Impact of functional recovery on patients having heart surgery.

Objective: To describe the results of a program developed to manage institutional postacute care (IPAC) (postacute skilled nursing, inpatient rehabilitation facility, and long-term acute care) in a CMS Bundled Payments for Care Improvement (BPCI) project for coronary artery bypass graft (CABG) surgery.

Study Design: We compared pre- and postutilization patterns during a 3-year period by evaluating risk-adjusted national, state, and other BPCI participant comparisons using a difference-in-differences (DID) analysis in a large urban community tertiary center with a CABG surgery program. Included in the analysis were all Medicare patients receiving CABG surgery at the institution (n = 504), across the nation (n = 213,423), and at other BPCI institutions (n = 4939).

Managing total knee replacement under value-based payments.

Objectives: To evaluate opportunity gaps and set outcome goals in knee replacement (KR) between a primary care group taking financial risk for managing its patients and 6 fee-for-service (FFS) orthopedic groups that serve their patients.

Study Design: The opportunity gap analysis was a cross-sectional evaluation of the outcomes of interest on a risk-adjusted basis using orthopedic groups, the primary care group's patients, and regional comparisons. The impact evaluation was a historical cohort comparison tracking outcomes of interest over the time frame of the intervention.

Morphology and composition of Goldeye (Hiodontidae; Hiodon alosoides) otoliths.

We provide up-to-date morphological and compositional data on otoliths of the osteoglossomorph Goldeye (Hiodon alosoides). Using computed tomography (CT) X-ray, we documented the location of each of the three pairs of otoliths (lapilli, sagittae, and asterisci) in relation to the swim bladder, which extended forward in close proximity to the sagittae and asterisci. The lappili were the largest otoliths in terms of surface area and volume, but the sagittae were highly modified, appearing spiral in shape when viewed dorsally, with a surface area to volume ratio more than double that of the lapilli.

Evaluating mobile monitoring of on-road emission factors by comparing concurrent PEMS measurements.

Many countries have adopted portable emissions measurement system (PEMS) testing in their latest regulations to measure real-world vehicular emissions. However, its fleetwide implementation is severely limited by the high equipment costs and lengthy setup procedures, posing a need to develop more cost-effective, efficient emission measurement methods, such as mobile chasing tests. We conducted conjoint PEMS-chasing experiments for twelve heavy-duty diesel vehicles (HDDTs) to evaluate the accuracy of mobile measurement results.

Outcomes of a conservative care program for knee osteoarthritis through translation of research into practice.

Introduction: Evidence-based guidelines suggest a conservative, nonsurgical approach as first-line treatment for knee osteoarthritis. However, previous literature has documented underutilization of the fundamental components of condition management emphasized in the guidelines. The intervention aim is to apply organized conservative components of care for knee osteoarthritis in an evidence-based management program through the translation of research into practice with a target to observe meaningful functional improvement in a distinct population.

On-Road Chemical Transformation as an Important Mechanism of NO Formation.

Nitrogen dioxide (NO) not only is linked to adverse effects on the respiratory system but also contributes to the formation of ground-level ozone (O) and fine particulate matter (PM). Our curbside monitoring data analysis in Detroit, MI, and Atlanta, GA, strongly suggests that a large fraction of NO is produced during the "tailpipe-to-road" stage. To substantiate this finding, we designed and carried out a field campaign to measure the same exhaust plumes at the tailpipe-level by a portable emissions measurement system (PEMS) and at the on-road level by an electric vehicle-based mobile platform.

An Evaluation of Reach for a Work Site Implementation of the National Diabetes Prevention Program Focusing on Diet and Exercise.

Purpose: Our objective is to evaluate the "reach" component of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework by comparing prediabetics who were and were not interested in enrolling in a free work site diabetes prevention program (DPP) during the first year of the program. Reach is defined as the proportion of eligible participants who enroll in a health program.

Design: A cross-sectional study design was used.

Temperature and Driving Cycle Significantly Affect Carbonaceous Gas and Particle Matter Emissions from Diesel Trucks.

The present study examines the effects of fuel [an ultralow sulfur diesel (ULSD) versus a 20% v/v soy-based biodiesel-80% v/v petroleum blend (B20)], temperature, load, vehicle, driving cycle, and active regeneration technology on gas- and particle-phase carbon emissions from light and medium heavy-duty diesel vehicles (L/MHDDV). The study is performed using chassis dynamometer facilities that support low-temperature operation (-6.7 °C versus 21.

A Prognostic Indicator for Patients Hospitalized with Heart Failure.

Background: Current methods for identifying patients at risk of dying within six months suffer from clinician biases resulting in underestimation of this risk. As a result, patients who are potentially eligible for hospice and palliative care services frequently do not benefit from these services until they are very close to the end of their lives.

Objective: To develop a prospective prognostic indicator based on actual survival within Centers for Medicare and Medicaid Services (CMS) claims data that identifies patients with congestive heart failure (CHF) who are at risk of six-month mortality.

Effects of Cold Temperature and Ethanol Content on VOC Emissions from Light-Duty Gasoline Vehicles.

Emissions of speciated volatile organic compounds (VOCs), including mobile source air toxics (MSATs), were measured in vehicle exhaust from three light-duty spark ignition vehicles operating on summer and winter grade gasoline (E0) and ethanol blended (E10 and E85) fuels. Vehicle testing was conducted using a three-phase LA92 driving cycle in a temperature-controlled chassis dynamometer at two ambient temperatures (-7 and 24 °C). The cold start driving phase and cold ambient temperature increased VOC and MSAT emissions up to several orders of magnitude compared to emissions during other vehicle operation phases and warm ambient temperature testing, respectively.

Temperature effects on particulate emissions from DPF-equipped diesel trucks operating on conventional and biodiesel fuels.

Unlabelled: Emissions tests were conducted on two medium heavy-duty diesel trucks equipped with a particulate filter (DPF), with one vehicle using a NOx absorber and the other a selective catalytic reduction (SCR) system for control of nitrogen oxides (NOx). Both vehicles were tested with two different fuels (ultra-low-sulfur diesel [ULSD] and biodiesel [B20]) and ambient temperatures (70ºF and 20ºF), while the truck with the NOx absorber was also operated at two loads (a heavy weight and a light weight). The test procedure included three driving cycles, a cold start with low transients (CSLT), the federal heavy-duty urban dynamometer driving schedule (UDDS), and a warm start with low transients (WSLT).

Cold temperature and biodiesel fuel effects on speciated emissions of volatile organic compounds from diesel trucks.

Speciated volatile organic compounds (VOCs) were measured in diesel exhaust from three heavy-duty trucks equipped with modern aftertreatment technologies. Emissions testing was conducted on a chassis dynamometer at two ambient temperatures (-7 and 22 °C) operating on two fuels (ultra low sulfur diesel and 20% soy biodiesel blend) over three driving cycles: cold start, warm start and heavy-duty urban dynamometer driving cycle. VOCs were measured separately for each drive cycle.

Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement.

Background: Health-care costs following acute hospital care have been identified as a major contributor to regional variation in Medicare spending. This study investigated the associations of preoperative physical therapy and post-acute care resource use and its effect on the total cost of care during primary hip or knee arthroplasty.

Methods: Historical claims data were analyzed using the Centers for Medicare & Medicaid Services Limited Data Set files for Diagnosis Related Group 470.

OMT associated with reduced analgesic prescribing and fewer missed work days in patients with low back pain: an observational study.

Context: Randomized controlled trials (RCTs) are considered the standard for establishing practice guidelines; however, they are expensive and time-consuming, and often the generalizability of the results is limited.

Objectives: To conduct an observational study using the findings of the American Osteopathic Association's Clinical Assessment Program (AOA-CAP) low back pain module, and to compare these findings with those of a major back pain-related RCT to determine the validity and generalizability of this pseudoexperimental model.

Methods: Data were abstracted from the AOA-CAP for Residencies platform from April 1, 2006, through October 5, 2007, with a diagnosis code consistent with low back pain.

Carbonaceous aerosols emitted from light-duty vehicles operating on gasoline and ethanol fuel blends.

This study examines the chemical properties of carbonaceous aerosols emitted from three light-duty gasoline vehicles (LDVs) operating on gasoline (e0) and ethanol-gasoline fuel blends (e10 and e85). Vehicle road load simulations were performed on a chassis dynamometer using the three-phase LA-92 unified driving cycle (UDC). Effects of LDV operating conditions and ambient temperature (-7 and 24 °C) on particle-phase semivolatile organic compounds (SVOCs) and organic and elemental carbon (OC and EC) emissions were investigated.

Racial disparities in African Americans with diabetes: process and outcome mismatch.

Background: Over the past 2 decades, numerous studies have demonstrated the existence of racial disparities in patient care in the United States. Specifically, African Americans with diabetes are less likely to have recommended process of care measures performed and outcome benchmarks for quality of care.

Objectives: To evaluate the delivery of diabetes care (processes and outcomes) associated with racial categories using a national web-based registry-the American Osteopathic Association Clinical Assessment Program (AOA-CAP).

Effects of repeated use of the American Osteopathic Association's Clinical Assessment Program on measures of care for patients with diabetes mellitus.

Context: The American Osteopathic Association developed its Clinical Assessment Program (AOA-CAP) for Residencies to provide a mechanism for osteopathic residency programs to measure and improve their quality of patient care.

Objective: To compare program performance in processes of care and intermediate outcomes for patients with diabetes mellitus in residency programs that contributed data to the AOA-CAP for the first time vs residency programs that contributed data repeatedly.

Methods: Osteopathic family medicine residency programs that entered data into the AOA-CAP diabetes registry between July 1, 2005, and December 31, 2007, were included in the present study.

Methods of characterizing the distribution of exhaust emissions from light-duty, gasoline-powered motor vehicles in the U.S. fleet.

Mobile sources significantly contribute to ambient concentrations of airborne particulate matter (PM). Source apportionment studies for PM10 (PM < or = 10 microm in aerodynamic diameter) and PM2.5 (PM < or = 2.

"All-or-none" (bundled) process and outcome indicators of diabetes care.

Objectives: To evaluate processes and outcomes of diabetes care using bundled indicators from a primary care registry of osteopathic training programs.

Study Design: Retrospective cohort analysis.

Methods: This study examined care delivered to 7333 patients across 95 family practice and internal medicine residency programs (July 1, 2005, through September 15, 2008) to determine diabetes care performance using measures of processes of care and outcomes.

Randomized trial assessing the impact of a musculoskeletal intervention for pain before participating in a weight management program.

Purpose: Obesity increases the risk of developing physical disability and pain. Persons with a body mass index (BMI) of 30 kg/m or more have an increased risk for osteoarthritis compared with those with a BMI between 25 and 29 kg/m. The purpose of this study was to examine the effect of treatment directed at reducing musculoskeletal pain on weight loss in obese subjects prior to participation in a 6-month weight management (WM) program.

The effect of a women- and healthcare-provider-focused heart health awareness initiative on diagnostic catheterization rates in women at community hospitals.

The American College of Cardiology-National Cardiovascular Data Registry was used to assess the impact of a community education campaign related to heart disease in women on the number of women, relative to men, receiving diagnostic catheterization prior to initiation of the campaign and at 2-year follow-up. Catheterizations fell 7.03% in men and 0.

Traffic and meteorological impacts on near-road air quality: summary of methods and trends from the Raleigh Near-Road Study.

A growing number of epidemiological studies conducted worldwide suggest an increase in the occurrence of adverse health effects in populations living, working, or going to school near major roadways. A study was designed to assess traffic emissions impacts on air quality and particle toxicity near a heavily traveled highway. In an attempt to describe the complex mixture of pollutants and atmospheric transport mechanisms affecting pollutant dispersion in this near-highway environment, several real-time and time-integrated sampling devices measured air quality concentrations at multiple distances and heights from the road.

Disseminating QI interventions.

Background: Partnerships contributed to the success of three diverse health care quality improvement (QI) projects. The Partnerships for Quality (PFQ) Dissemination Planning Tool was used to identify the most appropriate partners to disseminate the QI interventions for three projects, that is, partners most likely to reach and influence the target user(s)-(1) the Catholic Healthcare Partners Heart Failure Partnership, a multisite demonstration of the efficacy of a collaborative approach in the management of heart failure, (2) the Center for Value Purchasing, a collaborative study of the effects of quality incentives on the delivery of chronic disease care, and (3) the New York State Information Dissemination project, a collaborative partnership that targeted dissemination of evidence-based practices in the long term care setting.

Results: The RE-AIM model, a construct to aid planning, implementation, and evaluation of health behavior interventions, was used as a framework to examine the impact of partnerships on the three collaborative projects.