Beyond HCAHPS: Analysis of patients’ comments provides an expanded view of their hospital experiences

An important concern for health care professionals is that standardized patient surveys may not fully capture all the topics that are important to patients. As a result, health care professionals may not have a complete picture of what their patients experience. The purpose of this research is to utilize a state-of-the-art Natural Language Processing technique to make sense of patients’ solicited, unstructured comments to gain a deeper and broader understanding of their experiences in the hospital. We analyzed a large dataset of inpatient survey responses (48,592 patients generating 65,998 comments) by a patient experience survey vendor for an eleven-hospital health care system in a large Midwest US city. Comments were first analyzed by Top2Vec algorithm in Python and more than 650 groupings of comments were then reduced into 20 sub-domains within 4 topic domains to better understand patient feedback on their hospital experience. We find distinct domains in the textual data that are not completely captured by survey domains. Furthermore, these domains match components of a hierarchical model of health service quality: interpersonal, technical, environmental, and administrative quality. Our findings broaden and deepen understanding of domains on standardized surveys. That is, completely new issues that are not measured in structured surveys are found in patient comments, and even when patient comments can be assigned to specific domains (e.g., nurse communication, discharge, etc.) found in standardized surveys, novel sub-topics provide a more nuanced understanding of patients’ hospital experiences. Novel sub-topics found in patient comments include clinicians’ diagnostic skill, compassionate care, team coordination, transfer processes, roommates, and others. Health care organizations should utilize state-of-the-art methods to mine insights from patient comments, and ensure they have processes, resources, and capabilities needed to translate insights into action. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Effect of Multiple Rounds of Mass Drug Administration under Lymphatic Filariasis Elimination Program on Prevalence of Soil-Transmitted Helminthiasis in One of the Co-endemic Districts of India

Both soil-transmitted helminthiasis and lymphatic filariasis are co-endemic in some districts of India. The study was aimed at comparing the prevalence of soil-transmitted helminthiasis (STH) infection before and after mass drug administration (MDA) given for lymphatic filariasis at Alappuzha.We examined stool samples of 219 children aged between 9 and 10 years from nine schools at Alappuzha, Kerala, in June 2015. The current STH situation was compared with that in the year 1999 (before the institution of MDA) in the same age group in the same district. WHO-recommended Kato-Katz technique was used for STH prevalence estimation. Information regarding socio-demographic variables, sanitation, personal hygiene practices was also recorded. Chi-square test was used to study association of risk factors with STH infection.A total of 79 (36.07%) children were found to be positive for STH infection. Out of all samples positive for Ascaris lumbricoides, 4 (5%) were found co-infected with Trichuris trichiura and none with hookworm. Factors like absence of household latrine, lack of hand washing before meals and practice of consumingunwashed fruits were found to be significantly associated with occurrence of STH infection.Over the years, consecutive rounds of MDA for LF have led to a decline in intestinal worm burden but with little effect on the overall prevalence of STH. Thus, STH control activities working synergistically with the Filarial Elimination Strategy can yield better results in the co-endemic areas with optimum resourceutilization

Variations in hydro-chemical properties and source insights of coalbed methane produced water of Raniganj Coalfield, Jharkhand, India

The production of coalbed methane is increasing rapidly in Raniganj coalfield of India. The present statistics of methane gas production and produced water is about 1.7 mmscmd (million metric standard cubic meter per day) and 12160 m3/day respectively from 560 CBM wells. The major concerns are challenges related to CBM produced water treatment, it's handling, uses for various purposes and its proper disposal is yet to be resolved, considering physico-chemical parameters, socio-economic, environmental and techno-commercial aspects. In view of this, a detailed study of CBM produced water of Raniganj coalfield has been carried out to evaluate hydro-chemical variations, quantity, quality, related aquifer characteristics, options of treatment, suitable beneficial uses and disposal. The large amount of TDS is the major concern contributed by cations andanions like Na+, Ca2+ and HCO3−. The trace metal content obtained through Inductively Coupled Plasma Mass Spectrometry (ICPMS) analyses such as Fe2+, Mn2+, Zn2+, Sr2+and Al3+ varies from 0.12 to 0.94, 0.002 to 0.651, 0.001 to 0.041, 0.005 to 0.801 and 0.002–0.092 mg/l respectively. Atomic absorption spectroscopy (AAS) was used for cations (Na+, K+, Mg2+ and Ca2+) distribution found ranged from 289 to 1136, 0.00 to 0.94, 0.18 to 1.82 and 10.2–21.2 mg/l respectively, whereas, anions (SO42−, F−, Cl−, NO3− and HCO3−) were determined using Ion Chromatography (IC), found varying from 0.14 to 1.62, 1.042 to 4.862, 114.42 to 565.21, 7.41 to 70.4 and 1923.4–3129.4 mg/l respectively. The CBM produced water is classified as Na+–K+–CO32-–HCO3- and Na+–HCO3- type attributed to different rock formations of aquifers and deeper coal seams. TDS and trace metals concentrations are controlled by depositional environment, local marine transgression occurred during the Sakmarian - Artinskian geological period and inherited from groundwater mineral interactions. The results of proposed model for quality parameter prediction signifies TDS content is observed to be low during the initial five years of production and gradually increases with time. The similar trend is shown by HCO3−, Na+, SO42−, F−, Cl− and NO3− signifying the rock interaction and alterations is the only source of minerals and ions. Initially, the shallow aquifer water having interaction with fresh water recharge dilutes the concentrations of different water quality parameters, but as production continues, the concentration of constituents directly controlled by formation rocks and may increase until it reaches the saturation point. The continuous drawdown of water from a large number of CBM wells changing the regional static hydrological balance including a drainage system and it may take long spells to recuperate its original levels. This study can be utilized in designing treatment processes, beneficial uses and exploring the new water resources in Raniganj coalfield

Rib stability: A way forward for safe coal extraction in India

Ensuring rib stability during pillar extraction is of prime importance in bord and pillar (B&P) method of underground coal mining with caving. Rib stability has been assessed here by way of assessing factor of safety (FOS), a ratio of the strength of rib to stress on it. Earlier formulations for rib stability when applied to case studies gave very low FOS value suggesting significant ground control problems, which were contrary to the field observations. This has necessitated the need to revisit the concept of rib stability. The stress coming on the rib is estimated with the use of numerical modeling technique using the FLAC3D software. The methodology of assessing rib-stability with the help of suggested rib-strength formulation has been validated at eight Indian coal mines. The outcome of this study finds relevance and importance in ensuring underground coal liquidation with improved safety and conservation. Keywords: Rib stress estimation, Rib-strength, Rib-stability, Numerical modeling, Bord & pillar method, Underground coal extractio

Thick Coal Seam Mining Methods : Challenges and Opportunities

The geo-technical problems faced in thick seam mining in India are multi-fold, notables are conventional supports having serious limitations, inadequate rib design resulting into ineffectiveness and many time unpredictability at the goaf edges and risky caving in- bye. Most of the mining endeavors in thick seams are confined to semi-mechanized propositions. Mining with stowing becomes techno-economically non-viable due to fast pace of retreat now being planned and the rate of stowing not matching with it. In this paper, a review of different mining methods in bord and pillar (B&P) pattern with caving as goaf treatment have been presented. Longwalling and its variants like LTCC (Longwall top coal caving), multi-level and multi-section caving, etc. are yet to be established in an R&D demonstrative trial panel and hence not included in this paper. The case-study observations in B&P pattern have been analyzed so as to provide the mine operators to take cognizance of challenges and opportunities in this regard. The latest updates about various research inputs by CSIR-CIMFR have also been provided within the realms of thick seam mining methods

Extraction of Deep-Seated Coal Deposits Using Emerging Underground Mining Methods

The average depth of the underground coal workings has increased considerably due to the exhaustion of coal deposits near surface. Nevertheless, the coal extraction at depth is overwhelmed with geomining issues due to high in-situ stresses, dynamic behaviour of rockmas, large dilation in mine openings, etc. Therefore, to extract coal from deep mine safely, this paper assesses the geomechanical issues and the mining challenges of deep mining and emerging methods to manage these issues eectively for Indian mining conditions. The geo-mechanical issues have been assessed based on the basic rock mechanics of deep mines. The mining challenges are analyzed focusing on stable working face, roadways, transportation, etc. The comprehensive survey and critical studies of the emerging underground mining methods are done to nd out the prospective methods of underground mining which can negotiate the complexities of deep-seated coal deposits in India. The selection of mining methods suitable to the characteristics of coal deposits has been discussed and suggested for mining at greater depth. The works presented in this paper are highly pertinent to Indian mining industry and would provide an insight to select greener, economical and safe mining method to extract deep-seated coal deposit

A Cytological Study of Palpable Superficial Nodules of Parasitic Origin: A Study of 41 Cases

Background. Few parasitic infestations present as only superficial palpable subcutaneous or intramuscular nodule. The current study highlights the role of FNAC in the diagnosis of superficial palpable parasitic lesions. Methods. This was a retrospective study in which we reviewed the FNAC record of all patients over a period of two years from September 2011 to August 2013. During this period, FNA was performed on 5954 cases which presented as superficial palpable lump at various sites of body. There were 41 cases diagnosed as parasitic lesion or suspicious of parasitic lesion on cytology which were included in the study. Results. In the present study, most of the patients were children and young adults. The lesions were located over trunk in 18 (43.9%) cases, extremities in 12 (29.3%) cases, and head and neck region in 11 (26.8%) cases. Out of 41 cases, 27 (65.8%) cases were confirmed on cytology and/or histopathology as parasitic lesions, including 21 (51.2%) cases of cysticercosis, 5 (12.2%) cases of filariasis, and one (2.4%) case of hydatid cyst. Cytological findings of remaining cases were suggestive of parasitic lesion. Conclusion. Careful assessment of cytological material is helpful to detect parasite or inflammatory response to parasite even in asymptomatic patients

Aggressive angiomyxoma in pregnancy

Aggressive angiomyxoma (AA) is a rare, slow-growing mesenchymal neoplasm of vulvo-perineal region. Although AA is common in females of reproductive age, only a few cases during pregnancy have been documented in the English literature. It carries a high risk of local recurrence but rarely metastasizes. The high recurrence rate can partially be due to inadequate excision, which may be due to an incorrect preoperative diagnosis. We present a case of 25-year-old pregnant female presenting with a painless and soft mass attached to left labia majora by a stalk. This mass was clinically thought to be a lipoma. It was completely excised and was diagnosed as AA on histopathology. Gynecologists should consider the diagnosis of AA when a young female especially during her pregnancy presents with a vulvo-perineal mass. Incorrect diagnosis may lead to incomplete excision and recurrence

Jatropha Curcas : a bio diesel plant in reclamation of silica mining area

A silica mining area ,in Vindhayn hills of Allahabad District in Uttar Pradesh, India, is severely degraded due to open cast silica mining. This continuous process of opencast mining has scarred the landscape, disrupted ecosystems and destroyed microbial communities of the area. Apart from these unsightly impacts, the degraded environments created in the aftermath of opencast mining often cannot support biomass development. Over the long term, opencast mining reduces forest productivity, damages aquatic and atmospheric ecosystems and sometimes leads to substantial alterations in microclimates. Such changes, in turn, carry adverse economic and social impacts for nearby communities whose residents depend on the region’s natural resources for large portions of their incomes. Therefore there is an urgent need to reclaim these abandoned areas by using such plants, which can easily establish themselves in such adverse conditions and also support the economy of the local people. Jatropha curcas has been found most suitable for the purpose, especially due to the use of its seed oil as bio diesel and its resistant nature. It can be grown on such lands, which are largely unproductive for the time being, and are located in poverty stricken areas. The present study is on the performance of different provenances of Jatropha in silica mining area of Vindhayn hills, India. For this, total twenty-three provenances were collected from different parts of India. Their seedlings were raised in nursery. The growth performance of these provenances of Jatropha was recorded in nursery. After that, the field trial of these seedlings was carried out in the silica mining area. The growth performance was recorded. The provenance with best performance may further be recommended for the reclamation of such areas under similar agro climatic conditions and through Jatropha plantations, three major objectives, viz. wasteland reclamation, production of eco-friendly bio fuel, and socio-economic development of degraded areas can be achieved simultaneously.Non UBCUnreviewedOthe