Search

There has been always a need to search new mediums as well as techniques to send the data secretly. Recent research establishes Deoxyribonucleic Acid (DNA) as an interesting medium for Steganography. DNA have various artificial components that can be used for hiding and sending secret information from any source to destination. Genetic information obtained from DNA is encoded as a sequence of nucleotides i.e. Guanine, Adenine, Thymine and Cytosine denoted by the letters G, A, T and C respectively. A huge amount of information can be hidden using these four nucleotides. This paper proposes an improved algorithm namely Dictionary Based Substitution Method (DBSM) in order to increase the capacity and security of existing data hiding method i.e. Substitution Method (SM). In order to achieve this the proposal uses a dictionary to hide the message using four nucleotides elements. The paper contain different experiments to examine the performance and make comparisons on the basis of capacity, bits-per-nucleotide (bpn) and cracking probability.

OBJECTIVE: To evaluate the rate at which children with and without chronic conditions became recipients of Medicaid and the Children’s Health Insurance Program (CHIP) during a period of economic recession and to evaluate changes in spending and service utilization among children with chronic conditions. METHODS: Child recipients of Illinois fee-for-service Medicaid and CHIP from 2007 to 2010 were assigned to 5 chronic condition groups using 3M Clinical Risk Group software. Outcome measures were change in recipient number in each chronic condition category, total and per capita spending changes within various categories of service, and changes in service utilization. RESULTS: From 2007 to 2010, children with chronic conditions became recipients of Illinois fee-for-service Medicaid and CHIP at a higher rate than children without chronic conditions (26.7% vs 14.5%). Inflation-adjusted mean spending fell with a linear trend in all chronic condition categories except malignancy (P < .001). Per member inpatient and emergency department service utilization fell and outpatient service utilization increased in all condition categories. Average inpatient length of stay declined in all chronic condition groups (P < .001) but not in children without chronic conditions. CONCLUSIONS: From 2007 to 2010, a period of severe economic recession, a disproportionately high number of children with chronic conditions became Illinois Medicaid and CHIP recipients. Total spending increases were driven by an increase in the number of recipients with the most complex chronic conditions, not increases in per-member spending.

Objective To assess readmission rates identified by 3M-Potentially Preventable Readmissions software (3M-PPRs) in a national cohort of children's hospitals. Study design A total of 1 719 617 hospitalizations for 1 531 828 unique patients in 58 children's hospitals from 2009 to 2011 from the Children's Hospital Association Case-Mix Comparative database were examined. Main outcome measures included rates, diagnoses, and costs of potentially preventable readmissions (PPRs) and all-cause readmissions. Results The 7-, 15-, and 30-day rates by 3M-PPRs were 2.5%, 4.1%, and 6.2%, respectively. Corresponding all-cause readmission rates were 5.0%, 8.7%, and 13.3%. At 30 days, 60.6% of all-cause readmissions were considered nonpreventable by 3M-PPRs, more than one-half of which were related to malignancies. The percentage of readmissions rated as potentially preventable was similar at all 3 time intervals. Readmissions after chemotherapy, acute leukemia, and cystic fibrosis were all considered nonpreventable, and at least 80% of readmissions after index admissions for sickle cell crisis, bronchiolitis, ventricular shunt procedures, asthma, and appendectomy were designated potentially preventable. Total costs for all readmissions were $1.7 billion; PPRs accounted for 27.3% of these costs. The most costly readmissions were associated with ventricular shunt procedures ($26.5 million/year), seizures ($15.5 million/year), and sickle cell crisis ($15.0 million/year). Conclusions Rates of PPRs were significantly lower than all-cause readmission rates more than one-half of which were caused by exclusion of malignancies. Annual costs of PPRs, although significant in the aggregate, appear to represent a much smaller cost-savings opportunity for children than for adults. Our study may help guide children's hospitals to focus readmission reduction strategies on areas where the financial vulnerability is greatest based on 3M-PPRs.

Reliable assessment of cardiac function is an important tool for diagnosis and prognosis of multiple cardiac and extracardiac diseases. Echocardiography and MRI are the most commonly used methods to evaluate cardiac function, but can be limited or contraindicated in certain patients. Functional evaluation with CT may play an important role in these patients and in those patients being evaluated for coronary artery disease. Functional imaging requires a retrospectively gated acquisition and special attention must be paid to the contrast injection technique for appropriate analysis. Left and right ventricular analysis is evaluated both quantitatively and qualitatively. Quantitative measurements with CT have shown close correlation with values obtained with CMR. Acute and chronic infarcts and non-ischemic cardiomyopathies can have a characteristic appearance on imaging. Functional and volumetric measurements of the left atrium can be carried out with similar technique for evaluation of patients with mitral disease or atrial fibrillation.

To compare inpatient resource use trends for healthy children and children with chronic health conditions of varying degrees of medical complexity.Retrospective cohort analysis.Twenty-eight US children's hospitals.A total of 1 526 051 unique patients hospitalized from January 1, 2004, through December 31, 2009, who were assigned to 1 of 5 chronic condition groups using 3M's Clinical Risk Group software.None.Trends in the number of patients, hospitalizations, hospital days, and charges analyzed with linear regression.Between 2004 and 2009, hospitals experienced a greater increase in the number of children hospitalized with vs without a chronic condition (19.2% vs 13.7% cumulative increase, P.001). The greatest cumulative increase (32.5%) was attributable to children with a significant chronic condition affecting 2 or more body systems, who accounted for 19.2% (n = 63 203) of patients, 27.2% (n = 111 685) of hospital discharges, 48.9% (n = 1.1 million) of hospital days, and 53.2% ($9.2 billion) of hospital charges in 2009. These children had a higher percentage of Medicaid use (56.5% vs 49.7%; P.001) compared with children without a chronic condition. Cerebral palsy (9179 [14.6%]) and asthma (13 708 [21.8%]) were the most common primary diagnosis and comorbidity, respectively, observed among these patients.Patients with a chronic condition increasingly used more resources in a group of children's hospitals than patients without a chronic condition. The greatest growth was observed in hospitalized children with chronic conditions affecting 2 or more body systems. Children's hospitals must ensure that their inpatient care systems and payment structures are equipped to meet the protean needs of this important population of children.

Objective. To assess primary care pediatricians’ (PCPs’) perceptions of caring for children and youth with special health care needs (CYSHCN). Methods. Cross-sectional survey of Illinois pediatricians. Results. Thirty-five percent of surveys were returned and 26% were analyzed. The top 3 perceived barriers were insufficient time (72%), insufficient reimbursement (68%), and lack of support services (59%). Insufficient interest was the least cited barrier (19%). Preparedness to perform tasks related to care of CYSHCN ranged from 89% for accessing early intervention services to 24% for billing and coding. The percentage of PCPs somewhat or very comfortable providing primary care to patients with technology dependence ranged from 75% for blood glucose monitoring to 12% for dialysis. Conclusions. The issues of time, reimbursement, billing, and coding are perceived as significant barriers to the care CYSHCN. There is substantial variation in PCPs’ comfort in the care of CYSHCN who require the assistance of medical technologies.

Objective To describe the characteristics of hospitalizations for patients who use clinical programs that provide care coordination for children with multiple, chronic medical conditions. Study design Retrospective analysis of 1083 patients hospitalized between June 2006 and July 2008 who used a structured, pediatric complex-care clinical program within 4 children's hospitals. Chronic diagnosis prevalence (ie, technology assistance, neurologic impairment, and other complex chronic conditions), inpatient resource utilization (ie, length of stay, 30-day readmission), and reasons for hospitalization were assessed across the programs. Results Over the 2-year study period, complex-care program patients experienced a mean of 3.1 ± 2.8 admissions, a mean length of hospital stay per admission of 12.2 ± 25.5 days, and a 30-day hospital readmission rate of 25.4%. Neurologic impairment (57%) and presence of a gastrostomy tube (56%) were the most common clinical characteristics of program patients. Notable reasons for admission included major surgery (47.1%), medical technology malfunction (9.0%), seizure (6.4%), aspiration pneumonia (3.9%), vomiting/feeding difficulties (3.4%), and asthma (1.8%). Conclusions Hospitalized patients who used a structured clinical program for children with medical complexity experienced lengthy hospitalizations with high early readmission rates. Reducing hospital readmission may be one potential strategy for decreasing inpatient expenditures in this group of children with high resource utilization.

Children with medical complexity (CMC) have medical fragility and intensive care needs that are not easily met by existing health care models. CMC may have a congenital or acquired multisystem disease, a severe neurologic condition with marked functional impairment, and/or technology dependence for activities of daily living. Although these children are at risk of poor health and family outcomes, there are few well-characterized clinical initiatives and research efforts devoted to improving their care. In this article, we present a definitional framework of CMC that consists of substantial family-identified service needs, characteristic chronic and severe conditions, functional limitations, and high health care use. We explore the diversity of existing care models and apply the principles of the chronic care model to address the clinical needs of CMC. Finally, we suggest a research agenda that uses a uniform definition to accurately describe the population and to evaluate outcomes from the perspectives of the child, the family, and the broader health care system.

Objectives To profile the national prevalence of more medically complex children with special health care needs (CSHCN) and the diversity of caregiver challenges that their families confront. Design Secondary analysis of the 2005-2006 National Survey of Children With Special Health Care Needs (unweighted n = 40 723). Setting United States–based population. Participants National sample of CSHCN. Main Exposure More complex CSHCN were defined by incorporating components of child health and family need, including medical technology dependence and care by 2 or more subspecialists. Main Outcome Measures Caregiver challenges were defined by family-reported care burden (including hours providing care coordination and home care), medical care use (on the basis of health care encounters in the last 12 months), and unmet needs (defined by 15 individual medical care needs and a single nonmedical service need). Results Among CSHCN, 3.2% (weighted n = 324 323) met criteria for more complex children, representing 0.4% of all children in the United States. Caregivers of more complex CSHCN reported a median of 2 (interquartile range, 1-6) hours per week on care coordination and 11 to 20 (interquartile range, 3->21) hours per week on direct home care. More than half (56.8%) reported financial problems, 54.1% reported that a family member stopped working because of the child's health, 48.8% reported at least 1 unmet medical service need, and 33.1% reported difficulty in accessing nonmedical services. Conclusions Extraordinary and diverse needs are common among family caregivers of more complex CSHCN. Enhanced care coordination support, respite care, and direct home care may begin to address the substantial economic burden and the multiple unmet needs that many of these families face.

Early hospital readmission is emerging as an indicator of care quality. Some children with chronic illnesses may be readmitted on a recurrent basis, but there are limited data describing their rehospitalization patterns and impact.To describe the inpatient resource utilization, clinical characteristics, and admission reasons of patients recurrently readmitted to children's hospitals.Retrospective cohort analysis of 317,643 patients (n = 579,504 admissions) admitted to 37 US children's hospitals in 2003 with follow-up through 2008.Maximum number of readmissions experienced by each child within any 365-day interval during the 5-year follow-up period.In the sample, 69,294 patients (21.8%) experienced at least 1 readmission within 365 days of a prior admission. Within a 365-day interval, 9237 patients (2.9%) experienced 4 or more readmissions; time between admissions was a median 37 days (interquartile range [IQR], 21-63). These patients accounted for 18.8% (109,155 admissions) of all admissions and 23.2% ($3.4 billion) of total inpatient charges for the study cohort during the entire follow-up period. Tests for trend indicated that as the number of readmissions increased from 0 to 4 or more, the prevalences increased for a complex chronic condition (from 22.3% [n = 55,382/248,349] to 89.0% [n = 8225/9237]; P.001), technology assistance (from 5.3% [n = 13,163] to 52.6% [n = 4859]; P.001), public insurance use (from 40.9% [n = 101,575] to 56.3% [n = 5202]; P.001), and non-Hispanic black race (from 21.8% [n = 54,140] to 34.4% [n = 3181]; P.001); and the prevalence decreased for readmissions associated with an ambulatory care-sensitive condition (from 23.1% [62,847/272,065] to 14.0% [15,282/109,155], P.001). Of patients readmitted 4 or more times in a 365-day interval, 2633 (28.5%) were rehospitalized for a problem in the same organ system across all admissions during the interval.Among a group of pediatric hospitals, 18.8% of admissions and 23.2% of inpatient charges were accounted for by the 2.9% of patients with frequent recurrent admissions. Many of these patients were rehospitalized recurrently for a problem in the same organ system.