Larawestermann3474

When foraging, animals can maximize their fitness if they are able to tailor their foraging decisions to current environmental conditions. When making foraging decisions, individuals need to assess the benefits of foraging while accounting for the potential risks of being captured by a predator. However, whether and how different factors interact to shape these decisions is not yet well understood, especially in individual foragers. Here we present a standardized set of manipulative field experiments in the form of foraging assays in the tropical lizard Anolis cristatellus in Puerto Rico. We presented male lizards with foraging opportunities to test how the presence of conspecifics, predation-risk perception, the abundance of food, and interactions among these factors determines the outcome of foraging decisions. In Experiment 1, anoles foraged faster when food was scarce and other conspecifics were present near the feeding tray, while they took longer to feed when food was abundant and when no conspecifics were present. These results suggest that foraging decisions in anoles are the result of a complex process in which individuals assess predation risk by using information from conspecific individuals while taking into account food abundance. In Experiment 2, a simulated increase in predation risk (i.e., distance to the feeding tray) confirmed the relevance of risk perception by showing that the use of available perches is strongly correlated with the latency to feed. We found Puerto Rican crested anoles integrate instantaneous ecological information about food abundance, conspecific activity and predation risk, and adjust their foraging behavior accordingly.

The use of preoperative blood orders involved in major gastrointestinal surgery has been poorly studied. The objective of the current study was to analyze compliance with guidelines and factors associated with crossmatch and blood ordering among patients who underwent a hepatic or pancreatic resection.

All patients who underwent a hepatic or pancreatic resection between 2010 and 2013 at Johns Hopkins Hospital were identified. Crossmatch to transfusion (C/T) ratios were calculated based on transfusion rates and total units used. A C/T ratio of >2.0 was considered excessive.

Among the 2,629 patients, 11,574 units of packed red blood cells (PRBCs) were crossmatched (mean number of PRBC units crossmatched 5.9 ± 7.3). Of the 2,629 patients, 34.1% of patients received ≥ 1 PRBCs and 3,611 total units of PRBC were transfused, resulting in an institutional C/T ratio of 2.17 based on the proportion of patients transfused and 3.21 based on the overall number of PRBC units transfused. Using our criterion of exceer variation both among surgeons and anesthesiologists was an important factor associated with crossmatch variation and excessive ordering of blood for crossmatch in patients undergoing pancreatic and hepatic surgery.

Establishment of a biological pacemaker is expected to solve the persisting problems of a mechanical pacemaker including the problems of battery life and electromagnetic interference. Enhancement of the funny current (If) flowing through hyperpolarization-activated cyclic nucleotide-gated (HCN) channels and attenuation of the inward rectifier K+ current (IK1) flowing through inward rectifier potassium (Kir) channels are essential for generation of a biological pacemaker. Therefore, we generated HCN4-overexpressing mouse embryonic stem cells (mESCs) and induced cardiomyocytes that originally show poor IK1 currents, and we investigated whether the HCN4-overexpressing mESC-derived cardiomyocytes (mESC-CMs) function as a biological pacemaker in vitro.

The rabbit Hcn4 gene was transfected into mESCs, and stable clones were selected. mESC-CMs were generated via embryoid bodies and purified under serum/glucose-free and lactate-supplemented conditions. Approximately 90% of the purified cells were troponin I-posity in an in vitro co-culture system with other excitable cells. The results indicated that these cells could be applied to a biological pacemaker.

While the automatic processing of alcohol-related cues by alcohol abusers is well established in experimental psychopathology approaches, the cerebral regions involved in this phenomenon and the influence of alcohol intake on this process remain unknown. The aim of this functional magnetic resonance imaging (fMRI) study was to investigate the neural mechanisms underlying the processing of task-irrelevant alcohol-related stimuli in young heavy drinkers and their modulation by alcohol administration.

Twelve heavy drinking male participants were scanned on 2 separate days; once after a low dose of alcohol intake (0.4g/kg), and once after a placebo intake, in balanced order. Images of alcoholic drinks, soft drinks, or neutral objects were shown while participants' neural activity was recorded through fMRI. Moreover, participants' attentional focus was manipulated using a task which required them to process the central images of interest (focus alcohol condition) or a center unattended task (focus not on alcohn young heavy drinkers. Low dose of alcohol did not modulate the neural substrates involved in the processing of salient alcohol-related cues.Of the many problems facing the US healthcare system, the shortage of behavioral health providers in outpatient settings is particularly profound. To address this issue, Boston׳s Brigham and Women׳s Hospital identified ways to incorporate behavioral health into primary care when it opened the South Huntington Primary Care clinic in August 2011. When the needs of its patients were more complex than anticipated, the clinic created assessment tools and refined care processes to identify, triage, and monitor patients with mental illness. Key insights from the South Huntington experience include. • Hiring for roles instead of training can decrease costs of implementation. • A process for reflection, assessment, and adaptation is a critical component of innovation. • Innovations must adapt to the specific needs of the local community. • Innovations are most effective when they reflect the capabilities of local providers.To assist practices and institutions throughout the country in implementing clinical redesign supported by - and aligned with - payment reform, we present a case study of the New Mexico Cancer Center (NMCC) based on numerous stakeholder interviews, literature reviews, and a comprehensive site visit. This study explores the complex barriers oncologists face in improving the quality and outcomes of cancer care and reducing overall costs in a sustainable way. This case will explore the following questions How did the NMCC redesign care to improve quality, enhance patient experience and results, and reduce costs? How can an organization demonstrate they are improving quality to enable new payment contracts that enable sustainability? Are alternative payment models sustainable for an independent, community oncology practice?In all modern healthcare systems, it is difficult for hospitals to keep pace with the increasing number of clinical guidelines. In the Netherlands, this poses a specific problem, as the national quality regulator holds hospital boards responsible for compliance with guidelines. We sought to address this problem by constructing a centralized database of guidelines. Due to the enormous number and the inter-relatedness of the guidelines, this task was larger and more complex than anticipated. This raises questions regarding the feasibility of adhering to external demands and concerning effective management by hospital executive boards of compliance with clinical guidelines.The healthcare system is undergoing rapid transformation as national policies increase patient access, reward positive health outcomes, and push for an end to the current era of episodic care. Advances in health sensors are rapidly moving diagnostic and monitoring capabilities into consumer products, enabling new care models. Although hospitals and health care providers have been slow to embrace novel health technologies, such innovations may help meet mounting pressure to provide timely, high quality, and low-cost care to large populations. This leading edge perspective focuses on the quantified-self movement and highlights the opportunities and challenges for patients, providers, and researchers.The independent Office of the Actuary for CMS certified that the Pioneer ACO model has met the stringent criteria for expansion to a larger population. Significant savings have accrued and quality targets have been met, so the program as a whole appears to be working. Ironically, 13 of the initial 32 enrollees have left. We attribute this to the design of the ACO models which inadequately support efficient care delivery. Using Bellin-ThedaCare Healthcare Partners as an example, we will focus on correctible flaws in four core elements of the ACO payment model finance spending and targets, attribution, and quality performance.

Unclear roles in interdisciplinary primary care teams can impede optimal team-based care. We assessed perceived task allocation among primary care providers (PCPs) and staff during implementation of a new patient-centered care model in Veterans Affairs (VA) primary care practices.

We performed a cross-sectional survey of PCPs and primary care staff (registered nurses (RNs), licensed practical/vocational nurses (LPNs), and medical assistants/clerks (MAs)) in 23 primary care practices within one VA region. We asked subjects whether PCPs performed each of 14 common primary care tasks alone, or relied upon staff for help. Tasks included gathering preventive service history, disease screening, evaluating patients and making treatment decisions, intervening on lifestyle factors, educating patients about self-care activities and medications, refilling prescriptions, receiving and resolving patient messages, completing forms, tracking diagnostic data, referral tracking, and arranging home health care. We then perlely responsible for most clinical tasks. RNs, and LPNs felt they were relied upon for most of the same tasks, while medical assistants/clerks reported being relied on for fewer tasks. Better understanding of optimal inter-professional team task allocation in primary care is needed.

Medicare home health care spending increased under the prospective payment system (PPS) that was introduced specifically to control the rising spending. To explain this unexpected spending rise, we focused on new home health agencies that entered the market under the PPS. The high profit margins under the PPS attracted many new agencies to the market partially due to home health care's unique feature of low entry costs. We examined whether new entrants were more likely to adopt the practice patterns leading to higher profit margins than incumbent agencies that had been operating in the market before the PPS.

Using 2008 to 2010 Medicare Home Health Claims and Provider of Services File, we estimated regressions of agencies' practice patterns controlling for agency and patient characteristics.

We found that new entrants were more likely than incumbents to adopt practice patterns leading to high profit margins. They were more likely to target the 14th and 20th therapy visit where marginal revenue is relatively greater than that of other number of visits.