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BackgroundRisk factors common to nursing home (NH) residents are potentially not fully captured by the Hospital Readmissions Reduction Program (HRRP). The unique challenges faced by hospitals that disproportionately serve NH residents who are at greater risk of readmissions have not been studied.MethodsUsing 100% Medicare Provider Analysis and Review File and the Minimum Data Set from 2010-2013, we constructed a measure of hospital share of NH-originating hospitalizations (NOHs). We defined hospital share of NOHs as the proportion of inpatient stays by patients aged 65 or older who were directly admitted from NHs. To evaluate the impact of the share of NOHs on readmission penalties, we categorized hospitals into quartiles according to their share of NOHs and estimated the differences in the adjusted penalties across hospital quartiles after accounting for hospital characteristics, market characteristics and state fixed effects. We repeated the analyses for the penalties incurred in each year between 2015 and 2019.ResultsHospitals varied substantially in the share of NOHs (median [interquartile range], 11.3% [8.2%-15.1%]), with limited variation over time. In 2015, hospitals in the highest quartile of NOH received on average 0.58% Medicare payment reduction compared to 0.44% reduction among those in the lowest quartile (32.9% higher penalties, p

A literature review of peer-reviewed articles published 2000–2019 was conducted to determine the types and extent of hypertension-associated productivity loss among adults in the United States. All monetary outcomes were standardized to 2019 $ by using the Employment Cost Index. Twenty-seven articles met the inclusion criteria. Nearly half of the articles (12 articles) presented monetary outcomes of productivity loss. Absenteeism (14 articles) and presenteeism (8 articles) were most frequently assessed. Annual absenteeism was estimated to cost more than $11 billion, nationally controlling for sociodemographic characteristics. The annual additional costs per person were estimated at $63 for short-term disability, $72–$330 for absenteeism, and $53–$156 for presenteeism, controlling for participant characteristics; and may be as high as $2362 for absenteeism and presenteeism when considered in combination. The annual additional time loss per person was estimated as 1.3 days for absenteeism, controlling for common hypertension comorbidities, including stroke and diabetes; and 15.6 days for work and home productivity loss combined, controlling for sociodemographic characteristics. The loss from absenteeism alone might be more than 20% of the total medical expenditure of hypertension. Although the differences in estimation methods and study populations make it challenging to synthesize the costs across the studies, this review provides detailed information on the various types of productivity loss. In addition, the ways in which methods could be standardized for future research are discussed. Accounting for the costs from productivity loss can help public health officials, health insurers, employers, and researchers better understand the economic burden of hypertension.

Inverse stochastic resonance (ISR) is a modality of nonlinear response to noise, there is the biggest inhibitory effect of noise on neural electrical activity when the ISR happens. In this paper, the discharge activity of a triple-neuron feed-forward-loop (FFL) motif is investigated under the Gaussian colored noise and electromagnetic induction, where the FFL motif is constructed by Izhikevich neurons and connected by chemical synapse and the FFL motifs are classified into four types by the character of synaptic current. Here, the ISR induced by the Gaussian colored noise and electromagnetic induction is focused and various effects of different system parameters on ISR have been found. The most prominent ISR phenomenon will be seen in the case of low-input current and low cross-correlation ratio. There are no significant differences in the ISR curves for various chemical coupling strengths and chemical synapse delays, which conforms to the dynamic mechanisms of the ISR behavior. Besides, the ISR phenomenon also ensues under low electromagnetic induction levels and the effects of electromagnetic induction on the ISR are discussed. The results found here provide a novel perspective about the inhibitory effect on neural motif, which might help the biologists and pathologists understand some complex physiological phenomena of the nervous systems.

Purpose The survival benefits of patients with inoperable hepatocellular carcinoma (HCC) who undergo transarterial chemoembolization (TACE) and receive sorafenib therapy remain controversial. We aimed to identify clinical predictors in patients with inoperable HCC undergoing TACE and receiving sorafenib. Methods Between January 2014 and December 2017, 148 consecutive patients with inoperable HCC who were treated with TACE plus sorafenib were retrospectively analyzed. Critical clinical factors associated with overall survival (OS) were identified by Cox regression model analysis. Kaplan–Meier methods were used to calculate the survival times, which were compared with the log-rank test. Results Macrovascular invasion (MVI), radiologic response and sorafenib-related dermatologic toxicities were identified as independent factors associated with OS. MVI is a known prognostic factor before treatment. The median OS of patients with either radiologic response or dermatologic toxicities was significantly improved compared with that of patients without it (both 23.0 vs. 7.0 months, P P Conclusion The combination of radiologic response and sorafenib-related dermatologic toxicities is the most robust predictor of survival benefits for HCC patients after TACE plus sorafenib therapy. Level of Evidence Level 3.

Robot skin, as a key component to collect tactile information, plays an important role in human-robot interaction (HRI). Conventional robot skin is mainly made of rigid components and bendable films, which cannot provide a fully soft physical interface in HRI. In addition, the sensitivity of robot skin is still to be enhanced so that robot could perceive touch behavior more precisely from a human. Here, a novel robot skin with features of high sensitivity and softness is designed in this article. The proposed robot skin is composed of a matrix of carbon black-polyurethane sponge sensor units through a foaming process. The sensitivity of the sensor is further enhanced by optimizing its geometric structure, based on the finite element method and physical experimental tests. The excellent cycling stability and transient responsiveness of the sponge sensor embedded into the robot skin endow host robots with an accurate long-term perception of both transient and quasi-static force. Finally, the validation of the robot skin is carried out by installing it on the back of a collaborative robot to perceive four touch modalities, illustrating great application prospects in affective HRI.

International audience; Homeotropic alignment of liquid crystals (LCs) is one of the key modes used in commercial liquid crystal displays (LCDs) due to its advantages, such as high contrast ratios and fast response speed. Here, we report stable homeotropic LC alignment with a small pretilt angle in a nematic, negative LC host doped with additives including self-aligning agents, photoresponsive azo dyes, and reactive mesogen via an in situ self-assembled, dual-wavelength photoalignment approach. The underlying mechanism of stable, pretilted homeotropic LC alignment was further analyzed in detail. The achieved pretilted homeotropic LC cells are very stable against heat and UV light exposure and demonstrate excellent electro-optical characteristics. The experimental results show that such a noncontact, simple homeotropic alignment technique has big potential in many applications, such as high-quality LCDs, spatial light modulators, and other optoelectronic devices.

ImportanceCurrent estimates of productivity losses associated with heart disease and stroke in the US include income losses from premature mortality but do not include income losses from morbidity.ObjectiveTo estimate labor income losses associated with morbidity of heart disease and stroke in the US due to missed or lower labor force participation.Design, Setting, and ParticipantsThis cross-sectional study used 2019 Panel Study of Income Dynamics data to estimate labor income losses associated with heart disease and stroke by comparing labor income between persons with and without heart disease or stroke, after controlling for sociodemographic characteristics and other chronic conditions and considering the situation of zero labor income (eg, withdrawal from the labor market). The study sample included individuals aged 18 to 64 years who were reference persons or spouses or partners. Data analysis was conducted from June 2021 to October 2022.ExposureThe key exposure was heart disease or stroke.Main Outcomes and MeasuresThe main outcome was labor income, measured for the year 2018. Covariates included sociodemographic characteristics and other chronic conditions. Labor income losses associated with heart disease and stroke were estimated using the 2-part model, in which part 1 is to model the probability that labor income is greater than zero and part 2 is to regress positive labor income, with both parts having the same set of explanatory variables.ResultsIn the study sample consisting of 12 166 individuals (6721 [52.4%] females) representing a weighted mean income of $48 299 (95% CI, $45 712-$50 885), the prevalence of heart disease was 3.7% and the prevalence of stroke was 1.7%, and there were 1610 Hispanic persons (17.3%), 220 non-Hispanic Asian or Pacific Islander persons (6.0%), 3963 non-Hispanic Black persons (11.0%), and 5688 non-Hispanic White persons (60.2%). The age distribution was largely even, from 21.9% for the age 25 to 34 years group to 25.8% for the age 55 to 64 years group, except for young adults (age 18-24 years), who made up 4.4% of the sample. After adjustment for sociodemographic characteristics and other chronic conditions, persons with heart disease would receive an estimated $13 463 (95% CI, $6993-$19 933) less in annual labor income than those without heart disease (P P Conclusions and RelevanceThese findings suggest that total labor income losses associated with morbidity of heart disease and stroke were far greater than those from premature mortality. Comprehensive estimation of total costs of CVD may assist decision-makers in assessing benefits from averted premature mortality and morbidity and allocating resources to the prevention, management, and control of CVD.

Variations in the visceral vasculature are often encountered, but rarely cause clinical symptoms. We report a 12-year-old girl with portal hypertension caused by congenital variations in visceral vessels. The clinical manifestations included gastrointestinal hemorrhage and ascites. The common hepatic artery and splenic artery stem shared the same trunk from the aorta, and the common hepatic artery was directly connected with the main portal vein to form an arteriovenous fistula. In addition, the left hepatic artery and the left gastric artery shared a common trunk termed the “hepatic-gastric trunk” which originated from the anterior wall of the aorta, while the right hepatic artery originated from the superior mesenteric artery and supplied the right liver. The patient was treated with interventional embolization and remained in good condition throughout the follow-up and at the time of publication.

In human–robot collaboration, the wrapping material on robots is not only required to have the sensing ability to adapt to the external environment but also need to have the function of cushioning the collision between human and robot. Herein, a fluid‐driven soft robot skin with sensing and actuating function is successfully applied to a collaborative robot and working well with the host robot. The skin is an integration of sponge force sensors and pneumatic actuators. By altering the internal air pressure in pneumatic actuators, the developed robot skin can provide more than ten times tunable stiffness and sensitivity. In addition, the skin can reduce the peak force of the collision and achieve the actuating function. Using three‐dimensional printing and computer‐aided design, the skin is fabricated and attached to a collaborative robot conformally. Drawing upon the data acquisition and control system, the experiment for illustrating the applications of the CoboSkin is successfully performed. The skin provides the robot with multi‐functions, which are similar to the human muscle and skin attached to human bones. By mimicking human skin and muscle with tactile sensing function and stiffness tuning function, CoboSkin can enhance the adaptability of the robot to human daily life.

Background: The economic burden of stroke is high and expected to increase with the growing stroke incidence among younger adults and the aging population. However, we are unaware of a comprehensive review of the cost drivers across the stroke care continuum. We conducted a literature review and summarized the costs incurred in the inpatient and outpatient settings during the acute and post-acute periods. Methods: A systematic search of MEDLINE, EMBASE, CINAHL was conducted to identify cost-of-illness studies published during January 2000-October 2019 that evaluated the direct medical costs of stroke in the US. We extracted both the index hospitalization costs and the costs incurred thereafter. We summarized the costs by stroke type (ischemic, intracerebral hemorrhage, subarachnoid hemorrhage, transient ischemic attack) and by cost component (e.g., inpatient hospital stays, skilled nursing facility for rehabilitation, physician consultation, medication use). Cost estimates were adjusted to 2019 dollars by using the US Consumer Price Index. Results: Thirty-six studies were included. Thirteen studies (36%) focused on inpatient costs only, twenty-one (58%) estimated both inpatient and outpatient costs, two (6%) examined outpatient costs only. Nine studies (25%) estimated the stroke-attributable costs by using propensity score matching and econometric models. The index hospitalization costed $9,050-$74,525 per admission for ischemic stroke (15 studies), $18,554-$117,991 for hemorrhagic stroke (5 studies), and $9,658-$10,544 for transient ischemic attack (2 studies). Among studies that examined costs beyond the index hospitalization (n=22, 61%), follow-up periods varied from 30 days to 4 years. Sixteen of these studies (73%) estimated total costs only; five (23%) identified costs by period. For ischemic stroke, the total cumulative post-stroke costs were estimated at $15,037 (30-day period), $17,968-$29,704 (90-day), $27,072-$37,611 (180-day), $21,642-$87,135 (1-year), $50,153-$117,683 (2-year), and $70,513-$173,904 (4-year); the proportion attributed to inpatient care reduced from 65% (30-day period) to 46% (4-year). Skilled nursing facility care accounted for 19% of the costs four years post ischemic stroke and for 13% four years post intracerebral hemorrhage stroke. For subarachnoid hemorrhage stroke, inpatient care remained the biggest cost driver four years after the index event (70% of the total cost), followed by outpatient physician services (11%) and skilled nursing facility care (8%). Conclusions: While caution should be taken when interpreting the cost findings due to variation in data sources, study population and analytical methods, the costs of stroke are substantial. Inpatient, skilled nursing facility and outpatient physician costs are the main cost drivers and their contribution to total costs vary greatly over time and by stroke type.

In the past few decades, upconversion nanoparticles (abbreviated as UCNPs) have been more widely applied in the biomedical fields, such as in vitro and in vivo upconversion fluorescent bioimaging, photodynamic therapy, biological macromolecular detection, imaging mediated drug delivery and so on. But meanwhile, there is still not much research on the acute toxicity of upconversion nanoparticles in vivo, such as acute hepatotoxicity. In this work, we studied the in vivo biodistribution and acute hepatotoxicity of multimodal targeted contrast agent NaLuF4:Gd,Yb,Er-PEG/PEI-FA nanoprobe, which were synthesized by the solvothermal method and modified with Polyethylene glycol (PEG), Polyetherimide (PEI), folic acid (FA) on the surface. The acute hepatotoxicity in mice was systematically assessed after tail vein injection of different concentration of UCNPs. The results showed that NaLuF4:Gd,Yb,Er-PEG/PEI-FA nanoparticles with an average diameter of 44.5 ± 10.4 nm, and three typical upconversion fluorescence emission bands at 520 nm, 540 nm and 660 nm under the excitation of 980 nm laser. In vivo distribution experiments results demonstrated that approximately 87% of UCNPs injected through the tail vein accumulate in the liver. In the acute hepatotoxicity test, the intravenously injection dose of UCNPs was 10, 40, 70 and 100 mg/kg, respectively. The body weight, blood routine, serum biochemistry, histomorphology and liver oxidative stress were detected and observed no significant acute hepatotoxicity damage under the injection dose of 100 mg/kg. In conclusion, NaLuF4:Gd,Yb,Er-PEG/PEI-FA nanoprobes are safe and reliable, and have potential applications in the field of tumor targeted multimodal imaging.

In the past few decades, upconversion nanoparticles (abbreviated as UCNPs) have been more widely applied in the biomedical fields, such as in vitro and in vivo upconversion fluorescent bioimaging, photodynamic therapy, biological macromolecular detection, imaging mediated drug delivery and so on. But meanwhile, there is still not much research on the acute toxicity of upconversion nanoparticles in vivo, such as acute hepatotoxicity. In this work, we studied the in vivo biodistribution and acute hepatotoxicity of multimodal targeted contrast agent NaLuF

Prussian blue nanoprobes are widely studied and applied in tumor photothermal therapy (PTT) and magnetic resonance imaging (MRI), due to their low toxicity and excellent in vivo performance. However, the sizes of hitherto reported Prussian blue nanoprobes are generally larger than 50 nm, which greatly influence cell phagocytosis, in vivo circulation, and biodistribution. In this work, a novel method of doping zinc ions is used to control the size of Prussian blue nanoprobes. Consequently, the performances of the nanoprobes in PTT and MRI are both significantly improved. The results show that the minimum size of Prussian blue nanoprobes achieved by doping 10% zinc ions (abbreviated as SPBZn(10%)) is 3.8 ± 0.90 nm, and the maximum specific absorption coefficient, photothermal conversion efficiency, and longitudinal relaxation rates are 1.78 L g

Retroperitoneal ectopic pregnancy (REP) is an extremely rare type of ectopic pregnancy. Currently, surgery is the most widely used treatment method although it involves a high likelihood of intraoperative hemorrhage. In this case report, we describe a safe and effective alternative method for managing epigastric REP. We conducted a retrospective analysis of the clinical data of 2 patients with REP in the epigastrium who were treated at our hospital using our nonsurgical method. The treatment involved conservative management by computed tomographic-guided methotrexate injection in the gestational sac. We also present a literature review of 26 case reports and discuss the clinical features and various methods for treating REP. Our experience with the successful treatment of 2 patients suggests that the novel approach of computed tomographic-guided methotrexate injection in the gestational sac may be a safe and effective approach to manage REP. Further studies are warranted to confirm our findings.

Nursing home (NH) residents are disproportionately affected by poor oral health. But little we known about the root causes. We analyzed the 2000-2016 national inspection survey data for all certified-NHs (n=248,975 facility-years). Dental care performance was measured by two designated deficiency citations. Generalized estimating equation models were used to predict if the NH facility and market characteristics were associated with low performance. The rates of deficiency citation tripled from 1.2% in 2000 to 3.4% in 2016 (p

Minority older adults are at higher risks of poor oral health. Little is known about the extent of and the contributing factors to racial/ethnic disparity in dental care quality in the long-term care settings. Previous studies suggest that organizational and system-level factors are key determinants of oral health among minority older adults. We examined the racial/ethnic disparity in dental care delivery in nursing homes (NHs) by facility and market characteristics. We analyzed the 2000-2016 national Inspection Survey data for all certified-NHs (n=248,975 facility-years). Two designated deficiency citations were used to measure dental care performance. Generalized estimating equations were used to compare the rates of deficiency citations among NHs in different quartiles of the share of minority residents, adjusting for facility characteristics, market characteristics, year and state fixed effects. Overall, compared to NHs in the lowest quartile of the share of minority residents (average % minority residents =0.24%), NHs in the highest quartile of the share of minority residents (average % minority residents = 46.5%) and those in the second highest share (average % minority residents=13.9%) had 46.8% and 31.2% higher odds of receiving dental care citations(p

Since 2005 Massachusetts has publicly reported results from biennial surveys of satisfaction with nursing homes, completed by responsible parties for residents, to promote consumer-centered care. Our analysis of the results from 2005, 2007, and 2009 revealed generally high satisfaction with care, which remained stable over time. On a scale of 1 to 5 (from very dissatisfied to very satisfied), average satisfaction with overall care was 4.22-4.31, and satisfaction that overall residents' needs were met was 4.09-4.16. Around 90 percent of respondents would recommend the facility. Satisfaction ratings varied considerably across facilities, with higher scores associated with higher nursing staffinglevels, fewer deficiency citations, and nonprofit or government ownership. Scores for six domains of care were, in general, closely associated with satisfaction scores. However, family members seemed less satisfied with the physical and social activities available to residents and with the food and meals served than with such attributes as the physical environment. Our findings suggest that including the consumer's perspective would improve the Centers for Medicare and Medicaid Services' current nursing home reporting efforts. However, refinements may be necessary to detect the impact of consumer reporting on the quality of patient-centered care. © 2013 Project HOPE-The People-to-People Health Foundation, Inc.

Background The 2014 Institute of Medicine report recommended that healthcare providers caring for individuals with advanced illness have basic palliative care competencies in communication, inter-professional collaboration, and symptom management. Nursing homes, where one in three American decedents live and die, have fallen short of these competency goals. We implemented an intervention study to examine the efficacy of nursing home-based integrated palliative care teams in improving the quality of care processes and outcomes for residents at the end of life. Methods/design This paper describes the design, rationale, and challenges of a two-arm randomized controlled trial of nursing home-based palliative care teams in 31 facilities. The impact of the intervention on residents' outcomes is measured with four risk-adjusted quality indicators: place of death (nursing home or hospital), number of hospitalizations, and self-reported pain and depression in the last 90-days of life. The effect of the intervention is also evaluated with regard to staff satisfaction and impact on care processes (e.g. palliative care competency, communication, coordination). Both secondary (e.g. the Minimum Data Set) and primary (e.g. staff surveys) data are employed to examine the effect of the intervention. Discussion Several challenges in conducting a complex, nursing home-based intervention have been identified. While sustainability of the intervention without research funding is not clear, we surmise that without changes to the payment model that put palliative care services in this care setting on par with the more “skilled” care, it will not be reasonable to expect any widespread efforts to implement facility-based palliative care services.

Background One proposed strategy to expand primary care capacity is to use nurse practitioners (NPs) more effectively in health care delivery. However, the ability of NPs to provide care to the fullest extent of their education is moderated by state scope-of-practice (SOP) regulations. Purpose The purpose of this study was to examine the impact of state SOP regulations on the following three key issues: (a) NP workforce, (b) access to care and health care utilization, and (c) health care costs. Methods Systematic review. Results/Discussion States granting NPs greater SOP authority tend to exhibit an increase in the number and growth of NPs, greater care provision by NPs, and expanded health care utilization, especially among rural and vulnerable populations. Our review indicates that expanded NP practice regulation can impact health care delivery by increasing the number of NPs in combination with easing restrictions on their SOP. Conclusions Findings show promise that removing restrictions on NP SOP regulations could be a viable and effective strategy to increase primary care capacity.

Background Quality report cards have been shown to be effective in influencing patients' referrals and promoting quality improvement in some instances and not others. In this study, we investigate one of the mechanisms that may detract from their effectiveness: voluntary versus mandatory participation of nursing homes in public quality reporting. Objectives To answer 2 questions: (1) Were the nursing homes choosing not to participate low-quality performers relative to those who chose to participate? (2) Once participation became mandatory, did those that did not voluntarily participate initially, improve more than those that participated voluntarily? Research design Massachusetts published the Massachusetts Satisfaction Survey report card for nursing homes for the years 2005, 2007, and 2009. Nursing homes' participation was voluntary in 2005 and mandatory in 2007 and 2009. We performed a retrospective statistical analysis of the relationship between nursing homes' decision to participate in quality reporting and 12 quality outcomes: deficiency citations, staffing, and 8 survey domains. Subjects A total of 424 Massachusetts nursing homes. Results Sixty-seven percent of nursing homes participated in reporting voluntarily. Volunteer nursing homes had better quality for all measures (significant at the 0.05 level or trending toward significance at the 0.10 level for all but 2). Once reporting became mandatory, nonvolunteers improved more than volunteers in all but 2 staffing measures (trending toward significance at the 0.10 level in 5). Conclusions Report cards are more effective if nursing homes' participation is mandated. Nonmandatory reporting systems, as those implemented by some states and professional associations, lead to missed opportunities for quality improvements.

OBJECTIVETo examine the prevalence of healthcare-associated pathogens and the infection control policies and practices in a national sample of nursing homes (NHs).METHODSIn 2012, we conducted a national survey about the extent to which NHs follow suggested infection control practices with regard to 3 common healthcare-associated pathogens: methicillin-resistant Staphylococcus aureus, Clostridium difficile, and extended-spectrum β-lactamase producers, and their prevalence in NHs. We adapted a previously used and validated NH infection control survey, including questions on prevalence, admission and screening policies, contact precautions, decolonization, and cleaning practices.RESULTSA total of 1,002 surveys were returned. Of the responding NHs, 14.2% were less likely to accept residents with methicillin-resistant Staphylococcus aureus, with the principal reason being lack of single or cohort rooms. NHs do not routinely perform admission screening (96.4%) because it is not required by regulation (56.2%) and would not change care provision (30.7%). Isolation strategies vary substantially, with gloves being most commonly used. Most NHs (75.1%) do not decolonize carriers of methicillin-resistant Staphylococcus aureus, but some (10.6%) decolonize more than 90% of residents. Despite no guidance on how resident rooms on contact precautions should be cleaned, 59.3% of NHs report enhanced cleaning for such rooms.CONCLUSIONOverall, NHs tend to follow voluntary infection control guidelines only if doing so does not require substantial financial investment in new or dedicated staff or infrastructure.Infect Control Hosp Epidemiol 2015;36(7):759–766