in the analysis. Clinicians' ECG diagnosis of ischaemia for 30-day MACE: ECG ischaemia produces a sensitivity (Sn) of 19.54% (95% CI:11.81% to 29.43%), specificity (Sp) of 93.27% (95% CI:91.10% to 95.05%), positive predictive value (PPV) of 27.42% (95% CI:18.47% to 38.65%) and negative predictive value (NPV) of 89.91% (95%CI 88.92% to 90.83%). ECG ST depression produces Sn of 16.09% (9.09% to 25.52%), Sp of 89.69% (87.13% to 91.89%), PPV 16.87 (10.68% to 25.62%), and NPV 89.15% (88.19% to 90.04%). ECG ATWI produces Sn of 4.60% (1.27% to 11.36%), Sp of 91.63% (89.27% to 93.62%), PPV of 6.67% (2.59% to 16.12%) and NPV of 88.07% (87.52% to 88.6). This is the first prospective, multi-centre cohort study, that assess the diagnostic performance of EM clinician's ECG interpretation, with 30-day MACE as the primary outcome. The findings are highly relevant to EM as they represent the ECG terms used by popular acute coronary syndrome clinical decision rules

  18. Why Do SGLT2 inhibitors inhibit only 30-50% of renal glucose reabsorption in humans?

    Science.gov (United States)

    Liu, Jiwen Jim; Lee, TaeWeon; DeFronzo, Ralph A

    2012-09-01

    Sodium glucose cotransporter 2 (SGLT2) inhibition is a novel and promising treatment for diabetes under late-stage clinical development. It generally is accepted that SGLT2 mediates 90% of renal glucose reabsorption. However, SGLT2 inhibitors in clinical development inhibit only 30-50% of the filtered glucose load. Why are they unable to inhibit 90% of glucose reabsorption in humans? We will try to provide an explanation to this puzzle in this perspective analysis of the unique pharmacokinetic and pharmacodynamic profiles of SGLT2 inhibitors in clinical trials and examine possible mechanisms and molecular properties that may be responsible.

  19. Modified Starch of Sorghum Mutant Line Zh-30 for High Fiber Muffin Products

    Directory of Open Access Journals (Sweden)

    D.D.S. Santosa

    2009-01-01

    Full Text Available Sorghum mutant line Zh-30 is a breeding line developed at the Center for the Application of Isotope and Radiation Technology, BATAN by using mutation techniques. Gamma irradiation with the dose of 300 Gy was used to induce sorghum genetic variation. Through selection processes in several generations, the mutant line Zh-30 was identified to have better agronomic characteristics, better grain quality and higher grain yield than the original variety. Research on modified starch quality of this mutant line was done to identify its potential use in food industry. Functionality of pregelatinized, hydroxypropyl and crosslinked starch of this mutant line (Mutant TexInstant 30 has been studied for its use in high fiber muffin products. Characteristics of high fiber muffins containing 1.50; 3.50 and 5.50% of Mutant Tex-Instant 30 replacement levels to wheat flour were evaluated using both sensory panel and physical test methods. With regard to the sensory parameters, the high fiber muffins containing 1.50 - 5.50 % Mutant Tex-Instant 30 in general were not significantly different compared to the standard reference muffin. Results of physical evaluations showed that all Mutant Tex-Instant 30 containing products retained more moisture during baking than the standard reference. Tenderness of all products decreased at similar rate following 24 and 48 hr of room temperature storage and seven days at freezer temperature. These results suggested that sorghum mutant line Zh-30 starch could be modified and potentially used in food industry as a subtitute of wheat flour.

  20. Modified Starch of Sorghum Mutant Line Zh-30 For High Fiber Muffin Products

    International Nuclear Information System (INIS)

    Santosa, D. D. S; Human, S

    2009-01-01

    Sorghum mutant line Zh-30 is a breeding line developed at the Center for the Application of Isotope and Radiation Technology, BATAN by using mutation techniques. Gamma irradiation with the dose of 300 Gy was used to induce sorghum genetic variation. Through selection processes in several generations, the mutant line Zh-30 was identified to have better agronomic characteristics, better grain quality and higher grain yield than the original variety. Research on modified starch quality of this mutant line was done to identify its potential use in food industry. Functionality of pregelatinized, hydroxypropyl and crosslinked starch of this mutant line (Mutant TexInstant 30) has been studied for its use in high fiber muffin products. Characteristics of high fiber muffins containing 1.50; 3.50 and 5.50% of Mutant Tex-Instant 30 replacement levels to wheat flour were evaluated using both sensory panel and physical test methods. With regard to the sensory parameters, the high fiber muffins containing 1.50 - 5.50 % Mutant Tex-Instant 30 in general were not significantly different compared to the standard reference muffin. Results of physical evaluations showed that all Mutant Tex-Instant 30 containing products retained more moisture during baking than the standard reference. Tenderness of all products decreased at similar rate following 24 and 48 hr of room temperature storage and seven days at freezer temperature. These results suggested that sorghum mutant line Zh-30 starch could be modified and potentially used in food industry as a subtitute of wheat flour (author)

  1. The Glasgow Prognostic Score at the Time of Palliative Esophageal Stent Insertion is a Predictive Factor of 30-Day Mortality and Overall Survival.

    Science.gov (United States)

    Driver, Robert J; Handforth, Catherine; Radhakrishna, Ganesh; Bennett, Michael I; Ford, Alexander C; Everett, Simon M

    2018-03-01

    Optimizing the timing of esophageal stent insertion is a challenge, partly due to difficulty predicting survival in advanced malignancy. The Glasgow prognostic score (GPS) is a validated tool for predicting survival in a number of cancers. To assess the utility of the GPS in predicting 30-day mortality and overall survival postesophageal stent insertion. Patients at a tertiary referral center who had received an esophageal stent for palliation of dysphagia were included if they had a measurement of albumin and C-reactive protein (CRP) in the week preceding the procedure (n=209). Patients with both an elevated CRP (>10 mg/L) and hypoalbuminemia (L) were given a GPS score of 2 (GPS2). Patients with only one of these abnormalities were assigned as GPS1 and those with normal CRP and albumin were assigned as GPS0. Clinical and pathologic parameters were also collected to assess for potential confounding factors in the survival analysis. Increasing GPS was associated with 30-day mortality; for patients with GPS0, 30-day mortality was 5% (2/43), for GPS1 it was 23% (26/114), and for GPS2 it was 33% (17/52). The adjusted hazard ratio for overall poststent mortality was 1.6 (95% confidence interval, 1.1-2.4; P=0.02) for GPS1 and 2.4 (95% confidence interval, 1.5-3.8; PGPS2 patients compared with GPS0. GPS is an independent prognostic factor of 30-day mortality and overall survival after esophageal stent insertion. It is a potential adjunct to clinical assessment in identifying those patients at high-risk of short-term mortality poststent.

  2. Decreasing sedentary behavior by 30 minutes per day reduces cardiovascular disease risk factors in rural Americans.

    Science.gov (United States)

    Saleh, Zyad T; Lennie, Terry A; Mudd-Martin, Gia; Bailey, Alison L; Novak, Michael J; Biddle, Martha; Khalil, Amani A; Darawad, Muhammad; Moser, Debra K

    2015-01-01

    Regular physical activity has been associated with reduced cardiovascular disease (CVD) risk factors; however, a decrease in the amount of time spent during the remainder of the day in sedentary behavior may be equally important. The aim of this study was to examine the effects of a decrease in sedentary behavior on CVD risk factors among 205 individuals living in rural Appalachia. All participants received a comprehensive CVD risk reduction life-style intervention and measurement of major CVD risk factors and physical activity levels. Participants were divided into: 1) Adopters: those who decreased their sedentary behavior by 30 min or more per day post-intervention and 2) Non-adopters: those who did not. Repeated measures analysis of variance showed a significant group by time interaction showing that Adopters had a greater reduction in body weight and BMI than Non-adopters. These findings demonstrate that decreasing sedentary behavior is important for achieving optimal body weight. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. HTTR operation monitoring with neural network in 30 days operation at 850degC

    International Nuclear Information System (INIS)

    Shimizu, Atsushi; Nabeshima, Kunihiko; Nakagawa, Shigeaki

    2009-01-01

    The High temperature engineering test reactor (HTTR) executed the rated power operation for 30days of the first time (850degC in temperature of the nuclear reactor outlet coolant) until March, 27th through April, 26th, 2007. In this operation, HTTR was observed according to the operation monitoring model with the neural network, and the detection performance of neural network was verified during slight changes of reactor state at rated power. The neural network used for the operation monitoring was an auto-associative network, where 31 input 31 outputs and the hidden layers were connected with 20 units by the hierarchy of three layer structure. Back-propagation algorithm was used for study rule. The operation monitoring model in initial study was constructed by using the power up data between 30% and rated power, which were randomly studied. The adjustment study during the operation monitoring changes the internal structure of the initial study model to follow the changes of reactor status, such as the burn-up of the nuclear fuel for the rated power operation. As a monitoring result, slight changes of reactor state by the control system operation were correctly detected, and the on-line application to an early anomaly diagnosis for HTTR facilities will be expected. (author)

  4. The effect of regular walking and alternate day fasting on health-related factors in overweight and obese females

    Directory of Open Access Journals (Sweden)

    Roya Seighali

    2017-03-01

    Full Text Available Introduction: Obesity is a complex health problem. The aim of this study was to determine the effects of regular walking with alternate day fasting (ADF on health-related factors of overweight and obese females.‎  Methods: 30 healthy inactive, overweight and obese women were divided randomly into three equal groups.  The groups were: control group (BMI: 30.72±4.40 kg/m2; the experimental group I: ADF along with regular walking with 50% to 65% maximal heart rate (BMI: 28.69 ±2.81 kg/m2 and the experimental group II: ADF (BMI: 30.56 ±3.66 kg/m2. Participants were under the diet for six weeks. The diet ADF means that, they had days of fasting and free day (with regular walking, alternately. Two days before and two days after the end of the study, the participants’ fasting blood sugar were measured after 12 hours. Resting heart rate, blood pressure and body composition were assessed in the same day. The collected data were analyzed using paired t-test and ANOVA test. Results: Body mass index in both experimental groups had significant decrease‎ (P

  5. Safety Evaluation Report related to the operation of Diablo Canyon Nuclear Power Plant, Units 1 and 2 (Docket Nos. 50-275 and 50-323). Supplement No. 30

    International Nuclear Information System (INIS)

    1985-04-01

    Supplement 30 to the Safety Evaluation Report for the application by the Pacific Gas and Electric Company (PG and E) to operate the Diablo Canyon Nuclear Power Plant - Unit 2 (Docket No. 50-323) has been prepared by the Office of Nuclear Reactor Regulation of the US Nuclear Regulatory Commission. SSER 30 reports on the staff's technical review and evaluation of the design and analysis of Unit 2 piping systems and pipe supports. The staff effort includes an evaluation of PG and E's treatment of issues raised during the Unit 1 design verification, actions resulting from low power License Condition 2.C.(11) in the Unit 1 low power license DPR-76 and the Unit 2 applicability and resolution of certain allegations related to piping and supports

  6. Changes in the in-hospital mortality and 30-day post-discharge mortality in acutely admitted older patients : retrospective observational study

    NARCIS (Netherlands)

    van Rijn, Marjon; Buurman, Bianca M.; Vroomen, Janet L. Macneil; Suijker, Jacqueline J.; ter Riet, Gerben; van Charante, Eric P. Moll; de Rooij, Sophia E.

    Objectives: to compare changes over time in the in-hospital mortality and the mortality from discharge to 30 days postdischarge for six highly prevalent discharge diagnoses in acutely admitted older patients as well as to assess the effect of separately analysing the in-hospital mortality and the

  7. Processes controlling the surface temperature signature of the Madden-Julian oscillation in the thermocline ridge of the Indian Ocean

    Energy Technology Data Exchange (ETDEWEB)

    Jayakumar, A.; Gnanaseelan, C. [Indian Institute of Tropical Meteorology, Pune (India); Vialard, Jerome; Lengaigne, M. [CNRS, UPMC, IRD, Case 100, Universite P. et M. Curie, Laboratoire d' Oceanographie Experimentation et Approches Numeriques, LOCEAN, Paris Cedex 05 (France); National Institute of Oceanography, Goa (India); McCreary, Julian P. [University of Hawaii, International Pacific Research Centre, Hawaii (United States); Praveen Kumar, B. [National Institute of Oceanography, Goa (India)

    2011-12-15

    the SST signature during 2001 and contributes significantly during 2000. Interannual variations of the subsurface thermal structure associated with the Indian Ocean Dipole or El Nino/La Nina events modulate the MJO-driven SST signature only moderately (by up to 30%), mainly by changing the temperature of water entrained into the mixed layer. The primary factor that controls year-to-year changes in the amplitude of TRIO, intraseasonal SST anomalies is hence the characteristics of intraseasonal surface flux perturbations, rather than changes in the underlying oceanic state. (orig.)

  8. Estudo prospectivo comparativo entre a endarterectomia e a angioplastia com stent e proteção cerebral no tratamento das lesões ateroscleróticas carotídeas: resultados em 30 dias Prospective and comparative study between endarterectomy and stent angioplasty with cerebral protection in carotid atherosclerotic lesions: 30-day results

    Directory of Open Access Journals (Sweden)

    Eugênio Carlos de Almeida Tinoco

    2006-12-01

    Full Text Available OBJETIVO: Analisar comparativamente os resultados, em 30 dias, entre a endarterectomia e a angioplastia com stent auto-expansível e filtro de proteção cerebral, avaliando a incidência de acidente vascular cerebral e óbito, bem como o tempo de permanência hospitalar no tratamento das lesões ateroscleróticas da bifurcação carotídea. MÉTODO: Estudo prospectivo, em que foram tratados 80 pacientes, sintomáticos e assintomáticos, com lesões estenóticas maiores que 60 e 70%, respectivamente, da bifurcação carotídea. Os pacientes foram divididos em dois grupos de 40 pacientes, que foram avaliados quanto a sexo, idade, comorbidades associadas e tabagismo. RESULTADOS: A taxa de acidente vascular cerebral e óbito foi de 5,0% em ambas as técnicas. Ocorreu um caso (2,5% de ataque isquêmico transitório no grupo endovascular e nenhum na endarterectomia. No que se refere ao tempo de internação, o tratamento endovascular apresentou menor tempo em relação à endarterectomia, sendo estatisticamente significativo (P OBJECTIVE: To comparatively analyze the 30-day results between endarterectomy and angioplasty using self-expandable stent and filter protection in the treatment of carotid bifurcation atherosclerotic lesions. The primary endpoint was to analyze stroke and death rate, as well hospitalization time. METHODS: Comparative and prospective study in 80 symptomatic and asymptomatic patients, with carotid bifurcation stenotic lesions greater than 60 and 70%, respectively. The patients were divided into two groups of 40 and assessed according to gender, age, associated comorbid conditions and smoking. RESULTS: The stroke and death rate was 5.0% for both techniques. There was only one case of transient ischemic attack (2.5% in the endovascular group. Regarding hospitalization time, it was significantly lower in favor of the endovascular technique, with statistical significance (P < 0.002. CONCLUSIONS: This study demonstrated a 5.0

  9. Improvement of Systematic Bias of mean state and the intraseasonal variability of CFSv2 through superparameterization and revised cloud-convection-radiation parameterization

    Science.gov (United States)

    Mukhopadhyay, P.; Phani Murali Krishna, R.; Goswami, Bidyut B.; Abhik, S.; Ganai, Malay; Mahakur, M.; Khairoutdinov, Marat; Dudhia, Jimmy

    2016-05-01

    Inspite of significant improvement in numerical model physics, resolution and numerics, the general circulation models (GCMs) find it difficult to simulate realistic seasonal and intraseasonal variabilities over global tropics and particularly over Indian summer monsoon (ISM) region. The bias is mainly attributed to the improper representation of physical processes. Among all the processes, the cloud and convective processes appear to play a major role in modulating model bias. In recent times, NCEP CFSv2 model is being adopted under Monsoon Mission for dynamical monsoon forecast over Indian region. The analyses of climate free run of CFSv2 in two resolutions namely at T126 and T382, show largely similar bias in simulating seasonal rainfall, in capturing the intraseasonal variability at different scales over the global tropics and also in capturing tropical waves. Thus, the biases of CFSv2 indicate a deficiency in model's parameterization of cloud and convective processes. Keeping this in background and also for the need to improve the model fidelity, two approaches have been adopted. Firstly, in the superparameterization, 32 cloud resolving models each with a horizontal resolution of 4 km are embedded in each GCM (CFSv2) grid and the conventional sub-grid scale convective parameterization is deactivated. This is done to demonstrate the role of resolving cloud processes which otherwise remain unresolved. The superparameterized CFSv2 (SP-CFS) is developed on a coarser version T62. The model is integrated for six and half years in climate free run mode being initialised from 16 May 2008. The analyses reveal that SP-CFS simulates a significantly improved mean state as compared to default CFS. The systematic bias of lesser rainfall over Indian land mass, colder troposphere has substantially been improved. Most importantly the convectively coupled equatorial waves and the eastward propagating MJO has been found to be simulated with more fidelity in SP-CFS. The reason of

  10. [Natural infection by hemoparasites in calves submitted to chemoprophylaxis at 30 days of age].

    Science.gov (United States)

    da Silva, Rosângela A; Corrêa, Fabíola do N; Botteon, Rita de Cássia C M; Botteon, Paulo de Tarso L

    2007-01-01

    The tick-borne disease (TBD) brings great damages to cattle breeding. The most important etiologic agents are Babesia bigemina, B. bovis and Anaplasma marginale, being the tick Boophilus microplus the main vector. This work reports the occurrence of natural infection by hemoparasites of TBD in 36 calves with high ticks natural infestation submitted to chemoprophylaxis with 30 days year-old. The blood smears from animals of different ages were analized and were found B. bigemina (33.3%), B. bovis (11.1%) and A. marginale (13.9%). Six animals had clinical symptoms (16.7%) and one dead (2.8%). The number of clinical cases ocurred in consequence of an association of factors as high infestation of ticks and low passive immunity in period that calves had not developed enough active immunity.

  11. Changes in the in-hospital mortality and 30-day post-discharge mortality in acutely admitted older patients: retrospective observational study

    NARCIS (Netherlands)

    van Rijn, Marjon; Buurman, Bianca M.; MacNeil-Vroomen, Janet L.; Suijker, Jacqueline J.; ter Riet, Gerben; van Charante, Eric P. Moll; de Rooij, Sophia E.

    2016-01-01

    to compare changes over time in the in-hospital mortality and the mortality from discharge to 30 days post-discharge for six highly prevalent discharge diagnoses in acutely admitted older patients as well as to assess the effect of separately analysing the in-hospital mortality and the mortality

  12. Hospital Admissions, Costs, and 30-Day Readmissions Among Newly Diagnosed Nonvalvular Atrial Fibrillation Patients Treated with Dabigatran Etexilate or Warfarin.

    Science.gov (United States)

    Fonseca, Eileen; Sander, Stephen D; Hess, Gregory P; Ghosh, Sabyasachi

    2015-11-01

    Oral anticoagulation such as warfarin and dabigatran is indicated for atrial fibrillation (AF) patients at risk of ischemic stroke. Dabigatran etexilate was developed to address the limitations of warfarin, including the need for regular blood monitoring, which has the potential to lead to higher health care resource use, particularly in hospitalized patients. To evaluate whether hospitalization cost, length of hospital stay (LOS), likelihood of readmission within 30 days, and cost of readmissions differed across inpatient encounters among nonvalvular atrial fibrillation (NVAF) patients that were newly diagnosed and newly treated with either dabigatran or warfarin. A retrospective cohort study was conducted using IMS Health's Charge Detail Master (CDM) database. Hospitalizations were identified based on a primary or secondary AF diagnosis, dabigatran or warfarin use, and a discharge date from January 2011 through March 2012. The identified patients without valvular procedures and transient AF were required to have a minimum of 12 months of pharmacy and private practitioner records prior to the inpatient encounter to ensure that they were newly treated on dabigatran or warfarin. Propensity score matching was used to balance baseline characteristics between treatment cohorts. Outcomes assessed were LOS, 30-day readmissions, and costs. Because individual patients could have more than 1 hospital observation, generalized estimating equations (GEE) with a gamma distribution (log link) were used for the analysis of continuous outcome measures (e.g., LOS and costs) and a binominal distribution for dichotomous outcomes (hospital readmissions). Two cohorts were propensity score matched (1:2) on demographic and clinical characteristics. The dabigatran cohort included 646 hospitalizations, and the warfarin cohort included 1,292 hospitalizations. Hospitalizations were on average 13% shorter (4.8 vs. 5.5 days, P  less than  0.001) and cost 12% less ($14,794 vs. $16,826, P

  13. Zonal Wave Number 2 Rossby Wave (3.5-day oscillation) Over The Martian Lower Atmosphere

    Science.gov (United States)

    Ghosh, P.; Thokuluwa, R. K.

    2013-12-01

    Over the Mars, height (800-50 Pascal pressure coordinate) profiles of temperature (K), measured by radio occultation technique during the MGS (Mars Global Surveyor) mission, obtained for the period of 1-10 January 2006 at the Martian latitude of ~63N in almost all the longitudes are analyzed to study the characteristics of the 3.5-day oscillation. To avoid significant data gaps in a particular longitude sector, we selected a set of 7 Mars longitude regions with ranges of 0-30E, 35-60E, 65-95E, 190-230E, 250-280E, 290-320E, and 325-360E to study the global characteristics of the 3.5-day oscillation. The 3.5-day oscillation is not selected as a-priori but observed as a most significant oscillation during this period of 1-10 January 2006. It is observed that in the longitude of 0-30E, the 3.5-day oscillation shows statistically significant power (above the 95% confidence level white noise) from the lowest height (800 Pascal, 8 hPa) itself and up to the height of 450 Pascal level with the maximum power of ~130 K^2 at the 600 & 650 Pascal levels. It started to grow from the power of ~ 50 K^2 at the lowest height of 800 Pascal level and reached the maximum power in the height of 600-650 Pascal level and then it started to get lessened monotonously up to the height of 450 Pascal level where its power is ~ 20 K^2. Beyond this height and up to the height of 50 Pascal level, the wave amplitude is below the white noise level. As the phase of the wave is almost constant at all the height levels, it seems that the observed 3.5-day oscillation is a stationary wave with respect to the height. In the 35-60 E longitude sector, the vertical structure of the 3.5-day oscillation is similar to what observed for the 0-30 E longitude region but the power is statistically insignificant at all the heights. However in the 65-95E longitude sector, the wave grows from the lowest level (70 K^2) of 800 Pascal to its maximum power of 280 K^2 in the height of 700 Pascal level and then it started

  14. World Town Planning Day and GIS Day to be celebrated

    OpenAIRE

    Trulove, Susan

    2003-01-01

    On Wednesday, Nov. 19, Montgomery County will unveil the county's new comprehensive plan during a joint celebration of the fifth anniversary of Geographic Information Systems Day and the 30th anniversary of World Town Planning Day. The event will feature programs by the Virginia Tech Center for Geospatial Information Technology (CGIT) and Virginia's Geospatial Extension Program (GEP).

  15. Heat treatment and thickness-dependent electrical study of Se{sub 50}Te{sub 20}S{sub 30} thin film

    Energy Technology Data Exchange (ETDEWEB)

    Abd-Elrahman, M.I.; Hafiz, M.M.; Qasem, Ammar; Abdel-Rahim, M.A. [Assiut University, Physics Department, Faculty of Science, Assiut (Egypt)

    2016-08-15

    Chalcogenide Se{sub 50}Te{sub 20}S{sub 30} thin film of different thickness was deposited using thermal evaporation technique. The thermogram of the chalcogenide bulk Se{sub 50}Te{sub 20}S{sub 30} was obtained using a differential scanning calorimetry (DSC) with heating rate of 7.5 K/min. The glass transition temperature T{sub g}, crystallization temperature T{sub c} and peak crystallization temperature T{sub p} were identified. The X-ray diffraction (XRD) examination indicates the amorphous nature of the as-deposited film and polycrystalline structure of the thermal annealed ones. The dark electrical resistivity (ρ) measurements were taken in temperature range (300-500 K) and thickness range (200-450 nm). Analysis of the electrical resistivity results revealed two types of conduction mechanisms: conduction due to extended states in the temperature range (T > T{sub c}) and variable range hopping in the temperature range (T < T{sub c}). The effect of the heat treatment and thickness on the density of localized states at the Fermi level N(E{sub F}) and hopping parameters were studied. (orig.)

  16. Bacillus Coagulans GBI-30 (BC30 improves indices of Clostridium difficile-Induced colitis in mice

    Directory of Open Access Journals (Sweden)

    Fitzpatrick Leo R

    2011-10-01

    Full Text Available Abstract Background Probiotics have beneficial effects in rodent models of Clostridium difficile (C. diffiicle-induced colitis. The spore forming probiotic strain Bacillus Coagulans GBI-30, 6086 (BC30 has demonstrated anti-inflammatory and immune-modulating effects in vitro. Our goal was to determine if BC30 improved C. difficile-induced colitis in mice. Starting on study day 0, female C57BL/6 mice were dosed by oro-gastric gavage for 15 days with vehicle (saline or BC30 (2 × 109 CFU per day. Mice in the C. difficile groups received an antibiotic mixture (study days 5 to 8 in the drinking water, and clindamycin (10 mg/kg, i.p., on study day 10. The C. difficile strain VPI 10463 was given by gavage at 104 CFU to induce colitis on day 11. On day 16, stools and colons were collected for further analyses. Results All mice treated with BC30 survived on study day 13, while two mice treated with vehicle did not survive. On day 12, a significant difference (p = 0.0002 in the percentage of mice with normal stools (66.7% was found in the BC30/C. difficile group, as compared to the vehicle/C. diffcile group (13.0%. On study day 16, 23.8% of mice treated with BC30 had normal stools, while this value was 0% with vehicle treatment (p value = 0.0187. On this day, the stool consistency score for the BC30/C. difficile group (1.1 ± 0.2 was significantly lower (p C. difficile cohort (1.9 ± 0.2. BC30 modestly attenuated the colonic pathology (crypt damage, edema, leukocyte influx that was present following C. difficile infection. Colonic MIP-2 chemokine contents (pg/2 cm colon were: 10.2 ± 0.5 (vehicle/no C. difficile, 24.6 ± 9.5 (vehicle/C. difficile and 16.3 ± 4.3 (BC30/C. difficle. Conclusion The probiotic BC30 improved some parameters of C. difficile-induced colitis in mice. BC30 prolonged the survival of C. diffiicle infected mice. Particularly, this probiotic improved the stool consistency of mice, in this infectious colitis model.

  17. Bacillus Coagulans GBI-30 (BC30) improves indices of Clostridium difficile-Induced colitis in mice

    Science.gov (United States)

    2011-01-01

    Background Probiotics have beneficial effects in rodent models of Clostridium difficile (C. diffiicle)-induced colitis. The spore forming probiotic strain Bacillus Coagulans GBI-30, 6086 (BC30) has demonstrated anti-inflammatory and immune-modulating effects in vitro. Our goal was to determine if BC30 improved C. difficile-induced colitis in mice. Starting on study day 0, female C57BL/6 mice were dosed by oro-gastric gavage for 15 days with vehicle (saline) or BC30 (2 × 109 CFU per day). Mice in the C. difficile groups received an antibiotic mixture (study days 5 to 8 in the drinking water), and clindamycin (10 mg/kg, i.p., on study day 10). The C. difficile strain VPI 10463 was given by gavage at 104 CFU to induce colitis on day 11. On day 16, stools and colons were collected for further analyses. Results All mice treated with BC30 survived on study day 13, while two mice treated with vehicle did not survive. On day 12, a significant difference (p = 0.0002) in the percentage of mice with normal stools (66.7%) was found in the BC30/C. difficile group, as compared to the vehicle/C. diffcile group (13.0%). On study day 16, 23.8% of mice treated with BC30 had normal stools, while this value was 0% with vehicle treatment (p value = 0.0187). On this day, the stool consistency score for the BC30/C. difficile group (1.1 ± 0.2) was significantly lower (p < 0.05) than for the vehicle/C. difficile cohort (1.9 ± 0.2). BC30 modestly attenuated the colonic pathology (crypt damage, edema, leukocyte influx) that was present following C. difficile infection. Colonic MIP-2 chemokine contents (pg/2 cm colon) were: 10.2 ± 0.5 (vehicle/no C. difficile), 24.6 ± 9.5 (vehicle/C. difficile) and 16.3 ± 4.3 (BC30/C. difficle). Conclusion The probiotic BC30 improved some parameters of C. difficile-induced colitis in mice. BC30 prolonged the survival of C. diffiicle infected mice. Particularly, this probiotic improved the stool consistency of mice, in this infectious colitis model. PMID

  18. Intraseasonal variability of organized convective systems in the Central Andes: Relationship to Regional Dynamical Features

    Science.gov (United States)

    Mohr, K. I.; Slayback, D. A.; Nicholls, S.; Yager, K.

    2013-12-01

    The Andes extend from the west coast of Colombia (10N) to the southern tip of Chile (53S). In southern Peru and Bolivia, the Central Andes is split into separate eastern and western cordilleras, with a high plateau (≥ 3000 m), the Altiplano, between them. Because 90% of the Earth's tropical mountain glaciers are located in the Central Andes, our study focuses on this region, defining its zonal extent as 7S-21S and the meridional extent as the terrain 1000 m and greater. Although intense convection occurs during the wet season in the Altiplano, it is not included in the lists of regions with frequent or the most intense convection. The scarcity of in-situ observations with sufficient density and temporal resolution to resolve individual storms or even mesoscale-organized cloud systems and documented biases in microwave-based rainfall products in poorly gauged mountainous regions have impeded the development of an extensive literature on convection and convective systems in this region. With the tropical glaciers receding at unprecedented rates, leaving seasonal precipitation as an increasingly important input to the water balance in alpine valley ecosystems and streams, understanding the nature and characteristics of the seasonal precipitation becomes increasingly important for the rural economies in this region. Previous work in analyzing precipitation in the Central Andes has emphasized interannual variability with respect to ENSO, this is the first study to focus on shorter scale variability with respect to organized convection. The present study took advantage of the University of Utah's Precipitation Features database compiled from 14 years of TRMM observations (1998-2012), supplemented by field observations of rainfall and streamflow, historical gauge data, and long-term WRF-simulations, to analyze the intraseasonal variability of precipitating systems and their relationship regional dynamical features such as the Bolivian High. Through time series and

  19. Validation and Analysis of Microwave-Derived Rainfall Over the Tropics

    Science.gov (United States)

    1993-01-01

    Intraseasonal Oscillations In addition to the biennial signals identified by Meehl (1987), Lau and col- laborators (Peng 1987; Shen 1987) expound on...temporally integrated, over a 50 x 50 area for a minimum of one month, to create clima - tological rainfall composites. Validation of the ESMR-derived

  20. The impact of socioeconomic factors on 30-day mortality following elective colorectal cancer surgery: A nationwide study

    DEFF Research Database (Denmark)

    Frederiksen, B L; Osler, M; Harling, H

    2009-01-01

    We investigated postoperative mortality in relation to socioeconomic status (SES) in electively operated colorectal cancer patients, and evaluated whether social inequalities were explained by factors related to patient, disease or treatment. Data from the nationwide database of Danish Colorectal...... Cancer Group were linked to individual socioeconomic information in Statistics Denmark. Patients born before 1921 and those having local surgical or palliative procedures were excluded. A total of 7160 patients, operated on in the period 2001-2004, were included, of whom 342 (4.8%) died within 30 days...

  1. Assessing the Risk of Occult Cancer and 30-day Morbidity in Women Undergoing Risk-reducing Surgery: A Prospective Experience.

    Science.gov (United States)

    Bogani, Giorgio; Tagliabue, Elena; Signorelli, Mauro; Chiappa, Valentina; Carcangiu, Maria Luisa; Paolini, Biagio; Casarin, Jvan; Scaffa, Cono; Gennaro, Massimiliano; Martinelli, Fabio; Borghi, Chiara; Ditto, Antonino; Lorusso, Domenica; Raspagliesi, Francesco

    To investigate the incidence and predictive factors of 30-day surgery-related morbidity and occult precancerous and cancerous conditions for women undergoing risk-reducing surgery. A prospective study (Canadian Task Force classification II-1). A gynecologic oncology referral center. Breast-related cancer antigen (BRCA) mutation carriers and BRCAX patients (those with a significant family history of breast and ovarian cancer). Minimally invasive risk-reduction surgery. Overall, 85 women underwent risk-reducing surgery: 30 (35%) and 55 (65%) had hysterectomy plus bilateral salpingo-oophorectomy (BSO) and BSO alone, respectively. Overall, in 6 (7%) patients, the final pathology revealed unexpected cancer: 3 early-stage ovarian/fallopian tube cancers, 2 advanced-stage ovarian cancers (stage IIIA and IIIB), and 1 serous endometrial carcinoma. Additionally, 3 (3.6%) patients had incidental finding of serous tubal intraepithelial carcinoma. Four (4.7%) postoperative complications within 30 days from surgery were registered, including fever (n = 3) and postoperative ileus (n = 1); no severe (grade 3 or more) complications were observed. All complications were managed conservatively. The presence of occult cancer was the only factor predicting the development of postoperative complications (p = .02). Minimally invasive risk-reducing surgery is a safe and effective strategy to manage BRCA mutation carriers. Patients should benefit from an appropriate counseling about the high prevalence of undiagnosed cancers observed at the time of surgery. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.

  2. Acetylsalicylic Acid Daily vs Acetylsalicylic Acid Every 3 Days in Healthy Volunteers: Effect on Platelet Aggregation, Gastric Mucosa, and Prostaglandin E2 Synthesis.

    Science.gov (United States)

    Ferreira, Plinio Minghin Freitas; Gagliano-Jucá, Thiago; Zaminelli, Tiago; Sampaio, Marinalva Ferreira; Blackler, Rory Willian; Trevisan, Miriam da Silva; Novaes Magalhães, Antônio Frederico; De Nucci, Gilberto

    2016-07-01

    Substantial platelet inhibition was observed 3 days after a single administration of acetylsalicylic acid 81 mg to healthy volunteers. Here we investigate prostaglandin E2 (PGE2 ) antrum concentrations and gastrointestinal symptoms in two treatment groups: one receiving losartan and acetylsalicylic acid every day and the other receiving losartan every day and acetylsalicylic acid every 3 days. Twenty-eight healthy volunteers from both sexes received either 50 mg losartan and acetylsalicylic acid 81 mg daily or 50 mg losartan and acetylsalicylic acid 81 every 3 days with placebo on the other days. Therapy was delivered for 30 days for both groups. Gastric endoscopy was performed before and after treatment period. Biopsies were collected for PGE2 quantification. Platelet function tests were carried out before and during treatment and TXB2 release on platelet rich plasma was measured. The every 3 day low-dose acetylsalicylic acid regimen produced complete inhibition of platelet aggregation compared to the daily treatment. Thromboxane B2 release was substantially abolished for both groups during treatment. There was no significant difference on the endoscopic score of both treatment groups after the 30-day treatment (P = .215). There was over 50% suppression of antrum PGE2 content on volunteers receiving acetylsalicylic acid daily (P = .0016), while for the every 3 day dose regimen there was no significant difference between pre and post-treatment antrum PGE2 dosages (P = .4193). Since PGE2 is involved in gastric healing, we understand that this new approach could be safer and as efficient as the standard daily therapy on a long-term basis. © 2015, The American College of Clinical Pharmacology.

  3. The HOSPITAL score and LACE index as predictors of 30 day readmission in a retrospective study at a university-affiliated community hospital

    Directory of Open Access Journals (Sweden)

    Robert Robinson

    2017-03-01

    Full Text Available Introduction Hospital readmissions are common, expensive, and a key target of the Medicare Value Based Purchasing (VBP program. Validated risk assessment tools such as the HOSPITAL score and LACE index have been developed to identify patients at high risk of hospital readmission so they can be targeted for interventions aimed at reducing the rate of readmission. This study aims to evaluate the utility of HOSPITAL score and LACE index for predicting hospital readmission within 30 days in a moderate-sized university affiliated hospital in the midwestern United States. Materials and Methods All adult medical patients who underwent one or more ICD-10 defined procedures discharged from the SIU-SOM Hospitalist service from Memorial Medical Center (MMC from October 15, 2015 to March 16, 2016, were studied retrospectively to determine if the HOSPITAL score and LACE index were a significant predictors of hospital readmission within 30 days. Results During the study period, 463 discharges were recorded for the hospitalist service. The analysis includes data for the 432 discharges. Patients who died during the hospital stay, were transferred to another hospital, or left against medical advice were excluded. Of these patients, 35 (8% were readmitted to the same hospital within 30 days. A receiver operating characteristic evaluation of the HOSPITAL score for this patient population shows a C statistic of 0.75 (95% CI [0.67–0.83], indicating good discrimination for hospital readmission. The Brier score for the HOSPITAL score in this setting was 0.069, indicating good overall performance. The Hosmer–Lemeshow goodness of fit test shows a χ2 value of 3.71 with a p value of 0.59. A receiver operating characteristic evaluation of the LACE index for this patient population shows a C statistic of 0.58 (95% CI [0.48–0.68], indicating poor discrimination for hospital readmission. The Brier score for the LACE index in this setting was 0.082, indicating good

  4. Age-Specific Associations Between Violence Exposure and Past 30-Day Marijuana and Alcohol Use.

    Science.gov (United States)

    Goldstick, Jason E; Heinze, Justin E; Stoddard, Sarah A; Cunningham, Rebecca M; Zimmerman, Marc A

    2018-04-23

    Using data from a cohort study of students at risk for high school dropout, we examined associations between violence exposure and past 30-day alcohol and marijuana use. We used varying-coefficient regression with person-level fixed effects to estimate how those associations changed within-person across ages approximately 14-23. Generally, violence perpetration was most strongly associated with substance use, within-person. Substance use became increasingly associated with both observed violence and violence perpetration during early/middle adolescence; this increase continued longer into development (age 18+) for alcohol use. Across most of the age range studied here, violence victimization was minimally associated with within-person changes in substance use. Results indicate age-specific associations between violence exposure and alcohol and other drug use, which may be useful for informing prevention strategies. © 2018 Society for Research on Adolescence.

  5. Registration Day-Camp 2016

    CERN Multimedia

    Nursery School

    2016-01-01

    Registration for the CERN SA Day-camp are open for children from 4 to 6 years old From March 14 to 25 for children already enrolled in CERN SA EVE and School From April 4 to 15 for the children of CERN members of the personnel (MP) From April 18 for other children More information on the website: http://nurseryschool.web.cern.ch/. The day-camp is open to all children. An inscription per week is proposed, cost 480.-CHF/week, lunch included The camp will be open weeks 27, 28, 29 and 30, from 8:30 am to 5:30 pm. For further questions, thanks you for contacting us by email at Summer.Camp@cern.ch.

  6. Barotropic Interactions Between Summertime Tropical Cyclones/Sub-Monthly Wave Patterns and Intraseasonal Oscillations over the Western North Pacific

    Directory of Open Access Journals (Sweden)

    Ken-Chung Ko Huang-Hsiung Hsu

    2014-01-01

    Full Text Available This study used the barotropic kinetic energy conversion to record the active eddy-mean flow interaction between the TC/sub-monthly wave pattern (TSM and the intraseasonal oscillation (ISO in the western North Pacific (WNP. Overall, the TSM extracted (lost kinetic energy from (to the cyclonic (anticyclonic circulation of the ISO, which is located in the South China Sea and the Philippine Sea, during the ISO westerly (easterly phase. The phase change in barotropic energy conversion was due to the opposite background flow set up by the ISO. When the climatological-mean southwesterly was retained as part of the background flow in both ISO westerly and easterly phases as in previous studies, the ISO along with the low-frequency background flow always provided kinetic energy to the TSM regardless of the phase. The stronger (weaker southwesterly in the ISO westerly (easterly phase, the stronger (weaker energy conversion to the TSM. Climatological mean flow exclusion showed an upscale feedback in the TSM to the ISO during the easterly phase. However, this feedback was weaker than the downscale conversion from the ISO to the TSM during the westerly phase.

  7. Contribution of temporal data to predictive performance in 30-day readmission of morbidly obese patients

    Directory of Open Access Journals (Sweden)

    Petra Povalej Brzan

    2017-04-01

    Full Text Available Background Reduction of readmissions after discharge represents an important challenge for many hospitals and has attracted the interest of many researchers in the past few years. Most of the studies in this field focus on building cross-sectional predictive models that aim to predict the occurrence of readmission within 30-days based on information from the current hospitalization. The aim of this study is demonstration of predictive performance gain obtained by inclusion of information from historical hospitalization records among morbidly obese patients. Methods The California Statewide inpatient database was used to build regularized logistic regression models for prediction of readmission in morbidly obese patients (n = 18,881. Temporal features were extracted from historical patient hospitalization records in a one-year timeframe. Five different datasets of patients were prepared based on the number of available hospitalizations per patient. Sample size of the five datasets ranged from 4,787 patients with more than five hospitalizations to 20,521 patients with at least two hospitalization records in one year. A 10-fold cross validation was repeted 100 times to assess the variability of the results. Additionally, random forest and extreme gradient boosting were used to confirm the results. Results Area under the ROC curve increased significantly when including information from up to three historical records on all datasets. The inclusion of more than three historical records was not efficient. Similar results can be observed for Brier score and PPV value. The number of selected predictors corresponded to the complexity of the dataset ranging from an average of 29.50 selected features on the smallest dataset to 184.96 on the largest dataset based on 100 repetitions of 10-fold cross-validation. Discussion The results show positive influence of adding information from historical hospitalization records on predictive performance using all

  8. An examination of the first 30 days after patients are discharged to the community from hip fracture post-acute care

    Science.gov (United States)

    Leland, Natalie; Gozalo, Pedro; Christian, TJ; Bynum, Julie; Mor, Vince; Wetle, Terrie Fox; Teno, Joan

    2015-01-01

    Background Post-acute care (PAC) rehabilitation aims to maximize independence and facilitate a safe community transition. Yet little is known about PAC patients’ success in staying home post-discharge or differences on this outcome across PAC providers. Objectives Examine the percentage of PAC patients who remain in the community at least 30 days after discharge (i.e., successful community discharge) following hip fracture rehabilitation and describe differences among PAC facilities based on this outcome. Research Design Retrospective observational study. Subjects Community-dwelling, Medicare fee-for-service beneficiaries 75 years of age and older who experienced their first hip fracture between 1999–2007 (n=880,779). PAC facilities admitting hip fracture patients in 2006. Measures Successful community discharge, sites of readmission after PAC discharge. Results Between 1999 and 2007, 57% of patients achieved successful community discharge. Black were less likely (adjusted odds ratios=0.84, 95% confidence interval 0.82–0.86) than similar whites to achieve successful community discharge. Among all who re-entered the community (n=581,095), 14% remained in the community fewer than 30 days. Acute hospitals (67.5%) and institutional PAC (16.8%) were the most common sites of re-entry. The median proportion of successful community discharge among facilities was 49% (IQR: 33%–66%). Lowest-quartile facilities admitted older (85.9 vs. 84.1 years of age), sicker patients (e.g., higher rates of hospital complications 6.0% vs. 4.6%), but admitted fewer annually (7.1 vs. 19.3), compared to the highest quartile. Conclusions Re-entry into the healthcare system after PAC community discharge is common. Due to the distinct care needs of the PAC population there is a need for a quality measure that complements the current 30-day hospital readmission outcome and captures the objectives of PAC rehabilitation. PMID:26340664

  9. 75 FR 75872 - Airworthiness Directives; McDonnell Douglas Corporation Model DC-9-30, DC-9-40, and DC-9-50...

    Science.gov (United States)

    2010-12-07

    ... Airworthiness Directives; McDonnell Douglas Corporation Model DC- 9-30, DC-9-40, and DC-9-50 Series Airplanes...: We are adopting a new airworthiness directive (AD) for the McDonnell Douglas Corporation airplanes... to include an airworthiness directive (AD) that would apply to certain McDonnell Douglas Model DC-9...

  10. Investigating the widely held belief that men and women with learning disabilities receive poor quality healthcare when admitted to hospital: a single-site study of 30-day readmission rates.

    Science.gov (United States)

    Kelly, C L; Thomson, K; Wagner, A P; Waters, J P; Thompson, A; Jones, S; Holland, A J; Redley, M

    2015-09-01

    This study aims to use 30-day readmission rates to investigate the presumption that men and women with learning disabilities (LDs, known internationally as intellectual disabilities) receive poorer quality hospital care than their non-disabled peers. A 12-month retrospective audit was conducted using Hospital Episode Statistics (HES) at a single acute hospital in the East of England. This identified all in-patient admissions; admissions where the person concerned was recognised as having a LD; and all emergency readmissions within 30 days of discharge. Additionally, the healthcare records of all patients identified as having a LD and readmitted within 30 days as a medical emergency were examined in order to determine whether or not these readmissions were potentially preventable. Over the study period, a total of 66 870 adults were admitted as in-patients, among whom 7408 were readmitted as medical emergencies within 30 days of discharge: a readmission rate of 11%. Of these 66 870 patients, 256 were identified as having a LD, with 32 of them experiencing at least one emergency readmission within 30 days: a readmission rate of 13%. When examined, the healthcare records pertaining to these 32 patients who had a total of 39 unique 30-day readmissions revealed that 69% (n = 26) of these readmissions were potentially preventable. Although overall readmission rates were similar for patients with LDs and those from the general population, patients with LDs had a much higher rate of potentially preventable readmissions when compared to a general population estimate from van Walraven et al. This suggests that there is still work to be done to ensure that this patient population receives hospital care that is both safe and of high quality. © 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  11. Why Do SGLT2 Inhibitors Inhibit Only 3050% of Renal Glucose Reabsorption in Humans?

    Science.gov (United States)

    Liu, Jiwen (Jim); Lee, TaeWeon; DeFronzo, Ralph A.

    2012-01-01

    Sodium glucose cotransporter 2 (SGLT2) inhibition is a novel and promising treatment for diabetes under late-stage clinical development. It generally is accepted that SGLT2 mediates 90% of renal glucose reabsorption. However, SGLT2 inhibitors in clinical development inhibit only 3050% of the filtered glucose load. Why are they unable to inhibit 90% of glucose reabsorption in humans? We will try to provide an explanation to this puzzle in this perspective analysis of the unique pharmacokinetic and pharmacodynamic profiles of SGLT2 inhibitors in clinical trials and examine possible mechanisms and molecular properties that may be responsible. PMID:22923645

  12. Moderate nutrient restriction influences expression of genes impacting production efficiencies of beef cattle in fetal liver, muscle and cerebrum by day 50 of gestation

    Science.gov (United States)

    We hypothesized that a moderate maternal nutrient restriction during the first 50 days of gestation in beef heifers would affect expression of genes impacting production efficiency phenotypes in the fetal liver, muscle and cerebrum. Fourteen Angus-cross heifers were estrus synchronized and assigned ...

  13. Elevated plasma level of pentraxin-3 predicts in-hospital and 30-day clinical outcomes in patients with non-ST-segment elevation myocardial infarction who have undergone percutaneous coronary intervention.

    Science.gov (United States)

    Guo, Rong; Li, Yuanmin; Wen, Jing; Li, Weiming; Xu, Yawei

    2014-01-01

    This investigation explored the short-term prognostic value of pentraxin-3 (PTX3) levels in patients with non-ST-segment elevation myocardial infarction (NSTEMI) treated by percutaneous coronary intervention (PCI). We measured plasma levels of PTX3 and other biomarkers in 525 PCI-treated NSTEMI patients (mean age, 57.7 years; 328 males). The associations of PTX3 levels with cardiac events and cardiac deaths occurring within 30 days of discharge were evaluated with multivariable Cox proportional hazard models. Renal function, diabetes prevalence, systolic blood pressure, heart rate and ejection fraction differed significantly in the high PTX3 (≥3.0 ng/ml, n = 107) and low PTX3 (<3.0 ng/ml, n = 418) groups (all p < 0.05). Plasma PTX3 levels were correlated with high-sensitivity C-reactive protein, troponin T and N-terminal pro-B-type natriuretic peptide in NSTEMI patients (all p < 0.05). Kaplan-Meier analysis showed in-hospital and 30-day cardiac events and deaths were higher in the high PTX3 group (both p < 0.01). Elevated PTX3 was an independent predictor of 30-day cardiac events (95% CI 1.09-1.68; p = 0.006) and mortality (95% CI 1.18-2.15; p = 0.002). An elevated plasma level of PTX3 predicts 30-day cardiac events and mortality in PCI-treated NSTEMI patients. © 2014 S. Karger AG, Basel.

  14. In-hospital mortality, 30-day readmission, and length of hospital stay after surgery for primary colorectal cancer: A national population-based study.

    Science.gov (United States)

    Pucciarelli, S; Zorzi, M; Gennaro, N; Gagliardi, G; Restivo, A; Saugo, M; Barina, A; Rugge, M; Zuin, M; Maretto, I; Nitti, D

    2017-07-01

    The simultaneous assessment of multiple indicators for quality of care is essential for comparisons of performance between hospitals and health care systems. The aim of this study was to assess the rates of in-hospital mortality and 30-day readmission and length of hospital stay (LOS) in patients who underwent surgical procedures for colorectal cancer between 2005 and 2014 in Italy. All patients in the National Italian Hospital Discharge Dataset who underwent a surgical procedure for colorectal cancer during the study period were included. The adjusted odd ratios for risk factors for in-hospital mortality, 30-day readmission, and LOS were calculated using multilevel multivariable logistic regression. Among the 353 941 patients, rates of in-hospital mortality and 30-day readmission were 2.5% and 6%, respectively, and the median LOS was 13 days. High comorbidity, emergent/urgent admission, male gender, creation of a stoma, and an open approach increased the risks of all the outcomes at multivariable analysis. Age, hospital volume, hospital geographic location, and discharge to home/non-home produced different effects depending on the outcome considered. The most frequent causes of readmission were infection (19%) and bowel obstruction (14.6%). We assessed national averages for mortality, LOS and readmission and related trends over a 10-year time. Laparoscopic surgery was the only one that could be modified by improving surgical education. Higher hospital volume was associated with a LOS reduction, but our findings only partially support a policy of centralization for colorectal cancer procedures. Surgical site infection was identified as the most preventable cause of readmission. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  15. 30-day readmission, antibiotics costs and costs of delay to adequate treatment of Enterobacteriaceae UTI, pneumonia, and sepsis: a retrospective cohort study.

    Science.gov (United States)

    Zilberberg, Marya D; Nathanson, Brian H; Sulham, Kate; Fan, Weihong; Shorr, Andrew F

    2017-01-01

    Enterobacteriaceae are common pathogens in pneumonia, sepsis and urinary tract infection (UTI). Though rare, carbapenem resistance (CRE) among these organisms complicates efforts to ensure adequate empiric antimicrobial therapy. In turn this negatively impacts such outcomes as mortality and hospital costs. We explored proportion of total costs represented by antibiotics, 30-day readmission rates, and per-day costs of inadequate antimicrobial coverage among patients with Enterobacteriaceae pneumonia, sepsis and/or UTI in the context of inappropriate (IET) vs. appropriate empiric (non-IET) therapy and carbapenem resistance (CRE) vs. susceptibility (CSE). We conducted a retrospective cohort study in the Premier Research database (2009-2013) of 175 US hospitals. We included all adult patients admitted with a culture-confirmed UTI, pneumonia, or sepsis as principal diagnosis, or as a secondary diagnosis in the setting of respiratory failure. Patients with hospital acquired infections or transfers from other acute facilities were excluded. IET was defined as failure to administer an antibiotic therapy in vitro active against the culture-confirmed pathogen within 2 days of admission. Among 40,137 patients with Enterobacteriaceae infections (54.2% UTI), 4984 (13.2%) received IET. CRE (3.1%) was more frequent in patients given IET (13.0%) than non-IET (1.6%, p  $750 to hospital costs. Both CRE and IET were associated with an increased risk of readmission within 30 days.

  16. The Clinical Epidemiology and 30-Day Outcomes of Emergency Department Patients With Acute Kidney Injury

    Directory of Open Access Journals (Sweden)

    Frank Xavier Scheuermeyer

    2017-04-01

    Full Text Available Background: Acute kidney injury (AKI is associated with increased mortality and dialysis in hospitalized patients but has been little explored in the emergency department (ED setting. Objective: The objective of this study was to describe the risk factors, prevalence, management, and outcomes in the ED population, and to identify the proportion of AKI patients who were discharged home with no renal-specific follow-up. Design: This is a retrospective cohort study using administrative and laboratory databases. Setting: Two urban EDs in Vancouver, British Columbia, Canada. Patients: We included all unique ED patients over a 1-week period. Methods: All patients had their described demographics, comorbidities, medications, laboratory values, and ED treatments collected. AKI was defined pragmatically, based upon accepted guidelines. The cohort was then probabilistically linked to the provincial renal database to ascertain renal replacement (transplant or dialysis and the provincial vital statistics database to obtain mortality. The primary outcome was the prevalence of AKI; secondary outcomes included (1 the proportion of AKI patients who were discharged home with no renal-specific follow-up and (2 the combined 30-day rate of death or renal replacement among AKI patients. Results: There were 1651 ED unique patients, and 840 had at least one serum creatinine (SCr obtained. Overall, 90 patients had AKI (10.7% of ED patients with at least one SCr, 95% confidence interval [CI], 8.7%-13.1%; 5.5% of all ED patients, 95% CI, 4.4%-6.7% with a median age of 74 and 70% male. Of the 31 (34.4% AKI patients discharged home, 4 (12.9% had renal-specific follow-up arranged in the ED. Among the 90 AKI patients, 11 died and none required renal replacement at 30 days, for a combined outcome of 12.2% (95% CI, 6.5%-21.2%. Limitations: Sample sizes may be small. Nearly half of ED patients did not obtain an SCr. Many patients did not have sequential SCr testing, and a

  17. CERN's 50th anniversary open day attracts record number of visitors: an estimated 32,000 visitors, from across Europe and beyond, flocked to the laboratory for a day of tours, displays and presentations.

    CERN Multimedia

    Patrice Loiez

    2004-01-01

    When CERN opened its doors to the public for its open day on 16 October, the laboratory took on the air of a county fair. Children took rides around the site in a big lorry, visitors ate ice cream that had been handmade in a flash using liquid nitrogen, and crowds strolled the lanes as they visited more than 50 events across various sites in Switzerland and France.

  18. Pavel Haas Study Day a IMR Study Day: Inter-War Avant-Garde across National and Disciplinary Borders, 30. a 31. ledna 2016, Cardiff University School of Music, Cardiff, Velká Británie

    Czech Academy of Sciences Publication Activity Database

    Kratochvílová, Markéta; Zapletal, Miloš

    2016-01-01

    Roč. 53, č. 1 (2016), s. 101-102 ISSN 0018-7003. [Pavel Haas Study Day. Cardiff, 30.01.2016] R&D Projects: GA ČR(CZ) GP14-35842P Institutional support: RVO:68378076 Keywords : Pavel Haas * conference * music * inter-war * avantgarde Subject RIV: AL - Art, Architecture, Cultural Heritage

  19. Thirty-day readmission after spontaneous intracerebral hemorrhage.

    Science.gov (United States)

    Bjerkreim, Anna Therese; Khanevski, Andrej Netland; Glad, Solveig Bergliot; Thomassen, Lars; Naess, Halvor; Logallo, Nicola

    2018-03-01

    Intracerebral hemorrhage (ICH) is the most severe form of stroke, but data on readmission after ICH are sparse. We aimed to determine frequency, causes, and predictors of 30-day readmission after ICH. This retrospective cohort study includes all spontaneous ICH survivors admitted to the stroke unit at Haukeland University Hospital in Bergen in Norway from July 2007 to December 2013. Patients were followed by review of electronic medical charts, and the first unplanned readmission within 30 days after discharge was used as final outcome. Cox regression analysis was performed to identify predictors of 30-day readmission. We identified 226 patients with spontaneous ICH, 70 (31.0%) of whom died before discharge or were discharged to palliative care. Of the remaining 156 ICH survivors, 28 (18.0%) were readmitted within 30 days. Median time to readmission was 12 days (IQR 4.5 - 18.5). Most patients were readmitted due to infections ( N  = 13). None of the patients were readmitted with recurrent stroke. Pneumonia and enteral feeding during the index hospitalization were associated with readmission for infections (both p  readmission (HR 1.06, 95% CI 1.02 - 1.11, p  =   .006). Almost one in five of our spontaneous ICH survivors was readmitted within 30 days, and most readmissions were caused by infections.

  20. An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: a systematic review.

    Science.gov (United States)

    Mileski, Michael; Topinka, Joseph Baar; Lee, Kimberly; Brooks, Matthew; McNeil, Christopher; Jackson, Jenna

    2017-01-01

    The main objective was to investigate the applicability and effectiveness of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility (SNF)-to-hospital readmissions. The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature and PubMed to collect data about quality improvement implemented in SNFs. The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. These strategy examples can be useful to acute care hospitals attempting to lower bounce back from subacute care providers and long-term care facilities seeking quality improvement initiatives to reduce hospital readmissions.

  1. QuickSOFA is an independent predictor of 30-day mortality among patients admitted to an emergency department with suspected or documented infection

    DEFF Research Database (Denmark)

    Bin Abdullah, Osama; Grand, Johannes; Sijapati, Astha

    .78; 95% CI 2.09-10.91) and lactate values (lactate values 4.0 (OR 3.97; 95% CI 1.44-2,92) were associated with 30-day mortality. Conclusion. qSOFA can be helpful to identify infectious patients in an ED...

  2. The cost of clinical mastitis in the first 30 days of lactation: An economic modeling tool.

    Science.gov (United States)

    Rollin, E; Dhuyvetter, K C; Overton, M W

    2015-12-01

    Clinical mastitis results in considerable economic losses for dairy producers and is most commonly diagnosed in early lactation. The objective of this research was to estimate the economic impact of clinical mastitis occurring during the first 30 days of lactation for a representative US dairy. A deterministic partial budget model was created to estimate direct and indirect costs per case of clinical mastitis occurring during the first 30 days of lactation. Model inputs were selected from the available literature, or when none were available, from herd data. The average case of clinical mastitis resulted in a total economic cost of $444, including $128 in direct costs and $316 in indirect costs. Direct costs included diagnostics ($10), therapeutics ($36), non-saleable milk ($25), veterinary service ($4), labor ($21), and death loss ($32). Indirect costs included future milk production loss ($125), premature culling and replacement loss ($182), and future reproductive loss ($9). Accurate decision making regarding mastitis control relies on understanding the economic impacts of clinical mastitis, especially the longer term indirect costs that represent 71% of the total cost per case of mastitis. Future milk production loss represents 28% of total cost, and future culling and replacement loss represents 41% of the total cost of a case of clinical mastitis. In contrast to older estimates, these values represent the current dairy economic climate, including milk price ($0.461/kg), feed price ($0.279/kg DM (dry matter)), and replacement costs ($2,094/head), along with the latest published estimates on the production and culling effects of clinical mastitis. This economic model is designed to be customized for specific dairy producers and their herd characteristics to better aid them in developing mastitis control strategies. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

  3. Identification of climate-resilient integrated nutrient management practices for rice-rice cropping system--an empirical approach to uphold food security.

    Science.gov (United States)

    Subash, N; Gangwar, B; Singh, Rajbir; Sikka, A K

    2015-01-01

    Yield datasets of long-term experiments on integrated nutrient management in rice-rice cropping systems were used to investigate the relationship of variability in rainfall, temperature, and integrated nutrient management (INM) practices in rice-rice cropping system in three different agroecological regions of India. Twelve treatments with different combinations of inorganic (chemical fertilizer) and organic (farmyard manure, green manure, and paddy straw) were compared with farmer's conventional practice. The intraseasonal variations in rice yields are largely driven by rainfall during kharif rice and by temperature during rabi rice. Half of the standard deviation from the average monthly as well as seasonal rainfall during kharif rice and 1 °C increase or decrease from the average maximum and minimum temperature during rabi rice has been taken as the classification of yield groups. The trends in the date of effective onset of monsoon indicate a 36-day delay during the 30-year period at Rajendranagar, which is statistically significant at 95 % confidence level. The mean annual maximum temperature shows an increasing trend in all the study sites. The length of monsoon also showed a shrinking trend in the rate of 40 days during the 30-year study period at Rajendranagar representing a semiarid region. At Bhubaneshwar, the application of 50 % recommended NPK through chemical fertilizers and 50 % N through green manure resulted in an overall average higher increase of 5.1 % in system productivity under both excess and deficit rainfall years and also during the years having seasonal mean maximum temperature ≥35 °C. However, at Jorhat, the application of 50 % recommended NPK through chemical fertilizers and 50 % N through straw resulted in an overall average higher increase of 7.4 % in system productivity, while at Rajendranagar, the application of 75 % NPK through chemical fertilizers and 25 % N through green manusre resulted in an overall average higher increase of

  4. Identification of climate-resilient integrated nutrient management practices for rice-rice cropping system—an empirical approach to uphold food security

    Science.gov (United States)

    Subash, N.; Gangwar, B.; Singh, Rajbir; Sikka, A. K.

    2015-01-01

    Yield datasets of long-term experiments on integrated nutrient management in rice-rice cropping systems were used to investigate the relationship of variability in rainfall, temperature, and integrated nutrient management (INM) practices in rice-rice cropping system in three different agroecological regions of India. Twelve treatments with different combinations of inorganic (chemical fertilizer) and organic (farmyard manure, green manure, and paddy straw) were compared with farmer's conventional practice. The intraseasonal variations in rice yields are largely driven by rainfall during kharif rice and by temperature during rabi rice. Half of the standard deviation from the average monthly as well as seasonal rainfall during kharif rice and 1 °C increase or decrease from the average maximum and minimum temperature during rabi rice has been taken as the classification of yield groups. The trends in the date of effective onset of monsoon indicate a 36-day delay during the 30-year period at Rajendranagar, which is statistically significant at 95 % confidence level. The mean annual maximum temperature shows an increasing trend in all the study sites. The length of monsoon also showed a shrinking trend in the rate of 40 days during the 30-year study period at Rajendranagar representing a semiarid region. At Bhubaneshwar, the application of 50 % recommended NPK through chemical fertilizers and 50 % N through green manure resulted in an overall average higher increase of 5.1 % in system productivity under both excess and deficit rainfall years and also during the years having seasonal mean maximum temperature ≥35 °C. However, at Jorhat, the application of 50 % recommended NPK through chemical fertilizers and 50 % N through straw resulted in an overall average higher increase of 7.4 % in system productivity, while at Rajendranagar, the application of 75 % NPK through chemical fertilizers and 25 % N through green manusre resulted in an overall average higher increase of

  5. Recent trends in 30-day mortality in patients with blunt splenic injury: A nationwide trauma database study in Japan.

    Science.gov (United States)

    Tanaka, Chie; Tagami, Takashi; Matsumoto, Hisashi; Matsuda, Kiyoshi; Kim, Shiei; Moroe, Yuta; Fukuda, Reo; Unemoto, Kyoko; Yokota, Hiroyuki

    2017-01-01

    Splenic injury frequently occurs after blunt abdominal trauma; however, limited epidemiological data regarding mortality are available. We aimed to investigate mortality rate trends after blunt splenic injury in Japan. We retrospectively identified 1,721 adults with blunt splenic injury (American Association for the Surgery of Trauma splenic injury scale grades III-V) from the 2004-2014 Japan Trauma Data Bank. We grouped the records of these patients into 3 time phases: phase I (2004-2008), phase II (2009-2012), and phase III (2013-2014). Over the 3 phases, we analysed 30-day mortality rates and investigated their association with the prevalence of certain initial interventions (Mantel-Haenszel trend test). We further performed multiple imputation and multivariable analyses for comparing the characteristics and outcomes of patients who underwent TAE or splenectomy/splenorrhaphy, adjusting for known potential confounders and for within-hospital clustering using generalised estimating equation. Over time, there was a significant decrease in 30-day mortality after splenic injury (p splenic injury between 2004 and 2014, even after adjustment for within-hospital clustering and other factors independently associated with mortality. Over time, mortality rates decreased significantly after splenectomy/splenorrhaphy, but not after non-operative management. This information is useful for clinicians when making decisions about treatments for patients with blunt splenic injury.

  6. Performance of hospitals according to the ESC ACCA quality indicators and 30-day mortality for acute myocardial infarction: national cohort study using the United Kingdom Myocardial Ischaemia National Audit Project (MINAP) register.

    Science.gov (United States)

    Bebb, Owen; Hall, Marlous; Fox, Keith A A; Dondo, Tatendashe B; Timmis, Adam; Bueno, Hector; Schiele, François; Gale, Chris P

    2017-04-01

    To investigate the application of the European Society of Cardiology Acute Cardiovascular Care Association quality indicators (QI) for acute myocardial infarction for the study of hospital performance and 30-day mortality. National cohort study (n = 118,075 patients, n = 211 hospitals, MINAP registry), 2012-13. Overall, 16 of the 20 QIs could be calculated. Eleven QIs had a significant inverse association with GRACE risk adjusted 30-day mortality (all P < 0.005). The association with the greatest magnitude was high attainment of the composite opportunity-based QI (80-100%) vs. zero attainment (odds ratio 0.04, 95% confidence interval 0.04-0.05, P < 0.001), increasing attainment from low (0.42, 0.37- 0.49, P < 0.001) to intermediate (0.15, 0.13-0.16, P < 0.001) was significantly associated with a reduced risk of 30-day mortality. A 1% increase in attainment of this QI was associated with a 3% reduction in 30-day mortality (0.97, 0.97-0.97, P < 0.001). The QI with the widest hospital variation was 'fondaparinux received among NSTEMI' (interquartile range 84.7%) and least variation 'centre organisation' (0.0%), with seven QIs depicting minimal variation (<11%). GRACE risk score adjusted 30-day mortality varied by hospital (median 6.7%, interquartile range 5.4-7.9%). Eleven QIs were significantly inversely associated with 30-day mortality. Increasing patient attainment of the composite quality indicator was the most powerful predictor; a 1% increase in attainment represented a 3% decrease in 30-day standardised mortality. The ESC QIs for acute myocardial infarction are applicable in a large health system and have the potential to improve care and reduce unwarranted variation in death from acute myocardial infarction. © The Author 2017. Published on behalf of the European Society of Cardiology

  7. Low-frequency oscillations in radiative-convective models

    Energy Technology Data Exchange (ETDEWEB)

    Hu, Qi; Randall, D.A.

    1991-12-31

    Although eastward propagation is usually regarded as an essential feature of the low-frequency ``Madden-Julian oscillation`` observed in the tropical atmosphere, many observations indicate that there is an important stationary or quasi-stationary component of the oscillation. Yasunari (1979), for example, investigated the stationary 30--60 day variation in upper tropospheric cloudiness in the Asian summer monsoon region. In a case study of the 30--60 day oscillation. Hsu et al. (1990) found a strong stationary oscillation of the divergence, outgoing longwave mdiadon and other fields. A recent observational study by Weickmann and Khalsa (1990) offers further evidence that the Madden-Julian oscillation has an important stationary component. In this paper, we present evidence that intraseasonal oscillations can be produced by local radiative and convective processes. This suggests that the observed propagating Madden-Julian wave is produced by interactions between these local processes and the large scale motion field, and is not essential for the existence of the observed oscillation.

  8. Low-frequency oscillations in radiative-convective models

    Energy Technology Data Exchange (ETDEWEB)

    Hu, Qi; Randall, D.A.

    1991-01-01

    Although eastward propagation is usually regarded as an essential feature of the low-frequency Madden-Julian oscillation'' observed in the tropical atmosphere, many observations indicate that there is an important stationary or quasi-stationary component of the oscillation. Yasunari (1979), for example, investigated the stationary 30--60 day variation in upper tropospheric cloudiness in the Asian summer monsoon region. In a case study of the 30--60 day oscillation. Hsu et al. (1990) found a strong stationary oscillation of the divergence, outgoing longwave mdiadon and other fields. A recent observational study by Weickmann and Khalsa (1990) offers further evidence that the Madden-Julian oscillation has an important stationary component. In this paper, we present evidence that intraseasonal oscillations can be produced by local radiative and convective processes. This suggests that the observed propagating Madden-Julian wave is produced by interactions between these local processes and the large scale motion field, and is not essential for the existence of the observed oscillation.

  9. Ovarian condition of Holstein dairy cows between 30 and 90 days postpartum in the microregion of Uberlândia, MG

    Directory of Open Access Journals (Sweden)

    Anderson Kloster Munhoz

    2014-01-01

    Full Text Available Anestrous postpartum is a state of complete sexual inactivity without estrous manifestations and the return of ovarian activity in postpartum may be negatively affected by several factors, such as negative energy balance (NEB, loss of body condition score (BCS, season in which the calving occurs, nutritional deficiencies, dystocic calving, retained placenta, uterine infections and metabolic diseases. This study aimed to evaluate the effects of BCS and number of days in milk (DIM on ovarian cyclicity of Holstein dairy cows. Ovarian conditions of 168 cows between 30 to 90 days in milk (DIM were evaluated twice by ultrasonography with seven days of interval and cows were classified in four categories: ovaries with presence of small follicles (Category 1: up to 10 mm; ovaries with medium follicles (Category 2: 10 to 18 mm; ovaries with large follicles (Category 3: over 20 mm and ovaries with presence of corpus luteum (CL (Category 4. The cows classified in categories 1, 2 and 3 were considered in anestrous. Data were analyzed by logistic regression at Minitab (P<0.05. As a result 15 cows (8.93% were in Category 1, 34 (20.24% in Category 2, 4 (2.38% in Category 3 and 115 (68.45% in Category 4. There was no effect (P>0.05 of DIM in the percentage of cycling cows, however there was a tendency (P=0.074 that cows with greater BCS (≥ 2.75 had a higher cyclicity rate (74.44% vs. 61.54% than cows with lower BCS. Days in milk effect was not detected in cyclicity rate in cows between 30 and 90 DIM, but there was a tendency of Holstein cows with greater body condition score to had higher cyclicity rate.

  10. Gross domestic product and health expenditure associated with incidence, 30-day fatality, and age at stroke onset: a systematic review.

    Science.gov (United States)

    Sposato, Luciano A; Saposnik, Gustavo

    2012-01-01

    Differences in definitions of socioeconomic status and between study designs hinder their comparability across countries. We aimed to analyze the correlation between 3 widely used macrosocioeconomic status indicators and clinical outcomes. We selected population-based studies reporting incident stroke risk and/or 30-day case-fatality according to prespecified criteria. We used 3 macrosocioeconomic status indicators that are consistently defined by international agencies: per capita gross domestic product adjusted for purchasing power parity, total health expenditures per capita at purchasing power parity, and unemployment rate. We examined the correlation of each macrosocioeconomic status indicator with incident risk of stroke, 30-day case-fatality, proportion of hemorrhagic strokes, and age at stroke onset. Twenty-three articles comprising 30 population-based studies fulfilled the eligibility criteria. Age-adjusted incident risk of stroke using the standardized World Health Organization World population was associated to lower per capita gross domestic product adjusted for purchasing power parity (ρ=-0.661, P=0.027, R(2)=0.32) and total health expenditures per capita at purchasing power parity (ρ=-0.623, P=0.040, R(2)=0.26). Thirty-day case-fatality rates and proportion of hemorrhagic strokes were also related to lower per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity. Moreover, stroke occurred at a younger age in populations with low per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity. There was no correlation between unemployment rates and outcome measures. Lower per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity were associated with higher incident risk of stroke, higher case-fatality, a greater

  11. Evaluation of right atrium-to-right ventricle diameter ratio on computed tomography pulmonary angiography: Prediction of adverse outcome and 30-day mortality.

    Science.gov (United States)

    Oz, Ibrahim Ilker; Altınsoy, Bülent; Serifoglu, Ismail; Sayın, Rasit; Buyukuysal, Mustafa Cagatay; Erboy, Fatma; Akduman, Ece Isin

    2015-12-01

    The aim of this study was to examine the association between right atrium (RA) and right ventricle (RV) diameters on computed tomography (CT) pulmonary angiography in response to acute pulmonary embolism (APE), in addition to 30-day mortality and adverse outcomes in patients with APE. This retrospective study was accepted by the institutional ethics committee. From January 2013 to March 2014, 79 hospitalized adult patients with symptomatic APE were included. Inclusion criteria were a CT pulmonary angiography positive for pulmonary embolism, availability of patient records, and a follow-up of at least 30 days. A review of patient records and images was performed. The maximum diameters of the heart chambers were measured on a reconstructed four-chamber heart view, and the vascular obstruction index was calculated on CT pulmonary angiography. There were statistically significant relationships in both the RA/RV diameter ratio and the RV/left ventricle (LV) diameter ratio between patients with and without adverse outcomes (prights reserved.

  12. Post-operative delirium is an independent predictor of 30-day hospital readmission after spine surgery in the elderly (≥65years old): A study of 453 consecutive elderly spine surgery patients.

    Science.gov (United States)

    Elsamadicy, Aladine A; Wang, Timothy Y; Back, Adam G; Lydon, Emily; Reddy, Gireesh B; Karikari, Isaac O; Gottfried, Oren N

    2017-07-01

    In the last decade, costs of U.S. healthcare expenditures have been soaring, with billions of dollars spent on hospital readmissions. Identifying causes and risk factors can reduce soaring readmission rates and help lower healthcare costs. The aim of this is to determine if post-operative delirium in the elderly is an independent risk factor for 30-day hospital readmission after spine surgery. The medical records of 453 consecutive elderly (≥65years old) patients undergoing spine surgery at Duke University Medical Center from 2008 to 2010 were reviewed. We identified 17 (3.75%) patients who experienced post-operative delirium according to DSM-V criteria. Patient demographics, comorbidities, and post-operative complication rates were collected for each patient. Elderly patients experiencing post-operative delirium had an increased length of hospital stay (10.47days vs. 5.70days, p=0.009). Complication rates were similar between the cohorts with the post-operative delirium patients having increased UTI and superficial surgical site infections. In total, 12.14% of patients were re-admitted within 30-days of discharge, with post-operative delirium patients experiencing approximately a 4-fold increase in 30-day readmission rates (Delirium: 41.18% vs. No Delirium: 11.01%, p=0.002). In a multivariate logistic regression analysis, post-operative delirium is an independent predictor of 30-day readmission after spine surgery in the elderly (p=0.03). Elderly patients experiencing post-operative delirium after spine surgery is an independent risk factor for unplanned readmission within 30-days of discharge. Preventable measures and early awareness of post-operative delirium in the elderly may help reduce readmission rates. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. The impact of monsoon intraseasonal variability on renewable power generation in India

    International Nuclear Information System (INIS)

    Dunning, C M; Turner, A G; Brayshaw, D J

    2015-01-01

    India is increasingly investing in renewable technology to meet rising energy demands, with hydropower and other renewables comprising one-third of current installed capacity. Installed wind-power is projected to increase 5-fold by 2035 (to nearly 100GW) under the International Energy Agency's New Policies scenario. However, renewable electricity generation is dependent upon the prevailing meteorology, which is strongly influenced by monsoon variability. Prosperity and widespread electrification are increasing the demand for air conditioning, especially during the warm summer. This study uses multi-decadal observations and meteorological reanalysis data to assess the impact of intraseasonal monsoon variability on the balance of electricity supply from wind-power and temperature-related demand in India. Active monsoon phases are characterized by vigorous convection and heavy rainfall over central India. This results in lower temperatures giving lower cooling energy demand, while strong westerly winds yield high wind-power output. In contrast, monsoon breaks are characterized by suppressed precipitation, with higher temperatures and hence greater demand for cooling, and lower wind-power output across much of India. The opposing relationship between wind-power supply and cooling demand during active phases (low demand, high supply) and breaks (high demand, low supply) suggests that monsoon variability will tend to exacerbate fluctuations in the so-called demand-net-wind (i.e., electrical demand that must be supplied from non-wind sources). This study may have important implications for the design of power systems and for investment decisions in conventional schedulable generation facilities (such as coal and gas) that are used to maintain the supply/demand balance. In particular, if it is assumed (as is common) that the generated wind-power operates as a price-taker (i.e., wind farm operators always wish to sell their power, irrespective of price) then investors

  14. The impact of monsoon intraseasonal variability on renewable power generation in India

    Science.gov (United States)

    Dunning, C. M.; Turner, A. G.; Brayshaw, D. J.

    2015-06-01

    India is increasingly investing in renewable technology to meet rising energy demands, with hydropower and other renewables comprising one-third of current installed capacity. Installed wind-power is projected to increase 5-fold by 2035 (to nearly 100GW) under the International Energy Agency's New Policies scenario. However, renewable electricity generation is dependent upon the prevailing meteorology, which is strongly influenced by monsoon variability. Prosperity and widespread electrification are increasing the demand for air conditioning, especially during the warm summer. This study uses multi-decadal observations and meteorological reanalysis data to assess the impact of intraseasonal monsoon variability on the balance of electricity supply from wind-power and temperature-related demand in India. Active monsoon phases are characterized by vigorous convection and heavy rainfall over central India. This results in lower temperatures giving lower cooling energy demand, while strong westerly winds yield high wind-power output. In contrast, monsoon breaks are characterized by suppressed precipitation, with higher temperatures and hence greater demand for cooling, and lower wind-power output across much of India. The opposing relationship between wind-power supply and cooling demand during active phases (low demand, high supply) and breaks (high demand, low supply) suggests that monsoon variability will tend to exacerbate fluctuations in the so-called demand-net-wind (i.e., electrical demand that must be supplied from non-wind sources). This study may have important implications for the design of power systems and for investment decisions in conventional schedulable generation facilities (such as coal and gas) that are used to maintain the supply/demand balance. In particular, if it is assumed (as is common) that the generated wind-power operates as a price-taker (i.e., wind farm operators always wish to sell their power, irrespective of price) then investors in

  15. Associations between nursing home performance and hospital 30-day readmissions for acute myocardial infarction, heart failure and pneumonia at the healthcare community level in the United States.

    Science.gov (United States)

    Pandolfi, Michelle M; Wang, Yun; Spenard, Ann; Johnson, Florence; Bonner, Alice; Ho, Shih-Yieh; Elwell, Timothy; Bakullari, Anila; Galusha, Deron; Leifheit-Limson, Erica; Lichtman, Judith H; Krumholz, Harlan M

    2017-12-01

    To evaluate community-specific nursing home performance with community-specific hospital 30-day readmissions for Medicare patients discharged with acute myocardial infarction, heart failure or pneumonia. Cross-sectional study using 2009-2012 hospital risk-standardised 30-day readmission data for Medicare fee-for-service patients hospitalised for all three conditions and nursing home performance data from the Centers for Medicare & Medicaid Services Five-Star Quality Rating System. Medicare-certified nursing homes and acute care hospitals. 12,542 nursing homes and 3,039 hospitals treating 30 or more Medicare fee-for-service patients for all three conditions across 2,032 hospital service areas in the United States. Community-specific hospital 30-day risk-standardised readmission rates. Community-specific nursing home performance measures: health inspection, staffing, Registered Nurses and quality performance; and an aggregated performance score. Mixed-effects models evaluated associations between nursing home performance and hospital 30-day risk-standardised readmission rates for all three conditions. The relationship between community-specific hospital risk-standardised readmission rates and community-specific overall nursing home performance was statistically significant for all three conditions. Increasing nursing home performance by one star resulted in decreases of 0.29% point (95% CI: 0.12-0.47), 0.78% point (95% CI: 0.60-0.95) and 0.46% point (95% CI: 0.33-0.59) of risk-standardised readmission rates for AMI, HF and pneumonia, respectively. Among the specific measures, higher performance in nursing home overall staffing and Registered Nurse staffing measures was statistically significantly associated with lower hospital readmission rates for all three conditions. Notable geographic variation in the community-specific nursing home performance was observed. Community-specific nursing home performance is associated with community-specific hospital 30-day

  16. Evidence of organized intraseasonal convection linked to ocean dynamics in the Seychelles-Chagos thermocline ridge

    Science.gov (United States)

    D'Addezio, Joseph M.; Subrahmanyam, Bulusu

    2018-01-01

    The Madden-Julian oscillation (MJO) is the dominant driver of intraseasonal variability across the equatorial domain of the global ocean with alternating wet and dry bands that propagate eastward primarily between 5°N and 5°S. Past research has shown that MJOs impact the surface and subsurface variability of the Seychelles-Chagos thermocline ridge (SCTR) (55°E-65°E, 5°S-12°S) located in the southwest tropical Indian Ocean (SWTIO), but investigations of how SWTIO internal dynamics may play an important role in producing MJO events remain limited. This study uses Argo, in conjunction with several remote sensing and reanalysis products, to demonstrate that SWTIO oceanic dynamics, particularly barrier layer formation and near surface heat buildup, may be associated with MJO genesis between August and December of most years between 2005 and 2013. A total of eight SWTIO specific MJO events are observed, all occurring between August and December. Four of the eight events are correlated with positive SWTIO total heat content (THC) and barrier layer thickness (BLT) interannual anomalies. Two others formed over the SWTIO during times when only one of the variables was at or above their seasonal average, while two additional events occurred when both variables experienced negative interannual anomalies. Lacking complete 1:1 correlation between the hypothesized oceanic state and the identified SWTIO MJO events, we conclude that additional work is required to better understand when variability in key oceanic variables plays a primary role in regional MJO genesis or when other factors, such as atmospheric variability, are the dominate drivers.

  17. Return-on-Investment (ROI) Analyses of an Inpatient Lay Health Worker Model on 30-Day Readmission Rates in a Rural Community Hospital.

    Science.gov (United States)

    Cardarelli, Roberto; Bausch, Gregory; Murdock, Joan; Chyatte, Michelle Renee

    2017-07-07

    The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates. The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period. Using the hospital's utilization and financial data, a validated ROI calculator specific to care transition programs was used to assess the ROI of the BTH model comparing 3 types of payment models including Diagnosis Related Group (DRG)-only payments, pay-for-performance (P4P) contracts, and accountable care organizations (ACOs). The BTH program had a -$0.67 ROI if the hospital had only a DRG-based payment model. If the hospital had P4P contracts with payers and 0.1% of its annual operating revenue was at risk, the ROI increased to $7.03 for every $1 spent on the BTH program. However, if the hospital was an ACO as was the case for this study's community hospital, the ROI significantly increased to $38.48 for every $1 spent on the BTH program. The BTH model showed a viable ROI to be considered by community hospitals that are part of an ACO or P4P program. A LHW care transition model may be a cost-effective alternative for impacting excess 30-day readmissions and avoiding associated penalties for hospital systems with a value-based payment model. © 2017 National Rural Health Association.

  18. "It's my business, it's my body, it's my money": experiences of smokers who are not planning to quit in the next 30 days and their views about treatment options.

    Science.gov (United States)

    Bartlett, Y K; Gartland, N; Wearden, A; Armitage, C J; Borrelli, B

    2016-08-04

    Current evidence-based smoking cessation treatments in the UK are only offered to smokers ready to quit within 30 days. This study reports the experiences of smokers who are not ready to quit and explores the types of intervention approaches that might engage them. Five focus groups were conducted with smokers who had no plans to quit within 30 days (n = 32, 44 % female). Verbatim transcripts were analyzed thematically using Nvivo 10 software. Participants were ambivalent towards their own smoking, but the majority indicated they would like to quit someday. Smoking was seen both to hinder and facilitate social interactions, depending on the social norms of the participant's social circle. Participants reported that, when they perceive pressure to quit smoking, they respond defensively; concurrently, existing approaches to encouraging smoking cessation were seen as unappealing. In contrast, the importance of intrinsic motivation to quit was emphasized, and interventions that were tailored, increased intrinsic motivation and kept the smoker engaged in activities incompatible with smoking were preferred. Despite not planning to quit in the next 30 days, the majority of participants wanted to quit smoking at some point. Even if existing services were offered to smokers not planning to quit in the next 30 days, it is unlikely that these services would meet the needs of this population. Future research should explore novel approaches to appeal specifically to smokers not planning to quit in the next 30 days, such as encouraging engagement with activities incompatible with smoking and fostering non-smoking habits.

  19. Neuroendocrine recovery after 2-week 12-h day and night shifts: an 11-day follow-up.

    Science.gov (United States)

    Merkus, Suzanne L; Holte, Kari Anne; Huysmans, Maaike A; Hansen, Åse Marie; van de Ven, Peter M; van Mechelen, Willem; van der Beek, Allard J

    2015-02-01

    The study aimed to investigate the course and duration of neuroendocrine recovery after 2-week 12-h day and night shift working periods and to study whether there were differences in recovery between the shift groups. Twenty-nine male offshore employees working 2-week 12-h shift tours participated in the study; 15 participated after a day shift tour and 14 after a night shift tour. Salivary cortisol was assessed at awakening, 30 min after awakening, and before bedtime on the 1st, 4th, 7th, and 11th day of the free period, with a reference day prior to the offshore tour. Differences were tested using generalised estimating equations analysis. Compared to the reference day, night shift workers had a significantly flatter cortisol profile on the 1st day off, significantly lower cortisol concentrations at 30 min after awakening on day 4 and at awakening on day 7, and a significantly smaller decline to evening concentration on days 4 and 11. Compared to the reference day, day shift workers only showed a significantly lower cortisol concentration at awakening on the 1st day off. Compared to day workers, night shift workers had a flatter profile on the 1st day off and a lower cortisol concentration at awakening on the 4th day. Following 2-week 12-h night shift working periods, recovery was not fully complete up to day 11. Following 2-week 12-h day shift working periods, an indication of incomplete recovery was found on the 1st day off, with full recovery reached on day 4.

  20. Leading Comorbidity associated with 30-day post-anesthetic mortality in geriatric surgical patients in Taiwan: a retrospective study from the health insurance data

    Directory of Open Access Journals (Sweden)

    Chun-Lin Chu

    2017-10-01

    Full Text Available Abstract Background Elderly patients with aged physical status and increased underlying disease suffered from more postoperative complication and mortality. We design this retrospective cohort study to investigate the relationship between existing comorbidity of elder patients and 30 day post-anesthetic mortality by using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM from Health Insurance Database. Methods Patients aged above 65 years old who received anesthesia between 2000 and 2010 were included from 1 million Longitudinal Health Insurance Database in (LHID 2005 in Taiwan. We use age, sex, type of surgery to calculate propensity score and match death group and survival one with 1:4 ratio (death: survival = 1401: 5823. Multivariate logistic model with stepwise variable selection was employed to investigate the factors affecting death 30 days after anesthesia. Results Thirty seven comorbidities can independently predict the post-anesthetic mortality. In our study, the leading comorbidities predict post-anesthetic mortality is chronic renal disease (OR = 2.806, acute myocardial infarction (OR = 4.58, and intracranial hemorrhage (OR = 3.758. Conclusions In this study, we present the leading comorbidity contributing to the postoperative mortality in elderly patients in Taiwan from National Health Insurance Database. Chronic renal failure is the leading contributing comorbidity of 30 days mortality after anesthesia in Taiwan which can be explained by the great number of hemodialysis and prolong life span under National Taiwan Health Insurance. Large scale database can offer enormous information which can help to improve quality of medical care.

  1. Leading Comorbidity associated with 30-day post-anesthetic mortality in geriatric surgical patients in Taiwan: a retrospective study from the health insurance data.

    Science.gov (United States)

    Chu, Chun-Lin; Chiou, Hung-Yi; Chou, Wei-Han; Chang, Po-Ya; Huang, Yi-You; Yeh, Huei-Ming

    2017-10-24

    Elderly patients with aged physical status and increased underlying disease suffered from more postoperative complication and mortality. We design this retrospective cohort study to investigate the relationship between existing comorbidity of elder patients and 30 day post-anesthetic mortality by using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) from Health Insurance Database. Patients aged above 65 years old who received anesthesia between 2000 and 2010 were included from 1 million Longitudinal Health Insurance Database in (LHID) 2005 in Taiwan. We use age, sex, type of surgery to calculate propensity score and match death group and survival one with 1:4 ratio (death: survival = 1401: 5823). Multivariate logistic model with stepwise variable selection was employed to investigate the factors affecting death 30 days after anesthesia. Thirty seven comorbidities can independently predict the post-anesthetic mortality. In our study, the leading comorbidities predict post-anesthetic mortality is chronic renal disease (OR = 2.806), acute myocardial infarction (OR = 4.58), and intracranial hemorrhage (OR = 3.758). In this study, we present the leading comorbidity contributing to the postoperative mortality in elderly patients in Taiwan from National Health Insurance Database. Chronic renal failure is the leading contributing comorbidity of 30 days mortality after anesthesia in Taiwan which can be explained by the great number of hemodialysis and prolong life span under National Taiwan Health Insurance. Large scale database can offer enormous information which can help to improve quality of medical care.

  2. External Validation of a Case-Mix Adjustment Model for the Standardized Reporting of 30-Day Stroke Mortality Rates in China.

    Science.gov (United States)

    Yu, Ping; Pan, Yuesong; Wang, Yongjun; Wang, Xianwei; Liu, Liping; Ji, Ruijun; Meng, Xia; Jing, Jing; Tong, Xu; Guo, Li; Wang, Yilong

    2016-01-01

    A case-mix adjustment model has been developed and externally validated, demonstrating promise. However, the model has not been thoroughly tested among populations in China. In our study, we evaluated the performance of the model in Chinese patients with acute stroke. The case-mix adjustment model A includes items on age, presence of atrial fibrillation on admission, National Institutes of Health Stroke Severity Scale (NIHSS) score on admission, and stroke type. Model B is similar to Model A but includes only the consciousness component of the NIHSS score. Both model A and B were evaluated to predict 30-day mortality rates in 13,948 patients with acute stroke from the China National Stroke Registry. The discrimination of the models was quantified by c-statistic. Calibration was assessed using Pearson's correlation coefficient. The c-statistic of model A in our external validation cohort was 0.80 (95% confidence interval, 0.79-0.82), and the c-statistic of model B was 0.82 (95% confidence interval, 0.81-0.84). Excellent calibration was reported in the two models with Pearson's correlation coefficient (0.892 for model A, pcase-mix adjustment model could be used to effectively predict 30-day mortality rates in Chinese patients with acute stroke.

  3. Logistic growth models of China pinks, cultivated on seven substrates, as a function of degree days

    Directory of Open Access Journals (Sweden)

    Marília Milani

    Full Text Available ABSTRACT: The objective of this study was to characterize the height (H and leaf number (LN of China pinks, grown in seven substrates, as a function of degree days, using the logistic growth model. H and LN were measured from 56 plants per substrate, for 392 plants in total. Plants that were grown on substrates formed of 50% soil with 50% rice husk ash (50% S + 50% RH and 80% rice husk ash with 20% worm castings (80% RH + 20% W had the longest vegetative growth period (74d, corresponding to 1317.9ºCd. The logistic growth model, adjusted for H, showed differences in the estimation of maximum expected height (α between the substrates, with values between 10.47cm for 50% S + 50% RH and 35.75cm for Mecplant(r. When α was estimated as LN, variation was also observed between the different substrates, from approximately 30 leaves on plants growing on 50% S + 50% RH to 34 leaves on the plants growing on the substrate formed of 80% RH + 20% W. Growth of China pinks can be characterized using H or LN in the logistic growth model as a function of degree days, being the provided plants adequately fertilized. The best substrates in terms of maximum height and leaf number were 80% soil + 20% worm castings and Mecplant(r. However, users must recalibrate the model with the estimated parameters before applying it to different growing conditions.

  4. The Patient- And Nutrition-Derived Outcome Risk Assessment Score (PANDORA: Development of a Simple Predictive Risk Score for 30-Day In-Hospital Mortality Based on Demographics, Clinical Observation, and Nutrition.

    Directory of Open Access Journals (Sweden)

    Michael Hiesmayr

    Full Text Available To develop a simple scoring system to predict 30 day in-hospital mortality of in-patients excluding those from intensive care units based on easily obtainable demographic, disease and nutrition related patient data.Score development with general estimation equation methodology and model selection by P-value thresholding based on a cross-sectional sample of 52 risk indicators with 123 item classes collected with questionnaires and stored in an multilingual online database.Worldwide prospective cross-sectional cohort with 30 day in-hospital mortality from the nutritionDay 2006-2009 and an external validation sample from 2012.We included 43894 patients from 2480 units in 32 countries. 1631(3.72% patients died within 30 days in hospital. The Patient- And Nutrition-Derived Outcome Risk Assessment (PANDORA score predicts 30-day hospital mortality based on 7 indicators with 31 item classes on a scale from 0 to 75 points. The indicators are age (0 to 17 points, nutrient intake on nutritionDay (0 to 12 points, mobility (0 to 11 points, fluid status (0 to 10 points, BMI (0 to 9 points, cancer (9 points and main patient group (0 to 7 points. An appropriate model fit has been achieved. The area under the receiver operating characteristic curve for mortality prediction was 0.82 in the development sample and 0.79 in the external validation sample.The PANDORA score is a simple, robust scoring system for a general population of hospitalised patients to be used for risk stratification and benchmarking.

  5. Bacillus coagulans GBI-30, 6086 limits the recurrence of Clostridium difficile-Induced colitis following vancomycin withdrawal in mice

    Science.gov (United States)

    2012-01-01

    Background Recently, we found that the probiotic strain Bacillus coagulans GBI-30, 6086 (GanedenBC30) improved indices of Clostridium difficile (C. difficile)-induced colitis in mice (Fitzpatrick et al., Gut Pathogens, 2011). Our goal was to determine if BC30 could also prevent the recurrence of C. difficile-induced colitis in mice, following initial treatment with vancomycin. During study days 0 through 5, mice were treated with antibiotics. On day 6, the C. difficile strain VPI 10463 was given by oro-gastric gavage at ≈ 5x104 CFU to induce colitis. Mice were treated on study days 6 to 10 with vancomycin (50 mg/kg) (vanco) or vehicle (saline) by gavage. On days 10 to16, mice were dosed by gavage with saline vehicle or BC30 (2 x 109 CFU per day). Mice were monitored for mortality, weight loss and diarrhea. On study days 14, 16 and 17, stools and colons were collected for analyzing other parameters of colitis. Results The mean stool consistency score in Vehicle/C.difficile/Vanco mice increased from 0.4 (day 10) to a range of 1.1 to 1.4 (days 14 to 17), indicating the recurrence of colitis. On days 13 through 17, the stool consistency scores for the vancomycin/BC30 mice were significantly lower (p< 0.05) than for the vancomycin/vehicle cohort of animals. On day 17, 88.9% of mice treated with BC30 had normal stools, while this value was 0% with vehicle treatment (p value = 0.0004). Colonic myeloperoxidase (Units/2 cm colon) was significantly (p < 0.05) reduced from 4.3 ± 0.7 (Vehicle/C.difficile/Vanco) to 2.6 ± 0.2 (BC30/C. Difficle/Vanco). The colonic histology score and Keratinocyte derived-chemokine level in the colon were also lower in BC30 treated mice. Summary In BC30-treated mice, there was evidence of better stool consistency, as well as improved biochemical and histological indices of colitis, following initial treatment of animals with vancomycin. Conclusion BC30 limited the recurrence of CD-induced colitis following vancomycin withdrawal in mice. PMID

  6. Bacillus coagulans GBI-30, 6086 limits the recurrence of Clostridium difficile-Induced colitis following vancomycin withdrawal in mice.

    Science.gov (United States)

    Fitzpatrick, Leo R; Small, Jeffrey S; Greene, Wallace H; Karpa, Kelly D; Farmer, Sean; Keller, David

    2012-10-22

    Recently, we found that the probiotic strain Bacillus coagulans GBI-30, 6086 (GanedenBC30) improved indices of Clostridium difficile (C. difficile)-induced colitis in mice (Fitzpatrick et al., Gut Pathogens, 2011). Our goal was to determine if BC30 could also prevent the recurrence of C. difficile-induced colitis in mice, following initial treatment with vancomycin. During study days 0 through 5, mice were treated with antibiotics. On day 6, the C. difficile strain VPI 10463 was given by oro-gastric gavage at ≈ 5x104 CFU to induce colitis. Mice were treated on study days 6 to 10 with vancomycin (50 mg/kg) (vanco) or vehicle (saline) by gavage. On days 10 to16, mice were dosed by gavage with saline vehicle or BC30 (2 x 109 CFU per day). Mice were monitored for mortality, weight loss and diarrhea. On study days 14, 16 and 17, stools and colons were collected for analyzing other parameters of colitis. The mean stool consistency score in Vehicle/C.difficile/Vanco mice increased from 0.4 (day 10) to a range of 1.1 to 1.4 (days 14 to 17), indicating the recurrence of colitis. On days 13 through 17, the stool consistency scores for the vancomycin/BC30 mice were significantly lower (p< 0.05) than for the vancomycin/vehicle cohort of animals. On day 17, 88.9% of mice treated with BC30 had normal stools, while this value was 0% with vehicle treatment (p value = 0.0004). Colonic myeloperoxidase (Units/2 cm colon) was significantly (p < 0.05) reduced from 4.3 ± 0.7 (Vehicle/C.difficile/Vanco) to 2.6 ± 0.2 (BC30/C. Difficle/Vanco). The colonic histology score and Keratinocyte derived-chemokine level in the colon were also lower in BC30 treated mice. In BC30-treated mice, there was evidence of better stool consistency, as well as improved biochemical and histological indices of colitis, following initial treatment of animals with vancomycin. BC30 limited the recurrence of CD-induced colitis following vancomycin withdrawal in mice.

  7. Activation cross sections of deuteron induced reactions on niobium in the 3050 MeV energy range

    International Nuclear Information System (INIS)

    Ditrói, F.; Tárkányi, F.; Takács, S.; Hermanne, A.; Ignatyuk, A.V.

    2016-01-01

    Highlights: • Deuteron induced nuclear reactions on natural niobium up to 50 MeV. • Stacked foil irradiation technique. • Comparison of results with the ALICE-D, EMPIRE-D and TENDL-2015 calculations. • Application of radioisotopes in medicine and industry. - Abstract: Activation cross-sections of deuterons induced reactions on Nb targets were determined with the aim of different applications and comparison with theoretical models. We present the experimental excitation functions of "9"3Nb(d,x)"9"3"m","9"0Mo, "9"2"m","9"1"m","9"0Nb, "8"9","8"8Zr and "8"8","8"7"m","8"7"gY in the energy range of 3050 MeV. The results were compared with earlier measurements and with the cross-sections calculated by means of the theoretical model codes ALICE-D, EMPIRE-D and TALYS (on-line TENDL-2014 and TENDL-2015 libraries). Possible applications of the radioisotopes are discussed in detail.

  8. Survival curves to support quality improvement in hospitals with excess 30-day mortality after acute myocardial infarction, cerebral stroke and hip fracture: a before-after study.

    Science.gov (United States)

    Kristoffersen, Doris Tove; Helgeland, Jon; Waage, Halfrid Persdatter; Thalamus, Jacob; Clemens, Dirk; Lindman, Anja Schou; Rygh, Liv Helen; Tjomsland, Ole

    2015-03-25

    To evaluate survival curves (Kaplan-Meier) as a means of identifying areas in the clinical pathway amenable to quality improvement. Observational before-after study. In Norway, annual public reporting of nationwide 30-day in-and-out-of-hospital mortality (30D) for three medical conditions started in 2011: first time acute myocardial infarction (AMI), stroke and hip fracture; reported for 2009. 12 of 61 hospitals had statistically significant lower/higher mortality compared with the hospital mean. Three hospitals with significantly higher mortality requested detailed analyses for quality improvement purposes: Telemark Hospital Trust Skien (AMI and stroke), Østfold Hospital Trust Fredrikstad (stroke), Innlandet Hospital Trust Gjøvik (hip fracture). Survival curves, crude and risk-adjusted 30D before (2008-2009) and after (2012-2013). Unadjusted survival curves for the outlier hospitals were compared to curves based on pooled data from the other hospitals for the 30-day period 2008-2009. For patients admitted with AMI (Skien), stroke (Fredrikstad) and hip fracture (Gjøvik), the curves suggested increased mortality from the initial part of the clinical pathway. For stroke (Skien), increased mortality appeared after about 8 days. The curve profiles were thought to reflect suboptimal care in various phases in the clinical pathway. This informed improvement efforts. For 2008-2009, hospital-specific curves differed from other hospitals: borderline significant for AMI (p=0.064), highly significant (p≤0.005) for the remainder. After intervention, no difference was found (p>0.188). Before-after comparison of the curves within each hospital revealed a significant change for Fredrikstad (p=0.006). For the three hospitals, crude 30D declined and they were non-outliers for risk-adjusted 30D for 2013. Survival curves as a supplement to 30D may be useful for identifying suboptimal care in the clinical pathway, and thus informing design of quality improvement projects

  9. Open standing castration in Thoroughbred racehorses in Hong Kong: Prevalence and severity of complications 30 days post-castration.

    Science.gov (United States)

    Rosanowski, S M; MacEoin, F; Graham, R J T Y; Riggs, C M

    2018-05-01

    Complications following open standing castration (OSC) in Thoroughbred racehorses are well recognised but variation in their prevalence and severity between populations is not well documented. To describe the prevalence and severity of complications in the 30 days following OSC. A retrospective cohort study of veterinary clinical records relating to horses that underwent OSC between July 2007 and July 2012. Complications were graded on a severity score from N, no complications, to C3, severe complications. Additional data were accessed for each horse including age, import date, racing history, trainer and veterinarian performing the castration. Bacterial culture and antimicrobial sensitivities were performed on a limited number of castration wounds that became infected. In total, 250 horses were castrated in Hong Kong using the OSC technique over the period of the study. Sixty percent (150/250) of horses experienced some type of post-castration complication, with eight horses experiencing a severe (C3) complication requiring intensive veterinary treatment. Scrotal swelling, funiculitis and seroma formation were present in 70.0%, 36.7% and 24.7% of cases respectively. Most horses experiencing complications required wound reopening (87.3%; 131/150), and/or an extended course of first-line antimicrobials and/or nonsteroidal anti-inflammatory drugs (75/150; 50.0%). Eight horses had cultures submitted for bacterial sensitivity, with 17 bacterial isolates grown. In vitro, the bacteria cultured were sensitive to enrofloxacin (76%; 13/17) and ceftiofur (100%; 17/17). Resistance was detected to penicillin, gentamicin, oxytetracycline, metronidazole and trimethoprim-sulfadiazine. Differences in post-castration management cannot be accounted for in this study. Complications following OSC in horses in Hong Kong were common. The majority were mild and were successfully treated using antimicrobials and simple wound management. Given the high rate of complications and

  10. Orbital atherectomy for severely calcified lesions: More dissections in women but similar 30-day outcomes to men.

    Science.gov (United States)

    Chandrasekhar, Jaya; Mehran, Roxana

    2016-03-01

    Calcified lesions are associated with lower rates of successful percutaneous coronary intervention (PCI), greater stent thrombosis, and increased target vessel revascularization. Women undergoing PCI are more often older than men and likely to present with severe lesion calcification. The ORBIT II study, for the first time compares the effect of the orbital atherectomy system (OAS) in men and women undergoing PCI for severely calcified lesions. Although the adjusted risk of severe dissections was higher in women, the incidence of in-hospital and 30-day outcomes was similar to men. Randomized comparisons of the OAS with rotational atherectomy and with stenting without atherectomy are needed to further elucidate sex-based differences in calcified lesion PCI. © 2016 Wiley Periodicals, Inc.

  11. Thirty-Day Readmission Rates in Orthopedics: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Bernatz, James T.; Tueting, Jonathan L.; Anderson, Paul A.

    2015-01-01

    Background Hospital readmission rates are being used to evaluate performance. A survey of the present rates is needed before policies can be developed to decrease incidence of readmission. We address three questions: What is the present rate of 30-day readmission in orthopedics? How do factors such as orthopedic specialty, data source, patient insurance, and time of data collection affect the 30-day readmission rate? What are the causes and risk factors for 30-day readmissions? Methods/Findings A review was first registered with Prospero (CRD42014010293, 6/17/2014) and a meta-analysis was performed to assess the current 30-day readmission rate in orthopedics. Studies published after 2006 were retrieved, and 24 studies met the inclusion criteria. The 30-day readmission rate was extrapolated from each study along with the orthopedic subspecialty, data source, patient insurance, time of collection, patient demographics, and cause of readmission. A sensitivity analysis was completed on the stratified groups. The overall 30-day readmission rate across all orthopedics was 5.4 percent (95% confidence interval: 4.8,6.0). There was no significant difference between subspecialties. Studies that retrieved data from a multicenter registry had a lower 30-day readmission rate than those reporting data from a single hospital or a large national database. Patient populations that only included Medicare patients had a higher 30-day readmission rate than populations of all insurance. The 30-day readmission rate has decreased in the past ten years. Age, length of stay, discharge to skilled nursing facility, increased BMI, ASA score greater than 3, and Medicare/Medicaid insurance showed statistically positive correlation with increased 30-day readmissions in greater than 75 percent of studies. Surgical site complications accounted for 46 percent of 30-day readmissions. Conclusions This meta-analysis shows the present rate of 30-day readmissions in orthopedics. Demonstrable

  12. Association of Prehospital Blood Product Transfusion During Medical Evacuation of Combat Casualties in Afghanistan With Acute and 30-Day Survival.

    Science.gov (United States)

    Shackelford, Stacy A; Del Junco, Deborah J; Powell-Dunford, Nicole; Mazuchowski, Edward L; Howard, Jeffrey T; Kotwal, Russ S; Gurney, Jennifer; Butler, Frank K; Gross, Kirby; Stockinger, Zsolt T

    2017-10-24

    Prehospital blood product transfusion in trauma care remains controversial due to poor-quality evidence and cost. Sequential expansion of blood transfusion capability after 2012 to deployed military medical evacuation (MEDEVAC) units enabled a concurrent cohort study to focus on the timing as well as the location of the initial transfusion. To examine the association of prehospital transfusion and time to initial transfusion with injury survival. Retrospective cohort study of US military combat casualties in Afghanistan between April 1, 2012, and August 7, 2015. Eligible patients were rescued alive by MEDEVAC from point of injury with either (1) a traumatic limb amputation at or above the knee or elbow or (2) shock defined as a systolic blood pressure of less than 90 mm Hg or a heart rate greater than 120 beats per minute. Initiation of prehospital transfusion and time from MEDEVAC rescue to first transfusion, regardless of location (ie, prior to or during hospitalization). Transfusion recipients were compared with nonrecipients (unexposed) for whom transfusion was delayed or not given. Mortality at 24 hours and 30 days after MEDEVAC rescue were coprimary outcomes. To balance injury severity, nonrecipients of prehospital transfusion were frequency matched to recipients by mechanism of injury, prehospital shock, severity of limb amputation, head injury, and torso hemorrhage. Cox regression was stratified by matched groups and also adjusted for age, injury year, transport team, tourniquet use, and time to MEDEVAC rescue. Of 502 patients (median age, 25 years [interquartile range, 22 to 29 years]; 98% male), 3 of 55 prehospital transfusion recipients (5%) and 85 of 447 nonrecipients (19%) died within 24 hours of MEDEVAC rescue (between-group difference, -14% [95% CI, -21% to -6%]; P = .01). By day 30, 6 recipients (11%) and 102 nonrecipients (23%) died (between-group difference, -12% [95% CI, -21% to -2%]; P = .04). For the 386 patients without missing

  13. Greek Acute Coronary Syndrome Score for the Prediction of In-hospital and 30-Day Mortality of Patients With an Acute Coronary Syndrome.

    Science.gov (United States)

    Panagiotakos, Demosthenes B; Pitsavos, Christos; Georgousopoulou, Ekavi N; Notara, Venetia; Stefanadis, Christodoulos

    2015-01-01

    Risk evaluation of patients hospitalized with acute coronary syndrome (ACS) may contribute to their short-term prognosis improvement. The aim of this work was to develop a prediction index (score) for the risk assessment of 30-day death of ACS patients, using clinical and biological measurements at hospital admission. A sample of 6 Greek hospitals was selected, and almost all consecutive 2172 ACS patients from October 2003 to September 2004 were enrolled. Sociodemographic, biochemical, clinical, and lifestyle characteristics were recorded. Using as components age, systolic blood pressure, white blood cell count, creatine kinase-MB, and creatinine levels at the time of admission and the time between the onset of symptoms and presentation at hospital, a risk score (Greek Acute Coronary Syndrome score; range, 6-36) was developed and tested against in-hospital and 30-day outcome of the patients. The Greek Acute Coronary Syndrome score showed strong discriminating ability for in-hospital mortality (area under the receiver operating characteristic curve, 0.812; 95% confidence interval, 0.750-0.874; P period.

  14. Validez y reproducibilidad de un cuestionario de frecuencia de consumo de calcio para mujeres entre 30 y 50 años: Validation and reproducibility of a calcium frequency of consumption questionnaire for 30 through 50 year-old women

    Directory of Open Access Journals (Sweden)

    Carlos Rojas

    2011-07-01

    Full Text Available Objetivos: Medir la validez y la reproducibilidad de un cuestionario de frecuencia de consumo de alimentos (FCA, para evaluar el consumo de calcio en mujeres. Diseño: Estudio de tipo longitudinal y prospectivo. Lugar: Hogares en la ciudad del Lima, del entorno familiar de los estudiantes de la EAP de Nutrición. Participantes: Mujeres de 30 a 50 años. Métodos: Se capacitó 78 mujeres voluntarias entre 30 y 50 años de edad para llevar un registro de alimentos (REG ingeridos durante 7 días, en dos períodos distintos, con cuatro meses de diferencia entre ambos. En el segundo periodo se les administró una encuesta de FCA con 24 alimentos y preparaciones presentadas en porciones habituales. Para medir la concordancia se calculó la rho de Spearman y el coeficiente kappa; también la sensibilidad y especificidad de la FCA; se elaboró un gráfico de Bland y Altman. Principales medidas de resultados: Miligramos de calcio consumidos, según REG y FCA. Resultados: Los promedios de consumo de calcio durante 14 días en los registros de 24 horas, según FCA1 y el FCA2, fueron 415 mg ± 130,4 mg, 564 mg ± 362,5 y 490 mg ± 338,3 mg, respectivamente. El coeficiente kappa fue 0,247, bajo pero significativo. El 98,7% y 76,9% de las mujeres tuvieron consumo deficiente según los 14 registros y según la FCA, respectivamente. La sensibilidad fue 77,9%, la especificidad 100% y el valor predictivo positivo 100%. Conclusiones: Los coeficientes de asociación encontrados fueron bajos. Sin embargo, debido a la alta incidencia de consumo deficiente de calcio el formato empleado tiene una buena capacidad de detectar a las personas con un consumo deficiente.

  15. 76 FR 28986 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2011-05-19

    ... through a variety of research methods for developing and testing communications involving health....50 216 Screening for General Public Focus Group 2,160 1 10/60 360 Interviews Web usability testing sessions 144 1 1.50 216 Screening for Web usability testing 2,160 1 10/60 360 Self-Administered Surveys 2...

  16. Control of tropical instability waves in the Pacific

    Science.gov (United States)

    Allen, M. R.; Lawrence, S. P.; Murray, M. J.; Mutlow, C. T.; Stockdale, T. N.; Llewellyn-Jones, D. T.; Anderson, D. L. T.

    Westward-propagating waves with periods of 20-30 days and wavelengths of ˜ 1,100km are a prominent feature of sea-surface temperatures (SSTs) in the equatorial Pacific and Atlantic Oceans. They have been attributed to instabilities due to current shear. We compare SST observations from the spaceborne Along Track Scanning Radiometer (ATSR) and TOGA-TAO moored buoys with SSTs from a model of the tropical Pacific forced with observed daily windstress data. The phases of the strongest “Tropical Instability Waves” (TIWs) in the model are in closer correspondence with those observed than we would expect if these waves simply developed from infinitesimal disturbances (in which case their phases would be arbitrary). If we filter out the intraseasonal component of the windstress, all phase-correspondence is lost. We conclude that the phases of these waves are not arbitrary, but partially determined by the intraseasonal winds. The subsurface evolution of the model suggests a possible control mechanism is through interaction with remotely-forced subsurface Kelvin and Rossby waves. This is supported by an experiment which shows how zonal wind bursts in the west Pacific can modify the TIW field, but other mechanisms, such as local feedbacks, are also possible.

  17. 50 Div in Normandy: A Critical Analysis of the British 50th (Northumbrian) Division on D-Day and in the Battle of Normandy

    National Research Council Canada - National Science Library

    Williams, Ethan R

    2007-01-01

    ...: the 50th's prior combat experiences in France, North Africa, and Sicily; the 50th's overall readiness for war during the period before the invasion, including pre-invasion training; and the performance of the 50th Division in specific combat engagements in Normandy.

  18. [Risk Prediction Using Routine Data: Development and Validation of Multivariable Models Predicting 30- and 90-day Mortality after Surgical Treatment of Colorectal Cancer].

    Science.gov (United States)

    Crispin, Alexander; Strahwald, Brigitte; Cheney, Catherine; Mansmann, Ulrich

    2018-06-04

    Quality control, benchmarking, and pay for performance (P4P) require valid indicators and statistical models allowing adjustment for differences in risk profiles of the patient populations of the respective institutions. Using hospital remuneration data for measuring quality and modelling patient risks has been criticized by clinicians. Here we explore the potential of prediction models for 30- and 90-day mortality after colorectal cancer surgery based on routine data. Full census of a major statutory health insurer. Surgical departments throughout the Federal Republic of Germany. 4283 and 4124 insurants with major surgery for treatment of colorectal cancer during 2013 and 2014, respectively. Age, sex, primary and secondary diagnoses as well as tumor locations as recorded in the hospital remuneration data according to §301 SGB V. 30- and 90-day mortality. Elixhauser comorbidities, Charlson conditions, and Charlson scores were generated from the ICD-10 diagnoses. Multivariable prediction models were developed using a penalized logistic regression approach (logistic ridge regression) in a derivation set (patients treated in 2013). Calibration and discrimination of the models were assessed in an internal validation sample (patients treated in 2014) using calibration curves, Brier scores, receiver operating characteristic curves (ROC curves) and the areas under the ROC curves (AUC). 30- and 90-day mortality rates in the learning-sample were 5.7 and 8.4%, respectively. The corresponding values in the validation sample were 5.9% and once more 8.4%. Models based on Elixhauser comorbidities exhibited the highest discriminatory power with AUC values of 0.804 (95% CI: 0.776 -0.832) and 0.805 (95% CI: 0.782-0.828) for 30- and 90-day mortality. The Brier scores for these models were 0.050 (95% CI: 0.044-0.056) and 0.067 (95% CI: 0.060-0.074) and similar to the models based on Charlson conditions. Regardless of the model, low predicted probabilities were well calibrated, while

  19. A comparison of the survival (LD/sub 50/30/) of a number of inbred mouse strains after X and 60Co gamma irradiation

    International Nuclear Information System (INIS)

    Vacha, J.; Znojil, V.; Hola, J.; Sikulova, J.

    1984-01-01

    The value of LD/sub 50/30/ for X and 60 Co gamma radiation was ascertained for several inbred mouse strains and the significance of interstrain differences in these parameters determined. The rank order of strains according to LD/sub 50/30/ differs as between the two types of radiation with the exception of the strains BALB/c and B10.LP/Ph, which are the least resistant to radiation-induced lethality with both types of radiation. The strain C57BL/10ScSnPh is highly resistant to X irradiation. The relative biological effectiveness of 60 Co gamma radiation as compared with X-radiation from the point of view of lethality fluctuates between 0.748 and 0.952 in individual strains, with a mean value of 0.866 +- 0.033. The RBE values do not correlate with the radiosensitivity of the strain, but they do correlate with the relative contribution to erythropoiesis of the spleen. (author)

  20. Comparison of the survival (LD/sub 50/30/) of a number of inbred mouse strains after X and /sup 60/Co gamma irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Vacha, J.; Znojil, V.; Hola, J.; Sikulova, J. (Ceskoslovenska Akademie Ved, Brno. Biofysikalni Ustav)

    1984-01-01

    The value of LD/sub 50/30/ for X and /sup 60/Co gamma radiation was ascertained for several inbred mouse strains and the significance of interstrain differences in these parameters determined. The rank order of strains according to LD/sub 50/30/ differs as between the two types of radiation with the exception of the strains BALB/c and B10.LP/Ph, which are the least resistant to radiation-induced lethality with both types of radiation. The strain C57BL/10ScSnPh is highly resistant to X irradiation. The relative biological effectiveness of /sup 60/Co gamma radiation as compared with X-radiation from the point of view of lethality fluctuates between 0.748 and 0.952 in individual strains, with a mean value of 0.866 +- 0.033. The RBE values do not correlate with the radiosensitivity of the strain, but they do correlate with the relative contribution to erythropoiesis of the spleen.

  1. External Validation of a Case-Mix Adjustment Model for the Standardized Reporting of 30-Day Stroke Mortality Rates in China.

    Directory of Open Access Journals (Sweden)

    Ping Yu

    Full Text Available A case-mix adjustment model has been developed and externally validated, demonstrating promise. However, the model has not been thoroughly tested among populations in China. In our study, we evaluated the performance of the model in Chinese patients with acute stroke.The case-mix adjustment model A includes items on age, presence of atrial fibrillation on admission, National Institutes of Health Stroke Severity Scale (NIHSS score on admission, and stroke type. Model B is similar to Model A but includes only the consciousness component of the NIHSS score. Both model A and B were evaluated to predict 30-day mortality rates in 13,948 patients with acute stroke from the China National Stroke Registry. The discrimination of the models was quantified by c-statistic. Calibration was assessed using Pearson's correlation coefficient.The c-statistic of model A in our external validation cohort was 0.80 (95% confidence interval, 0.79-0.82, and the c-statistic of model B was 0.82 (95% confidence interval, 0.81-0.84. Excellent calibration was reported in the two models with Pearson's correlation coefficient (0.892 for model A, p<0.001; 0.927 for model B, p = 0.008.The case-mix adjustment model could be used to effectively predict 30-day mortality rates in Chinese patients with acute stroke.

  2. Effects of light on NO3 uptake in small forested streams: diurnal and day-to-day variations

    Energy Technology Data Exchange (ETDEWEB)

    Mulholland, Patrick J [ORNL

    2006-08-01

    We investigated the effects of autotrophy on short-term variations in nutrient dynamics by measuring diurnal and day-to-day variations in light level, primary productivity, and NO{sub 3}{sup -} uptake during early and late spring in 2 forested streams, the East and West Forks of Walker Branch in eastern Tennessee, USA. We predicted that diurnal and day-to-day variations in NO{sub 3}{sup -} uptake rate would be larger in the West Fork than in the East Fork in early spring because of higher rates of primary productivity resulting from a more stable substratum in the West Fork. We also predicted minimal diurnal variations in both streams in late spring after forest leaf emergence when light levels and primary productivity are uniformly low. Reach-scale rates of gross primary production (GPP) were determined using the diurnal dissolved O{sub 2} change technique, and reach-scale rates of NO{sub 3}{sup -} uptake were determined by tracer {sup 15}N-NO{sub 3}{sup -} additions. In the West Fork, significant diurnal and day-to-day variations in NO{sub 3}{sup -} uptake were related to variations in light level and primary productivity in early spring but not in late spring, consistent with our predictions. In early spring, West Fork NO{sub 3}{sup -} uptake rates were 2 to 3x higher at midday than during predawn hours and 50% higher on 2 clear days than on an overcast day several days earlier. In the East Fork, early spring rates of GPP were 4 to 5x lower than in the West Fork and diurnal and day-to-day variations in NO{sub 3}{sup -} uptake rates were <30%, considerably lower than in the West Fork. However, diurnal variations in NO{sub 3}{sup -} uptake rates were greater in late spring in the East Fork, possibly because of diurnal variation in water temperature. Our results indicate the important role of autotrophs in nutrient uptake in some forested streams, particularly during seasons when forest vegetation is dormant and light levels are relatively high. Our results also

  3. FRAKSINASI PROTEIN KAPANG LAUT Xylaria psidii KT30 DAN SITOTOKSISITASNYA TERHADAP SEL HeLa [Fractionation of Proteins of Marine Fungus Xylaria psidii KT30 and their Cytotoxicity against HeLa Cells

    Directory of Open Access Journals (Sweden)

    Mita Gebriella Inthe

    2014-06-01

    Full Text Available Cervical cancer is the most common cause of death for Indonesian women after human breast cancer. One of the efforts of cancer treatment is the utilization of natural compounds. One of the microorganisms having the potential as anticancer agent is endophytic fungi. Endophytic fungi from the marine habitat can be isolated from sea weeds, sea grasses, sponges, and mangroves. Xylaria psidii KT30, a marine fungus used in this study was isolated from red seaweed Kappaphycus alvarezii. Xylaria psidii KT30 was cultivated in potato dextrose broth medium for nine days at room temperature 27-29°C in shaking condition. This study aimed to obtain protein fractions from X. psidii KT30 and determine their toxicity againt Chang and HeLa cells. The fractionation process was conducted using DEAE Sephadex A-50 column chromatography and the toxicity was determined by Brine Shrimp Lethality Test (BSLT. The metabolites excreted in the culture broth was extracted using 90% of ammonium sulphate. The extract was then tested for their toxicity against HeLa and Chang cells by Microculture Tetrazolium Technique (MTT assay.The results revealed that LC50 of the protein extract of X. psidii KT30 was 104.95 ppm and IC50 was 69.9 ppm. Based on the National Cancer Institute (NCI, this value showed moderate cytotoxicity against HeLa cells.

  4. Dementia and Risk of 30-Day Readmission in Older Adults After Discharge from Acute Care Hospitals.

    Science.gov (United States)

    Sakata, Nobuo; Okumura, Yasuyuki; Fushimi, Kiyohide; Nakanishi, Miharu; Ogawa, Asao

    2018-02-20

    To assess the association between dementia and risk of hospital readmission and to evaluate whether the effect of dementia on hospital readmission varies according to primary diagnosis. Retrospective cohort study. Nationwide discharge database of acute care hospitals in Japan. Individuals aged 65 and older diagnosed with one of the 30 most common diagnoses and discharged from 987 hospitals between April 2014 and September 2015 (N = 1,834,378). The primary outcome was unplanned hospital readmission within 30 days. Poisson generalized estimating equation models were fitted to assess the risks of readmission for individuals with and without dementia, using primary diagnosis as a possible effect modifier and clinical factors as potential confounders. The overall prevalence of dementia was 14.7% and varied according to primary diagnosis, ranging from 3.0% in individuals with prostate cancer to 69.4% in those with aspiration pneumonia. Overall, individuals with dementia had a higher risk of hospital readmission (8.3%) than those without (4.1%) (adjusted risk ratio (aRR])=1.46, 95% confidence interval (CI)=1.44-1.49), although diagnostic category substantially modified the relationship between dementia and hospital readmission. For hip fracture, dementia was associated with greater risk of hospital readmission (adjusted risk 11.5% vs 7.9%; aRR=1.46; 95% CI=1.28-1.68); this risk was attenuated for cholecystitis (adjusted risk 12.8% vs 12.4%; aRR=1.03; 95% CI=0.90-1.18). Risk of hospital readmission associated with dementia varied according to primary diagnosis. Healthcare providers could enforce interventions to minimize readmission by focusing on comorbid conditions in individuals with dementia and specific primary diagnoses that increase their risk of readmission. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

  5. An Examination of the First 30 Days After Patients are Discharged to the Community From Hip Fracture Postacute Care.

    Science.gov (United States)

    Leland, Natalie E; Gozalo, Pedro; Christian, Thomas J; Bynum, Julie; Mor, Vince; Wetle, Terrie F; Teno, Joan M

    2015-10-01

    Postacute care (PAC) rehabilitation aims to maximize independence and facilitate a safe community transition. Yet little is known about PAC patients' success in staying home after discharge or differences on this outcome across PAC providers. Examine the percentage of PAC patients who remain in the community at least 30 days after discharge (ie, successful community discharge) after hip fracture rehabilitation and describe differences among PAC facilities based on this outcome. Retrospective observational study. Community-dwelling, Medicare fee-for-service beneficiaries 75 years of age and above who experienced their first hip fracture between 1999 and 2007 (n=880,779). PAC facilities admitting hip fracture patients in 2006. Successful community discharge, sites of readmission after PAC discharge. Between 1999 and 2007, 57% of patients achieved successful community discharge. Black were less likely (adjusted odds ratios=0.84; 95% confidence interval, 0.82-0.86) than similar whites to achieve successful community discharge. Among all who reentered the community (n=581,095), 14% remained in the community community discharge among facilities was 49% (interquartile range, 33%-66%). Lowest-quartile facilities admitted older (85.9 vs. 84.1 y of age), sicker patients (eg, higher rates of hospital complications 6.0% vs. 4.6%), but admitted fewer annually (7.1 vs. 19.3), compared with the highest quartile. Reentry into the health care system after PAC community discharge is common. Because of the distinct care needs of the PAC population there is a need for a quality measure that complements the current 30-day hospital readmission outcome and captures the objectives of PAC rehabilitation.

  6. MC-50 AVF cyclotron operation

    International Nuclear Information System (INIS)

    Kim, Yu Seok; Chai, Jong Seo; Bak, Seong Ki; Park, Chan Won; Jo, Young Ho; Hong, Seong Seok; Lee, Min Yong; Jang Ho Ha

    2000-01-01

    The first cyclotron in Korea, MC-50 cyclotron is used for neutron irradiation, radionuclide development, production and material and biomedical research. 50.5MeV and 35MeV proton beam have been extracted with 20-60μA. A total of beam extraction time are 1095.7 hours. 206.5 hours are used for the developments and 663.8 hours are for radionuclide production and development and 225.4 hours for application researches. The shutdown days are 23 days. Fundamental data for failure decrement and efficient beam extraction were composed and maintenance technologies were developed

  7. MC-50 AVF cyclotron operation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yu Seok; Chai, Jong Seo; Bak, Seong Ki; Park, Chan Won; Jo, Young Ho; Hong, Seong Seok; Lee, Min Yong; Jang Ho Ha

    2000-01-01

    The first cyclotron in Korea, MC-50 cyclotron is used for neutron irradiation, radionuclide development, production and material and biomedical research. 50.5MeV and 35MeV proton beam have been extracted with 20-60{mu}A. A total of beam extraction time are 1095.7 hours. 206.5 hours are used for the developments and 663.8 hours are for radionuclide production and development and 225.4 hours for application researches. The shutdown days are 23 days. Fundamental data for failure decrement and efficient beam extraction were composed and maintenance technologies were developed.

  8. Predicting all-cause risk of 30-day hospital readmission using artificial neural networks.

    Science.gov (United States)

    Jamei, Mehdi; Nisnevich, Aleksandr; Wetchler, Everett; Sudat, Sylvia; Liu, Eric

    2017-01-01

    Avoidable hospital readmissions not only contribute to the high costs of healthcare in the US, but also have an impact on the quality of care for patients. Large scale adoption of Electronic Health Records (EHR) has created the opportunity to proactively identify patients with high risk of hospital readmission, and apply effective interventions to mitigate that risk. To that end, in the past, numerous machine-learning models have been employed to predict the risk of 30-day hospital readmission. However, the need for an accurate and real-time predictive model, suitable for hospital setting applications still exists. Here, using data from more than 300,000 hospital stays in California from Sutter Health's EHR system, we built and tested an artificial neural network (NN) model based on Google's TensorFlow library. Through comparison with other traditional and non-traditional models, we demonstrated that neural networks are great candidates to capture the complexity and interdependency of various data fields in EHRs. LACE, the current industry standard, showed a precision (PPV) of 0.20 in identifying high-risk patients in our database. In contrast, our NN model yielded a PPV of 0.24, which is a 20% improvement over LACE. Additionally, we discussed the predictive power of Social Determinants of Health (SDoH) data, and presented a simple cost analysis to assist hospitalists in implementing helpful and cost-effective post-discharge interventions.

  9. 41 CFR 301-71.209 - Must we pay a late payment fee if we fail to reimburse the employee within 30 calendar days after...

    Science.gov (United States)

    2010-07-01

    ... payment fee if we fail to reimburse the employee within 30 calendar days after receipt of a proper travel claim? 301-71.209 Section 301-71.209 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY...

  10. Observed to expected or logistic regression to identify hospitals with high or low 30-day mortality?

    Science.gov (United States)

    Helgeland, Jon; Clench-Aas, Jocelyne; Laake, Petter; Veierød, Marit B.

    2018-01-01

    Introduction A common quality indicator for monitoring and comparing hospitals is based on death within 30 days of admission. An important use is to determine whether a hospital has higher or lower mortality than other hospitals. Thus, the ability to identify such outliers correctly is essential. Two approaches for detection are: 1) calculating the ratio of observed to expected number of deaths (OE) per hospital and 2) including all hospitals in a logistic regression (LR) comparing each hospital to a form of average over all hospitals. The aim of this study was to compare OE and LR with respect to correctly identifying 30-day mortality outliers. Modifications of the methods, i.e., variance corrected approach of OE (OE-Faris), bias corrected LR (LR-Firth), and trimmed mean variants of LR and LR-Firth were also studied. Materials and methods To study the properties of OE and LR and their variants, we performed a simulation study by generating patient data from hospitals with known outlier status (low mortality, high mortality, non-outlier). Data from simulated scenarios with varying number of hospitals, hospital volume, and mortality outlier status, were analysed by the different methods and compared by level of significance (ability to falsely claim an outlier) and power (ability to reveal an outlier). Moreover, administrative data for patients with acute myocardial infarction (AMI), stroke, and hip fracture from Norwegian hospitals for 2012–2014 were analysed. Results None of the methods achieved the nominal (test) level of significance for both low and high mortality outliers. For low mortality outliers, the levels of significance were increased four- to fivefold for OE and OE-Faris. For high mortality outliers, OE and OE-Faris, LR 25% trimmed and LR-Firth 10% and 25% trimmed maintained approximately the nominal level. The methods agreed with respect to outlier status for 94.1% of the AMI hospitals, 98.0% of the stroke, and 97.8% of the hip fracture hospitals

  11. Comparative study of buffered 50% glycolic acid (pH 3.0) + 0.5% salicylic acid solution vs Jessner's solution in patients with acne vulgaris.

    Science.gov (United States)

    In Jae, Jeong; Dong Ju, Hyun; Dong Hyun, Kim; Yoon, Moon Soo; Lee, Hee Jung

    2017-11-21

    Superficial chemical peels are frequently used in acne vulgaris treatment. Although glycolic acid (GA) has been widely used in clinical practice, its pH ranges from 0.08-2.75 and thus should be neutralized after application to avoid burns. To evaluate treatment efficacy and safety of chemical peeling using buffered 50% GA (pH 3.0) + 0.5% salicylic acid (SA) solution that does not need to be neutralized in the treatment of acne vulgaris compared to the conventional peeling using Jessner's solution. We performed a prospective, randomized, evaluator-blind, split-face clinical trial. Twenty patients were randomized by assigning one side of each patient's face to receive a 50% GA (pH 3.0) + 0.5% SA peel (GA side) and the other side to receive the Jessner's solution (Jessner's solution side). All patients underwent 2 sessions of treatment spaced 2 weeks apart. Lesion count, acne severity, subjective efficacy assessment, and side effects were evaluated. The total lesion count was significantly reduced for the GA and Jessner's solution sides (P  .05). The GA side had fewer side effects than the Jessner's solution side. The results of this study suggest that chemical peeling using the 50% GA (pH 3.0) + 0.5% SA solution can be as effective and convenient as the conventional peeling using Jessner's solution in the treatment of acne vulgaris and may show fewer adverse events than the conventional peeling. © 2017 Wiley Periodicals, Inc.

  12. Thirty-day outcomes underestimate endocrine and exocrine insufficiency after pancreatic resection.

    Science.gov (United States)

    Lim, Pei-Wen; Dinh, Kate H; Sullivan, Mary; Wassef, Wahid Y; Zivny, Jaroslav; Whalen, Giles F; LaFemina, Jennifer

    2016-04-01

    Long-term incidence of endocrine and exocrine insufficiency after pancreatectomy is poorly described. We analyze the long-term risks of pancreatic insufficiency after pancreatectomy. Subjects who underwent pancreatectomy from 2002 to 2012 were identified from a prospective database (n = 227). Subjects who underwent total pancreatectomy or pancreatitis surgery were excluded. New post-operative endocrine and exocrine insufficiency was defined as the need for new pharmacologic intervention within 1000 days from resection. 28 (16%) of 178 subjects without pre-existing endocrine insufficiency developed post-operative endocrine insufficiency: 7 (25%) did so within 30 days, 8 (29%) between 30 and 90 days, and 13 (46%) after 90 days. 94 (43%) of 214 subjects without pre-operative exocrine insufficiency developed exocrine insufficiency: 20 (21%) did so within 30 days, 29 (31%) between 30 and 90 days, and 45 (48%) after 90 days. Adjuvant radiation was associated with new endocrine insufficiency. On multivariate regression, pancreaticoduodenectomy and chemotherapy were associated with a greater risk of exocrine insufficiency. Reporting 30-day functional outcomes for pancreatic resection is insufficient, as nearly 45% of subjects who develop disease do so after 90 days. Reporting of at least 90-day outcomes may more reliably assess risk for post-operative endocrine and exocrine insufficiency. Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

  13. Error sensitivity analysis in 10-30-day extended range forecasting by using a nonlinear cross-prediction error model

    Science.gov (United States)

    Xia, Zhiye; Xu, Lisheng; Chen, Hongbin; Wang, Yongqian; Liu, Jinbao; Feng, Wenlan

    2017-06-01

    Extended range forecasting of 10-30 days, which lies between medium-term and climate prediction in terms of timescale, plays a significant role in decision-making processes for the prevention and mitigation of disastrous meteorological events. The sensitivity of initial error, model parameter error, and random error in a nonlinear crossprediction error (NCPE) model, and their stability in the prediction validity period in 10-30-day extended range forecasting, are analyzed quantitatively. The associated sensitivity of precipitable water, temperature, and geopotential height during cases of heavy rain and hurricane is also discussed. The results are summarized as follows. First, the initial error and random error interact. When the ratio of random error to initial error is small (10-6-10-2), minor variation in random error cannot significantly change the dynamic features of a chaotic system, and therefore random error has minimal effect on the prediction. When the ratio is in the range of 10-1-2 (i.e., random error dominates), attention should be paid to the random error instead of only the initial error. When the ratio is around 10-2-10-1, both influences must be considered. Their mutual effects may bring considerable uncertainty to extended range forecasting, and de-noising is therefore necessary. Second, in terms of model parameter error, the embedding dimension m should be determined by the factual nonlinear time series. The dynamic features of a chaotic system cannot be depicted because of the incomplete structure of the attractor when m is small. When m is large, prediction indicators can vanish because of the scarcity of phase points in phase space. A method for overcoming the cut-off effect ( m > 4) is proposed. Third, for heavy rains, precipitable water is more sensitive to the prediction validity period than temperature or geopotential height; however, for hurricanes, geopotential height is most sensitive, followed by precipitable water.

  14. Intraseasonal variation in survival and probable causes of mortality in greater sage-grouse Centrocercus urophasianus

    Science.gov (United States)

    Blomberg, Erik J.; Gibson, Daniel; Sedinger, James S.; Casazza, Michael L.; Coates, Peter S.

    2013-01-01

    The mortality process is a key component of avian population dynamics, and understanding factors that affect mortality is central to grouse conservation. Populations of greater sage-grouse Centrocercus urophasianus have declined across their range in western North America. We studied cause-specific mortality of radio-marked sage-grouse in Eureka County, Nevada, USA, during two seasons, nesting (2008-2012) and fall (2008-2010), when survival was known to be lower compared to other times of the year. We used known-fate and cumulative incidence function models to estimate weekly survival rates and cumulative risk of cause-specific mortalities, respectively. These methods allowed us to account for temporal variation in sample size and staggered entry of marked individuals into the sample to obtain robust estimates of survival and cause-specific mortality. We monitored 376 individual sage-grouse during the course of our study, and investigated 87 deaths. Predation was the major source of mortality, and accounted for 90% of all mortalities during our study. During the nesting season (1 April - 31 May), the cumulative risk of predation by raptors (0.10; 95% CI: 0.05-0.16) and mammals (0.08; 95% CI: 0.03-013) was relatively equal. In the fall (15 August - 31 October), the cumulative risk of mammal predation was greater (M(mam) = 0.12; 95% CI: 0.04-0.19) than either predation by raptors (M(rap) = 0.05; 95% CI: 0.00-0.10) or hunting harvest (M(hunt) = 0.02; 95% CI: 0.0-0.06). During both seasons, we observed relatively few additional sources of mortality (e.g. collision) and observed no evidence of disease-related mortality (e.g. West Nile Virus). In general, we found little evidence for intraseasonal temporal variation in survival, suggesting that the nesting and fall seasons represent biologically meaningful time intervals with respect to sage-grouse survival.

  15. FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN OBESITAS SENTRAL PADA WANITADEWASA (30-50 TAH UN DI KECAMATAN LUBUK SIKAPING TAHUN 2008

    Directory of Open Access Journals (Sweden)

    Ida Trisna

    2009-03-01

    Full Text Available Nutritionproblem in Indonesia now is recognized as multiple Nutritionproblem (double burden where Faced in the form of less and over nutrition. It happened not only in urban but also in rural area. High energy intake not in concurrently with physical activity will result in energy excess stored in adipose tissue in unlimited number. With the increasing of age. the increasing of adipose cell at woman 30-50 years happened significantly. Waist circumference Measurement is one way of assessing fat hoard in stomach. This research was aimed to know The relation of energy intake, carbohydrate, fat and physical activities with obesity central at women (30-50 years Kecamatan Lubuk Sikaping Kabupaten Pasaman 2008. This research type is cross sectional study, with test chi-square, analyzed in univariat, bivariate and multivariat. Sample amounts to / 73 people who selected in stratified random sampling; data was collected through interview with the instrument of questionnaire and conducted in March until June 2008 in Kecamatan Lubuk Sikaping Pasaman. Prom this research were found central obesity prevalence of 49, 7%, with average of energy intake from carbohydrate percentage higher than recommended. This research concludes that there is significant relationship between intakeof energy, carbohydrate, fat and physical activity with central obesity. From multivariate analysis wasfound that responder with average of energy intake from percentage carbohydrate > 60% is 10,9 times in risk. From result of this research it is expected to related institution and the community to intensify the program preventive and in handling over nutrition by socializing PUGS periodically and without disregarding the problem of less nutrition.

  16. Multi-pentad prediction of precipitation variability over Southeast Asia during boreal summer using BCC_CSM1.2

    Science.gov (United States)

    Li, Chengcheng; Ren, Hong-Li; Zhou, Fang; Li, Shuanglin; Fu, Joshua-Xiouhua; Li, Guoping

    2018-06-01

    Precipitation is highly variable in space and discontinuous in time, which makes it challenging for models to predict on subseasonal scales (10-30 days). We analyze multi-pentad predictions from the Beijing Climate Center Climate System Model version 1.2 (BCC_CSM1.2), which are based on hindcasts from 1997 to 2014. The analysis focus on the skill of the model to predict precipitation variability over Southeast Asia from May to September, as well as its connections with intraseasonal oscillation (ISO). The effective precipitation prediction length is about two pentads (10 days), during which the skill measured by anomaly correlation is greater than 0.1. In order to further evaluate the performance of the precipitation prediction, the diagnosis results of the skills of two related circulation fields show that the prediction skills for the circulation fields exceed that of precipitation. Moreover, the prediction skills tend to be higher when the amplitude of ISO is large, especially for a boreal summer intraseasonal oscillation. The skills associated with phases 2 and 5 are higher, but that of phase 3 is relatively lower. Even so, different initial phases reflect the same spatial characteristics, which shows higher skill of precipitation prediction in the northwest Pacific Ocean. Finally, filter analysis is used on the prediction skills of total and subseasonal anomalies. The results of the two anomaly sets are comparable during the first two lead pentads, but thereafter the skill of the total anomalies is significantly higher than that of the subseasonal anomalies. This paper should help advance research in subseasonal precipitation prediction.

  17. Impact of Intraseasonal Oscillations on the Tropical Cyclone Activity Over the Gulf of Mexico and Western Caribbean Sea in GFDL HiRAM

    Science.gov (United States)

    Gao, Kun; Chen, Jan-Huey; Harris, Lucas M.; Lin, Shian-Jiann; Xiang, Baoqiang; Zhao, Ming

    2017-12-01

    The tropical cyclones (TCs) that form over the warm waters in the Gulf of Mexico region pose a major threat to the surrounding coastal communities. Skillful subseasonal prediction of TC activity is important for early preparedness and reducing the TC damage in this region. In this study, we evaluate the performance of a 25 km resolution Geophysical Fluid Dynamics Laboratory (GFDL) High Resolution Atmospheric Model (HiRAM) in simulating the modulation of the TC activity in the Gulf of Mexico and western Caribbean Sea by the intraseasonal oscillation (ISO) based on multiyear retrospective seasonal predictions. We demonstrate that the HiRAM faithfully captures the observed influence of ISO on TC activity over the region of interest, including the formation of tropical storms and (major) hurricanes, as well as the landfalling storms. This is likely because of the realistic representation of the large-scale anomalies associated with boreal summer ISO over Northeast Pacific in HiRAM, especially the enhanced (reduced) moisture throughout the troposphere during the convectively enhanced (suppressed) phase of ISO. The reasonable performance of HiRAM suggests its potential for the subseasonal prediction of regional TC risk.

  18. Dependence between LD50 for Rodents and LC50 for Adult Fish and Fish Embryos.

    Science.gov (United States)

    Zolotarev, K V; Belyaeva, N F; Mikhailov, A N; Mikhailova, M V

    2017-02-01

    We revealed empirical dependences between common logarithm of a ratio of rat oral LD 50 to LC a 50 for adult fish and lgP for 50 different chemicals; and common logarithm of a ratio of the oral LD 50 in rodents to LC e 50 for fish embryos and lgP for 30 different chemicals. The dependences were obtained by constructing a trend line between experimental points and calculation of Pearson's R correlation coefficient as a measure of regression significance. These dependences can show the influence of substance lipophilicity on its toxicity for aquatic organisms comparing to mammals.

  19. Influence of employments physical exercises on age-dependent changes and rates of senescence of organism for women 30-50 years

    Directory of Open Access Journals (Sweden)

    Sorokina S.A.

    2010-07-01

    Full Text Available The special program of positive influence is developed on the general state of organism of women. The analysis of the special literature is conducted. In an experiment 26 women took part in age 30-50 years. Practical recommendations are developed in relation to employments by physical exercises. The use at health run and walking, respiratory exercises, exercises under musical accompaniment, engaged in yoga, is offered. Positive changes are fixed in the indexes of the functional state of the cardiovascular system and nervous system.

  20. Three stops of fuel reloading with length of less 30 days in the Laguna Verde Central; Tres paradas de recarga de combustible con duracion de menos de 30 dias en la Central Laguna Verde

    Energy Technology Data Exchange (ETDEWEB)

    Lozano L, A. [Comision Federal de Electricidad, Central Laguna Verde, Subgerencia General de Operacion Planeacion, Veracruz (Mexico)]. e-mail: agustin.lozano@cfe.gob.mx

    2007-07-01

    The Laguna Verde Central having established as mission 'With maximum priority in the safety, to generate electricity by nuclear means with quality and cost competitive, sustained in our personnel's continuous overcoming and deep respect to the environment' and respecting our values (safety, responsibility by results, professional integrity, continuous improving, team working, excellence in the acting, quality of service, protection to the environment) they thought about our strategic objectives of the power station being born this way one of them that it is the program of improvement 'Reduction of reload times' looking for to be improves every day comparing us with the best plants in the world efficient all the processes in the power station that allowed us to measure our acting with the same parameters that settle down at international level like they are nuclear safety, industrial safety, radiological safety, capacity factor, readiness factor, cleaning of the power station attachment to procedures, attention to the detail and certainly to be competitive in the economic aspect. After analyzing the acting record of the power station, evaluating our technical capacity, economic, the location of the installation besides revising the international experiences it was defined that one of the concepts that impact considerably so much to the capacity and readiness factors besides the dose and production cost is the duration of the reload periods, for this reason they were elaborated work strategies to be able to reach our goal of reload days considered in being able to carry out them in less than 30 days, here the actions carried out that they made us complete the three last reloads in less than 30 days are captured. (Author)

  1. Predicting all-cause risk of 30-day hospital readmission using artificial neural networks.

    Directory of Open Access Journals (Sweden)

    Mehdi Jamei

    Full Text Available Avoidable hospital readmissions not only contribute to the high costs of healthcare in the US, but also have an impact on the quality of care for patients. Large scale adoption of Electronic Health Records (EHR has created the opportunity to proactively identify patients with high risk of hospital readmission, and apply effective interventions to mitigate that risk. To that end, in the past, numerous machine-learning models have been employed to predict the risk of 30-day hospital readmission. However, the need for an accurate and real-time predictive model, suitable for hospital setting applications still exists. Here, using data from more than 300,000 hospital stays in California from Sutter Health's EHR system, we built and tested an artificial neural network (NN model based on Google's TensorFlow library. Through comparison with other traditional and non-traditional models, we demonstrated that neural networks are great candidates to capture the complexity and interdependency of various data fields in EHRs. LACE, the current industry standard, showed a precision (PPV of 0.20 in identifying high-risk patients in our database. In contrast, our NN model yielded a PPV of 0.24, which is a 20% improvement over LACE. Additionally, we discussed the predictive power of Social Determinants of Health (SDoH data, and presented a simple cost analysis to assist hospitalists in implementing helpful and cost-effective post-discharge interventions.

  2. Four stops of fuel reloading with duration of less of 30 days in the Laguna Verde Central; Cuatro paradas de recarga de combustible con duracion de menos de 30 dias en la central laguna verde

    Energy Technology Data Exchange (ETDEWEB)

    Lozano L, A. [CFE, Central Laguna Verde, Planeacion, Veracruz (Mexico)]. e-mail: agustin.lozano@cfe.gob.mx

    2008-07-01

    The Laguna Verde Central having established as mission 'With maximum priority in the safety, to generate electricity by nuclear means with competitive quality and cost, sustained in our personnel's continuous overcoming and deep respect to the environment' and respecting our values (safety, responsibility by results, professional integrity, continuous improvement, team work, excellence in the performance, quality of service, protection to the environment its thought about our strategic objectives of the power station being born by this way one of them that it is the improvement program 'reduction of reloading times' looking for to be improves every day comparing us with the best plants of the world effectiveness all the processes in the power station that allowed us to measure our performance with the same parameters that settle down at international level as its are nuclear safety, industrial safety, radiological safety, capacity factor, readiness factor, cleaning of the power station attachment to procedures, attention to the detail and certainly to be competitive in the economic aspect. After analyzing the performance record of the power station, evaluating our technical, economic capacity, the location of the installation besides revising the international experiences was defined that one of the concepts that impact considerably so much to the capacity factors and readiness besides the dose and production cost is the duration of the reloading periods, for this reason work strategies were elaborated to be able to reach our goals of reloading days in less than 30 days, here are formed the carried out actions that they made us complete the four last reloading in less than 30 days. (Author)

  3. Comparison of the pharmacokinetics of a new 30 mg modified-release tablet formulation of metoclopramide for once-a-day administration versus 10 mg immediate-release tablets: a single and multiple-dose, randomized, open-label, parallel study in healthy male subjects.

    Science.gov (United States)

    Bernardo-Escudero, Roberto; Alonso-Campero, Rosalba; Francisco-Doce, María Teresa de Jesús; Cortés-Fuentes, Myriam; Villa-Vargas, Miriam; Angeles-Uribe, Juan

    2012-12-01

    The study aimed to assess the pharmacokinetics of a new, modified-release metoclopramide tablet, and compare it to an immediate-release tablet. A single and multiple-dose, randomized, open-label, parallel, pharmacokinetic study was conducted. Investigational products were administered to 26 healthy Hispanic Mexican male volunteers for two consecutive days: either one 30 mg modified-release tablet every 24 h, or one 10 mg immediate-release tablet every 8 h. Blood samples were collected after the first and last doses of metoclopramide. Plasma metoclopramide concentrations were determined by high-performance liquid chromatography. Safety and tolerability were assessed through vital signs measurements, clinical evaluations, and spontaneous reports from study subjects. All 26 subjects were included in the analyses [mean (SD) age: 27 (8) years, range 18-50; BMI: 23.65 (2.22) kg/m², range 18.01-27.47)]. Peak plasmatic concentrations were not statistically different with both formulations, but occurred significantly later (p 0.05)]. One adverse event was reported in the test group (diarrhea), and one in the reference group (headache). This study suggests that the 30 mg modified-release metoclopramide tablets show features compatible with slow-release formulations when compared to immediate-release tablets, and is suitable for once-a-day administration.

  4. Risk-adjustment models for heart failure patients' 30-day mortality and readmission rates: the incremental value of clinical data abstracted from medical charts beyond hospital discharge record.

    Science.gov (United States)

    Lenzi, Jacopo; Avaldi, Vera Maria; Hernandez-Boussard, Tina; Descovich, Carlo; Castaldini, Ilaria; Urbinati, Stefano; Di Pasquale, Giuseppe; Rucci, Paola; Fantini, Maria Pia

    2016-09-06

    Hospital discharge records (HDRs) are routinely used to assess outcomes of care and to compare hospital performance for heart failure. The advantages of using clinical data from medical charts to improve risk-adjustment models remain controversial. The aim of the present study was to evaluate the additional contribution of clinical variables to HDR-based 30-day mortality and readmission models in patients with heart failure. This retrospective observational study included all patients residing in the Local Healthcare Authority of Bologna (about 1 million inhabitants) who were discharged in 2012 from one of three hospitals in the area with a diagnosis of heart failure. For each study outcome, we compared the discrimination of the two risk-adjustment models (i.e., HDR-only model and HDR-clinical model) through the area under the ROC curve (AUC). A total of 1145 and 1025 patients were included in the mortality and readmission analyses, respectively. Adding clinical data significantly improved the discrimination of the mortality model (AUC = 0.84 vs. 0.73, p < 0.001), but not the discrimination of the readmission model (AUC = 0.65 vs. 0.63, p = 0.08). We identified clinical variables that significantly improved the discrimination of the HDR-only model for 30-day mortality following heart failure. By contrast, clinical variables made little contribution to the discrimination of the HDR-only model for 30-day readmission.

  5. Variation of explosive force at different times of day

    Directory of Open Access Journals (Sweden)

    R Pereira

    2011-03-01

    Full Text Available AIM: The purpose of this study was to compare the explosive force and electromyographic (EMG activity at three different times of the day. METHODS: Thirty healthy subjects took part in the study, and carried out two maximum isometric voluntary knee extensions to measure explosive force, through contractile impulse (CI and rate of force development (RFD, and myoelectric signals from quadriceps muscles in the following periods: 07:30-09:30, 13:30-15:30 and 19:30-21:30 (called morning, afternoon and night respectively, on three non-consecutive days. RESULTS: The body temperature was lower in the morning than in the afternoon and night periods. The explosive force, evaluated through contractile impulse (CI and rate of force development (RFD, was greater at night than in the morning, without differences in the myoelectric signal. CONCLUSION: The ability to produce explosive force varies throughout different times of the day without variation in muscular recruitment, indicating that peripheral and not neural mechanisms could be responsible for this variation.

  6. Performance of hospitals according to the ESC ACCA quality indicators and 30-day mortality for acute myocardial infarction:national cohort study using the United Kingdom Myocardial Ischaemia National Audit Project (MINAP) register

    OpenAIRE

    Bebb, Owen; Hall, Marlous; Fox, Keith A A; Dondo, Tatendashe B; Timmis, Adam; Bueno, Hector; Schiele, François; Gale, Chris P

    2017-01-01

    Aims: To investigate the application of the European Society of Cardiology Acute Cardiovascular Care Association quality indicators (QI) for acute myocardial infarction for the study of hospital performance and 30-day mortality.Methods and results: National cohort study (n = 118,075 patients, n = 211 hospitals, MINAP registry), 2012-13. Overall, 16 of the 20 QIs could be calculated. Eleven QIs had a significant inverse association with GRACE risk adjusted 30-day mortality (all P < 0.005). ...

  7. Blood Transfusion and 30-Day Mortality in Patients With Coronary Artery Disease and Anemia Following Noncardiac Surgery.

    Science.gov (United States)

    Hollis, Robert H; Singletary, Brandon A; McMurtrie, James T; Graham, Laura A; Richman, Joshua S; Holcomb, Carla N; Itani, Kamal M; Maddox, Thomas M; Hawn, Mary T

    2016-02-01

    Although liberal blood transfusion thresholds have not been beneficial following noncardiac surgery, it is unclear whether higher thresholds are appropriate for patients who develop postoperative myocardial infarction (MI). To evaluate the association between postoperative blood transfusion and mortality in patients with coronary artery disease and postoperative MI following noncardiac surgery. Retrospective cohort study involving Veterans Affairs facilities from January 1, 2000, to December 31, 2012. A total of 7361 patients with coronary artery disease who underwent inpatient noncardiac surgery and had a nadir postoperative hematocrit between 20% and 30%. Patients with significant bleeding, including any preoperative blood transfusion or transfusion of greater than 4 units during the intraoperative or postoperative setting, were excluded. Mortality rates were compared using both logistic regression and propensity score matching. Patients were stratified by postoperative nadir hematocrit and the presence of postoperative MI. Initial postoperative blood transfusion. The 30-day postoperative mortality rate. Of the 7361 patients, 2027 patients (27.5%) received at least 1 postoperative blood transfusion. Postoperative mortality occurred in 267 (3.6%), and MI occurred in 271 (3.7%). Among the 5334 patients without postoperative blood transfusion, lower nadir hematocrit was associated with an increased risk for mortality (hematocrit of 20% to blood transfusion was associated with lower mortality, for those with hematocrit of 20% to 24% (odds ratio, 0.28; 95% CI, 0.13-0.64). In patients without postoperative MI, transfusion was associated with significantly higher mortality for those with hematocrit of 27% to 30% (odds ratio, 3.21; 95% CI, 1.85-5.60). These findings support a restrictive postoperative transfusion strategy in patients with stable coronary artery disease following noncardiac surgery. However, interventional studies are needed to evaluate the use of a more

  8. Extended-range forecast for the temporal distribution of clustering tropical cyclogenesis over the western North Pacific

    Science.gov (United States)

    Zhu, Zhiwei; Li, Tim; Bai, Long; Gao, Jianyun

    2017-11-01

    Based on outgoing longwave radiation (OLR), an index for clustering tropical cyclogenesis (CTC) over the western North Pacific (WNP) was defined. Around 76 % of total CTC events were generated during the active phase of the CTC index, and 38 % of the total active phase was concurrent with CTC events. For its continuous property, the CTC index was used as the representative predictand for extended-range forecasting the temporal distribution of CTC events. The predictability sources for CTC events were detected via correlation analyses of the previous 35-5-day lead atmospheric fields against the CTC index. The results showed that the geopotential height at different levels and the 200 hPa zonal wind over the global tropics possessed large predictability sources, whereas the predictability sources of other variables, e.g., OLR, zonal wind, and relatively vorticity at 850 hPa and relatively humility at 700 hPa, were mainly confined to the tropical Indian Ocean and western Pacific Ocean. Several spatial-temporal projection model (STPM) sets were constructed to carry out the extended-range forecast for the CTC index. By combining the output of STPMs separately conducted for the two dominant modes of intraseasonal variability, e.g., the 10-30 and the 30-80 day mode, useful forecast skill could be achieved for a 30-day lead time. The combined output successfully captured both the 10-30 and 30-80 day mode at least 10 days in advance. With a relatively low rate of false alarm, the STPM achieved hits for 80 % (69 %) of 54 CTC events during 2003-2014 at the 10-day (20-day) lead time, suggesting a practical value of the STPM for real-time forecasting WNP CTC events at an extended range.

  9. Mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary European cohort of patients: How can early risk prediction be improved? The six-month GRACE risk score.

    Science.gov (United States)

    Raposeiras-Roubín, Sergio; Abu-Assi, Emad; Cambeiro-González, Cristina; Álvarez-Álvarez, Belén; Pereira-López, Eva; Gestal-Romaní, Santiago; Pedreira-López, Milagros; Rigueiro-Veloso, Pedro; Virgós-Lamela, Alejandro; García-Acuña, José María; González-Juanatey, José Ramón

    2015-06-01

    Given the increasing focus on early mortality and readmission rates among patients with acute coronary syndrome (ACS), this study was designed to evaluate the accuracy of the GRACE risk score for identifying patients at high risk of 30-day post-discharge mortality and cardiovascular readmission. This was a retrospective study carried out in a single center with 4229 ACS patients discharged between 2004 and 2010. The study endpoint was the combination of 30-day post-discharge mortality and readmission due to reinfarction, heart failure or stroke. One hundred and fourteen patients had 30-day events: 0.7% mortality, 1% reinfarction, 1.3% heart failure, and 0.2% stroke. After multivariate analysis, the six-month GRACE risk score was associated with an increased risk of 30-day events (HR 1.03, 95% CI 1.02-1.04; p<0.001), demonstrating good discrimination (C-statistic: 0.79 ± 0.02) and optimal fit (Hosmer-Lemeshow p=0.83). The sensitivity and specificity were adequate (78.1% and 63.3%, respectively), and negative predictive value was excellent (99.1%). In separate analyses for each event of interest (all-cause mortality, reinfarction, heart failure and stroke), assessment of the six-month GRACE risk score also demonstrated good discrimination and fit, as well as adequate predictive values. The six-month GRACE risk score is a useful tool to predict 30-day post-discharge death and early cardiovascular readmission. Clinicians may find it simple to use with the online and mobile app score calculator and applicable to clinical daily practice. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  10. The recovery of bone marrow derived GM-CFU in baboons unilaterally exposed to a total body LD50/30d mixed neutron-gamma irradiation

    International Nuclear Information System (INIS)

    Herodin, F.; Orfeuvre, H.; Janodet, D.; Mestries, J.C.; Fatome, M.

    1990-01-01

    The unilateral exposure of baboons to a total body LD 50/30d mixed neutron/gamma irradiation was characterized to be non uniform in dose distribution. The pattern of recovery of granulocyte-macrophage progenitors in bone marrow samples collected from entrance and exit sides respectively is consistent with this observed heterogeneity [fr

  11. Elastic scattering of charged mesons, antiprotons and protons on protons at incident momenta of 20, 30 and 50 GeV/c in the momentum tranfer range 0.52

    International Nuclear Information System (INIS)

    Asa'd, Z.; Coupland, M.; Davis, D.G.; Duff, B.G.; Fearnley, T.; Heymann, F.F.; Imrie, D.C.; Lush, G.J.; Phillips, M.; Baglin, C.; Guillaud, J.P.; Poulet, M.; Myrheim, J.; Gjerpe, I.K.; Buran, T.; Buzzo, A.; Ferroni, S.; Gracco, V.; Kirsebom, K.; Macri, M.; Santroni, A.; Soersdal, T.

    1985-01-01

    Results are presented from experiment WA7 at the CERN SPS, which has measured the elastic differential cross sections of πsup(+-)p, Ksup(+-)p, anti pp and pp at incident momenta of 20, 30 and 50 GeV/c. The measurements cover the momentum transfer range 0.5 2 , corresponding to c.m. scattering angles between 10 0 and 50 0 . The experimental set-up, trigger logic and data analysis are described. The experimental results are compared with existing meson-proton and nucleon-proton data at lower and higher energies covering the medium- and large-vertical stroketvertical stroke region. Some prominent models and their predictions for elastic scattering at WA7 energies and beyond are reviewed, with emphasis on geometrical scaling, factorizing eikonal models, lowest-order QCD and other dynamical exchange-type models. Results for anti pp two-body annihilation into π - π + and K - K + at 30 and 50 GeV/c, obtained in parallel with the elastic anti pp data, are also presented. (orig.)

  12. 50th anniversary

    CERN Document Server

    2004-01-01

    CERN's 50th anniversary Official Ceremony Tuesday 19 October 2004 2.00 p.m. - 5.00 p.m. The event will be broadcast by closed-circuit television in the Council Chamber, the Main Auditorium, and the Auditoria of AB Department (Prévessin) and AT Department (Building 30).

  13. Shoulder Arthroscopy in Adults 60 or Older: Risk Factors That Correlate With Postoperative Complications in the First 30 Days.

    Science.gov (United States)

    Rubenstein, William J; Pean, Christian A; Colvin, Alexis C

    2017-01-01

    To investigate the 30-day postoperative adverse event (AE) rates of adults 60 years or older after shoulder arthroscopy and identify risk factors for complications in this patient population. Patients aged 60 or more who underwent shoulder arthroscopy were identified in the American College of Surgeons National Surgery Quality Improvement Program database from 2006 to 2013 using 12 Current Procedural Terminology codes related to shoulder arthroscopy. Complications were categorized as severe AEs, minor AEs, and infectious AEs for separate analyses. Pearson's χ 2 tests were used to identify associations between patient characteristics and AE occurrence and binary logistic regression for multivariate analysis of independent risk factors. In total, 7,867 patients were included for analysis. Overall, 1.6% (n = 127) of the older adults experienced at least one AE with 1.1% (n = 90) severe AEs, 0.6% (n = 46) minor AEs, and 0.4% (n = 28) infectious complications. Multivariate analysis revealed that age 80 years or older (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.2-2.7, P = .01), body mass index greater than 35 (OR = 1.8, 95% CI = 1.1-2.7, P = .01), functionally dependent status (OR = 2.9, 95% CI = 1.3-6.8, P = .01), American Society of Anesthesiologists class greater than 2 (OR = 1.5, 95% CI = 1.0-2.2, P = .04), congestive heart failure (OR = 6.1, 95% CI = 1.8-21.2, P = .03), disseminated cancer (OR = 7.9, 95% CI = 1.4-43.9, P = .02), and existence of an open wound at the time of surgery (OR = 4.0, 95% CI = 1.1-14.6, P = .03) were independently associated with the occurrence of an AE. Nineteen of the patients included in the study required readmission to the hospital within the 30-day period for an overall readmission rate of 0.2%. Patients 60 years or older who underwent shoulder arthroscopy for a variety of indications have a low overall 30-day postoperative complication rate of 1.6%. Although low, this is a higher rate than

  14. 50 CFR 222.403 - Duration of selection; effective date.

    Science.gov (United States)

    2010-10-01

    ... to make the rule effective without a 30-day delay. ... rule for five years, without need for NMFS to include the fishery in the intervening proposed annual... 30-day delay in effective date for implementing observer coverage will follow the annual notification...

  15. Bion M1. Peculiarities of life activities of microbes in 30-day spaceflight

    Science.gov (United States)

    Viacheslav, Ilyin; Korshunov, Denis; Morozova, Julia; Voeikova, Tatiana; Tyaglov, Boris; Novikova, Liudmila; Krestyanova, Irina; Emelyanova, Lydia

    The aim of this work was to analyze the influence of space flight factors ( SFF) to microorganism strains , exposed inside unmanned spacecraft Bion M-1 during the 30- day space flight. Objectives of the work - the study of the influence of the SFF exchange chromosomal DNA in crosses microorganisms of the genus Streptomyces; the level of spontaneous phage induction of lysogenic strains fS31 from Streptomyces lividans 66 and Streptomyces coelicolor A3 ( 2 ) on the biosynthesis of the antibiotic tylosin strain of Streptomyces fradiae; survival electrogenic bacteria Shewanella oneidensis MR- 1 is used in the microbial fuel cell As a result of this work it was found that the SFF affect the exchange of chromosomal DNA by crossing strains of Streptomyces. Was detected polarity crossing , expressed in an advantageous contribution chromosome fragment of one of the parent strains in recombinant offspring. This fact may indicate a more prolonged exposure of cells in microgravity and , as a consequence, the transfer of longer fragments of chromosomal DNA This feature is the transfer of genetic material in microgravity could lead to wider dissemination and horizontal transfer of chromosomal and plasmid DNA of symbiotic microflora astronauts and other strains present in the spacecraft. It was shown no effect on the frequency of recombination PCF and the level of mutation model reversion of auxotrophic markers to prototrophy It was demonstrated that PCF increase the level of induction of cell actinophage fS31 lysogenic strain of S. lividans 66, but did not affect the level of induction of this phage cells S. coelicolor A3 ( 2). It is shown that the lower the level of synthesis PCF antibiotic aktinorodina (actinorhodin) in lysogenic strain S. coelicolor A3 ( 2). 66 Strains of S. lividans and S. coelicolor A3 ( 2 ) can be used as a biosensor for studying the effect on microorganisms PCF It is shown that the effect of the PCF reduces synthesis of tylosin and desmicosyn S. fradiae at

  16. Trükitööstuste TOP 50

    Index Scriptorium Estoniae

    2002-01-01

    Trükitööstuste TOP 50. Käibe TOP 30. Käibe kasum TOP 30. Kasvu TOP 30. Kasumi kasvu TOP 30. Rentaabluse TOP. Varade tootlikkuse TOP. Trükitööstusettevõtete üldandmed. Trükitööstusettevõtete finantsandmed

  17. Determination of carcinogenic threshold limit values using the tumorigenic dose rate 50% (TD50)

    International Nuclear Information System (INIS)

    Bonvalot, Y.; Oudiz, A.; Hubert, P.; Abenhaim, L.

    1989-01-01

    The objective of the present study is to propose a simple procedure for the determination of Occupational Limit Values (OLVs) based on the TD 50 concept (Tumorigenic Dose Rate 50%). The TD 50 concept was introduced by Peto R. and al. to help classify chemical substances according to their carcinogenic potency. The TD 50 is that dose rate (in mg/KXg body weight/day) which, if administered chronically for the standard lifespan of the species will halve the probability of remaining tumorless throughout that period. Using TD 50 values available for 776 substances, the procedure presented here allows one to determine OLVs corresponding to a fixed excess risk. It is based on a mathematical high-to-low doses extrapolation of the TD 50 . OLVs obtained with this procedure are compared with currently available TLVs and other occupational guidelines. (author)

  18. Implantation and 30-Day Follow-Up on All 4 Valve Sizes Within the Portico Transcatheter Aortic Bioprosthetic Family

    DEFF Research Database (Denmark)

    Möllmann, Helge; Linke, Axel; Holzhey, David M

    2017-01-01

    OBJECTIVES: The aim of this study was to evaluate the short-term safety and performance of the full range of valve sizes offered within the Portico transcatheter aortic valve replacement system. BACKGROUND: The Portico transcatheter aortic heart valve is a fully resheathable, repositionable.......8% of patients improved by ≥1 New York Heart Association functional class at 30 days. The rate of moderate paravalvular leak was 5.7%, with no severe paravalvular leak reported. No differences in paravalvular leak incidence and severity were observed among valve sizes (p = 0.24). CONCLUSIONS: Across all valve...... sizes, use of the repositionable Portico transcatheter aortic valve replacement system resulted in safe and effective treatment of aortic stenosis in high-risk patients....

  19. Feasibility and safety of same-day discharge after laparoscopic radical hysterectomy for cervix cancer.

    Science.gov (United States)

    Philp, Lauren; Covens, Allan; Vicus, Danielle; Kupets, Rachel; Pulman, Katherine; Gien, Lilian T

    2017-12-01

    To evaluate the safety and feasibility of same day-discharge (SDD) after laparoscopic radical hysterectomy for cervix cancer by determining complication rates and factors associated with post-operative admission. In this retrospective cohort study, patients undergoing laparoscopic radical hysterectomy for cervix cancer at a single institution from January 2006 to November 2015 were identified. Admitted patients were compared to same-day discharge patients. Rates of post-operative complications and readmission were analyzed and regression analysis used to determine factors associated with admission. 119 patients were identified. 75 (63%) were SDD patients (mean stay 156.7±50.2min) and 44 (37%) were admitted patients (mean stay 1.2±0.6days). Ten (13%) SDD patients sought medical attention within 30days post-operatively vs. nine (20%) admitted patients (p=0.17). Reasons SDD patients sought attention included pain (n=1), wound concerns (n=2), vaginal bleeding (n=2), DVT/VTE (n=1), fever (n=2) and fistula (n=2). All patients developed symptoms and presented between 5 and 13days post-operatively thus no complications could have been detected or prevented through initial admission. Four SDD patients were readmitted within 30days of surgery (p=0.25), two required re-operation (p=0.16). Admitted patients were older (p=0.049), had longer operations (p=0.02), increased blood loss (p=0.0004), increased intra-operative complications (p=0.001), surgery later in the day (p=0.004) and before April 2010 (p=0.001). On multivariate analysis, older age (OR1.05, p=0.03), surgery later in the day (OR 7.22, p=0.002) and presence of an intra-operative complication (OR 10.25, p=0.02) were significantly associated with admission. Same-day discharge after laparoscopic radical hysterectomy for cervix cancer is safe, with a low risk of post-operative morbidity and hospital readmission. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Intermittent-sprint performance and muscle glycogen after 30 h of sleep deprivation.

    Science.gov (United States)

    Skein, Melissa; Duffield, Rob; Edge, Johann; Short, Michael J; Mündel, Toby

    2011-07-01

    The aim of this study was to determine the effects of 30 h of sleep deprivation on consecutive-day intermittent-sprint performance and muscle glycogen content. Ten male, team-sport athletes performed a single-day "baseline" session and two consecutive-day experimental trials separated either by a normal night's sleep (CONT1 and CONT2) or no sleep (SDEP1 and SDEP2). Each session included a 30-min graded exercise run and 50-min intermittent-sprint exercise protocol, including a 15-m maximal sprint every minute and self-paced exercise bouts of varying intensities. Muscle biopsies were extracted before and after exercise during the baseline session and before exercise on day 2 during experimental trials. Voluntary force and activation of the right quadriceps, nude mass, HR, core temperature, capillary blood lactate and glucose, RPE, and a modified POMS were recorded before, after, and during the exercise protocols. Mean sprint times were slower on SDEP2 (2.78±0.17 s) compared with SDEP1 (2.70±0.16 s) and CONT2 (2.74±0.15 s, PSleep loss did not affect RPE but negatively affected POMS ratings (PSleep loss and associated reductions in muscle glycogen and perceptual stress reduced sprint performance and slowed pacing strategies during intermittent-sprint exercise for male team-sport athletes.