Patient evaluations of the interpersonal care experience (ICE) in U.S. hospitals: A factor analysis of the HCAHPS survey

The Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS) is widely used to evaluate patients’ perceptions of their inpatient healthcare experiences. The HCAHPS is organized into 10 measures: six composite measures, two individual measures, and two global measures.1 In prior research on the link between patients’ care experiences and hospital’s quality and cost outcomes, scholars have grouped these measures in a variety of ways. The evident lack of consistency in these groupings along with the persistent lack of empirical justification for these groupings suggests a need to empirically examine the relational structure of HCAHPS measures. Accordingly, the purpose of this study is to determine the degree to which patient care evaluations captured by HCAHPS reflect unmeasured aspects of the patient experience. We use two-step factor analytic process on a nationally representative split sample of HCAHPS performance from 2007-2011. The results of the analysis reveal a single latent factor consisting of five measures that correspond conceptually to patients’ evaluations of care provider behaviors during their interpersonal interactions with them. We label this factor Interpersonal Care Experience (I.C.E) and argue that it may prove useful in future practical and scholarly explorations of the link between patient experience and other performance outcomes

Severity of Depression Predicts Remission Rates Using Transcranial Magnetic Stimulation

Background: Multiple factors likely impact response and remission rates in the treatment of depression with repetitive transcranial magnetic stimulation (rTMS). Notably the role of symptom severity in outcomes with rTMS is poorly understood.Objective/Hypothesis: This study investigated the predictors of achieving remission in patients suffering from depression who receive ≥3 rTMS treatments per week. Methods: Available data on 41 patients treated at Walter Reed National Military Medical Center from 2009 to 2014 were included for analysis. Patients received a range of pulse sequences from 3,000 to 5,000 with left sided or bilateral coil placement. Primary outcome measures were total score on the Patient Health Questionnaire (PHQ-9) or the Quick Inventory of Depressive Symptomatology—Self Rated (QIDS-SR). Remission was defined as a total score less than five, and response was defined as a 50% decrease in the total score on both outcome metrics. Outcomes in patients diagnosed as suffering from mild or moderate depression were compared to those suffering from severe depression. Results: Of the 41 patients receiving treatment, 16 reached remission by the end of treatment. Remission rate was associated with the initial severity of depression, with patients with mild or moderate depression reaching remission at a significantly higher rate than those with severe depression. Total number of rTMS sessions or length of treatment were not predictors of remission. Conclusion: Patients with a baseline level of depression characterized as mild or moderate had significantly better outcomes following rTMS compared to patients with severe depression

The Detection and Characterization of cm Radio Continuum Emission from the Low-mass Protostar L1014-IRS

Observations by the Cores to Disk Legacy Team with the Spitzer Space Telescope have identified a low luminosity, mid-infrared source within the dense core, Lynds 1014, which was previously thought to harbor no internal source. Followup near-infrared and submillimeter interferometric observations have confirmed the protostellar nature of this source by detecting scattered light from an outflow cavity and a weak molecular outflow. In this paper, we report the detection of cm continuum emission with the VLA. The emission is characterized by a quiescent, unresolved 90 uJy 6 cm source within 0.2" of the Spitzer source. The spectral index of the quiescent component is $\alpha = 0.37\pm 0.34$ between 6 cm and 3.6 cm. A factor of two increase in 6 cm emission was detected during one epoch and circular polarization was marginally detected at the $5\sigma$ level with Stokes {V/I} $= 48 \pm 16$% . We have searched for 22 GHz H2O maser emission toward L1014-IRS, but no masers were detected during 7 epochs of observations between June 2004 and December 2006. L1014-IRS appears to be a low-mass, accreting protostar which exhibits cm emission from a thermal jet or a wind, with a variable non-thermal emission component. The quiescent cm radio emission is noticeably above the correlation of 3.6 cm and 6 cm luminosity versus bolometric luminosity, indicating more radio emission than expected. We characterize the cm continuum emission in terms of observations of other low-mass protostars, including updated correlations of centimeter continuum emission with bolometric luminosity and outflow force, and discuss the implications of recent larger distance estimates on the physical attributes of the protostar and dense molecular core.Comment: 14 pages. Accepted for publication in Ap

Systematic Review and Meta-analysis of SurgicalTreatment of Non-Zenker?s Oesophageal Diverticula

Background Oesophageal diverticula are rare outpouchings of the oesophagus which may be classified anatomically as pharyngeal (Zenker’s), mid-oesophageal and epiphrenic. While surgery is indicated for symptomatic patients, no consensus exists regarding the optimum technique for non-Zenker’s oesophageal diverticula. The aim of this study was to determine the outcome of surgery in patients with non-Zenker’s oesophageal diverticula. Methods PubMed, MEDLINE and the Cochrane Library (January 1990 to January 2016) were searched for studies which reported outcomes of surgery in patients with non-Zenker’s oesophageal diverticula. Primary outcome measure was the rate of staple line leakage. Results Twenty-five observational studies involving 511 patients (259 male, median age 62 years) with mid-oesophageal (n = 53) and epiphrenic oesophageal (n = 458) diverticula who had undergone surgery [thoracotomy (n = 252), laparoscopy (n = 204), thoracoscopy (n = 42), laparotomy (n = 5), combined laparoscopy and thoracoscopy (n = 8)] were analysed. Myotomy was performed in 437 patients (85.5%), and anti-reflux procedures were performed in 342 patients (69.5%). Overall pooled staple line leak rates were reported in 13.3% [95% c.i. (11.0–15.7), p < 0.001] and were less common after myotomy (12.4%) compared with no myotomy (26.1%, p = 0.002). Conclusions No consensus exists regarding the surgical treatment of non-Zenker’s oesophageal diverticula, but staple line leakage is common and is reduced significantly by myotomy

Ernst Freund as Precursor of the Rational Study of Corporate Law

Gindis, David, Ernst Freund as Precursor of the Rational Study of Corporate Law (October 27, 2017). Journal of Institutional Economics, Forthcoming. Available at SSRN: https://ssrn.com/abstract=2905547, doi: https://dx.doi.org/10.2139/ssrn.2905547The rise of large business corporations in the late 19th century compelled many American observers to admit that the nature of the corporation had yet to be understood. Published in this context, Ernst Freund's little-known The Legal Nature of Corporations (1897) was an original attempt to come to terms with a new legal and economic reality. But it can also be described, to paraphrase Oliver Wendell Holmes, as the earliest example of the rational study of corporate law. The paper shows that Freund had the intuitions of an institutional economist, and engaged in what today would be called comparative institutional analysis. Remarkably, his argument that the corporate form secures property against insider defection and against outsiders anticipated recent work on entity shielding and capital lock-in, and can be read as an early contribution to what today would be called the theory of the firm.Peer reviewe

What are the hot R Coronae Borealis stars?

We investigate the evolutionary status of four stars: V348 Sgr, DY Cen, and MV Sgr in the Galaxy and HV 2671 in the LMC. These stars have in common random deep declines in visual brightness, which are characteristic of R Coronae Borealis (RCB) stars. RCB stars are typically cool hydrogen-deficient supergiants. The four stars studied in this paper are hotter (Teff = 15–20 kK) than the majority of RCB stars (Teff = 5000–7000 K). Although these are commonly grouped together as the hot RCB stars they do not necessarily share a common evolutionary history. We present new observational data and an extensive collection of archival and previously published data that is reassessed to ensure internal consistency. We find temporal variations of various properties on different timescales that will eventually help us to uncover the evolutionary history of these objects. DY Cen and MV Sgr have typical RCB helium abundances, which exclude any currently known post–asymptotic giant branch (post-AGB) evolutionary models. Moreover, their carbon and nitrogen abundances present us with further problems for their interpretation. V348 Sgr and HV 2671 are in general agreement with a born-again post-AGB evolution, and their abundances are similar to Wolf-Rayet central stars of planetary nebulae (PNs). The three Galactic stars in the sample have circumstellar nebulae, which produce forbidden line radiation (for HV 2671 we have no information). V348 Sgr and DY Cen have low-density, low-expansion velocity nebulae (resolved in the case of V348 Sgr), while MV Sgr has a higher density, higher expansion velocity nebula. All three stars, on the other hand, have split emission lines, which indicate the presence of an equatorial bulge but not of a Keplerian disk. In addition, the historical light curves for the three Galactic hot RCB stars show evidence for a significant fading in their maximum-light brightnesses of ~1 mag over the last 70 yr. From this we deduce that their effective temperatures increased by a few thousand degrees. If V348 Sgr is a born-again star, as we presume, this means that the star is returning from the born-again AGB phase to the phase of a central star of PN. Spectroscopically, no dramatic change is observed over the last 50 years for V348 Sgr and MV Sgr. However, there is some evidence that the winds of V348 Sgr and DY Cen have increased in strength in the last decade. HV 2671, located in the LMC, has not been analyzed in detail but at 5 Å… resolution is almost identical to V348 Sgr. Through the bolometric correction derived for V348 Sgr and the known distance, we can estimate the absolute ν magnitude of HV 2671 (Mν = -3.0 mag) and its bolometric luminosity (~6000 L⊙)

Res Medica, Autumn 1959, Volume 2, Number 1

TABLE OF CONTENTSSYLLABUS FOR THE 223RD SESSIONHYPOTENSIVE DRUGS: G. E. Mawer, B.ScAN OCULIST LOOKS ATENDOCRINE EXOPHTHALMOS: C. R. S. Jackson.M.A., M.D., D.O.M .S., F.R.C.S.E.RES MEDICA THE TREATMENT OF CANCER: John McKendrick,M.B., Ch.B.DOCTORS AND ARTISTS: Professor W. I. C.Morris, F.R.C.S.E.SOME ASPECTS OFRHEUMATIC FEVER: David J. ClarkABDOMINAL PAIN: Geoffrey T. Millar,M.B., Ch.B.TWO HUNDRED YEARS AGO: James A. Gray, M.B..Ch.B

1965: Abilene Christian College Bible Lectures - Full Text

LIFT UP YOUR EYES” Being the Abilene Christian College Annual Bible Lectures 1965 Price: $3.95 Published by ABILENE CHRISTIAN COLLEGE STUDENTS EXCHANGE ACC Station Abilene. Texa

Small Scattered Fragments Do Not a Dwarf Make: Biological and Archaeological Data Indicate that Prehistoric Inhabitants of Palau Were Normal Sized

Current archaeological evidence from Palau in western Micronesia indicates that the archipelago was settled around 3000–3300 BP by normal sized populations; contrary to recent claims, they did not succumb to insular dwarfism