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In 2008, the Centers for Medicare and Medicaid Services (CMS) stopped reimbursing for hospital-acquired conditions (HACs) not present on admission (POA). We sought to understand why this policy did not impact central line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) trends.
Retrospective cohort study.
Acute-care hospitals in the United States.
Fee-for-service Medicare patients discharged January 1, 2007, through December 31, 2011.
Using inpatient Medicare claims data, we analyzed billing practices before and after the HAC policy was implemented, including the use and POA designation of codes for CLABSI or CAUTI. For the 3-year period following policy implementation, we determined the impact on diagnosis-related groups (DRG) determining reimbursement as well as hospital characteristics associated with the reimbursement impact.
During the study period, 65,205,607 Medicare fee-for-service hospitalizations occurred at 3,291 acute-care, nonfederal US hospitals. Based on coding, CLABSI and CAUTI affected 0.23% and 0.06% of these hospitalizations, respectively. In addition, following the HAC policy, 82% of the CLABSI codes and 91% of the CAUTI codes were marked POA, which represented a large increase in the use of this designation. Finally, for the small numbers of CLABSI and CAUTI coded as not POA, financial impacts were detected on only 0.4% of the hospitalizations with a CLABSI code and 5.7% with a CAUTI code.
Part of the reason the HAC policy did not have its intended impact is that billing codes for CLABSI and CAUTI were rarely used, were commonly listed as POA in the postpolicy period, and infrequently impacted hospital reimbursement.
In 2012, the Centers for Medicare and Medicaid Services expanded a 2008 program that eliminated additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) to include Medicaid. We aimed to evaluate the impact of this Medicaid program on mediastinitis rates reported by the National Healthcare Safety Network (NHSN) compared with the rates of a condition not targeted by the program, deep-space surgical site infection (SSI) after knee replacement.
Interrupted time series with comparison group.
We included surveillance data from nonfederal acute-care hospitals participating in the NHSN and reporting CABG or knee replacement outcomes from January 2009 through June 2017. We examined the Medicaid program’s impact on NHSN-reported infection rates, adjusting for secular trends. The data analysis used generalized estimating equations with robust sandwich variance estimators.
During the study period, 196 study hospitals reported 273,984 CABGs to the NHSN, resulting in 970 mediastinitis cases (0.35%), and 294 hospitals reported 555,395 knee replacements, with 1,751 resultant deep-space SSIs (0.32%). There was no significant change in incidence of either condition during the study. Mediastinitis models showed no effect of the 2012 Medicaid program on either secular trend during the postprogram versus preprogram periods (P=.70) or an immediate program effect (P=.83). Results were similar in sensitivity analyses when adjusting for hospital characteristics, restricting to hospitals with consistent NHSN reporting or incorporating a program implementation roll-in period. Knee replacement models also showed no program effect.
The 2012 Medicaid program to eliminate additional payments for mediastinitis following CABG had no impact on reported mediastinitis rates.
Four species of malaria parasite, Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae and Plasmodium knowlesi infect humans living in the Khanh Phu commune, Khanh Hoa Province, Vietnam. The latter species also infects wild macaque monkeys in this region. In order to understand the transmission dynamics of the three species, we attempted to detect gametocytes of the three species in the blood of infected individuals, and sporozoites in the salivary glands of mosquitoes from the same region. For the detection of gametocyte-specific mRNA, we targeted region 3 of pfg377, pvs25, pmg and pks25 as indicators of the presence of P. falciparum, P. vivax, P. malariae and P. knowlesi gametocytes, respectively. Gametocyte-specific mRNA was present in 37, 61, 0 and 47% of people infected with P. falciparum (n = 95), P. vivax (n = 69), P. malariae (n = 6) or P. knowlesi (n = 32), respectively. We found that 70% of mosquitoes that had P. knowlesi in their salivary glands also carried human malaria parasites, suggesting that mosquitoes are infected with P. knowlesi from human infections.
Since the discovery of fading X-rays from Gamma-Ray Bursts (GRBs) with BeppoSAX (Piro et al. 1997, Costa et al. 1997), world-wide follow-up observations in optical band have achieved the fruitful results. The case of GRB 970228, there was an optical transient, coincides with the BeppoSAX position and faded (Paradijs et al. 1997, Sahu et al. 1997). These optical observations also confirmed the extended component, which was associated with the optical transient. The new transient are fading with a power-law function in time and the later observation of HST confirmed the extended emission is stable (Fruchter et al. 1997). This extended object seems to be a distant galaxy and strongly suggests to be the host.
X-ray images of rotation-powered pulsars were examined using ASCA Gas Imaging Spectrometer (GIS). The data sets are taken from those available in the ASCA public archive in the performance verification (PV) phase and the guest-observing (GO) phase 1. We detected diffuse X-ray sources in the vicinity of nine pulsars including five new detections. There are large variety in their morphology and spatial size. The high probability of finding such diffuse sources around pulsars suggests that they exist universally for all the active pulsars, and that they are powered by the pulsars. We propose that the pulsar-powered nebula is a good probe to measure the otherwise invisible energy flux dissipating from a pulsar into the surrounding space.
The High Energy Transient Explorer 2 is a small scientific satellite designed to detect and localize gamma-ray bursts (GRBs). The coordinates of GRBs detected by HETE-2 will be distributed to interested ground-based observers within seconds of burst detection, thereby allowing detailed observations of the initial phases of GRBs. HETE-2 was launched successfully on October 9, 2000. The GRB positions will start to be delivered after a few months of the complete testing and calibration of the spacecraft system and the science instruments.
In October 2008, Medicare ceased additional payment for hospital-acquired conditions not present on admission. We evaluated the policy’s differential impact in hospitals with high vs low operating margins. Medicare’s payment policy may have had an impact on reducing central line–associated bloodstream infections in hospitals with low operating margins.
Infect. Control Hosp. Epidemiol. 2015;37(1):100–103
The 2008 Centers for Medicare & Medicaid Services hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable.
To examine whether this policy was associated with decreases in billing rates for 2 targeted conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections (CAUTI).
Adult Medicare patients admitted to 569 acute care hospitals in California, Massachusetts, or New York and subject to the policy.
We used an interrupted times series design to assess whether the hospital-acquired conditions policy was associated with changes in billing rates for VCAI and CAUTI.
Before the policy, billing rates for VCAI and CAUTI were increasing (prepolicy odds ratio per quarter for VCAI, 1.17 [95% CI, 1.11–1.23]; for CAUTI, 1.19 [1.16–1.23]). The policy was associated with an immediate drop in billing rates for VCAI and CAUTI (odds ratio for change at policy implementation for VCAI, 0.75 [95% CI, 0.69–0.81]; for CAUTI, 0.87 [0.79–0.96]). In the postpolicy period, we observed a decreasing trend in the billing rate for VCAI and a leveling-off in the billing rate for CAUTI (postpolicy odds ratio per quarter for VCAI, 0.98 [95% CI, 0.97–0.99]; for CAUTI, 0.99 [0.97–1.00]).
The Centers for Medicare & Medicaid Services hospital-acquired conditions policy appears to have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight decreasing trend or leveling-off in rates. These billing rates, however, may not correlate with changes in clinically meaningful patient outcomes and may reflect changes in coding practices.
Infect. Control Hosp. Epidemiol. 2015;36(8):871–877
Policymakers may wish to align healthcare payment and quality of care while minimizing unintended consequences, particularly for safety net hospitals.
To determine whether the 2008 Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy had a differential impact on targeted healthcare-associated infection rates in safety net compared with non–safety net hospitals.
Interrupted time-series design.
SETTING AND PARTICIPANTS
Nonfederal acute care hospitals that reported central line–associated bloodstream infection and ventilator-associated pneumonia rates to the Centers for Disease Control and Prevention’s National Health Safety Network from July 1, 2007, through December 31, 2013.
We did not observe changes in the slope of targeted infection rates in the postpolicy period compared with the prepolicy period for either safety net (postpolicy vs prepolicy ratio, 0.96 [95% CI, 0.84–1.09]) or non–safety net (0.99 [0.90–1.10]) hospitals. Controlling for prepolicy secular trends, we did not detect differences in an immediate change at the time of the policy between safety net and non–safety net hospitals (P for 2-way interaction, .87).
The Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy did not have an impact, either positive or negative, on already declining rates of central line–associated bloodstream infection in safety net or non–safety net hospitals. Continued evaluations of the broad impact of payment policies on safety net hospitals will remain important as the use of financial incentives and penalties continues to expand in the United States.
Limited studies exist regarding whether incorporating micronutrient supplements during tuberculosis (TB) treatment may improve cell-mediated immune response. We examined the effect of micronutrient supplementation on lymphocyte proliferation response to mycobacteria or T-cell mitogens in a randomized trial conducted on 423 patients with pulmonary TB. Eligible participants were randomly assigned to receive a daily dose of micronutrients (vitamins A, B-complex, C, E, and selenium) or placebo at the time of initiation of TB treatment. We found no overall effect of micronutrient supplements on lymphocyte proliferative responses to phytohaemagglutinin or purified protein derivatives in HIV-negative and HIV-positive TB patients. Of HIV-negative TB patients, the micronutrient group tended to show higher proliferative responses to concanavalin A than the placebo group, although the clinical relevance of this finding is not readily notable. The role of nutritional intervention in this vulnerable population remains an important area of future research.
Monitor of All-sky X-ray Image (MAXI) on board International Space Station is capable of
observing gamma-ray bursts (GRBs) and sending notices of GRBs or other transient events,
using real time connection to the ground. MAXI observed 32 GRBs or short X-ray transients
as of the end of September 2012. Among them, eleven events were simultaneously detected by
other satellites. The observed rate of the MAXI GRBs is about one event per month. This
rate is comparable to a past observation with larger effective area and larger field of
view. The fact indicates that MAXI has better sensitivity to observe GRBs because of low
background. The distribution of the spectral hardness of MAXI GRBs is similar to the
results of a past instrument, which is sensitive to similar energy range.
Large-eddy simulation (LES) is utilized to investigate flow physics and lower-fidelity modelling assumptions in the simulation of an oblique shock impinging on a supersonic turbulent boundary layer (OSTBLI). A database of LES solutions is presented, covering a range of shock strengths and Reynolds numbers, that is utilized as a surrogate-truth model to explore three topics. First, detailed conservation budgets are extracted within the framework of parametric investigation to identify trends that might be used to mitigate statistical (aleatory) uncertainties in inflow conditions. It is found, for instance, that an increase in Reynolds number does not significantly affect length of separation. Additionally, it is found that variation in the shock-generating wedge angle has the effect of increasing the intensity of low-frequency oscillations and moving these motions towards longer time scales, even when scaled by interaction length. Next, utilizing the LES database, a detailed analysis is performed of several existing models describing the low-frequency unsteady motion of the OSTBLI system. Most significantly, it is observed that the length scale of streamwise coherent structures appears to be dependent on Reynolds number, and at the Reynolds number of the present simulations, these structures do not exist on time scales long enough to be the primary cause of low-frequency unsteadiness. Finally, modelling errors associated with turbulence closures using eddy-viscosity and stress-transport-based Reynolds-averaged Navier–Stokes (RANS) simulations are investigated. It is found that while the stress-transport models offer improved predictions, inadequacies in modelling the turbulence transport terms and the isotropic treatment of the dissipation is seen to limit their accuracy.
We have measured the complex dielectric function of BizSr2Ca1Cu2Ox samples in the near infrared region directly by spectroellipsometry. As for both single crystal and thin film, superconducting samples have a zero point in the real part (ε1) of the complex dielectric function (ε*) and a clear peak of the imaginary part of the inverse ε* at almost the same frequency. On the other hand, non-superconducting samples have no such ei zero point, and the peak height of (-Im(1/ε*)) becomes small. Then we can determine the superconductivity of samples by this spectroellipsometry measurement at room temperature.
Synthesis of diamond thin-films has been tried by an ArF excimer laser-induced chemical vapor deposition (LCVD) technique, using acetylene diluted with hydrogen as a source gas and a silicon wafer as a substrate. In these experiments, irradiation geometry, substrate temperature and laser power density were varied. Upon irradiation by a focused laser beam, deposition of diamond on substrates heated above 400°Cwas observed, and was confirmed by reflection electron diffraction (RED) photographs. Homogeneity of the diamond films was improved by irradiation parallel to the substrate. These facts suggest that the formation of diamond proceeds through multiple photon decomposition of the reactant gas, and that electronic excitation of gas phase rather than that of substrate or adsorbate layer is essential to form diamond.
High-resolution and “environmental cell” microscopy were applied for surveying the reaction of hydrides in Vanadium and Magnesium based alloys, which are candidate for hydrogen storage materials of advanced hydrogen energy systems. For clarify the hydrogenation process, in-situ experiment was carried out by using 200 kV TEM equipped with a newly developed environmental cell, which is enable to observe transmitted image and electron-diffraction under gas reaction under hydrogen environment of 0.1 MPa at room temperature. In case of Vanadium, bending fringe was created under hydrogen-gas of 0.1 MPa, which means that hydrogen reaction is not so quick in this case, and the local stress due to the hydrogen solution caused the fringes. In case of Magnesium, the gas reacted with the powders and showed the swelling, where the surface steps with several ten nm become to more straight, and also SADP showed the formation of MgH2. In-situ experiment for hydrogenation reaction by using the environmental cell has started recently, therefore the precise studies will be continued, as well as its improvement, especially in the transparence films.
We have formed PbTIO thin films on SrTiO3 substrate (100) at low temperature of 350°C using an ArF excimer laser ablation technique. Until now, the PbTiO3 films have not been formed at the temperature lower than 500°C using other thin film techniques. The Important points In the present study are the laser excitation of the substrate during the film growth and the lattice matching between the film and the substrate. The film deposited on the SrTiO3 substrate, shows preferential orientation of the c-axis perpendicular to the substrate surface.