Predictors for Unplanned Readmissions within 18 Days after Hospital Discharge: a Retrospective Cohort Study

Since the introduction of the reimbursement system based on diagnosis-related groups (DRG) in Swiss hospitals in 2012, most readmissions occurring within 18 days and appertaining to the same major diagnostic category (MDC) are merged and thus often reimbursed to a lesser extent. While readmissions reflect increased distress for patients and their relatives, the causes are mainly patient-related and difficult to influence. However, it may be possible to identify cases at higher risk for readmission. Therefore, the aim of this study was to find predictors for early readmissions in the same MDC, to identify high-risk index hospitalizations and possibly prevent unnecessary readmissions. The data of all patients admitted to the Clinic of Internal Medicine at the University Hospital of Basel, Switzerland, hospitalized for longer than 24 hours during the pre-DRG period between October 2009 and September 2010 were retrospectively collected. Data were examined for predictors of unplanned readmission within 18 days under the same MDC ('relevant readmission') by means of logistic regression. 7479 patients (median age 67.8 years, 56% male) were admitted to the Clinic of Internal Medicine, with 232 patients (3.1%) being readmitted at least once. Logistic regression revealed male sex (p =0.035) and a high number of prescribed drugs at discharge (p <0.005) as patient-related predictors. The MDCs respiratory system, cardiovascular system, and gastrointestinal/hepatobiliary system were identified as high-risk categories (each p <0.005). Age and length of index hospital stay added no significant explanatory value to the regression model. Unplanned readmissions under the same MDC within 18 days were infrequent and not related to patients' age or length of hospital stay. Overall, multimorbid patients, and hospitalizations regarding the cardiovascular, respiratory, or gastrointestinal system appear to be most at risk and should therefore be specifically targeted in the prevention of early readmissions.

A fast sol–gel synthesis leading to highly crystalline birnessites under non-hydrothermal conditions

Manganese oxides from the compound family of layered birnessites have attracted interest for their use as cathode materials in Li-ion batteries, as supercapacitors, and as water oxidation catalysts.

Consequences of crown shortening canine teeth in Greenland sled dogs

OBJECTIVES

To evaluate the consequences of crown shortening, focusing on the prevalence of pulp exposure and periapical pathology in Greenland sled dogs that had had their canine crowns shortened at an early age.

METHODS

Five cadaver heads and 54 sled dogs underwent an oral examination for dental fractures and pulp exposure of canines. All canines were radiographed and evaluated for periapical pathology.

RESULTS

The prevalence of canine pulp exposure in 12 (5 heads and 7 dogs) crown shortened dogs was 91 · 7%, and 21 · 3% in 47 not-crown shortened dogs. A significant (P < 0 · 001) risk of pulp exposure of the canines in the crown shortened group compared to the not-crown shortened group was seen with a relative risk of 4 · 3 on a dog basis and a relative risk of 12 · 2 on a tooth basis. In dogs with pulp exposure of canines (n = 51) the prevalence of periapical pathology was 82 · 4%, but only 0 · 8% in dogs without pulp exposure (n = 133) resulting in a significant (relative risk, 109 · 5; P < 0 · 001) risk of periapical pathology in teeth with pulp exposure compared to teeth without pulp exposure.

CLINICAL SIGNIFICANCE

The high risk of periapical pathology observed in teeth with pulp exposure confirms that these teeth should not be neglected in affected dogs.

In situ transmission electron microscopy of light-induced photocatalytic reactions

Transmission electron microscopy (TEM) makes it possible to obtain insight into the structure, composition and reactivity of photocatalysts, which are of fundamental interest for sustainable energy research. Such insight can be used for further material optimization. Here, we combine conventional TEM analysis of photocatalysts with environmental TEM (ETEM) and photoactivation using light. Two novel types of TEM specimen holder that enable in situ illumination are developed to study light-induced phenomena in photoactive materials, systems and photocatalysts at the nanoscale under working conditions. The technological development of the holders is described and two representative photo-induced phenomena are studied: the photodegradation of Cu₂O and the photodeposition of Pt onto a GaN:ZnO photocatalyst.

Optimal active recovery intensity in standardbreds after submaximal work

REASONS FOR PERFORMING STUDY

A retrospective study concerning spontaneous active recovery intensity, i.e. at a freely chosen speed, after a submaximal exercise in trotters showed that the mean intensity demanded by trainers corresponds to 40-50% of maximal heart rate (max HR; unpublished data). However, in human athletes, optimal active recovery intensity was found to be about 60-70% of max HR. Is the spontaneous recovery optimal after a submaximal exercise in trotters?

OBJECTIVES

To compare different recovery intensities and define the most efficient one.

METHODS

Thirty-seven trotters performed a standardised exercise test on the track. Horses were randomly divided into 4 groups of recovery: passive recovery (n = 10), 10 min walk recovery (n = 10, 100 m/min), 10 min slow trot recovery (n = 9, 250 m/min) and 10 min fast trot recovery (n = 8, 420 m/min). Before, during and 1 h after exercise, speed, heart rate, blood lactate concentration were measured as well as respiratory frequency and rectal temperature. Creatine kinase (CK) was measured 1, 3 and 5 h after exercise.

RESULTS

Walk, slow trot and fast trot recovery corresponded respectively to 45-50%, 55-60% and 65-70% of max HR. Heart rate and blood lactate concentration were significantly lower after the 10 sec recovery with increasing intensity of recovery.

CONCLUSION

The most efficient intensity of recovery was the 10 min fast trot recovery (65-70% max HR) as this type of recovery allows the optimal blood lactate disappearance.

POTENTIAL RELEVANCE

Considering the usual habits of trainers or drivers, recovery intensity after trot races should be increased in intensity to optimise its efficiency.

Predicting Catalysis: Understanding Ammonia Synthesis from First-Principles Calculations

Here, we give a full account of a large collaborative effort toward an atomic-scale understanding of modern industrial ammonia production over ruthenium catalysts. We show that overall rates of ammonia production can be determined by applying various levels of theory (including transition state theory with or without tunneling corrections, and quantum dynamics) to a range of relevant elementary reaction steps, such as N(2) dissociation, H(2) dissociation, and hydrogenation of the intermediate reactants. A complete kinetic model based on the most relevant elementary steps can be established for any given point along an industrial reactor, and the kinetic results can be integrated over the catalyst bed to determine the industrial reactor yield. We find that, given the present uncertainties, the rate of ammonia production is well-determined directly from our atomic-scale calculations. Furthermore, our studies provide new insight into several related fields, for instance, gas-phase and electrochemical ammonia synthesis. The success of predicting the outcome of a catalytic reaction from first-principles calculations supports our point of view that, in the future, theory will be a fully integrated tool in the search for the next generation of catalysts.

Ammonia Synthesis from First-Principles Calculations

The rate of ammonia synthesis over a nanoparticle ruthenium catalyst can be calculated directly on the basis of a quantum chemical treatment of the problem using density functional theory. We compared the results to measured rates over a ruthenium catalyst supported on magnesium aluminum spinel. When the size distribution of ruthenium particles measured by transmission electron microscopy was used as the link between the catalyst material and the theoretical treatment, the calculated rate was within a factor of 3 to 20 of the experimental rate. This offers hope for computer-based methods in the search for catalysts.

Amino acid catabolism and generation of volatiles by lactic acid bacteria

Twelve isolates of lactic acid bacteria, belonging to the Lactobacillus, Lactococcus, Leuconostoc, and Enterococcus genera, were previously isolated from 180-d-old Serra da Estrela cheese, a traditional Portuguese cheese manufactured from raw milk and coagulated with a plant rennet. These isolates were subsequently tested for their ability to catabolize free amino acids, when incubated independently with each amino acid in free form or with a mixture thereof. Attempts were made in both situations to correlate the rates of free amino acid uptake with the numbers of viable cells. When incubated individually, leucine, valine, glycine, aspartic acid, serine, threonine, lysine, glutamic acid, and alanine were degraded by all strains considered; arginine tended to build up, probably because of transamination of other amino acids. When incubated together, the degradation of free amino acids by each strain was dependent on pH (with an optimum pH around 6.0). The volatiles detected in ripened Serra da Estrela cheese originated mainly from leucine, phenylalanine, alanine, and valine, whereas in vitro they originated mainly from valine, phenylalanine, serine, leucine, alanine, and threonine. The wild strains tested offer a great potential for flavor generation, which might justify their inclusion in a tentative starter/nonstarter culture for that and similar cheeses.

Atomic-resolution in situ transmission electron microscopy of a promoter of a heterogeneous catalyst

Insight into the location, state, and function of a promoter in heterogeneous catalysis was obtained through atomic-resolution in situ transmission electron microscopy. In the most active ruthenium catalyst for ammonia synthesis known so far, the barium promoter is shown to be located in two different phases in the catalyst. The increased activity is suggested to be related to a two-dimensional barium-oxygen overlayer on the ruthenium crystals. The possibility for conducting such studies for other reactions could add substantially to our current understanding of heterogeneous catalysis. Heterogeneous catalysis plays an increasingly important role in environmental protection processes, in fuel upgrading, and in providing the majority of the chemical building blocks required by contemporary society. Most heterogeneous catalysts of industrial importance are multicomponent materials that are designed by trial-and-error experimentation. Application of even the most sophisticated physical-chemical characterization techniques is usually not sufficient to obtain a complete understanding of the structure of the active site, the reaction mechanism and kinetics, the structural dynamics, and the specific roles of all catalyst components.

Prevalence of SIDS risk factors: before and after the "Back to Sleep" campaign in North Dakota Caucasian and American Indian infants

The objective of this study was to compare rates of infant sleeping position and other risk factors for sudden infant death syndrome from 1991 before the "Back to Sleep" campaign to rates in 1998 after the campaign. We used a cross-sectional risk factor prevalence study of risk factors for the years 1991 and 1998. In North Dakota the prevalence rates of prone sleeping declined 72% for American Indian infants and 62% for Caucasian infants. We were unable to identify a corresponding decline in SIDS in North Dakota for this time period. The relationship between sleeping position and SIDS may be more complex in rural and frontier settings and in American Indian populations than in urban and majority populations. The generalizability of this study is limited by the rural setting and small sample size. Longer term surveillance and additional reports from sites with pre "Back to Sleep" data as a baseline for both SIDS rates and sleeping position will be important to clarify the rate of prone sleeping position and SIDS.

Drosophila beta spectrin functions independently of alpha spectrin to polarize the Na,K ATPase in epithelial cells

Spectrin has been proposed to function as a sorting machine that concentrates interacting proteins such as the Na,K ATPase within specialized plasma membrane domains of polarized cells. However, little direct evidence to support this model has been obtained. Here we used a genetic approach to directly test the requirement for the beta subunit of the alphabeta spectrin molecule in morphogenesis and function of epithelial cells in Drosophila. beta Spectrin mutations were lethal during late embryonic/early larval development and they produced subtle defects in midgut morphology and stomach acid secretion. The polarized distributions of alphabeta(H) spectrin and ankyrin were not significantly altered in beta spectrin mutants, indicating that the two isoforms of Drosophila spectrin assemble independently of one another, and that ankyrin is upstream of alphabeta spectrin in the spectrin assembly pathway. In contrast, beta spectrin mutations had a striking effect on the basolateral accumulation of the Na,K ATPase. The results establish a role for beta spectrin in determining the subcellular distribution of the Na, K ATPase and, unexpectedly, this role is independent of alpha spectrin.

Effects of phosphodiesterase inhibitors and salbutamol on microvascular leakage in guinea-pig trachea

The aim of this study was to investigate the effects of selective phosphodiesterase inhibitors and their combination with salbutamol on antigen-induced microvascular leakage in the trachea. In actively sensitized anaesthetized guinea-pigs, the non-selective phosphodiesterase inhibitor theophylline (100 mg/kg p.o.) and the selective phosphodiesterase type 4 inhibitor Ro 20-1724 (30 mg/kg p.o.) inhibited antigen-induced microvascular leakage (-73.8% and -44.1%, respectively) as demonstrated by a reduced extravasation of plasma proteins measured by the use of Evans blue dye. No significant reduction in microvascular leakage was seen with (a) the selective phosphodiesterase type 4 inhibitor rolipram (10 mg/kg p.o.), (b) the selective phosphodiesterase type 3 inhibitors milrinone (30 mg/kg p.o.) and SK and F 94-836 (30 mg/kg p.o.) or (c) the selective phosphodiesterase type 1/5 inhibitor zaprinast (30 mg/kg p.o.). Neither Ro 20-1724 nor rolipram and theophylline inhibited microvascular leakage induced by either substance P or histamine. Pretreatment with aerosolized salbutamol (10 microg/ml) potentiated the inhibitory effects of theophylline (-49.8% at 30 mg/kg p.o.) and Ro 20-1724 (-52.6% at 10 mg/kg p.o.) versus antigen-induced microvascular leakage. Furthermore, a significant inhibitory effect of rolipram (10 mg/kg, p.o.) was obtained following pretreatment with this concentration of aerosolized salbutamol. Even at higher concentrations (0.3-2 mg/ml) salbutamol did not augment the corresponding inhibitory effects of rolipram and Ro 20-1724 versus microvascular leakage induced by either histamine or substance P. Theophylline had no effect versus substance P-induced microvascular leakage, but did inhibit it significantly (P < 0.05) after pretreatment with aerosolized salbutamol (0.3 mg/ml). The potentiation by salbutamol of the inhibitory effects of both non-selective and selective phosphodiesterase type 4 inhibitors versus antigen-induced microvascular leakage probably results from a synergistic reduction in the release of anaphylactic mediators.

Traumatic events and predictive factors for posttraumatic symptoms in displaced Bosnian women in a war zone

A study was conducted among 209 displaced women attending a Women's Center in a war zone in Bosnia-Herzegovina in 1994. Information on war-related traumatic events, sociodemographic factors and posttraumatic symptomatology was collected by means of a questionnaire. Post-traumatic symptoms were registered by using a 10-item Posttraumatic Symptom Scale (PTSS-10). Women with six or more symptoms were classified as a "posttraumatic symptom case" (PTS-case). Among women who had survived the most severe traumas (concentration camps or other kinds of detention) the proportion of PTS-cases was highest: 71% compared to 47% of the women without this kind of traumatic background. High numbers of traumas, having children, being over 25 years of age, and the reporting of an absent husband, were characteristics associated with being a PTS-case. In the multivariate analysis, severe trauma and reporting of an absent husband remained significantly associated with PTS-cases. Clinical implications were discussed.

Health profile of Danish army personnel

The purpose of the present study was to delineate a health profile of professional Danish army personnel. Two-hundred twenty officers, noncommissioned officers, and gunners on active duty at Varde Barracks, housing the South Jutland Artillery Regiment and the Danish Army Artillery School, were asked about their physical and psychological health, interpersonal relations, and working conditions as well as their dietary, drinking, and smoking habits. Measurements were made of resting pulse rate, blood pressure, height, weight, waist and hip girth, and pulmonary function. The ratio of waist-to-hip girth and body mass index (BMI) were calculated. Psychological well-being was evaluated using the 12-item version of the General Health Questionnaire (GHQ). Psychosomatic symptoms were frequently reported, but very few of those surveyed appeared to have psychiatric disorders as measured by the GHQ. Also, somatic health problems were frequently reported, the most frequent being lower-back pain, mild chest pain, and sensory disorders. Differences in interpretation and reporting of "lasting health problems" may explain the relatively high score for this question. The interpersonal relations, both upward and downward in the hierarchy rank order, received high scores. Compared with the general population, alcohol consumption was very low, whereas smoking-in particular heavy smoking-was much more frequent among professional Danish army personnel. Lung function testing showed significantly poorer mean values of forced expiratory volume in 1st second of expiration and mean forced expiratory flow 25 to 75% of forced vital capacity among smokers compared with nonsmokers, although the mean values for the whole group of both smokers and nonsmokers were well above reference values for all lung function parameters. The frequency of moderately overweight individuals (25 < BMI < or = 30) was significantly higher among the male army personnel than in the general population, whereas this was not the case for obesity (BMI > 30). Abdominal obesity, regarded as an independent risk factor for the development of ischemic heart disease, stroke, diabetes, hypertension, and all-cause mortality, was present in 5%, and 3% belonged to the highest-risk group by having a low BMI as well as abdominal obesity.

[Cheese-packers' disease--respiratory complaints at a cheese-packing dairy]

Twenty-one present and three former employees working in the paching room of a cheese-making dairy underwent clinical examinations including symptom history, smoking habits, chest examination, and pulmonary function tests. Blood samples were drawn to determine level of peripheral eosinophil count and antibodies to microorganisms detected by air samples. Air sample concentrations of Penicillium camemberti var. candidum, used in the cheese-production, were very high (> 6000 colony forming units per cubic metre of air). In 15 of the 24 exposed workers, precipitating antibodies towards this fungus were detected, but no antibodies were detected in a reference consisting of pooled blood from 1000 donors. Of the sixteen workers with airway symptoms five had asthma requiring treatment. Two-thirds of the symptomatic cheeseworkers but only half of those without symptoms had precipitating antibodies. The high frequency of precipitating antibodies together with the clinical causes of the airway symptoms indicates an aetiological relationship between airway symptoms and heavy exposure to Penicillium camemberti.

The establishment of an HNPCC register

Guidelines for the establishment of an HNPCC-register are presented. The aims of a register are discussed. Steps in identification of families and persons at risk are suggested, and possible sources of family and pedigree data are mentioned. The role of a register in surveillance, information of family members and medical colleagues, research and international collaboration are discussed.

[Reported occupational diseases. A 5-year follow-up study from the county of Ribe]

The present study sought to examine the health-related, work-related, social and economic consequences of occupational disorders. The survey included 503 patients and was undertaken approximately five years after the disease was notified to the Registry of Occupational Diseases (Danish Working Environment services). The response rate was 80% with women accounting for 56% of the responding group. The mean age was 39.5 years. More than half of all respondents were unskilled workers. White-collar workers and civil servants constituted 14%. Musculo-skeletal disorders were the most frequently diagnosed condition. Forty percent of the occupational diseases were reported in the year in which symptoms arose, while 21% of the patients had been symptomatic for more than six years before the disease was notified. The study indicates that many patients' occupational diseases caused them significant social and medical consequences. During their often protracted illnesses, patients underwent numerous medical examinations and additionally contacted several agencies other than health care providers. Economic consequences for the patient were considerable: reduced earning capacity and expenses were only partially offset by the workers' compensation system. The impact on the health care system was also considerable: occupational disease sufferers averaged one week of hospitalization and 18 visits to a general practitioner or specialist.

Collaborating to develop a community-based health service for rural homeless persons

In the current healthcare environment, public health nursing administrators are called on to create and manage programs and services while reducing cost and improving access. Public health science provides a framework on which to base program planning and management. Using this approach, the authors describe the establishment of a health services center to meet an identified gap in service to homeless persons in a rural area.

[Peak flow monitoring of asthmatic patients. 1. Basis for measurement procedures and normal values]

Peak flow monitoring (PEFM) consists of repeated measurements of the peak expiratory flow rate (PEF) frequently measured by means of small transportable peak flow metres which have proved sufficiently accurate for registration of alterations in PEF. In the majority of persons, not only asthmatics but also healthy individuals, characteristic diurnal variations in PEF are found. The variation amplitude is greatest in asthmatics. The scientific basis for the proposed norms and standards is incomplete but suggests that normal daily variations in PEF are less than 15-20%, calculated as the difference between the highest and lowest daily values as a percentage of the highest. At least 2-4 daily measurements should be made to obtain a reliable picture of the pattern of variation.

[Peak flow monitoring of patients with asthma. 2. Practical use]

Despite its simplicity, peak flow monitoring (PEFM) has proved to be a valuable method of investigation of the degree of severity of bronchial asthma and the effect of treatment and it has, therefore, been employed in a series of scientific investigations and testing of medicaments. On account of its simplicity, the method is suitable for outpatient monitoring of asthmatic patients in general practice and it can provide a valuable objective assessment of pulmonary function to supplement clinical assessment and the patient's symptoms. Employment of PEFM as a predictor of the short-term of long-term prognosis is good on a group basis but unsatisfactory in prediction of the prognosis for the individual patient. Although a series of sources of error are present, patients can achieve reliable results of measurements after meticulous instruction.

Acute response to rape--a PTSD variant

The relationship between the acute response to rape and the symptoms of Post-Traumatic Stress Disorder (PTSD) was studied in 55 victims of rape and attempted rape during the first two weeks after the assault. The results show that in the majority of victims the response to rape within the first two weeks displays the symptoms of PTSD, although the criterion of duration is not fulfilled. Specific features of the response to rape, like shame, guilt and suicidal ideation are discussed. The importance of early detection to enable the administration of adequate treatment is emphasized and suggestions for further research are offered.

Splenic injury--a prospective multicentre diagnostic study

One hundred and forty-seven patients with splenic injury were entered in a prospective multicentre study including 18 hospitals. The diagnosis was made by scintigraphy in 55 patients, ultrasonography in 51 and computed axial tomography in 31. Exploratory laparotomy was performed in 52 patients, in 23 of these after a positive peritoneal lavage. Splenic injury was found in 33 per cent of the ultrasound examinations, indicated in another 20 per cent and not indicated in 16 per cent. In 31 per cent increased intraperitoneal effusion was the only finding. There was a tendency towards an underestimation of the injury by ultrasonography. Peritoneal lavage was positive in all examinations.