WorldWideScience

Sample records for public comment 30-day

  1. 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...

  2. 77 FR 67657 - Request for Public Comment: 30-Day Proposed Information Collection: Indian Health Service (IHS...

    Science.gov (United States)

    2012-11-13

    ... timely fashion; (c) the accuracy of the public burden estimate (the estimated amount of time needed for... requests, comments, and return address to: [email protected] . Comment Due Date: December 13, 2012. Your...

  3. 78 FR 7436 - Request for Public Comment: 30-Day Proposed Information Collection: Indian Health Service...

    Science.gov (United States)

    2013-02-01

    ... timely fashion; (c) the accuracy of the public burden estimate (this is the amount of time needed for... requests, comments, and return address to: [email protected] . DATES: Comment Due Date: March 4, 2013...

  4. 75 FR 27346 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2010-05-14

    ... of a proposed collection for public comment. Interested persons are invited to send comments... plans, employers, and health care providers. We know very little about why consumers, and specifically... the newer, more robust Internet-based tools for tracking their health and health care services. This...

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 78 FR 49532 - Request for Public Comment: 30-Day Proposed Information Collection: Application for Participation...

    Science.gov (United States)

    2013-08-14

    ... agency processes the information collected in a useful and timely fashion; (c) the accuracy of public...)--443-6048, or send your email requests, and return address to: [email protected] . Direct Your...

  10. 75 FR 68609 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2010-11-08

    ... the Teen Pregnancy Prevention Initiative. OAH is working collaboratively with the Office of the... evidence on effective ways to reduce teen pregnancy. The evaluation will document and test a range of... interest to the general public, to policy-makers, and to organizations interested in teen pregnancy...

  11. 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...

  12. 75 FR 65357 - Request for Public Comment: 30-Day Proposed Information Collection: Office of Urban Indian Health...

    Science.gov (United States)

    2010-10-22

    ... reporting on annual trends. Affected Public: Title V funded urban Indian health programs. Type of... information collected in a useful and timely fashion; (c) the accuracy of public burden estimate (the...

  13. 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...

  14. 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...

  15. 78 FR 48178 - Submission for OMB Review; 30-day Comment Request: Autism Spectrum Disorder Research Portfolio...

    Science.gov (United States)

    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...

  16. 78 FR 78369 - Submission for OMB Review; 30-Day Comment Request: Early Career Reviewer Program Online...

    Science.gov (United States)

    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...

  17. 75 FR 45121 - Agency Information Collection Request; 30-Day Public Comment Request; 30-Day Notice

    Science.gov (United States)

    2010-08-02

    ... location within the United States Code. The Trafficking Victims Protection Act of 2000 (Section 106), as... DEPARTMENT OF HEALTH AND HUMAN SERVICES [Document Identifier OS-4040-0007] Agency Information... of the Secretary (OS), Department of Health and Human Services, is publishing the following summary...

  18. 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...

  19. 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...

  20. 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...

  1. 75 FR 32809 - 30-Day Notice of Submission to the Office of Management and Budget (OMB); Opportunity for Public...

    Science.gov (United States)

    2010-06-09

    ...) invites public comments on a proposed new collection of information (OMB 1024-XXXX). DATES: Public...: You may submit comments directly to the Desk Officer for the Department of the Interior (OMB 1024-XXXX...

  2. 76 FR 32008 - 30-Day Notice of Proposed Information Collections: RPPR Public Diplomacy Surveys

    Science.gov (United States)

    2011-06-02

    ... forms of social media and similar collaborative technologies to interact on Public Diplomacy themes in... as needed. Respondents: U.S. public diplomacy participants in select foreign countries. Estimated Number of Respondents: 3,300. Estimated Number of Responses: 3,300. Average Hours Per Response: 30...

  3. 78 FR 71624 - Submission for OMB Review; 30-Day Comment Request; Data Collection To Understand How NIH Programs...

    Science.gov (United States)

    2013-11-29

    ... control number. Direct Comments to OMB: Written comments and/or suggestions regarding the item(s... organizational effectiveness. The Office of Management and Budget (OMB) and Office of Science and Technology... research programs apply methodologies to improve their organizational effectiveness. The degree of an...

  4. 78 FR 76311 - Submission for OMB Review; 30-Day Comment Request: Outcomes Evaluation of the National Cancer...

    Science.gov (United States)

    2013-12-17

    ... information collection. Thank you for your inquiry, comments and/or suggestions''. The purpose of this notice... 20892-9712 or call non-toll-free number 240-276-5650 or Email your request, including your address to...

  5. 78 FR 43215 - Submission for OMB review; 30-day Comment Request: The Agricultural Health Study: A Prospective...

    Science.gov (United States)

    2013-07-19

    ... the estimated public burden and associated response time, should be directed to the: Office of... medical history information for licensed pesticide applicators and their spouses enrolled in the AHS. The new BEEA dust component will include a brief paper-and-pen questionnaire mailed to the participant in...

  6. 77 FR 68134 - Submission for OMB Review; Comment Request (30-day): National Institute of Nursing Research (NINR...

    Science.gov (United States)

    2012-11-15

    ... data collection plans and instruments, contact: Dr. Amanda Greene, Office of Science Policy and Public... participants are alumni of this training institute which began in 2000. The survey inquires about career activities, including research, clinical, teaching and educational activities, since completion of the NINR...

  7. 76 FR 81942 - Agency Information Collection Request 30-Day Public Comment Request

    Science.gov (United States)

    2011-12-29

    ... Pregnancy Prevention Initiative demonstrate effects on adolescent sexual risk behavior and teenage pregnancy... Pregnancy Prevention Replication Evaluation: Implementation Data Collection--OMB No. OS-0990-NEW--The Office... coordinating adolescent pregnancy prevention evaluation efforts as part of [[Page 81943

  8. 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...

  9. 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...

  10. 76 FR 4905 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2011-01-27

    ... information about the company's product through MedicalCountermeasures.gov . Using this information and a... performance of the agency's functions; (2) the accuracy of the estimated burden; (3) ways to enhance the...

  11. 75 FR 62542 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2010-10-12

    ... collection. The American Recovery and Reinvestment Act (ARRA) Prevention and Wellness- Leveraging National...: Category A: Obesity prevention through improved nutrition and increased physical activity Category B... Organizations will work to sustain community prevention efforts beyond Recovery Act CPPW funding and support the...

  12. 75 FR 75677 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2010-12-06

    ... American Recovery and Reinvestment Act (ARRA) Prevention and Wellness-Leveraging National Organizations is... A: Obesity prevention through improved nutrition and increased physical activity Category B: Tobacco... sustain community prevention efforts beyond Recovery Act CPPW funding and support the National Prevention...

  13. 76 FR 79683 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2011-12-22

    ... changes among students in the 7 colleges over a two-year project period regarding: (1) Awareness and knowledge of risk factors and prevention methods for HIV/AIDS transmission; (2) the occurrence of high-risk behaviors; and (3) access to HIV/AIDS prevention, counseling, testing and referral services. Implementation...

  14. 75 FR 45120 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2010-08-02

    ... reflect changes in location within the United States Code. The Trafficking Victims Protection Act of 2000... DEPARTMENT OF HEALTH AND HUMAN SERVICES [Document Identifier OS-4040-0009] Agency Information... Secretary (OS), Department of Health and Human Services, is publishing the following summary of a proposed...

  15. 76 FR 78012 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2011-12-15

    ... PCCC evaluation will assess whether disseminating a diabetes education intervention in a community... notice directly to the OS OMB Desk Officer; faxed to OMB at (202) 395-5806. Proposed Project: Patient... data collection activities for the Patient Centered Care Collaboration to Improve Minority Health...

  16. 76 FR 55066 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2011-09-06

    ... Survey of Single Parent Caregivers--OMB No. 0990-NEW-OWH; HHS, Office on Women's Health. Abstract: The National Survey of Single Parent Caregivers will measure the size, characteristics, and unmet needs of single parents providing care for an adult family member or friend. Single parent caregivers provide...

  17. 76 FR 40912 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2011-07-12

    ... compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Office... grantee staff at all sites and from clients at up to 10 sites (client exam/survey). An Emergency Clearance... SMI Clients Client Exam and Survey- 1,000 1 45/60 750 Baseline. SMI Clients Client Exam and Survey- 1...

  18. 75 FR 76468 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2010-12-08

    ... Coordinator for Health Information Technology (ONC), HHS. In compliance with the requirement of section 3506(c... members, and competency exam takers; and a Web-based survey of community college faculty. Estimated... Workforce program. Focus groups with Exam takers Competency exam 32 1 1.5 48 takers not enrolled in...

  19. 77 FR 13128 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2012-03-05

    ... quality, utility, and clarity of the information to be collected; and (4) the use of automated collection... will collect information on awareness of the ``Make the Call--Don't Miss a Beat'' campaign, knowledge... respondent base will be surveyed only once, as this is a single-wave survey. The sampling plan is to include...

  20. 76 FR 71036 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2011-11-16

    ... referenced above, email your request, including your address, phone number, OMB number, and OS document...-entering Fathers and their Partners (MFS-IP). This demonstration program, funded in 2006 by the Office of... partners, and children. The MFS-IP evaluation will assess the effects of these activities by comparing...

  1. 76 FR 53902 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2011-08-30

    ... performance of the agency's functions; (2) the accuracy of the estimated burden; (3) ways to enhance the... Health and the Centers for Disease Control and Prevention (CDC) are working collaboratively to address the high pregnancy rate of women between the ages of 15-19 by demonstrating the effectiveness of...

  2. 78 FR 2412 - Request for Public Comment: 30-Day Proposed Information Collection: Indian Health Service Forms...

    Science.gov (United States)

    2013-01-11

    ... Accounting of Disclosures,'' is used to document an individual's request for an accounting of disclosures of...-2) Request for Accounting of Disclosures (OMB Form 15,000 1 10/60 2,500 No. 0917-0030, IHS-913... receive a valid authorization for its use or disclosure of protected health information for other than for...

  3. 76 FR 59129 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2011-09-23

    ... Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Pub. L. 108-173) and became operational on July 1, 2005. The MMA legislation and implementing regulations issued on March 8, 2007 instituted a number of changes in the appeals process. The MMA legislation also directed the U.S. Department...

  4. 75 FR 3906 - Request for Public Comment: 30-Day Proposed Information Collection: Indian Health Service...

    Science.gov (United States)

    2010-01-25

    ... Proposed Information Collection: Indian Health Service Customer Satisfaction Survey AGENCY: Indian Health...: 0917-NEW, ``Indian Health Service Customer Satisfaction Survey.'' Type of Information Collection... facilities programs will make improvements that will result in improved quality of services. Voluntary...

  5. 77 FR 24206 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2012-04-23

    ... Guide (Attachment B). Enrollment Extraction Form State-level 6 1 40 240 (Attachment C). computer... local-levels). Non-ELE Case Study Protocol Key informants 90 1 1 90 (Attachment D2). (non-ELE states--state- and local- levels). Moderator's Guide (Attachments Focus group 240 1 1.5 360 E1 and E2...

  6. 77 FR 18246 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2012-03-27

    ... data collection will enable OMH to track progress on this measure over time as necessitated by current... of Minority Health (OMH). Abstract: The proposed survey seeks to collect data for one of OMH's annual..., within and outside of HHS, who are interested in capturing progress made over time as HHS disseminates...

  7. 75 FR 66101 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2010-10-27

    ... Medicaid Fraud Control Units' Reports--OMB No. 0990-0162-Extension--Office of Inspector General (OIG... collection of information to specifically comply with the requirements in Title 19 of the Social Security Act... Inspector General (OIG) by the fifty established State Medicaid Fraud Control Units (Units). OIG uses the...

  8. 76 FR 30363 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2011-05-25

    .... Proposed Project: Multi-Component Evaluation of the BodyWorks Program-- OMB No. 0990-NEW--Office on Women's...-component 3.5 year evaluation of the BodyWorks Program. These forms will support three evaluation tasks: (1... Evaluation. English and 300 8 5/60 200 Spanish Participant Session Feedback Forms-- Full Evaluation. English...

  9. 76 FR 53901 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2011-08-30

    .... Proposed Project: The Office of Adolescent Health (OAH) Teen Pregnancy Prevention Performance Measure... grantees to conduct teen pregnancy prevention programs. Grantees are funded to either replicate evidence-based teen pregnancy prevention programs (75 OAH grantees) or to implement research and demonstration...

  10. 77 FR 506 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2012-01-05

    .... Proposed Project: Teen Pregnancy Prevention Replication Evaluation Study: Baseline Data Collection--OMB No... overseeing and coordinating adolescent pregnancy prevention evaluation efforts as part of the Teen Pregnancy... jointly oversee with ASPE the Teen Pregnancy Prevention Replication Evaluation Study (TPP Replication...

  11. 75 FR 13288 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2010-03-19

    ...' attitudes toward electronic health information exchange and the extent to which they are interested in... permit us to better understand individuals' attitudes toward electronic health information exchange and... Toward Electronic Health Information Exchange and Associated Privacy and Security Aspects--OMB No. 0990...

  12. 77 FR 10530 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2012-02-22

    ... campaign and be used to inform campaign strategies, messages, materials and Web sites. Due to the growing... Clearance for Communications Testing for Comprehensive Communication Campaign for HITECH Act--Revision--OMB... 2009, ONC is proposing to conduct a nationwide communication campaign to meet the Congressional mandate...

  13. 75 FR 37811 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2010-06-30

    ... of the campaign. The data will be used to inform campaign strategies, messages, materials and Web...: Comprehensive Communication Campaign for HITECH Act--OMB No. 0990-NEW--Office National Coordinator for Health... Health Act (HITECH Act) of 2009, ONC is proposing to conduct a nationwide communication campaign to meet...

  14. 77 FR 37407 - Agency Information Collection Request-30-Day Public Comment Request

    Science.gov (United States)

    2012-06-21

    ... inform campaign strategies, messages, materials and outreach. OCR will oversee this one year... Project: New Comprehensive Communication Campaign on Right To Non-Discrimination in Certain Health and... conduct a nationwide communication campaign to educate the Latino community, particularly Limited English...

  15. 75 FR 8953 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2010-02-26

    ... responding to a mini-questionnaire and participating in a bulletin board focus group. Participants will self- administer the mini-questionnaire at home on personal computers and will also participate in the focus group... and mini-questionnaire. 13-15. Total 2,160 420 Seleda M. Perryman, Office of the Secretary, Paperwork...

  16. 76 FR 71035 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2011-11-16

    .... This data collection effort is crucial to HPP's decision-making process regarding the continued... following subjects: (1) The necessity and utility of the proposed information collection for the proper... quality, utility, and clarity of the information to be collected; and (4) the use of automated collection...

  17. 76 FR 4904 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2011-01-27

    ... datasets that are not specific to individual's personal health information to improve decision making by... following subjects: (1) The necessity and utility of the proposed information collection for the proper... quality, utility, and clarity of the information to be collected; and (4) the use of automated collection...

  18. 76 FR 28987 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2011-05-19

    ... and sustainable CER enterprise. In addition, ARRA established the Federal Coordinating Council on... CER expenditures. This project seeks to evaluate and assess the products and outcomes of ARRA-funded... (SSLA).. Key stakeholders: 600 2 15/60 300 patients/ consumers. Attachment E: Focus group Members of the...

  19. 76 FR 45574 - Agency Information Collection Request: 30-Day Public Comment Request

    Science.gov (United States)

    2011-07-29

    ... actuaries at health insurers. Data collection activities will be completed within 60 days (two months) of...-administered web survey Chief Actuary at health insurance 408 1 45/60 306 companies. Mary Forbes, Paperwork...

  20. 76 FR 60840 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2011-09-30

    ... collection for the proper performance of the agency's functions; (2) the accuracy of the estimated burden; (3... evaluation efforts as part of the Teen Pregnancy Prevention Initiative. OAH is working collaboratively with... Oklahoma Institute of Child Advocacy/Power 360 1 36/60 216 Through Choices Engender Health/Gender Matters...

  1. 77 FR 12305 - Agency Information Collection Request; 30-Day Public Comment Request

    Science.gov (United States)

    2012-02-29

    ... performance of the agency's functions; (2) the accuracy of the estimated burden; (3) ways to enhance the... efforts as part of the Teen Pregnancy Prevention Initiative. OAH is working collaboratively with the... Choices. Control Group Youth. Engender Health/Gender Matters Participating 300 1 36/60 180 Youth and...

  2. 76 FR 81943 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2011-12-29

    ... performance of the agency's functions; (2) the accuracy of the estimated burden; (3) ways to enhance the... is working collaboratively with the Office of the Assistant Secretary for Planning and Evaluation... Engender Health/Gender Matters 375 1 36/60 225 Ohio Health/T.O.P.P 200 1 42/60 140 Live the Life Ministries...

  3. 77 FR 32638 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2012-06-01

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES [Document Identifier OS-0990-0388] Agency Information... Secretary (OS), Department of Health and Human Services, is publishing the following summary of a proposed... long-term, sustainable and holistic approach to fighting childhood obesity. This activity is requesting...

  4. 77 FR 32974 - Agency Information Collection Request. 30-Day Public Comment Request

    Science.gov (United States)

    2012-06-04

    .... The study will explore physicians' level of understanding of oral disease and what constitutes health for the oral cavity, oral health training and support needs, current practices and barriers to further...

  5. 76 FR 66305 - Agency Information Collection Request, 30-Day Public Comment Request

    Science.gov (United States)

    2011-10-26

    ...: (1) Community awareness, (2) capacity building, and (3) prevention education. The multisite... participant knowledge and behavior related to sexual health. The multisite evaluation is comprised of two main... activities and (2) Prevention Education Version to be administered to women who receive prevention education...

  6. 78 FR 65697 - 30-Day Notice of Proposed Information Collection: Public Housing, Contracting With Resident-Owned...

    Science.gov (United States)

    2013-11-01

    ... Information Collection: Public Housing, Contracting With Resident-Owned Businesses--Application Requirements..., Contracting with Resident-Owned Businesses-Application Requirements. OMB Approval Number: 2577-0161. Type of... State law; Certification that shows the business is owned by residents, disclosure documents that...

  7. 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...

  8. 77 FR 2601 - 30-Day Notice of Proposed Information Collection: DS-4164 OMB Control #1405-XXXX

    Science.gov (United States)

    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...

  9. 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,...

  10. 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.

  11. 78 FR 55083 - Submission for OMB Review; 30-day Comment Request; Genomics and Society Public Surveys in...

    Science.gov (United States)

    2013-09-09

    ... site. The URL for this survey site will also be advertised separately through media and social media... information on the proposed project, contact: Laura M. Koehly, Ph.D., Senior Investigator, Social and... in health conditions and associated risk factors; The role of friends, family, media, and health...

  12. 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...

  13. 75 FR 77901 - 30-Day Notice of Opportunity for Public Comment on U.S. Nominations to the World Heritage List...

    Science.gov (United States)

    2010-12-14

    ..., interpretation, and education; (iv) Potential threats to the property's integrity or its current state of... and the University of Virginia Historic District) Mount Vernon, Virginia Poverty Point National..., California Marin County Civic Center, San Rafael, California Frederick C. Robie House, Chicago, Illinois...

  14. 75 FR 8315 - Submission for OMB Review; Comment Request; Correction

    Science.gov (United States)

    2010-02-24

    ..., a 30-day public comment period notice will be published. The Acting Director, Information Collection... published a 30-day comment period notice in the Federal Register (Page 7264, Column 3) seeking public.... James Hyler, Acting Director, Information Collection Clearance Division, Regulatory Information...

  15. Proposed standby gasoline rationing plan: public comments

    Energy Technology Data Exchange (ETDEWEB)

    1978-12-01

    Under the proposed plan, DOE would allocate ration rights (rights to purchase gasoline) to owners of registered vehicles. All vehicles in a given class would receive the same entitlement. Essential services would receive supplemental allotments of ration rights as pririty firms. Once every 3 months, ration checks would be mailed out to all vehicle registrants, allotting them a certain amount of ration rights. These checks would then be cashed at Coupon Issuance Points, where the bearer would receive ration coupons to be used at gasoline stations. Large users of gasoline could deposit their allotment checks in accounts at ration banks. Coupons or checks would be freely exchangeable in a white market. A certain percentage of the gasoline supply would be set aside in reserve for use in national emergencies. When the plan was published in the Federal Register, public comments were requested. DOE also solicited comments from private citizens, public interest groups, business and industry, state and local governments. A total of 1126 responses were reveived and these are analyzed in this paper. The second part of the report describes how the comments were classified, and gives a statistical breakdown of the major responses. The last section is a discussion and analysis of theissue raised by commenting agencies, firms, associations, and individuals. (MCW)

  16. 77 FR 43412 - 30-Day Notice of Proposed Information Collection: DS 7655, Iraqi Citizens and Nationals Employed...

    Science.gov (United States)

    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...

  17. 77 FR 24509 - Notice of Proposed Information Collection for Public Comment Emergency Comment Request; Single...

    Science.gov (United States)

    2012-04-24

    ... Information Collection for Public Comment Emergency Comment Request; Single Family Customer Satisfaction... information: Title of Proposal: Single Family Customer Satisfaction Survey. Description of Information... and changes in performance. In addition to the importance HUD management places on the information...

  18. 48 CFR 3401.501-2 - Opportunity for public comments.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Opportunity for public comments. 3401.501-2 Section 3401.501-2 Federal Acquisition Regulations System DEPARTMENT OF EDUCATION ACQUISITION REGULATION GENERAL ED ACQUISITION REGULATION SYSTEM Agency and Public Participation 3401.501-2 Opportunity for public comments. Unless th...

  19. 78 FR 21708 - Proposed Collection; Comment Request for Publication 1345

    Science.gov (United States)

    2013-04-11

    ... Publication 1345 AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request for comments... Publication 1345, Handbook for Authorized IRS e-file Providers. DATES: Written comments should be received on... [email protected] . SUPPLEMENTARY INFORMATION: Title: Publication 1345, Handbook for Authorized...

  20. 75 FR 29817 - Proposed Collection; Comment Request for Publication 1345

    Science.gov (United States)

    2010-05-27

    ... Publication 1345 AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request for comments... Publication 1345, Handbook for Authorized IRS e-file Providers. DATES: Written comments should be received on....gov . SUPPLEMENTARY INFORMATION: Title: Publication 1345, Handbook for Authorized IRS e-file Providers...

  1. 76 FR 50483 - Submission for OMB Review; Comment Request

    Science.gov (United States)

    2011-08-15

    ... energy vulnerability and prevent homelessness as a result of the inability to pay energy bills; (3... having its full effect if OMB receives it within 30 days of publication. Written comments and...

  2. 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.

  3. 78 FR 23980 - Proposed Collection; Comment Request for Publication 1075

    Science.gov (United States)

    2013-04-23

    ... Publication 1075 AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request for comments... Publication 1075, Tax Information Security Guidelines for Federal, State, and Local Agencies. DATES: Written... copies of the publication should be directed to Allan Hopkins at Internal Revenue Service, Room 6129...

  4. 76 FR 44660 - Proposed Collection; Comment Request for Publication 3319

    Science.gov (United States)

    2011-07-26

    ... Publication 3319 AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request for comments... Publication 3319, Low-Income Taxpayer Clinics 2012 Grant Application Package and Guidelines. DATES: Written... or copies of publication should be directed to Joel Goldberger, at (202) 927-9368, or at Internal...

  5. 75 FR 5865 - Proposed Collection; Comment Request for Publication 1075

    Science.gov (United States)

    2010-02-04

    ... Publication 1075 AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request for comments... Publication 1075, Tax Information Security Guidelines for Federal, State, and Local Agencies. [[Page 5866... information or copies of the publication should be directed to Dawn Bidne at Internal Revenue Service, room...

  6. 75 FR 21641 - Infusion Pumps; Public Meeting; Request for Comments

    Science.gov (United States)

    2010-04-26

    ...] Infusion Pumps; Public Meeting; Request for Comments AGENCY: Food and Drug Administration, HHS. ACTION... announcing a public meeting regarding external infusion pumps. The purpose of the meeting is to inform the public about current problems associated with external infusion pump use, to help the agency identify...

  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. 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

  9. 76 FR 9849 - 30-Day Notice of Proposed Information Collection: Refugee Biographic Data, OMB Control Number...

    Science.gov (United States)

    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...

  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. 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.

  12. 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.

  13. Centers for Disease Control review panel's recommendations on health effects and epidemiological studies of operations at the Savannah River Plant, Aiken, South Carolina. Public comment and meeting report

    International Nuclear Information System (INIS)

    1985-05-01

    Based on the request of the US Department of Energy, the Centers for Disease Control of the US Department of Health and Human Services organized a panel to review the feasibility and usefulness of conducting further epidemiologic studies of delayed health effects around the Department of Energy's Savannah River Plant. The review and recommendations of the panel were documented in a report entitled Epidemiologic Projects Considered Possible to Undertake in Populations Around the Savannah River Plant. On November 30, 1984, the Department of Energy announced in the Federal Register (49 FR 47095) the conduct of a public meeting and a 30-day public comment period between December 1 and December 30, 1984, on the recommendations of the review panel. Based on the requests of individuals and representatives of organizations attending the December 18, 1984, public meetings, the Department of Energy subsequently announced in the Federal Register on December 31, 1984 (49 FR 50767) an extension of the public comment period to January 31, 1985. This report documents the public meeting and comment process, and provides responses to the public comments that were submitted during this process. In addition, this report contains the Department of Energy's position based on the recommendations of the Centers for Disease Control review panel and the public comments. 23 refs., 16 tabs

  14. 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.

  15. 77 FR 33243 - Public Comment and Public Meeting on Draft Revisions to the Federal Environment Element of the...

    Science.gov (United States)

    2012-06-05

    ... Comprehensive Plan Public Comment, National Capital Planning Commission, 401 9th Street NW., Suite 500, Washington, DC 20004. The public meeting will be held at 401 9th Street NW., North Lobby, Suite 500...: Electronic Access and Filing Addresses You may submit comments electronically at the public comment portal at...

  16. 76 FR 43355 - Public Comment and Public Meeting on Draft Revisions to the Transportation Element and Federal...

    Science.gov (United States)

    2011-07-20

    ... Public Comment, National Capital Planning Commission, 401 9th Street, NW., Suite 500, Washington, DC 20004. The public meeting will be held at 401 9th Street, NW., North Lobby, Suite 500, Washington, DC...: Electronic Access and Filing Addresses You may submit comments electronically at the public comment portal at...

  17. 77 FR 13619 - Notice of Proposed Information for Public Comment for: Public Housing Capital Fund Program

    Science.gov (United States)

    2012-03-07

    ... that are not subject to Independent Public Accountant (IPA) audit requirements. Agency form numbers, if... Information for Public Comment for: Public Housing Capital Fund Program AGENCY: Office of the Assistant Secretary for Public and Indian Housing, HUD. ACTION: Notice. SUMMARY: The proposed information collection...

  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. 78 FR 64598 - Bank Enterprise Award (BEA) Program; Programmatic and Administrative Aspects; Public Comment Request

    Science.gov (United States)

    2013-10-29

    ... DEPARTMENT OF THE TREASURY Community Development Financial Institutions Fund Bank Enterprise Award (BEA) Program; Programmatic and Administrative Aspects; Public Comment Request AGENCY: Community Development Financial Institutions Fund, Department of the Treasury. ACTION: Request for public comment...

  1. 78 FR 34700 - Data Collection Available for Public Comments

    Science.gov (United States)

    2013-06-10

    ... Finance Center, Small Business Administration, 721 19th Street, 3rd Floor, Denver, CO 80202. FOR FURTHER... SMALL BUSINESS ADMINISTRATION Data Collection Available for Public Comments ACTION: 60-Day Notice... announces the Small Business Administration's intentions to request approval on a new and/or currently...

  2. 14 CFR 11.75 - Does FAA invite public comment on petitions for rulemaking?

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Does FAA invite public comment on petitions... Rulemaking and for Exemption § 11.75 Does FAA invite public comment on petitions for rulemaking? Generally, FAA does not invite public comment on petitions for rulemaking. ...

  3. 78 FR 66670 - Housing Counseling Program: New Certification Requirements; Extension of Public Comment Period

    Science.gov (United States)

    2013-11-06

    ... Counseling Program: New Certification Requirements; Extension of Public Comment Period AGENCY: Office of the... inviting public comment on proposed changes to the Housing Counseling Program regulations for the purpose... housing counseling statute. This document announces that HUD is extending the public comment period, for...

  4. 75 FR 1656 - Draft Safety Culture Policy Statement: Request for Public Comments; Extension of Comment Period

    Science.gov (United States)

    2010-01-12

    ... culture policy statement, including: (1) development of a common safety culture definition; and (2... NUCLEAR REGULATORY COMMISSION [NRC-2009-0485] Draft Safety Culture Policy Statement: Request for...: Issuance of draft safety culture policy statement and notice of opportunity for public comment; Extension...

  5. 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.

  6. 77 FR 39724 - U.S. Coral Reef Task Force Public Meeting and Public Comment

    Science.gov (United States)

    2012-07-05

    ...-DS61200000] U.S. Coral Reef Task Force Public Meeting and Public Comment AGENCY: Fish and Wildlife Service... Wildlife Service (Service), announce a public meeting of the U.S. Coral Reef Task Force (USCRTF) and a... strengthen U.S. government actions to better preserve and protect coral reef ecosystems. The Departments of...

  7. 76 FR 7579 - U.S. Coral Reef Task Force Public Meeting and Public Comment

    Science.gov (United States)

    2011-02-10

    .... Coral Reef Task Force Public Meeting and Public Comment AGENCY: Fish and Wildlife Service, Interior... Service (Service), announce a public business meeting of the U.S. Coral Reef Task Force (USCRTF) [email protected] ); or Liza Johnson, U.S. Coral Reef Task Force Department of the Interior Liaison, U.S...

  8. 75 FR 14150 - Proposed Rate Adjustment, Public Forum, and Opportunities for Public Review and Comment for...

    Science.gov (United States)

    2010-03-24

    ... DEPARTMENT OF ENERGY Southeastern Power Administration Proposed Rate Adjustment, Public Forum, and Opportunities for Public Review and Comment for Georgia-Alabama-South Carolina System of Projects AGENCY: Southeastern Power Administration, DOE. ACTION: Notice to change date and location of the Public Information...

  9. 77 FR 1497 - Notice of Proposed Information for Public Comment for: Public/Private Partnerships for the Mixed...

    Science.gov (United States)

    2012-01-10

    ... diligence in order to approve the mixed-finance development of public housing prior to a financial closing... Information for Public Comment for: Public/ Private Partnerships for the Mixed-Finance Development of Public... comments on the subject proposal. The 1998 Public Housing Reform Act allowed the Mixed-Finance development...

  10. 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.

  11. 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.

  12. Public comments and responses to the 1989 Hanford cleanup five-year plan

    International Nuclear Information System (INIS)

    1991-06-01

    In April 1990 the US Department of Energy (DOE) issued a site- specific Five-Year Plan (DOE-RL 1989a) on Hanford's cleanup for public review and comment. The plan guides Hanford in carrying out DOE's national plan for environmental restoration and waste management. During the 90-day public comment period, DOE held nine public meetings to answer questions and gather comments on the plan. This report is in three main sections. The first presents consolidated public comments and responses. These were compiled from both verbal comments from public meetings and written comments. The second section contains comments not responded to in this plan. Those comments were outside this plan's scope, related to how we gathered public comments, or intended for and directed to DOE-Headquarters. In the appendixes are the written comment letters we received and a short glossary and list of special terms we use. The source of comments is shown in parentheses after the comment. The individual who made the comment, the city of the public meeting, or the organization name is generally used. When several sources gave the same comment, a source was not listed. 26 refs

  13. In science "there is no bad publicity": papers criticized in comments have high scientific impact.

    Science.gov (United States)

    Radicchi, Filippo

    2012-01-01

    Comments are special types of publications whose aim is to correct or criticize previously published papers. For this reason, comments are believed to make commented papers less worthy or trusty to the eyes of the scientific community, and thus predestined to have low scientific impact. Here, we show that such belief is not supported by empirical evidence. We consider thirteen major publication outlets in science, and perform systematic comparisons between the citations accumulated by commented and non commented articles. We find that (i) commented papers are, on average, much more cited than non commented papers, and (ii) commented papers are more likely to be among the most cited papers of a journal. Since comments are published soon after criticized papers, comments should be viewed as early indicators of the future impact of criticized papers.

  14. 14 CFR 11.85 - Does FAA invite public comment on petitions for exemption?

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Does FAA invite public comment on petitions... Rulemaking and for Exemption § 11.85 Does FAA invite public comment on petitions for exemption? Yes, FAA... the reasons for requesting it; and (e) A request for comments to assist FAA in evaluating the petition. ...

  15. 14 CFR 11.38 - What public comment procedures does the FAA follow for Special Conditions?

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false What public comment procedures does the FAA... § 11.38 What public comment procedures does the FAA follow for Special Conditions? Even though the Administrative Procedure Act does not require notice and comment for rules of particular applicability, FAA does...

  16. 75 FR 28622 - FDA Transparency Initiative: Draft Proposals for Public Comment Regarding Disclosure Policies of...

    Science.gov (United States)

    2010-05-21

    ...] FDA Transparency Initiative: Draft Proposals for Public Comment Regarding Disclosure Policies of the U...: Notice of availability; request for comments. SUMMARY: As part of the second phase of the Transparency... Transparency Initiative: Draft Proposals for Public Comment Regarding Disclosure Policies of the U.S. Food and...

  17. 28 CFR 302.1 - Public and private sector comment procedures.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Public and private sector comment procedures. 302.1 Section 302.1 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE COMMENTS ON UNICOR BUSINESS OPERATIONS § 302.1 Public and private sector comment procedures. (a...

  18. 40 CFR 166.24 - Public notice of receipt of application and opportunity for public comment.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Public notice of receipt of application and opportunity for public comment. 166.24 Section 166.24 Protection of Environment ENVIRONMENTAL... of the applicant's description of the emergency conditions including the pest and the site or crop to...

  19. 76 FR 18570 - Notice of Proposed Information Collection for Public Comment; HOPE VI Public Housing Programs...

    Science.gov (United States)

    2011-04-04

    ... Information Collection for Public Comment; HOPE VI Public Housing Programs: Funding and Program Data... responses. This Notice also lists the following information: Title of Proposal: HOPE VI program. OMB Control... (Pub. L. 105- 276, 112 Stat. 2461, approved October 21, 1998) and revised by the HOPE VI Program...

  20. 76 FR 18772 - Notice of Extension of Proposed Information Collection for Public Comment; Public Housing...

    Science.gov (United States)

    2011-04-05

    .... Requiring PHAs to report electronically has enabled HUD to provide a comprehensive financial assessment of... Proposed Information Collection for Public Comment; Public Housing Financial Management Template AGENCY... whether the proposed collection of information is necessary for the proper performance of the functions of...

  1. A comment on framing effects in linear public good games

    OpenAIRE

    Cartwright, Edward

    2016-01-01

    A number of recent papers have looked at framing effects in linear public good games. In this comment, I argue that, within this literature, the distinction between give-take and positive–negative framing effects has become blurred, and that this is a barrier towards understanding the experimental evidence on framing effects. To make these points, I first illustrate that frames can differ along both an externality and choice dimension. I then argue that the existing evidence is consistent wit...

  2. 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

  3. 76 FR 18165 - Request for Public Comments Concerning Regulatory Cooperation Activities That Would Help...

    Science.gov (United States)

    2011-04-01

    ... DEPARTMENT OF COMMERCE International Trade Administration Request for Public Comments Concerning Regulatory Cooperation Activities That Would Help Eliminate or Reduce Unnecessary Regulatory Divergences in... ``Help'' tab.) All comments and recommendations submitted in response to this notice will be made...

  4. 78 FR 63170 - Integrated Postsecondary Education Data System (IPEDS) 2013-2016; Extension of Public Comment...

    Science.gov (United States)

    2013-10-23

    ... DEPARTMENT OF EDUCATION Integrated Postsecondary Education Data System (IPEDS) 2013-2016; Extension of Public Comment Period; Correction AGENCY: Department of Education. ACTION: Correction notice... entitled, ``Integrated Postsecondary Education Data System (IPEDS) 2013-2016''. The comment period for this...

  5. 78 FR 41407 - Agency Information Collection Activities; Proposed Collection; Public Comment Request

    Science.gov (United States)

    2013-07-10

    ... programs responsible for making award decisions. This announcement is a request for comments on the..., validating and verifying information, processing and maintaining information, and disclosing and providing... Information Collection Activities; Proposed Collection; Public Comment Request AGENCY: Health Resources and...

  6. 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

  7. 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.

  8. Review of public comments on proposed seismic design criteria

    International Nuclear Information System (INIS)

    Philippacopoulos, A.J.; Shaukat, S.K.; Chokshi, N.C.; Bagchi, G.; Nuclear Regulatory Commission, Washington, DC; Nuclear Regulatory Commission, Washington, DC

    1989-01-01

    During the first quarter of 1988, the Nuclear Regulatory Commission (NRC) prepared a proposed Revision 2 to the NUREG-0800 Standard Review Plan (SRP) Sections 2.5.2 (Vibratory Ground Motion), 3.7.1 (Seismic Design Parameters), 3.7.2 (Seismic Systems Analysis) and 3.7.3 (Seismic Subsystem Analysis). The proposed Revision 2 to the SRP was a result of many years' work carried out by the NRC and the nuclear industry on the Unresolved Safety Issue (USI) A-40: ''Seismic Design Criteria.'' The background material related to NRC's efforts for resolving the A-40 issue is described in NUREG-1233. In June 1988, the proposed Revision 2 of the SRP was issued by NRC for public review and comments. Comments were received from Sargent and Lundy Engineers, Westinghouse Electric Corporation, Stevenson and Associates, Duke Power Company, General Electric Company and Electric Power Research Institute. In September 1988, Brookhaven National Laboratory (BNL) and its consultants (C.J. Costantino, R.P. Kennedy, J. Stevenson, M. Shinozuka and A.S. Veletsos) were requested to carry out a review of the comments received from the above six organizations. The objective of this review was to assist the NRC staff with the evaluation and resolution of the public comments. This review was initiated during October 1988 and it was completed on January 1989. As a result of this review, a set of modifications to the above mentioned sections of the SRP were recommended by BNL and its consultants. This paper summarizes the recommended modifications. 4 refs

  9. 77 FR 13594 - Proposed Rate Adjustment, Public Forum, and Opportunities for Public Review and Comment for...

    Science.gov (United States)

    2012-03-07

    ... Carolina System and applicable to energy from pumping operations at the Carters and Richard B. Russell... Opportunities for Public Review and Comment for Georgia-Alabama-South Carolina System of Projects AGENCY... of power from the Georgia-Alabama-South Carolina System of Projects effective for a 5-year period...

  10. 75 FR 57826 - Notice of Public Meeting and Opportunity To Submit Written Comments Concerning the Administration...

    Science.gov (United States)

    2010-09-22

    ... soliciting written comments and will hold a public meeting concerning the Administration's review of the U.S... DEPARTMENT OF STATE [Public Notice 7175] Notice of Public Meeting and Opportunity To Submit Written Comments Concerning the Administration's Review of the U.S. National Contact Point for the OECD...

  11. 76 FR 54283 - 30-Day Notice of Proposed Information Collections: Language Learning Survey Questions

    Science.gov (United States)

    2011-08-31

    ...: Language Learning Survey Questions ACTION: Notice of request for public comment and submission to OMB of... the Paperwork Reduction Act of 1995. Title of Information Collection: Language Learning Programs: Pre... critical language learning instruction. Estimated Number of Respondents: 1,400 annually Estimated Number of...

  12. 78 FR 47479 - 30-Day Notice of Proposed Information Collection: Nonimmigrant Treaty Trader/Investor Application

    Science.gov (United States)

    2013-08-05

    ...: Nonimmigrant Treaty Trader/Investor Application ACTION: Notice of request for public comment and submission to.../Investor Application OMB Control Number: OMB-1405-0101 Type of Request: Extension of a Currently Approved... Investor Estimated Number of Respondents: 41,752 Estimated Number of Responses: 41,752 Average Time per...

  13. 78 FR 52008 - 30-Day Notice of Proposed Information Collection: Multifamily Housing Service Coordinator Program

    Science.gov (United States)

    2013-08-21

    ... community engagement; including meetings with community agencies and residents and Attendance at or planning... comments from members of the public and affected parties concerning the collection of information described... through the use of appropriate automated collection techniques or other forms of information technology, e...

  14. 78 FR 13394 - 30-Day Notice of Proposed Information Collection: Office of Language Services Contractor...

    Science.gov (United States)

    2013-02-27

    ... of Language Services Contractor Application Form ACTION: Notice of request for public comment and...: Title of Information Collection: Office of Language Services Contractor Application Form. OMB Control... States. If candidates successfully become contractors for the U.S. Department of State, Office of...

  15. 78 FR 58377 - 30-Day Notice of Proposed Information Collection: Nonimmigrant Fiance(e) Visa Application

    Science.gov (United States)

    2013-09-23

    ... conjunction with a personal interview, to determine this eligibility of an alien applicant for a non-immigrant... record. Before including any detailed personal information, you should be aware that your comments as submitted, including your personal information, will be available for public review. Abstract of proposed...

  16. 78 FR 3453 - Public Comment and Public Meeting on Draft Revisions to the Visitors Element of the Comprehensive...

    Science.gov (United States)

    2013-01-16

    ... draft revisions to Comprehensive Plan Public Comment, National Capital Planning Commission, 401 9th Street NW., Suite 500, Washington, DC 20004. The public meeting will be held at 401 9th Street NW., North.... SUPPLEMENTARY INFORMATION: Electronic Access and Filing Addresses You may submit comments electronically at the...

  17. Centers for Disease Control review panel's recommendations on health effects and epidemiological studies of operations at the Savannah River Plant, Aiken, South Carolina. Public comment and meeting report

    Energy Technology Data Exchange (ETDEWEB)

    1985-05-01

    Based on the request of the US Department of Energy, the Centers for Disease Control of the US Department of Health and Human Services organized a panel to review the feasibility and usefulness of conducting further epidemiologic studies of delayed health effects around the Department of Energy's Savannah River Plant. The review and recommendations of the panel were documented in a report entitled Epidemiologic Projects Considered Possible to Undertake in Populations Around the Savannah River Plant. On November 30, 1984, the Department of Energy announced in the Federal Register (49 FR 47095) the conduct of a public meeting and a 30-day public comment period between December 1 and December 30, 1984, on the recommendations of the review panel. Based on the requests of individuals and representatives of organizations attending the December 18, 1984, public meetings, the Department of Energy subsequently announced in the Federal Register on December 31, 1984 (49 FR 50767) an extension of the public comment period to January 31, 1985. This report documents the public meeting and comment process, and provides responses to the public comments that were submitted during this process. In addition, this report contains the Department of Energy's position based on the recommendations of the Centers for Disease Control review panel and the public comments. 23 refs., 16 tabs.

  18. 77 FR 47690 - 30-Day Notice of Proposed Information Collection: Civilian Response Corps Database In-Processing...

    Science.gov (United States)

    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...

  19. 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.

  20. 78 FR 69709 - Notice of Extension to Public Comment Period for Consent Decree Under the Clean Air Act and the...

    Science.gov (United States)

    2013-11-20

    ... Clean Air Act and the Emergency Planning and Community Right- To Know Act'' On September 30, 2013, the... lawsuit filed under the Clean Air Act and the Emergency Planning & Community Right to Know Act, the United... would receive comments concerning the settlement for a period of thirty (30) days from the date of...

  1. 77 FR 16205 - National Defense Stockpile Market Impact Committee Request for Public Comments on the Potential...

    Science.gov (United States)

    2012-03-20

    .... The Committee is seeking public comments on the potential market impact of the material research and... Defense Stockpile Market Impact Committee Request for Public Comments on the Potential Market Impact of... National Defense Stockpile Market Impact Committee, co-chaired by the Departments of Commerce and State, is...

  2. 76 FR 22740 - Comment Request on Existing Private and Public Efforts To Educate Investors

    Science.gov (United States)

    2011-04-22

    ... Existing Private and Public Efforts To Educate Investors AGENCY: Securities and Exchange Commission. ACTION: Request for comment. SUMMARY: In connection with a study regarding financial literacy among investors as... private and public efforts to educate investors. DATES: Comments should be received on or before June 21...

  3. 76 FR 9004 - Public Comment on Setting Achievement Levels in Writing

    Science.gov (United States)

    2011-02-16

    ... DEPARTMENT OF EDUCATION Public Comment on Setting Achievement Levels in Writing AGENCY: U.S... Achievement Levels in Writing. SUMMARY: The National Assessment Governing Board (Governing Board) is... for NAEP in writing. This notice provides opportunity for public comment and submitting...

  4. IRIS Toxicological Review of Tert-Butyl Alcohol (Tert-Butanol) (Public Comment Draft)

    Science.gov (United States)

    EPA is developing an Integrated Risk Information System (IRIS) assessment of tert-butyl Alcohol (tert-butanol) and has released the public comment draft assessment for public comment and external peer review. When final, the assessment will appear on the IRIS databa...

  5. PUBLIC COMMENT ON THE DEPARTMENT OF HEALTH AND HUMAN SERVICES 2018 FEDERAL PHYSICAL ACITIVTY GUIDELINES

    Science.gov (United States)

    Title: Public Comment on Department of Health and Human Services (DHHS) 2018 Physical Activity Guidelines Author: Wayne E. Cascio, Director, Environmental Public Health Division, US EPA Abstract: In the 2008 Physical Activity Guidelines, the effects of air pollution and advers...

  6. 75 FR 5706 - Federal Housing Administration: Insurance for Manufactured Housing: Reopening of Public Comment...

    Science.gov (United States)

    2010-02-04

    ... 2502-AI45 Federal Housing Administration: Insurance for Manufactured Housing: Reopening of Public.... ACTION: Proposed rule; reopening of public comment period. SUMMARY: On September 15, 2008, HUD published a proposed rule entitled ``Federal Housing Administration: Insurance for Manufactured Housing.'' The...

  7. 78 FR 19496 - Submission for OMB Review; 30-day Comment Request; The National Cancer Institute (NCI...

    Science.gov (United States)

    2013-04-01

    ... smoking cessation intervention designed for young adult smokers ages 18 to 29. The SmokefreeTXT program is... examine how exposure to the SmokefreeTXT intervention affects participants' success at quitting smoking..., Bethesda, MD 20892-7337 or call non-toll-free number 301-435-7610 or Email your request, including your...

  8. 78 FR 58318 - Submission for OMB Review; 30-day Comment Request: The Framingham Heart Study (FHS)

    Science.gov (United States)

    2013-09-23

    ... 10/60 42 B. EXAM: a. Clinic Exam 100 1 175/60 292 b. Home or nursing home visit 100 1 60/60 100 c... respondents respondent (in hours) burden hour I. PARTICIPANT COMPONENTS A. PRE-EXAM: a. Telephone contact to set up 60 1 10/60 10 appointment b. Exam Appointment, Scheduling, 55 1 35/60 32 Reminder, and...

  9. 78 FR 59706 - Proposed Collection; 30-Day Comment Request; Evaluation of a Kidney Disease Education and...

    Science.gov (United States)

    2013-09-27

    ... respondent burden (hours) hours Pilot study collection: Promotores Promotores training pre-test, post- 12 1 5... Regulatory Affairs, OIRA--submission @omb.eop.gov or by fax to 202-395-6974, Attention: NIH Desk Officer. To... community health workers). A pilot evaluation will assess: (a) Overall quality of the program from the...

  10. 78 FR 44136 - Submission for OMB review; 30-day Comment Request: National Cancer Institute (NCI) Cancer...

    Science.gov (United States)

    2013-07-23

    ... award performance and the effectiveness of the program as a whole. The respondents are the Principal Investigators of the awards, along with their institutional business officials. The awards are administered by... costs to respondents other than their time. The estimated annualized burden hours are 72. Estimated...

  11. 78 FR 60886 - Submission for OMB Review; 30-day Comment Request; Quantification of Behavioral and Physiological...

    Science.gov (United States)

    2013-10-02

    ... effectiveness of mobile, smartphone/tablet-based neurocognitive assessment that can provide a multifactorial.... Driving Survey Adults 1 15/60 18 Realism Survey Adults 1 3/60 4 Sleep and Intake Questionnaire Adults 2 3...

  12. 76 FR 72923 - Pool Corporation; Analysis To Aid Public Comment

    Science.gov (United States)

    2011-11-28

    ... manufacturers, warehouse them, and then resell the products to pool retail stores, pool service companies and.... ADDRESSES: Interested parties may file a comment online or on paper, by following the instructions in the... 0115'' on your comment, and file your comment online at https://ftcpublic.commentworks.com/ftc...

  13. 77 FR 1956 - National Science Board; Notice of Opportunity for Public Comment on the National Science Board...

    Science.gov (United States)

    2012-01-12

    ... NATIONAL SCIENCE FOUNDATION National Science Board; Notice of Opportunity for Public Comment on the National Science Board Data Policies Report AGENCY: National Science Board (NSB), NSF. ACTION: Request for public comments. SUMMARY: The National Science Board seeks comments from the public on the...

  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. Dual axis radiographic hydrodynamic test facility. Final environmental impact statement, Volume 2: Public comments and responses

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-08-01

    On May 12, 1995, the U.S. Department of Energy (DOE) issued the draft Dual Axis Radiographic Hydrodynamic Test Facility Environmental Impact Statement (DARHT EIS) for review by the State of New Mexico, Indian Tribes, local governments, other Federal agencies, and the general public. DOE invited comments on the accuracy and adequacy of the draft EIS and any other matters pertaining to their environmental reviews. The formal comment period ran for 45 days, to June 26, 1995, although DOE indicated that late comments would be considered to the extent possible. As part of the public comment process, DOE held two public hearings in Los Alamos and Santa Fe, New Mexico, on May 31 and June 1, 1995. In addition, DOE made the draft classified supplement to the DARHT EIS available for review by appropriately cleared individuals with a need to know the classified information. Reviewers of the classified material included the State of New Mexico, the U.S. Environmental Protection Agency, the Department of Defense, and certain Indian Tribes. Volume 2 of the final DARHT EIS contains three chapters. Chapter 1 includes a collective summary of the comments received and DOE`s response. Chapter 2 contains the full text of the public comments on the draft DARHT EIS received by DOE. Chapter 3 contains DOE`s responses to the public comments and an indication as to how the comments were considered in the final EIS.

  16. 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.

  17. Analysis of public comments on the proposed rule on nuclear power plant license renewal

    International Nuclear Information System (INIS)

    1991-12-01

    This report provides a summary and analysis of public comments on the proposed license renewal rule for the nuclear power plants (10 CFR Part 54) published in the Federal Register on 17 July 1990. It also documents the NRC's resolution of the issues raised by the commenters. Comments from 121 organizations and 76 individuals were reviewed and analyzed to identify the issues, including those pertaining to the adequacy of the licensing basis, the performance of an integrated plant assessment, backfit considerations, and need for public hearings. The analysis included grouping of commenters' views according to the issues raised. The public comments analyzed in this report were taken into consideration in the development of the final rule and revisions to the supporting documents

  18. 76 FR 38108 - Request for Public Comments for Special Supplemental Nutrition Program for Women, Infants and...

    Science.gov (United States)

    2011-06-29

    ... additional elements should FNS consider as a component of the selection criteria for this local agency... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Request for Public Comments for Special... Breastfeeding Support Practices AGENCY: Food and Nutrition Service, USDA. ACTION: Notice of request for comments...

  19. 77 FR 42271 - National Defense Stockpile Market Impact Committee Request for Public Comments on the Potential...

    Science.gov (United States)

    2012-07-18

    ... comments on the potential market impact associated with the two material research and development projects... Defense Stockpile Market Impact Committee Request for Public Comments on the Potential Market Impact of... National Defense Stockpile Market Impact Committee, co-chaired by the Departments of Commerce and State, is...

  20. 75 FR 7268 - Agency Information Collection Request; 60-Day Public Comment Request

    Science.gov (United States)

    2010-02-18

    ... information collection request for public comment. Interested persons are invited to send comments regarding... plans, employers, and health care providers. We know very little about why consumers, and specifically... the newer, more robust Internet-based tools for tracking their health and health care services. This...

  1. 75 FR 10798 - Richard J. Stanton; Analysis of Proposed Consent Order to Aid Public Comment

    Science.gov (United States)

    2010-03-09

    ... involves respondent's marketing and distribution of a variety of online seal certification marks (``website... contact information for individuals from the public comments it receives before placing those comments on... related products or services. Part VI mandates that respondent file an initial compliance report with the...

  2. 78 FR 65421 - Proposed Agency Information Collection Activities; Comment Request

    Science.gov (United States)

    2013-10-31

    ... respective comments to OMB within 30 days of publication to best ensure having their full effect. 5 CFR 1320... information collected with FRA employees, State DOT partners, and law enforcement agencies. Form Number(s... the following: Whether the proposed collection of information is necessary for the proper performance...

  3. 78 FR 70398 - Proposed Agency Information Collection Activities; Comment Request

    Science.gov (United States)

    2013-11-25

    ... information or produce any material acquired as part of the performance of that employee's official duties or..., respondents should submit their respective comments to OMB within 30 days of publication to best ensure having... operating assumption behind C\\3\\RS is that by assuring confidentiality, employees will report events which...

  4. 78 FR 36817 - Proposed Agency Information Collection Activities; Comment Request

    Science.gov (United States)

    2013-06-19

    .... Therefore, respondents should submit their respective comments to OMB within 30 days of publication to best..., and the test results in order to demonstrate compliance with the performance standard. Annual... testing standards are effective. FRA also uses the information collected to alert railroad employees and...

  5. 75 FR 81615 - Submission for OMB Review; Comment Request

    Science.gov (United States)

    2010-12-28

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Submission for... Specific Consent. OMB No.: New Collection. Description: The William Wilberforce Trafficking Victims... effect if OMB receives it within 30 days of publication. Written comments and recommendations for the...

  6. Recommendations for resolution of public comments on USI [Unresolved Safety Issues] A-40, ''Seismic Design Criteria''

    International Nuclear Information System (INIS)

    Philippacopoulos, A.J.

    1989-06-01

    In June 1988 the Nuclear Regulatory Commission (NRC) issued for public comment the proposed Revision 2 of the Standard Review Plan (SRP) Sections 2.5.2, 3.7.1, 3.7.2. and 3.7.3. Comments were received from six organizations. Brookhaven National Laboratory (BNL) was requested by NRC to provide expert consultation in the seismic and soil-structure interaction areas for the review and resolution of these comments. For this purpose, a panel of consultants was established to assist BNL with the review and evaluation of the public comments. This review was carried out during the period of October 1988 through January 1989. Many of the suggestions given in the public comments were found to be significant and a number of modifications to appropriate SRP sections are recommended. Other public comments were found to have no impact on the proposed Revision 2 of the SRP. Major changes are recommended to the SRP sections dealing with (a) Power Spectral Density (PSD) and ground motion requirements and (b) soil-structure interaction requirements. This report contains specific recommendations to NRC for resolution of the public comments made on the proposed Revision 2 of the SRP

  7. Understanding Public Perceptions of the HPV Vaccination Based on Online Comments to Canadian News Articles.

    Directory of Open Access Journals (Sweden)

    Yael Feinberg

    Full Text Available Given the variation in human papillomavirus (HPV vaccine coverage across Canada, and debate regarding delivery of HPV vaccines in Catholic schools, we studied online comments on Canadian news websites to understand public perceptions of HPV and HPV vaccine.We searched English- and French-language Canadian news websites for 2012 articles that contained the terms "HPV" or "human papillomavirus." Articles about HPV vaccinations that contained at least one comment were included. Two researchers independently coded comments, analyzing them for emerging themes.We identified 3073 comments from 1198 individuals in response to 71 news articles; 630 (52.6% individuals expressed positive sentiments about HPV vaccination (2.5 comments/individual, 404 (33.7% were negative (3.0 comments/individual, 34 (2.8% were mixed (1.5 comments/individual and 130 (10.8% were neutral (1.6 comments/individual. Vaccine-supportive commenters believed the vaccine is safe and effective. Common themes in negative comments included concerns regarding HPV vaccine safety and efficacy, distrust of pharmaceutical companies and government, and belief that school-age children are too young for HPV vaccine. Many comments focused on whether the Catholic Church has the right to inform health policy for students, and discussion often evolved into debates regarding HPV and sexual behaviour. We noted that many individuals doubted the credibility of vaccine safety information.The majority of commenters do not appear to be against HPV vaccination, but public health messaging that focuses on both the vaccine's safety profile, and its use as a means to prevent cancer rather than sexually transmitted HPV infection may facilitate its acceptance.

  8. Public comments and responses to the 1991 Hanford Cleanup Five-Year Plan

    International Nuclear Information System (INIS)

    1992-05-01

    The Department of Energy (DOE) Richland Field Office (RL) updated its Site-Specific Plan (DOE-RL 1991a) dealing with cleanup and operation of the Hanford Site in September 1991. The plan provides direction as to how DOE will carry out the national strategy for managing and cleaning up the Hanford Site wastes resulting from production of nuclear weapons. The plan is updated annually. We asked the public to comment on the plan during its 60-day public comment period. This report presents the comments and provides responses. The introduction explains how the comments were gathered and how we responded. This report is in four main sections: (1) comments and responses addressed locally; (2) comments forwarded to DOE-Headquarters for their response (these responses will appear in the National Five-Year Plan [DOE 1991a]); (3) comments we did not respond to here because they were outside the scope, or about how we gathered the public's comments; and (4) the appendices, which include a glossary, a list of acronyms used in the document, and the letters and cards we received reproduced in their entirety

  9. 75 FR 4042 - Proposed Information Collection; Comment Request; Survey of Public Perceptions and Attitudes...

    Science.gov (United States)

    2010-01-26

    ... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration Proposed Information Collection; Comment Request; Survey of Public Perceptions and Attitudes About Hawaiian Monk Seals AGENCY..., attitudes, beliefs, values, and behaviors regarding the endangered Hawaiian monk seal. The information...

  10. Antimony Trioxide (ATO) - Summary of External Peer Review and Public Comments and Disposition

    Science.gov (United States)

    This document summarizes the public and external peer review comments that the EPA’s Office of Pollution Prevention and Toxics (OPPT) received for the draft work plan risk assessment for Antimony Trioxide (ATO).

  11. 77 FR 70828 - Proposed Extension of Information Collection Requests Submitted for Public Comment

    Science.gov (United States)

    2012-11-27

    ... DEPARTMENT OF LABOR Employee Benefits Security Administration Proposed Extension of Information Collection Requests Submitted for Public Comment AGENCY: Employee Benefits Security Administration... collection requirements and provide the requested data in the desired format. The Employee Benefits Security...

  12. 78 FR 30333 - Proposed Extension of Information Collection Requests Submitted for Public Comment

    Science.gov (United States)

    2013-05-22

    ... DEPARTMENT OF LABOR Employee Benefits Security Administration Proposed Extension of Information Collection Requests Submitted for Public Comment AGENCY: Employee Benefits Security Administration... collection requirements and provide the requested data in the desired format. The Employee Benefits Security...

  13. 78 FR 10246 - Data Collection Available for Public Comments and Recommendations

    Science.gov (United States)

    2013-02-13

    ... Personal History.'' Description of Respondents: Small Business Lending Companies. Form Number: 1081. Annual... SMALL BUSINESS ADMINISTRATION Data Collection Available for Public Comments and Recommendations... of 1995, this notice announces the Small Business Administration's intentions to request approval on...

  14. 75 FR 75707 - Request for Public Comment on the Draft National Nanotechnology Initiative Strategy for...

    Science.gov (United States)

    2010-12-06

    ... Nanotechnology Initiative Strategy for Nanotechnology-Related Environmental, Health, and Safety Research AGENCY..., Engineering, and Technology Subcommittee of the National Science and Technology Council request comments from the public regarding the draft National Nanotechnology Initiative (NNI) Strategy for Nanotechnology...

  15. 76 FR 2428 - Request for Public Comment on the Draft National Nanotechnology Initiative Strategy for...

    Science.gov (United States)

    2011-01-13

    ... Nanotechnology Initiative Strategy for Nanotechnology-Related Environmental, Health, and Safety Research AGENCY..., Engineering, and Technology Subcommittee of the National Science and Technology Council request comments from the public regarding the draft National Nanotechnology Initiative (NNI) Strategy for Nanotechnology...

  16. 78 FR 77690 - Agency Information Collection Activities: Proposed Collection: Public Comment Request

    Science.gov (United States)

    2013-12-24

    ... injuries, child abuse, neglect, or maltreatment, and reduction of emergency room visits; (3) improvement in... Administration for Children and Families Agency Information Collection Activities: Proposed Collection: Public Comment Request AGENCY: Health Resources and Services Administration, HHS. Administration for Children and...

  17. 77 FR 27467 - Proposed Information Collection; Request for Public Comment: Indian Health Service Loan Repayment...

    Science.gov (United States)

    2012-05-10

    ... fashion; (c) The accuracy of public burden estimate (the estimated amount of time needed for individual... (301) 443-2316; or send your email requests, comments, and return address to: [email protected

  18. 77 FR 69865 - 60-Day Proposed Information Collection; Request for Public Comment: Indian Health Service...

    Science.gov (United States)

    2012-11-21

    ... collected in a useful and timely fashion; (c) the accuracy of the public burden estimate (this is the amount... facsimile to (301) 443-2316, or send your email requests, comments, and return address to [email protected

  19. 76 FR 61366 - Food and Drug Administration Transparency Initiative: Draft Proposals for Public Comment to...

    Science.gov (United States)

    2011-10-04

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2009-N-0247] Food and Drug Administration Transparency Initiative: Draft Proposals for Public Comment to Increase...: Food and Drug Administration, HHS. [[Page 61367

  20. 76 FR 39842 - Draft Investigation Report-DuPont Belle; Public Comment Requested

    Science.gov (United States)

    2011-07-07

    ... the CSB Web site ( http://www.csb.gov .). Comments may also be sent to CSB Headquarters (see address... public review either at CSB Headquarters or by following directions posted on the CSB Web site. By..., operating [[Page 39843

  1. 75 FR 5621 - Notice of Proposed Information Collection for Public Comment; Multifamily Tenant Characteristics...

    Science.gov (United States)

    2010-02-03

    ... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5383-N-01] Notice of Proposed Information Collection for Public Comment; Multifamily Tenant Characteristics Family Reporting AGENCY: Office... following information: Title of Proposal: Multifamily Tenant Characteristics Family Report and Moving To...

  2. 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

  3. 75 FR 19297 - Medical Loss Ratios; Request for Comments Regarding Section 2718 of the Public Health Service Act

    Science.gov (United States)

    2010-04-14

    ... public comments in advance of future rulemaking. DATES: Submit written or electronic comments by May 14... 2718, and specifies that the Secretary may provide for appropriate penalties. F. Taxation of Certain...

  4. 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.

  5. 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.

  6. 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...

  7. 75 FR 61706 - Request for Public Comments Regarding Small and Medium Enterprises' Understanding of and...

    Science.gov (United States)

    2010-10-06

    ... Public Comments Regarding Small and Medium Enterprises' Understanding of and Compliance With the Export... the public regarding small and medium enterprises' (SMEs) understanding of and compliance with export... report, Small and Medium-Sized Enterprises: Overview of Participation in U.S. Exports (USITC Publication...

  8. 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...

  9. 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.

  10. 78 FR 26398 - Public Comment and Public Meeting on Draft Revisions to the Foreign Missions and International...

    Science.gov (United States)

    2013-05-06

    ....ncpc.gov/compplan by Monday, May 6, 2013. Printed copies are available upon request from the contact... Comprehensive Plan Public Comment, National Capital Planning Commission, 401 9th Street NW., Suite 500, Washington, DC 20004. The public meeting will be held at 401 9th Street NW., North Lobby, Suite 500...

  11. 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.

  12. 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

  13. 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.

  14. 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.

  15. 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

  16. Fitness for duty in the nuclear power industry: Responses to public comments

    International Nuclear Information System (INIS)

    Bush, L.L.; Grimes, B.K.

    1989-05-01

    The Nuclear Regulatory Commission published for public comment a proposed rule concerning the fitness for duty of commercial nuclear power plant workers (53 FR 36795). The proposed rule focused on methods for controlling the use of substances that may affect the trustworthiness and performance of workers. It provides for chemical testing, behavioral observation, employee awareness and education, and employee assistance programs as means for assuring fitness for duty. This report summarizes the comments received on the proposed rule and provides the staff resolutions of the issues raised by the comments. 3 refs

  17. 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.

  18. 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.

  19. 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.

  20. 75 FR 53968 - Reverb Communications, Inc.; Analysis of Proposed Consent Order To Aid Public Comment

    Science.gov (United States)

    2010-09-02

    ... final the agreement's proposed order. This matter involves the public relations, marketing, and sales... FEDERAL TRADE COMMISSION [File No. 092 3199] Reverb Communications, Inc.; Analysis of Proposed Consent Order To Aid Public Comment AGENCY: Federal Trade Commission. ACTION: Proposed Consent Agreement...

  1. 75 FR 41509 - Notice of Proposed Information Collection for Public Comment; LOCCS Voice Response System Payment...

    Science.gov (United States)

    2010-07-16

    ... Information Collection for Public Comment; LOCCS Voice Response System Payment Vouchers for Public and Indian... lists the following information: Title of Proposal: LOCCS Voice Response System Payment Vouchers for... system. The information collected on the payment voucher will also be used as an internal control measure...

  2. 78 FR 76834 - Request for Public Comment on the Proposed Adoption of Administration for Native Americans...

    Science.gov (United States)

    2013-12-19

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families [CFDA Numbers: 93.581, 93.587, 93.612] Request for Public Comment on the Proposed Adoption of Administration for Native... by members of the public at the Administration for Native Americans, 901 D Street SW., Washington, DC...

  3. 75 FR 70940 - Notice of Proposed Information Collection for Public Comment: 2011 Rental Housing Finance Survey

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    2010-11-19

    ...The proposed information collection requirement described below will be submitted to the Office of Management and Budget (OMB) for review, as required by the Paperwork Reduction Act of 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). The Department is soliciting public comments on the subject proposal.

  4. 75 FR 58411 - Center for Veterinary Medicine eSubmitter Workshop; Public Workshop; Request for Comments

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    2010-09-24

    ...] Center for Veterinary Medicine eSubmitter Workshop; Public Workshop; Request for Comments AGENCY: Food... Drug Administration (FDA) is announcing a public workshop entitled: ``Center for Veterinary Medicine... be emailed to all registrants. Contact Person: Charles Andres, Center for Veterinary Medicine (HFV...

  5. 77 FR 48160 - Division of Cardiovascular Devices 30-Day Notices and Annual Reports; Public Workshop; Request...

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    2012-08-13

    ... performed. For parking and security information, please refer to: http://www.fda.gov/AboutFDA/WorkingatFDA... attendee, including name, title, affiliation, address, email, and telephone number. Those without Internet... the Internet at http://www.fda.gov/MedicalDevices/NewsEvents/WorkshopsConferences/default.htm...

  6. Predicting 30-day Hospital Readmission with Publicly Available Administrative Database. A Conditional Logistic Regression Modeling Approach.

    Science.gov (United States)

    Zhu, K; Lou, Z; Zhou, J; Ballester, N; Kong, N; Parikh, P

    2015-01-01

    This article is part of the Focus Theme of Methods of Information in Medicine on "Big Data and Analytics in Healthcare". Hospital readmissions raise healthcare costs and cause significant distress to providers and patients. It is, therefore, of great interest to healthcare organizations to predict what patients are at risk to be readmitted to their hospitals. However, current logistic regression based risk prediction models have limited prediction power when applied to hospital administrative data. Meanwhile, although decision trees and random forests have been applied, they tend to be too complex to understand among the hospital practitioners. Explore the use of conditional logistic regression to increase the prediction accuracy. We analyzed an HCUP statewide inpatient discharge record dataset, which includes patient demographics, clinical and care utilization data from California. We extracted records of heart failure Medicare beneficiaries who had inpatient experience during an 11-month period. We corrected the data imbalance issue with under-sampling. In our study, we first applied standard logistic regression and decision tree to obtain influential variables and derive practically meaning decision rules. We then stratified the original data set accordingly and applied logistic regression on each data stratum. We further explored the effect of interacting variables in the logistic regression modeling. We conducted cross validation to assess the overall prediction performance of conditional logistic regression (CLR) and compared it with standard classification models. The developed CLR models outperformed several standard classification models (e.g., straightforward logistic regression, stepwise logistic regression, random forest, support vector machine). For example, the best CLR model improved the classification accuracy by nearly 20% over the straightforward logistic regression model. Furthermore, the developed CLR models tend to achieve better sensitivity of more than 10% over the standard classification models, which can be translated to correct labeling of additional 400 - 500 readmissions for heart failure patients in the state of California over a year. Lastly, several key predictor identified from the HCUP data include the disposition location from discharge, the number of chronic conditions, and the number of acute procedures. It would be beneficial to apply simple decision rules obtained from the decision tree in an ad-hoc manner to guide the cohort stratification. It could be potentially beneficial to explore the effect of pairwise interactions between influential predictors when building the logistic regression models for different data strata. Judicious use of the ad-hoc CLR models developed offers insights into future development of prediction models for hospital readmissions, which can lead to better intuition in identifying high-risk patients and developing effective post-discharge care strategies. Lastly, this paper is expected to raise the awareness of collecting data on additional markers and developing necessary database infrastructure for larger-scale exploratory studies on readmission risk prediction.

  7. 78 FR 75366 - 30-Day Notice of Proposed Information Collection: Public Housing Energy Audits and Utility...

    Science.gov (United States)

    2013-12-11

    ... Number: 2577-062. Type of Request: Reinstatement, with change, of previously approved collection. Form....506--Establishment of 200 1 200 1 200 Surcharges for Excess Consumption Optional Benchmarking (50078...

  8. Public comments and responses to the 1993 Hanford cleanup five-year plan

    International Nuclear Information System (INIS)

    1993-08-01

    In March 1993, the US Department of Energy, Richland Operations Office (DOE-RL) published its annual Site-Specific Five-Year Plan. The Site-Specific Plan is published to inform the public about the background, status, and plans for Environmental Restoration (ER) and Waste Management (WM) activities at the Hanford site. It is the only document that seeks to bring all ER and WM elements together in one document. The Site-Specific Plan is a companion document to the National Five-Year Plan that deals with all the sites within the DOE complex on a summary level. This Response to Comments document does not try to address every question or concern raised during the public comment period. Some questions were outside the scope of the Five-Year Plan, some we could not decipher, others were variations of the same question. The initial round of public meetings was held in Portland, Oregon, and Seattle, Pasco, and Olympia, Washington. At the request of the Oregon Department of Energy (ODOE) and the Washington State Department of Ecology (Ecology), a second round of meetings was held in Portland and Olympia. Both agencies felt that the first two meetings were held with too little advance notice, and before the Plan could be distributed. Once the public meetings were over and the comment period closed, we then compiled the public comments, largely from audio tapes of the meetings. Individual functions within Hanford were asked to consider and respond to the comments

  9. 78 FR 47814 - Data Collection Available for Public Comments

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    2013-08-06

    ... only the relevant information to the audience member's specific needs, Information is also collected to... information, contribute information, and interact with SBA and other users of the site. Description of... approved information collection. DATES: Submit comments on or before October 7, 2013. ADDRESSES: Send all...

  10. 78 FR 77194 - Data Collection Available for Public Comments

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    2013-12-20

    ... comments to Andrea Giles, Supervisory Financial Analyst, Office of Credit Risk Management, Small Business..., Supervisory Financial Analyst, 202-205-6301, [email protected] , or Curtis B. Rich, Management Analyst, 202... these institutions, SBA requires them to submit audited financial statements annually as well as interim...

  11. 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

  12. 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.

  13. 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

  14. 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.

  15. 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

  16. 77 FR 13149 - Agency Information Collection Activities: Proposed Collection; Comments Requested: Office of...

    Science.gov (United States)

    2012-03-05

    ... State criminal jurisdiction under Public Law 280 (18 U.S.C. 1162(a)) to request that the United States... Collection; Comments Requested: Office of Tribal Justice; Assumption of Concurrent Federal Criminal Jurisdiction in Certain Areas of Indian Country ACTION: 30-Day notice of information collection under review...

  17. Summary and analysis of public comments on NUREG-1317: Regulatory options for nuclear plant license renewal: Final report

    International Nuclear Information System (INIS)

    Ligon, D.M.; Seth, S.S.

    1989-03-01

    On August 29, 1988, the US Nuclear Regulatory Commission (NRC) issued an Advance Notice of Proposed Rulemaking on nuclear plant license renewal and solicited public comments on NUREG-1317, ''Regulatory Options for Nuclear Plant License Renewal.'' NUREG-1317 presents a discussion of fifteen topics involving technical, environmental, and procedural issues and poses a set of related questions. As part of its ongoing task for the NRC, The MITRE Corporation has summarized and analyzed the public comments received. Fifty-three written comments were received. Of these, 83 percent were from nuclear industry representatives; the remaining comments represented federal and state agencies, public interest groups, and a private citizen

  18. 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.

  19. 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...

  20. 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...

  1. 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

  2. 78 FR 64143 - 30-Day Notice of Proposed Information Collection: Contractor's Requisition-Project Mortgages

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    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...

  3. 78 FR 36012 - 30-Day Notice of Proposed Information Collection: Export Declaration of Defense Technical Data or...

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    2013-06-14

    ... Collection: Export Declaration of Defense Technical Data or Services. OMB Control Number: 1405-0157. Type of... Declaration of Defense Technical Data or Services ACTION: Notice of request for public comment and submission... and brokering of defense articles, defense services and related technical data are licensed by the...

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    2010-07-09

    ... 1995 and 5 CFR Part 1320, Reporting and Record Keeping Requirements, the National Park Service (NPS... Register notice to solicit public comments on these information collection requirements on January 29, 2010... obligations assumed. It also requires that franchise fees be determined with consideration to the opportunity...

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    2011-07-07

    .../V Youth and Leadership Survey Questions ACTION: Notice of request for public comment and submission... following information collection requests to the Office of Management and Budget (OMB) for approval in... Leadership Programs: Pre Program Survey Questions. OMB Control Number: None. Type of Request: New Collection...

  6. 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 30 days 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

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. Self-Governance on Trial: A Public Sphere Analysis of News Website Forum Comments

    Directory of Open Access Journals (Sweden)

    J. David Wolfgang

    2016-04-01

    Full Text Available The online public sphere offers society an opportunity to pursue self-governance through rational-critical discourse of public issues. However, testing the effectiveness of the sphere involves studying the structure of the online forum (e.g. whether the forum allows for pseudonymous comments or not and the quality of the content in the forum. This research studied online news forums on the topics of gun control and civil unions in Colorado to see what barriers to participating in the forum might exist in the structure of the forum and then what types of content was produced in the forum. The research showed that a forum allowing commenters to use a pseudonym led to comments with more exchange and critique of reasoned normative positions and use of supporting facts. However, neither the pseudonymous forum nor the identified forum had stronger levels of commitment to constructive dialogue in the forum. Also, commenters showed no reflexivity in their comments, meaning that participants were not assessing their own positions or changing their perspectives based on the arguments of others. While this shows that reducing barriers to accessing the forum helps to produce a public sphere environment, there is still work to be done in improving the level of constructive dialogue and stimulating negotiation and consensus building.

  12. 77 FR 65760 - Request for Public Comments To Compile the Reports on Sanitary and Phytosanitary and Technical...

    Science.gov (United States)

    2012-10-30

    ... Technical Barriers to Trade (2012 TBT Report) respectively. The TPSC invites written comments from the public on issues that USTR should examine in preparing the SPS and TBT Reports. DATES: Public comments..., Director of Sanitary and Phytosanitary Affairs, USTR (202-395-6127). Questions regarding the TBT Report or...

  13. 76 FR 62389 - Request for Comments and Notice of Public Hearings on the Study of International Patent...

    Science.gov (United States)

    2011-10-07

    ...] Request for Comments and Notice of Public Hearings on the Study of International Patent Protection for... international patent protection. Issues for Testimony and/or Written Comment: Interested members of the public... patents: (a) In obtaining international patent rights? (b) In maintaining international patent rights? (c...

  14. 75 FR 74056 - Request for Public Comment on the Proposed Adoption of Administration for Native Americans (ANA...

    Science.gov (United States)

    2010-11-30

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Request for Public Comment on the Proposed Adoption of Administration for Native Americans (ANA) Program Policies and...) 690-7441. Comments will be available for inspection by members of the public at the Administration for...

  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 30 days 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. Text mining analysis of public comments regarding high-level radioactive waste disposal

    International Nuclear Information System (INIS)

    Kugo, Akihide; Yoshikawa, Hidekazu; Shimoda, Hiroshi; Wakabayashi, Yasunaga

    2005-01-01

    In order to narrow the risk perception gap as seen in social investigations between the general public and people who are involved in nuclear industry, public comments on high-level radioactive waste (HLW) disposal have been conducted to find the significant talking points with the general public for constructing an effective risk communication model of social risk information regarding HLW disposal. Text mining was introduced to examine public comments to identify the core public interest underlying the comments. The utilized test mining method is to cluster specific groups of words with negative meanings and then to analyze public understanding by employing text structural analysis to extract words from subjective expressions. Using these procedures, it was found that the public does not trust the nuclear fuel cycle promotion policy and shows signs of anxiety about the long-lasting technological reliability of waste storage. To develop effective social risk communication of HLW issues, these findings are expected to help experts in the nuclear industry to communicate with the general public more effectively to obtain their trust. (author)

  17. Comment

    DEFF Research Database (Denmark)

    Sørensen, Peter Birch

    1999-01-01

    Comment on: Besley and Seabright (1999) The effects and policy implications of state aid to industry: an economic analysis. Economic Policy 14 (28), 13-53......Comment on: Besley and Seabright (1999) The effects and policy implications of state aid to industry: an economic analysis. Economic Policy 14 (28), 13-53...

  18. Comment

    DEFF Research Database (Denmark)

    Sørensen, Peter Birch

    1999-01-01

    Comment on: Alessandra Casella (1999) Tradable deficit permits: efficient implementation of the Stability Pact in the European Monetary Union. Economic Policy 14 (29), 321-362......Comment on: Alessandra Casella (1999) Tradable deficit permits: efficient implementation of the Stability Pact in the European Monetary Union. Economic Policy 14 (29), 321-362...

  19. 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

  20. 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

  1. Surplus plutonium disposition environmental impact statement. Public scoping meeting: Comment summary report

    International Nuclear Information System (INIS)

    1997-09-01

    The Department of Energy (DOE) issued a Record of Decision for the Storage and Disposition of Weapons-Usable Fissile Materials Programmatic Environmental Impact Statement (S ampersand D PEIS) (DOE/EIS-0229) on January 14, 1997. In that Record of Decision, DOE stated its decision to pursue a strategy for plutonium disposition that allows for immobilization of surplus weapons plutonium in glass or ceramic forms and irradiating the surplus plutonium as mixed oxide (MOX) fuel in existing reactors, while reserving the option to immobilize all the surplus weapons plutonium. The Department also decided that the extent to which either or both of these disposition approaches would ultimately be deployed would depend in part upon future National Environmental Policy Act (NEPA) review for surplus weapons plutonium disposition. On May 22, 1997, DOE published in the Federal Register (62 FR 28013) a Notice of Intent to prepare an environmental impact statement (tiered from the S ampersand D PEIS) on the disposition of United States' surplus weapons-usable plutonium. The purpose of the Notice of Intent was to describe DOE's proposed action, to solicit public input, and to announce the schedule for the public scoping meetings. During the public scoping period (May 22 - July 22, 1997), the public was invited to submit written comments by U.S. mail, fax, or through the Office of Fissile Materials Disposition's Website, as well as to provide oral comments by voicemail or by participating in public scoping meetings. Written and oral comments on the scope of the SPD EIS that were submitted during the formal comment period have been uniquely identified and have become part of the official record. This is the case whether the comments were submitted via U.S. mail, fax, website, toll-free telephone number, or through participation at a public scoping meeting

  2. 75 FR 56911 - Request for Public Comment on the United States Standards for Corn

    Science.gov (United States)

    2010-09-17

    ... Public Comment on the United States Standards for Corn AGENCY: Grain Inspection, Packers and Stockyards... Standards and grading procedures for corn under the United States Grain Standards Act (USGSA). Since the standards were last revised, the use of corn for ethanol and the number of different varieties of corn has...

  3. 76 FR 64367 - Notice of Proposed Information Collection for Public Comment: Pre-Purchase Homeownership...

    Science.gov (United States)

    2011-10-18

    ... types of counseling (the remaining 1,700 study participants constitute the control group). Staff of the... Information Collection for Public Comment: Pre-Purchase Homeownership Counseling Demonstration and Impact... Counseling Demonstration and Impact Evaluation. Description of the need for the information and proposed use...

  4. 77 FR 42314 - Proposed Data Collections Submitted for Public Comment and Recommendations

    Science.gov (United States)

    2012-07-18

    ... characteristics of the work environment, such as the norms, rules, and common understandings that influence employees' perceptions of the importance that the organization places on safety. NIOSH requests OMB approval...] Proposed Data Collections Submitted for Public Comment and Recommendations In compliance with the...

  5. 75 FR 36120 - Proposed Information Collection Request Submitted for Public Comment and Recommendations; Program...

    Science.gov (United States)

    2010-06-24

    ... Submitted for Public Comment and Recommendations; Program To Prevent Smoking Underground and in Hazardous... mine operators are required to develop programs to prevent persons from carrying smoking materials, matches, or lighters underground and to prevent smoking in hazardous areas, such as in or around oil...

  6. 76 FR 147 - Proposed Data Collections Submitted for Public Comment and Recommendations

    Science.gov (United States)

    2011-01-03

    ... technology. Written comments should be received within 60 days of this notice. Proposed Project Healthcare... Healthcare Preparedness Activity, Division of Healthcare Quality Promotion (DHQP) at the Centers for Disease... other public and private organizations to promote collaboration amongst healthcare partners, and to...

  7. 75 FR 40856 - Data Collection Available for Public Comments and Recommendations

    Science.gov (United States)

    2010-07-14

    ... extended to a small business concern. SBA uses this information to complied statistics on the SBIC program... SMALL BUSINESS ADMINISTRATION Data Collection Available for Public Comments and Recommendations..., this notice announces the Small Business Administration's intentions to request approval on a new and...

  8. 77 FR 13258 - Biotechnology Regulatory Services; Changes Regarding the Solicitation of Public Comment for...

    Science.gov (United States)

    2012-03-06

    ...] Biotechnology Regulatory Services; Changes Regarding the Solicitation of Public Comment for Petitions for..., Chief of Staff, Biotechnology Regulatory Services, APHIS, 4700 River Road Unit 147, Riverdale, MD 20737... process changes APHIS is making to our petition process, go to http://www.aphis.usda.gov/biotechnology/pet...

  9. 76 FR 5394 - Notice of Proposed Information Collection for Public Comment; Memorandum of Agreement (MOA) and...

    Science.gov (United States)

    2011-01-31

    ... Information Collection for Public Comment; Memorandum of Agreement (MOA) and Improvement Plan (IP) in... (this is not a toll-free number) or email Ms. Pollard at [email protected] . Persons with hearing...: Title of Proposal: Memorandum of Agreement (MOA), Progress Report and Improvement Plan (IP). OMB Control...

  10. 76 FR 44014 - Generic Drug User Fee; Public Meeting; Request for Comments

    Science.gov (United States)

    2011-07-22

    ... generic drug user fees. New legislation would be required for FDA to establish and collect user fees for... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2010-N-0381] Generic Drug User Fee; Public Meeting; Request for Comments AGENCY: Food and Drug Administration, HHS...

  11. 76 FR 24035 - Generic Drug User Fee; Public Meeting; Request for Comments

    Science.gov (United States)

    2011-04-29

    ... legislation would be required for FDA to establish and collect user fees for generic drugs, and FDA is... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2010-N-0381] Generic Drug User Fee; Public Meeting; Request for Comments AGENCY: Food and Drug Administration, HHS...

  12. 78 FR 31972 - Notice of Proposed Information Collection for Public Comment; Request Voucher for Grant Payment...

    Science.gov (United States)

    2013-05-28

    ... Information Collection for Public Comment; Request Voucher for Grant Payment and Line of Credit Control System... information: Title Of Proposal: Request Voucher for Grant Payment and Line of Credit Control System (LOCCS... and proposed use: Payment request vouchers for distribution of grant funds using the automated Voice...

  13. 78 FR 31940 - Proposed Data Collections Submitted for Public Comment and Recommendations

    Science.gov (United States)

    2013-05-28

    ... techniques or other forms of information technology. Written comments should be received within 60 days of this notice. Proposed Project ``So What? Telling a Compelling Story'' Template--New--Office of Public... and Brief Description Background: Stories are difficult to gather and track; therefore, OPHPR must use...

  14. 75 FR 49502 - Medical Device User Fee Act; Public Meeting; Request for Comments

    Science.gov (United States)

    2010-08-13

    ... of all stakeholder interest groups. Registrants will receive confirmation once they have been... FDA and a series of panels representing different stakeholder interest groups (such as patient... public meeting, interested persons may submit either electronic or written comments by October 14, 2010...

  15. 78 FR 18674 - Invitation for Public Comment on Draft DOT Research, Development and Technology Strategic Plan...

    Science.gov (United States)

    2013-03-27

    ... and strategic process to cover the years 2013-2018, and responds to feedback from the National... administrations. Two cross-modal bodies participated in the process: the RD&T Planning Team Council (composed of...-0002] Invitation for Public Comment on Draft DOT Research, Development and Technology Strategic Plan...

  16. 75 FR 12251 - Notice of Proposed Information Collection for Public Comment; FHA Lender Approval, Annual Renewal...

    Science.gov (United States)

    2010-03-15

    ... Lenders. OMB Control Number, if applicable: 2502-0005. Description of the need for the information and proposed use: The information is used by FHA to verify that lenders meet all approval, renewal, update and... Information Collection for Public Comment; FHA Lender Approval, Annual Renewal, Periodic Updates and...

  17. 78 FR 17937 - Notice of Proposed Information Collection for Public Comment; FHA Lender Approval, Annual Renewal...

    Science.gov (United States)

    2013-03-25

    ... Lenders. OMB Control Number, if applicable: 2502-0005. Description of the need for the information and proposed use: The information is used by FHA to verify that lenders meet all approval, renewal, update and... Information Collection for Public Comment; FHA Lender Approval, Annual Renewal, Periodic Updates and...

  18. 77 FR 63323 - Notice of Proposed Information Collection for Public Comment; FHA Lender Approval, Annual Renewal...

    Science.gov (United States)

    2012-10-16

    ... Lenders OMB Control Number, if applicable: 2502-0005. Description of the need for the information and proposed use: The information is used by FHA to verify that lenders meet all approval, renewal, update and... Information Collection for Public Comment; FHA Lender Approval, Annual Renewal, Periodic Updates and...

  19. 77 FR 21793 - Notice of Proposed Information Collection for Public Comment; Loan Guarantee for Indian Housing

    Science.gov (United States)

    2012-04-11

    ... Number: 2577-0200. Description of the need for the information and proposed use: The information is... service areas. Mortgage lenders approved by HUD provide borrower and lender information to HUD for... Information Collection for Public Comment; Loan Guarantee for Indian Housing AGENCY: Office of the Assistant...

  20. 78 FR 76655 - Notice of Receipt of Complaint; Solicitation of Comments Relating to the Public Interest

    Science.gov (United States)

    2013-12-18

    ... Trade Commission (USITC): http://edis.usitc.gov . \\3\\ Electronic Document Information System (EDIS... INTERNATIONAL TRADE COMMISSION Notice of Receipt of Complaint; Solicitation of Comments Relating to the Public Interest AGENCY: U.S. International Trade Commission. ACTION: Notice. SUMMARY: Notice...

  1. 75 FR 3502 - Data Collection Available for Public Comments and Recommendations

    Science.gov (United States)

    2010-01-21

    ..., and management and technical assistance through 7(j) designated funds) to foster the business growth... SMALL BUSINESS ADMINISTRATION Data Collection Available for Public Comments and Recommendations..., this notice announces the Small Business Administration's intentions to request approval on a new and...

  2. 76 FR 68791 - Notice of Availability for Public Comment on the Interagency Ocean Observing Committee Draft...

    Science.gov (United States)

    2011-11-07

    .... This criteria was developed in response to a requirement in the Integrated Coastal Ocean Observation....us . For the public unable to access the internet, printed copies can be requested by contacting the.... Comments may be submitted in writing to the Consortium for Ocean Leadership, Attention: IOOC Support Office...

  3. 78 FR 4157 - Notice of Proposed Information Collection for Public Comment: Survey of Manufactured (Mobile...

    Science.gov (United States)

    2013-01-18

    ... Information Collection for Public Comment: Survey of Manufactured (Mobile) Home Placements AGENCY: Office of.... Chapter 35, as amended). I. Abstract The Survey of Manufactured (Mobile) Home Placements collects data on... affordability. Furthermore, the Survey of Manufactured (Mobile) Home Placements serves as the basis for HUD's...

  4. 75 FR 8364 - Proposed Data Collections Submitted for Public Comment and Recommendations

    Science.gov (United States)

    2010-02-24

    ... on proposed data collection projects, the Centers for Disease Control and Prevention (CDC) will... data base containing identifying death record information submitted annually to NCHS by all the State...] Proposed Data Collections Submitted for Public Comment and Recommendations In compliance with the...

  5. 77 FR 71804 - Antiseptic Patient Preoperative Skin Preparation Products; Public Hearing; Request for Comments...

    Science.gov (United States)

    2012-12-04

    ...] Antiseptic Patient Preoperative Skin Preparation Products; Public Hearing; Request for Comments; Correction... ``Antiseptic Patient Preoperative Skin Preparation Products.'' The document was published with an incorrect... New Hampshire Ave. Silver Spring, MD 20903, 301-796-3441, Fax: 301-847-8753, email: CDER- Antiseptic...

  6. 76 FR 18225 - Request for Public Comment on Proposed Funding Opportunity Announcement for Special Initiative...

    Science.gov (United States)

    2011-04-01

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Request for Public Comment on Proposed Funding Opportunity Announcement for Special Initiative Concerning the Assets... of the AFI program and Individual Development Accounts (IDAs). SUMMARY: In FY 2011, the Office of...

  7. 75 FR 67803 - Data Collection Available for Public Comments and Recommendations

    Science.gov (United States)

    2010-11-03

    ... used to provide loans to start-up, newly established, and growing small business concerns for working... SMALL BUSINESS ADMINISTRATION Data Collection Available for Public Comments and Recommendations..., this notice announces the Small Business Administration's intentions to request approval on a new and...

  8. 75 FR 37806 - Twitter, Inc.; Analysis of Proposed Consent Order to Aid Public Comment

    Science.gov (United States)

    2010-06-30

    ... FEDERAL TRADE COMMISSION [File No. 092 3093] Twitter, Inc.; Analysis of Proposed Consent Order to... in paper form. Comments should refer to``Twitter, Inc., File No. 092 3093'' to facilitate the... weblink: ( http://public.commentworks.com/ftc/twitter ) and following the instructions on the web-based...

  9. 76 FR 28234 - Proposed Data Collections Submitted for Public Comment and Recommendations

    Science.gov (United States)

    2011-05-16

    ... requirement of Section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 for opportunity for public comment... (CDC). Background and Brief Description Section 212(a), (1) of the Immigration and Nationality Act... an application for waiver is filed and approved by the U.S. Citizenship and Immigration Services...

  10. 77 FR 8253 - Notice of Proposed Settlement Agreement and Opportunity for Public Comment: Hidden Lane Landfill...

    Science.gov (United States)

    2012-02-14

    ... ENVIRONMENTAL PROTECTION AGENCY [FRL-9631-3] Notice of Proposed Settlement Agreement and Opportunity for Public Comment: Hidden Lane Landfill Superfund Site ACTION: Notice. SUMMARY: In accordance... (``DOJ'') on behalf of EPA, in connection with the Hidden Lane Landfill Superfund Site, Sterling, Loudoun...

  11. 75 FR 35843 - Proposed Extension of Information Collection Request Submitted for Public Comment; Form 5500...

    Science.gov (United States)

    2010-06-23

    ... welfare plans (collectively referred to as employee benefit plans) to file returns or reports annually... DEPARTMENT OF LABOR Employee Benefits Security Administration Proposed Extension of Information Collection Request Submitted for Public Comment; Form 5500, Annual Return/Report of Employee Benefit Plan...

  12. 76 FR 23328 - Notice of Proposed Information Collection for Public Comment; Indian Community Development Block...

    Science.gov (United States)

    2011-04-26

    ... Information Collection for Public Comment; Indian Community Development Block Grant Information Collection... lists the following information: Title of Proposal: Indian Community Development Block Grant Information... Block Grants, requires that grants for Indian Tribes be awarded on a competitive basis. The purpose of...

  13. 77 FR 14016 - Agency Information Collection Request; 60-Day Public Comment Request

    Science.gov (United States)

    2012-03-08

    ... 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; 60-Day Public Comment Request AGENCY: Office of the Secretary, HHS. In compliance with...

  14. 75 FR 14658 - Invitation for Public Comment on Mitigation Options for Global Positioning System Satellite...

    Science.gov (United States)

    2010-03-26

    ... Public Comment on Mitigation Options for Global Positioning System Satellite Vehicle Number 49 AGENCY... options prior to changing the health status of Global Positioning System (GPS) satellite IIR-20M (satellite vehicle number 49--SVN 49) from unhealthy to healthy. The potential mitigations are each designed...

  15. 76 FR 34091 - Notice of Proposed Information Collection for Public Comment; FHA Lender Approval, Annual Renewal...

    Science.gov (United States)

    2011-06-10

    ... managing its financial risks and protect consumers from lender noncompliance with FHA rules and regulations... Information Collection for Public Comment; FHA Lender Approval, Annual Renewal, Periodic Updates and Noncompliance Reporting by FHA Approved Lenders AGENCY: Office of the Assistant Secretary for Housing, HUD...

  16. 78 FR 35285 - Agency Information Collection Activities; Proposed Collection; Public Comment Request

    Science.gov (United States)

    2013-06-12

    ... training, administrative and organizational structures, clinical service, challenges, innovations, costs... for public comment on proposed data collection projects (Section 3506(c)(2)(A) of the Paperwork... 20857. FOR FURTHER INFORMATION CONTACT: To request more information on the proposed project or to obtain...

  17. 76 FR 14018 - Proposed Data Collections Submitted for Public Comment and Recommendations

    Science.gov (United States)

    2011-03-15

    ... requirement of Section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 for opportunity for public comment... of the effort. Although up to 70% of neural tube defects can be prevented if a woman consumes folic... status shall be explored through segmentation of the focus groups. Sixteen focus groups will be conducted...

  18. 75 FR 20849 - Proposed Data Collections Submitted for Public Comment and Recommendations

    Science.gov (United States)

    2010-04-21

    ... requirement of Section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 for opportunity for public comment... to ensure that program messages/materials, and their placement, can successfully gain the attention... indicated. Other variables for segmentation may include, but not be limited to, geography, language, and...

  19. 76 FR 44334 - Proposed Data Collections Submitted for Public Comment and Recommendations

    Science.gov (United States)

    2011-07-25

    ... requirement of Section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 for opportunity for public comment... effort. Although up to 70% of neural tube defects can be prevented if a woman consumes folic acid before... be explored through segmentation of the focus groups. Sixteen focus groups will be conducted in both...

  20. 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...

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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

  7. 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.

  8. 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.

  9. 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.

  10. [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.

  11. 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.

  12. 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.

  13. Internet comments as a barometer of public opinion

    Science.gov (United States)

    Oster, Elad; Gilad, Erez; Feigel, Alexander

    2015-07-01

    A new method is developed to estimate social influence in Internet communities that follow a specific developing news story. The technique stems from mean-field treatment of magnetic systems and provides a measure for community stability, such as the potential of a small perturbation to culminate in a phase-transition-like phenomenon. Three real cases of developing news stories from CNN news website are analyzed. Continuous dynamics of social influence together with time is observed together with a significant increase of social influence after the announcement of important information, such as the jury decision in a legal case. This work makes it possible to estimate the size of a group that can change the opinion of the entire population. We argue that Internet comments may predict the level of social response similar to a barometer that predicts the intensity of a coming storm in still calm environment.

  14. 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

  15. 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.

  16. 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

  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. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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

  3. 75 FR 60854 - 2010 Special 301 Out of Cycle Review of Notorious Markets: Request for Public Comment

    Science.gov (United States)

    2010-10-01

    ... result of that discussion, USTR has concluded that it can further publicize and potentially expand on the... infringing materials; any positive progress made. Any comments that include quantitative loss claims should... English. All comments should be sent electronically via http://www.regulations.gov , docket number USTR...

  4. 77 FR 56674 - United States v. Humana Inc. and Arcadian Management Services, Inc.; Public Comment and Response...

    Science.gov (United States)

    2012-09-13

    ... students in the United States. The AMA's comment states that: MA [Medicare Advantage] plans in competitive... Services, Inc.; Public Comment and Response on Proposed Final Judgment Pursuant to the Antitrust Procedures... on the proposed Final Judgment in United States v. Humana Inc. and Arcadian Management Services, Inc...

  5. 75 FR 28809 - Notice of Request for Public Comment

    Science.gov (United States)

    2010-05-24

    ... use of genetic technologies and, as warranted, to provide advice on these issues. For more information... Services (HHS) on genetics education and training of health care professionals, public health providers... 301-496- 9839. FOR FURTHER INFORMATION CONTACT: Kathryn Camp, NIH Office of Biotechnology Activities...

  6. 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

  7. 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

  8. 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

  9. 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.

  10. 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.

  11. Summary, analysis, and response to public comments on proposed amendments to 10 CFR Parts 30, 40, 50, 51, 70, and 72: Decommissioning criteria for nuclear facilities

    International Nuclear Information System (INIS)

    1988-06-01

    On February 11, 1985, the NRC issued for public comment proposed rules on decommissioning of nuclear facilities (50 FR 5600). Comment letters were received from 143 organizations and individuals. This report provides a summary and analysis and response to the public comments received

  12. 76 FR 50286 - Request for Comments and Notice of Public Hearing Concerning China's Compliance With WTO Commitments

    Science.gov (United States)

    2011-08-12

    ...., subsidies, standards and technical regulations, sanitary and phytosanitary measures, government procurement... Concerning China's Compliance With WTO Commitments AGENCY: Office of the United States Trade Representative. ACTION: Request for comments and notice of public hearing concerning China's compliance with its WTO...

  13. 77 FR 33218 - Graco, Inc.; Analysis of Proposed Agreement Containing Consent Orders To Aid Public Comment

    Science.gov (United States)

    2012-06-05

    ... ``Graco, Dkt. No. 9350'' on your comment, and file your comment online at https://ftcpublic.commentworks... ``Graco, Dkt. No. 9350'' on your comment. Your comment--including your name and your state--will be placed... file a comment through that Web site. If you file your comment on paper, write ``Graco, Dkt. No. 9350...

  14. 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

  15. 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.

  16. 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...

  17. 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...

  18. 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....

  19. 78 FR 41971 - 30-Day Notice of Proposed Information Collection: Electronic Diversity Visa Entry Form

    Science.gov (United States)

    2013-07-12

    ... Affairs at the Office of Management and Budget (OMB). You may submit comments by the following methods... from a low admission country, is a high school graduate, or has two years of experience in a job that requires two years of training. The foreign nationals complete the electronic entry forms and then...

  20. 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....

  1. 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.

  2. 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...

  3. [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.

  4. 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.

  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. 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.

  7. 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)

  8. 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.

  9. 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.

  10. 78 FR 42090 - Submission for OMB Review; 30-day Comment Request; NIH Office of Intramural Training & Education...

    Science.gov (United States)

    2013-07-15

    ... such as: Personal information, eligibility criteria, contact information, student identification number... contact, travel information, as well as feedback questions about interviews and application submission... Partnership) National Graduate Student Research Conference 800.0 1.0 1.0 800.00 (NGSRC) Undergraduate...

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    ... Institute, 11400 Rockville Pike, Room 707, Rockville, MD 20852 or call non-toll- free number 301-480-0541 or Email your request, including your address to: [email protected] . Formal requests for... (NIH) Institutes. Along with the analysis, NCI's ongoing education and outreach effort has increased...

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    2013-12-18

    ... understand what activities are feasible in specific settings, participants' willingness to complete requested..., Primary Caregiver, Secondary Residence Caregiver. Validation Interview (Pre- Pregnant Woman, 850 1 2/60 28 Pregnancy to 60M). Father/Father Figure, Biological Mother, Primary Caregiver, Secondary Residence Caregiver...

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    2013-04-04

    ... greatest capacity of being received, understood, and accepted by their target audiences. Since NCI's OCE is... (attitudes, beliefs, and behaviors) of the intended target audience and use this information in the... relevance, utility, appropriateness, and impact for/to target audiences; and (3) expend limited program...

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    2013-03-06

    ... the greatest capacity of being received, understood, and accepted by their target audiences. Since NCI... (attitudes, beliefs, and behaviors) of the intended target audience and use this information in the... relevance, utility, appropriateness, and impact for/to target audiences; and (3) expend limited program...

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    2013-11-19

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  16. 78 FR 15958 - Submission for OMB Review; 30-day Comment Request: Pediatric Palliative Care Campaign Pilot Survey

    Science.gov (United States)

    2013-03-13

    ... current perceptions, challenges, and information needs of health care providers when it comes to... can be used by a wider audience of health care providers. OMB approval is requested for 1 year. There...

  17. National Energy Strategy: A compilation of public comments; Interim Report

    Energy Technology Data Exchange (ETDEWEB)

    1990-04-01

    This Report presents a compilation of what the American people themselves had to say about problems, prospects, and preferences in energy. The Report draws on the National Energy Strategy public hearing record and accompanying documents. In all, 379 witnesses appeared at the hearings to exchange views with the Secretary, Deputy Secretary, and Deputy Under Secretary of Energy, and Cabinet officers of other Federal agencies. Written submissions came from more than 1,000 individuals and organizations. Transcripts of the oral testimony and question-and-answer (Q-and-A) sessions, as well as prepared statements submitted for the record and all other written submissions, form the basis for this compilation. Citations of these sources in this document use a system of identifying symbols explained below and in the accompanying box. The Report is organized into four general subject areas concerning: (1) efficiency in energy use, (2) the various forms of energy supply, (3) energy and the environment, and (4) the underlying foundations of science, education, and technology transfer. Each of these, in turn, is subdivided into sections addressing specific topics --- such as (in the case of energy efficiency) energy use in the transportation, residential, commercial, and industrial sectors, respectively. 416 refs., 44 figs., 5 tabs.

  18. 76 FR 22701 - Notice of Public Information Collection(s) Being Reviewed by the Federal Communications...

    Science.gov (United States)

    2011-04-22

    ... access. Needs and Uses: Section 15.615 requires entities operating Access BPL systems shall supply to an... systems for inclusion into a publicly available database, within 30 days prior to installation of service... comments to Nicholas A. Fraser, Office of Management and Budget, via fax at 202-395-5167 or via the...

  19. 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

  20. Puget Sound Reinforcement Project : Planning for Peak Power Needs : Scoping Report, Part A, Summary of Public Comments.

    Energy Technology Data Exchange (ETDEWEB)

    United States. Bonneville Power Administration.

    1990-07-01

    This report summarizes public participation in the environmental scoping process for the Puget Sound Reinforcement Project, a Bonneville Power Administration (BPA) and Puget Sound area utilities study of voltage stability in northwestern Washington state. The environmental scoping phase of the Puget Sound project consisted of a series of public meetings and a public comment period. The content of these meetings is summarized in 2.0, Public Involvement. In 3.0, Comment Summary, the report summarizes comments received via meetings, mail and phone. The report ends with a description of the next steps in the project. Chapter 4.0, describes the decision process to be used by BPA and area utilities. Chapter 5.0 describes opportunities for public participation in decisions to be made about the future reliability of Puget Sound's electricity supply.

  1. 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.

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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.

  7. 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)

  8. 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.

  9. 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...

  10. 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.

  11. 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)

  12. [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.

  13. 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)

  14. 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.

  15. 78 FR 36197 - Request for Public Comment: 60-Day Proposed Information Collection: Application for Participation...

    Science.gov (United States)

    2013-06-17

    ... function; (b) whether the agency processes the information collected in a useful and timely fashion; (c... requests, comments, and return address to: [email protected] . Comment Due Date: Comments regarding this...

  16. Comment

    Science.gov (United States)

    2001-07-01

    schools and colleges are exploring electronic learning through the internet and virtual labs (see Steve Mellema's use of IT in his Lecture for the 21st Century). We aim to provide useful material for everybody at and in between the extremes. But some words of caution, sounded by Robertson in Stirling: today we might find that our classes are motivated and interested when we use computers, but how long will the excitement last? If every lesson faces children with computer screens will they soon get bored and demotivated? Individual learning, through worksheets, was a great success when it was developed in the 70s, but when every lesson faced a child with yet another worksheet, students were turned off. It became known as 'death by a thousand worksheets'. Let's not abuse computers in the same way. Physics for the beach and the igloo Physics is about being cool, as we are always trying to tell our students! In this 'summer' issue we have two papers which allow us to demonstrate this practically. I should also like to remind readers that Physics Education is available online (www.iop.org/Journals/pe) in addition to the paper version. The electronic version has the advantages of hotlinks to websites, search facilities and the ability to download teaching materials. My guess is that we haven't begun to explore the possibilities of the electronic journal as a teaching resource for teachers. If it can be stored electronically, we can include it as a multimedia clip pictures, worksheets, spreadsheets, videos, sounds... But there are also many advantages of paper—convenience and permanence being just two. Physics Education is a worthwhile publication and it feels like that in your hand. Having a journal like this, to put in my bag, or stack on my bookshelf, still feels good to me. And judging by readers' comments, you agree. IOPP will, no doubt, support both formats for a long time to come. So, this summer, enjoy the format you are reading, read Physics Education on screen or on

  17. 78 FR 78341 - Extension of Comment Period for Public Comments on Department of Commerce Green Paper, Copyright...

    Science.gov (United States)

    2013-12-26

    ... policy issues critical to economic growth, job creation, and cultural development that were identified in...-meeting comments. DATES: To be ensured of consideration, post-meeting comments are due on or before... confidential business information or otherwise sensitive or protected information. The Task Force will accept...

  18. National radioactive waste repository site selection study. Phase 2. A report on public comment

    International Nuclear Information System (INIS)

    1995-11-01

    Agreement was reached in principle between State/Territory and the Commonwealth of Australia Governments that a suitable site for a radioactive wastes repository must be found. The discussion papers resulting from the Phase 1 and Phase 2 of the site selection study were released for public comment. The national repository will be for disposal of low level and short-lived intermediate level radioactive wastes streaming from the medical, research and industrial use of radioisotopes in Australia. The purpose of this report is to summarise and respond in general terms to comment received on the discussion paper -Phase 2 of the study. Forty five submissions were received. Of these: 18 supported the Phase 2 study approach and the concept of a national repository; 13 did not state a clear position but either requested more information or provided constructive comment on the siting process; 7 supported the site selection approach and the repository concept but suggested that the repository should not be sited in a particular area; 3 opposed the siting of the repository in their vicinity but not necessarily the repository concept and site selection approach; 4 opposed the concept of a national repository. This compares with 124 submissions on Phase 1 of the study, of which 57 opposed the national repository concept (52 of these were from letters elicited by Greenpeace) and 48 supported the establishment of a national repository and the site selection approach proposed. 3 figs

  19. Do Online Comments Influence the Public's Attitudes Toward an Organization? Effects of Online Comments Based on Individuals' Prior Attitudes.

    Science.gov (United States)

    Sung, Kang Hoon; Lee, Moon J

    2015-01-01

    The authors investigated the effects of reading different types of online comments about a company on people's attitude change based on individual's prior attitude toward the company. Based on Social Judgment Theory, several hypotheses were tested. The results showed that the effects of online comments interact with individuals' prior attitudes toward a corporation. People with a strong negative attitude toward a corporation were less influenced by other's online comments than people with a neutral attitude in general. However, people with a prior negative attitude were more affected by refutational two-sided comments than one-sided comments. The results suggest that the effects of user generated content should be studied in a holistic manner, not only by investigating the effects of online content itself, but also by examining how others' responses to the content shape or change individuals' attitudes based on their prior attitudes.

  20. 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....

  1. 75 FR 67666 - Use of Various Winemaking Terms on Wine Labels and in Advertisements; Request for Public Comment

    Science.gov (United States)

    2010-11-03

    ...The Alcohol and Tobacco Tax and Trade Bureau is considering amending the regulations concerning various winemaking terms commonly used on labels and in advertisements to provide consumers with information about the growing or bottling conditions of wine. We invite comments from industry members, consumers, and other interested parties as to whether and to what extent we should propose specific regulatory amendments for further public comment.

  2. MX: Milestone II. Final Environmental Impact Statement. Volume 6. Public Comments

    Science.gov (United States)

    1978-10-06

    8217VPaoli, molyore, ’leming# Daily, Otis, AKrun, Brus , LcKley, "ray, Jos, Id~lia, and Vernon. Thjen tncrc are a nuuber ul CceUCeerleS in tebween witl Ourialz...KS Public Comments VI - 5-101 Grace Eastin Yuma, CO M. H. Eaton Oakley, KS Mr. Dan R. Ebener Dubuque, IA Mr. Tom Eberhart Burlington, CO Elizabeth ...Russell Springs, KS Burlington, CO Rebecca L. Smith Mrs. Elizabeth StevensWinona, KS Potter, NE * r. Ronald L. Smith Mr. Wesley L. Stevens Winona, KS

  3. NRC staff preliminary analysis of public comments on advance notice of proposed rulemaking on emergency planning

    International Nuclear Information System (INIS)

    Peabody, C.A.; Hickey, J.W.N.

    1980-01-01

    The Nuclear Regulatory Commission (NRC) published an advance notice of proposed rulemaking on emergency planning on July 17, 1979 (44 FR 41483). In October and November 1979, the NRC staff submitted several papers to the Commission related to the emergency planning rulemaking. One of these papers was a preliminary analysis of public comments received on the advance notice (SECY-79-591B, November 13, 1979). This document consists of the preliminary analysis as it was submitted to the Commission, with minor editorial changes

  4. 75 FR 17942 - Notice of Proposed Information Collection for Public Comment on the Quality Control for Rental...

    Science.gov (United States)

    2010-04-08

    ... Information Collection for Public Comment on the Quality Control for Rental Assistance Subsidy Determinations... respondent burden (e.g., permitting electronic submission of responses). Title of Proposal: Quality Control... covered by the Public Housing and Section 8 housing subsidies. The Quality Control process involves...

  5. 75 FR 19335 - Premium Review Process; Request for Comments Regarding Section 2794 of the Public Health Service Act

    Science.gov (United States)

    2010-04-14

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary 45 CFR Parts 146 and 148 Premium Review Process; Request for Comments Regarding Section 2794 of the Public Health Service Act AGENCY..., which added Section 2794 to the Public Health Service Act (the PHS Act). Section 2794 of the PHS Act...

  6. 76 FR 67418 - Request for Comments on NIST Special Publication 500-293, US Government Cloud Computing...

    Science.gov (United States)

    2011-11-01

    ...-1659-01] Request for Comments on NIST Special Publication 500-293, US Government Cloud Computing... Publication 500-293, US Government Cloud Computing Technology Roadmap, Release 1.0 (Draft). This document is... (USG) agencies to accelerate their adoption of cloud computing. The roadmap has been developed through...

  7. 78 FR 63464 - Notice of Extension of the Public Comment Period on the Draft Toxicological Review of Benzo[a...

    Science.gov (United States)

    2013-10-24

    ... from October 21, 2013, to November 21, 2013. The draft assessment will be added to the agenda for the...]pyrene to the Agenda for the December 2013 IRIS Bimonthly Meeting AGENCY: Environmental Protection Agency (EPA). ACTION: Notice of Extension of the Public Comment Period to November 21, 2013, and the Public...

  8. 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.

  9. Vancomycin AUC/MIC ratio and 30-day mortality in patients with Staphylococcus aureus bacteremia.

    Science.gov (United States)

    Holmes, Natasha E; Turnidge, John D; Munckhof, Wendy J; Robinson, J Owen; Korman, Tony M; O'Sullivan, Matthew V N; Anderson, Tara L; Roberts, Sally A; Warren, Sanchia J C; Gao, Wei; Howden, Benjamin P; Johnson, Paul D R

    2013-04-01

    A ratio of the vancomycin area under the concentration-time curve to the MIC (AUC/MIC) of ≥ 400 has been associated with clinical success when treating Staphylococcus aureus pneumonia, and this target was recommended by recently published vancomycin therapeutic monitoring consensus guidelines for treating all serious S. aureus infections. Here, vancomycin serum trough levels and vancomycin AUC/MIC were evaluated in a "real-world" context by following a cohort of 182 patients with S. aureus bacteremia (SAB) and analyzing these parameters within the critical first 96 h of vancomycin therapy. The median vancomycin trough level at this time point was 19.5 mg/liter. There was a significant difference in vancomycin AUC/MIC when using broth microdilution (BMD) compared with Etest MIC (medians of 436.1 and 271.5, respectively; P AUC/MIC of ≥ 400 using BMD was not associated with lower 30-day all-cause or attributable mortality from SAB (P = 0.132 and P = 0.273, respectively). However, an alternative vancomycin AUC/MIC of >373, derived using classification and regression tree analysis, was associated with reduced mortality (P = 0.043) and remained significant in a multivariable model. This study demonstrated that we obtained vancomycin trough levels in the target therapeutic range early during the course of therapy and that obtaining a higher vancomycin AUC/MIC (in this case, >373) within 96 h was associated with reduced mortality. The MIC test method has a significant impact on vancomycin AUC/MIC estimation. Clinicians should be aware that the current target AUC/MIC of ≥ 400 was derived using the reference BMD method, so adjustments to this target need to be made when calculating AUC/MIC ratio using other MIC testing methods.

  10. 75 FR 47624 - U.S. Coral Reef Task Force Public Meeting and Public Comment

    Science.gov (United States)

    2010-08-06

    ... DEPARTMENT OF THE INTERIOR Fish and Wildlife Service U.S. Coral Reef Task Force Public Meeting and... (Service), announce a public meeting of the U.S. Coral Reef Task Force (USCRTF) and a request for written.... Coral Reef Task Force Department of the Interior Liaison, U.S. Department of the Interior, MS-3530-MIB...

  11. 77 FR 17479 - Star Pipe Products, Ltd.; Analysis of Proposed Consent Order To Aid Public Comment

    Science.gov (United States)

    2012-03-26

    ... FEDERAL TRADE COMMISSION [Docket No. 9351] Star Pipe Products, Ltd.; Analysis of Proposed Consent... ``Star Pipe, Docket No. 9351'' on your comment, and file your comment online at https://ftcpublic..., 2012. Write ``Star Pipe, Docket No. 9351'' on your comment. Your comment-- including your name and your...

  12. 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

  13. 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

  14. Public comments on the draft generic environmental impact statement for management of commercially generated radioactive waste

    International Nuclear Information System (INIS)

    Kreiter, M.R.; Unruh, C.M.; McCallum, R.F.

    1980-01-01

    The US Department of Energy has the responsibility for developing the technology required for managing commercial radioactive wastes in an environmentally acceptable manner. As part of this responsibility, DOE has prepared a draft environmental impact statement on the management of commercially generated radioactive waste. The draft was issued for public comment in April of 1979; five public hearings were held. The draft GEIS is intended to provide environmental input for the selection of an appropriate program strategy for the permanent isolation of commercially generated high-level and transuranic wastes. The scope of such a strategy includes research and development into alternative treatment processes and emplacement media, site investigations into candidate media, and the examination of advanced waste management technologies. The draft statement describes the commercial radioactive wastes that would have to be managed for very long periods of time from an assumed nuclear generation scenario of 10,000 GWe-yr of power over a 65-year period ending in 2040

  15. Indiana application for interim authorization, phase I, hazardous waste management program--Environmental Protection Agency. Notice of public hearing and public comment period.

    Science.gov (United States)

    1982-04-12

    EPA regulations to protect human health and the environment from the improper management of hazardous waste were published in the Federal Register on May 19, 1980 (45 FR 33063). These regulations include provisions for authorization of State programs to operate in lieu of the Federal program. Today EPA is announcing the availability for public review of the Indiana application for Phase I Interim Authorization, inviting public comment, and giving notice of a public hearing to be held on the application.

  16. 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.

  17. Final environmental impact statement for the Nevada test site and off-site locations in the State of Nevada. Public comment and response document, Volume 3, Part A comments

    International Nuclear Information System (INIS)

    1996-08-01

    On February 2, 1996, the U.S. Department of Energy (DOE) issued the Draft Environmental Impact Statement for the Nevada Test Site and Off-Site Locations in the State of Nevada (NTS EIS) for review by the state of Nevada, Indian tribes, local governments, other federal agencies, groups and organizations, and the general public. The formal comment period lasted 90 days, ending May 3, 1996. As part of the comment process, the DOE held public hearings in St. George, Utah, and in Pahrump, Reno, and Las Vegas, Nevada. Community Workshops were held in Caliente, Tonopah, Boulder City, and North Las Vegas, Nevada, in conjunction with the University of Nevada Las Vegas to discuss the Draft NTS EIS. Volume 3 of the Final NTS EIS contains 3 chapters. Chapter 1 summarizes the major issues raised by the public. Chapter 2 contains the full text of the public comments on the Draft NTS EIS received by the DOE; it includes public hearing transcripts, written comments, and comments received via a toll-free comment open-quotes hot line.close quotes Chapter 3 contains the DOE's responses to the public comments and describes how the comments were considered in the Final NTS EIS

  18. 77 FR 52749 - 30-Day Proposed Information Collection: Addendum to Declaration for Federal Employment, Child...

    Science.gov (United States)

    2012-08-30

    ... of 18 to assure that all existing and newly hired employees undergo a criminal history background... useful and timely fashion; (c) the accuracy of the public burden estimate (the estimated amount of time...

  19. Heart rate variability predicts 30-day all-cause mortality in intensive ...

    African Journals Online (AJOL)

    ... is co-published by Medpharm Publications, NISC (Pty) Ltd and Taylor & Francis, and Informa business .... univariable logistic regression for each of the candidate predictor .... diagnostic and prognostic tool in anesthesia and intensive care.

  20. 77 FR 59354 - Removal of 30-Day Residency Requirement for Per Diem Payments

    Science.gov (United States)

    2012-09-27

    ... that VA calculates occupancy rate ``by dividing the total number of patients in the nursing home or... sector of the economy, productivity, competition, jobs, the environment, public health or safety, or...

  1. 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.

  2. 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.

  3. 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.

  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. 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.

  6. 77 FR 56857 - Notice of Proposed Information Collection for Public Comment; Public Housing Mortgage Program and...

    Science.gov (United States)

    2012-09-14

    ... of the loan resulting from the mortgage or security interest are used for low-income housing uses... mortgage or security interest in any public housing real estate or other assets, a proposal must be submitted to HUD. After approval and execution of any legal documents associated with the loan and related...

  7. 77 FR 76064 - Notice of Proposed Information Collection for Public Comment; Public Housing Reform Act: Changes...

    Science.gov (United States)

    2012-12-26

    ... through the Freedom of Information Act. Written documentation of policies relating to public housing and... . Persons with hearing or speech impairments may access this number through TTY by calling the toll-free... is not a toll-free number). Persons with hearing or speech impairments may access this number via TTY...

  8. 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.

  9. 78 FR 12132 - 30-Day Notice of Proposed Information Collection: Reporting Requirements on Responsible...

    Science.gov (United States)

    2013-02-21

    ... Requirements on Responsible Investment in Burma. OMB Control Number: None. Type of Request: New Collection... through the commission of human rights abuses and pervasive public corruption. In Executive Order 13619 of... potential adverse human rights, worker rights, anti-corruption, environmental, or other impacts resulting...

  10. Effects of Online Comments on Smokers' Perception of Anti-Smoking Public Service Announcements.

    Science.gov (United States)

    Shi, Rui; Messaris, Paul; Cappella, Joseph N

    2014-07-01

    On YouTube anti-smoking PSAs are widely viewed and uploaded; they also receive extensive commentary by viewers. This study examined whether such evaluative comments with or without uncivil expressions influence evaluations by subsequent viewers. Results showed PSAs with positive (i.e. anti-smoking) comments were perceived by smokers as more effective than PSAs with negative (pro smoking) comments. Smokers in the no comment condition gave the highest perceived effectiveness score to PSAs. Smokers' readiness to quit smoking moderated the effect of comments on PSA evaluation. Smokers reading negative uncivil comments reported more negative attitude toward quitting and a lower level of perceived risk of smoking than those reading negative civil comments but positive civil and positive uncivil comments didn't elicit different responses.

  11. Effects of Online Comments on Smokers’ Perception of Anti-Smoking Public Service Announcements

    Science.gov (United States)

    Shi, Rui; Messaris, Paul; Cappella, Joseph N.

    2014-01-01

    On YouTube anti-smoking PSAs are widely viewed and uploaded; they also receive extensive commentary by viewers. This study examined whether such evaluative comments with or without uncivil expressions influence evaluations by subsequent viewers. Results showed PSAs with positive (i.e. anti-smoking) comments were perceived by smokers as more effective than PSAs with negative (pro smoking) comments. Smokers in the no comment condition gave the highest perceived effectiveness score to PSAs. Smokers’ readiness to quit smoking moderated the effect of comments on PSA evaluation. Smokers reading negative uncivil comments reported more negative attitude toward quitting and a lower level of perceived risk of smoking than those reading negative civil comments but positive civil and positive uncivil comments didn't elicit different responses. PMID:25561825

  12. 77 FR 71593 - Robert Bosch GmbH; Analysis of Agreement Containing Consent Orders To Aid Public Comment

    Science.gov (United States)

    2012-12-03

    ..., Inc., Dkt. No. 9302, 2006 FTC LEXIS 101 (Aug. 20, 2006), rev'd, Rambus Inc. v. F.T.C., 522 F.3d 456 (D... Order to Aid Public Comment Sec. V.B. \\12\\ See, e.g., In re Rambus, Inc., Dkt. No. 9302 (FTC Aug. 2...

  13. 77 FR 34010 - Notice of Opportunity To Submit Comment on the Public Release Time of Several Major USDA...

    Science.gov (United States)

    2012-06-08

    ... Statistics Service and Office of the Chief Economist, Department of Agriculture. ACTION: Notice and request... the Chief Economist are currently accepting stakeholder input on the public release time and... the Chief Economist are seeking comments on the release time of several of their major statistical...

  14. 75 FR 16819 - Notice of Proposed Information Collection for Public Comment Civil Rights Front End and Limited...

    Science.gov (United States)

    2010-04-02

    ... Information Collection for Public Comment Civil Rights Front End and Limited Monitoring Review AGENCY: Office... Office of Management and Budget (OMB) for review, as required by the Paperwork Reduction Act. The...-free Federal Information Relay Service at 800-877-8339. (Other than the HUD USER information line and...

  15. 76 FR 62066 - Phusion Projects, LLC, et al.; Analysis of Proposed Consent Order To Aid Public Comment

    Science.gov (United States)

    2011-10-06

    ..., including routine uses permitted by the Privacy Act, in the Commission's privacy policy, at http://www.ftc.gov/ftc/privacy.htm . Analysis of Agreement Containing Consent Order To Aid Public Comment The Federal... servings of alcohol in the container. Part II of the proposed order further prohibits, commencing six (6...

  16. 77 FR 4336 - Notice of Proposed Information Collection for Public Comment on the Study of: Housing for Youth...

    Science.gov (United States)

    2012-01-27

    ... Information Collection for Public Comment on the Study of: Housing for Youth Aging Out of Foster Care AGENCY... information: Title of Proposal: Housing for Youth Aging Out of Foster Care. OMB Control Number: XXXX-pending... serving youth aging out of foster care, and why or why not; and for those PHAs that are serving youth, to...

  17. 78 FR 41803 - Establishment of a Public Docket for Comment on the Report Prepared Under the Food and Drug...

    Science.gov (United States)

    2013-07-11

    ... Administration Safety and Innovation Act (FDASIA) Section 1138, enacted July 9, 2012, and posted on the FDA Web... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2013-N-0757] Establishment of a Public Docket for Comment on the Report Prepared Under the Food and Drug Administration...

  18. 78 FR 44117 - Notice of a Public Comment Period on the Draft IRIS Carcinogenicity Assessment for Ethylene Oxide

    Science.gov (United States)

    2013-07-23

    ... Public Comment Period on the Draft IRIS Carcinogenicity Assessment for Ethylene Oxide AGENCY... Carcinogenicity of Ethylene Oxide'' (EPA/635/R-13/128a) and on the draft peer review charge questions. The draft... on the draft Evaluation of the Inhalation Carcinogenicity of Ethylene Oxide and on the draft peer...

  19. 75 FR 22890 - Notice of Extension of Public Comment Period for the Proposed Keystone XL Pipeline Project Draft...

    Science.gov (United States)

    2010-04-30

    ... notice that listed the public comment meetings and additional information on the DEIS was published in.... By mail addressed to: Elizabeth Orlando, Keystone XL Project Manager, U.S. Department of State, OES... screening. Fax to: (202) 647-1052, attention Elizabeth Orlando. FOR FURTHER INFORMATION CONTACT: For...

  20. 78 FR 44188 - Paperwork Reduction Act of 1995, as Amended by Public Law 104-13; Proposed Collection, Comment...

    Science.gov (United States)

    2013-07-23

    ... TENNESSEE VALLEY AUTHORITY Paperwork Reduction Act of 1995, as Amended by Public Law 104-13; Proposed Collection, Comment Request AGENCY: Tennessee Valley Authority. ACTION: Proposed Collection... preference. The information is used to make comparative appraisals and to assist in selections. The affected...

  1. 75 FR 27863 - Paperwork Reduction Act of 1995, as Amended by Public Law 104-13; Proposed Collection, Comment...

    Science.gov (United States)

    2010-05-18

    ... TENNESSEE VALLEY AUTHORITY Paperwork Reduction Act of 1995, as Amended by Public Law 104-13; Proposed Collection, Comment Request AGENCY: Tennessee Valley Authority. ACTION: Proposed collection... preference. The information is used to make comparative appraisals and to assist in selections. The affected...

  2. 77 FR 2924 - Notice of Public Meeting and Request for Comment on the Branch Technical Position on the Import...

    Science.gov (United States)

    2012-01-20

    ... phrase ``Of U.S. origin'' to the first exclusion to the definition of ``radioactive waste'' in Sec. 110.2...'' exclusion. The staff is holding a public meeting to obtain comments from stakeholders on the draft BTP and... practical to do so. NRC plans to consider these stakeholder views in the development of a revised draft BTP...

  3. 77 FR 66483 - Public Comment on the Draft Federal Urban Design Element and the Draft Update to the Federal...

    Science.gov (United States)

    2012-11-05

    ... NCPC review required by law. The new Federal Urban Design Element provides policies that will guide the... public comment a draft new Federal Urban Design Element and draft revisions to the Preservation and... Features Element articulates policies that guide federal actions preserving Washington's historic character...

  4. 78 FR 16567 - Notice of Opportunity for Public Comment on Non-Rule Making Action To Change Land Use From...

    Science.gov (United States)

    2013-03-15

    ... Public Comment on Non-Rule Making Action To Change Land Use From Aeronautical to Non-Aeronautical at... layout plan update, if approved, would change the land use on 72.13 acres from aeronautical to non-aeronautical. The property will then be leased for Commercial Development. The location of the land relative to...

  5. 78 FR 49789 - Request for Comments and Notice of Public Hearing Concerning Russia's Implementation of Its WTO...

    Science.gov (United States)

    2013-08-15

    ... its obligations as a Member of the World Trade Organization (WTO). SUMMARY: The interagency Trade... the WTO are contained in the Marrakesh Agreement Establishing the World Trade Organization (WTO... OFFICE OF THE UNITED STATES TRADE REPRESENTATIVE Request for Comments and Notice of Public Hearing...

  6. 77 FR 41406 - Request for Public Comment on a Nomination to the Office of Health Assessment and Translation

    Science.gov (United States)

    2012-07-13

    ..., which was nominated for a possible evaluation by the Office of Health Assessment and Translation (OHAT... substances, or mixtures (collectively referred to as ``substances'') cause adverse health effects and... DEPARTMENT OF HEALTH AND HUMAN SERVICES Request for Public Comment on a Nomination to the Office...

  7. 77 FR 39459 - Fisheries of the United States; National Standard 1 Guidelines; Extension of Public Comment Period

    Science.gov (United States)

    2012-07-03

    .... 120425420-2420-01] RIN 0648-BB92 Fisheries of the United States; National Standard 1 Guidelines; Extension... adjustments to the National Standard 1 Guidelines, one of 10 national standards for fishery conservation and... National Standard 1 Guidelines. The ANPR provides the public with a formal opportunity to comment on the...

  8. 75 FR 70903 - Eastern North Pacific Gray Whale; Notice of Extension of Public Comment Period on Marine Mammal...

    Science.gov (United States)

    2010-11-19

    ... North Pacific Gray Whale; Notice of Extension of Public Comment Period on Marine Mammal Protection Act... whales (Eschrichtius robustus) as a depleted stock under the Marine Mammal Protection Act (MMPA) and... report for Eastern North Pacific gray whales is available on the Internet at the following address: http...

  9. 75 FR 66773 - Notice of Proposed Information Collection for Public Comment; FY 2010 Capital Fund Community and...

    Science.gov (United States)

    2010-10-29

    ... Information Collection for Public Comment; FY 2010 Capital Fund Community and Education Training Facilities... 2010 Capital Fund Community and Education Training Facilities NOFA. OMB Control Number: 2577-0268...) enhance the quality, utility, and clarity of the information to be collected; and (4) minimize the burden...

  10. 75 FR 45693 - Request for Comments and Notice of Public Hearing Concerning China's Compliance With WTO Commitments

    Science.gov (United States)

    2010-08-03

    ..., government procurement, trade-related investment measures, taxes and charges levied on imports and exports... Concerning China's Compliance With WTO Commitments AGENCY: Office of the United States Trade Representative. ACTION: Request for comments and notice of public hearing concerning China's compliance with its WTO...

  11. 77 FR 50206 - Request for Comments and Notice of Public Hearing Concerning China's Compliance With WTO Commitments

    Science.gov (United States)

    2012-08-20

    ..., government procurement, trade-related investment measures, taxes and charges levied on imports and exports... Concerning China's Compliance With WTO Commitments AGENCY: Office of the United States Trade Representative. ACTION: Request for comments and notice of public hearing concerning China's compliance with its WTO...

  12. IRIS Toxicological Review of Hexahydro-1,3,5-Trinitro-1,3,5-Triazine (RDX) (Public Comment Draft)

    Science.gov (United States)

    EPA is developing an Integrated Risk Information System (IRIS) assessment of hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) and has released the draft assessment for public comment. When final, the assessment will appear on the IRIS database.

  13. 78 FR 63974 - Student Assistance General Provisions-Subpart K-Cash Management; Extension of Public Comment...

    Science.gov (United States)

    2013-10-25

    ... DEPARTMENT OF EDUCATION Student Assistance General Provisions--Subpart K--Cash Management... an information collection entitled, ``Student Assistance General Provisions--Subpart K--Cash Management''. ED is extending the comment period to November 18, 2013 due to the public's inability to access...

  14. 77 FR 75177 - Impact of Approved Drug Labeling on Chronic Opioid Therapy; Public Hearing; Request for Comments

    Science.gov (United States)

    2012-12-19

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-N-1172] Impact of Approved Drug Labeling on Chronic Opioid Therapy; Public Hearing; Request for Comments AGENCY... impact the entire class of opioid drugs or a large subcategory thereof (e.g., ER/LA opioids), such as the...

  15. 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.

  16. 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...

  17. 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

  18. 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...

  19. 77 FR 3748 - Request for Comments and Notice of Public Hearings on Genetic Diagnostic Testing

    Science.gov (United States)

    2012-01-25

    ...: Written comments should be sent by email to [email protected] . Comments may also be submitted by postal... subject line of the email or postal mailing as ``Genetic Testing Study.'' Because written comments and... wishing to present oral testimony at either hearing must request an opportunity to do so in writing no...

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. Record of responses to public comments on proposed general guidelines for recommendation of sites for nuclear waste repositories

    International Nuclear Information System (INIS)

    1983-01-01

    The Nuclear Waste Policy Act of 1982 (Public Law 97-425, referred to in this document as the Act) assigned to the US Department of Energy (DOE) the authority for the disposal of high-level radioactive waste and spent nuclear fuel. Among other provisions, the Act specifies a process and schedule for the siting of two geologic repositories for this purpose. The Act requires that the DOE issue general guidelines for the recommendation of sites for repositories. The guidelines are to be developed in consultation with three Federal agencies (the Council on Environmental Quality, the US Environmental Protection Agency, and the US Geological Survey) and with interested Governors and issued with the concurrence of the US Nuclear Regulatory Commission. To meet this directive, the DOE convened a task force of program experts to develop proposed guidelines, issued the proposed guidelines on February 7, 1983, and invited comments from the specified Federal agencies, interested Governors, and the general public. Public hearings on the proposed guidelines were held in March at the following locations: Chicago, New Orleans, Washington, DC, Salt Lake City, and Seattle. After considering the resulting comments and preparing responses to them, the task force prepared a draft of this comment-response document and a set of alternative guidelines; these documents were issued on May 27, 1983. This document summarizes the record of comments that directly led to the alternative guidelines of May 27, 1983. It contains synopses of comments, presents the responses of the task force to the comments, and briefly describes how the proposed guidelines of February 7, 1983, were revised to produce the alternative guidelines of May 27, 1983. 13 references

  7. 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.

  8. Public comments and Task Force responses regarding the environmental survey of the reprocessing and waste management portions of the LWR fuel cycle

    International Nuclear Information System (INIS)

    1977-03-01

    This document contains responses by the NRC Task Force to comments received on the report ''Environmental Survey of the Reprocessing and Waste Management Portions of the LWR Fuel Cycle'' (NUREG-0116). These responses are directed at all comments, inclding those received after the close of the comment period. Additional information on the environmental impacts of reprocessing and waste management which has either become available since the publication of NUREG-0116 or which adds requested clarification to the information in that document

  9. NRC Task Force report on review of the Federal/State program for regulation of commercial low-level radioactive waste burial grounds. Analysis of public comments

    International Nuclear Information System (INIS)

    1977-09-01

    Correspondence after publication of NUREG-0217 in the Federal Register is listed by docket. A summary of the comments is given. Comments on the task force conclusions on federal/state roles, comprehensive regulator program, and need to study alternatives, provide adequate capacity, and avoid proliferation are analyzed. A breakdown of the comments of states, industry, and others on the task force conclusions and recommendations is tabulated

  10. 76 FR 71564 - ScanScout, Inc.; Analysis of Proposed Consent Order To Aid Public Comment

    Science.gov (United States)

    2011-11-18

    ... behavioral advertising, the practice of collecting and storing information about consumers' online activities... behavioral advertising. ScanScout's privacy policy stated that by changing their browser settings, consumers... data for online behavioral advertising. First, within thirty (30) days after service of the proposed...

  11. Symbolic mediation in public debates: the case of the accident of Fukushima on web comment boards

    International Nuclear Information System (INIS)

    Carbou, Guillaume

    2015-01-01

    This thesis aims to contribute to the construction of a theoretical and methodological framework for the analysis of symbolic mediations which occur in the public sphere during public debates. Firstly, we discuss the epistemological conditions of a search for ideological forms shaped by the circulation of discourses. Secondly, we show that conversations about civil nuclear power among internet users on comment boards of online news web sites are structured by a limited number of frames of intelligibility that we call 'modes of apprehension'. These modes of apprehension never occur in their canonic form: they only appear by fragments in the speech of individuals. Hence, an argumentative analysis of discourse can be used to rebuild them by reordering the multiple 'topoi' in consistent and coherent universes of meaning. Bringing out these modes of apprehension, forged and perpetuated by the circulation of discourses, has three main interests: we highlight some of the symbolic mediations of the social communication about civil nuclear power after Fukushima; we underline some of the main political and philosophical issues of the question; and we examine some of the dominant ideological sedimentations of our modernity. (author)

  12. 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...

  13. 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...

  14. 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.

  15. Comment

    Science.gov (United States)

    2001-01-01

    where teachers could enjoy the fun in physics again. Even physics teachers are human! It is so easy to get bogged down in the drudge of everyday teaching and forget the students, let alone ourselves. But if you think back to the good teachers you had at school - weren't they the ones who were enjoying themselves, and maybe not perfectly organized. There has to be a moment at which a good teacher says 'I'm going to do this, because I want to... it's fun physics!' No other justification is needed. Our new look for 2001 So here is the first issue of the new-look Physics Education - and we sincerely hope that you enjoy it. The Editorial Board and the publishing team have been working hard for the past few months to keep the best of the old format, but to make a fresher, more user-friendly publication. As incoming Editor I must acknowledge the excellent work done by Ken Dobson and Jill Membrey, the outgoing team. It is a tough act to follow, but a challenge I am privileged to undertake. As a physics teacher I know how difficult it can be to stay inspired and up-to-date, so as Editor of Physics Education I want to support your professional development as much as possible. Starting with support for student teachers (see Starting Out), through to teachers in charge of equipment and budgets (see Technical Trimmings and Reviews): we want to share good practice. Finally, let's laugh at ourselves-don't miss Signing Off: a humorous look at physics teaching. I've really enjoyed working on this new format, and I hope that you enjoy the read. Please give us lots of feedback and send in your own contributions. I'm very pleased that our first issue has two special features: to me they represent the potential and the purpose of physics education. Sport is an exciting growth area of science in which increasing numbers of students want to understand the basic laws of motion and the application of sophisticated technology; and communicating physics - well that's not just fun, it

  16. 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.

  17. 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

  18. 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.

  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. 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.

  1. 75 FR 56562 - Proposed Information Collection Request Submitted for Public Comment and Recommendations; Slope...

    Science.gov (United States)

    2010-09-16

    ... by midnight Eastern Daylight Savings Time on November 15, 2010. ADDRESSES: Comments must clearly be... format, reporting burden (time and financial resources) is minimized, collection instruments are clearly...

  2. 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

  3. 78 FR 58305 - Honeywell International, Inc.; Analysis of Agreement Containing Consent Order To Aid Public Comment

    Science.gov (United States)

    2013-09-23

    ... interpret and analyze. Products such as retail store scanners, kiosks and rugged mobile handheld computers...://ftcpublic.commentworks.com/ftc/honeywellintermecconsent online or on paper, by following the instructions in... Intermec, File No. 131 0070'' on your comment and file your comment online at https://ftcpublic...

  4. 76 FR 15311 - Legacy Learning Systems, Inc.; Analysis of Proposed Consent Order To Aid Public Comment

    Science.gov (United States)

    2011-03-21

    ... FEDERAL TRADE COMMISSION [File No. 102 3055] Legacy Learning Systems, Inc.; Analysis of Proposed... electronically or in paper form. Comments should refer to ``Legacy Learning Systems, File No. 102 3055'' to... it. A comment filed in paper form should include the ``Legacy Learning Systems, File No. 102 3055...

  5. 77 FR 2988 - Extension of Public Comment Period; Mechanisms of Compliance With United States Citizenship...

    Science.gov (United States)

    2012-01-20

    ... with a wide variety of complex organizational structures and trading practices. DATES: Comments and... mechanisms employed by companies that utilize a wide variety of organizational structures, and the additional... on the ``Submit a Comment'' box, which will then become highlighted in blue. In the ``Document Type...

  6. 77 FR 35683 - Agency Information Collection Activities; Proposed Collection; Comment Request; Public Health...

    Science.gov (United States)

    2012-06-14

    ...: Submit either electronic or written comments on the collection of information by August 13, 2012. ADDRESSES: Submit electronic comments on the collection of information to http://www.regulations.gov... justification for types of tissues, cells, and plasma, and quantities of plasma and leukocytes collected. 4.1.1...

  7. 78 FR 13673 - HTC America, Inc.; Analysis of Proposed Consent Order To Aid Public Comment

    Science.gov (United States)

    2013-02-28

    ... that your comment does not include any sensitive personal information, like anyone's Social Security... delay due to heightened security screening. As a result, we encourage you to submit your comments online... computers using Google Inc.'s Android operating system and Microsoft Corporation's Windows Mobile and...

  8. 75 FR 56561 - Proposed Information Collection Request Submitted for Public Comment and Recommendations...

    Science.gov (United States)

    2010-09-16

    ... Conditions Complaints 30 CFR 43.4 and 43.7. DATES: All comments must be received by midnight Eastern Daylight Savings Time on November 15, 2010. ADDRESSES: Comments must clearly be identified with the rule title and... to assure that requested data can be provided in the desired format, reporting burden (time and...

  9. 77 FR 2743 - Notice of Proposed Information Collection for Public Comment: Choice Neighborhoods Evaluation...

    Science.gov (United States)

    2012-01-19

    ... outcomes of interest, including housing location and quality; and resident physical and mental health... are invited to submit comments regarding this proposal. Comments should refer to the proposal by name and/or OMB Control Number and should be sent electronically to Paul[email protected] or in hard copy to...

  10. 77 FR 52110 - Agency Response to Public Comments of Safety Measurement System Changes

    Science.gov (United States)

    2012-08-28

    ... (IEP) regulations; Aligning violations that are included in the SMS with Commercial Vehicle Safety... least one other BASIC. Better Align SMS With IEP Regulations Comments: Many of the commenters that..., FMCSA adopted regulations to require IEPs to: register and file with FMCSA an IEP Identification Report...

  11. 78 FR 55076 - Ganley Ford West, Inc.; Analysis of Proposed Consent Order To Aid Public Comment

    Science.gov (United States)

    2013-09-09

    ... FEDERAL TRADE COMMISSION [File No. 122 3269] Ganley Ford West, Inc.; Analysis of Proposed Consent... for Comment part of the SUPPLEMENTARY INFORMATION section below. Write ``Ganley Ford, File No. 122... receive it on or before October 3, 2013. Write ``Ganley Ford, File No. 122 3269'' on your comment. Your...

  12. 30 days in medicine

    African Journals Online (AJOL)

    Of the 58 men who tested positive for oral gonorrhoea, 33 were randomly ... Medicine suggests that compressing this amount of physical activity into a weekend ... practise medicine differently; for example, women are more likely to adhere to ...

  13. 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.

  14. 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.

  15. 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

  16. 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

  17. 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...

  18. 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...

  19. 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.

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. 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 30 days 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 30 days of hospital discharge censored for death analysed with an intention-to-treat approach. Secondary endpoints included observation status readmission within 30 days, time to readmission, all-cause emergency department revisits within 30 days, 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

  5. 75 FR 63540 - Request for Public Comment, Morgantown Municipal Airport, Morgantown, WV

    Science.gov (United States)

    2010-10-15

    ... Plan. Fair Market Value has been determined based upon an appraisal of the Property. DATES: Comments..., the land will change to a non-aeronautical use and will be transferred to the West Virginia Army...

  6. 76 FR 47582 - Public Information Collection Being Submitted to OMB for Review and Approval, Comments Requested

    Science.gov (United States)

    2011-08-05

    ... display a valid Office of Management and Budget (OMB) control number. DATES: Written comments should be..., including documentary and other evidence, and in the case of VRS, such documentary and other evidence shall...

  7. 78 FR 22302 - United States v. United Technologies Corporation and Goodrich Corporation; Public Comments and...

    Science.gov (United States)

    2013-04-15

    ... negotiation of the Proposed Final Judgment. Although Mr. Reusser supervised the Goodrich organization... to persuade Mr. Oak not to do so. B. Joseph C. Jefferis 1. Summary of the Comment Mr. Joseph C...

  8. 78 FR 17408 - Proposed Data Collections Submitted for Public Comment and Recommendations

    Science.gov (United States)

    2013-03-21

    ... technology transfer. The PTCs and CBAs offer classroom and experiential training, web- based training... techniques or other forms of information technology. Written comments should be received within 60 days of...

  9. 78 FR 65293 - Collection of Information; Proposed Extension of Approval; Comment Request-Publicly Available...

    Science.gov (United States)

    2013-10-31

    ... harm, manufacturer comments, branding information, and the Small Batch Manufacturer Registry (SBMR..., mail, or fax. Branding Information: Using the business portal, registered businesses may voluntarily submit branding information to assist CPSC in correctly and timely routing reports of harm involving...

  10. 77 FR 11558 - Request for Public Comment; 60-Day Proposed Information Collection: Indian Health Service; Loan...

    Science.gov (United States)

    2012-02-27

    ...) Whether the agency processes the information collected in a useful and timely fashion; (c) The accuracy of... facsimile to (301) 443-2316; or send your email requests, comments, and return address to: [email protected

  11. 77 FR 72359 - Animal Generic Drug User Fee Act; Public Meeting; Request for Comments

    Science.gov (United States)

    2012-12-05

    ... Parklawn Dr., Element Bldg., Rockville, MD 20857. Comments: Interested persons may submit either written... to brand name drugs for consumers. Under AGDUFA I, FDA agreed to meet review performance goals for...

  12. 75 FR 56560 - Proposed Information Collection Request Submitted for Public Comment and Recommendations; Health...

    Science.gov (United States)

    2010-09-16

    ... be received by midnight Eastern Daylight Savings Time on November 15, 2010. ADDRESSES: Comments must... to assure that requested data can be provided in the desired format, reporting burden (time and...

  13. 75 FR 36122 - Proposed Information Collection Request Submitted for Public Comment and Recommendations...

    Science.gov (United States)

    2010-06-24

    ... midnight Eastern Daylight Savings Time on August 23, 2010. ADDRESSES: Comments must clearly be identified... program helps to ensure that requested data can be provided in the desired format, reporting burden (time...

  14. 77 FR 58204 - International Joint Commission Invites Public Comment on Upper Great Lakes Report via...

    Science.gov (United States)

    2012-09-19

    ... to dial in 10 minutes before the 7 p.m. (EDT) start time: English speaking line: Telephone 877-413-4814, PIN 7297456 French speaking line: Telephone 877-413-4814, PIN 2641187 Written comments may also...

  15. 77 FR 54908 - Extension of the Public Review and Comment Period and Announcement of an Additional Public...

    Science.gov (United States)

    2012-09-06

    ... plutonium from pits that were declared excess to national defense needs. It also updates previous DOE NEPA analyses on plutonium disposition to consider additional options for pit disassembly and conversion, which... ADDRESSES. In preparing the final SPD Supplemental EIS, DOE will consider all comments presented at the...

  16. 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

  17. 75 FR 37519 - 30-Day Notice of Proposed Information Collection: Forms DS-4138, Request for Escort Screening...

    Science.gov (United States)

    2010-06-29

    ...). You may submit comments by the following methods: E-mail: [email protected] . You must... obtains a photograph and/or signature for use in the production of an identification card, a sales tax exemption card, or DOS driver license when applications are submitted electronically (thru e-Gov) for...

  18. 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.

  19. Adaptive Changes in the Vestibular System of Land Snail to a 30-Day Spaceflight and Readaptation on Return to Earth

    Directory of Open Access Journals (Sweden)

    Nikolay Aseyev

    2017-11-01

    Full Text Available The vestibular system receives a permanent influence from gravity and reflexively controls equilibrium. If we assume gravity has remained constant during the species' evolution, will its sensory system adapt to abrupt loss of that force? We address this question in the land snail Helix lucorum exposed to 30 days of near weightlessness aboard the Bion-M1 satellite, and studied geotactic behavior of postflight snails, differential gene expressions in statocyst transcriptome, and electrophysiological responses of mechanoreceptors to applied tilts. Each approach revealed plastic changes in the snail's vestibular system assumed in response to spaceflight. Absence of light during the mission also affected statocyst physiology, as revealed by comparison to dark-conditioned control groups. Readaptation to normal tilt responses occurred at ~20 h following return to Earth. Despite the permanence of gravity, the snail responded in a compensatory manner to its loss and readapted once gravity was restored.

  20. 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 30 days. 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...

  1. Association of Comorbidity with Anastomotic Leak, 30-day Mortality, and Length of Stay in Elective Surgery for Colonic Cancer

    DEFF Research Database (Denmark)

    Krarup, Peter-Martin; Nordholm-Carstensen, Andreas; Jørgensen, Lars Nannestad

    2015-01-01

    BACKGROUND: Comorbidity has a negative influence on the long-term prognosis in patients with colorectal cancer, whereas its impact on the postoperative course is less clear. OBJECTIVES: The aim of this study was to investigate the influence of comorbidity on anastomotic leak and short-term outcomes....... MAIN OUTCOME MEASURES: The primary outcome was the ability of comorbidity to predict anastomotic leak. Secondary outcomes were 30-day mortality and length of stay. Comorbidity was assessed by the Charlson Comorbidity Index. Multivariable logistic regression and receiver operating characteristics curves...... were used to adjust for confounding. RESULTS: The rate of anastomotic leak was 535/8597 (6.2%). The mean (95% CI) Charlson score was 0.83 (0.72-0.94) and 0.63 (0.61-0.66) for patients with and without anastomotic leak, p

  2. Hip Fractures: What Information Does the Evidence Show That Patients and Families Need to Decrease 30-Day Readmission?

    Science.gov (United States)

    Gardner, Kristin OʼMara

    2015-01-01

    The current bundled payment reimbursement from the Centers for Medicare & Medicaid Services will not cover the additional cost of hospital readmission for the same diagnosis, and patients with hip fractures have one of the highest cost-saving opportunities when compared with other admission reasons. Common reasons for readmission to the hospital after hip fracture include pneumonia, dehydration, and mobility issues. The learning modalities including visual, aural, read/write, and kinesthetic were used to make recommendations on how the education can be incorporated into the instruction of patients with hip fractures and their families. These learning techniques can be used to develop education to decrease possibility of 30-day readmission after hip fracture. Nurses must focus their education to meet the needs of each individual patient, adapting to different types of adult learners to increase the health literacy of patients with hip fractures and their families.

  3. Why Public Comments Matter: The Case of the National Institutes of Health Policy on Single Institutional Review Board Review of Multicenter Studies.

    Science.gov (United States)

    Ervin, Ann-Margret; Taylor, Holly A; Ehrhardt, Stephan; Meinert, Curtis L

    2018-03-06

    In 2014, the National Institutes of Health (NIH) requested public comments on a draft policy requiring NIH-funded, U.S.-based investigators to use a single institutional review board (sIRB) for ethical review of multicenter studies. The authors conducted a directed content analysis and qualitative summary of the comments and discuss how they shaped the final policy. Two reviewers independently assessed support for the policy from a review of comments responding to the draft policy in 2016. A reviewer conducted an open text review to identify prespecified and additional comment themes. A second researcher reviewed 20% of the comments; discrepancies were resolved through discussion. The NIH received 167 comments: 65% (108/167) supportive of the policy, 23% (38/167) not supportive, and 12% (21/167) not indicating support. Clarifications or changes to the policy were suggested in 102/167 comments (61%). Criteria for selecting sIRBs were addressed in 32/102 comments (31%). Also addressed were IRB responsibilities (39/102; 38%), cost (27/102; 26%), the role of local IRBs (14/102; 14%), and allowable policy exceptions (19/102; 19%). The NIH further clarified or provided additional guidance for selection criteria, IRB responsibilities, and cost in the final policy (June 2016). Local IRB reviews and exemptions guidance were unchanged. In this case study, public comments were effective in shaping policy as the NIH modified provisions or planned supplemental guidance in response to comments. Yet critical knowledge gaps remain and empirical data are necessary. The NIH is considering mechanisms to support the establishment of best practices for sIRB implementation.

  4. 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.

  5. Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of incomplete atrioventricular septal defect

    Directory of Open Access Journals (Sweden)

    Marcelo Felipe Kozak

    2015-04-01

    Full Text Available AbstractIntroduction:Left atrioventricular valve regurgitation is the most concerning residual lesion after surgical correction of atrioventricular septal defect.Objective:To determine factors associated with moderate or greater left atrioventricular valve regurgitation within 30 days of surgical repair of incomplete atrioventricular septal defect.Methods:We assessed the results of 51 consecutive patients 14 years-old and younger presenting with incomplete atrioventricular septal defect that were operated on at our practice between 2002 and 2010. The following variables were considered: age, weight, absence of Down syndrome, grade of preoperative left atrioventricular valve regurgitation, abnormalities on the left atrioventricular valve and the use of annuloplasty. The median age was 4.1 years; the median weight was 13.4 Kg; 37.2% had Down syndrome. At the time of preoperative evaluation, there were 23 cases with moderate or greater left atrioventricular valve regurgitation (45.1%. Abnormalities on the left atrioventricular valve were found in 17.6%; annuloplasty was performed in 21.6%.Results:At the time of postoperative evaluation, there were 12 cases with moderate or greater left atrioventricular valve regurgitation (23.5%. The variation between pre- and postoperative grades of left atrioventricular valve regurgitation of patients with atrioventricular valve malformation did not reach significance (P=0.26, unlike patients without such abnormalities (P=0.016. During univariate analysis, only absence of Down syndrome was statistically significant (P=0.02. However, after a multivariate analysis, none of the factors reached significance.Conclusion:None of the factors studied was determinant of a moderate or greater left atrioventricular valve regurgitation within the first 30 days of repair of incomplete atrioventricular septal defect in the sample. Patients without abnormalities on the left atrioventricular valve benefit more of the operation.

  6. 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.

  7. 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)

  8. Public comments and Task Force responses regarding the environmental survey of the reprocessing and waste management portions of the LWR fuel cycle

    Energy Technology Data Exchange (ETDEWEB)

    1977-03-01

    This document contains responses by the NRC Task Force to comments received on the report ''Environmental Survey of the Reprocessing and Waste Management Portions of the LWR Fuel Cycle'' (NUREG-0116). These responses are directed at all comments, inclding those received after the close of the comment period. Additional information on the environmental impacts of reprocessing and waste management which has either become available since the publication of NUREG-0116 or which adds requested clarification to the information in that document.

  9. Final generic environmental statement on the use of recycle plutonium in mixed oxide fuel in light water cooled reactors. Volume 5. Public comments and Nuclear Regulatory Commission responses

    International Nuclear Information System (INIS)

    1976-08-01

    Copies of 69 letters are presented commenting on the Draft Generic Environmental Statement (GESMO) WASH-1327 and the NRC's responses to the comments received from Federal, State and local agencies; environmental and public interest groups, members of the academic and industrial communities, and individual citizens. An index to these letters indicating the number assigned to each letter, the author, and organization represented, is provided in the Table of Contents

  10. Final generic environmental statement on the use of recycle plutonium in mixed oxide fuel in light water cooled reactors. Volume 5. Public comments and Nuclear Regulatory Commission responses

    Energy Technology Data Exchange (ETDEWEB)

    1976-08-01

    Copies of 69 letters are presented commenting on the Draft Generic Environmental Statement (GESMO) WASH-1327 and the NRC's responses to the comments received from Federal, State and local agencies; environmental and public interest groups, members of the academic and industrial communities, and individual citizens. An index to these letters indicating the number assigned to each letter, the author, and organization represented, is provided in the Table of Contents.

  11. Summary of public comments and NRC staff analysis relating to rulemaking on emergency planning for nuclear power plants

    International Nuclear Information System (INIS)

    1980-09-01

    This NUREG provides a summary and discussions of public comments received during the expedited rulemaking to upgrade emergency preparedness around nuclear power reactor sites. The final rule was published in the Federal Register (45 FR 55402) on August 19, 1980. The information in NUREG-0684 was excerpted in the main from internal paper SECY-80-275 (June 3, 1980) which forwarded the final rule to the Commission for consideration. This document, along with NUREG-0628, NUREG/CP-0011, and the materials cited in the Final Rules, should be considered a compendium of the major issues raised in this proceeding and acted upon by the Commission

  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. 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

  14. Exposure to microgravity for 30 days onboard Bion M1 caused muscle atrophy and impaired regeneration in murine femoral Quadriceps

    Science.gov (United States)

    Radugina, E. A.; Almeida, E. A. C.; Blaber, E.; Poplinskaya, V. A.; Markitantova, Y. V.; Grigoryan, E. N.

    2018-02-01

    Mechanical unloading in microgravity during spaceflight is known to cause muscular atrophy, changes in muscle fiber composition, gene expression, and reduction in regenerative muscle growth. Although some limited data exists for long-term effects of microgravity in human muscle, these processes have mostly been studied in rodents for short periods of time. Here we report on how long-term (30-day long) mechanical unloading in microgravity affects murine muscles of the femoral Quadriceps group. To conduct these studies we used muscle tissue from 6 microgravity mice, in comparison to habitat (7), and vivarium (14) ground control mice from the NASA Biospecimen Sharing Program conducted in collaboration with the Institute for Biomedical Problems of the Russian Academy of Sciences, during the Russian Bion M1 biosatellite mission in 2013. Muscle histomorphology from microgravity specimens showed signs of extensive atrophy and regenerative hypoplasia relative to ground controls. Specifically, we observed a two-fold decrease in the number of myonuclei, compared to vivarium and ground controls, and central location of myonuclei, low density of myofibers in the tissue, and of myofibrils within a fiber, as well as fragmentation and swelling of myofibers. Despite obvious atrophy, muscle regeneration nevertheless appeared to have continued after 30 days in microgravity as evidenced by thin and short newly formed myofibers. Many of them, however, showed evidence of apoptotic cells and myofibril degradation, suggesting that long-term unloading in microgravity may affect late stages of myofiber differentiation. Ground asynchronous and vivarium control animals demonstrated normal, well-developed tissue structure with sufficient blood and nerve supply and evidence of regenerative formation of new myofibers free of apoptotic nuclei. Regenerative activity of satellite cells in muscles was observed both in microgravity and ground control groups, using Pax7 and Myogenin

  15. 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

  16. 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

  17. 77 FR 3781 - Pediatric Medical Devices; Public Workshop; Reopening of Comment Period

    Science.gov (United States)

    2012-01-25

    ... devices. DATES: Submit either electronic or written comments by March 5, 2012. ADDRESSES: Submit.... Designing pediatric medical devices can be challenging; children are often smaller and more active than adults; body structures and functions change throughout childhood, and children may be long-term device...

  18. 75 FR 58391 - Proposed Data Collections Submitted for Public Comment and Recommendations

    Science.gov (United States)

    2010-09-24

    ... technology. Written comments should be received within 60 days of this notice. Proposed Project Human... Brief Description Cyanobacteria (also called blue-green algae) can be found in terrestrial, fresh... animals (including other mammals, fish, and birds). A number of human health effects, including...

  19. 75 FR 41205 - Proposed Data Collections Submitted for Public Comment and Recommendations

    Science.gov (United States)

    2010-07-15

    ... an e-mail to [email protected] . Comments are invited on: (a) Whether the proposed collection of... two separate forms. These forms are: (1) Application for Permit to Import or Transport Etiologic Agents, Hosts, or Vectors of Human Disease; and (2) Application for Permit to Import or Transport Live...

  20. 76 FR 12305 - Extension of Public Comment Period for Proposed Action on Interstate Transport of Pollution...

    Science.gov (United States)

    2011-03-07

    ... select ``Air'' before submitting comments. E-mail: Mr. Guy Donaldson at [email protected] . Please also send a copy by e-mail to the person listed in the FOR FURTHER INFORMATION CONTACT section below... or e-mail. The http://www.regulations.gov Web site is an ``anonymous access'' system, which means EPA...