The Evolving Relationships Between Hospital, Physician and Patient in Modern American Healthcare

This article explores the ways in which health care has evolved over the past few years for patients, doctors and hospitals in the United States, and the impact these changes have made on modern American health care. As the amount of money the nation spends on health care continues to increase at alarming rates, patients, doctors, and hospitals all appear to have greater struggles than before.This inherent disconnection between the changes in American health care system and the satisfaction of patients and providers leaves much to be desired and considered. Before a solution can be found, however, we must first understand the problem

The relaxation of OH (v = 1) and OD (v = 1) by H2O and D2O at temperatures from 251 to 390 K

We report rate coefficients for the relaxation of OH(v = 1) and OD(v = 1) by H2O and D2O as a function of temperature between 251 and 390 K. All four rate coefficients exhibit a negative dependence on temperature. In Arrhenius form, the rate coefficients for relaxation (in units of 10–12 cm3 molecule–1 s–1) can be expressed as: for OH(v = 1) + H2O between 263 and 390 K: k = (2.4 ± 0.9) exp((460 ± 115)/T); for OH(v = 1) + D2O between 256 and 371 K: k = (0.49 ± 0.16) exp((610 ± 90)/T); for OD(v = 1) + H2O between 251 and 371 K: k = (0.92 ± 0.16) exp((485 ± 48)/T); for OD(v = 1) + D2O between 253 and 366 K: k = (2.57 ± 0.09) exp((342 ± 10)/T). Rate coefficients at (297 ± 1 K) are also reported for the relaxation of OH(v = 2) by D2O and the relaxation of OD(v = 2) by H2O and D2O. The results are discussed in terms of a mechanism involving the formation of hydrogen-bonded complexes in which intramolecular vibrational energy redistribution can occur at rates competitive with re-dissociation to the initial collision partners in their original vibrational states. New ab initio calculations on the H2O–HO system have been performed which, inter alia, yield vibrational frequencies for all four complexes: H2O–HO, D2O–HO, H2O–DO and D2O–DO. These data are then employed, adapting a formalism due to Troe (J. Troe, J. Chem. Phys., 1977, 66, 4758), in order to estimate the rates of intramolecular energy transfer from the OH (OD) vibration to other modes in the complexes in order to explain the measured relaxation rates—assuming that relaxation proceeds via the hydrogen-bonded complexes

Prevalence of Illicit Use and Abuse of Prescription Stimulants, Alcohol, and Other Drugs Among College Students: Relationship with Age at Initiation of Prescription Stimulants

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90112/1/phco.27.5.666.pd

Physicians\u27 ability to predict hospital length of stay for patients admitted to the hospital from the emergency department.

Accurate predictions of patient length of stay (LOS) in the hospital can effectively manage hospital resources and increase efficiency of patient care. A study was done to assess emergency medicine physicians\u27 ability of predicting the LOS of patients who enter the hospital through the ER. Results indicate that EM physicians are relatively accurate with their pediatric patients than any other age groups. In addition, as actual hospital LOS increases, the prediction accuracy decreases. Possible reasons may be due increasing medical complications associated with increasing age and this may lead to overall longer stays. Other variables such as the admitted service of the patient are not statistically significant in predicting LOS in this study. Future studies should be done in order to determine other variables that may affect LOS predictions

Physicians' Ability to Predict Hospital Length of Stay for Patients Admitted to the Hospital from the Emergency Department

Accurate predictions of patient length of stay (LOS) in the hospital can effectively manage hospital resources and increase efficiency of patient care. A study was done to assess emergency medicine physicians' ability of predicting the LOS of patients who enter the hospital through the ER. Results indicate that EM physicians are relatively accurate with their pediatric patients than any other age groups. In addition, as actual hospital LOS increases, the prediction accuracy decreases. Possible reasons may be due increasing medical complications associated with increasing age and this may lead to overall longer stays. Other variables such as the admitted service of the patient are not statistically significant in predicting LOS in this study. Future studies should be done in order to determine other variables that may affect LOS predictions

Modus Vivendi Beyond the Social Contract: Peace, Justice, and Survival in Realist Political Theory

This essay examines the promise of the notion of modus vivendi for realist political theory. I interpret recent theories of modus vivendi as affirming the priority of peace over justice, and explore several ways of making sense of this idea. I proceed to identify two key problems for modus vivendi theory, so conceived. Normatively speaking, it remains unclear how this approach can sustain a realist critique of Rawlsian theorizing about justice while avoiding a Hobbesian endorsement of absolutism. And conceptually, the theory remains wedded to a key feature of social contract theory: political order is conceived as based on agreement. This construes the horizontal tensions among individual or group agents in society as prior to the vertical, authoritative relations between authorities and their subjects. Political authority thereby appears from the start as a solution to societal conflict, rather than a problem in itself. I argue that this way of framing the issue abstracts from political experience. Instead I attempt to rethink the notion of modus vivendi from within the lived experience of political conflict, as oriented not primarily toward peace, but political survival. With this shift of perspective, the idea of modus vivendi shows us, pace Bernard Williams, that the “first political question” is not how to achieve order and stability, but rather: what can I live with

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Background Poor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses. Methods and Findings Mixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically. Results We found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy. Conclusions and Implications We found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from ward staff and how this could be changed

Monte Carlo Simulations of Conformal Theory Predictions for the 3-state Potts and Ising Models

The critical properties of the 2D Ising and 3-state Potts models are investigated using Monte Carlo simulations. Special interest is given to measurement of 3-point correlation functions and associated universal objects, i.e. structure constants. The results agree well with predictions coming from conformal field theory confirming, for these examples, the correctness of the Coulomb gas formalism and the bootstrap method.Comment: 11 pages, 6 Postscript figures, uses Revte

Practical long-distance quantum key distribution system using decoy levels

Quantum key distribution (QKD) has the potential for widespread real-world applications. To date no secure long-distance experiment has demonstrated the truly practical operation needed to move QKD from the laboratory to the real world due largely to limitations in synchronization and poor detector performance. Here we report results obtained using a fully automated, robust QKD system based on the Bennett Brassard 1984 protocol (BB84) with low-noise superconducting nanowire single-photon detectors (SNSPDs) and decoy levels. Secret key is produced with unconditional security over a record 144.3 km of optical fibre, an increase of more than a factor of five compared to the previous record for unconditionally secure key generation in a practical QKD system.Comment: 9 page