General reversal of N-decomposition relationship during long-term decomposition in boreal and temperate forests.

Decomposition of dead organic matter is fundamental to carbon (C) and nutrient cycling in terrestrial ecosystems, influencing C fluxes from the biosphere to the atmosphere. Theory predicts and evidence strongly supports that the availability of nitrogen (N) limits litter decomposition. Positive relationships between substrate N concentrations and decomposition have been embedded into ecosystem models.

Reading tea leaves worldwide: Decoupled drivers of initial litter decomposition mass-loss rate and stabilization.

The breakdown of plant material fuels soil functioning and biodiversity. Currently, process understanding of global decomposition patterns and the drivers of such patterns are hampered by the lack of coherent large-scale datasets. We buried 36,000 individual litterbags (tea bags) worldwide and found an overall negative correlation between initial mass-loss rates and stabilization factors of plant-derived carbon, using the Tea Bag Index (TBI).

Exchangeable manganese regulates carbon storage in the humus layer of the boreal forest.

The huge carbon stock in humus layers of the boreal forest plays a critical role in the global carbon cycle. However, there remains uncertainty about the factors that regulate below-ground carbon sequestration in this region. Notably, based on evidence from two independent but complementary methods, we identified that exchangeable manganese is a critical factor regulating carbon accumulation in boreal forests across both regional scales and the entire boreal latitudinal range.

Predominant contributions through lichen and fine litter to litterfall mercury deposition in a subalpine forest.

Litterfall, typically referring to needles/leaves, may stand for >50% of the total mercury (Hg) deposition in forest ecosystems. By detailed categorisation, we reveal for the first time that the contributions through lichens and fine litter, together 9.98 μg Hg m yr, could be as high as that in needle litter (9.

Modeling Family Medicine Provider Care Team Design to Improve Patient Care Continuity.

Background And Objectives: Continuity of care is an integral aspect of high-quality patient care in primary care settings. In the Department of Family Medicine at Mayo Clinic, providers have multiple responsibilities in addition to clinical duties or panel management time (PMT). These competing time demands limit providers' clinical availability.

Balancing Clinician Workload Through Strategic Patient Panel Designs.

Background And Objectives: Clinician workload is a key contributor to burnout and well-being as well as overtime and staff shortages, particularly in the primary care setting. Appointment volume is primarily driven by the size of patient panels assigned to clinicians. Thus, finding the most appropriate panel size for each clinician is essential to optimization of patient care.

Coordination of Intraoperative Neurophysiologic Monitoring Technologist and Surgery Schedules.

Resource coordination in surgical scheduling remains challenging in health care delivery systems. This is especially the case in highly-specialized settings such as coordinating Intraoperative Neurophysiologic Monitoring (IONM) resources. Inefficient coordination yields higher costs, limited access to care, and creates constraints to surgical quality and outcomes.

Mitigating Nonattendance Using Clinic-Resourced Incentives Can Be Mutually Beneficial: A Contingency Management-Inspired Partially Observable Markov Decision Process Model.

Objectives: Nonattendance of appointments in outpatient clinics results in many adverse effects including inefficient use of valuable resources, wasted capacity, increased delays, and gaps in patient care. This research presents a modeling framework for designing positive incentives aimed at decreasing patient nonattendance.

Methods: We develop a partially observable Markov decision process (POMDP) model to identify optimal adaptive reinforcement schedules with which financial incentives are disbursed.

Return to work after deceased donor kidney transplant under the kidney allocation system.

Background: The Kidney Allocation System (KAS) includes a scoring system to match transplant candidate life expectancy with expected longevity of the donor kidney, and a backdating policy that gives waitlist time credit to patients waitlisted after starting dialysis treatment (post-dialysis). We estimated the effect of the KAS on employment among patient subgroups targeted by the policy.

Methods: We used a sample selection model to compare employment after transplant before and after KAS implementation among patients on the kidney-only transplant waitlist between December 4, 2011 and December 31, 2017.

An Algorithm for Pairing Interventionalists and Surgeons for the TAVR Procedure.

The Transcatheter Aortic Valve Replacement (TAVR) procedure requires an initial consultation and a subsequent procedure by an interventionalist (IC) and surgeon. The IC-surgeon pair coordination is extremely challenging, especially at Mayo Clinic due to provider time commitments distributed across practice, research, and education activities. Current practice aims to establish the coordination manually, resulting in a scheduling process that is cumbersome and time consuming for the schedulers.

Major, trace and rare earth elements dynamics in decomposing litters on successional sites in a cool temperate region of South Korea.

Evaluating the decomposition-based change dynamics of various elements in plant litter is important for improving our understanding about their biogeochemical cycling in ecosystems. We have studied the concentrations of major, trace, and rare earth elements (REEs) (34 elements) in green tissue litter, and soil and their dynamics in the decomposing litters of successional annual fleabane (Erigeron annuus) and silvergrass (Miscanthus sinensis). Concentrations of major and trace elements in the litter of annual fleabane were 1.

A Method for Balancing Provider Schedules in Outpatient Specialty Clinics.

Variability in outpatient specialty clinic schedules contributes to numerous adverse effects including chaotic clinic settings, provider burnout, increased patient waiting times, and inefficient use of resources. This research measures the benefit of balancing provider schedules in an outpatient specialty clinic. We developed a constrained optimization model to minimize the variability in provider schedules in an outpatient specialty clinic.

Provider Scheduling to Maximize Patient Access.

Introduction: We describe and demonstrate an efficient method for assigning clinic days to urology providers in academic and large urology group practices given their numerous scheduling constraints including evaluation and management visits, office or operating room procedures/surgeries, teaching, trainee mentorship, committee work and outreach activities.

Methods: We propose an integer programming model for scheduling providers for clinic shifts in order to maximize patient access to appointments considering the aforementioned scheduling constraints. We present results for a case study with an academic urology clinic and lessons learned from implementing the model generated schedule.

Trends of major, minor and rare earth elements in decomposing litter in a cool temperate ecosystem, South Korea.

The decomposition dynamics of 34 different elements in four different litter types (foliar and woody litter) from Pinus densiflora (Korean red pine) and Castanea crenata (Korean chestnut) was investigated in a cool temperate ecosystem using the litterbag method. Two contrasting trends were observed in the dynamics of elements with accumulated mass loss of litter and carbon. Leaf litter of Korean chestnut, which was richer in elements, showed a general decrease in concentrations of elements with accumulated mass loss of litter and carbon on a dry mass basis during decomposition in the field.

Improving Clinic Operational Efficiency and Utilization with RTLS.

New sources of operational data are leading to novel healthcare delivery system design and opportunities to support operational planning and decision-making. Technologies such as real time locating systems (RTLS) provide a unique view and understanding of how healthcare delivery settings behave and respond to operational design changes. In this paper RTLS data from an outpatient clinical setting is leveraged to identify the appropriate number of scheduled providers in order to improve the utilization of the clinical space while balancing the negative effects of clinic congestion.

Contrasting dynamics and trait controls in first-order root compared with leaf litter decomposition.

Decomposition is a key component of the global carbon (C) cycle, yet current ecosystem C models do not adequately represent the contributions of plant roots and their mycorrhizae to this process. The understanding of decomposition dynamics and their control by traits is particularly limited for the most distal first-order roots. Here we followed decomposition of first-order roots and leaf litter from 35 woody plant species differing in mycorrhizal type over 6 years in a Chinese temperate forest.

Early stage litter decomposition across biomes.

Through litter decomposition enormous amounts of carbon is emitted to the atmosphere. Numerous large-scale decomposition experiments have been conducted focusing on this fundamental soil process in order to understand the controls on the terrestrial carbon transfer to the atmosphere. However, previous studies were mostly based on site-specific litter and methodologies, adding major uncertainty to syntheses, comparisons and meta-analyses across different experiments and sites.

Manganese availability is negatively associated with carbon storage in northern coniferous forest humus layers.

Carbon sequestration below ground depends on organic matter input and decomposition, but regulatory bottlenecks remain unclear. The relative importance of plant production, climate and edaphic factors has to be elucidated to better predict carbon storage in forests. In Swedish forest soil inventory data from across the entire boreal latitudinal range (n = 2378), the concentration of exchangeable manganese was singled out as the strongest predictor (R = 0.

Healthcare Burden and Costs Associated with Urinary Tract Infections in Type 2 Diabetes Mellitus Patients: An Analysis Based on a Large Sample of 456,586 German Patients.

Objectives: We examined the real-world treatment of urinary tract infections (UTIs) in a type 2 diabetes mellitus (T2DM) population, evaluated UTI-related healthcare resource use and direct treatment costs, and assessed factors that may predict UTI-related costs.

Methods: We analyzed an anonymized dataset from a regional German healthcare fund (2010-2012). UTI-associated resource use was described by the number of UTI-associated outpatient visits, the number and length of UTI-related acute hospital visits, and the number of UTI-related antibiotics prescriptions.

Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV).

Background: Aim of the study was to compare the short-term effects of oxygen therapy via a high-flow nasal cannula (HFNC) on functional and subjective respiratory parameters in patients with acute hypoxic respiratory failure in comparison to non-invasive ventilation (NIV) and standard treatment via a Venturi mask.

Methods: Fourteen patients with acute hypoxic respiratory failure were treated with HFNC (FiO2 0.6, gas flow 55 l/min), NIV (FiO2 0.

Estimating the cost of no-shows and evaluating the effects of mitigation strategies.

Objective: To measure the cost of nonattendance ("no-shows") and benefit of overbooking and interventions to reduce no-shows for an outpatient endoscopy suite.

Methods: We used a discrete-event simulation model to determine improved overbooking scheduling policies and examine the effect of no-shows on procedure utilization and expected net gain, defined as the difference in expected revenue based on Centers for Medicare & Medicaid Services reimbursement rates and variable costs based on the sum of patient waiting time and provider and staff overtime. No-show rates were estimated from historical attendance (18% on average, with a sensitivity range of 12%-24%).

Effect of illness severity and comorbidity on patient safety and adverse events.

The objective was to investigate the effect of admission health status on hospital adverse events and added costs. Secondary data were from merged administrative and clinical sources for Mayo Clinic Rochester, Minnesota hospital discharges in 2005 (N = 60,599). This was a retrospective cross-sectional study of the effect of demographics, diagnosis group, comorbidity, and admission illness severity on adverse events, incremental costs, and length of stay (LOS) using the Agency for Healthcare Research and Quality Patient Safety Indicators and provider-reported events with harm.

A discrete event simulation model to evaluate operational performance of a colonoscopy suite.

Background And Aims: Colorectal cancer, a leading cause of cancer death, is preventable with colonoscopic screening. Colonoscopy cost is high, and optimizing resource utilization for colonoscopy is important. This study's aim is to evaluate resource allocation for optimal use of facilities for colonoscopy screening.

Effect of weekend hospital admission on gastrointestinal hemorrhage outcomes.

Objective: To determine whether outcomes for patients admitted with UGIH differ depending on weekend versus weekday admission, and whether any such differences are mediated by discrepancies in the use and timing of endoscopy.

Methods: This was a cross-sectional comparison of mortality, resource use, and the utilization and timing of esophagogastroduodenoscopy (EGD) among patients admitted with upper gastrointestinal hemorrhage (UGIH) on weekends to those admitted on a weekday. Hospitals in 31 states from the Nationwide Inpatient Sample between 1998 and 2003 were included.