Impact Of Asset Age/Fiscal Viability On Selected Measures Of Patient Care In Nursing Homes

Forty-five New York nursing homes were examined to determine if a relationship between age of assets, fiscal viability and quality of nursing homes, as measured by patient care indices and survey deficiencies, existed. These factors were examined on 2004 data for the nursing homes selected. Several financial variables were used to construct a fiscal viability index; and a patient care index was created from selected procedural measures that may be used to measure specific aspects of institutional care. The premise is that age of assets and fiscal viability will influence quality of patient care/survey deficiencies. Utilizing both the financial and patient care and survey indices, the following statistical models were prepared

Case Study: A Comparative Analysis Of Financial And Quality Indicators Of Nursing Homes That Have Closed And Nursing Homes That Have Remained Open

Eight New York nursing homes, 4 open and 4 closed, were chosen at random for analysis.  They were examined to determine if a relationship between age of assets, fiscal viability and quality   of care existed.  Three years of data for each nursing home was selected  Several financial variables were used to construct a fiscal viability index; and a patient care index was created from selected measures that are used to measure specific aspects of institutional care.  The premise was that the constructed indices will demonstrate a significant difference between closed nursing homes and homes remaining open.  The analysis found that fiscal viability index could be a significant factor to differentiate the two groups of nursing homes, but the quality index showed no significant difference between the two groups

A Comparative Analysis: The Impact Of Non-Operating Revenues On Financial Viability Of Urban And Rural Hospitals

Fifty New York hospitals, 25 urban facilities and 25 rural facilities, were chosen at random for analysis.  They were examined to determine whether non-operating revenue – contributions, gifts, grants (as defined by IRS, Form 990) – plays an important role in fiscal viability .  Three years of data, 2005 – 2007, for each hospital was selected, and several financial variables were used to construct a fiscal viability index. The purpose of this study was to determine whether there is a positive difference in the fiscal health of hospitals when the hospitals can solicit more income from non-healthcare/non-operating activities in the form of outside gifts and grants.  Another main purpose of this study was to determine which hospital sector, if any – urban vs. rural – is more dependent upon non-operating revenues for their fiscal viability

Impact Of Nurse Unionization On Fiscal Viability And Selected Measures Of Quality In Hospitals

Seventy-three New York hospitals were examined to determine if a difference existed between hospitals with nursing unions versus those without as it pertains to fiscal viability and quality of care.  Several financial variables were used to construct a fiscal viability index; and a quality index was created from selected mortality and procedural measures that may be used to measure specific aspects of institutional care.  The premise that the union status of a hospital’s nursing staff will influence fiscal viability and quality is based on the impact that unionization may have on staffing and cost per patient.  The literature is replete with studies that assess the relationship between nurse staffing levels and quality.  In some cases there is a clear and compelling relationship, but in others, it is indeterminate.  Utilizing union status, selected employee variables, and financial and quality of care indices, four statistical models were prepared to explain these the interaction of these variables &nbsp

Rapid and Accurate Detection of Mycobacterium tuberculosis in Sputum Samples by Cepheid Xpert MTB/RIF Assay-A Clinical Validation Study

Background: A crucial impediment to global tuberculosis control is the lack of an accurate, rapid diagnostic test for detection of patients with active TB. A new, rapid diagnostic method, (Cepheid) Xpert MTB/RIF Assay, is an automated sample preparation and real-time PCR instrument, which was shown to have good potential as an alternative to current reference standard sputum microscopy and culture.Methods: We performed a clinical validation study on diagnostic accuracy of the Xpert MTB/RIF Assay in a TB and HIV endemic setting. Sputum samples from 292 consecutively enrolled adults from Mbeya, Tanzania, with suspected TB were subject to analysis by the Xpert MTB/RIF Assay. The diagnostic performance of Xpert MTB/RIF Assay was compared to standard sputum smear microscopy and culture. Confirmed Mycobacterium tuberculosis in a positive culture was used as a reference standard for TB diagnosis.Results: Xpert MTB/RIF Assay achieved 88.4% (95% CI = 78.4% to 94.9%) sensitivity among patients with a positive culture and 99% (95% CI = 94.7% to 100.0%) specificity in patients who had no TB. HIV status did not affect test performance in 172 HIV-infected patients (58.9% of all participants). Seven additional cases (9.1% of 77) were detected by Xpert MTB/RIF Assay among the group of patients with clinical TB who were culture negative. Within 45 sputum samples which grew non-tuberculous mycobacteria the assay's specificity was 97.8% (95% CI = 88.2% to 99.9%).Conclusions: The Xpert MTB/RIF Assay is a highly sensitive, specific and rapid method for diagnosing TB which has potential to complement the current reference standard of TB diagnostics and increase its overall sensitivity. Its usefulness in detecting sputum smear and culture negative patients needs further study. Further evaluation in high burden TB and HIV areas under programmatic health care settings to ascertain applicability, cost-effectiveness, robustness and local acceptance are required

The human syndrome of dendritic cell, monocyte, B and NK lymphoid deficiency

Human immunodeficiency syndrome with loss of DCs, monocytes, and T reg cells; preservation of Langerhans cells; associated loss of BM multilymphoid progenitors; and overproduction of Flt3 ligand

Volume-based solvation models out-perform area-based models in combined studies of wild-type and mutated protein-protein interfaces

<p>Abstract</p> <p>Background</p> <p>Empirical binding models have previously been investigated for the energetics of protein complexation (ΔG models) and for the influence of mutations on complexation (i.e. differences between wild-type and mutant complexes, ΔΔG models). We construct binding models to directly compare these processes, which have generally been studied separately.</p> <p>Results</p> <p>Although reasonable fit models were found for both ΔG and ΔΔG cases, they differ substantially. In a dataset curated for the absence of mainchain rearrangement upon binding, non-polar area burial is a major determinant of ΔG models. However this ΔG model does not fit well to the data for binding differences upon mutation. Burial of non-polar area is weighted down in fitting of ΔΔG models. These calculations were made with no repacking of sidechains upon complexation, and only minimal packing upon mutation. We investigated the consequences of more extensive packing changes with a modified mean-field packing scheme. Rather than emphasising solvent exposure with relatively extended sidechains, rotamers are selected that exhibit maximal packing with protein. This provides solvent accessible areas for proteins that are much closer to those of experimental structures than the more extended sidechain regime. The new packing scheme increases changes in non-polar burial for mutants compared to wild-type proteins, but does not substantially improve agreement between ΔG and ΔΔG binding models.</p> <p>Conclusion</p> <p>We conclude that solvent accessible area, based on modelled mutant structures, is a poor correlate for ΔΔG upon mutation. A simple volume-based, rather than solvent accessibility-based, model is constructed for ΔG and ΔΔG systems. This shows a more consistent behaviour. We discuss the efficacy of volume, as opposed to area, approaches to describe the energetic consequences of mutations at interfaces. This knowledge can be used to develop simple computational screens for binding in comparative modelled interfaces.</p