How Well Do All Patient Refined–Diagnosis-Related Groups Explain Costs of Pediatric Cancer Chemotherapy Admissions in the United States?

Purpose: State-based Medicaid programs have begun using All Patient Refined–Diagnosis-Related Groups (APR-DRGs) to determine hospital reimbursement rates. Medicaid provides coverage for 45% of childhood cancer admissions. This study aimed to examine how well APR-DRGs reflect admission costs for childhood cancer chemotherapy to inform clinicians, hospitals, and policymakers in the wake of policy changes.Methods: We identified 25,613 chemotherapy admissions in the 2009 Kids’ Inpatient Database. To determine how well APR-DRGs explain costs, we applied a hierarchic linear regression model of hospital costs, allowing for a variety of patient, hospital, and geographic confounders.Results: APR-DRGs proved to be the most important predictors of admission costs (P <.001), with costs increasing by DRG severity code. Diagnosis, age, and hospital characteristics also predicted costs above and beyond those explained by APR-DRGs. Compared with admissions for patients with acute lymphoblastic leukemia, costs of admissions for patients with acute myelomonocytic leukemia were 82% higher; non-Hodgkin lymphoma, 20% higher; Hodgkin lymphoma, 25% lower; and CNS tumors, 27% lower. Admissions for children who were 10 years of age or older cost 26% to 35% more than admissions for infants. Admissions to children’s hospitals cost 46% more than admissions to other hospital types.Conclusion: APR-DRGs developed for adults are applicable to childhood cancer chemotherapy but should be refined to account for cancer diagnosis and patient age. Possible policy and clinical management changes merit further study to address factors not captured by APR-DRGs

Overseas development needs and the world wheat problem today : paper prepared for delivery at the International Wheat Surplus Utilization Conference, July 20-August 2, 1958, proceedings to be published early in 1959

Cover titleAt head of title: Econ. Dev. Program. India Project"November 1958.""L2-507"--handwritten on cove

Alberta oil sands hydrological research

Extraction of bitumen from the Alberta Oil Sands by surface mining will have a major impact on the hydrology of the areas immediately adjacent to each mine, and an impact on any drainage system receiving discharge from the mining or processing areas. Conversely, the hydrology will have a major impact on the mining operations. The exact nature of the impacts is difficult to evaluate, because: (a) both surface and subsurface hydrologic systems of the lower Athabasca River basin are poorly known, (b) the exact nature, amounts and ultimate fate of effluent and tailings materials are uncertain, (c) the degree of utilization of the waters within each basin and the possible physical changes to each basin ate essentially unknown, and (d) the nature and stability of the post-mining landscape, including particularly the success of reclamation and revegetation is open to speculation. In fact, at present we cannot predict even the simpler natural hydrologic characteristics of the river, nor do we have any real idea of the effect of the effluents produced by the oil sands plants. In this context, we generally conclude that the main initial emphasis of hydrologic studies should be on gathering sufficient information that the questions implied in items (a), (b) and (c) can be answered, and hence item (d) appraised. Sufficient data are needed to simulate surface runoff through the mining areas and to simulate groundwater flow systems in the mining areas; background data are needed on the physical and chemical characteristics of rivers and streams to determine present status, and so that pollution loads and other changes can be monitored. It is necessary to know, among other things: flood flows, to decide on the needs for and designs of stream diversions; the low-flow characteristics streams, for pollution control; and the severity of ice runs, again for flood information and diversion designs. To obtain this information, a general two-phase approach is needed: (1) an inventory of the hydrologic resources in the drainage basins likely to be affected by mining in the near future, and also in the Peace-Athabasca delta, and (2) a detailed examination of existing operations, to study water use and water wastes, including drainage of mining areas, tailings ponds, etc. To achieve this, specific study topics are set out below (in outline only, due to time constraints). These research needs should be formulated more specifically as projects, including scope, method, precision and timing before they are allocated and funded. In this respect, to help ensure that the desired results will be obtained and to obtain some measure of continuity, task force members consider that their respective agencies should have the opportunity of contributing more specifically to project formulation. Beyond this, hydrologic research needs will become apparent from the results of the first-phase investigations and the detailed nature of the mining developments. Definition of these needs is thus a continuing process; this report should not be considered the definitive and final document, but rather the initiation of a spectrum of projects. It was particularly noted, however, that time and again discussion ultimately and inevitably led back to one key issue – the nature and disposition of the tailings and plant effluents. These will determine the size of development impact on the hydrologic system – either directly, or indirectly through the degree of success of reclamation, which is intimately dependent on the nature of the solids and liquids left in the mined-out regions. The research needs are set out in two groups – (1) describing existing hydrologic resources and (2) development impact studies. Within these two groups listing is in descending order of priority

Operations Guidance Report on Water Facilities for Atascosa River Watershed Texas

Excerpts: The purpose of this report is to present the physical and economic characteristics of the Atascosa Area, and from these data, to formulate a plan for the proper use of land and water. The report points out certain chases of misuse and maladjustment in the utilization of both land and water and attempts to provide the criteria for guidance in a program of adjustment where such adjustment is necessary. The report is divided into three parts. The first part presents an inventory of the physical features of the area which must serve as a basis in planning the proper use of land and water. The second part of the report reviews the present utilization of land and water, and the last part gives recommendations for certain adjustments of the use of land and water within the area to promote a better agricultural economy. The area includes the entire drainage basin of the Atascosa River above its confluence with the Frio River in southwestern Texas. Both of these streams are a part of the major Nueces River drainage. The Atascosa River watershed is located on the east side of what is commonly known as the "Winter Garden" district, and includes nearly all of Atascosa County, as well as smaller parts of southeastern Medina, northeastern Frio, southern Bexar, southwestern Wilson and Karnes, northern Live Oak and northeastern McMullen counties

Edible Soybean Protein and Related Studies: A List of Publications and Patents, 1962-1969

Contents: Publications (Protein, Protein Isolates, Whey Proteins, Trypsin Inhibitor – Analytical Methods – Fermented Foods – Flavor and Stability Studies – Biological Activity) --- Patent

Edible Soybean Protein Products; A List of Publications and Patents, 1936-1961, Northern Regional Research Laboratory

Contents: Publications (Foods – Baking and Bakery Products – Foreign, Fermented Foods – Biological Activity) --- Patents

Location and Character of Indian Lands in California

Excerpt: This report gives for each of the 132 Indian reservations in the State the location; sizes; manner of acquisitions ownership status; and a description of the natural cover, soils, precipitation, topography, temperature range, normal growing season, and type-of-farming (if any). An appraisal, based on these and other data including some field investigation, has been made of the agricultural, grazing, and timber value. This information is conveniently summarized for each reservation, for the five Indian jurisdictions, and for the State. A table presenting the most important characteristics of each reservation is inserted immediately preceding this foreword

Epidemiology of Aortic Aneurysm Repair in the United States from 1993 to 2003

The epidemiology of abdominal aortic aneurysm (AAA) disease has been well described over the preceding 50 years. This disease primarily affects elderly males with smoking, hypertension, and a positive family history contributing to an increased risk of aneurysm formation. The aging population as well as increased screening in high-risk populations has led some to suggest that the incidence of AAAs is increasing. The National Inpatient Sample (1993 2003), a national representative database, was used in this study to determine trends in mortality following AAA repair in the United States. In addition, the impact of the introduction of less invasive endovascular AAA repair was assessed. Overall rates of treated unruptured and ruptured AAAs remained stable (unruptured 12 to 15 100,000; ruptured 1 to 3 100,000). In 2003, 42.7 of unruptured and 8.8 of ruptured AAAs were repaired through an endovascular approach. Inhospital mortality following unruptured AAA repair continues to decline for open repair (5.3 to 4.7 , P 0.007). Mortality after elective endovascular AAA repair also has statistically decreased (2.1 to 1.0 , P 0.024) and remains lower than open repair. Mortality rates for ruptured AAAs following repair remain high (open: 46.5 to 40.7 , P 0.01; endovascular: 40.0 to 35.3 , P 0.823). These data suggest that the numbers of patients undergoing elective AAA repair have remained relatively stable despite the introduction of less invasive technology. A shift in the treatment paradigm is occurring with a higher percentage of patients subjected to elective endovascular AAA repair compared to open repair. This shift, at least in the short term, appears justified as the mortality in patients undergoing elective endovascular AAA repair is significantly reduced compared to patients undergoing open AAA repair.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73855/1/annals.1383.030.pd