Rationale: Approximately 20% of patients hospitalized for COPD exacerbations in the United States will be readmitted within 30 days. The Centers for Medicare and Medicaid Services has recently proposed to revise the Hospital Readmissions Reduction Program to financially penalize hospitals with high all-cause 30-day rehospitalization rates after a hospitalization for COPD exacerbation on or after October 1, 2014.Objectives: To report the results of a systematic review of randomized clinical trials evaluating interventions to reduce the rehospitalizations after COPD exacerbations.Methods: Multiple electronic databases were systematically searched to identify relevant studies published between January 1966 and June 2013. Titles, abstracts, and, subsequently, full-text articles were assessed for eligibility. Each study was appraised using predefined criteria.Measurements and Main Results: Among 913 titles and abstracts screened, 5 studies (1,393 participants) met eligibility criteria. All studies had a primary outcome of rehospitalization at 6 or 12 months. No study examined 30-day rehospitalization as the primary outcome. Each study tested a different set of interventions. Two studies (one conducted in Canada and one conducted in Spain and Belgium) showed a decrease in all-cause rehospitalization over 12 months in the intervention group versus comparator group (mean number of hospitalizations per patient, 1.0 vs. 1.8; P = 0.01; percent hospitalized, 45 vs. 67%; P = 0.028; respectively). The only study conducted in the United States found a greater than twofold higher risk of mortality in the intervention group (17 vs. 7%, P = 0.003) but no significant difference in rehospitalizations. It was unclear which set of interventions was effective or harmful. Conclusions:The evidence base is inadequate to recommend specific interventions to reduce rehospitalizations in this population and does not justify penalizing hospitals for high 30-day rehospitalization rates after COPD exacerbations.

Biotic Np(V) reduction is studied in light of its potential role for the environmental immobilization of this hazardous radionuclide. The speciation of Np in Desulfovibrio desulfuricans cultures is compared with Np speciation in the spent medium and in the uninoculated medium. Precipitates formed in all three samples. Optical spectroscopy, x-ray diffraction, and x-ray absorption near edge structure (XANES) were used to determine the Np speciation. After 5 days of incubation, there was very little Np left in solution, which was present as Np(V). The precipitate that formed in all samples is an amorphous Np(IV) species, establishing that Np(V) is almost quantitatively reduced. These results demonstrate that the reduction of Np is independent of Desulfovibrio desulfuricans. The underlying chemistry associated with these results is discussed.

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Primary cardiac tumors are extremely rare and have a dynamic range of symptoms based on their type and location. Among these tumors are angiosarcomas, very rare tumor which arise predominantly in the right atrium. Cardiac angiosarcoma have a poor prognosis and most patients succumb to the disease within months.

Angiosarcomas are rare, highly aggressive neoplasms originating from vascular or lymphatic endothelium [1]. Cutaneous angiosarcoma of the scalp has a predilection to involve pleural/subpleural surfaces [2,3]. Able to induce pneumothorax, hemothorax, and pleural effusion, few reports link angiosarcoma of the scalp to cystic lung disease [3]. Herein, we present a case of cutaneous angiosarcoma of the scalp associated with cystic lung disease and hydropneumothorax.