OBJECTIVE:To determine the association between patient literacy and hospitalization. DESIGN: Prospective cohort study.SETTING: Urban public hospital. PATIENTS: CONCLUSIONS:In this study population, patients with inadequate functional health literacy had an increased risk of hospital admission.

OBJECTIVES: This study examined the relationship of functional health literacy to self-reported health and use of health services. METHODS: Patients presenting to two large, urban public hospitals in Atlanta, Ga, and Torrance, Calif, were administered a health literacy test about their overall health and use of health care services during the 3 months preceding their visit. RESULTS: Patients with inadequate functional health literacy were more likely than patients with adequate literacy to report their health as poor. Number of years of school completed was less strongly associated with self-reported health. Literacy was not related to regular source of care or physician visits, but patients in Atlanta with inadequate literacy were more likely than patients with adequate literacy to report a hospitalization in the previous year. CONCLUSIONS: Low literacy is strongly associated with self-reported poor health and is more closely associated with self-reported health than number of years of school completed.

A harmonic balance technique for modeling unsteady nonlinear ows in turbomachinery is presented. The analysis exploits the fact that many unsteady ows of interest in turbomachinery are periodic in time. Thus, the unsteady ow conservation variables may be represented by a Fourier series in time with spatially varying coef cients. This assumption leads to a harmonic balance form of the Euler or Navier-Stokes equations, which, in turn, can be solved ef ciently as a steady problem using conventional computational uid dynamic (CFD) methods, including pseudotime time marching with local time stepping and multigrid acceleration. Thus, the method is computationally ef cient, at least one to two orders of magnitude faster than conventional nonlinear time-domain CFD simulations. Computational results for unsteady, transonic, viscous ow in the front stage rotor of a high-pressure compressor demonstrate that even strongly nonlinear ows can be modeled to engineering accuracy with a small number of terms retained in the Fourier series representation of the ow. Furthermore, in some cases, uid nonlinearities are found to be important for surprisingly small blade vibrations.

Our preliminary data indicate that 15% of African-American patients presenting with diabetic ketoacidosis (DKA) are obese. To determine underlying mechanisms, we analyzed the clinical characteristics and indexes of insulin secretion and insulin sensitivity in 35 obese patients with DKA, 22 obese patients with hyperglycemia, 10 lean patients with DKA, and 10 obese nondiabetic subjects. Studies were performed 1 day after resolution of DKA and after 12 weeks of follow-up. At presentation, both obese DKA and obese hyperglycemic patients had no detectable insulin response to intravenous glucose, but they did respond to glucagon administration. The acute insulin response (AIR) to glucagon in obese DKA patients (0.9 +/- 0.1 ng/ml, P < 0.01), but significantly greater than in lean patients with DKA (0.1 +/- 0.1 ng/ml, P < 0.01). After 12 weeks of follow-up, the AIR to glucose improved in both groups of obese diabetic patients but remained significantly lower than in nondiabetic control subjects (both P < 0.01). In contrast, the AIR to glucagon was not significantly different from that in obese control subjects. Insulin sensitivity was decreased in both groups of obese diabetic patients at presentation and improved after follow-up to levels similar to those in obese nondiabetic control subjects. Reactivity with islet cell antibodies was not detected in any of the patients. During follow-up, 25 of 35 obese DKA and 16 of 22 hyperglycemic patients were able to discontinue insulin therapy, with continued good metabolic control. Our results indicate that in African-Americans, obese patients with DKA represent a subset of type II diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)

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