The CTAs that are ordered in the emergency department are more than twice as likely to find an incidental pulmonary nodule or adenopathy than a PE. Systematic approaches should be developed to help primary care physicians contend with a growing number of clinically relevant incidental radiologic findings.

Cystic Fibrosis is the most common inherited genetic respiratory disorder in the Western World. Hypovitaminosis D is almost universal in CF patients, likely due to a combination of inadequate absorption, impaired metabolism, and lack of sun exposure. Inadequate levels are associated with the high prevalence of bone disease or osteoporosis in CF patients, which is associated with increased morbidity including fractures, kyphosis, and worsening pulmonary status. Treatment goals include regular monitoring 25 hydroxyvitamin D (25OHD) levels with aggressive treatment for those with levels <75 nmol/L (<30 ng/mL). More research is needed to determine optimal supplementation goals and strategies.

The question of determining the maximal number of mutually unbiased bases in dimension six has received much attention since their introduction to quantum information theory, but a definitive answer has still not been found. In this paper we move away from the traditional analytic approach and use a numerical approach to attempt to determine this number. We numerically minimise a non-negative function N d,N of a set of N + 1 orthonormal bases in dimension d which only evaluates to zero if the bases are mutually unbiased. As a result we find strong evidence that (as has been conjectured elsewhere) there are no more than three mutually unbiased bases in dimension six.

No abstract

Rationale: The National Quality Forum recently endorsed in-hospital mortality and intensive care unit length of stay (LOS) as quality indicators for patients in the intensive care unit. These measures may be affected by transferring patients to long-term acute care hospitals (LTACs). Objectives: To quantify the implications of LTAC transfer practices on variation in mortality index and LOS index for patients in academic medical centers. Methods: We used a cross-sectional study design using data reported to the University HealthSystem Consortium from 2008-2009. Data were from patients who were mechanically ventilated for more than 96 hours. Measurements and Main Results: Using linear regression, we measured the association between mortality index and LTAC transfer rate, with the hospital as the unit of analysis. Similar analyses were conducted for LOS index and cost index. A total of 137 hospitals were analyzed, averaging 534 transfers to LTAC per hospital during the study period. Mean 6 SD in-hospital mortality was 24 6 6.4%, and observed LOS was 30.4 6 8.2 days. The mean LTAC transfer rate was 15.7 6 13.7%. Linear regression demonstrated a significant correlation between transfer rate and mortality index (R 2 ¼ 0.14; P , 0.0001) and LOS index (R 2 ¼ 0.43; P , 0.0001). Conclusions: LTAC hospital transfer rate has a significant impact on reported mortality and LOS indices for patients requiring prolonged acute mechanical ventilation. This is an example of factors unrelated to quality of medical care or illness severity that must be considered when interpreting mortality and LOS as quality indicators.Keywords: National Quality Forum; American Thoracic Society; quality improvement Rising health care costs, increased demand for quality health care, and emphasis on pay-for-performance measures have led to the creation of benchmarks to measure quality. Recently, the National Quality Forum (NQF) endorsed the measures of in-hospital mortality rates and intensive care unit (ICU) length of stay (LOS) as quality indicators for patients receiving care in acute hospital ICUs (1). These measures have been questioned by several professional organizations, such as the American Thoracic Society, the American College of Chest Physicians, and the American Association of Critical Care Nurses, because they may be subject to bias from individual hospital characteristics unrelated to medical practice (2). One example is variation in transfer patterns to long-term acute care (LTACs) hospitals.Since the 1980s, LTACs have provided care to patients with prolonged acute care needs, such as weaning from mechanical ventilation, prolonged intravenous antibiotics, or complex wound care (3). Throughout the United States, LTAC transfer rates vary considerably among large hospitals (4). Although this is partly explained by heterogeneous LTAC distribution, LTAC transfer rates frequently differ greatly among hospitals in the same region.Previous studies using modeled data suggest that standardized mortality ratios can be improved by increasing tran...