Relationship of provider characteristics to outcomes, process, and costs of care for community-acquired pneumonia

OBJECTIVES: The authors describe the relation of provider characteristics to processes, costs, and outcomes of medical care for elderly patients hospitalized for community-acquired pneumonia. METHODS: Using Medicare claims data, Medicare beneficiaries discharged from Pennsylvania hospitals during 1990 with community-acquired pneumonia were identified. Claims data were used to ascertain mortality, readmissions, use of procedures and physician consultations, and the costs of care. The relationship of these measures to provider characteristics was analyzed using regression techniques to adjust for patient characteristics, including comorbidity and microbial etiology. RESULTS: Among 22,294 pneumonia episodes studied, 30-day mortality was 17.0%. After adjusting for patient characteristics, 30-day mortality and readmission rates were unrelated to hospital teaching status or urban location or to physician specialty. Use of procedures and physician consultations was more common and costs were 11% higher among patients discharged from teaching hospitals compared with nonteaching hospitals. Similarly, costs were 15% higher at urban hospitals compared with rural hospitals. General internists and medical subspecialists used more procedures and had higher costs than family practitioners. CONCLUSIONS: Processes and costs of care for community-acquired pneumonia varied by provider characteristics, but neither mortality nor readmission rates did. These differences cannot be explained by clinical variables in the database. Further studies should determine whether less costly patterns of care for pneumonia, and perhaps other conditions, could replace more costly ones without compromising patient outcomes.     

第一批人凝血因子Ⅶ浓制剂国家标准品协作标定

目的 协作标定第一批人凝血因子Ⅶ浓制剂国家标准品。方法 以 WHO 97/592批人凝血因子Ⅶ浓制剂国际标准品为对照,采用一期法标定我国首批人凝血因子Ⅶ因家标准品,并将标准品分别置4℃、22℃、37℃保存5个月,用加速破坏试验进行稳定性考查。结果 该批标准品效价为16.0IU/支,稳定性良好。其他项目均达到国家标准品要求。结论 已成功研制第一批人凝血因子Ⅶ浓制剂国家标准品。     

Developmental variations in plasma leptin,leptin soluble receptor and their molar ratio in healthy infants

Background  

Leptin and its soluble receptor (sOB-R) are important to regulation of body composition but there are no data on the developmental variations in these plasma variables and their relationship with body composition measurements,     

Master batch approach for developing PVDF/EVA/CNT nanocomposites with co-continuous morphology and improved electrical conductivity

Conducting polymer composites constituted by co-continuous poly (vinylidene fluoride) (PVDF)/ ethylene- vinyl acetate copolymer (EVA) blends with multiwalled carbon nanotube (CNT) were prepared by melt mixing using different procedures. The effect of the master batch approach on the conductivity, morphology, mechanical, thermal and rheological properties of PVDF/EVA/CNT nanocomposites was compared with that based on one step mixing strategy. The selective extraction experiments revealed that CNT was preferentially localized in the EVA phase in all situations, even when PVDF@CNT master batch was employed. Nanocomposites prepared with EVA@CNT master batch displayed higher conductivity, whose value reached around 10⁻¹ S m⁻¹ with the addition of 0.56 vol% of CNT. The better electrical performance was attributed to the better distribution of the filler, as indicated by transmission electron microscopy and rheological behavior. The electrical and rheological behavior were also investigated as a function of the CNT content.     

The teacher's responsibility in whole‐class debriefing of mathematical activity

Abstract

Prompted by recent moves in the United Kingdom to guide teachers’ practices in whole‐class, direct interactive teaching, in this article, we offer an opportunity for North American mathematics educators to reflect on possibilities for whole‐class teaching of mathematics. We focus particularly on the plenary aspect of lessons—what might be considered the debriefing of mathematical activity—and specifically on the teacher's responsibility during those sessions, both to his or her students and to the authenticity of the discipline of mathematics. Drawing on data from a Grade‐3 classroom and invoking complexity science as a theoretical lens to explore the classroom as a complex learning system, we present implications for teaching in whole‐class debriefings of mathematical activity.     

Validation of GOES and MODIS active fire detection products using ASTER and ETM+ data

In this study we implemented a comprehensive analysis to validate the MODIS and GOES satellite active fire detection products (MOD14 and WFABBA, respectively) and characterize their major sources of omission and commission errors which have important implications for a large community of fire data users. Our analyses were primarily based on the use of 30 m resolution ASTER and ETM+ imagery as our validation data. We found that at the 50% true positive detection probability mark, WFABBA requires four times more active fire area than is necessary for MOD14 to achieve the same probability of detection, despite the 16× factor separating the nominal spatial resolutions of the two products. Approximately 75% and 95% of all fires sampled were omitted by the MOD14 and WFABBA instantaneous products, respectively; whereas an omission error of 38% was obtained for WFABBA when considering the 30-minute interval of the GOES data. Commission errors for MOD14 and WFABBA were found to be similar and highly dependent on the vegetation conditions of the areas imaged, with the larger commission errors (approximately 35%) estimated over regions of active deforestation. Nonetheless, the vast majority (> 80%) of the commission errors were indeed associated with recent burning activity where scars could be visually confirmed in the higher resolution data. Differences in thermal dynamics of vegetated and non-vegetated areas were found to produce a reduction of approximately 50% in the commission errors estimated towards the hours of maximum fire activity (i.e., early-afternoon hours) which coincided with the MODIS/Aqua overpass. Lastly, we demonstrate the potential use of temporal metrics applied to the mid-infrared bands of MODIS and GOES data to reduce the commission errors found with the validation analyses.     

Batch process modelling with mixtures of Gaussian processes

In recent years Gaussian processes have attracted a significant amount of interest with the particular focus being that of process modelling. This has primarily been a consequence of their good predictive performance and inherent analytical properties. Gaussian processes are a member of the family of non-parametric Bayesian regression models and can be derived from the perspective of neural networks. Their behaviour is controlled through the structure of the covariance function. However, when applied to batch processes, whose data exhibits different variance structures throughout the duration of the batch, a single Gaussian process may not be appropriate for the accurate modelling of its behaviour. Furthermore there are issues with respect to the computational costs of Gaussian processes. The implementation of a Gaussian process model requires the repeated computation of a matrix inverse whose order is the cubic of the number of training data points. This renders the algorithm impractical when dealing with large data sets. To address these two issues, a mixture model of Gaussian processes is proposed. The resulting prediction is attained as a weighted sum of the outputs from each Gaussian process component, with the weights determined by a Gaussian kernel gating network. The model is implemented through a Bayesian approach utilising Markov chain Monte Carlo algorithms. The proposed methodology is applied to data from a bench-mark batch simulation polymerization process, methyl methacrylate (MMA), and the results are compared with those from a single Gaussian process to illustrate the advantages of the proposed mixture model approach.     

Axonal regeneration and physiological activity following transection and immunological disruption of myelin within the hatchling chick spinal cord

Transections of the chicken spinal cord after the developmental onset of myelination at embryonic day (E) 13 results in little or no functional regeneration. However, intraspinal injection of serum complement proteins with complement-binding GalC or 04 antibodies between E9-E12 results in a delay of the onset of myelination until E17. A subsequent transection of the spinal cord as late as E15 (i.e., during the normal restrictive period for repair) results in neuroanatomical regeneration and functional recovery. Utilizing a similar immunological protocol, we evoked a transient alteration of myelin structure in the posthatching (P) chicken spinal cord, characterized by widespread "unravelling" of myelin sheaths and a loss of MBP immunoreactivity (myelin disruption). Myelin repair began within 7 d of cessation of the myelin disruption protocol. Long term disruption of thoracic spinal cord myelin was initiated after a P2-P10 thoracic transection and maintained for > 14 d by intra-spinal infusion of serum complement proteins plus complement-binding GalC or 04 antibodies. Fourteen to 28 d later, retrograde tract tracing experiments, including double-labeling protocols, indicated that approximately 6-19% of the brainstem-spinal projections had regenerated across the transection site to lumbar levels. Even though voluntary locomotion was not observed after recovery, focal electrical stimulation of identified brainstem locomotor regions evoked peripheral nerve activity in paralyzed preparations, as well as leg muscle activity patterns typical of stepping in unparalyzed animals. This indicated that a transient alteration of myelin structure in the injured adult avian spinal cord facilitated brainstem-spinal axonal regrowth resulting in functional synaptogenesis with target neurons.