The Revolving Door: A Report on U.S. Hospital Readmissions

The U.S. health care system suffers from a chronic malady -- the revolving door syndrome at its hospitals. It is so bad that the federal government says one in five elderly patients is back in the hospital within 30 days of leaving.Some return trips are predictable elements of a treatment plan. Others are unplanned but difficult to prevent: patients go home, new and unexpected problems arise, and they require an immediate trip back to the hospital.But many of these readmissions can and should be prevented. They are the result of a fragmented system of care that too often leaves discharged patients to their own devices, unable to follow instructions they didn't understand, and not taking medications or getting the necessary follow-up care.The federal government has pegged the cost of readmissions for Medicare patients alone at $26 billion annually, and says more than$17 billion of it pays for return trips that need not happen if patients get the right care. This is one reason the Centers for Medicare & Medicaid Services has identified avoidable readmissions as one of the leading problems facing the U.S. health care system and now penalizes hospitals with high rates of readmissions for their heart failure, heart attack, and pneumonia patients. This report is being released in conjunction with the Robert Wood John Foundation's Care About Your Care initiative, which is devoted to improving care transitions when people leave the hospital. It looks at the issue of readmissions in two ways: by the numbers and through the eyes of the people who live them

A hardware spinal decoder

Spinal codes are a recently proposed capacity-achieving rateless code. While hardware encoding of spinal codes is straightforward, the design of an efficient, high-speed hardware decoder poses significant challenges. We present the first such decoder. By relaxing data dependencies inherent in the classic M-algorithm decoder, we obtain area and throughput competitive with 3GPP turbo codes as well as greatly reduced latency and complexity. The enabling architectural feature is a novel alpha-beta incremental approximate selection algorithm. We also present a method for obtaining hints which anticipate successful or failed decoding, permitting early termination and/or feedback-driven adaptation of the decoding parameters. We have validated our implementation in FPGA with on-air testing. Provisional hardware synthesis suggests that a near-capacity implementation of spinal codes can achieve a throughput of 12.5 Mbps in a 65 nm technology while using substantially less area than competitive 3GPP turbo code implementations.Irwin Mark Jacobs and Joan Klein Jacobs Presidential FellowshipIntel Corporation (Fellowship)Claude E. Shannon Research Assistantshi

A tale of two cities: restoring water services in Kabul and Monrovia

Kabul and Monrovia, the respective capitals of Afghanistan and Liberia, have recently emerged from long-lasting armed conflicts. In both cities, a large number of organisations took part in emergency water supply provision and later in the rehabilitation of water systems. Based on field research, this paper establishes a parallel between the operations carried out in the two settings, highlighting similarities and analysing the two most common strategies. The first strategy involves international financial institutions, which fund large-scale projects focusing on infrastructural rehabilitation and on the institutional development of the water utility, sometimes envisaging private-sector participation. The second strategy involves humanitarian agencies, which run community-based projects, in most cases independently of the water utilities, and targeting low-income areas. Neither of these approaches manages to combine sustainability and universal service. The paper assesses their respective strengths and weaknesses and suggests ways of improving the quality of assistance provided

Obtaining material identification with cosmic ray radiography

The passage of muons through matter is mostly affected by their Coulomb interactions with electrons and nuclei. The muon interactions with electrons lead to continuous energy loss and stopping of muons, while their scattering off nuclei lead to angular 'diffusion'. By measuring both the number of stopped muons and angular changes in muon trajectories we can estimate density and identify materials. Here we demonstrate the material identification using data taken at Los Alamos with the Mini Muon Tracker.Comment: 10 pages, 9 figures, Accepted to AIP Advance

Nocardia kroppenstedtii sp. nov., a novel actinomycete isolated from a lung transplant patient with a pulmonary infection

An actinomycete, strain N1286T, isolated from a lung transplant patient with a pulmonary infection, was provisionally assigned to the genus Nocardia. The strain had chemotaxonomic and morphological properties typical of members of the genus Nocardia and formed a distinct phyletic line in the Nocardia 16S rRNA gene tree. It was most closely related to Nocardia farcinica DSM 43665T (99.8% gene similarity) but was distinguished from the latter by a low level of DNA:DNA relatedness. These strains were also distinguished by a broad range of phenotypic properties. On the basis of these data, it is proposed that isolate N1286T (=DSM 45810T = NCTC 13617T) should be classified as the type strain of a new Nocardia species for which the name Nocardia kroppenstedtii is proposed

Perceived credibility and eyewitness testimony of children with intellectual disabilities

Background: Although children with intellectual disabilities (ID) often provide accurate witness testimony, jurors tend to perceive their witness statements to be inherently unreliable. Method: The current study explored the free recall transcripts of child witnesses with ID who had watched a video clip, relative to those of typically developing (TD) age-matched children, and assessed how mock jurors perceived these transcripts in the absence of knowledge of group (ID or TD) membership. A further aim of this research was to determine whether perceptions of credibility were associated with levels of free recall and witness characteristics (anxiety and mental age). Results: Mock jurors rated the testimony of children with ID as less credible than that of a TD age-matched comparison group. This was largely because of the transcripts of the children with ID containing fewer details than those of the TD children. Anxiety and mental age were found to have no effect on perceived levels of credibility. Conclusions: It appears that even in the absence of knowledge of whether a child does or does not have ID, this factor still affects perceptions of credibility among mock jurors. Our findings suggest that fundamental differences in the quality of the witness transcripts lead to lower perceptions of credibility for children with ID

The diagnostic and therapeutic implications of phenocopies and mimics of Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a common myocardial disease defined by increased left ventricular wall thickness unexplained by loading conditions. It is frequently caused by pathogenic variants in sarcomeric protein genes, but several other syndromic, metabolic, infiltrative, and neuromuscular diseases can result in HCM phenocopies. This review summarizes the current understanding of these HCM mimics, highlighting their importance across the life course. The central role of a comprehensive, multiparametric diagnostic approach and the potential of precision medicine in tailoring treatment strategies are emphasized

Service-users’ experiences of an early intervention in psychosis service: an interpretative phenomenological analysis

OBJECTIVES: Previous research regarding Early Intervention in Psychosis (EIP) services has mainly adopted quantitative methodologies, in order to study the effectiveness of EIP services. Research studies that have explored service-users' experiences of EIP services are small in number. This research aimed to explore service-users' experiences of being in contact with an EIP service, its impact of their experience of psychosis and current life situation. DESIGN: Interpretative Phenomenological Analysis (IPA) was used to conduct an in-depth qualitative study of a small sample of EIP service-users, in order to explore their experiences of being in contact with the service. METHOD: Flexibly guided interviews were conducted with eight service-users who had been receiving a service from an EIP team for more than 2 years and were recruited using a purposive sampling method. Verbatim interview transcripts were analysed using IPA. RESULTS: Five super-ordinate themes, developed from the analysis, are discussed in sections: Stigma, Relationships, Understanding the experiences, Sense of agency, and Impact on sense of self. Sub-themes of these super-ordinate themes are also discussed. CONCLUSIONS: The themes developed from the analysis were envisioned as representing an overarching theme of 'A personal journey of recovery', which was influenced by participants' involvement with the EIP service. Clinical implications include the need for EIP services, as with other mental health services, to find ways to promote recovery and create opportunities for agency and control. Future research directions are also discussed