简介：AbstractObjective:Unplanned 30-day readmissions result in increased costs and decreased patient satisfaction. The objective of this study was to compare readmission rates before and after a multidisciplinary quality improvement initiative that focused on patient and staff education, use of targeted skilled nursing facilities, and appropriate use of patient observation status.Methods:This was a quality improvement study of all unplanned admissions to the Head and Neck Oncology service at a tertiary care facility during a 3-year period between October 2015 and September 2018. In October 2016, the Head and Neck Oncology service revised its discharge practices for patients undergoing extirpative and/or reconstructive surgery. These changes included enhancing patient education, increasing the use of a skilled nursing facility with directed staff education and patient handoffs by advanced practice nurses, and appropriate utilization of 23-h observation status for returning patients. The readmission rate from the pre-intervention era (October 2015 through September 2016) was compared to the readmission rate from the post-intervention era (October 2016 through September 2018). Secondary outcomes were the rates of 23-h observation within 30 days of the discharge as well as emergency room visits within 30 days of discharge.Results:In this sample of 449 patients, 161 (35.9%) were observed before the change-in-practice (before October 2016), and 288 (64.1%) were observed following the change-in-practice (after September 2016). On univariable analysis, the risk of readmission declined by approximately 41.4% from the pre-intervention era, though this conclusion was not statistically significant (P= 0.06). On multivariable analysis, patients at moderate or high risk of death were 2.31 times more likely than those at minor risk of death to readmit within 30 days (P = 0.03). Similarly, those with recurrent or persistent cancer were 3.33 times more likely than those undergoing initial curative surgical management of cancer to readmit within 30 days (P= 0.001). No patient characteristics were associated with a 23-h observation following discharge (all P > 0.05). Conclusions were similar for emergency room visits following discharge.Conclusions:A three-part quality improvement strategy resulted in a clinically important decrease in 30-day readmissions, though the decline was not statistically significant. There were no significant changes in 23-h observation within 30 days of discharge or emergency room visits within 30 days of discharge.

简介：热带降雨测量的影响结构和intraseasonal摆动(ISO)的内在的物理上的使命(TRMM)降水产品与美国国家航空学和观察系统模型版本3的空格管理戈达德土(GEOS-3)被调查数据吸收系统(DAS)。在1998夏天的强壮的ISO阶段显然位于亚洲季风区域和东方赤道的和平的区域。当向东北的繁殖是在30点的突出的ISO到超过10的60天的摆动时，东方繁殖是为在20点的热带ISO的一个主导的特征到30天的摆动

简介：AbstractBackground:Hospital-acquired pneumonia (HAP) is the most common hospital-acquired infection in China with substantial morbidity and mortality. But no specific risk assessment model has been well validated in patients with HAP. The aim of this study was to investigate the published risk assessment models that could potentially be used to predict 30-day mortality in HAP patients in non-surgical departments.Methods:This study was a single-center, retrospective study. In total, 223 patients diagnosed with HAP from 2012 to 2017 were included in this study. Clinical and laboratory data during the initial 24 hours after HAP diagnosis were collected to calculate the pneumonia severity index (PSI); consciousness, urea nitrogen, respiratory rate, blood pressure, and age ≥65 years (CURB-65); Acute Physiology and Chronic Health Evaluation II (APACHE II); Sequential Organ Failure Assessment (SOFA); and Quick Sequential Organ Failure Assessment (qSOFA) scores. The discriminatory power was tested by constructing receiver operating characteristic (ROC) curves, and the areas under the curve (AUCs) were calculated.Results:The all-cause 30-day mortality rate was 18.4% (41/223). The PSI, CURB-65, SOFA, APACHE II, and qSOFA scores were significantly higher in non-survivors than in survivors (all P < 0.001). The discriminatory abilities of the APACHE II and SOFA scores were better than those of the CURB-65 and qSOFA scores (ROC AUC: APACHE II vs. CURB-65, 0.863 vs. 0.744, Z = 3.055, P= 0.002; APACHE II vs. qSOFA, 0.863 vs. 0.767, Z= 3.017, P= 0.003; SOFA vs. CURB-65, 0.856 vs. 0.744, Z= 2.589, P = 0.010; SOFA vs. qSOFA, 0.856 vs. 0.767, Z = 2.170, P = 0.030). The cut-off values we defined for the SOFA, APACHE II, and qSOFA scores were 4, 14, and 1.Conclusions:These results suggest that the APACHE II and SOFA scores determined during the initial 24 h after HAP diagnosis may be useful for the prediction of 30-day mortality in HAP patients in non-surgical departments. The qSOFA score may be a simple tool that can be used to quickly identify severe infections.

简介：Byusingtheupper-winddatafromJuly1980toJune1983,thevariationsofthelow-frequencyoscillation(LFO)intheatmospherebeforeandduring1982ElNinohavebeeninvestigated.BeforetheElNino,theLFOpropagatesfromwesttoeastovertheequatoroftheEasternHemisphereandfromeasttowestover20°N.TheeastwardpropagatingLFOovertheequatorconsistsofzonalwavenumber1propagatingeastwardandzonalwavenumber2withacharacterofstationarywave.Theoscillationofzonalwavenumber2canmodulatetheoscillationstrength.AftertheonsetoftheElNino,thepropagatingdirectionsoftheLFOovertheequatorand20°NoftheEasternHemispherechangetobewestwardandeastward,respectively.TheLFOoverthewesternPacificweakensrapidlyandonecomingfrommiddleandhighlatitudespropagatestotheequator.Fromthephasecompositionsofstreamlinefieldsforthezonalwavenumber1ofequatorialwestwardpropa-gatirgLFO,itisfoundthattheatmosphericheatsourceintheequatoroftheeasternPacific(EEP)excitesaseriesoftheequatorialcyclonesandanticycloneswhichmovenorthwardandwestwardandformthewestwardpropagatingLFOovertheequator.Withthewavelengthof20000km,thiskindofequatorialwaveissimilartothemixingRossby-gravitywave.Initswestwardandnorthwardmovement,thecirculationinEastAsiaismodified.ThismaybethemechanismoftheinfluenceofElNinoontheclimateofChina.

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简介：Abaroclinicsemi-geostrophicmodelwithevaporation-windfeedbackmechanism(EWFM)andCISKisestablished,twonon-dimensionalparametersaandηareintroducedtorepresentEWFMandCISK,respectively.Analyticsolutionsofthemodelsystemareobtained,dynamicsanalysesandthemodelatmospherecalculationsfurtherconfirmthatEWFMandCISKareveryimportantphysicalprocessesinleadingtothelow-frequencyoscillationsinthetropics.

简介：Toaddtothegrowingmatureresearchonthetropical30-50dayoscillationsfromanewprospective,thecurrentworkbasesondynamicanalysisofbaroclinicquasi-geostrophicmodelstodiscussdynamicmechanismsforthegenerationandpropagationofCISK-Rossbywaves,andtounderstandrestraintsandeffectsofdifferentwavestructuresandthermodynamicforcingonthe30-50dayoscillationsinthetropicalatmosphere.Someimportantpropertiesoftheoscillationpropagationhavebeenexplainedand,indetail,withrespecttoitsmeridionalpropagationandvertical'baroclinic'structure.Theworkhascomeupwithsomenewopinionsandviewpoints.Newopinionsaboutthepropagationandenergydispersionaretobeprovedbymoreobservationsandstudy.

简介：在在东亚上的降水之间的关系(20祣汣湯獥

简介：12月岁末2008年最后的测试在西班牙的赫雷斯进行。在3天的测试中,我参加了第2天和第3天的测试。据说为这个冬季测试提供餐饮服务的工作人员以前曾服务过丰田车队，每天都有意大利面配肉和蔬菜套餐。不过这次测试中，帐篷内还准备了寿司手卷这样的日本料理。味道方面由于米的种类不同所以很难和日本的一样。但车队工作人员都觉得很好吃。我也吃了几个，不过我个人还是觉得意大利面和英国料理更好吃。

简介：<正>PeopleintheUnitedStateshonortheirparentswithtwospecialdays:Mother’sDay,onthesecond

简介：BasedontheNCEP/NCARreanalysisdataandtheobservedprecipitationdatainthesouthofChinafrom1958to2000,theimpactof30to60dayoscillationofatmosphericheatsourcesonthedroughtandfloodeventsinJuneinthesouthofChinaisdiscussed.Duringtheflood(drought)events,thereexistsananomalouslow-frequencyanticyclone(cyclone)atthelowlevelofthetroposphereovertheSouthChinaSeaandthenorthwesternPacific,accompaniedwithanomalouslow-frequencyheatsinks(heatsources),whilethereexistsananomalouslow-frequencycyclone(anticyclone)withanomalousheatsources(sinks)overtheareafromthesouthofChinatothesouthofJapan.Onaverage,thephaseevolutionofthelow-frequencyindroughteventsis7to11daysaheadofthatinfloodeventsinMaytoJuneinthesouthofChina.Infloodevents,low-frequencyheatsourcesandcyclonesarepropagatednorthwardfromthesouthernSouthChinaSea,northwestwardfromthewarmpoolofthewesternPacificandwestwardfromthenorthwesternPacificaround140°E,whichhaveveryimportantimpactontheabundantrainfallinJuneinthesouthofChina.However,indroughtevents,thenorthwardpropagationsofthelow-frequencyheatsourcesandcyclonesfromtheSouthChinaSeaanditsvicinityareratherlatecomparedwiththoseinfloodevents,andthereisnoobviouswestwardpropagationoftheheatsourcesfromthenorthwesternPacific.Thetimingofthelow-frequencyheatsourcepropagationhasremarkableimpactontheJunerainfallinthesouthofChina.

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简介：<正>在中国,每当谈到MayDay“五一”,我们马上会想到“五一国际劳动节”。而近几年,谈到“五一”我们就会想到与之相连的“五一”长假。对全球来说,MayDay也确实是国际劳动

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简介：圣诞节到了!孩子们个个都期待欣赏雪景和收到礼物。聆听这首歌，然后试试跟着音乐一起唱吧!

简介：ThefirstThanksgivingDaycelebrationinAmericawasinthefallof1621.Thecolonistsgatheredtogivethanksforthesummer'sharvest.Theyhadstruggledthroughahardwinter.Manypeoplehaddied.Thecoldwasterrible.Therehadnotbeenmuchfoodthatfirstwinter.

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简介：今天，爸爸给我讲了感恩节的由来。这个节日最早是美洲移民为了感谢和纪念印第安人的帮助而设定的，现今的主要内容就是感恩和吃火鸡。

简介：Itisafineday.Thesunisinthesky.MrGreenandhisfamilyareinthepark.MrandMrsGreenaresittingunderthetreeandlookingattheirchildren.Theirdaughter,Annisflyingakite.