Associations of Emergency Department Length of Stay With Publicly Reported Quality-of-care Measures.

OBJECTIVE: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length of stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals. METHODS: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare. We included hospitals reporting Hospital Compare timeliness measure of LOS for admitted patients. We used AHA and CMS data to incorporate hospital predictors of interest. We used the method of first differences to test for relationships in the change over time between timeliness measures and six hospital-level measures. RESULTS: The cohort consisted of 2,619 hospitals. Each additional hour of ED LOS was associated with a 0.7% decrease in proportion of patients giving a top satisfaction rating, a 0.7% decrease in proportion of patients who would definitely recommend the hospital, and a 6-minute increase in time to pain management for long bone fracture (p \u3c 0.01 for all). A 1-hour increase in ED LOS is associated with a 44% increase in the odds of having an increase in left without being seen (95% confidence interval = 25% to 68%). ED LOS was not associated with hospital readmissions (p = 0.14) or time to percutaneous coronary intervention (p = 0.14). CONCLUSION: In this longitudinal study of hospitals across the United States, improvements in ED timeliness measures are associated with improvements in the patient experience

Improving InSAR geodesy using global atmospheric models

Spatial and temporal variations of pressure, temperature and water vapor content in the atmosphere introduce significant confounding delays in Interferometric Synthetic Aperture Radar (InSAR) observations of ground deformation and bias estimatesof regional strain rates. Producing robust estimates of tropospheric delays remains one of the key challenges in increasing the accuracy of ground deformation measurements using InSAR. Recent studies revealed the efficiency of global atmospheric reanalysis to mitigate the impact of tropospheric delays, motivating further exploration of their potential. Here, we explore the effectiveness of these models in several geographic and tectonic settings on both single interferograms and time series analysis products. Both hydrostatic and wet contributions to the phase delay are important to account for. We validate these path delay corrections by comparing with estimates of vertically integrated atmospheric water vapor content derived from the passive multi-spectral imager MERIS, onboard the ENVISAT satellite. Generally, the performance of the prediction depends on the vigor of atmospheric turbulence. We discuss (1) how separating atmospheric and orbital contributions allows one to better measure long wavelength deformation, (2) how atmospheric delays affect measurements of surface deformation following earthquakes and (3) we show that such a method allows us to reduce biases in multi-year strain rate estimates by reducing the influence of unevenly sampled seasonal oscillations of the tropospheric delay

Depth, balancing, and limits of the Elo model

-Much work has been devoted to the computational complexity of games. However, they are not necessarily relevant for estimating the complexity in human terms. Therefore, human-centered measures have been proposed, e.g. the depth. This paper discusses the depth of various games, extends it to a continuous measure. We provide new depth results and present tool (given-first-move, pie rule, size extension) for increasing it. We also use these measures for analyzing games and opening moves in Y, NoGo, Killall Go, and the effect of pie rules

A novel inhibitor of p75-neurotrophin receptor improves functional outcomes in two models of traumatic brain injury.

The p75 neurotrophin receptor is important in multiple physiological actions including neuronal survival and neurite outgrowth during development, and after central nervous system injury. We have discovered a novel piperazine-derived compound, EVT901, which interferes with p75 neurotrophin receptor oligomerization through direct interaction with the first cysteine-rich domain of the extracellular region. Using ligand binding assays with cysteine-rich domains-fused p75 neurotrophin receptor, we confirmed that EVT901 interferes with oligomerization of full-length p75 neurotrophin receptor in a dose-dependent manner. Here we report that EVT901 reduces binding of pro-nerve growth factor to p75 neurotrophin receptor, blocks pro-nerve growth factor induced apoptosis in cells expressing p75 neurotrophin receptor, and enhances neurite outgrowth in vitro Furthermore, we demonstrate that EVT901 abrogates p75 neurotrophin receptor signalling by other ligands, such as prion peptide and amyloid-β. To test the efficacy of EVT901 in vivo, we evaluated the outcome in two models of traumatic brain injury. We generated controlled cortical impacts in adult rats. Using unbiased stereological analysis, we found that EVT901 delivered intravenously daily for 1 week after injury, reduced lesion size, protected cortical neurons and oligodendrocytes, and had a positive effect on neurological function. After lateral fluid percussion injury in adult rats, oral treatment with EVT901 reduced neuronal death in the hippocampus and thalamus, reduced long-term cognitive deficits, and reduced the occurrence of post-traumatic seizure activity. Together, these studies provide a new reagent for altering p75 neurotrophin receptor actions after injury and suggest that EVT901 may be useful in treatment of central nervous system trauma and other neurological disorders where p75 neurotrophin receptor signalling is affected

Magnetic and pair correlations of the Hubbard model with next-nearest-neighbor hopping

A combination of analytical approaches and quantum Monte Carlo simulations is used to study both magnetic and pairing correlations for a version of the Hubbard model that includes second-neighbor hopping $t^{\prime }=-0.35t$ as a model for high-temperature superconductors. Magnetic properties are analyzed using the Two-Particle Self-Consistent approach. The maximum in magnetic susceptibility as a function of doping appears both at finite $$ and at $t^{\prime }=0$ but for two totally different physical reasons. When $t^{\prime }=0$, it is induced by antiferromagnetic correlations while at $t^{\prime }=-0.35t$ it is a band structure effect amplified by interactions. Finally, pairing fluctuations are compared with $$-matrix results to disentangle the effects of van Hove singularity and of nesting on superconducting correlations. The addition of antiferromagnetic fluctuations increases slightly the $d$-wave superconducting correlations despite the presence of a van Hove singularity which tends to decrease them in the repulsive model. Some aspects of the phase diagram and some subtleties of finite-size scaling in Monte Carlo simulations, such as inverted finite-size dependence, are also discussed.Comment: Revtex, 8 pages + 15 uuencoded postcript figure

Interaction matters: Strategies to promote engaged learning in an online introductory nutrition course

Fostering interaction in the online classroom is an important consideration in ensuring that students actively create their own knowledge and reach a high level of achievement in science courses. This study focuses on fostering interaction in an online introductory nutrition course offered in a public institution of higher education in Hawai‘i, USA. Interactive features included synchronous discussions and polls in scheduled sessions, and social media tools for sharing of information and resources. Qualitative student feedback was solicited regarding the new course features. Findings indicated that students who attended monthly synchronous sessions valued live interaction with peers and the instructor. Issues identified included technical difficulties during synchronous sessions, lack of participation on the part of fellow students in discussion and inability to attend synchronous sessions due to scheduling conflicts. In addition, few students made use of the opportunity to interact via social media. While students indicated that the interactive components of the course were valuable, several areas in which improvement may be made remain. Future studies may explore potential solutions to issues identified with new features to further promote interaction and foster learning in the course. Recommendations for instructors who are interested in offering online science courses in higher education are provided

The effect of a home-based strength training program on type 2 diabetes risk in obese Latino boys

This paper is designed to determine the effects of a home-based strength training (HBST) intervention on insulin sensitivity (SI), compensatory acute insulin response and β-cell function, body composition measures, and maximum strength in obese Latino boys. A total of 26 obese Latino males aged between 14 and 18 years were randomized to either a twice-weekly (n=15) or a control group (C; n=15) for 16 weeks. HBST for 16 weeks, composed of two 1-h sessions per week. Outcome measures were assessed pre-and post-intervention/control condition and included SI, acute insulin response to glucose (AIR) and disposition index (DI), fasting glucose, 2-h glucose, body composition using waist-hip circumferences, body mass index (BMI), dual energy X-ray absorptiometry (DEXA) scan, blood pressure, and strength by 1-repetition maximum. A repeated measures GLM was used to assess differences in changes in outcome measures, between the C and the HBST groups. There were no significant overall intervention effects on any of the outcome variables (p<0.05). These results suggest that an HBST does not improve SI, maximal strength or decrease adiposity in obese Latino boys

Deficiency of Mkrn2 causes abnormal spermiogenesis and spermiation, and impairs male fertility.

Although recent studies have shed insights on some of the potential causes of male infertility, new underlining molecular mechanisms still remain to be elucidated. Makorin-2 (Mkrn2) is an evolutionarily conserved gene whose biological functions are not fully known. We developed an Mrkn2 knockout mouse model to study the role of this gene, and found that deletion of Mkrn2 in mice led to male infertility. Mkrn2 knockout mice produced abnormal sperms characterized by low number, poor motility, and aberrant morphology. Disruption of Mkrn2 also caused failure of sperm release (spermiation failure) and misarrangement of ectoplasmic specialization (ES) in testes, thus impairing spermiogenesis and spermiation. To understand the molecular mechanism, we found that expression of Odf2, a vital protein in spermatogenesis, was significantly decreased. In addition, we found that expression levels of Odf2 were decreased in Mkrn2 knockout mice. We also found that MKRN2 was prominently expressed in the sperm of normal men, but was significantly reduced in infertile men. This result indicates that our finding is clinically relevant. The results of our study provided insights into a new mechanism of male infertility caused by the MKRN2 downregulation

Coiling Instability of Multilamellar Membrane Tubes with Anchored Polymers

We study experimentally a coiling instability of cylindrical multilamellar stacks of phospholipid membranes, induced by polymers with hydrophobic anchors grafted along their hydrophilic backbone. Our system is unique in that coils form in the absence of both twist and adhesion. We interpret our experimental results in terms of a model in which local membrane curvature and polymer concentration are coupled. The model predicts the occurrence of maximally tight coils above a threshold polymer occupancy. A proper comparison between the model and experiment involved imaging of projections from simulated coiled tubes with maximal curvature and complicated torsions.Comment: 11 pages + 7 GIF figures + 10 JPEG figure