About 1 in 5 Medicare fee-for-service patients discharged from the hospital is rehospitalized within 30 days. Beginning in 2013, hospitals with high risk-standardized readmission rates will be ...subject to a Medicare reimbursement penalty.
To describe interventions evaluated in studies aimed at reducing rehospitalization within 30 days of discharge.
MEDLINE, EMBASE, Web of Science, and the Cochrane Library were searched for reports published between January 1975 and January 2011.
English-language randomized, controlled trials; cohort studies; or noncontrolled before-after studies of interventions to reduce rehospitalization that reported rehospitalization rates within 30 days.
2 reviewers independently identified candidate articles from the results of the initial search on the basis of title and abstract. Two 2-physician reviewer teams reviewed the full text of candidate articles to identify interventions and assess study quality.
43 articles were identified, and a taxonomy was developed to categorize interventions into 3 domains that encompassed 12 distinct activities. Predischarge interventions included patient education, medication reconciliation, discharge planning, and scheduling of a follow-up appointment before discharge. Postdischarge interventions included follow-up telephone calls, patient-activated hotlines, timely communication with ambulatory providers, timely ambulatory provider follow-up, and postdischarge home visits. Bridging interventions included transition coaches, physician continuity across the inpatient and outpatient setting, and patient-centered discharge instruction.
Inadequate description of individual studies' interventions precluded meta-analysis of effects. Many studies identified in the review were single-institution assessments of quality improvement activities rather than those with experimental designs. Several common interventions have not been studied outside of multicomponent "discharge bundles."
No single intervention implemented alone was regularly associated with reduced risk for 30-day rehospitalization.
None.
We report a precision measurement of the parity-violating asymmetry APV in the elastic scattering of longitudinally polarized electrons from 208Pb. We measure APV= 550 ± 16 (stat) ±8 (syst) parts per ...billion, leading to an extraction of the neutral weak form factor FW(Q2= 0.00616 GeV2) = 0.368 ± 0.013. Combined with our previous measurement, the extracted neutron skin thickness is Rn-Rp= 0.283 ± 0.071 fm. The result also yields the first significant direct measurement of the interior weak density of 208Pb: ρ$^0_W$ = -0.0796 ± 0.0036(exp) ± 0.0013(theo) fm-3 leading to the interior baryon density ρ$^0_b$ = 0.1480 ± 0.0036(exp) ± 0.0013(theo) fm-3. Finally, the measurement accurately constrains the density dependence of the symmetry energy of nuclear matter near saturation density, with implications for the size and composition of neutron stars.
BACKGROUND
Assessing couple fecundity on a nation-wide basis without excluding couples who eventually remain infertile is challenging. Our aim was to describe couple fecundity (in terms of frequency ...of involuntary infertility) among the general population living in France.
METHODS
We used a current-duration design. A random sample of 64 262 households was selected in 2007–2008, allowing us to identify 15 810 women aged 18–44 years. Eligible women (n= 1089) were those having regular sexual intercourse with a male partner, not using any method of contraception and not having delivered in the previous 3 months. These women reported information on the current duration of unprotected intercourse (CDUI, the time elapsed between the start of the period of unprotected intercourse and the time of inclusion in the study). The CDUI distribution was used to estimate the frequency of involuntary infertility, using a newly developed statistical technique that does not require couples to be followed up until the end of the period of unprotected intercourse.
RESULTS
CDUI was defined for 867 women. An estimated 46% of couples had no detected pregnancy conceived during the first 6 months of unprotected intercourse 95% confidence interval (CI), 36–56%. The proportions of couples with no detected pregnancy within 12 and 24 months were 24% (19–30%) and 11% (8–14%), respectively.
CONCLUSIONS
These results constitute one of the few descriptions of the fecundity of a nation-wide representative sample of couples from the general population, not limited to couples who eventually conceived or to those resorting to medical help.
•Cholinergic tracer binding is described in regions that have not hitherto been explored in human in vivo imaging.•The in vivo cholinergic spatial distribution aligns with immunohistochemical stains ...reported in post-mortem studies.•The spatial distribution of 18FFEOBV PET correlates with regional expression levels of the VAChT-coding SLC18A3 gene.
18Ffluoroetoxybenzovesamicol (18FFEOBV) is a positron emission topography (PET) tracer for the vesicular acetylcholine transporter (VAChT), a protein located predominantly in synaptic vesicles in cholinergic nerve terminals. We aimed to use 18FFEOBV PET to study the cholinergic topography of the healthy human brain.
18FFEOBV PET brain data volumes of healthy elderly humans were normalized to standard space and intensity-normalized to the white matter. Stereotactic atlases of regions of interest were superimposed to describe and quantify tracer distribution. The spatial distribution of 18FFEOBV PET uptake was compared with histological and gene expression data.
Twenty participants of both sexes and a mean age of 73.9 ± 6.0 years, age-range 64; 86, were recruited. Highest tracer binding was present in the striatum, some thalamic nuclei, and the basal forebrain. Intermediate binding was found in most nuclei of the brainstem, thalamus, and hypothalamus; the vermis and flocculonodular lobe; and the hippocampus, amygdala, insula, cingulate, olfactory cortex, and Heschl's gyrus. Lowest binding was present in most areas of the cerebral cortex, and in the cerebellar nuclei and hemispheres. The spatial distribution of tracer correlated with immunohistochemical post-mortem data, as well as with regional expression levels of SLC18A3, the VAChT coding gene.
Our in vivo findings confirm the regional cholinergic distribution in specific brain structures as described post-mortem. A positive spatial correlation between tracer distribution and regional gene expression levels further corroborates 18FFEOBV PET as a validated tool for in vivo cholinergic imaging. The study represents an advancement in the continued efforts to delineate the spatial topography of the human cholinergic system in vivo.
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Satellite data show that oceanic eddies generated in the Southern Antarctic Circumpolar Current Front (SACCF) are associated with increased phytoplankton biomass. Cyclonic eddies with high ...chlorophyll a concentration (Chl-a) retain phytoplankton within the eddy cores and increase the light available for photosynthesis in the upper mixed layer by limiting vertical mixing and lifting of the isopycnal surfaces. Anticyclonic eddies have low Chl-a in the core but increased Chl-a in the periphery. Cross-frontal mixing mediated by eddies transports nutrients (e.g., Fe and Si) to the north and contributes to the increased Chl-a in the frontal zone. Interannual variations in the cyclonic eddy activity are positively correlated with variations in Chl-a during the spring bloom in regions of the Antarctic Circumpolar Current around South Georgia.
Pathogenic germline mutations in BRCA1 or BRCA2 are detected in less than one third of families with a strong history of breast cancer. It is therefore expected that mutations still remain undetected ...by currently used screening methods. In addition, a growing number of BRCA1/2 sequence variants of unclear pathogen significance are found in the families, constituting an increasing clinical challenge. New methods are therefore needed to improve the detection rate and aid the interpretation of the clinically uncertain variants. In this study we analyzed a series of 33 BRCA1, 22 BRCA2, and 128 sporadic tumors by RNA profiling to investigate the classification potential of RNA profiles to predict BRCA1/2 mutation status. We found that breast tumors from BRCA1 and BRCA2 mutation carriers display characteristic RNA expression patterns, allowing them to be distinguished from sporadic tumors. The majority of BRCA1 tumors were basal-like while BRCA2 tumors were mainly luminal B. Using RNA profiles, we were able to distinguish BRCA1 tumors from sporadic tumors among basal-like tumors with 83% accuracy and BRCA2 from sporadic tumors among luminal B tumors with 89% accuracy. Furthermore, subtype-specific BRCA1/2 gene signatures were successfully validated in two independent data sets with high accuracies. Although additional validation studies are required, indication of BRCA1/2 involvement ("BRCAness") by RNA profiling could potentially be valuable as a tool for distinguishing pathogenic mutations from benign variants, for identification of undetected mutation carriers, and for selecting patients sensitive to new therapeutics such as PARP inhibitors.
The conversion of nonedible biomass to protein for use in feed is an attractive strategy toward improved sustainability in aquaculture. We have studied the possibility to produce protein-rich yeast ...Candida utilis on a medium consisting of enzymatically hydrolyzed sulphite-pulped spruce wood, mainly providing glucose, and enzymatically hydrolyzed brown seaweed, supplemented with ammonium sulfate. The results show that this blend constitutes a complete fermentation medium that enables good growth rates and cell yields. Results from a salmon feeding trial showed that the yeast can replace parts of a traditional fishmeal diet without harmful effects, although the apparent protein digestibility coefficient for the yeast was suboptimal. While further optimization of both the fermentation process and downstream processing is needed, the present proof-of-concept study shows a path to the production of microbial protein based on a simple, local and sustainable fermentation medium.
Polarization dependent ground state absorption, excited state absorption and emission cross sections of Pr, Mg:SrAl
12
O
19
are determined in the visible and ultraviolet spectral region. It is shown ...that excited state absorption to the 4
f
5
d
configuration does neither occur on the pump wavelength in the blue region nor on any of the visible laser transitions. Efficient laser action at 643.5 nm is demonstrated with slope efficiencies of up to 47% with respect to the absorbed pump power. Output powers up to 75 mW are achieved by pumping with an InGaN laser diode at 444 nm.
The objective of the current study was to examine the effects of yeasts on intestinal health and transcriptomic profiles from the distal intestine and spleen tissue of Atlantic salmon fed SBM-based ...diets in seawater.
(CJ) and
(WA) yeasts were heat-inactivated with spray-drying (ICJ and IWA) or autolyzed at 50 °C for 16 h (ACJ and AWA), followed by spray-drying. Six diets were formulated, one based on fishmeal (FM), a challenging diet with 30% soybean meal (SBM) and four other diets containing 30% SBM and 10% of each of the four yeast fractions (i.e., ICJ, ACJ, IWA and AWA). The inclusion of CJ yeasts reduced the loss of enterocyte supranuclear vacuolization and reduced the population of CD8α labeled cells present in the lamina propria of fish fed the SBM diet. The CJ yeasts controlled the inflammatory responses of fish fed SBM through up-regulation of pathways related to wound healing and taurine metabolism. The WA yeasts dampened the inflammatory profile of fish fed SBM through down-regulation of pathways related to toll-like receptor signaling, C-lectin receptor, cytokine receptor and signal transduction. This study suggests that the yeast species,
and
are novel high-quality protein sources with health-beneficial effects in terms of reducing inflammation associated with feeding plant-based diets to Atlantic salmon.
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