Measuring patient-perceived quality of care in US hospitals using Twitter

BACKGROUND: Patients routinely use Twitter to share feedback about their experience receiving healthcare. Identifying and analysing the content of posts sent to hospitals may provide a novel real-time measure of quality, supplementing traditional, survey-based approaches. OBJECTIVE: To assess the use of Twitter as a supplemental data stream for measuring patient-perceived quality of care in US hospitals and compare patient sentiments about hospitals with established quality measures. DESIGN: 404 065 tweets directed to 2349 US hospitals over a 1-year period were classified as having to do with patient experience using a machine learning approach. Sentiment was calculated for these tweets using natural language processing. 11 602 tweets were manually categorised into patient experience topics. Finally, hospitals with ≥50 patient experience tweets were surveyed to understand how they use Twitter to interact with patients. KEY RESULTS: Roughly half of the hospitals in the US have a presence on Twitter. Of the tweets directed toward these hospitals, 34 725 (9.4%) were related to patient experience and covered diverse topics. Analyses limited to hospitals with ≥50 patient experience tweets revealed that they were more active on Twitter, more likely to be below the national median of Medicare patients (p<0.001) and above the national median for nurse/patient ratio (p=0.006), and to be a non-profit hospital (p<0.001). After adjusting for hospital characteristics, we found that Twitter sentiment was not associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings (but having a Twitter account was), although there was a weak association with 30-day hospital readmission rates (p=0.003). CONCLUSIONS: Tweets describing patient experiences in hospitals cover a wide range of patient care aspects and can be identified using automated approaches. These tweets represent a potentially untapped indicator of quality and may be valuable to patients, researchers, policy makers and hospital administrators

An Event Structure Model for Probabilistic Concurrent Kleene Algebra

We give a new true-concurrent model for probabilistic concurrent Kleene algebra. The model is based on probabilistic event structures, which combines ideas from Katoen's work on probabilistic concurrency and Varacca's probabilistic prime event structures. The event structures are compared with a true-concurrent version of Segala's probabilistic simulation. Finally, the algebraic properties of the model are summarised to the extent that they can be used to derive techniques such as probabilistic rely/guarantee inference rules.Comment: Submitted and accepted for LPAR19 (2013

Gliotransmission modulates baseline mechanical nociception

Pain is a physiological and adaptive process which occurs to protect organisms from tissue damage and extended injury. Pain sensation beyond injury, however, is a pathological process which is poorly understood. Experimental models of neuropathic pain demonstrate that reactive astrocytes contribute to reduced nociceptive thresholds. Astrocytes release "gliotransmitters" such as D-serine, glutamate, and ATP, which is extracellularly hydrolyzed to adenosine. Adenosine 1 receptor activation in the spinal cord has anti-nociceptive effects on baseline pain threshold, but the source of the endogenous ligand (adenosine) in the spinal cord is unknown. In this study we used a transgenic mouse model in which SNARE-mediated gliotransmission was selectively attenuated (called dnSNARE mice) to investigate the role of astrocytes in mediating baseline nociception and the development of neuropathic pain. Under baseline conditions, immunostaining in the dorsal horn of the spinal cord showed astrocyte-specific transgene expression in dnSNARE mice, and no difference in expression levels of the astrocyte marker GFAP and the microglia marker Iba1 relative to wild-type mice. The Von Frey filament test was used to probe sensitivity to baseline mechanical pain thresholds and allodynia following the spared nerve injury model of neuropathic pain. DnSNARE mice exhibit a reduced nociceptive threshold in response to mechanical stimulation compared to wild-type mice under baseline conditions, but nociceptive thresholds following spared nerve injury were similar between dnSNARE and wild-types. This study is the first to provide evidence that gliotransmission contributes to basal mechanical nociception

Bounded Model Checking for Probabilistic Programs

In this paper we investigate the applicability of standard model checking approaches to verifying properties in probabilistic programming. As the operational model for a standard probabilistic program is a potentially infinite parametric Markov decision process, no direct adaption of existing techniques is possible. Therefore, we propose an on-the-fly approach where the operational model is successively created and verified via a step-wise execution of the program. This approach enables to take key features of many probabilistic programs into account: nondeterminism and conditioning. We discuss the restrictions and demonstrate the scalability on several benchmarks

PrIC3: Property Directed Reachability for MDPs

IC3 has been a leap forward in symbolic model checking. This paper proposes PrIC3 (pronounced pricy-three), a conservative extension of IC3 to symbolic model checking of MDPs. Our main focus is to develop the theory underlying PrIC3. Alongside, we present a first implementation of PrIC3 including the key ingredients from IC3 such as generalization, repushing, and propagation

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63263/1/thy.2006.16.109.pd

Solutions of the sDiff(2)Toda equation with SU(2) Symmetry

We present the general solution to the Plebanski equation for an H-space that admits Killing vectors for an entire SU(2) of symmetries, which is therefore also the general solution of the sDiff(2)Toda equation that allows these symmetries. Desiring these solutions as a bridge toward the future for yet more general solutions of the sDiff(2)Toda equation, we generalize the earlier work of Olivier, on the Atiyah-Hitchin metric, and re-formulate work of Babich and Korotkin, and Tod, on the Bianchi IX approach to a metric with an SU(2) of symmetries. We also give careful delineations of the conformal transformations required to ensure that a metric of Bianchi IX type has zero Ricci tensor, so that it is a self-dual, vacuum solution of the complex-valued version of Einstein's equations, as appropriate for the original Plebanski equation.Comment: 27 page

Model exploration and analysis for quantitative safety refinement in probabilistic B

The role played by counterexamples in standard system analysis is well known; but less common is a notion of counterexample in probabilistic systems refinement. In this paper we extend previous work using counterexamples to inductive invariant properties of probabilistic systems, demonstrating how they can be used to extend the technique of bounded model checking-style analysis for the refinement of quantitative safety specifications in the probabilistic B language. In particular, we show how the method can be adapted to cope with refinements incorporating probabilistic loops. Finally, we demonstrate the technique on pB models summarising a one-step refinement of a randomised algorithm for finding the minimum cut of undirected graphs, and that for the dependability analysis of a controller design.Comment: In Proceedings Refine 2011, arXiv:1106.348

Widest Paths and Global Propagation in Bounded Value Iteration for Stochastic Games

Solving stochastic games with the reachability objective is a fundamental problem, especially in quantitative verification and synthesis. For this purpose, bounded value iteration (BVI) attracts attention as an efficient iterative method. However, BVI's performance is often impeded by costly end component (EC) computation that is needed to ensure convergence. Our contribution is a novel BVI algorithm that conducts, in addition to local propagation by the Bellman update that is typical of BVI, global propagation of upper bounds that is not hindered by ECs. To conduct global propagation in a computationally tractable manner, we construct a weighted graph and solve the widest path problem in it. Our experiments show the algorithm's performance advantage over the previous BVI algorithms that rely on EC computation.Comment: v2: an URL to the implementation is adde