Superbugs Versus Outsourced Cleaners: Employment Arrangements and the Spread of Health Care-Associated Infections

On any given day, about one in 25 hospital patients in the United States has a health care–associated infection (HAI) that the patient contracts as a direct result of his or her treatment. Fortunately, the spread of most HAIs can be halted through proper disinfection of surfaces and equipment. Consequently, cleaners—“environmental services” (EVS) in hospital parlance—must take on the important task of defending hospital patients (as well as staff and the broader community) from the spread of HAIs. Despite the importance of this task, hospitals frequently outsource this function, increasing the likelihood that these workers are under-rewarded, undertrained, and detached from the organization and the rest of the care team. As a result, the outsourcing of EVS workers could have the unintended consequence of increasing the incidence of HAIs. The authors demonstrate this relationship empirically, finding support for their theory by using a self-constructed data set that marries infection data to structural, organizational, and workforce features of California’s general acute care hospitals. The study thus advances the literature on nonstandard work arrangements—outsourcing in particular—while sounding a cautionary note to hospital administrators and health care policymakers

A Coupled Analysis of Atmospheric Mass Loss and Tidal Evolution in XUV Irradiated Exoplanets: The TRAPPIST-1 Case Study

Exoplanets residing close to their stars can experience evolution of both their physical structures and their orbits due to the influence of their host stars. In this work, we present a coupled analysis of dynamical tidal dissipation and atmospheric mass loss for exoplanets in X-ray and ultraviolet (XUV) irradiated environments. As our primary application, we use this model to study the TRAPPIST-1 system and place constraints on the interior structure and orbital evolution of the planets. We start by reporting on an ultraviolet continuum flux measurement (centered around ~1900 Å) for the star TRAPPIST-1, based on 300 ks of Neil Gehrels Swift Observatory data, and which enables an estimate of the XUV-driven thermal escape arising from XUV photodissociation for each planet. We find that the X-ray flaring luminosity, measured from our X-ray detections, of TRAPPIST-1 is 5.6 × 10⁻⁴ L*, while the full flux including non-flaring periods is 6.1 × 10⁻⁵ L*, when L* is TRAPPIST-1's bolometric luminosity. We then construct a model that includes both atmospheric mass loss and tidal evolution and requires the planets to attain their present-day orbital elements during this coupled evolution. We use this model to constrain the ratio Q′ = 3Q/2k₂ for each planet. Finally, we use additional numerical models implemented with the Virtual Planet Simulator VPLanet to study ocean retention for these planets using our derived system parameters

Impact of hospital diagnosis-specific quality measures on patients’ experience of hospital care: Evidence from 14 states, 2009-2011

In order to assess consistency across quality measures for Untied States hospitals, this paper uses patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for three years (2009-2011) from 1,333 acute-care hospitals in fourteen states to analyze patterns in hospital-reported patient experience-of-care scores by diagnosis-specific process and outcome measures for acute myocardial infarction, heart failure, and pneumonia. We also evaluate how scores have changed over the three-year period. We find significant differences in patient experience-of-care scores for 195 out of 230 relationships between HCAHPS patient experience-of-care scores and 23 diagnosis-specific process and outcomes measures. We find nearly no significant differences in changes in scores from 2009-2011 (8 out of 230) when comparing the same experience-of-care and diagnosis-specific quality measures. For the majority of measures, high scores on the quality metrics were associated with high patient experience-of-care scores

Cosmology of Axions and Moduli: A Dynamical Systems Approach

This paper is concerned with string cosmology and the dynamics of multiple scalar fields in potentials that can become negative, and their features as (Early) Dark Energy models. Our point of departure is the "String Axiverse", a scenario that motivates the existence of cosmologically light axion fields as a generic consequence of string theory. We couple such an axion to its corresponding modulus. We give a detailed presentation of the rich cosmology of such a model, ranging from the setting of initial conditions on the fields during inflation, to the asymptotic future. We present some simplifying assumptions based on the fixing of the axion decay constant $f_a$, and on the effective field theory when the modulus trajectory is adiabatic, and find the conditions under which these assumptions break down. As a by-product of our analysis, we find that relaxing the assumption of fixed $f_a$ leads to the appearance of a new meta-stable de-Sitter region for the modulus without the need for uplifting by an additional constant. A dynamical systems analysis reveals the existence of many fixed point attractors, repellers and saddle points, which we analyse in detail. We also provide geometric interpretations of the phase space. The fixed points can be used to bound the couplings in the model. A systematic scan of certain regions of parameter space reveals that the future evolution of the universe in this model can be rich, containing multiple epochs of accelerated expansion.Comment: 27 pages, 12 figures, comments welcome, v2 minor correction

Variations in the patients’ hospital care experience by states’ strategy for Medicaid expansion: 2009-2013

Our investigation evaluates the extent of differences in the patient’s hospital experience due to variations among state strategies to adopt, or not adopt, their Medicaid plans to the 2010 ACA legislation. Using ten HCAHPS measures, we analyze patient hospital experience data for the 2009 - 2013 period for all 50 states and the District of Columbia grouped by those states that (1) did not expand, (2) expanded Medicaid through Section 1115 waivers, (3) expanders early, and (4) expanded Medicaid concurrent with the new ACA legislation. Our findings reveal that those states that opted out of Medicaid expansion typically started with higher patient experience scores in 2009 on all 10 HCAHPS hospital measures and maintained their higher scores levels for all five years over the other three state expansion strategies for most measures. While states that were early expanders and those that expanded concurrent with the ACA implementation generally show higher growth rates over the five-year period for most HCAHPS measures when compared to states that opted out of the Medicaid expansion, our multivariate results indicate that their rates of growth were not statistically superior to those states that opted out of the expansion. We conclude that while there have been concerns that the patients in opt-out states would experience lower levels of satisfaction from their state’s actions, the patient experience scores in these states show that they perform better or as well as those states that expanded early, expanded under waivers, and expanded with the implementation of the ACA legislation

Impact of hospital characteristics on patients’ experience of hospital care: Evidence from 14 states, 2009-2011

This paper uses patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for three years (2009-2011) from 1,333 acute-care hospitals in fourteen states to analyze patterns in 10 hospital-reported patient experience-of-care scores by 29 characteristics classified as: patient characteristics, payer source, patient severity, hospital characteristics, hospital operations, and market characteristics. We also evaluate how scores have changed over the three-year period. We find significant differences in patient experience-of-care scores by hospital characteristics for 250 out of 290 HCAHPS-hospital characteristic combinations measured. We find fewer significant differences in changes in scores from 2009-2011 (135 out of 290), with hospitals categorized as high scoring also reporting consistently greater improvement. We conclude that patient experience-of-care scores vary by hospital characteristics, although improvements in scores show less variety by hospital categorization

Factors in patients’ experience of hospital care: Evidence from California, 2009–2011

The use of measures of patient-centered care to evaluate hospital care is mandated by The Patient Protection and Affordable Care Act of 2010. Using three years of data from 315 California acute-care hospitals and data collected from patients via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, we seek to evaluate patients’ hospital-care experience by (1) analyzing patients’ experience-of-care scores in light of these hospitals’ patient profiles, structural characteristics, and outcomes in 2011, and (2) determining and analyzing the extent of changes in patients’ experience of care over the three-year period 2009–2011. For 2011, we find significant variation in patients’ experience-of-care scores associated with hospitals’ different patient profiles and structural characteristics. In spite of these single-year differences, virtually all aspects of patients’ experience of care showed improvement over the 2009-2011 period