Hospital Compare and Hospital Choice: Public Reporting and Hospital Choice by Hip Replacement Patients in Texas.

The Centers for Medicare & Medicaid Services publicizes comparative performance data on Hospital Compare, a website maintained to support consumer decision making. Given the agency's goal, this study investigates the relationship between public reporting and hospital choices of hip replacement patients in Texas. Estimating individual-level valuations of provider characteristics allowing for heterogeneity across patients, we find consumer selections and hospitals' displayed performance vary together in time. Comparing associations involving public reporting with those associated with more readily observable hospital attributes, we conclude relationships coinciding with release of comparative performance data are modest, but not inconsequential. Our use of an empirical strategy novel for evaluation of public reporting has methodological implications, while the study's affirmative result is of potential interest to policy makers and administrators.

CF3+ and CF2H+: new reagents for n-alkane determination in chemical ionisation reaction mass spectrometry.

Alkanes provide a particular analytical challenge to commonly used chemical ionisation methods such as proton-transfer from water owing to their basicity. It is demonstrated that the fluorocarbon ions CF3+ and CF2H+, generated from CF4, as reagents provide an effective means of detecting light n-alkanes in the range C2-C6 using direct chemical ionisation mass spectrometry. The present work assesses the applicability of the reagents in Chemical Ionisation Mass Spectrometric (CI-TOF-MS) environments with factors such as high moisture content, operating pressures of 1-10 Torr, accelerating electric fields (E/N) and long-lived intermediate complex formation. Of the commonly used chemical ionisation reagents, H3O+ and NO+ only react with hexane and higher while O2+ reacts with all the target samples, but creates significant fragmentation. By contrast, CF3+ and CF2H+ acting together were found to produce little or no fragmentation. In dry conditions with E/N = 100 Td or higher the relative intensity of CF2H+ to CF3+ was mostly less than 1% but always less than 3%, making CF3+ the main reagent ion. Using O2+ in a parallel series of experiments, a substantially greater degree of fragmentation was observed. The detection sensitivities of the alkanes with CF3+ and CF2H+, while relatively low, were found to be better than those observed with O2+. Experiments using alkane mixtures in the ppm range have shown the ionisation technique based on CF3+ and CF2H+ to be particularly useful for measurements of alkane/air mixtures found in polluted environments. As a demonstration of the technique's effectiveness in complex mixtures, the detection of n-alkanes in a smoker's breath is demonstrated.

Metabolite profiling of the ripening of Mangoes Mangifera indica L. cv. 'Tommy Atkins' by real-time measurement of volatile organic compounds.

Real-time profiling of mango ripening based on proton transfer reaction-time of flight-mass spectrometry (PTR-ToF-MS) of small molecular weight volatile organic compounds (VOCs), is demonstrated using headspace measurements of 'Tommy Atkins' mangoes. VOC metabolites produced during the ripening process were sampled directly, which enabled simultaneous and rapid detection of a wide range of compounds. Headspace measurements of 'Keitt' mangoes were also conducted for comparison. A principle component analysis of the results indicated that several mass channels were not only key to the ripening process but could also be used to distinguish between mango cultivars. The identities of 22 of these channels, tentatively speciated using contemporaneous GC-MS measurements of sorbent tubes, are rationalized through examination of the biochemical pathways that produce volatile flavour components. Results are discussed with relevance to the potential of headspace analysers and electronic noses in future fruit ripening and quality studies.

Observations of the release of non-methane hydrocarbons from fractured shale.

The organic content of shale has become of commercial interest as a source of hydrocarbons, owing to the development of hydraulic fracturing ("fracking"). While the main focus is on the extraction of methane, shale also contains significant amounts of non-methane hydrocarbons (NMHCs). We describe the first real-time observations of the release of NMHCs from a fractured shale. Samples from the Bowland-Hodder formation (England) were analyzed under different conditions using mass spectrometry, with the objective of understanding the dynamic process of gas release upon fracturing of the shale. A wide range of NMHCs (alkanes, cycloalkanes, aromatics, and bicyclic hydrocarbons) are released at parts per million or parts per billion level with temperature- and humidity-dependent release rates, which can be rationalized in terms of the physicochemical characteristics of different hydrocarbon classes. Our results indicate that higher energy inputs (i.e., temperatures) significantly increase the amount of NMHCs released from shale, while humidity tends to suppress it; additionally, a large fraction of the gas is released within the first hour after the shale has been fractured. These findings suggest that other hydrocarbons of commercial interest may be extracted from shale and open the possibility to optimize the "fracking" process, improving gas yields and reducing environmental impacts.

Real-time multi-marker measurement of organic compounds in human breath: towards fingerprinting breath.

The prospects for exploiting proton transfer reaction-time of flight-mass spectrometry (PTR-ToF-MS) in medical diagnostics are illustrated through a series of case studies. Measurements of acetone levels in the breath of 68 healthy people are presented along with a longitudinal study of a single person over a period of 1 month. The median acetone concentration across the population was 484 ppbV with a geometric standard deviation (GSD) of 1.6, whilst the average GSD during the single subject longtitudinal study was 1.5. An additional case study is presented which highlights the potential of PTR-ToF-MS in pharmacokinetic studies, based upon the analysis of online breath samples of a person following the consumption of ethanol. PTR-ToF-MS comes into its own when information across a wide mass range is required, particularly when such information must be gathered in a short time during a breathing cycle. To illustrate this property, multicomponent breath analysis in a small study of cystic fibrosis patients is detailed, which provides tentative evidence that online PTR-ToF-MS analysis of tidal breath can distinguish between active infection and non-infected patients.

Increased sensitivity in proton transfer reaction mass spectrometry by incorporation of a radio frequency ion funnel.

A drift tube capable of simultaneously functioning as an ion funnel is demonstrated in proton transfer reaction mass spectrometry (PTR-MS) for the first time. The ion funnel enables a much higher proportion of ions to exit the drift tube and enter the mass spectrometer than would otherwise be the case. An increase in the detection sensitivity for volatile organic compounds of between 1 and 2 orders of magnitude is delivered, as demonstrated using several compounds. Other aspects of analytical performance explored in this study include the effective E/N (ratio of electric field to number density of the gas) and dynamic range over which the drift tube is operated. The dual-purpose drift tube/ion funnel can be coupled to various types of mass spectrometers to increase the detection sensitivity and may therefore offer considerable benefits in PTR-MS work.

Detection of chemical weapon agents and simulants using chemical ionization reaction time-of-flight mass spectrometry.

Chemical ionization reaction time-of-flight mass spectrometry (CIR-TOF-MS) has been used for the analysis of prepared mixtures of chemical weapon agents (CWAs) sarin and sulfur mustard. Detection of the CWA simulants 2-chloroethyl ethyl sulfide, triethyl phosphate, and dimethyl methyl phosphonate has also been investigated. Chemical ionization of all the agents and simulants was shown to be possible using the CIR-TOF-MS technique with a variety of reagent ions, and the sensitivity was optimized by variation of instrument parameters. The ionization process was found to be largely unaffected by sample humidity levels, demonstrating the potential suitability of the method to a range of environmental conditions, including the analysis of CWAs in air and in the breath of exposed individuals.

Differentiation of isobaric compounds using chemical ionization reaction mass spectrometry.

The technique of proton transfer reaction mass spectrometry (PTR-MS) couples a proton transfer reagent, usually H3O+, with a drift tube and mass spectrometer to determine concentrations of volatile organic compounds. Here we describe a first attempt to use chemical ionization (CI) reagents other than proton transfer species inside a PTR-MS instrument. The ability to switch to other types of CI reagents provides an extra dimension to the technique. This capability is demonstrated by focusing on the ability to distinguish several isobaric aldehydes and ketones, including the atmospherically important molecules methacrolein and methyl vinyl ketone. Two CI reagents were selected, H3O+ and NO+, both being cleanly generated in a low intensity radioactive source prior to injection into the drift tube. By recording spectra with both of these reagents, the contributions from different isobaric molecules can be separated by virtue of their unique spectrometric 'fingerprints'. The work demonstrates that this form of instrumentation is not restricted to proton transfer reagents and is the basis of a more general technique, chemical ionization reaction mass spectrometry (CIRMS).

Demonstration of proton-transfer reaction time-of-flight mass spectrometry for real-time analysis of trace volatile organic compounds.

A proton-transfer reaction mass spectrometer based on time-of-flight mass spectrometry is described. This instrument couples a radioactive ion source and drift tube with a reflectron time-of-flight mass spectrometer. Volatile organic compounds in the gas phase with concentrations at the parts per billion by volume level can be detected in a matter of seconds, and crucially, the multichannel data acquisition in TOF-MS means that this detection sensitivity is available in all mass channels simultaneously. The typical mass resolution (m/Deltam) is in excess of 1000. The performance of the instrument is demonstrated using urban air measurements and a linear response/calibration test.