Currently, a large number of home health care episodes end in acute care hospitalization (ACH). The Centers for Medicare and Medicaid Services reports publically a set of quality measures, including ...ACH rate, for home health agencies. The objective of this study was to determine the relationship between reported Home Health Compare metrics and ACH rates. Using beta regression and controlling for urban/rural classification, median household income, and state levels of rehospitalizations, we modeled the multivariate relationship between acute hospital utilization and each separate measure of home care processes and outcomes. From our analysis, we found that two measures addressing the issue of pain management and improvement in bathing ability had strong associations with a decrease in ACH rate.
. Engström G, Berglund G, Göransson M, Hansen O, Hedblad B, Merlo J, Tydén P, Janzon L (Malmö University Hospital, Malmö, Sweden). Distribution and determinants of ischaemic heart disease in an urban ...population. A study from the myocardial infarction register in Malmö, Sweden. J Intern Med 2000: 247; 588–596.
Objective. Age adjusted incidence of myocardial infarction has been found to vary substantially between the residential areas of the city of Malmö. The objective of this study was to assess the extent to which major biological risk factors and socio‐economic circumstances account for the differences in incidence of and mortality from myocardial infarction.
Design. Ecological study of risk factor prevalence and incidence and mortality from myocardial infarction.
Setting. Seventeen administrative areas in Malmö, Sweden.
Subjects. Assessment of risk factor prevalence was based on 28 466 men and women, ranging from 45 to 73 years old, who were recruited as participants in the Malmö Diet and Cancer study. Information on serum lipids was available in a random subsample of 5362 subjects. Information about socio‐economic level of the residential area was based on statistics from the Malmö City Council and Statistics Sweden.
Main outcome measures. Weighted least square regressions between prevalence of risk factors (i.e. smoking, hypertension, obesity, diabetes, hypercholesterolemia and hypertriglyceridemia), a myocardial infarction risk score, a socio‐economic score and incidence and mortality from myocardial infarction.
Results. The risk factor prevalence and myocardial infarction incidence was highest in areas with low socio‐economic level. Prevalence of smoking, obesity and hypertension was significantly associated with myocardial infarction incidence and mortality rates amongst men (all r > 0.60). Prevalence of smoking was significantly associated with incidence and mortality from myocardial infarction amongst women (r = 0.66 and r = 0.61, respectively). A myocardial infarction risk score based on four biological risk factors explained 40–60% of the intra‐urban geographical variation in myocardial infarction incidence and mortality. The socio‐economic score added a further 2–16% to the explained variance.
Conclusion. In an urban population with similar access to medical care, well‐known biological cardiovascular risk factors account for a substantial proportion of the intra‐urban geographical variation of incidence of and mortality from myocardial infarction. The socio‐economic circumstances further contribute to the intra‐urban variation in disease.
The area of Greece has experienced a complex tectonic history dominated by the subduction of the African plate beneath Eurasia. In this study the variations of the crustal thickness in the area of ...Greece were obtained by means of the multiple‐source Werner deconvolution (MSWD) method applied to gravity data. Thicknesses of 40–49 km are estimated beneath the Hellenides mountain belt to the west. Eastward thinning of the crust, to thicknesses ranging from 25 km in the north to 30 km in the south is seen in the Aegean region. These results are in good agreement with recent seismological results, demonstrating that the MSWD method successfully treated the problem. Using the crustal model we derived, we computed the gravity effect of the crust and extracted it from the Bouguer anomaly. We also extracted the gravity effect of the subducting lithosphere from the Bouguer anomaly, producing a residual map where most of the original gravity variation has been successfully removed. The remaining anomalies appear related to near‐surface features and an area of low‐velocity mantle in the central Aegean Sea.
STUDY OBJECTIVE To assess whether the increased incidence of myocardial infarction and death associated with smoking, hypertension, hyperlipidaemia and diabetes varies significantly between groups ...defined in terms of occupation, education and marital status. SETTING Malmö, Sweden. PARTICIPANTS 9351 women, aged 28–55, with a mean follow up of 10.7 years. MAIN RESULTS Smoking, hypertension (⩾160/95 mm Hg or treatment), hyperlipidaemia (cholesterol ⩾6.5 mmol/l or triglycerides ⩾2.3 mmol/l), diabetes, low occupation and education levels were significantly more common among women who experienced a fatal or non-fatal myocardial infarction during the follow up (n=104) than in other women (n=9247). Exposure to smoking, hypertension and hyperlipidaemia showed substantial differences between groups defined in terms of education, occupation and marital status. The association between low occupation and myocardial infarction remained statistically significant after adjustments for several potential confounders (RR=2.6, 95%CI 1.1, 6.0). Single women had similarly higher adjusted mortality rates than married women (RR=1.4, 95%CI 1.1, 1.8). When other major risk factors were taken into account, the relative risk for mortality and myocardial infarction associated with smoking was 2.6 (95%CI 2.0, 3.4) and 7.8 (95%CI 4.4, 13.9), respectively. CONCLUSION In this urban female population, short education and low occupation level were both associated with an increased prevalence of smoking, hypertension, hyperlipidaemia and diabetes. Low occupation level increases the rate of cardiac events caused by exposure to these four risk factors.
Here, a mass spectroscopy experiment with a pair of nearly identical high resolution spectrometers and a tritium target was performed in Hall A at Jefferson Lab. Utilizing the (e,e'K+) reaction, ...enhancements, which may correspond to a possible $\Lambda$nn resonance and a pair of ΣNN states, were observed with an energy resolution of about 1.21 MeV (σ), although greater statistics are needed to make definitive identifications. An experimentally measured Λnn state may provide a unique constraint in determining the Λn interaction, for which no scattering data exist. In addition, although bound A = 3 and 4 Σ hypernuclei have been predicted, only an A = 4 Σ hypernucleus ($^4_Σ$He) was found, utilizing the (K-,π-) reaction on a 4He target. The possible bound ΣNN state is likely a Σ0nn state, although this has to be confirmed by future experiments.
Direct bonding is an advanced joining technique for bonding of silicon based surfaces at low temperature without any specific surface pretreatment. The main purpose of this work is to develop new ...techniques to enhance the fabrication process for nanofluidic systems for in situ transmission electron microscopy (TEM) by improving low temperature annealing bonding strength when using atomic layer deposition of aluminum oxide. We have investigated and characterized bonding of Al2O3-SixNy (low stress silicon rich nitride) and Al2O3-Si3N4 (stoichiometric nitride) thin films annealed from room temperature up to 600 °C without pretreatment prior to the pre-bonding. We find that bonding of Al2O3-SixNy and Al2O3-Si3N4 is favorable in a temperature range from room temperature to 600 °C. We report bonding strength of 1300 ± 150 mJ/m2 comparable to and in some case even higher than that of other materials Al2O3 can be bonded to. Preliminary tests demonstrating a well-defined nanochannel system with ~ 100 nm high channels successfully bonded and tests against leaks using optical fluorescence technique and transmission electron microscopy (TEM) characterization of liquid samples are also reported. Moreover, the current bonding method can be also used for further MEMS applications.
Two-particle interferometry of positive kaons is studied in Pb+Pb collisions at mean transverse momenta <p(T)> approximately 0.25 and 0.91 GeV/c. A three-dimensional analysis was applied to the lower ...p(T) data, while a two-dimensional analysis was used for the higher p(T) data. We find that the source-size parameters are consistent with the m(T) scaling curve observed in pion-correlation measurements in the same collisions, and that the duration time of kaon emission is consistent with zero within the experimental sensitivity.
Where large-scale plantation agriculture spatially coexists with smallholding agriculturalists, they interact in multiple ways. A number of researchers have addressed the broader social, ...environmental, and economic consequences of smallholder/plantation relationships. Few studies, however, have examined the household-level conditions that drive smallholders to engage in plantation wage work. Research from off-farm and non-farm labor markets offer a number of clues to what types of households participate in plantation wage work. These studies, however, use aggregate economic categories and fail to consider the specific case of plantation wage work. Utilizing household survey data, this paper seeks to understand the relationship between smallholders and plantations by examining the household-level conditions that lead to engagement with plantation wage work within Costa Rica's Dos Novillos watershed. Our principle findings are: (1) agricultural assets are negatively predictive of engagement in plantation wage work; (2) a household's male labor availability is strongly predictive of a household's level of engagement in the plantation economy; (3) participation in plantation wage work appears to be an income strategy for asset-poor households more generally. Overall, this study finds little engagement in plantation wage work by smallholding agricultural households. Instead, this type of work appears to be the domain of asset-poor households that are marginally engaged in agriculture. This paper concludes by suggesting policy prescriptions and an agenda for future research in this watershed.
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