Hospital implementation of health information technology and quality of care: are they related?

Recently, there has been considerable effort to promote the use of health information technology (HIT) in order to improve health care quality. However, relatively little is known about the extent to which HIT implementation is associated with hospital patient care quality. We undertook this study to determine the association of various HITs with: hospital quality improvement (QI) practices and strategies; adherence to process of care measures; risk-adjusted inpatient mortality; patient satisfaction; and assessment of patient care quality by hospital quality managers and front-line clinicians.This work was supported by a grant from the Commonwealth Fund. We are indebted to Anthony Shih and Anne-Marie Audet of the Fund for their advice, support, and constructive suggestions throughout the design and conduct of the study. We thank our colleagues - Raymond Kang, Peter Kralovec, Sally Holmes, Frances Margolin, and Deborah Bohr - for their valuable contributions to the development of the QAS, the CPS, and the database on which the analytic findings reported here were based. We also thank 3 M (TM) Health Information Systems' for use of its All Patient Refined Diagnosis Related Groups (APR-DRGs) software. We especially wish to thank Jennifer Drake for her contributions not only to survey development, but also to earlier analysis of survey findings relevant to this paper. (Commonwealth Fund)Published versio

Post-hospital medical respite care and hospital readmission of homeless persons

Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This article examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital

A Three-Parameter Binomial Approximation

We approximate the distribution of the sum of independent but not necessarily identically distributed Bernoulli random variables using a shifted binomial distribution where the three parameters (the number of trials, the probability of success, and the shift amount) are chosen to match up the first three moments of the two distributions. We give a bound on the approximation error in terms of the total variation metric using Stein's method. A numerical study is discussed that shows shifted binomial approximations typically are more accurate than Poisson or standard binomial approximations. The application of the approximation to solving a problem arising in Bayesian hierarchical modeling is also discussed

Creating ecologically sound buildings by integrating ecology, architecture and computational design

1. Research is revealing an increasing number of positive effects of nature for humans. At the same time, biodiversity in cities, where most humans live, is often low or in decline. Tangible solutions are needed to increase urban biodiversity. 2. Architecture is a key discipline that has considerable influence on the built-up area of cities, thereby influencing urban biodiversity. In general, architects do not design for biodiversity. Conversely, urban conservation planning generally focuses on the limited space free of buildings and does not embrace architecture as an important discipline for the creation of urban green infrastructure. 3. In this paper, we argue that the promotion of biodiversity needs to become a key driving force of architectural design. This requires a new multi-species design paradigm that considers both human and non-human needs. Such a design approach needs to maintain the standards of the architectural profession, including the aim to increase the well-being of humans in buildings. Yet, it also needs to add other stakeholders, organisms such as animals, plants and even microbiota. New buildings designed for humans and other inhabitants can then increase biodiversity in cities and also increase the benefits that humans can derive from close proximity to nature. 4. We review the challenges that this new design approach poses for both architecture and ecology and show that multi-species-design goes beyond existing approaches in architecture and ecology. The new design approach needs to make ecological knowledge available to the architectural design process, enabling practitioners to find architectural solutions that can facilitate synergies from a multi-species perspective. 5. We propose that a first step in creating such a multi-species habitat is the design of buildings with an ecolope, a multi criteria-designed building envelope that takes into account the needs of diverse organisms. Because there is no framework to design such an ecolope, we illustrate how multi-species design needs to draw on knowledge from ecology, as well as architecture, and design computation. 6. We discuss how architectures designed via a multi-species approach can be an important step in establishing beneficial human-nature relationships in cities, and contribute to human well-being and biodiversity conservation.Read the free Plain Language Summary for this article on the Journal blog

Distributed optimization with arbitrary local solvers

With the growth of data and necessity for distributed optimization methods, solvers that work well on a single machine must be re-designed to leverage distributed computation. Recent work in this area has been limited by focusing heavily on developing highly specific methods for the distributed environment. These special-purpose methods are often unable to fully leverage the competitive performance of their well-tuned and customized single machine counterparts. Further, they are unable to easily integrate improvements that continue to be made to single machine methods. To this end, we present a framework for distributed optimization that both allows the flexibility of arbitrary solvers to be used on each (single) machine locally, and yet maintains competitive performance against other state-of-the-art special-purpose distributed methods. We give strong primal-dual convergence rate guarantees for our framework that hold for arbitrary local solvers. We demonstrate the impact of local solver selection both theoretically and in an extensive experimental comparison. Finally, we provide thorough implementation details for our framework, highlighting areas for practical performance gains

Anomalous nonlinear X-ray Compton scattering

X-ray scattering is typically used as a weak linear atomic-scale probe of matter. At high intensities, such as produced at free-electron lasers, nonlinearities can become important, and the probe may no longer be considered weak. Here we report the observation of one of the most fundamental nonlinear X-ray–matter interactions: the concerted nonlinear Compton scattering of two identical hard X-ray photons producing a single higher-energy photon. The X-ray intensity reached 4 × 1020 W cm−2, corresponding to an electric field well above the atomic unit of strength and within almost four orders of magnitude of the quantum-electrodynamic critical field. We measure a signal from solid beryllium that scales quadratically in intensity, consistent with simultaneous non-resonant two-photon scattering from nearly-free electrons. The high-energy photons show an anomalously large redshift that is incompatible with a free-electron approximation for the ground-state electron distribution, suggesting an enhanced nonlinearity for scattering at large momentum transfer

Anomalous nonlinear X-ray Compton scattering

X-ray scattering is typically used as a weak linear atomic-scale probe of matter. At high intensities, such as produced at free-electron lasers, nonlinearities can become important, and the probe may no longer be considered weak. Here we report the observation of one of the most fundamental nonlinear X-ray–matter interactions: the concerted nonlinear Compton scattering of two identical hard X-ray photons producing a single higher-energy photon. The X-ray intensity reached 4 × 1020 W cm−2, corresponding to an electric field well above the atomic unit of strength and within almost four orders of magnitude of the quantum-electrodynamic critical field. We measure a signal from solid beryllium that scales quadratically in intensity, consistent with simultaneous non-resonant two-photon scattering from nearly-free electrons. The high-energy photons show an anomalously large redshift that is incompatible with a free-electron approximation for the ground-state electron distribution, suggesting an enhanced nonlinearity for scattering at large momentum transfer

Precision measurement of charged pion and kaon differential cross sections in electron-positron annihilation at Q = 10.52 GeV

Measurements of inclusive differential cross sections for charged pion and kaon production in electron-positron annihilation have been carried out at a center-of-mass energy of Q = 10.52 GeV. The measurements were performed with the Belle detector at the KEKB electron-positron collider using a data sample containing 113 million e+e- -> qqbar events, where q={u,d,s,c}. We present charge-integrated differential cross sections d\sigma_h+-/dz for h+- = pi+-, K+- as a function of the relative hadron energy z = 2*E_h / sqrt{s} from 0.2 to 0.98. The combined statistical and systematic uncertainties for pi+- (K+-) are 4% (4%) at z ~ 0.6 and 15% (24%) at z ~ 0.9. The cross sections are the first measurements of the z-dependence of pion and kaon production for z > 0.7 as well as the first precision cross section measurements at a center-of-mass energy far below the Z^0 resonance used by the experiments at LEP and SLC.Comment: 7 pages, 3 figures. Ancillary file including all cross section and uncertainty values with 10 pages, 5 figure