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Summary Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric procedure. To study the safety of LSG done with Nissen Fundoplication (NF) in patients affected by obesity and GERD and assess the complication rate. A retrospective cohort study using the Nationwide Readmissions Database from 2016 to 2019. A total of 236111 patients underwent LSG with and without NF. A matched cohort of 1096 without NF and 548 with NF was obtained. The median age of patients was 47 years old. Median length of hospital stay was higher in the LSG with NF group. Median total charge was higher in the LSG with NF group. There was no statistically significant difference in 30‐day readmission rates in patients with obesity and GERD who received LSG with NF compared to those who received LSG alone. Complications after both procedures were low, which highlights the safety of both procedures. [ABSTRACT FROM AUTHOR]

AimsThe safety and feasibility of combining percutaneous catheter ablation (CA) for atrial fibrillation with left atrial appendage occlusion (LAAO) as a single procedure in the USA have not been investigated. We analyzed the US National Readmission Database (NRD) to investigate the incidence of combined LAAO + CA and compare major adverse cardiovascular events (MACEs) with matched LAAO-only and CA-only patients.Methods and resultsIn this retrospective study from NRD data, we identified patients undergoing combined LAAO and CA procedures on the same day in the USA from 2016 to 2019. A 1:1 propensity score match was performed to identify patients undergoing LAAO-only and CA-only procedures. The number of LAAO + CA procedures increased from 28 (2016) to 119 (2019). LAAO + CA patients (n = 375, mean age 74 ± 9.2 years, 53.4% were males) had non-significant higher MACE (8.1%) when compared with LAAO-only (n = 407, 5.3%) or CA-only patients (n = 406, 7.4%), which was primarily driven by higher rate of pericardial effusion (4.3%). All-cause 30-day readmission rates among LAAO + CA patients (10.7%) were similar when compared with LAAO-only (12.7%) or CA-only (17.5%) patients. The most frequent primary reason for readmissions among LAAO + CA and LAAO-only cohorts was heart failure (24.6 and 31.5%, respectively), while among the CA-only cohort, it was paroxysmal atrial fibrillation (25.7%).ConclusionWe report an 63% annual growth (from 28 procedures) in combined LAAO and CA procedures in the USA. There were no significant difference in MACE and all-cause 30-day readmission rates among LAAO + CA patients compared with matched LAAO-only or CA-only patients.

Abstract Background People with human immunodeficiency virus have an increased risk of developing AIDS-defining malignancies including Burkitt lymphoma. Survival outcomes in HIV-associated Burkitt lymphoma remain worse than non-HIV-associated Burkitt lymphoma, despite widespread implementation of antiretroviral therapy. We aimed to determine the association between HIV status and risk for 30-day and 90-day readmission in the US after index hospitalization for Burkitt lymphoma. Methods Data were abstracted from the 2010–2020 Nationwide Readmissions Database; hospitalizations included patients with a primary BL diagnosis and were stratified by comorbid HIV. The primary outcome was all-cause readmission (30-day and 90-day). Secondary outcomes were in-hospital mortality, length of stay (LOS), and hospital cost. Between-HIV differences were evaluated via logistic and log-normal regression; multivariable models adjusted for comorbid kidney disease, hypertension, fluid and electrolyte disorders, and sepsis. Results Overall, there were 8,453 hospitalizations for BL and 6.0% carried an HIV diagnosis. Of BL hospitalizations, 68.4% were readmitted within 30-days post index BL hospitalization and 6.8% carried a HIV diagnosis. HIV-associated BL was associated with 43% higher adjusted odds of 30-day readmission (aOR 95% CI: 4% higher to 97% higher, p = 0.026). For 90-day readmission, 76.0% of BL patients were readmitted and 7.0% carried a HIV diagnosis. HIV-associated BL was not statistically associated with all-cause 90-day readmission (aOR 1.46, aOR 95% CI: 0% higher to 115% higher, p = 0.053). Conclusions HIV-positive status is associated with an increased risk for 30-day readmission after index hospitalization for Burkitt lymphoma.

Background: People with human immunodeficiency virus have an increased risk of developing AIDS-defining malignancies including Burkitt lymphoma. Survival outcomes in HIV-associated Burkitt lymphoma remain worse than non-HIV-associated Burkitt lymphoma, despite widespread implementation of antiretroviral therapy. We aimed to determine the association between HIV status and risk for 30-day and 90-day readmission in the US after index hospitalization for Burkitt lymphoma. Methods: Data were abstracted from the 2010–2020 Nationwide Readmissions Database; hospitalizations included patients with a primary BL diagnosis and were stratified by comorbid HIV. The primary outcome was all-cause readmission (30-day and 90-day). Secondary outcomes were in-hospital mortality, length of stay (LOS), and hospital cost. Between-HIV differences were evaluated via logistic and log-normal regression; multivariable models adjusted for comorbid kidney disease, hypertension, fluid and electrolyte disorders, and sepsis. Results: Overall, there were 8,453 hospitalizations for BL and 6.0% carried an HIV diagnosis. Of BL hospitalizations, 68.4% were readmitted within 30-days post index BL hospitalization and 6.8% carried a HIV diagnosis. HIV-associated BL was associated with 43% higher adjusted odds of 30-day readmission (aOR 95% CI: 4% higher to 97% higher, p = 0.026). For 90-day readmission, 76.0% of BL patients were readmitted and 7.0% carried a HIV diagnosis. HIV-associated BL was not statistically associated with all-cause 90-day readmission (aOR 1.46, aOR 95% CI: 0% higher to 115% higher, p = 0.053). Conclusions: HIV-positive status is associated with an increased risk for 30-day readmission after index hospitalization for Burkitt lymphoma. [ABSTRACT FROM AUTHOR]

BackgroundThe burden of amyloidosis among hospitalized patients is increasing over time. However, amyloidosis remains an underdiagnosed cause of heart failure (HF) hospitalization among older adults.ObjectivesWe investigated the prevalence and prognostic implications of amyloidosis among patients hospitalized with HF.MethodsAll hospitalizations for primary diagnosis of HF between January 1, 2010, and August 31, 2015, identified in the Nationwide Readmissions Database were categorized into those with and without a secondary diagnosis of amyloidosis. HF hospitalizations with amyloidosis were then matched in a 3:1 fashion to HF hospitalizations without amyloidosis using the year of admission, discharge quarter, age, sex, and Charlson comorbidity index. Primary outcomes were inpatient mortality and 30-day readmission. Multivariable logistic regression was used to estimate the association between HF with amyloidosis and clinical outcomes.ResultsOf 1,593,360 HF hospitalizations that met inclusion criteria, 2,846 (0.18%) had HF with a secondary diagnosis of amyloidosis and were matched to 8,515 hospitalizations for HF without amyloidosis. Hospitalizations for HF with amyloidosis were associated with higher prevalence of kidney disease (56% vs. 45%), malignancy (20% vs. 4%), and higher inpatient mortality (6% vs. 3%) as compared with HF without amyloidosis. In adjusted analyses, HF with amyloidosis was associated with higher odds of in-hospital mortality (odds ratio: 1.46; 95% confidence interval [CI]: 1.17 to 1.82), 30-day readmission (odds ratio: 1.17; 95% CI: 1.05 to 1.31), and longer mean length of stay (least-squares mean difference: 1.46; 95% CI: 1.12 to 1.80).ConclusionsIn patients hospitalized with decompensated HF, presence of amyloidosis was associated with higher risk of inpatient mortality and 30-day readmission.

BETWEEN CONDEMNATION AND (N)OSTALGIA: ON THE POLITISATION OF THE LEGACY OF GDR IN REUNIFIED GERMANY Reunified Germany emerged on the map of Europe in 1990. At first, settling an account with the communist Germany proceeded in a simplified way – everything about them seemed evil. Over time, this judgement became less biased and more comprehensive. At the beginning of the 21st century, the “trend for the East”, which was called Ostalgie, prevailed. From that point forward, dealing with their past balances between a sentimental journey to the time of the German Democratic Republic and a harsh assessment of that reality. Until this day, modern Germany constitutes two unequal parts, as the polls confirm. They continue to be divided by a mental barrier — an invisible ‘wall in people’s heads’, and many residents of the new lands still feel foreign in their own country. Their dissatisfaction is consciously and effectively exploited by the populist Alternative for Germany party. How the East German heritage becomes an instrument of political influence is the leading question of this article. The sources, mainly German, consist primarily of subject literature, documents, statistical reports and analysis of public opinion research centres, as well as comments of experts and press.

Reunified Germany emerged on the map of Europe in 1990. At first, settling an account with the communist Germany proceeded in a simplified way – everything about them seemed evil. Over time, this judgement became less biased and more comprehensive. At the beginning of the 21st century, the “trend for the East”, which was called Ostalgie, prevailed. From that point forward, dealing with their past balances between a sentimental journey to the time of the German Democratic Republic and a harsh assessment of that reality. Until this day, modern Germany constitutes two unequal parts, as the polls confirm. They continue to be divided by a mental barrier — an invisible ‘wall in people’s heads’, and many residents of the new lands still feel foreign in their own country. Their dissatisfaction is consciously and effectively exploited by the populist Alternative for Germany party. How the East German heritage becomes an instrument of political influence is the leading question of this article. The sources, mainly German, consist primarily of subject literature, documents, statistical reports and analysis of public opinion research centres, as well as comments of experts and press. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study. Objectives: Spinal epidural abscess (SEA) is a rare but potentially life-threatening infection treated with antimicrobials and, in most cases, immediate surgical decompression. Previous studies comparing medical and surgical management of SEA are low powered and limited to a single institution. As such, the present study compares readmission in surgical and non-surgical management using a large national dataset. Methods: We identified all hospital admissions for SEA using the Nationwide Readmissions Database (NRD), which is the largest collection of hospital admissions data. Patients were grouped into surgically and non-surgically managed cohorts using ICD-10 coding and compared using information retrieved from the NRD such as demographics, comorbidities, length of stay and cost of admission. Results: We identified 350 surgically managed and 350 non-surgically managed patients. The 90-day readmission rates for surgical and non-surgical management were 26.0% and 35.1%, respectively (P <.05). Expectedly, surgical management was associated with a significantly higher charge and length of stay at index hospital admission. Surgically managed patients had a significantly lower risk of readmission for osteomyelitis (P <.05). Finally, in patients with a low comorbidity burden, we observed a significantly lower 90-day readmission rate for surgically managed patients (surgical: 23.0%, non-surgical: 33.8%, P <.05). Conclusion: In patients with a low comorbidity burden, we observed a significantly lower readmission rate for surgically managed patients than non-surgically managed patients. The results of this study suggest a lower readmission rate as an advantage to surgical management of SEA and emphasize the importance of SEA as a not-to-miss diagnosis. [ABSTRACT FROM AUTHOR]

Background: Longitudinal data on the trends in systemic lupus erythematous (SLE) readmissions are limited. We aimed to study trends in 30-day readmissions of patients admitted for SLE flares and all SLE hospitalizations in the USA from 2010 to 2018. Materials and methods: Data were obtained from the nationwide readmission database (NRD). We performed a retrospective 9-year longitudinal trend analysis using the 2010–2018 NRD databases. We searched for index hospitalizations of adult patients diagnosed with SLE using the International Classification of Diseases (ICD) codes. Elective and traumatic readmissions were excluded from the study. Multivariable logistic and linear regression analyses were used to calculate the adjusted p value trend for categorical and continuous outcomes, respectively. Results: The 30-day readmissions following index admissions of all SLE patients and for SLE flares decreased from 15.6% in 2010 to 13.3% in 2018 (adjusted p trend < 0.0001), and 20.3% in 2010 to 17.6% in 2018 (adjusted p trend = 0.009) respectively. Following SLE-flare admissions, hospital length of stay (LOS) decreased from 6.7 to 6 days (adjusted p trend = 0.045), while the proportion with a Charlson comorbidity index (CCI) score ≥ 3 increased from 42.2 to 54.4% (adjusted p trend < 0.0001) during the study period. SLE and its organ involvement, sepsis, and infections were common reasons for 30-day readmissions. Conclusion: About 1 in 5 SLE-flare admissions resulted in a 30-day readmission. The 30-day readmissions following index hospitalization for SLE flares and all SLE hospitalizations have decreased in the last decade. Although the readmission LOS was reduced, the CCI score increased over time. Key Points • The 30-day readmissions following index hospitalization for SLE flares and all SLE hospitalizations have reduced in the last decade although the CCI score increased over time. • SLE, its organ involvement, and infections are common reasons for readmission. • Infection control strategies, optimal management of SLE and its complications, and emphasis on an ideal transition of care are essential in reducing SLE readmissions. [ABSTRACT FROM AUTHOR]

This article presents a study and comparison of the plasmonic non-radiating dielectric (NRD) waveguide and slot waveguide simulations, which includes the reproduction and comparison of the reported results in previous literature. These simulated results help us understand the different solver and their settings for such high-frequency applications. Also, it cross-verify the concepts related to this colorful field. Most of the related articles reproduced in this article are either fabricated or based on pure simulations. They discuss or examine the properties such as dispersion curves, propagation length along with the slot, propagation loss, and electric field magnitude or intensity plot SPP propagation. [ABSTRACT FROM AUTHOR]

Abstract Background The Hospital Readmissions Reduction Program (HRRP) was introduced to reduce readmission rates among Medicare beneficiaries, however little is known about readmissions and costs for HRRP-targeted conditions in younger populations. The primary objective of this study was to examine readmission trends and costs for targeted conditions during policy implementation among younger and older adults in the U.S. Methods We analyzed the Nationwide Readmission Database from January 2010 to September 2015 in younger (18–64 years) and older (≥65 years) patients with acute myocardial infarction (AMI), heart failure (HF), pneumonia, and acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Pre- and post-HRRP periods were defined based on implementation of the policy for each condition. Readmission rates were evaluated using an interrupted time series with difference-in-difference analyses and hospital cost differences between early and late readmissions (≤30 vs. > 30 days) were evaluated using generalized linear models. Results Overall, this study included 16,884,612 hospitalizations with 3,337,266 readmissions among all age groups and 5,977,177 hospitalizations with 1,104,940 readmissions in those aged 18–64 years. Readmission rates decreased in all conditions. In the HRRP announcement period, readmissions declined significantly for those aged 40–64 years for AMI (p

Z filmów wytwórni Defa autor wywodzi hipotezę reglamentowanego multikulturalizmu kina NRD. Wskazuje na dyskursy multikulturowe w filmach na temat dalszej i bliższej historii: wielokulturowego pogranicza Prus Zachodnich w końcu XIX w. (Młyn Lewina, reż. Horst Seemann, 1980) czy konfrontacji kultury pruskiej i urugwajskiej na przełomie XVIII i XIX w. (Zdobywanie Chimborazo, reż. Rainer Simon, 1989). Podejmuje kwestię konfrontacji kultury NRD-owskiej i polskiej (Klucze, reż. Egon Günther, 1972/1974; Przez siedem mostów musisz przejść, reż. Hans Werner, 1978). Proponuje namysł nad propagandowym lokowaniem wizerunków Angeli Davis i Deana Reeda w dwóch filmach związanych z X Światowym Festiwalem Młodzieży i Studentów w Berlinie w sierpniu 1973 r. Główny akcent zostaje zaś położony na filmy tematyzujące emigrację polityczną z Ameryki Południowej (Kwiecień ma 30 dni, reż. Gunther Scholz, 1979; Izabela na schodach, reż. Hannelore Unterberg, 1984; Blond Tango, reż. Lothar Warneke, 1986).

Background: There is a paucity of data on readmission rates and predictors of readmissions in cardiogenic shock patients after contemporary Extracorporeal Membrane Oxygenation (ECMO) use. Methods: Using the Nationwide Readmission Database, we included adult patients (≥18 years old) hospitalized between January to November 2016–2018 for cardiogenic shock requiring ECMO support. Thirty-day readmission rates, associated variables, and predictors of readmission were assessed. Results: A total of 10,723 patients underwent ECMO for cardiogenic shock. After excluding patients who died (n = 5602; 52%) and who underwent LVAD or OHT during index admission (n = 892; 8%), 4229 patients discharged alive were included. Of those, 694 (16.4%) were readmitted within 30 days. The median time to readmission was 10 days. Diabetes mellitus (OR = 1.77; 95% CI 1.32–2.37), chronic liver disease (OR = 1.35; 95% CI 1.03–1.77), and prolonged LOS (≥30 days; OR = 1.38; 95% CI 1.05–1.81) were associated with increased risk of 30-day readmissions while heart failure diagnosis (OR = 0.69; 95% CI 0.50–0.95) and short-term hospital post-discharge care (OR = 0.53; 95% CI 0.28–0.99) conferred a lower risk. Sepsis, followed by congestive heart failure, was the most common readmission diagnoses. Conclusions: Patients with CS requiring ECMO support have high mortality and high 30-day readmission rates, with sepsis being the leading cause of readmissions followed by heart failure.

As early as August 1980, the GDR authorities were monitoring their communist allies in Poland to see if there were any plans to suppress the ongoing strikes and later to pacify the Independent Self-Governing Trade Union “Solidarność”. Reports on this topic were provided by the Ministry for State Security (Stasi), military intelligence and the embassy in Warsaw, among others. Initially, such information was coming in only sporadically. With time – and especially since September 1981 – more regularly and more in-depth. Specific undertakings were reported: prepared lists of arrests, plans for a military takeover of the mass media and the dissolution of all political parties. Still, these signals were underestimated by the East German analysts. They ignored General Wojciech Jaruzelski’s growing readiness to confront the opposition and preferred to trust these voices in the Polish United Workers’ Party that expressed doubts about the ability of the First Secretary to use force. [ABSTRACT FROM AUTHOR]

Copyright of Wortfolge. Szyk Słów is the property of Wydawnictwo Uniwersytetu Slaskiego and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Readmission for achalasia treatment is associated with significant morbidity and cost. Factors predictive of readmission would be useful in identifying patients at risk. Methods: We performed a retrospective study using the Nationwide Readmission Database for the year 2016 and 2017. We collected data on hospital readmissions of 17,848 adults who were hospitalized for achalasia and discharged. The 30-day readmission rate as well as the primary cause, mortality rate, in-hospital adverse events, and total hospitalization charges were examined. A cox multivariate regression model was used to identify independent risk factors for 30-day readmission, including the surgical or endoscopic treatment used during the index admission. Results: From 2016 to 2017, the 30-day readmission rate for index admission with achalasia was 15.2%. Of these 15.2%, 34% were readmitted with persistent symptoms of achalasia or treatment-related complications. Older age, higher comorbidity index, possessing private insurance, and those with either pneumatic balloon dilation or no endoscopic/surgical treatment showed higher odds of readmission on multivariate analysis. Those treated with laparoscopic Heller myotomy (LHM) or peroral endoscopic myotomy (POEM) showed lower odds of readmission. There was no difference in rates of readmission between those undergoing POEM or LHM, but mortality rate for readmission was significantly higher for the LHM group. The in-hospital mortality rate and length of stay were significantly higher for readmissions (p < 0.01) than the index admissions. Conclusion: Three in 20 patients admitted with achalasia are likely to be readmitted within 30 days of their initial hospitalization, a number which can be higher in untreated patients and in those with multiple comorbidities. Rehospitalizations bear a higher mortality rate than the initial admission and present a burden to the healthcare system. [ABSTRACT FROM AUTHOR]

Objective: Our study aimed to determine the national estimates of the 30-day all-cause readmission rate among patients with spontaneous pneumothorax and to investigate the burden of these readmissions in terms of mortality, length of stay and hospitalization costs in the USA. Methods: We utilized the Nationwide Readmission Database for 2013–2014 and identified adults with a primary diagnosis of spontaneous pneumothorax. We analyzed and reported patient- and hospital-level variables of the study cohort. Our primary outcome was 30-day readmission rate, including the reasons for readmission. Our secondary outcomes included all-cause mortality, resources utilization and predictors of readmissions. Results: We identified 47,108 index admissions with spontaneous pneumothorax. The 30-day readmission rate was 13.6%. The most common reason for admission was recurrent pneumothorax. In index admissions, the in-hospital mortality rate was 3.1%; whereas, in readmissions, the mortality was higher (4.6%, p < 0.001). Both age group 45–64 (HR: 1.31, 95% CI: [1.15–1.49], p < 0.001) and history of cancer (HR: 1.34, 95% CI: [1.17–1.53], p < 0.001) were found to predict the risk of 30-day readmission. Conclusion: The 30-day readmission rate in patients with spontaneous pneumothorax was 13.6%, and a recurrent event was the most likely cause. The 30-day readmissions were associated with higher mortality and hospitalization charges. Middle age and history of cancer increase likelihood of 30-day readmission.

The mobility of contaminants from mine waste can be assessed using different extraction methods. Aqua regia (AR) extraction is the most commonly used method in Finland. Another method is the analysis of leachate from net acid generation (NAG) tests, which is primarily designed for acid production potential assessment. We investigated the performance of single-addition NAG test leachate analysis and AR extraction in drainage quality prediction, using waste rock and drainage water samples from several Finnish waste rock sites. Our objective was to improve interpretation of the AR and single-addition NAG test leachate analysis results in drainage quality prediction. The AR extraction effectively reflected elements that occurred in elevated concentrations in drainage water, though it over-predicted Al, As, Cd, Co, Cu, and Ni in some circumneutral drainages, and Cr in general. The single-addition NAG test leachate analysis also performed well in assessing the mobility of contaminants including Al and Cr at acid mine drainage sites. As the contaminants tend to precipitate in neutral NAG test solution, the usability of the method in neutral mine drainage cases should be further investigated. Furthermore, the conclusions presented in this study are limited to waste rock samples collected from the surface of piles; future work will examine waste rock history, dump cores, drainage quality changes, etc. in more detail. [ABSTRACT FROM AUTHOR]

Background and Aim: The impact of household income, a surrogate of socioeconomic status, on hospital readmission rates for patients with decompensated cirrhosis has not been well characterized. Methods: The Nationwide Readmission Database from 2012 to 2014 was used to study the association of lower median household income on 30‐, 90‐, and 180‐day hospital readmission rates for patients with decompensated cirrhosis. Results: From the 42 679 001 hospital admissions contained in the sample, there were 82 598 patients with decompensated cirrhosis who survived a hospital admission in the first 6 months of the year. During a uniform 6‐month follow‐up period, 25 914 (31.4%), 39 928 (48.3%), and 47 496 (57.5%) patients were readmitted at 30, 90, and 180 days, respectively. After controlling for demographic and clinical confounders, patients residing in the three lowest income quartiles were significantly more likely to be readmitted at 30 days than those in the fourth quartile (first quartile, odds ratio [OR] 1.32 [95% confidence interval, CI, 1.17–1.47, P < 0.01]; second quartile, OR 1.25 [95% CI 1.13–1.38, P < 0.01]; and third quartile, OR 1.08 [95% CI 0.97–1.20, P = 0.07]). The association between lower socioeconomic status and the higher risk of readmissions persisted at 90 days (first quartile, OR 1.21 [95% CI 1.14–1.30, P < 0.01]) and 180 days (first quartile, OR 1.32 [95% CI 1.20–1.44, P < 0.01]). Conclusion: Patients with decompensated cirrhosis residing in the lowest income quartile had a 32% higher odds of hospital readmissions at 30, 90, and 180 days compared with those in the highest income quartile. [ABSTRACT FROM AUTHOR]

Unplanned rehospitalization is considered an adverse quality of care indicator. Minimally invasive operations carry the potential to reduce resource use while enhancing recovery. Robotic-assisted pancreaticoduodenectomy (RAPD) has been used to improve outcomes of its morbid open counterpart. We sought to identify factors associated with readmission between RAPD and open pancreaticoduodenectomy (OPD). We used the 2010-17 National Readmissions Database to identify adults who underwent RAPD or OPD. The primary outcome was 30-day readmission. Secondary outcomes included readmission diagnosis: index, readmission, and total (index + readmission) length of stay, costs, and mortality. Of an estimated 84,036 patients undergoing pancreaticoduodenectomy, 96.9% survived index hospitalization. Frequency of both RAPD and OPD increased during the study period with similar mortality (2.5% versus 3.2%, P = 0.46). Compared with OPD , RAPD was not an independent predictor of 30-day readmission (adjusted odds ratio (AOR): 1.0, P = 0.98). Disposition with home health care (AOR: 1.1, P < 0.001) or to a skilled nursing facility (AOR: 1.5, P < 0.001) was significantly associated with increased 30-day readmission. Readmission after pancreaticoduodenectomy is common, regardless of surgical approach. Although RAPD saves in-patient days on index admission, readmission rates and length of stay are similar between the two modalities. Neither RAPD nor OPD is a risk factor for readmission, highlighting the complexity of pancreaticoduodenectomy, with complications that may result from factors independent of the operative approach. [ABSTRACT FROM AUTHOR]

Background: The data on readmissions following tricuspid valve repair/replacement (TVR) are scarce. We examined rates, predictors, causes, and outcomes of readmissions after TVR, using the National Readmission Database.Methods: The International Classification of Diseases-9th version was used to identify the patients who underwent isolated TVR or concomitant aortic, mitral, and coronary bypass surgeries. Rates, causes, and outcomes were assessed using the analysis of variance and the χ2 test, and predictors of readmissions were evaluated using multivariate analysis.Results: A total of 8254 patients who underwent TVR during 2013 to 2014 were included, of whom 1994 (24.16%) were isolated, and 6260 (75.84%) were performed concomitantly with other heart valve or coronary bypass surgery. A total of 1720 (20.84%) patients were readmitted within 30 days. The readmission rates were 448 (22.46%) after isolated TVR and similar after concomitant TVR (TVR + aortic valve replacement, TVR + mitral valve repair, TVR + coronary artery bypass graft, and TVR + multiple) (P = .194); whereas 1305 (20.11%) and 414 (23.45%) were after tricuspid valve repair and replacement (P = .080), respectively. The independent predictors of readmission were acute kidney injury during index visit and Charlson comorbidity index of more than 2. Mean time to readmission and median length of stay during readmission were 13.02 (±7.93) and 5 (interquartile range: 3-9) days, respectively. Total mortality during rehospitalization was 105 (6.1%), a very high (26.86%) number of patients were discharged to skilled facilities after readmission.Conclusions: One out of five patients were readmitted within 30 days after the TVR, associated with 6.1% mortality during rehospitalization, and very high need for skilled facility placement. [ABSTRACT FROM AUTHOR]

Copyright of Acta Universitatis Lodziensis. Folia Litteraria Polonica is the property of Wydawnictwo Uniwersytetu Lodzkiego and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Study Design: Retrospective cohort study of the 2012 to 2014 Healthcare Cost and Utilization Project Nationwide Readmissions Database.Objective: To identify risk factors for 30- and 90-day readmission due to fluid and electrolyte disorders following posterior lumbar fusion.Summary Of Background Data: Thirty- and 90-day readmission rates are important quality and outcome measures for hospitals and physicians. These measures have been tied to financial penalties for abnormally high rates of readmission. Furthermore, complex and high cost surgeries have been increasingly reimbursed in the form of bundled disease resource group payments, where any treatment within 90-day postdischarge is covered within the original bundled payment scheme.Methods: A total of 65,121 patients in the Healthcare Cost and Utilization Project Nationwide Readmissions Database met our inclusion criteria, of which 1128 patients (1.7%) were readmitted within 30 days, and 1669 patients (2.6%) were readmitted within 90 days due to fluid and electrolyte abnormalities. A bivariate analysis was performed to compare baseline characteristics between patients readmitted with fluid and electrolyte disorders and the remainder of the cohort. A multivariate regression analysis was then performed to identify independent risk factors for readmission due to fluid and electrolyte disorders at 30 and 90 days.Results: The strongest independent predictors of 30-day readmissions were age ≥80 years, age 65 to 79 years, age 55 to 64 years, liver disease, and drug use disorder. The five strongest predictors of 90-day readmissions were age ≥80 years, age 65 to 79 years, age 55 to 64 years, liver disease, and fluid and electrolyte disorders.Conclusion: Patients with baseline liver disease, previously diagnosed fluid and electrolyte disorders, age older than 55 years, or drug use disorders are at higher risk for readmissions with fluid and electrolyte disorders following posterior lumbar fusion. Close monitoring of fluid and electrolyte balance in the perioperative period is essential to decrease complications and reduce unplanned readmissions.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the incidence, causes, risk factors, and costs associated with 30-day readmissions in parotidectomy patients utilizing the Nationwide Readmissions Database (NRD).Study Design: Retrospective cohort study.Methods: We examined the NRD for patients who underwent parotidectomy between 2010 and 2014. Rates, causes, and costs of 30-day readmissions were determined. Multivariate logistic regression was used to identify risk factors for readmission.Results: Among 15,102 included patients, 594 (3.9%) were readmitted within 30 days. The average cost per readmission was $12,502. Infectious (22.7%) and wound (11.2%) complications were the two most common causes of readmission. After controlling for other covariates, significant predictors of readmission included advanced comorbidity (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.09-2.37), a malignant parotid tumor (OR, 2.37; 95% CI, 1.63-3.43), length of stay ≥2 days (OR, 1.54; 95% CI, 1.09-2.18), and nonroutine discharge destinations (home with care [OR, 1.88; 95% CI, 1.27-2.78] and nursing facility [OR, 2.69; 95% CI, 1.55-4.67]).Conclusion: In this nationwide database analysis, we found that nearly 4% of all patients undergoing parotidectomy are readmitted within 30 days. Readmissions are commonly due to infections and wound complications. Quality improvement proposals targeting avoidable readmissions should focus on early recognition and prevention of infection and wound complications. Risk factors contributing to readmission include advanced comorbidity, malignant parotid tumor, prolonged index hospitalization, and nonroutine discharge destinations.Level Of Evidence: NA Laryngoscope, 130:1212-1217, 2020. [ABSTRACT FROM AUTHOR]

The most crucial function of lowland-confined floodplains with low slopes is to support flood conveyance and fasten floods; however, obstacles can hinder it. The management of riparian vegetation is often neglected, though woody species increase the vegetation roughness of floodplains and increase flood levels. The aims are (1) to determine the branch density of various riparian vegetation types in the flood conveyance zone up to the level of artificial levees (up to 5 m), and (2) to assess the spatial distribution of densely vegetated patches. Applying a decision tree and machine learning, six vegetation types were identified with an accuracy of 83%. The vegetation density was determined within each type by applying the normalized relative point density (NRD) method. Besides, vegetation density was calculated in each submerged vegetation zone (1–2 m, 2–3 m, etc.). Thus, the obstacles for floods with various frequencies were mapped. In the study area, young poplar plantations offer the most favorable flood conveyance conditions, whereas invasive Amorpha thickets and the dense stands of native willow forests provide the worst conditions for flood conveyance. Dense and very dense vegetation patches are common in all submerged vegetation zones; thus, vegetation could heavily influence floods.

The article focuses on the material culture of the German Democratic Republic (GDR) as portrayed in selected German films made after 1990 and set in the GDR. The objects that are used in the films serve as a special kind of artefacts, symbolizing the reality of the GDR and defining it as imperfect, below expectations, and inefficient in meeting consumer demand. An important point of reference in the article is the context of post-communist nostalgia, which is a source of interesting symbolic redefinitions. [ABSTRACT FROM AUTHOR]

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The opioid epidemic in the United States has been on the rise. Acute exacerbations of chronic pancreatitis (AECP) patients are at higher risk for Opioid Use Disorder (OUD). Evidence on OUD's impact on healthcare utilization, especially hospital re-admissions is scarce. We measured the impact of OUD on 30-day readmissions, in patients admitted with AECP from 2010 to 2014. This is a retrospective cohort study which included patients with concurrently documented CP and acute pancreatitis as first two diagnoses, from the National Readmissions Database (NRD). Pancreatic cancer patients and those who left against medical advice were excluded. We compared the 30-day readmission risk between OUD-vs.-non-OUD, while adjusting for other confounders, using multivariable exact-matched [(EM); 18 confounders; n = 28,389] and non-EM regression/time-to-event analyses. 189,585 patients were identified. 6589 (3.5%) had OUD. Mean age was 48.7 years and 57.5% were men. Length-of-stay (4.4 vs 3.9 days) and mean index hospitalization costs ($10,251 vs. $9174) were significantly higher in OUD-compared to non-OUD-patients (p < 0.001). The overall mean 30-day readmission rate was 27.3% (n = 51,806; 35.3% in OUD vs. 27.0% in non-OUD; p < 0.001). OUD patients were 25% more likely to be re-admitted during a 30-day period (EM-HR: 1.25; 95%CI: 1.16–1.36; p < 0.001), Majority of readmissions were pancreas-related (60%), especially AP. OUD cases' aggregate readmissions costs were $23.3 ± 1.5 million USD (n = 2289). OUD contributes significantly to increased readmission risk in patients with AECP, with significant downstream healthcare costs. Measures against OUD in these patients, such as alternative pain-control therapies, may potentially alleviate such increase in health-care resource utilization. [ABSTRACT FROM AUTHOR]

Hospital readmissions with 30 days after vascular surgical interventions have been associated with increased morbidity, mortality, and cost. Readmission rates, now a Centers for Medicare and Medicaid Services quality measure, have been studied in databases that have excluded certain payer types and states and have not accounted for readmission to a hospital different from that of the index admission. More accurate and nationally representative data are needed, because this fragmentation of care could lead to flawed conclusions. The purpose of the present study was to examine the incidence and risk factors for readmission to a nonindex hospital for patients admitted for claudication or critical limb ischemia (CLI). We also examined how this disruption of patient care affects mortality. The 2013 to 2014 Nationwide Readmissions Database was queried for all patients admitted for claudication or CLI who had undergone angioplasty, lower extremity bypass, or aortobifemoral bypass. The outcomes of interest were 30- and 365-day readmission rates to any hospital, 30- and 365-day readmission rates to a nonindex hospital, and mortality rates. Multivariable logistic regression was used to identify risk factors for readmission to a nonindex hospital. The most common readmission diagnoses and diagnosis-related groups were identified. A total of 92,769 patients had been admitted with peripheral vascular disease (33,055 with claudication and 59,714 with CLI). The 30- and 365-day readmission rate was 8.97% and 21.49% and 19.26% and 40.36%, for claudication and CLI, respectively. Of the 30- and 365-day readmissions, 20.47% and 24.92% had occurred at a nonindex hospital, respectively. Significantly higher mortality rates were found for patients with 30- or 365-day readmissions to different hospitals (odds ratio, 1.4 and 1.8, respectively). Multivariable analysis revealed that procedural indication and angioplasty are not significant risk factors for readmission to a different hospital. However, female sex, length of stay >7 days, and Charlson Comorbidity Index >3 remained significant risk factors for nonindex readmissions. The most common disease groups for nonindex readmission were "septicemia and disseminated infections" (6.5%), "heart failure" (6.4%), "other vascular procedures" (6.1%), and "amputation of lower limb except toes" (4.0%). Previously unreported, ≥1 in 4 readmissions after lower extremity vascular procedures for peripheral vascular disease will occur at a nonindex hospital. This fragmentation of care is associated with increased mortality and has serious implications for guiding outcome and quality measures. With a sizeable portion of patients missed by current metrics, concern exists that providers are using flawed data. Further study into social- and patient-specific risk factors might provide methods to prevent these readmissions and improve outcomes in this difficult patient population. [ABSTRACT FROM AUTHOR]

Study Design: Secondary analysis of a large administrative database.Objective: The objectives of this study are to: 1) identify the incidence and cause of 90-day readmissions following primary elective lumbar spine surgery, 2) offer insight into potential risk factors that contribute to these readmissions, and 3) quantify the cost associated with these readmissions.Summary Of Background Data: As bundled-payment models for the reimbursement of surgical services become more popular in spine, the focus is shifting toward long-term patient outcomes in the context of 90-day episodes of care. With limited data available on national 90-day readmission statistics available, we hope to provide evidence that will aid in the development of more cost-effective perioperative care models.Methods: Using ICD-9 coding, we identified all patients 18 years of age and older in the 2014 Nationwide Readmissions Database (NRD) who underwent an elective, inpatient, primary lumbar spine surgery. Using multivariate logistic regression, we identified independent predictors of 90-day readmission while controlling for a multitude of confounding variables and completed a comparative cost analysis.Results: We identified 169,788 patients who underwent a primary lumbar spine procedure. In total 4268 (2.5%) were readmitted within 90 days. There was no difference in comorbidity burden between cohorts (readmitted vs. not readmitted) as quantified by the Elixhauser Comorbidity index. Independent predictors of increased odds of 90-day readmission were: anemia, uncomplicated diabetes and diabetes with chronic complications, surgical wound disruption and acute myocardial infarction at the time of the index admission, self-pay status, and an anterior surgical approach. Implant complications were identified as the primary related cause of readmission. These readmissions were associated with a significant cost increase.Conclusion: There are clearly identifiable risk factors that increase the odds of hospital readmission within 90 days of primary lumbar spine surgery. An overall 90-day readmission rate of 2.5%, while relatively low, carries significantly increased cost to both the patient and hospital.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

A fair number of hospital admissions occur after 30 days; thus, the true readmission rate could have been underestimated. Therefore, we hypothesized that the 90-day readmission rate might better characterize the factors contributing to readmission for pediatric patients undergoing spinal tumor resection. The Nationwide Readmissions Database was used to study the patient demographic data, comorbidities, admissions, hospital course, spinal tumor behavior (malignant vs. benign), complications, revisions, and 30- and 90-day readmissions. Of the 397 patients included in the 30-day cohort, 43 (10.8%) had been readmitted. In comparison, the 90-day readmission rate was significantly greater; 52 of 325 patients were readmitted (16.0%; P < 0.04). Patients aged 16–20 constituted the largest subgroup. However, the highest readmission rate was observed for patients aged <5 years (30-day, 21.7%; 90-day, 26.4%). Medicaid patients were more likely to be readmitted than were private insurance patients (30-day odds ratio [OR], 3.3 [ P < 0.001]; 90-day OR, 2.29 [ P < 0.02]). In both cohorts, patients with malignant tumors required readmission more often than did those with benign tumors (30-day OR, 2.78 [ P < 0.02]; 90-day OR, 1.92 [ P = 0.08]). In the 90-day cohort, the patients had been readmitted 26.4 days after discharge versus 10.6 days in the 30-day cohort. Within the 90-day cohort, 18.6% of the readmissions were for spinal reoperation, 28.3% for chemotherapy or hematologic complications, and 25.6% for other central nervous system disorders. The median charges for each readmission were ∼$50,000 and ∼$40,000 for the 30- and 90-day cohorts, respectively. Medicaid insurance, malignant tumors, and younger age were significant predictors of readmission in the 90-day cohort. The prevalence and charges associated with unplanned hospital readmissions after spinal tumor resection were remarkably high. Younger age, Medicaid insurance, malignant tumors, and complications during the initial admission were significant predictors of 90-day readmission. [ABSTRACT FROM AUTHOR]

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Abstract Background Cardiogenic shock (CS) in absence of acute myocardial infarction (AMI) has significant morbidity and mortality. This population of patients has been excluded from prior major randomized trials and observational studies. Methods We included patients with CS in absence of AMI from the 2013–14 HCUP's National Readmission Database. 30-day readmissions were studied and etiology for readmission was identified by using ICD-9CM codes in primary diagnosis field. Multivariable mixed effect logistic regression models were created to identify predictors of 30-day readmission and in-hospital mortality, respectively. Results We studied 38,198 index admissions with non-AMI CS, with an in-hospital mortality of 35.4%. Mean age, length and cost of stay were 63.6 years, 16.9 days and 69,947$, respectively among survivors of index admission. Among those discharged, 22.6% were readmitted within 30 days with >50% readmissions occurring within 11-days. Cardiovascular etiologies (42.3%), especially heart failure (24.0%) comprised the commonest reason for readmission. Among non-cardiac causes were infectious (11.7%) and respiratory (9.2%) etiologies. Older age (50–64 years odds ratio:1.29, 65–79 years, OR:1.59, ≥80 years OR:2.69), ventilator use (OR:4.25), sepsis (OR:1.12), use of short term devices (intra-aortic balloon pump OR:2.67, Impella/TandemHeart OR:4.84, extracorporeal membrane oxygenation OR:3.68) and non-ischemic cardiomyopathy(OR:0.65) were among the predictors of in-hospital mortality. Older age (65–79 years, OR:1.25, ≥80 years OR:1.41), male sex (OR:1.08), and ventilator use (OR:1.21) predicted higher 30-day readmission. Conclusion Both, in-hospital mortality and 30-day readmission among those admitted for non-AMI CS were significantly elevated. The majority of readmissions were due to non-cardiovascular causes. Identifying high-risk factors may help devise strategies to improve quality of care and reduce adverse outcome rates. Highlights • Admission for non AMI related CS is associated with significant in-hospital mortality and 30-day readmission post discharge. • Roughly three-fifths of the readmissions within 30 days occurred due to non-cardiovascular etiologies. • Heart failure represented the commonest cardiovascular cause for readmission. • Older age, ventilator use, and short term mechanical circulatory support use predicted higher hospital mortality. • Older age and male sex were among predictors for increased 30-day readmission. [ABSTRACT FROM AUTHOR]

Sport played a .special role in the political system of the GDR and was used to achieve political goals, especially in terms of diplomacy. The aim of the article is to show examples of the instrumen-talization of sport in the GDR in the context of competition within the Eastern Bloc countries. In the light of the attitude of East German authorities to sport competition and the so-called sporting policy the study points to examples oof competition between athletes from the GDR and the Soviet Union and other satellite states. The premise of the article is to point to the reactions of the GDR authorities to the intra-system rivalry of athletes, as well as its political foundations and attempts at instrumentalization. Politically declared friendship and close political cooperation usually did not reflect real competition, which - especially in sport and contrary to propaganda slogans - was usually extremely ruthless and uncompromising. The text is based on the research of thematic German literature and supported by analysis and interpretation of published source materials and archival research. [ABSTRACT FROM AUTHOR]

Udział polskich aktorów w produkcjach wschodnioniemieckiej Defy jest na ogół znany, choć nie dość wyczerpująco opisany. Oczywiście nie chodzi jedynie o koprodukcje, choć i one (jak chociażby pierwsza z nich, Milcząca gwiazda Kurta Maetziga, 1960) zaświadczają o aktorskim transferze między Warszawą a Berlinem. Deficyt aktorów w NRD, ale także dobra marka kina polskiego w NRD sprawiły, że często korzystano z zasobów polskiego rynku aktorskiego. Autor skupia się na analizie oraz interpretacji zjawiska przechodniości sztuki aktorskiej między kinematografiami narodowymi. Niezwykła w tym względzie okazała się zwłaszcza rola młodej i pięknej pani inżynier w wykonaniu Krystyny Stypułkowskiej, która zagrała w kultowym filmie Ślad kamieni (1966) Beyera – wystylizowanym na western produkcyjniaku, odesłanym przez NRD-owską cenzurę na półki do roku 1990. Na szczególne miejsce w takiej perspektywie oglądu zasługuje sztuka aktorska Franciszka Pieczki w rozliczeniowym filmie Jadup i Boel (1980/1988) Rainera Simona, a zwłaszcza jego tytułowa rola właściciela objazdowego teatru lalek w filmie Fariaho…! (1983) Rolanda Gräfa. Pieczka zagrał także m.in. w zachodnioniemieckim Dawidzie (1979) Petera Lilienthala (pierwszym filmie produkcji RFN, który otrzymał Złotego Niedźwiedzia w kategorii filmu fabularnego – na Berlinale 1979). Obok niego kinematografię Niemiec Zachodnich zasilili m.in. aktorzy grający w filmach Volkera Schlöndorffa, a wśród nich Jerzy Skolimowski jako dziennikarz na walczącym Bliskim Wschodzie (Fałszerstwo, 1981). W artykule Andrzej Gwóźdź szuka odpowiedzi na pytania dotyczące zjawiska eksportu aktorów jako faktu głównie kulturowego.

The German Democratic Republic, despite limited economic and demographic opportunities, achieved an incredible success in sports, becoming in the second half of the 20th century a real sports superpower. Competition at the international level, especially the Olympic Games were arenas for the presentation of the country's supremacy in sport, on account of which it began to be called "Sportwunderland". The article attempts to identify the most important components of the sport success of the GDR - institutional structures and implementation of the achievements of science in sport, together with the pathological use of prohibited pharmacological assistance, as well as methods of acquiring and selecting outstanding sportspersons. In addition, the article provides an analysis of the situation of East German sport after the unification of Germany and discusses ways of dealing with the dark sides of its past. [ABSTRACT FROM AUTHOR]

The article presents the development of German States 'fleets in the 20th century. It shows their evolution over the last one hundred years. The author focuses on the evolution of the place and role of the German Fleet from the Imperial Navy up to the contemporary Deutsche Marine, which concentrates on performing the tasks of joint forces within NATO. It also shows GDR and FRG fleets during the division of Germany. Contemporary German fleet and the FRG's armed forces in general are rather modest compared to the economic capacities of today's Germany. This situation coincides with an atmosphere of increasing pacifism that permeates the German society. [ABSTRACT FROM AUTHOR]

This article follows up on a thorough review and analysis of Polish and German literature on the subject matter of national anthems. The aim of the author was to familiarize readers with the origins of national anthems of the major European countries, notably that of Germany. Throughout this paper, the main focus is the origins of the Deutschlandlied as well as other popular songs such as ''Heil Dir im Siegenkranz, ''Wacht Am Rhein", "Horst-Wessel-Lied" of the Nazi era and ''Auferstanden aus Ruinen'', the national anthem of the German Democratic Republic. [ABSTRACT FROM AUTHOR]