From 15 to 30% of people who have colorectal surgery will get an surgical-site infection?and those surgical infections (just among colorectal patients) cost an estimated $1 billion a year. The surgical infections cause longer hospital stays; are the most common cause of hospital readmission within 30 days; and require more doctor visits, wound-care supplies, and home care. Not to mention the added difficulties for patients and their families.
A two-year study at Johns Hopkins Hospital, just published in the August 2012 Journal of the American College of Surgeons, describes how a team of front-line providers used their ?local wisdom? plus an evidence-based safety system to cut their infection rate in colorectal surgery patients by 33.3 percent in one year.
Reducing surgical infections improves patient care and saves dollars?a national priority shared by Medicare and other insurers, medical staff, and patients alike. A national Surgical Care Improvement Project (SCIP) using standardized checklists and measures was launched six years ago, but four recent studies show little connection between compliance and?overall patient outcomes.
Leaders at Johns Hopkins Hospital decided to add an element seen in other successful quality-improvement programs?intentionally bridging the typical divide between front-line staff and the experts who bring in a standardized improvement system.
They formed a team of surgery, anesthesia, nursing, and infection control leaders, plus a team coach (to facilitate meetings and manage improvement projects), and a hospital executive who could help front-line staff overcome institutional barriers. The leadership team also invited other interested front-line nurses, nurse anesthetists, scrub technicians, and anesthesiologists to join what became a 36-member team. They launched a CUSP (Comprehensive Unit-based Safety Program) that used the national SCIP checklist, but also added their own interventions to the checklist:
Only surgical nurses, rather than a variety of staff, did the pre-op skin preparation on each patient ;
All patients were given antibiotic-treated wash cloths to use the evening before surgery;
After studying literature, the team added oral antibiotics to routine pre-surgical mechanical bowel preparation;
Because a separate hospital study showed that many patients were hypothermic both before and after surgery, they began warming patients in the pre-anesthesia area;
When scrub technicians pointed out that instruments used for intestinal suturing were also frequently used for skin closure, the team designed a system to replace all instruments and change the entire teams? surgical gloves after completing the bowel work and again before beginning wound closure; and
The team found and fixed lapses in giving antibiotics after surgery.
This last action showed why ?local wisdom? might improve standardized checklists.
Previous compliance was 99 percent with the national SCIP measure of ?appropriate antibiotic selection.? But frank talk on the team revealed that staff didn?t think all patients were actually getting the correct medications. In fact, before the team was formed, only 33% of penicillin-allergic patients were getting recommended doses of the gentamicin/clindamycin recommended by the infection control staff. (Patients were either under-dosed or not receiving gentamicin because of concerns about side-effects.) After team intervention, 92% of patients received the correct antibiotics.
Based on average costs of $6,000 to $10,000 per surgical-site infection, the study authors estimated that by decreasing their infection rate by 33%, their hospital saved from $168,000 to $280,000 in one year alone? just among?its 278 colorectal surgery patients.
The authors described study limitations?it was not randomized; it was only at one hospital; and all improvement measures were introduced simultaneously and not analyzed separately for effectiveness. They called for further, multi-institutional studies.
But their overall conclusion: ?Formation of small groups of front-line providers to address patient harm using local wisdom and existing evidence can improve patient safety. ?
SOURCE: August 2012 Journal of the American College of Surgeons?????
OPEN HOUSE 2-4 FANTASTIC 2 STORY HOME with multiple living areas. Mas- ter suite downstairs, formal dining plus hearthroom, granite and SS appliances. Sink in laundry room. Side entry garage. 2 bedrooms upstairs plus a loft and 24?9?10?6 bonus with a closet could be 4th bedroom or great media. $289,900. Hosted by ALICIA DEMAREST I540 take Promenade exit West/ Left on Champions/ R on Southgate/ L on Liberty Bell/ R on Bainbridge/ house on right. 6109 BAINBRIDGE ROGERS OPEN HOUSE 2-4 RIGGINS CONSTRUCTION & DEVELOPMENT, WINNER of 6 Parade of Homes 2012 awards & OVERALL BUYERS CHOICE home builder offering new custom homes with low-e windows, crown molding, hand scraped hardwood flooring, granite counter tops, wired for security system, plumbed for central vac, & iPod ready stereo in- tercom offered in many multi level homes. $325,000. Hosted by FRAN FITZGERALD Highway 265, turn onto Hearthstone (right across from the Botanical Gardens). Go to the end of Hearthstone, and turn right onto Rockledge Drive. 4626 ROCKLEDGE FAYETTEVILLE NEW LISTING FAYETTEVILLE ? 276 RIGGINS CONSTRUCTION & DEVELOPMENT, WINNER of 6 Parade of Homes 2012 awards & OVERALL BUYERS CHOICE home builder of- fering new custom homes with low-e windows, crown molding, hand scraped hardwood flooring, granite counter tops, wired for security system, plumbed for central vac, & iPod ready stereo intercom offered in many multi level homes. $431,500. Call Kendall Rig- gins 957-6002 or 521-6611. MLS#: 662237 NEW LISTING PRAIRIE GROVE ? 333 THIS IS A NEW HOME BASICALLY that started life as a shop. Almost impossible to find a 4 bedroom home on a large lot with trees. Tall ceilings. New master bath. Sits back off road for priva- cy. Something a little different. Additional lot may be purchased. $137,500. Call Gary Boyle 267-7727 or 521-6611. MLS#: 662414 NEW LISTING FAYETTEVILLE ? 419 ADORABLE HOME IS IN MOVE-IN CONDITION & located on fantastic lot. The rooms in this home are open, airy & spacious. Large living room with fire- place opens into spacious eat-in kitchen with cherry stained cabinets & granite countertops. Bedrooms are arranged in a split plan with the master bedroom having three walk-in closets! $165,000. Call Martha Haguewood 601-7921 or 521-6611. MLS#: 662674 FAYETTEVILLE 74 MILLION DOLLAR VIEWS just minutes from town!! This amazing estate is tucked away over- looking the White River. 5,000sqft, 5BR, 4BA, huge barn, 2nd barn shop heated and cooled, pool, pond, koi pond. Did I mention the view? Additional acreage available. Too many details to list them all. $1,700,000. Call Jana Heck 790-1559 or Janice Harris 409-7469. MLS#: 660830 HINDSVILLE 98 WANT PEACE AND QUIET, small house with horse barn & pasture? All brick 3/2 ready to move into. Seller owns propane tank, two outbuildings, new roof in 2011. Great country home with deer all around. Property will qualify for RD loan. Great house, great buy Furniture in the house negotiable. $119,900. Call Brad Bruns 466-1700 or 521-6611. MLS#: 660946 SPRINGDALE 374 BUILDER?S PERSONAL HOME. All on one floor except bonus room with 1/2 bath. 4BR/ 3full BA. Huge office, 2nd living room, formal dining, and eat-in kitchen, corner lot, Bentonville Schools, almost an acre lot. Trees, wonderful lo- cation, covered deck. $350,000. Call Mary Ann Wood 200-0600 or 521-6611. MLS#: 649521
OPEN HOUSE 2-4 BEAUTIFUL HOME FROM THE OUTSIDE TO THE INSIDE. Great curb appeal. Private backyard overlooking pasture. Pretty paint colors. Updated wood floors & fixtures. Nice kitchen with cute breakfast nook & formal dining. Living room includes wood burning fireplace, office or 2nd living. MBR features balcony. $163,900. Hosted by JULIE FRAUENTHAL From Main Street in Johnson/ North on Carley Rd/ West on Colton. 3312 COLTON SPRINGDALE OPEN HOUSE 2-4 BEAUTIFUL 2 STORY, 3BR/2.5BA, brick & rock home. Up- graded SS appliances, beautiful custom raised door maple cabinets, granite, low E windows, gutters, sprinkler system, bonus room/home office, crown molding. Great location close to 540. Great backyard, covered patio. $229,900. Hosted by MARY ANN WOOD Hwy 540 N/ Exit Elm Springs East (R)/ Left on 40th/ Right on Chevalier to home on left. 3944 CHEVALIER SPRINGDALE NEW LISTING FAYETTEVILLE ? 288 ENJOY WATCH- ING THE EAGLES SOAR from their nests on the wonderful bluffs just across the lake from either the master bedroom, back porch, or walking along the almost 1,800 feet of Beaver Lake shoreline at this lovely 4BR/2BA home nestled on the almost 30 acre gently sloping lot. $625,000. Call Morris Hanks 530-7376 or 521-6611. MLS#: 662261 NEW LISTING FAYETTEVILLE ? 334 GOLF COURSE FRONT LOT, OVERLOOKING BEAUTIFUL #12 AT THE BLESSINGS GOLF COURSE. BANK OWNED $149,900. Call Kyle Pattillo 957-1267 or 521-6611. MLS#: 591944 NEW LISTING FAYETTEVILLE ? 611 BEAUTIFUL CUSTOM HOME complete with all of the upgrades ? 2 inte- rior living areas, granite counter tops, ice maker, trash compactor, instant hot water at kitchen sink, recirculating hot water pump, built ins, 350 sq.ft. of attic storage and more. $245,000. Call Kelsey Roemer 313-4687 or 521-6611. MLS#: 662231 SPRINGDALE 78 VINTAGE CHARM IN DOWNTOWN AREA. 2 bedrooms and nice living space, great location & lot. Has been used as a rental in the past with good rental history & income. $67,000. Call Julie Frauenthal 966-1553 or 521-6611. MLS#: 656903 FAYETTEVILLE 99 OPPORTUNITY TO OWN A PIECE OF THE TOP OF FAYETTEVILLE! This property sits on the south end of Skyline with huge view to the south. This property is being sold ?AS IS, WHERE IS?. There is little value in the home but the value is in the lot. You could possibly restore the original portion of the rock house. $115,000. Call Curtis Wray 527-8765 or 521-6611. MLS#: 660948 LOWELL 455 GREAT LOCATION, next to park, very well maintained home, large living room, tall ceilings, nice large privacy fenced backyard on corner lot. Light & bright eat-in kitchen and pantry. Has an awning in the backyard cover- ing back porch. A/C cap aritor replaced sum- mer 2010. New epoxy on garage floor, new roof in July 2011. $119,900. Call Chase Miller 530-9777 or 521-6611. MLS#: 659004 SPRINGDALE 643 LARGE CORNER LOT with sprinkler sys- tem! Wood floors in kitchen & stainless steel ap- pliances. Granite counters, large island & built in desk! Vaulted ceiling in living room includes fire- place with gas logs. Master bedroom and pow- der room on main level. All bedrooms have large walk in closets. $194,900. Call John Carpenter 957-8181 or 521-6611. MLS#: 656342 OPEN HOUSE 2-4 WELCOME TO GRAND VALLEY-Creating community and convenience! Cute craftman style homes with great floorplans to fit any lifestyle. Beautiful trim pack- age, granite, fireplace and patio. Large living area and nice master suite. Great location just off the Don Tyson Parkway for prime location. $149,900. Hosted by MEL- LY SALONEN Take Don Tyson Parkway East/ Subdivision on the corner of DTP & Butterfield Coach Rd. 3730 GRAND VALLEY SPRINGDALE OPEN HOUSE 2-4 SOUGHT AFTER LOCATION IN HIDDEN SPRINGS. Great 5 bedroom/3 bath home. Tall ceilings, wood floors, tile, cor- ner lot with beautiful trees, covered patio, walk-in closets, pantry, close to Wal-Mart home office, formal dining, open floor plan, 2 bedrooms down, 3 bedrooms & bonus room up. $339,500. Hosted by RUSSELL WOOD Walton North/ right on Tiger/ Left on Ash/ Left on Genisus/ Right on Turner 2106 TURNER BENTONVILLE NEW LISTING SPRINGDALE ? 290 CLEAN, WELL MAIN- TAINED, one owner 3BR/2BA in newer neigh- borhood. Amenities include gas log fireplace, jacuzzi tub, pantry, and 6? wood privacy fence. Enjoy relaxing or entertaining on the no-main- tenance composite deck. Priced to sell! Don?t miss this one! $94,900. Call Bill Burrows 409- 6876 or 521-6611. MLS#: 662293 NEW LISTING BENTONVILLE ? 338 RIGGINS CONSTRUCTION & DEVELOPMENT, WINNER of 6 Parade of Homes 2012 awards & OVERALL BUYERS CHOICE home builder of- fering new custom homes with low-e windows, crown molding, hand scraped hardwood flooring, granite coun- ter tops, wired for security system, plumbed for central vac, & iPod ready stereo intercom offered in many multi level homes. $223,000. Call Kendall Riggins 957-6002 or 521-6611. MLS#: 662519 FAYETTEVILLE 57 FABULOUS NEW FLOOR PLAN built by Riggins. Custom cabinets, hand scraped hard- wood floors, 3cm granite in kitchen & baths, stainless steel appliances, plumbed for central vac system, security system, intercom system, gutters, 2? faux wood blinds, full privacy fence, sprinkler system, gas cook tops, pop-fillers, and much more. $374,500. Call Melanie Gabel 422-4221 or 521-6611. MLS#: 656856 ROGERS 80 BEAUTIFUL NEW HOME JUST FIN- ISHED! This home features all the ameni- ties expected and priced to sell. Central Park Elementary/ Ruth Barker Middle School. One of a kind kitchen with granite countertops, beautiful master suite and MORE! $232,128. Call Whitley Dunn 601-5826 or 521-6611. MLS#: 648380 SPRINGDALE 101 ROD WALLIS SOUNDLY BUILT HOME. Covered patio overlooks this privacy fenced backyard. Inside you have great trim, tall ceilings, hardwoods in entry hall, plus in fourth bedroom that is currently being used as an office. Beau- tiful cabinetry outlines the granite countertops. Wonderful split bedroom with good size master suite. $169,900. Call Brad Bruns 466-1700 or 521-6611. MLS#: 660982 ROGERS 490 BEAUTIFUL NEW HOME with all the amenities. Great NWA location. Central Park Elementary/Ruth Barker MS. Don?t miss your change!! CALL TODAY!! $280,072. Call Whitley Dunn 601-5826 or 521-6611. MLS#: 650119 FAYETTEVILLE 759 3BR/2.5BA DUPLEX in Huntingdon Subdivision. Community pool, washer, dryer, and refrigerator convey. All bedrooms upstairs. Living room, dining area, kitchen, and half bath downstairs. $239,900. Call Bryan Wil- liams 263-8881 or 521-6611. MLS#: 657633 OPEN HOUSE 2-4 BEAUTIFUL ALL BRICK HOME in dynamite location. Easy access to 540 for quick travel. Split, open foor- plan with plenty of storage. Nice size rooms with hardwood flooring in the dining room. Cozy wood- burning fireplace in living room. Professionally land- scaped. Great backyard in awesome neighborhood. New roof last year. $163,900. Hosted by CLINT MILLER Carley Rd/ West on Colton 3110 COLTON SPRINGDALE OPEN HOUSE 12-2 NEXT SAT., SEPT. 1 Legacy Condos, Fayetteville ? Near UofA, great views, prestigious Legacy Build- ing & Luxury Condos. Create your own interior (white box). From $249,000 to $629,000. Hosted by BILL GRAY College Ave S to Dickson St/R to West St/N (right)/Legacy Building on R NEW LISTING SPRINGDALE ? 292 DOUBLE WIDE WITH FOUNDATION. Split floor plan, master has whirlpool tub, 3 bedrooms, 2 full baths, large lot, tons of privacy, new back deck, backs up to woods. $99,900. Call Brad Bruns 466-1700 or 521-6611. MLS#: 662339 NEW LISTING FAYETTEVILLE ? 346 BEAUTIFUL 3 OR 4 BED- ROOM traditional style home with open floor plan. Hardwood floors in living areas, carpet in bed- rooms. Kitchen has granite counters, stainless steel appliances. Formal and informal dining areas. Huge back yard on quiet street. Bonus room upstairs can be used as 4th bedroom. $214,000. Call Paige Crockett 790-8327 or 521-6611. MLS#: 662525 FAYETTEVILLE 65 RIGGINS CONSTRUCTION open floor plan with formal dining room. Living room opens to kitchen with extra seating at counter top bar. Volume ceiling with beams. Master bedroom includes two closets! 4 bedrooms, 2 Full baths & powder room. Split bedroom floor plan, granite counters, wood floors. $239,000. Call John Car- penter 957-8181 or 521-6611. MLS#: 660747 BENTONVILLE 90 RIGGINS CONSTRUCTION & DEVELOP- MENT, WINNER of 6 Parade of Homes 2012 awards & OVERALL BUYERS CHOICE home builder offering new custom homes with low-e windows, crown molding, hand scraped hardwood flooring, granite counter tops, wired for security system, plumbed for central vac, & iPod ready stereo intercom offered in many multi level homes. $439,000. Call Kendall Rig- gins 957-6002 or 521-6611. MLS#: 660933 LOWELL 118 OVER 400FT OF BEAVER LAKE SHORE LINE. the views are to die for on this 13 plus acres. Cedar home on a very private setting on top of the hill with large pasture in front. 4 bedrooms upstairs, 2.5 baths. Large living area and kitchen. 900sf of unfinished upstairs above the garage perfect for a bonus room. $449,900. Call Brad Bruns 466-1700 or 521-6611. MLS#: 661158 SPRINGDALE 521 ON THE WAY TO WAR EAGLE, a double- wide in good shape. In a private setting with lots of wildlife and a place for a garden. Covered front porch. Split floor plan with good size master 7 master bath has garden tub & stand alone shower. Outbuilding has one car garage and shop area with storage on the side. Fenced backyard. $109,900. Call Brad Bruns 466-1700 or 521-6611. MLS#: 656324 FAYETTEVILLE 852 BENTON RIDGE SUBDIVISION?S upscale Townhomes. Includes front yard sprinkler system, security system, 2 car ga- rage, and washers, dryers, and refrigerators. Great opportunity for owner occupants or investors. $139,900. Call Kyle Pattillo 957- 1267 or 521-6611. MLS#: 651485 OPEN HOUSE 2-4 RIGGINS CONSTRUCTION & DEVELOPMENT, WINNER of 6 Parade of Homes 2012 awards & OVERALL BUYERS CHOICE home builder offering new custom homes with low-e windows, crown molding, hand scraped hardwood flooring, granite counter tops, wired for security system, plumbed for central vac, & iPod ready stereo intercom offered in many multi level homes. $195,900. Hosted by HEATHER JOHNSON I-540/W ON ELM SPRINGS RD/N ON BALL TO LEGENDARY S/D ENTRANCE 7368 DEVONSHIRE SPRINGDALE NEW LISTING LINCOLN ? 263 BEAUTIFUL FAMILY HOME on 11 acres with privacy yet close to town. Large vaulted living space with 2 din- ing areas. Brick & vinyl exterior for low main- tenance. Above ground pool, large wood deck, utility shed & storage building. Large private driveway. $188,500. Call Gary Boyle 263-7727 or 521-6611. MLS#: 662221 NEW LISTING SPRINGDALE ? 317 SPACE, STYLE, AND LOCA- TION in Southwind Terrace S/D! Amazing 4,400 sq ft home perfect for the growing family equipped w/ a basement apartment/mother-in-law suite! 5 bdrms, 3.5 baths, 3 living areas, frml dining, office, EIK w/ 3cm granite counter tops, see through fireplace, tons of updating!! $369,900. Call Melanie Gabel 422- 4221 or 521-6611. MLS#: 662389 NEW LISTING SPRINGDALE ? 360 RIGGINS CONSTRUCTION & DEVELOPMENT, WINNER of 6 Parade of Homes 2012 awards & OVERALL BUYERS CHOICE home builder offering new custom homes with low-e win- dows, crown molding, hand scraped hardwood floor- ing, granite counter tops, wired for security system, plumbed for central vac, & iPod ready stereo inter- com offered in many multi level homes. $132,900. Call Kendall Riggins 957-6002 or 521-6611. MLS#: 662575 FAYETTEVILLE 73 RIGGINS CONSTRUCTION HOME has covered outdoor living area w/fireplace & patterned, stained concrete measures ~ 3 Bedrooms and Office! Kitch- en includes Island w/sink, walk in pantry & stainless steel appliances. Granite counters, powder room, hardwood floors. 2nd level includes 2 bedrooms and full bath. $224,900. Call John Carpenter 957-8181 or 521-6611. MLS#: 660774 BENTONVILLE 97 RIGGINS CONSTRUCTION & DEVELOP- MENT, WINNER of 6 Parade of Homes 2012 awards & OVERALL BUYERS CHOICE home builder offering new custom homes with low-e windows, crown molding, hand scraped hardwood flooring, granite counter tops, wired for security system, plumbed for central vac, & iPod ready stereo intercom offered in many multi level homes. $438,500. Call Kendall Rig- gins 957-6002 or 521-6611. MLS#: 660936 FAYETTEVILLE 314 CUTE 3BR HOME IN WILLOW SPRINGS. Privacy fence & Rainbird sprin- kler system, tile floors. $129,900. Call Chase Miller 530-9777 or 521-6611. MLS#: 660191 FAYETTEVILLE 525 GREAT LOCATION for U of A stu- dents. Less than one mile from U of A. 3 BRS, 2.5 baths, oversized fenced lot for pets. Zoned for residential or commercial. Well positioned for salon, spa or rental investment. $127,900. Call Linda Gaddy 236-1886 or Anna Mullis-Manthe 957- 7678 MLS#: 657402 FAYETTEVILLE 897 CHARMING BUNGALOW conveniently lo- cated to UofA campus, downtown Fayetteville & easy access to I-540. This home has living room, eat-in kitchen, two bedrooms & one bathroom. Lots of nice trees & some recent updates. Great in- vestment property! $75,000. Call Martha Hague- wood 601-7921 or 521-6611. MLS#: 650760
HINDSVILLE 341 ALL BRICK HOME with metal roof, top of hill, great barn and shed, good works pens, nice garden area, great view, spring fed pond, good fences. $199,900. Call Tex Holt 479-530-1191. MLS#: 642848 FARMINGTON 602 WONDERFUL FAMILY HOME on 1 acre just west of Farmington. Walk out basement area would be great for in-law setup. Just needs kitchenette. Beautifully decorated and nice floor plan. Lots of new or near new items. Low price for a lot of house. Has a lot to offer that you don?t see from the street. $249,000. Call Gary Boyle 263-7727 or 521-6611. MLS#: 656229 SILOAM SPRINGS 910 GREAT PRICE ON A NICE HOME close to all of Siloam Springs. Lots of re- modeling done. New floors, appliances, cabinets, and much more. Privacy fenced backyard and a patio for outdoor enjoy- ment. Low traffic culdesac street. $79,000. Call Gary Boyle 267-7727 or 521-6611. MLS#: 651607 ROGERS 3 BEDROOMS, 4 CAR GARAGE & in- door workshop on one level! Many custom features in this gorgeous Pinnacle home. Travertine flooring, huge master suite w/ unbelievable closet & open floor plan. Call Meza Harris 366- 2626 or Nicki Rogers 659-2631. (640764) CENTERTON SPACE AND CURB APPEAL. 5 BRs or 4 BR & bonus room. Beautiful crown mould- ing throughout. Formal dining w/hard- wood floors. Custom Cabinets, SS appli- ances, granite countertops. $181,000. Call The Moore Team 246- 1683. (654039) ROGERS GOLF MEMBERSHIP CONVEYS when you purchase this 5255 SF Shadow Valley home. 5BR/4BA, bonus room, 3 car garage! Plan- tation shutters, double sided FP, gourmet kitchen, tornado shelter & sunroom. Call Meza Harris 479-366-2626 or Nicki Rogers 479-659-2631. (657896) OPEN HOUSE 2-4 IN SHADOW VALLEY COUNTRY CLUB. Corner lot w/fenced in backyard. Granite countertops, hardwood floors, cov?d deck, faux finishes, office & bonus room. Comes w/golf membership valued at $5,000. $369,000. Hosted by Cory Parker. (649908) From I-540 take Promenade Exit/East to Pinnacle after circle take left/Right to Southgate Road/Left into Shadow Valley subd/At stop sign, make a Right to Shadow Valley Rd/Right to Osage Creek/Left on Inglewood Ct/House on corner 7001 INGLEWOOD CT ROGERS NEW LISTING BENTONVILLE ? NORTH BENTONVILLE HOME CLOSE TO EVERYTHING! 4BR/5.5BA, 3 car garage. Wine cellar, media room, master suite with his & her baths, large flat yard & deck w/built-in gas grill. Call Meza Harris 479- 366-2626 or Nicki Rogers 479-659-2631. (662301) PINEVILLE 205 ACRE FARM w/2 acre pond, fenced & cross fenced, leased for cattle, 3BR, 2 bath, double wide mobile home that rents for $500/month. Main house is 2600 sq ft w/3BR/2 baths! Call Bernard Jones 479- 633-5290. (631019) ROGERS CUSTOM HOME BACK ON THE MAR- KET. Maintenance free, handicapped ac- cessible. Large living room w/woodburning FP. Large Master, walk in closets, 3BR/3BA. Beautiful kitchen, load of built-ins. 67 sq ft. Call Connie Bentley 640-0126 or 246- 1613. (604714) ROGERS LAKEFRONT w/easy access to water & dock! Close to town yet private w/4BR/3 full baths & 2 car garage! Open & bright w/windows & balconies to enjoy the lakev- iew! Call Meza Harris 479-366-2626 or Nicki Rogers 479- 659-2631. (653318) BENTONVILLE ALL BRICK HOME ON CORNER LOT PRICED TO SELL. Pergo floors, large great room with fireplace, sunroom, nice master suite and fenced yard. Call Phil Fielding 479-531-7941. (658439) BELLA VISTA GREAT STARTER HOME. 3BR/2 full baths, oversized garage w/workshop area. Nice deck overlooking woods. Cul-de-sac. Large kitchen, dining & living room. Bentonville schools. Only $89,000. Motivated seller. Call Amy Rollins 479-366-7677. (657989) NOEL RUSTIC, CAPE COD STYLE HOUSE with azalea garden on 40 or 50 acres SET IN Pine trees. 2 story, 3 bed/2 bath with beautiful view and very peaceful. 30?60 shop and carport. Call Maydelle Bayona. (651896) NEW LISTING BENTONVILLE ? CLOSE TO CRYSTAL BRIDG- ES in the Chapel Hill subd! 4800 SF, 4BR/4.5BA, 3 car garage. Community pool, recreation room & trails! Gorgeous woodwork, mouldings, wood floors & architectural detail. Media & game room. Call Meza Harris 479-366-2626 or Nicki Rogers 479-659- 2631. (662129) NEW LISTING BENTONVILLE ? EVERYTHING you could want in this custom built 3 level home in a sought out after neighborhood. 5BR, 3 car garage, 4922 SF, in ground pool. $498,500. Call Fred Johnson 531-8233 or Janice Smith 366-4482. (662536) ROGERS VARIOUS SIZES OF LEASE SPACE ON WALNUT STREET. Excellent signage, great place for your retail/office needs. Call Jeff Allen 246-1657. (648248) ROGERS $117,000. VERY UNIQUE 2,034 SQ FT HOME. 3 bedroom, one of a kind. High wood ceilings and large living area. Call Kathy Bell 479-531-3876. (654805) ROGERS NEW CONSTRUCTION IN THE PEAKS by Promenade Mall! 3BR/2.5BA, large bo- nus room, formal dining, eat-in kitchen & 3 car garage! Wood flooring, crown mould- ing & granite! Call Meza Harris 366-2626 or Nicki Rogers 659- 2631. (650956) BELLA VISTA PRICED TO SELL! Cute 3BR/2BA on quiet street close to Metfield Golf. New carpet & fresh paint throughout. Detached workshop 18?x13 w/overhead door. Fire- place in den. Only $94,500. Call Ruby Ball 621-1233. (608286) JOPLIN GATED GORGEOUS ESTATE ON 10 ACRES M/L. Pond, 10,820 SF, 3 car ga- rage, 3 baths, basement. Built in 2002 (RV parking w/water, elec). 3/4 iron fence in footing, detached workshop with 1/2 bath. Call Maydelle Bayona. (643025) PEA RIDGE BIG SUGAR BEAUTY! Beautiful 4BR home sitting on a large, very private lot just above Big Sugar Golf Course. Multi-coffed ceilings, beautiful woodwork. 3 car garage, large covered patio! Only $309,000. Call Martha Prowell 640-4633. (654313) NEW LISTING ROGERS ? 1 LEVEL 1550 SQ FT UP- DATED BRICK HOME IS READY FOR YOU! 3BR/2 bath, open kitchen/family room, perfect for entertaining. $119,900. Call Nancy Jones 936-4005 or Tayna Sage 877-0396. (662328) NEW LISTING BENTONVILLE ? CUTE AND NEAT 3BR/ 2BA. Like new interior w/many additional improvements, large master BR and bath. Corner fireplace & beautiful ceiling treat- ment create the perfect living area. Call Martha Odle. (662416) BENTONVILLE YES, YOU CAN HAVE IT ALL! Beauti- ful private home on 2.80 acres minutes to I-540, downtown B?ville & Walmart HO. Saltwater swimming pool w/cool decking. Split floor plan, tile & wood floors. Extra storage. B?ville schools. Call Maria Fairch- ild or Cory Parker. (656888) ROGERS HOUSE & 20 ACRES OF PASTURE within minutes of downtown Rogers. 3200 SF ranch style home. Sunroom, in- ground pool, 8 car garage. 5760 SF pole barn plus horsebarn. $875,000. Call Fred Johnson 531-8233 or Janice Smith 366- 4482. (628618) ROGERS 1.67 +/- AC TRACT W/HOME OFFICE/ GREENHOUSE. Irrigated, shade, build- ings, storage or shop areas. Zoned C-2, 205? +/- frontage on Hwy 102/Hudson. Only 1.5 miles to I-540. Call Bill McClard. (653890) ROGERS AMAZING LOCATION W/3.1 ACRES AVAILABLE. Endless possibilities! Flat land, high traffic count. Zoned industrial on each side. Prime commercial location! Farm house in good shape. Call Meza Harris 366-2626 or Nicki Rogers 659-2631. (543306) ROGERS LOCATION, LOCATION! 3108 SF beauty w/4BRs & bonus room on 0.68 acre cul- de-sac lot in Bel Air Subd off Olive & 28th! Fantastic curb appeal, lovely interior w/ex- tra storage & superb lot! Call Meza Harris 479-366-2626 or Nicki Rogers 479-659- 2631. (657957) BELLA VISTA $53,100. FANNIE MAE. B?ville schools. 2-3 BR, 2 BA, lovely 4 Season room, up- dated. Private yard w/fence. 1443 h/c SF (m/l) + additional 336 SF. Call Holli Car- penter 479-644-1853. (658085)
OPEN HOUSE 2-4 BEAUTY IN BELLA VISTA! 2BR/2BA, over 1400 SF. Will not be disappointed in what you see inside & out! Lots of updates, nice sized bedrooms, huge deck w/ enclosed patio. Well cared for home in great location. Only $127,500. Hosted by Jennifer Fuller. (661030) 71 North to Trafalgar/East to Commonwealth/Turn Right, then Left on Duxford Circle on your Left 3 DUXFORD CIR BELLA VISTA NEW LISTING GARFIELD ? 8.95 ACRES MOSTLY ROLLING PASTURE LAND with a single wide mobile home consisting of 924 sq ft, 3 bedrooms and 2 baths. Includes a separate barn/shop. $65,000. Call Jeff Mortensen 640-2900. (662207) CENTERTON TRULY A BEAUTIFUL, SPACIOUS HOME! 4BR/2BA, 2600 SF. Enjoy a summer barbeque in the private fenced backyard. Don?t miss seeing this beautiful spacious home. Priced to sell at $199,900. Call Mary Halstead 381-7075. (657232) BENTONVILLE WONDERFUL NEW CONSTRUCTION HOME by Riggins with all the bells & whistles! 3411 +/- SF under construction in Quailridge. Hurry to pick your colors! $326,112. Call Deb Welch to see it 640- 7654. (656761) ROGERS NEAT HOME FOR 1ST TIME BUYERS. 2 bedroom, wood floors, some new win- dows, refrigerator stays. Large lot, 17?12 storage building. $54,500. Call Connie Bentley 640-0126 or 246-1613. (658682) ROGERS ADORABLE ALL BRICK, MAINTE- NANCE FREE HOUSE. One owner well maintained 1500 SF. 3BR/2BA, large living room w/brick FP w/gas logs. Split BR plan, cov?d patio, large fenced backyard. Great neighborhood. All for only $115,000. Call Martha Prowell. (657993) BENTONVILLE THE GREENEST YARD ON THE STREET! Huge living room w/vaulted ceil- ing and gas log fireplace. 3 Bd/2 Bath with fenced backyard. All brick exterior. Call Meza Harris 479-366-2626 or Nicki Rog- ers 479-659-2631 (652613) CAVE SPRINGS 4 BED/3.5 BATH 2,755 SQ FT HOME on .82 acre. Large open kitchen & family room. Beautifully trimmed out! Wood floors and much more. ?Bentonville Schools? Call Jeff Mortensen 640-2900.(622507) SPRINGDALE ESTATE HOME. 6000 SF, 5BR/4.5BA + 12 acres & guest house. Bring the horses, 4 stall pole barn, indoor heated pool with waterfall slide and diving board. So beauti- ful, your guests won?t want to leave. Call Maydelle Bayona 936-1035. (617004) OPEN HOUSE 1-3 COUNTRY LIVING W/CITY AMENITIES. Close to downtown Rogers & 540. Located in beautiful Brush Creek. Lg 2BD/2.5BA, sunroom, screened porch, 2 car garage sitting on a wooded lot. Hosted by Janice Smith $129,900 (656741) Hwy 94 N, R into middle entrance of Brush Creek onto Yocam, R onto Alton Circle to property. 53 ALTON CIR ROGERS NEW LISTING SPRINGDALE ? LOVELY WELL MAIN- TAINED HOME in well established subd. A must see 3BR/2BA, LR, study, spacious family room w/woodburning FP. Beautiful fenced backyard w/storage/shop, cov?d patio. 2 car garage. $129,900. Call Ben Carson 531-2462. (662296) ROGERS NESTLED NEAR HOBBS STATE PARK & WAR EAGLE, you?ll find a well main- tained home with charm & warmth. 4BR/2 bath and carport. Call Martha Prowell 479-640-4633. (647540) ROGERS LAKE FRONT PROPERTY, great views, easy to water. Completely remodeled & updated 2011. Like new, over 3000 SF, 3BR/3BA, 3 FPs, large deck & patio, boat slip w/left + 2 ski lifts. Only $399,000. Call Martha Prowell for your private showing today. 479-640- 4633 (656657) BENTONVILLE 6000 SF DESIGNED FOR DISTINCTIVE TASTE. 5 bedrooms, over 5 bathrooms, 2 living areas with media system, exquisite lighting, 2 FPs, gorgeous cabinetry, large pool & trek decks, 3 bay garage. $735,000. Call the Moore Team 246-1683. (649253) BENTONVILLE BRAND NEW! En- ergy efficient Craftsman style new homes. Lots of ameni- ties, great location and very affordable. 3 bedrooms and 2 full baths. $131,500. Call Fred Johnson 531-8233 or Janice Smith 366-4482. (641995) BENTONVILLE MUSEUM DISTRICT! Great 5-plex close to Crystal Bridges. Extremely nice units. Great income potential. $186,500. Call Ted Viala. (651957) CENTERTON SPECTACULAR BRICK HOME of ex- treme quality. Hardwood floors through- out except tile in wet areas. Huge privacy fenced yard w/covered patio. Security sys- tem. Move in ready. $127,000. Call Donna Bell 479-644-1982 dbell@lindsey.com or Eric Bell 479-544-6135 ebell@lindsey. com (649624) CAVE SPRINGS CENTRALLY LOCATED TO ALL OF NWA! 4BR home offers office, game room, 3 car garage, formal dining & stor- age on 0.6 acre lot! Neighborhood pool & clubhouse in beautiful subd. Call Meza Harris 479-366-2626 or Nicki Rogers 479- 659-2631. (653933)
3 OPEN HOUSES 2-4 NEW CONSTRUCTION IN WARREN GLEN. 4 bedrooms, 3 baths, 3 car garage. 4502 and 4506 has a formal dining & living room, family room & bonus room. 4503 has formal dining, family room & bonus room. Lots of wood flooring, granite, gas cook top, wall oven, fenced backyards. Community pool. Hosted by Jerry Danehower. From SW Bellview St, turn West on West Dr then North on SW 46th St/Right on Warbal St/Left on SW 45th St/Left on Mourning Dove
Filed under : Bella Vista, Bentonville, Cave Springs, Centerton, Fayetteville, Garfield, Hindsville, Lincoln, Lindsey & Associates, Lowell, Pea Ridge, Prime Location, Rogers, Siloam Springs, Springdale
When Qa?im (Shia refer to their Mahdi as Al-Qa?im) appears, they (the Shia) will bring every Nasib (a term used by Shia to refer to Sunnis) to him (Shia?s Mahdi). If he (the Nasib) accepts I
slam, and it is recognition of Al-Wilaya (meaning Imam Ali is Representative of God), he will be freed; otherwise his head will be cut off. Alternatively, if he accepts jizyah (penalty tax), he will be required to pay as a Zhimmi (Zhimmi is a status given by Islam to Christians & Jews).. ( Baqir Al-Majlisi?s Bihar Al-Anwar, Vol. 52, page 373 and Furat ibn Ibrahim?s Tafseer , page 100)
They (Sunnis) may marry from us and inherit from us until the Mahdi emerges. He starts by killing the scholars of the Sunnis and then ordinary Sunnis.? (Baqir Al-Majlisi?s Haq Al-Yaqeen)
In a narration attributed to Imam Abu Abdullah [a.s.], (Shia?s 6th Imams), he says: ?As mankind realize what is going to be done by Al-Qaim (Shia?s Mahdi) when he appears, most people will prefer not to see him because of the killings he will do to mankind, it makes most mankind say: ' He is not from the House of Muhammad, if he were from the House of Muhammad, he would certainly have compassion.' ? (Baqir Majlisi, Bihar Al-Anwar, Vol. 52, page 353)
Indeed, most the killings (by the Mahdi & his followers) that happen to mankind will be directed against the Muslims. Then, he (Shia?s Mahdi) will distribute a copy of his book (a new scripture, not the current Quran)...? (Sayyid Husein Al-Musawi, Li Allah Thumma Li Tarikh, p.137)
For those in our (Shia?s) State who differ with us, there is a punishment. God has made their blood Halal (permissible to be shed) when our Qa?im (Shia?s Mahdi) emerges.?( Baqir Al-Majlisi?s Bihar Al-Anwar, Vol. 50, p. 373)
An ongoing legal battle regarding gene patents began in 2009 when the ACLU representing numerous clients sued Myriad Genetics and the USPTO. The dispute is over patents on two genes, BRCA1 and BRCA2, discovered in the 1990s which have a correlation to increased rates of breast and ovarian cancer.
The case subsequently went to the Federal Appeals Court that handles biotechnology patents, the Supreme Court, and was earlier this year remanded back to the Federal Appeals Court. On August 16, 2012 the Federal Appeals Court reaffirmed that gene patents are legal. So, why did the activists lose the legal battle?
Whether you are conservative, liberal, or libertarian, or an expert or amateur patent attorney or molecular biologist; the odds are that you have objections to gene patents and made up your mind based on uniformed opinions. The Federal Appeals Court decided that these arguments are misconceptions and consequently were not very convincing. If you are an activist, do you know what a gene patent actually means? Do you know what actually receives patent protection?
In the law suit, the plaintiffs argued that gene patents violate the First Amendment and are therefore invalid and unconstitutional, because genes are products of nature. The court wisely determined everything is a product of nature, but is not always natural. Man derives baseball bats from the wood of ash trees, then carves them in to a desired shape and receives patent protection.
Similarly, isolated BRCA genes are chemically distinct from natural DNA. In nature, BRCA genes are covalently bonded and from a chemist?s perspective they are different molecules than the isolated version. Although the information in both versions of the genes is identical, the patents are on a physical entity. That entity is a molecule, similar to the naturally occurring molecules insulin, EPO, and penicillin produced by man which have also received patent protection.??
Activists routinely refer to ownership of genes which they perceive as immoral. In patent law, however, gene patents do not convey ownership of a gene, rather are a property right guaranteed by the Constitution which temporarily excludes others from receiving financial rewards from a patent holder?s work. Furthermore, the Thirteenth Amendment which abolished slavery prohibits owning genes.
The plaintiffs also argued that the gene patents restrict scientific research. However, the evidence does not support this claim. A National Academy of Sciences study(2003) conducted by Walsh, Arora, and Cohen found:
"Changes in technology and policy over the last several decades have led to concerns that the patent system may be creating difficulties for those trying to perform research in biomedical fields. However, we find that drug discovery has not been substantially impeded by these changes. We also find little evidence that university research has been impeded by concerns about patents on research tools. Rather researchers managed to adopt solutions or work around the problems through licensing, going offshore, using public data, legal action,and infringement."
Furthermore, according to statistics compiled by Bloomberg News more than 18,000 scientists have researched the BRCA genes publishing more than 9,000 research papers.?
The second major dispute of the lawsuit alleges that Myriad?s $3000 screening test for mutations on the BRCA genes is too expensive and restricts access to medical care although it is covered by health insurance. However, a study conducted by Duke University researchers found that contrary to expectations, the BRCA screening test is not particularly costly relative to other tests.
The Duke study found that systemic transaction costs that exist within the medical industry are responsible for high medical costs in general. According to Genomics Law Report, Myriad?s revenues for the diagnostic test reached over $400 million during the company?s most recent fiscal year. Myriad?s BRCA patents are set to expire in 2015.
ScienceDaily (Aug. 20, 2012) ? A humble soil bacterium called Ralstonia eutropha has a natural tendency, whenever it is stressed, to stop growing and put all its energy into making complex carbon compounds. Now scientists at MIT have taught this microbe a new trick: They've tinkered with its genes to persuade it to make fuel -- specifically, a kind of alcohol called isobutanol that can be directly substituted for, or blended with, gasoline.
Christopher Brigham, a research scientist in MIT's biology department who has been working to develop this bioengineered bacterium, is currently trying to get the organism to use a stream of carbon dioxide as its source of carbon, so that it could be used to make fuel out of emissions. Brigham is co-author of a paper on this research published this month in the journal Applied Microbiology and Biotechnology.
Brigham explains that in its natural state, when the microbe's source of essential nutrients (such as nitrate or phosphate) is restricted, "it will go into carbon-storage mode," essentially storing away food for later use when it senses that resources are limited.
"What it does is take whatever carbon is available, and stores it in the form of a polymer, which is similar in its properties to a lot of petroleum-based plastics," Brigham says. By knocking out a few genes, inserting a gene from another organism, and tinkering with the expression of other genes, Brigham and his colleagues were able to redirect the microbe to make fuel instead of plastic.
While the team is focusing on getting the microbe to use CO2 as a carbon source, with slightly different modifications the same microbe could also potentially turn almost any source of carbon, including agricultural waste or municipal waste, into useful fuel. In the laboratory, the microbes have been using fructose, a sugar, as their carbon source.
At this point, the MIT team -- which includes chemistry graduate student Jingnan Lu, biology postdoc Claudia Gai, and is led by Anthony Sinskey, professor of biology -- have demonstrated success in modifying the microbe's genes so that it converts carbon into isobutanol in an ongoing process.
"We've shown that, in continuous culture, we can get substantial amounts of isobutanol," Brigham says. Now, the researchers are focusing on finding ways to optimize the system to increase the rate of production and to design bioreactors to scale the process up to industrial levels.
Unlike some bioengineered systems in which microbes produce a wanted chemical within their bodies but have to be destroyed to retrieve the product, R. eutropha naturally expels the isobutanol into the surrounding fluid, where it can be continuously filtered out without stopping the production process, Brigham says. "We didn't have to add a transport system to get it out of the cell," he says.
A number of research groups are pursuing isobutanol production through various pathways, including other genetically modified organisms; at least two companies are already gearing up to produce it as a fuel, fuel additive or a feedstock for chemical production. Unlike some proposed biofuels, isobutanol can be used in current engines with little or no modification, and has already been used in some racing cars.
The work is funded by the U.S. Department of Energy's Advanced Research Projects Agency -- Energy (ARPA-E).
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The above story is reprinted from materials provided by Massachusetts Institute of Technology, via EurekAlert!, a service of AAAS. The original article was written by David Chandler.
Note: Materials may be edited for content and length. For further information, please contact the source cited above.
Journal Reference:
Jingnan Lu, Christopher J. Brigham, Claudia S. Gai, Anthony J. Sinskey. Studies on the production of branched-chain alcohols in engineered Ralstonia eutropha. Applied Microbiology and Biotechnology, 2012; DOI: 10.1007/s00253-012-4320-9
Note: If no author is given, the source is cited instead.
Disclaimer: Views expressed in this article do not necessarily reflect those of ScienceDaily or its staff.
Although females consideration pregnancy like a fantastic and unforgettable experience, other people recall it as a time of cramps, aches, acid reflux, feeling sick, and pressing desires. These pointers had been published to help you comprehend and control some of the things that your whole body is certainly going via. Get a couple of minutes to see and appreciate this beneficial report.
Consuming too much and achieving unneeded bodyweight during pregnancy can result in the difficult job of burning off everything that weight later. There is no need to double the level of what you eat. To ensure that the infant appropriately expands and grows, you should eat one more 200-300 calorie consumption daily, specifically during the last six months of childbearing.
If your spouse are planning to start up a loved ones, you must every single pay a visit to having a medical doctor for a check out-up. This enables you to plan exams that are based on your individual medical history. This is an opportunity to inquire about pregnancy and be sure do you know what you will get into.
Preserving physical exercise that is certainly harmless for expectant women is an integral part of the healthy actions you need to get while being pregnant. It has a number of results, such as protecting against miscarriages, lowering labor time, and making it easier to slim down after having a baby.
Once you know you will be expecting a baby, but don?t want other individuals to know however, you can find solutions to blow off of alcoholic drinks without getting discovered. One particular method is to tell individuals you will be on an anti-biotic. You can also make-believe to be enjoying wines by placing a red-tinted juice, for example cranberry juice, in your glass. If you?re much more of a white colored wines drinker, try consuming white colored grape fruit juice. Of course, if this doesn?t operate, you may resort to the school many years secret of hauling all around an alcohol and preparing it on the basin when nobody?s hunting. Your partner?s assistance is usually necessary in this particular charade however.
Treat problems, like acid reflux and queasiness, with home cures. Take note that a majority of the over the counter medicines for these kind of disorders aren?t suited to females which can be pregnant simply because they can leads to lots of terrible side effects. Speak to your medical professional for potential home made remedies which provide you reduction while sparing your baby damage.
Build an everyday schedule. Pay specific focus to planning for your bed whenever you strategy your brand-new program. This will help to you sleep better, which is often difficult to do during pregnancy. Getting rid of anxiety within the evenings can help you to get to sleeping. A cozy bath can help when making you sleepy, and herbal tea that is certainly clear of caffeinated drinks may help as well.
During expecting, stay away from utilizing salicyclic acidity being an acne cure. It could be very effective for exfoliation and serious cleaning up, but it can be risky for your personal infant. Use milder organic cleansers to help remedy zits throughout prenancy.
Snoring loudly can occasionally boost while being pregnant, even if you in no way snored just before. This occurs simply because being pregnant leads to the nasal membranes to swell. Should your elevated loud snoring will become upsetting for your companion, use nasal pieces to get rid of your nose passages. Yet another substitute is perfect for your spouse to use hearing plugs.
Rubbing your stomach might be valuable in several ways, it?s best to start off at the conclusion of another trimester. Position two bedroom pillows at your again although resting comfortably in your bed furniture or sofa. Use essential oil in contrast to lotion although kneading your tummy softly. Exercise your inhaling and exhaling techniques and hear comforting audio. Not only will your abdomen advantage, yet your infant is going to be calmed too.
Acid reflux is among the significantly less joyful parts of being pregnant. To remove heartburn symptoms as well as be comfy, make an effort to scale back on meals that create it. Caffeinated drinks, wealthy chocolate and hot food items are common popular culprits of heartburn symptoms. Take in more frequently as well as in smaller portions, making sure the food is properly chewed for far better digestive system.
Not all craving you have, whilst expecting, ought to be pleased. Your establishing child, precisely like you, has particular dietary requirements. Gorging oneself on certain desires only fulfills individuals cravings, not the requirements of your child, so be sure that you still eat well.
Do pelvic tilts to hold lumbar pain under control if you are expecting. This requires receiving down on all fours and changing between the pet cat and cow poses of yoga exercise, that happen to be actually just arching your backbone down and up. Tilting your rear in this fashion can provide wonderful alleviation! In addition, tilts can position your child to make ultimate delivery easier.
Foster oneself along with your baby by attending pre- and postnatal trips and making sure that you consistently receive the required attention. Maternity is in lots of ways the two a health and life-altering encounter, so moms have to stay with a brilliant strategy. Excellent prenatal treatment and postnatal attention is not just a luxury, you should the health of mom and child.
For supplementary points on handprint cufflinks check out Fermin X. Sebeniecher?s site there?s loads of information not outlined in this article, go to Author?s site to uncover more information.
Contact: Sarah McDonnell s_mcd@mit.edu 617-253-8923 Massachusetts Institute of Technology
Distinctive patterns could allow doctors to develop better rehab programs for stroke patients
CAMBRIDGE, MA -- The simple act of picking up a pencil requires the coordination of dozens of muscles: The eyes and head must turn toward the object as the hand reaches forward and the fingers grasp it. To make this job more manageable, the brain's motor cortex has implemented a system of shortcuts. Instead of controlling each muscle independently, the cortex is believed to activate muscles in groups, known as "muscle synergies." These synergies can be combined in different ways to achieve a wide range of movements.
A new study from MIT, Harvard Medical School and the San Camillo Hospital in Venice finds that after a stroke, these muscle synergies are activated in altered ways. Furthermore, those disruptions follow specific patterns depending on the severity of the stroke and the amount of time that has passed since the stroke.
The findings, published this week in the Proceedings of the National Academy of Sciences, could lead to improved rehabilitation for stroke patients, as well as a better understanding of how the motor cortex coordinates movements, says Emilio Bizzi, an Institute Professor at MIT and senior author of the paper.
"The cortex is responsible for motor learning and for controlling movement, so we want to understand what's going on there," says Bizzi, who is a member of the McGovern Institute for Brain Research at MIT. "How does the cortex translate an idea to move into a series of commands to accomplish a task?"
Coordinated control
One way to explore motor cortical functions is to study how motor patterns are disrupted in stroke patients who suffered damage to the motor areas.
In 2009, Bizzi and his colleagues first identified muscle synergies in the arms of people who had suffered mild strokes by measuring electrical activity in each muscle as the patients moved. Then, by utilizing a specially designed factorization algorithm, the researchers identified characteristic muscle synergies in both the stroke-affected and unaffected arms.
"To control, precisely, each muscle needed for the task would be very hard. What we have proven is that the central nervous system, when it programs the movement, makes use of these modules," Bizzi says. "Instead of activating simultaneously 50 muscles for a single action, you will combine a few synergies to achieve that goal."
In the 2009 study, and again in the new paper, the researchers showed that synergies in the affected arms of patients who suffered mild strokes in the cortex are very similar to those seen in their unaffected arms even though the muscle activation patterns are different. This shows that muscle synergies are structured within the spinal cord, and that cortical stroke alters the ability of the brain to activate these synergies in the appropriate combinations.
However, the new study found a much different pattern in patients who suffered more severe strokes. In those patients, synergies in the affected arm merged to form a smaller number of larger synergies. And in a third group of patients, who had suffered their stroke many years earlier, the muscle synergies of the affected arm split into fragments of the synergies seen in the unaffected arm.
This phenomenon, known as fractionation, does not restore the synergies to what they would have looked like before the stroke. "These fractionations appear to be something totally new," says Vincent Cheung, a research scientist at the McGovern Institute and lead author of the new PNAS paper. "The conjecture would be that these fragments could be a way that the nervous system tries to adapt to the injury, but we have to do further studies to confirm that."
Toward better rehabilitation
The researchers believe that these patterns of synergies, which are determined by both the severity of the deficit and the time since the stroke occurred, could be used as markers to more fully describe individual patients' impaired status. "In some of the patients, we see a mixture of these patterns. So you can have severe but chronic patients, for instance, who show both merging and fractionation," Cheung says.
The findings could also help doctors design better rehabilitation programs. The MIT team is now working with several hospitals to establish new therapeutic protocols based on the discovered markers.
About 700,000 people suffer strokes in the United States every year, and many different rehabilitation programs exist to treat them. Choosing one is currently more of an art than a science, Bizzi says. "There is a great deal of need to sharpen current procedures for rehabilitation by turning to principles derived from the most advanced brain research," he says. "It is very likely that different strategies of rehabilitation will have to be used in patients who have one type of marker versus another."
###
The research was funded by the National Institutes of Health and the Italian Ministry of Health.
Written by Anne Trafton, MIT News Office
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Contact: Sarah McDonnell s_mcd@mit.edu 617-253-8923 Massachusetts Institute of Technology
Distinctive patterns could allow doctors to develop better rehab programs for stroke patients
CAMBRIDGE, MA -- The simple act of picking up a pencil requires the coordination of dozens of muscles: The eyes and head must turn toward the object as the hand reaches forward and the fingers grasp it. To make this job more manageable, the brain's motor cortex has implemented a system of shortcuts. Instead of controlling each muscle independently, the cortex is believed to activate muscles in groups, known as "muscle synergies." These synergies can be combined in different ways to achieve a wide range of movements.
A new study from MIT, Harvard Medical School and the San Camillo Hospital in Venice finds that after a stroke, these muscle synergies are activated in altered ways. Furthermore, those disruptions follow specific patterns depending on the severity of the stroke and the amount of time that has passed since the stroke.
The findings, published this week in the Proceedings of the National Academy of Sciences, could lead to improved rehabilitation for stroke patients, as well as a better understanding of how the motor cortex coordinates movements, says Emilio Bizzi, an Institute Professor at MIT and senior author of the paper.
"The cortex is responsible for motor learning and for controlling movement, so we want to understand what's going on there," says Bizzi, who is a member of the McGovern Institute for Brain Research at MIT. "How does the cortex translate an idea to move into a series of commands to accomplish a task?"
Coordinated control
One way to explore motor cortical functions is to study how motor patterns are disrupted in stroke patients who suffered damage to the motor areas.
In 2009, Bizzi and his colleagues first identified muscle synergies in the arms of people who had suffered mild strokes by measuring electrical activity in each muscle as the patients moved. Then, by utilizing a specially designed factorization algorithm, the researchers identified characteristic muscle synergies in both the stroke-affected and unaffected arms.
"To control, precisely, each muscle needed for the task would be very hard. What we have proven is that the central nervous system, when it programs the movement, makes use of these modules," Bizzi says. "Instead of activating simultaneously 50 muscles for a single action, you will combine a few synergies to achieve that goal."
In the 2009 study, and again in the new paper, the researchers showed that synergies in the affected arms of patients who suffered mild strokes in the cortex are very similar to those seen in their unaffected arms even though the muscle activation patterns are different. This shows that muscle synergies are structured within the spinal cord, and that cortical stroke alters the ability of the brain to activate these synergies in the appropriate combinations.
However, the new study found a much different pattern in patients who suffered more severe strokes. In those patients, synergies in the affected arm merged to form a smaller number of larger synergies. And in a third group of patients, who had suffered their stroke many years earlier, the muscle synergies of the affected arm split into fragments of the synergies seen in the unaffected arm.
This phenomenon, known as fractionation, does not restore the synergies to what they would have looked like before the stroke. "These fractionations appear to be something totally new," says Vincent Cheung, a research scientist at the McGovern Institute and lead author of the new PNAS paper. "The conjecture would be that these fragments could be a way that the nervous system tries to adapt to the injury, but we have to do further studies to confirm that."
Toward better rehabilitation
The researchers believe that these patterns of synergies, which are determined by both the severity of the deficit and the time since the stroke occurred, could be used as markers to more fully describe individual patients' impaired status. "In some of the patients, we see a mixture of these patterns. So you can have severe but chronic patients, for instance, who show both merging and fractionation," Cheung says.
The findings could also help doctors design better rehabilitation programs. The MIT team is now working with several hospitals to establish new therapeutic protocols based on the discovered markers.
About 700,000 people suffer strokes in the United States every year, and many different rehabilitation programs exist to treat them. Choosing one is currently more of an art than a science, Bizzi says. "There is a great deal of need to sharpen current procedures for rehabilitation by turning to principles derived from the most advanced brain research," he says. "It is very likely that different strategies of rehabilitation will have to be used in patients who have one type of marker versus another."
###
The research was funded by the National Institutes of Health and the Italian Ministry of Health.
Written by Anne Trafton, MIT News Office
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
A Brokerage relationship is a working relationship, between a licensed real estate broker and a buyer or seller, to engage the services of the licensed broker on behalf of the buyer or seller in acquiring or marketing real property. This relationship may be limited agency or non-agency according to the agreement of the parties. In [...]
Welcome to Reader Rants, the weekly post where the readers take over and have their say. If you want to be a part of a future Reader Rants, like Cagewriter on Facebook and comment on any of the stories that show up in your newsfeed. To start out this week?s rants, not everyone was disappointed [...]
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The television actor, who received an Emmy Award for his work in "My World" and "Welcome to It" and is well-known for his roles on "Star Trek" and "Murder, She Wrote," died in his California home from congestive heart failure on Thursday, according to the New York Times.
Windom was 88.
Real World's Joey Kovar dies at 29
During his early years, Windom joined the army and served as a paratrooper in World War II. He later attended the University of Kentucky, among several other higher-education institutions, and decided to pursue acting.
Windom also appeared on episodes of "The Twilight Zone" and the '60s comedy series "The Farmer's Daughter," where he played a Minnesota congressman, a position served in real-life by his great-grandfather, whom he was named after.
The award-winning actor also landed film roles, including a part in "To Kill a Mockingbird," as the prosecuting attorney who faced off against Gregory Peck's Atticus Finch in court.
Windom is survived by his wife of 37 years, Patricia, and four children, Rachel, Heather, Hope and Rebel.
LONDON (AP) ? Britain's prime minister says the officials charged with doling out the country's knighthoods and other honors will have their work cut out for them in the wake of the London Olympics.
David Cameron told journalists Sunday that the Britain's huge haul of gold medals in the 2012 Games means there will be plenty of options when deciding who Queen Elizabeth II will reward in her semiannual honors list.
Sportsmen and sportswomen are staples of the honors list, which is intended to recognize people from all walks of life for merit, gallantry or service.
Olympians who have already received knighthoods include champion rower Sir Steve Redgrave and Sir Chris Hoy, the Scottish cyclist who won his sixth career gold medal in London.
Health care organizations find risks and opportunities in the quest for reduced costs and improved quality
Rochester, MN, August 2, 2012 Many health care systems across the US have declined to participate in the Centers for Medicare and Medicaid Services' (CMMS) Accountable Care Organization (ACO) program, developed under the Patient Protection and Affordable Care Act (PPACA), to improve efficiency and quality of health care delivery. In a groundbreaking collection of commentaries in the current issue of Mayo Clinic Proceedings, representatives of six leading health care organizations write about the challenges of reducing health care costs while improving health care quality. They further explain why they did or did not choose to participate in one of the two models now operational at CMMS.
"The US Supreme Court's decision upholding the constitutionality of the Patient Protection and Affordable Care Act provides some security for the fates of the Medicare ACO programs and the private sector's parallel initiatives although political rally cries for repeal of the Act continue to be raised in the build-up to the 2012 election," comments David Ballard, MD, MSPH, PhD, Baylor Health Care System, Dallas, TX, Health Care Policy Section Editor for the journal. "Regardless of the ultimate outcome, we should not ignore the current opportunity to learn from these activities and health care organizations' experiences implementing (or not implementing) them. Such study can inform future national and global economic initiatives aimed at lessening health care costs and waste and improving health care value."
The debate over the PPACA has focused primarily on individual coverage, but experts believe that the most critical issue in health care is delivery system reform. "To put it simply, effective access for tens of millions of Americans is at risk not to mention most other public priorities and middle class jobs in a global economy if we fail to improve the efficiency with which high-quality care is delivered," says Len M. Nichols, PhD, of the Center for Health Policy Research and Ethics, George M. Mason University, Fairfax, VA, a contributor to the special report.
ACOs are groups of physicians, hospitals, and other health care providers that are willing to assume responsibility for the care of a clearly defined population of Medicare beneficiaries. If an ACO succeeds in improving care and reducing costs, they receive a share in the savings achieved for Medicare. The CMMS created two ACO programs, the Pioneer Model, with 32 registered organizations, and the Medicare Shared Savings Program (MSSP), with 27 registered organizations. The basic difference is that the Pioneer program has a greater degree of financial risk and reward. "Many highly regarded health systems developed concerns after initial enthusiasm about the MSSP ACO model as a mechanism for accelerating their efforts to reduce costs while improving health care quality," notes Dr. Ballard.
Robert G. Porter, JD, MBA, and Amanda P. Tosto, RN, MS, of St. Louis-based SSM Health Care, consider the lack of beneficiary engagement in the CMMS ACO models to be a serious design flaw in the program. "The rule provides for invisible enrollment, meaning each beneficiary is enrolled on the basis of their claims history without regard for their actual preferences. This type of enrollment isn't consistent with SSMSL's transition to a patient-centered model of care that is based on the development of a transparent partnership among health care professionals, patients, and their families to ensure that decisions respect the patient's wants, needs, and preferences," they say.
Baylor Health Care System would like to file for Medicare Shared Savings ACO designation, but cannot. The program requires patient attribution via the tax identification number of the physician. Many of Baylor's physicians practice in groups that include non-Baylor physicians, with the entire group sharing a single tax ID. Therefore, Baylor would become financially responsible for the patients of physicians who are not part of the ACO. Health Choice, LLC, in Memphis, TN, had concerns about retrospective patient attribution and administrative complexity.
In contrast, the Atlantic Health System has already begun to see benefits from the formation of its ACO. Author David J. Shulkin, MD, of the Morristown Medical Center and Atlantic Health System ACO, Morristown, NJ, explains that in New Jersey's fragmented health system, patients have a 25% greater chance of staying in an intensive care unit and 75% greater use of specialists than the national average. "New Jersey needed a catalyst for change," Dr. Shulkin notes, "and the MSSP presented us with just that option."
The Atlantic Health ACO consists of four geographically based pods, each consisting of a hospital, physicians, and other community-based organizations in the region. Clinical navigators collaborate with primary care physicians to identify patients with short- and long-term care needs and guide them through planned pathways of care. Sixteen "Centers of Excellence" incorporate multidisciplinary approaches to care management. The Cardiac Success program has achieved 4% to 6% 30-day all-cause readmission rates, compared to the national average of 20-25%, by incorporating protocol-based approaches. "Little by little, New Jersey's fragmented health care system is being replaced with coordination and integration," Dr. Shulkin says.
Ascension Health will use its two Pioneer ACOs, Seton Health Alliance ACO and Genesys Physician Hospital Organization, to teach the rest of its large system about both medical and financial management as well as strategies for engaging physicians around values and shared business goals. Creagh E. Milford, DO, and Timothy G. Ferris, MD, MPH, of Partners HealthCare in Boston, MA, cite key differences from the health care reforms of the 1990s that influenced the decision to participate as a Pioneer ACO, including the preservation of patient choice and improved technology and electronic health records.
Dr. Nichols comments that none of the organizations represented in this special report think that the goals of the PPACA or the ACO experiments are misguided, and in fact there is a groundswell of parallel incentive realignments in the private sector as well. For example, Baylor has formed the Baylor Quality Alliance to develop a clinically integrated delivery organization, and is creating disease-management, population-management care delivery protocols and pathways. The BQA expects to sign an ACO contract with the Baylor Health Center System Employee Benefit Plan, and is in discussions with several Medicare Advantage plans and commercial plans.
In an interview with Dr. Ballard, Carl E. Couch, MD, MMM, of Baylor Health Care System, notes that the recent Supreme Court ruling on the PPACA confirms that the country is headed in this direction. "Regardless of the decision and the potential political implications this fall in terms of sustaining or overthrowing the act, the fundamental problems remain. Health care still costs too much and the trajectory of the costs is unsustainable. And we still have serious quality problems that can be best addressed by physicians and hospitals committing themselves in an accountable way to improve them. We have the same work to do whether the law is here or not."
###
Notes for editors
The articles are published in Mayo Clinic Proceedings, Volume 87, Issue 8 (August 2012), published by Elsevier.
Full text of the articles is available to credentialed journalists upon request. Contact Rachael Zaleski at +1 215 239 3658 or mcpmedia@elsevier.com to obtain copies. See article citations below for contact information for individual authors.
"The Potential of Medicare Accountable Care Organizations to Transform the American Health Care Marketplace: Rhetoric and Reality," D.J. Ballard, MD, MSPH, PhD, FACP. DOI: 10.1016/j.mayocp.2012.06.005.
Author contact: DavidBa@BaylorHealth.edu
"Accountable Care Organization Pathways: Diverse but Ultimately Parallel," Len M. Nichols, PhD. DOI: 10.1016/j.mayocp.2012.06.010.
Author contact: lnichol9@gmu.edu
"Ascension Health Partners With Centers for Medicare and Medicaid Services to Provide Patient-Centered Care Through the Pioneer Accountable Care Organization Model," R.D. Anderson, PhD, E. Aderholdt, N. Chenven, MD et al. DOI: 10.1016/j.mayocp.2012.06.004.
"A Modified "Golden Rule" for Health Care Organizations," by C.E. Milford, DO and T.G. Ferris, MD, MPH. DOI: 10.1016/j.mayocp.2012.06.009
Author contacts: Cmilford1@partners.org or Tferris@partners.org
"Building an Accountable Care Organization for All the Wrong Reasons," D.J. Shulkin, MD. DOI: 10.1016/j.mayocp.2012.06.012.
Author contact: 973 971 5450 or David.Shulkin@atlantichealth.org
"Why Baylor Health Care System Would Like to File for Medicare Shared Savings Accountable Care Organization Designation but Cannot," C.E. Couch, MD, MMM. DOI: 10.1016/j.mayocp.2012.06.011.
Author contact: carlc@BaylorHealth.edu
"A Physician Hospital Organization's Approach to Clinical Integration and Accountable Care," G. Mayzell, MD, MBA. DOI: 10.1016/j.mayocp.2012.06.019.
Author contact: mayzellg@myhealthchoice.com
"The SSM Health Care Approach to Achieving "True North": Improving Health Care Quality While Reducing Costs," R.G. Porter, JD, MBA, A.P. Tosto, RN, MS. DOI: 10.1016/j.mayocp.2012.06.008.
Author contact: Robert_Porter@ssmhc.com
Videos of Dr. Ballard interviewing contributors about their organizations' decision to enroll in CMMS's ACO program, and the changes in store for physicians and health systems can be found at:
www.youtube.com/watch?v=90HMhC4e0GM (Shulkin)
www.youtube.com/watch?v=hXwp4azHLqI (Couch)
www.youtube.com/watch?v=EgCfzb6I3Bw (Haydar)
About the authors
David J. Ballard, MD, MSPH, PhD, FACP, Baylor Health Care System, Dallas, TX
Len M. Nichols, PhD, Center for Health Policy Research and Ethics, George Mason University, Fairfax, VA
Raymond D. Anderson, PhD, Ascension Health, St. Louis, MO
Elizabeth Aderholdt, Genesys Regional Medical Center, Grand Blanc, MI
Norman Chenven, MD, Austin Regional Clinic, Austin, TX
Meredith Duncan, Seton Health Alliance, Austin, TX
Nancy Haywood, Genesys Regional Medical Center, Grand Blanc, MI
Michael James, Genesys PHO, Grand Blanc, MI
Samson Jesudass, MD, Seton Healthcare Family, Austin, TX
Amy M.H. Johnson, Ascension Health, St. Louis, MO
Gary King, MD, Genesys PHO, Grand Blanc, MI
Greg Sheff, MD, Seton Health Alliance, Austin, TX
Creagh E. Milford, DO, Massachusetts General Hospital, Boston, MA
Timothy G. Ferris, MD, MPH, Massachusetts General Hospital and Partners HealthCare, Boston, MA
David J. Shulkin, MD, Morristown Medical Center and Atlantic Health System Accountable Care Organization, Morristown, NJ
Carl E. Couch, MD, MMM, Baylor Health Care System, Dallas, TX
George Mayzell, MD, MBA, Health Choice, LLC, Memphis, TN
Robert G. Porter, JD, MBA, SSM Health Care, St. Louis, MO
Amanda P. Tosto, RN, MS, ECG Management Consultants, Inc., St. Louis, MO
About Mayo Clinic Proceedings
The flagship journal of Mayo and one of the premier peer-reviewed clinical journals in general medicine, Mayo Clinic Proceedings is among the most widely read and highly cited scientific publications for physicians, with a circulation of approximately 124,000. While the Proceedings is sponsored by Mayo Clinic, it welcomes submissions from authors worldwide, publishing articles that focus on clinical medicine and support the professional and educational needs of its readers. The journal's mission is to promote the best interests of patients by advancing the knowledge and professionalism of the physician community. www.mayoclinicproceedings.org
About Mayo Clinic
Mayo Clinic is a nonprofit worldwide leader in medical care, research, and education for people from all walks of life. For more information visit www.mayoclinic.org/about / and www.mayoclinic.org/news.
About Elsevier
Elsevier is a world-leading provider of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including The Lancet and Cell, and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier's online solutions include ScienceDirect, Scopus, Reaxys, ClinicalKey and Mosby's Nursing Suite, which enhance the productivity of science and health professionals, and the SciVal suite and MEDai's Pinpoint Review, which help research and health care institutions deliver better outcomes more cost-effectively.
A global business headquartered in Amsterdam, Elsevier employs 7,000 people worldwide. The company is part of Reed Elsevier Group PLC, a world-leading publisher and information provider, which is jointly owned by Reed Elsevier PLC and Reed Elsevier NV. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Health care organizations quest for reduced costs and improved qualityPublic release date: 2-Aug-2012 [ | E-mail | Share ]
Health care organizations find risks and opportunities in the quest for reduced costs and improved quality
Rochester, MN, August 2, 2012 Many health care systems across the US have declined to participate in the Centers for Medicare and Medicaid Services' (CMMS) Accountable Care Organization (ACO) program, developed under the Patient Protection and Affordable Care Act (PPACA), to improve efficiency and quality of health care delivery. In a groundbreaking collection of commentaries in the current issue of Mayo Clinic Proceedings, representatives of six leading health care organizations write about the challenges of reducing health care costs while improving health care quality. They further explain why they did or did not choose to participate in one of the two models now operational at CMMS.
"The US Supreme Court's decision upholding the constitutionality of the Patient Protection and Affordable Care Act provides some security for the fates of the Medicare ACO programs and the private sector's parallel initiatives although political rally cries for repeal of the Act continue to be raised in the build-up to the 2012 election," comments David Ballard, MD, MSPH, PhD, Baylor Health Care System, Dallas, TX, Health Care Policy Section Editor for the journal. "Regardless of the ultimate outcome, we should not ignore the current opportunity to learn from these activities and health care organizations' experiences implementing (or not implementing) them. Such study can inform future national and global economic initiatives aimed at lessening health care costs and waste and improving health care value."
The debate over the PPACA has focused primarily on individual coverage, but experts believe that the most critical issue in health care is delivery system reform. "To put it simply, effective access for tens of millions of Americans is at risk not to mention most other public priorities and middle class jobs in a global economy if we fail to improve the efficiency with which high-quality care is delivered," says Len M. Nichols, PhD, of the Center for Health Policy Research and Ethics, George M. Mason University, Fairfax, VA, a contributor to the special report.
ACOs are groups of physicians, hospitals, and other health care providers that are willing to assume responsibility for the care of a clearly defined population of Medicare beneficiaries. If an ACO succeeds in improving care and reducing costs, they receive a share in the savings achieved for Medicare. The CMMS created two ACO programs, the Pioneer Model, with 32 registered organizations, and the Medicare Shared Savings Program (MSSP), with 27 registered organizations. The basic difference is that the Pioneer program has a greater degree of financial risk and reward. "Many highly regarded health systems developed concerns after initial enthusiasm about the MSSP ACO model as a mechanism for accelerating their efforts to reduce costs while improving health care quality," notes Dr. Ballard.
Robert G. Porter, JD, MBA, and Amanda P. Tosto, RN, MS, of St. Louis-based SSM Health Care, consider the lack of beneficiary engagement in the CMMS ACO models to be a serious design flaw in the program. "The rule provides for invisible enrollment, meaning each beneficiary is enrolled on the basis of their claims history without regard for their actual preferences. This type of enrollment isn't consistent with SSMSL's transition to a patient-centered model of care that is based on the development of a transparent partnership among health care professionals, patients, and their families to ensure that decisions respect the patient's wants, needs, and preferences," they say.
Baylor Health Care System would like to file for Medicare Shared Savings ACO designation, but cannot. The program requires patient attribution via the tax identification number of the physician. Many of Baylor's physicians practice in groups that include non-Baylor physicians, with the entire group sharing a single tax ID. Therefore, Baylor would become financially responsible for the patients of physicians who are not part of the ACO. Health Choice, LLC, in Memphis, TN, had concerns about retrospective patient attribution and administrative complexity.
In contrast, the Atlantic Health System has already begun to see benefits from the formation of its ACO. Author David J. Shulkin, MD, of the Morristown Medical Center and Atlantic Health System ACO, Morristown, NJ, explains that in New Jersey's fragmented health system, patients have a 25% greater chance of staying in an intensive care unit and 75% greater use of specialists than the national average. "New Jersey needed a catalyst for change," Dr. Shulkin notes, "and the MSSP presented us with just that option."
The Atlantic Health ACO consists of four geographically based pods, each consisting of a hospital, physicians, and other community-based organizations in the region. Clinical navigators collaborate with primary care physicians to identify patients with short- and long-term care needs and guide them through planned pathways of care. Sixteen "Centers of Excellence" incorporate multidisciplinary approaches to care management. The Cardiac Success program has achieved 4% to 6% 30-day all-cause readmission rates, compared to the national average of 20-25%, by incorporating protocol-based approaches. "Little by little, New Jersey's fragmented health care system is being replaced with coordination and integration," Dr. Shulkin says.
Ascension Health will use its two Pioneer ACOs, Seton Health Alliance ACO and Genesys Physician Hospital Organization, to teach the rest of its large system about both medical and financial management as well as strategies for engaging physicians around values and shared business goals. Creagh E. Milford, DO, and Timothy G. Ferris, MD, MPH, of Partners HealthCare in Boston, MA, cite key differences from the health care reforms of the 1990s that influenced the decision to participate as a Pioneer ACO, including the preservation of patient choice and improved technology and electronic health records.
Dr. Nichols comments that none of the organizations represented in this special report think that the goals of the PPACA or the ACO experiments are misguided, and in fact there is a groundswell of parallel incentive realignments in the private sector as well. For example, Baylor has formed the Baylor Quality Alliance to develop a clinically integrated delivery organization, and is creating disease-management, population-management care delivery protocols and pathways. The BQA expects to sign an ACO contract with the Baylor Health Center System Employee Benefit Plan, and is in discussions with several Medicare Advantage plans and commercial plans.
In an interview with Dr. Ballard, Carl E. Couch, MD, MMM, of Baylor Health Care System, notes that the recent Supreme Court ruling on the PPACA confirms that the country is headed in this direction. "Regardless of the decision and the potential political implications this fall in terms of sustaining or overthrowing the act, the fundamental problems remain. Health care still costs too much and the trajectory of the costs is unsustainable. And we still have serious quality problems that can be best addressed by physicians and hospitals committing themselves in an accountable way to improve them. We have the same work to do whether the law is here or not."
###
Notes for editors
The articles are published in Mayo Clinic Proceedings, Volume 87, Issue 8 (August 2012), published by Elsevier.
Full text of the articles is available to credentialed journalists upon request. Contact Rachael Zaleski at +1 215 239 3658 or mcpmedia@elsevier.com to obtain copies. See article citations below for contact information for individual authors.
"The Potential of Medicare Accountable Care Organizations to Transform the American Health Care Marketplace: Rhetoric and Reality," D.J. Ballard, MD, MSPH, PhD, FACP. DOI: 10.1016/j.mayocp.2012.06.005.
Author contact: DavidBa@BaylorHealth.edu
"Accountable Care Organization Pathways: Diverse but Ultimately Parallel," Len M. Nichols, PhD. DOI: 10.1016/j.mayocp.2012.06.010.
Author contact: lnichol9@gmu.edu
"Ascension Health Partners With Centers for Medicare and Medicaid Services to Provide Patient-Centered Care Through the Pioneer Accountable Care Organization Model," R.D. Anderson, PhD, E. Aderholdt, N. Chenven, MD et al. DOI: 10.1016/j.mayocp.2012.06.004.
"A Modified "Golden Rule" for Health Care Organizations," by C.E. Milford, DO and T.G. Ferris, MD, MPH. DOI: 10.1016/j.mayocp.2012.06.009
Author contacts: Cmilford1@partners.org or Tferris@partners.org
"Building an Accountable Care Organization for All the Wrong Reasons," D.J. Shulkin, MD. DOI: 10.1016/j.mayocp.2012.06.012.
Author contact: 973 971 5450 or David.Shulkin@atlantichealth.org
"Why Baylor Health Care System Would Like to File for Medicare Shared Savings Accountable Care Organization Designation but Cannot," C.E. Couch, MD, MMM. DOI: 10.1016/j.mayocp.2012.06.011.
Author contact: carlc@BaylorHealth.edu
"A Physician Hospital Organization's Approach to Clinical Integration and Accountable Care," G. Mayzell, MD, MBA. DOI: 10.1016/j.mayocp.2012.06.019.
Author contact: mayzellg@myhealthchoice.com
"The SSM Health Care Approach to Achieving "True North": Improving Health Care Quality While Reducing Costs," R.G. Porter, JD, MBA, A.P. Tosto, RN, MS. DOI: 10.1016/j.mayocp.2012.06.008.
Author contact: Robert_Porter@ssmhc.com
Videos of Dr. Ballard interviewing contributors about their organizations' decision to enroll in CMMS's ACO program, and the changes in store for physicians and health systems can be found at:
www.youtube.com/watch?v=90HMhC4e0GM (Shulkin)
www.youtube.com/watch?v=hXwp4azHLqI (Couch)
www.youtube.com/watch?v=EgCfzb6I3Bw (Haydar)
About the authors
David J. Ballard, MD, MSPH, PhD, FACP, Baylor Health Care System, Dallas, TX
Len M. Nichols, PhD, Center for Health Policy Research and Ethics, George Mason University, Fairfax, VA
Raymond D. Anderson, PhD, Ascension Health, St. Louis, MO
Elizabeth Aderholdt, Genesys Regional Medical Center, Grand Blanc, MI
Norman Chenven, MD, Austin Regional Clinic, Austin, TX
Meredith Duncan, Seton Health Alliance, Austin, TX
Nancy Haywood, Genesys Regional Medical Center, Grand Blanc, MI
Michael James, Genesys PHO, Grand Blanc, MI
Samson Jesudass, MD, Seton Healthcare Family, Austin, TX
Amy M.H. Johnson, Ascension Health, St. Louis, MO
Gary King, MD, Genesys PHO, Grand Blanc, MI
Greg Sheff, MD, Seton Health Alliance, Austin, TX
Creagh E. Milford, DO, Massachusetts General Hospital, Boston, MA
Timothy G. Ferris, MD, MPH, Massachusetts General Hospital and Partners HealthCare, Boston, MA
David J. Shulkin, MD, Morristown Medical Center and Atlantic Health System Accountable Care Organization, Morristown, NJ
Carl E. Couch, MD, MMM, Baylor Health Care System, Dallas, TX
George Mayzell, MD, MBA, Health Choice, LLC, Memphis, TN
Robert G. Porter, JD, MBA, SSM Health Care, St. Louis, MO
Amanda P. Tosto, RN, MS, ECG Management Consultants, Inc., St. Louis, MO
About Mayo Clinic Proceedings
The flagship journal of Mayo and one of the premier peer-reviewed clinical journals in general medicine, Mayo Clinic Proceedings is among the most widely read and highly cited scientific publications for physicians, with a circulation of approximately 124,000. While the Proceedings is sponsored by Mayo Clinic, it welcomes submissions from authors worldwide, publishing articles that focus on clinical medicine and support the professional and educational needs of its readers. The journal's mission is to promote the best interests of patients by advancing the knowledge and professionalism of the physician community. www.mayoclinicproceedings.org
About Mayo Clinic
Mayo Clinic is a nonprofit worldwide leader in medical care, research, and education for people from all walks of life. For more information visit www.mayoclinic.org/about / and www.mayoclinic.org/news.
About Elsevier
Elsevier is a world-leading provider of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including The Lancet and Cell, and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier's online solutions include ScienceDirect, Scopus, Reaxys, ClinicalKey and Mosby's Nursing Suite, which enhance the productivity of science and health professionals, and the SciVal suite and MEDai's Pinpoint Review, which help research and health care institutions deliver better outcomes more cost-effectively.
A global business headquartered in Amsterdam, Elsevier employs 7,000 people worldwide. The company is part of Reed Elsevier Group PLC, a world-leading publisher and information provider, which is jointly owned by Reed Elsevier PLC and Reed Elsevier NV. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
From 15 to 30% of people who have colorectal surgery will get an surgical-site infection?and those surgical infections (just among colorectal patients) cost an estimated $1 billion a year. The surgical infections cause longer hospital stays; are the most common cause of hospital readmission within 30 days; and require more doctor visits, wound-care supplies, and home care. Not to mention the added difficulties for patients and their families.
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