Correction: A quality improvement initiative for COPD patients: A cost analysis.

[This corrects the article DOI: 10.1371/journal.pone.0235040.].

A quality improvement initiative for COPD patients: A cost analysis.

The objective of this analysis was to evaluate and report on the economic impact of implementing an integrated, quality, and operational improvement program on chronic obstructive pulmonary disease (COPD) care from acute through post-acute care settings. This initiative was established in a cohort of 12 hospitals in Alabama and sought to address COPD readmission through improved workflows pertaining to early diagnosis, efficient care transitions, and patient visibility across the entire care episode. Implementation of the initiative was influenced by lean principles, particularly cross-functional agreement of workflows to improve COPD care delivery and outcomes. A budget impact model was developed to calculate cost savings directly from objective data collected during this initiative. The model estimated payer annual savings over 5 years. Patients were classified for analysis based on whether or not they received noninvasive ventilation. Scenario analyses calculated savings for payers covering different COPD cohort sizes. The base case revealed annual per patient savings of $11,263 for patients treated through the quality improvement program versus traditional care. The model projected cumulative savings of $52 million over a 5-year period. Clinical incorporation of non-invasive ventilation (NIV) resulted in $20,535 annual savings per patient and projected $91 million over 5 years. We conclude that an integrated management program for COPD patients across the care continuum is associated with substantial cost savings and significantly reduced hospital readmissions.

A compact high-resolution X-ray powder diffractometer.

A new powder diffractometer operating in transmission mode is described. It can work as a rapid very compact instrument or as a high-resolution instrument, and the sample preparation is simplified. The incident beam optics create pure Cu Kα1 radiation, giving rise to peak widths of ∼0.1° in 2θ in compact form with a sample-to-detector minimum radius of 55 mm, reducing to peak widths of <0.05° in high-resolution mode by increasing the detector radius to 240 mm. The resolution of the diffractometer is shown to be governed by a complex mixture of angular divergence, sample size, diffraction effects and the dimensions of the detector pixels. The data can be collected instantaneously, which combined with trivial sample preparation and no sample alignment, makes it a suitable method for very rapid phase identification. As the detector is moved further from the sample, the angular step from the pixel dimension is reduced and the resolution improves significantly for very detailed studies, including structure determination and analysis of the microstructure. The advantage of this geometry is that the resolution of the diffractometer can be calculated precisely and the instrumental artefacts can be analysed easily without a sample present. The performance is demonstrated with LaB6 and paracetamol, and a critical appraisal of the uncertainties in the measurements is presented. The instantaneous data collection offers possibilities in dynamic experiments.

Atypically high insulin responses to some foods relate to sugars and satiety.

Much research has focused on how the glycemic index (GI) of the diets of healthy people relates to long-term risk for coronary heart disease, stroke, and non-insulin dependent diabetes. Low-GI diets appear to produce some of their beneficial effects largely by moderating insulinemic responses to meals. Wolever and Bolognesi (1996) have derived a formula for predicting the insulinemic index (II) from the GI for starchy foods. Using data from Holt et al. (1995, 1997) on a wide variety of common foods, we have examined differences between the observed II and GI-based estimates of the II. These differences were found to correlate negatively with satiety index ratings and positively with contents of total sugars. We suggest that the aforementioned method of measuring and expressing the relation between the GI and the II may prove useful in exploring how various components and sensory properties of food may affect hunger and energy intake.