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RNA viruses, such as poliovirus, have a great evolutionary capacity, allowing them to quickly adapt and overcome challenges encountered during infection. Here we show that poliovirus infection in immune-competent mice requires adaptation to tissue-specific innate immune microenvironments. The ability of the virus to establish robust infection and virulence correlates with its evolutionary capacity. We further identify a region in the multi-functional poliovirus protein 2B as a hotspot for the accumulation of minor alleles that facilitate a more effective suppression of the interferon response. We propose that population genetic dynamics enables poliovirus spread between tissues through optimization of the genetic composition of low frequency variants, which together cooperate to circumvent tissue-specific challenges. Thus, intrahost virus evolution determines pathogenesis, allowing a dynamic regulation of viral functions required to overcome barriers to infection. [ABSTRACT FROM AUTHOR]

The HCAHPS Survey obtains hospital patients’ experiences using four modes: Mail Only, Phone Only, Mixed (mail/phone follow-up), and Touch-Tone (push-button) Interactive Voice Response with option to transfer to live interviewer (TT-IVR/Phone). A new randomized experiment examines two less expensive modes: Web/Mail (mail invitation to participate by Web or request a mail survey) and Speech-Enabled IVR (SE-IVR/Phone; speaking to a voice recognition system; optional transfer to an interviewer). Web/Mail had a 12% response rate (vs. 32% for Mail Only and 33% for SE-IVR/Phone); Web/Mail respondents were more educated and less often Black than Mail Only respondents. SE-IVR/Phone respondents (who usually switched to an interviewer) were less often older than 75 years, more often English-preferring, and reported better care than Mail Only respondents. Concerns regarding inconsistencies across implementations, low adherence to primary modes, or low response rate may limit the applicability of the SE-IVR/Phone and Web/Mail modes in HCAHPS and similar standardized environments. [ABSTRACT FROM PUBLISHER]

Collagen molecules, self-assembled into macroscopic hierarchicaltissue networks, are the main organic building block of many biologicaltissues. A particularly common and important form of this self-assemblyconsists of type I collagen fibrils, which exhibit a nanoscopic signature,D-periodic gap/overlap spacing, with a distribution of values centeredat approximately 67 nm. In order to better understand the relationshipbetween type I collagen self-assembly and D-spacing distribution,we investigated surface-mediated collagen self-assembly as a functionof substrate and incubation concentration. Collagen fibril assemblyon phlogopite and muscovite mica as well as fibrillar gel coextrusionin glass capillary tubes all exhibited D-spacing distributions similarto those commonly observed in biological tissues. The observationof D-spacing distribution by self-assembly of type I collagen aloneis significant as it eliminates the necessity to invoke other preassemblyor postassembly hypotheses, such as variation in the content of collagentypes, enzymatic cross-linking, or other post-translational modifications,as mechanistic origins of D-spacing distribution. The D-spacing distributionon phlogopite mica is independent of type I collagen concentration,but on muscovite mica D-spacing distributions showed increased negativeskewness at 20 μg/mL and higher concentrations. Tilted D-spacingangles were found to correlate with decreased D-spacing measurements,an effect that can be removed with a tilt angle correction, resultingin no concentration dependence of D-spacing distribution on muscovitemica. We then demonstrated that tilted D-spacing is uncommon in biologicaltissues and it does not explain previous observations of low D-spacingvalues in ovariectomized dermis and bone. [ABSTRACT FROM AUTHOR]

Using HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems, also known as the CAHPS Hospital Survey) data from 2,684 hospitals, the authors compare the experiences of Hispanic, African American, Asian/Pacific Islander, American Indian/Alaska Native, and multiracial inpatients with those of non-Hispanic White inpatients to understand the roles of between- and within-hospital differences in patients' perspectives of hospital care. The study finds that, on average, non-Hispanic White inpatients receive care at hospitals that provide better experiences for all patients than the hospitals more often used by minority patients. Within hospitals, patient experiences are more similar by race/ethnicity, though some disparities do exist, especially for Asians. This research suggests that targeting hospitals that serve predominantly minority patients, improving the access of minority patients to better hospitals, and targeting the experiences of Asians within hospitals may be promising means of reducing disparities in patient experience. [ABSTRACT FROM AUTHOR]

Prior research suggests hospital quality of care is multidimensional. In this study, the authors jointly examine patient experience of care and clinical care measures from 2,583 hospitals based on inpatients discharged in 2006 and 2007. The authors use multinomial logistic regression to identify key characteristics of hospitals that perform in the top quartile on both, either, and neither dimension of quality. Top performers on both quality measures tend to be small (<100 beds), large (>200 beds) and rural, located in the New England or West North Central Census divisions, and nonprofit. Top performers in patient experience only are most often small and rural, located in the East South Central division, and government owned. Top performers in clinical care only are most often medium to large and urban, located in the West North Central division, and non-government owned. These findings provide an overview of how these dimensions of quality vary across hospitals. [ABSTRACT FROM AUTHOR]

The authors describe the history and development of the CAHPS Hospital Survey (also known as HCAHPS) and its associated protocols. The randomized mode experiment, vendor training, and "dry runs" that set the stage for initial public reporting are described. The rapid linkage of HCAHPS data to annual payment updates ("pay for reporting") is noted, which in turn led to the participation of approximately 3,900 general acute care hospitals (about 90% of all such United States hospitals). The authors highlight the opportunities afforded by this publicly reported data on hospital inpatients' experiences and perceptions of care. These data, reported on www.hospitalcompare.hhs. gov, facilitate the national comparison of patients' perspectives of hospital care and can be used alone or in conjunction with other clinical and outcome measures. Potential benefits include increased transparency, improved consumer decision making, and increased incentives for the delivery of high-quality health care. [ABSTRACT FROM AUTHOR]

Prior research documents differences in patient-reported experiences by patient characteristics. Using nine measures of patient experience from 1,203,229 patients discharged in 2006-2007 from 2,684 acute and critical access hospitals, the authors find that adjusted hospital scores measure distinctions in quality for the average patient with high reliability. The authors also find that hospital "ranks" (the relative scores of hospitals for patients of a given type) vary substantially by patient health status and race/ ethnicity/language, and moderately by patient education and age (p < .05 for almost all measures). Quality improvement efforts should examine hospital performance with both sicker and healthier patients, because many hospitals that do well with one group (relative to other hospitals) may not do well with another. The experiences of American Indians/Alaska Natives should also receive particular attention. As HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) data accumulate, reports that drill down to hospital performance for patient subtypes (especially by health status) may be valuable. [ABSTRACT FROM AUTHOR]

The Food and Drug Administration issued a black box warning in response to concerns that antidepressants may increase the risk or suicidality in children and young adults. In the effort to weigh the benefits and risks of anti-depressants, numerous methodological challenges preclude the determination of a definitive answer. The available empirical findings and mixed, with some studies displaying an association between antidepressant use and reduced suicidality, and other studies uncovering a significant risk of suicidality for patients treated with antidepressants compared to placebo. In the absence of more conclusive information regarding the relative safety and efficacy of antidepressant medication, frequent monitoring, especially during the first weeks of treatment, should be a component of all treatment plans. Further research is needed to determine which patients might benefit most from antidepressant treatment, as well as whether the black box warning has prevented suicide, or merely hindered the prescription of potentially helpful medication. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the need for survey mode adjustments to hospital care evaluations by discharged inpatients and develop the appropriate adjustments. Data Source. A total of 7,555 respondents from a 2006 national random sample of 45 hospitals who completed the CAHPS® Hospital (HCAHPS [Hospital Consumer Assessments of Healthcare Providers and Systems]) Survey. Study Design/Data Collection/Extraction Methods. We estimated mode effects in linear models that predicted each HCAHPS outcome from hospital-fixed effects and patient-mix adjustors. Principal Findings. Patients randomized to the telephone and active interactive voice response (IVR) modes provided more positive evaluations than patients randomized to mail and mixed (mail with telephone follow-up) modes, with some effects equivalent to more than 30 percentile points in hospital rankings. Mode effects are consistent across hospitals and are generally larger than total patient-mix effects. Patient-mix adjustment accounts for any nonresponse bias that could have been addressed through weighting. Conclusions. Valid comparisons of hospital performance require that reported hospital scores be adjusted for survey mode and patient mix. [ABSTRACT FROM AUTHOR]

Objective. To describe the developmental process for the CAHPS® Hospital Survey. Study Design. A pilot was conducted in three states with 19,720 hospital discharges. Methods of Analysis. A rigorous, multi-step process was used to develop the CAHPS Hospital Survey. It included a public call for measures, multiple Federal Register notices soliciting public input, a review of the relevant literature, meetings with hospitals, consumers and survey vendors, cognitive interviews with consumer, a large-scale pilot test in three states and consumer testing and numerous small-scale field tests. Findings. The current version of the CAHPS Hospital Survey has survey items in seven domains, two overall ratings of the hospital and five items used for adjusting for the mix of patients across hospitals and for analytical purposes. Conclusions. The CAHPS Hospital Survey is a core set of questions that can be administered as a stand-alone questionnaire or combined with a broader set of hospital specific items. [ABSTRACT FROM AUTHOR]

This article estimates differences and difference-in-differences in patient experiences for Veterans Health Administration (VA) compared to non-VA patients in 2017, when there was concern about the health quality of VA hospitals, and in 2021, the second year of the COVID-19 pandemic, both overall, and for specific patient groups. We used data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. In 2017, HCAHPS performance was somewhat better for non-VA than for VA hospitals, with Care Transition being the only measure for which VA hospitals performed better on average. By 2021, HCAHPS performance was better for VA than for non-VA hospitals for all but two measures (Quietness and Discharge Information), for which there were no differences from non-VA hospitals. In 2017, the VA provided worse experiences than non-VA hospitals for Black and poor-health patients; in 2021, VA hospitals outperformed non-VA hospitals for these, and all patient subgroups examined. [ABSTRACT FROM AUTHOR]

Background: Web-first multimode survey protocols increase HCAHPS survey response rates and representativeness but may result in different HCAHPS scores because of survey mode effects and selective email address availability. A variable absent from many patient-mix adjustment models that may result in more positive patient experiences is whether the hospital admission was planned; adjustment for planned stays may better measure hospital performance., Objectives: Develop adjustments for new Web-first survey protocols and planned admissions to facilitate comparisons across hospitals., Research Design: Using 2021 survey mode experiment data, we estimate survey protocol effects in linear models predicting HCAHPS top-box outcomes from protocol indicators (which incorporate email availability for Web-first protocols), patient-mix adjustors, and hospital intercepts. We evaluate the unique effect on scores of whether a stay was planned., Results: Phone-only and Web-Phone without email produce more positive responses than Mail-only, requiring negative adjustments. All other survey protocol effects and adjustments are mixed in direction and generally small. Planned stays are associated with more positive experiences for otherwise similar patients and make a unique contribution beyond other current patient-mix adjustment variables., Conclusions: It is important to adjust HCAHPS scores for survey protocol effects to ensure fair comparisons across hospitals and to enable hospitals to choose the survey protocol that best represents their patients. Incomplete email address availability necessitates that HCAHPS survey protocol adjustment control for email address availability when a Web-first protocol is used. Accounting for differences associated with planned stays may improve patient-mix adjustment., Competing Interests: W.G.L. and E.G. are employees of the sponsoring agency, the Centers for Medicare & Medicaid Services. The remaining authors declare no conflict of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

A general method for the enantioselective synthesis of carbo- and heterocyclic carbonyl compounds bearing fluorinated α-tetrasubstituted stereocenters using palladium-catalyzed decarboxylative allylic alkylation is described. The stereoselective C sp 3 -C sp 3 cross-coupling reaction delivers five- and six-membered ketone and lactam products bearing (poly)fluorinated tetrasubstituted chiral centers in high yields and enantioselectivities. These fluorinated, stereochemically rich building blocks hold potential value in medicinal chemistry and are prepared using an orthogonal and enantioselective approach into such chiral moieties compared to traditional approaches, often without the use of electrophilic fluorinating reagents.

The Medicare+Choice (M+C) program, created by the 1997 Balanced Budget Act (BBA), expands Medicare's health insurance options to include a wider range of health plan options. In this article, we describe the Consumer Assessment of Health Plans Study (CAHPS ® ) survey and its use with beneficiaries receiving care through Medicare managed care (MMC) plans. We also discuss the implications of these efforts for future quality improvement efforts.