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Sample records for adjustable hospital bed

  1. 21 CFR 880.5110 - Hydraulic adjustable hospital bed.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hydraulic adjustable hospital bed. 880.5110... Therapeutic Devices § 880.5110 Hydraulic adjustable hospital bed. (a) Identification. A hydraulic adjustable hospital bed is a device intended for medical purposes that consists of a bed with a hydraulic...

  2. 21 CFR 880.5110 - Hydraulic adjustable hospital bed.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hydraulic adjustable hospital bed. 880.5110... Therapeutic Devices § 880.5110 Hydraulic adjustable hospital bed. (a) Identification. A hydraulic adjustable hospital bed is a device intended for medical purposes that consists of a bed with a hydraulic...

  3. 21 CFR 880.5110 - Hydraulic adjustable hospital bed.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hydraulic adjustable hospital bed. 880.5110... Therapeutic Devices § 880.5110 Hydraulic adjustable hospital bed. (a) Identification. A hydraulic adjustable hospital bed is a device intended for medical purposes that consists of a bed with a hydraulic...

  4. 21 CFR 880.5120 - Manual adjustable hospital bed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Manual adjustable hospital bed. 880.5120 Section... Therapeutic Devices § 880.5120 Manual adjustable hospital bed. (a) Identification. A manual adjustable hospital bed is a device intended for medical purposes that consists of a bed with a manual...

  5. 21 CFR 880.5110 - Hydraulic adjustable hospital bed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hydraulic adjustable hospital bed. 880.5110... Therapeutic Devices § 880.5110 Hydraulic adjustable hospital bed. (a) Identification. A hydraulic adjustable hospital bed is a device intended for medical purposes that consists of a bed with a hydraulic...

  6. 21 CFR 880.5110 - Hydraulic adjustable hospital bed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hydraulic adjustable hospital bed. 880.5110 Section 880.5110 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... hospital bed is a device intended for medical purposes that consists of a bed with a hydraulic...

  7. 21 CFR 880.5120 - Manual adjustable hospital bed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Manual adjustable hospital bed. 880.5120 Section 880.5120 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... hospital bed is a device intended for medical purposes that consists of a bed with a manual...

  8. 21 CFR 880.5100 - AC-powered adjustable hospital bed.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false AC-powered adjustable hospital bed. 880.5100... Therapeutic Devices § 880.5100 AC-powered adjustable hospital bed. (a) Identification. An AC-powered... electric motor and remote controls that can be operated by the patient to adjust the height and...

  9. 21 CFR 880.5100 - AC-powered adjustable hospital bed.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false AC-powered adjustable hospital bed. 880.5100... Therapeutic Devices § 880.5100 AC-powered adjustable hospital bed. (a) Identification. An AC-powered... electric motor and remote controls that can be operated by the patient to adjust the height and...

  10. 21 CFR 880.5100 - AC-powered adjustable hospital bed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false AC-powered adjustable hospital bed. 880.5100... Therapeutic Devices § 880.5100 AC-powered adjustable hospital bed. (a) Identification. An AC-powered... electric motor and remote controls that can be operated by the patient to adjust the height and...

  11. 21 CFR 880.5100 - AC-powered adjustable hospital bed.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false AC-powered adjustable hospital bed. 880.5100... Therapeutic Devices § 880.5100 AC-powered adjustable hospital bed. (a) Identification. An AC-powered... electric motor and remote controls that can be operated by the patient to adjust the height and...

  12. 21 CFR 880.5100 - AC-powered adjustable hospital bed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false AC-powered adjustable hospital bed. 880.5100 Section 880.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Therapeutic Devices § 880.5100...

  13. Practice Hospital Bed Safety

    MedlinePlus

    ... Bed? Todd says that there is no standard definition for hospital beds, a fact that consumers shopping ... in retail stores that don’t meet the definition of medical devices under the law, but which ...

  14. Bed bathing patients in hospital.

    PubMed

    Downey, Lindsey; Lloyd, Hilary

    There are a number of circumstances that may affect an individual's ability to maintain personal hygiene. Hospitalised patients, and in particular those who are bedridden, may become dependent on nursing staff to carry out their hygiene needs. Assisting patients to maintain personal hygiene is a fundamental aspect of nursing care. However, it is a task often delegated to junior or newly qualified staff. This article focuses on the principles of bed bathing patients in hospital, correct procedure and the importance of maintaining patient dignity and respect in clinical practice. PMID:18543852

  15. A multistage model of hospital bed requirements.

    PubMed Central

    Pendergast, J F; Vogel, W B

    1988-01-01

    This article presents a model for projecting future hospital bed requirements, based on clinical judgment and basic probability theory. Clinical judgment is used to define various categories of care, including a category for patients who are inappropriately hospitalized, for a large teaching hospital with a heavy indigent and psychiatric workload. Survey results and discharge abstract data are then used to calculate expected discharges and patient days for each clinical category. These expected discharges and patient days are converted into estimated bed requirements using a simple deterministic equation. Results of this multistage model are compared with the results obtained from exercising the simple deterministic equation alone. Because the multistage model removes patients from the hospital if they are deemed inappropriately placed, this model results in the projection of 5.1 percent fewer hospital beds than the simple deterministic equation alone. PMID:3403276

  16. Bed surface bed profile adjustments to a series of water pulses in gravel bed rivers

    NASA Astrophysics Data System (ADS)

    Ferrer-Boix, C.; Hassan, M. A.

    2014-12-01

    This research aims to explore the interactions between the bed surface texture, the bed topography and the sediment transport (rate and grain size distribution) to a series of water pulses in gravel bed-rivers. We conducted a set of runs in a 18 m-long tilting flume, 1 m-wide. Low flow discharges (Q = 65 l/s) during periods of variable duration (between t = 10 h and t = 1 h) were alternated with high flow rates (Q = 90 l/s) of constant duration (t = 1.5 h). Sediment was fed at a constant rate (Qfeed = 7.5 kg/h) throughout the runs. Eight experiments were consecutively conducted: the final configuration of the previous run was the initial condition for the subsequent experiment. The initial bed texture of the experiments was obtained after a 280 h-long run at low flow, the last 40 h of which under starving conditions. The initial bed slope was S0 = 0.022 m/m. A poorly-sorted grain size distribution (Dg = 5.65 mm and sg = 3.05) was used as a feeding material. The same material was used as the initial condition for the antecedent experiment (280 h-long). Intensive measurements of the bed surface, bed topography and sediment transport were taken during the runs. Provisional results of the experimental campaign demonstrate that: (i) bed topography rapidly adjusts to water pulses: bed aggrades during low flow periods to subsequently degrade during water pulses. However, the rate of change of the bed profile decreases with the number of water pulses; (ii) the surface texture maintains an approximately invariant texture during the runs with no significant changes before and after the pulses; (iii) bedload transport dramatically adjusts to water pulses (increasing its rate and getting coarser). The relative increase in the bedload transport during the pulses diminishes as the number of pulses increases. A detailed analysis of the evolution of the bed profile shows the formation of transverse ribs during low flow periods which slowly migrate upstream. These bedforms are not

  17. 21 CFR 880.5140 - Pediatric hospital bed.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Pediatric hospital bed. 880.5140 Section 880.5140... Devices § 880.5140 Pediatric hospital bed. (a) Identification. A pediatric hospital bed is a device intended for medical purposes that consists of a bed or crib designed for the use of a pediatric...

  18. 21 CFR 880.5140 - Pediatric hospital bed.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Pediatric hospital bed. 880.5140 Section 880.5140... Devices § 880.5140 Pediatric hospital bed. (a) Identification. A pediatric hospital bed is a device intended for medical purposes that consists of a bed or crib designed for the use of a pediatric...

  19. 21 CFR 880.5140 - Pediatric hospital bed.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Pediatric hospital bed. 880.5140 Section 880.5140... Devices § 880.5140 Pediatric hospital bed. (a) Identification. A pediatric hospital bed is a device intended for medical purposes that consists of a bed or crib designed for the use of a pediatric...

  20. 21 CFR 880.5140 - Pediatric hospital bed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Pediatric hospital bed. 880.5140 Section 880.5140... Devices § 880.5140 Pediatric hospital bed. (a) Identification. A pediatric hospital bed is a device intended for medical purposes that consists of a bed or crib designed for the use of a pediatric...

  1. 21 CFR 880.5140 - Pediatric hospital bed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pediatric hospital bed. 880.5140 Section 880.5140... Devices § 880.5140 Pediatric hospital bed. (a) Identification. A pediatric hospital bed is a device intended for medical purposes that consists of a bed or crib designed for the use of a pediatric...

  2. 42 CFR 447.280 - Hospital providers of NF services (swing-bed hospitals).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Hospital providers of NF services (swing-bed hospitals). 447.280 Section 447.280 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Inpatient Hospital and Long-Term Care Facility Services Swing-Bed Hospitals § 447.280 Hospital providers...

  3. 76 FR 49458 - TRICARE; Hospital Outpatient Radiology Discretionary Appeal Adjustments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-10

    ... of the Secretary TRICARE; Hospital Outpatient Radiology Discretionary Appeal Adjustments AGENCY... hospitals of an opportunity for net adjusted payments for radiology services for which TRICARE payments were... radiology services specified in the regulation as being reimbursed under the allowable charge...

  4. 75 FR 54911 - Certain Adjustable-Height Beds and Components Thereof; Notice of Investigation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-09

    ... COMMISSION Certain Adjustable-Height Beds and Components Thereof; Notice of Investigation AGENCY: U.S... of certain adjustable-height beds and components thereof by reason of infringement of certain claims... after importation of certain adjustable- height beds and components thereof that infringe one or more...

  5. Between two beds: inappropriately delayed discharges from hospitals.

    PubMed

    Holmås, Tor Helge; Islam, Mohammad Kamrul; Kjerstad, Egil

    2013-12-01

    Acknowledging the necessity of a division of labour between hospitals and social care services regarding treatment and care of patients with chronic and complex conditions, is to acknowledge the potential conflict of interests between health care providers. A potentially important conflict is that hospitals prefer comparatively short length of stay (LOS) at hospital, while social care services prefer longer LOS all else equal. Furthermore, inappropriately delayed discharges from hospital, i.e. bed blocking, is costly for society. Our aim is to discuss which factors that may influence bed blocking and to quantify bed blocking costs using individual Norwegian patient data, merged with social care and hospital data. The data allow us to divide hospital LOS into length of appropriate stay (LAS) and length of delay (LOD), the bed blocking period. We find that additional resources allocated to social care services contribute to shorten LOD indicating that social care services may exploit hospital resources as a buffer for insufficient capacity. LAS increases as medical complexity increases indicating hospitals incentives to reduce LOS are softened by considerations related to patients’ medical needs. Bed blocking costs constitute a relatively large share of the total costs of inpatient care. PMID:24122364

  6. Hospital staffing adjustments under global budgeting.

    PubMed

    Lehner, L A; Burgess, J F; Stefos, T

    1995-01-01

    The U.S. Department of Veterans Affairs operates a hospital system that distributes a national global budget to 159 hospital units. Over recent years, cost containment and downward budgetary pressures have affected hospital performance and the quality of care delivered in unknown ways. This article examines hospital staffing levels as potential performance measures. We first develop a regression model to estimate the number and types of clinical staff required to meet current inpatient workloads at VA medical centers. We are able to improve on previous analyses by employing better data on physicians and by evaluating the behavior of hospitals in consecutive years. Our findings provide managers of hospital systems with promising new approaches for comparing hospital production processes and more information on the effects of global budgeting on individual hospital staffing within systems. PMID:10153372

  7. Strategies for cutting hospital beds: the impact on patient service.

    PubMed Central

    Green, L V; Nguyen, V

    2001-01-01

    OBJECTIVE: To develop insights on the impact of size, average length of stay, variability, and organization of clinical services on the relationship between occupancy rates and delays for beds. DATA SOURCES: The primary data source was Beth Israel Deaconess Medical Center in Boston. Secondary data were obtained from the United Hospital Fund of New York reflecting data from about 150 hospitals. STUDY DESIGN: Data from Beth Israel Deaconess on discharges and length of stay were analyzed and fit into appropriate queueing models to generate tables and graphs illustrating the relationship between the variables mentioned above and the relationship between occupancy levels and delays. In addition, specific issues of current concern to hospital administrators were analyzed, including the impact of consolidation of clinical services and utilizing hospital beds uniformly across seven days a week rather than five. PRINCIPAL FINDINGS: Using target occupancy levels as the primary determinant of bed capacity is inadequate and may lead to excessive delays for beds. Also, attempts to reduce hospital beds by consolidation of different clinical services into single nursing units may be counterproductive. CONCLUSIONS: More sophisticated methodologies are needed to support decisions that involve bed capacity and organization in order to understand the impact on patient service. Images Figure 2 PMID:11409821

  8. Equity analysis of hospital beds distribution in Shiraz, Iran 2014

    PubMed Central

    Hatam, Nahid; Zakeri, Mohammadreza; Sadeghi, Ahmad; Darzi Ramandi, Sajad; Hayati, Ramin; Siavashi, Elham

    2016-01-01

    Background: One of the important aspects of equity in health is equality in the distribution of resources in this sector. The present study aimed to assess the distribution of hospital beds in Shiraz in 2014. Methods: In this retrospective cross-sectional study, the population density index and fair distribution of beds were analyzed by Lorenz curve and Gini coefficient, respectively. Descriptive data were analyzed using Excel software. We used Distributive Analysis Stata Package (DASP) in STATA software, version 12, for computing Gini coefficient and drawing Lorenz curve. Results: The Gini coefficient was 0.68 in the population. Besides, Gini coefficient of hospital beds’ distribution based on population density was 0.70, which represented inequality in the distribution of hospital bedsamong the nine regions of Shiraz. Conclusion: Although the total number of hospital beds was reasonable in Shiraz, distribution of these resources was not fair, and inequality was observed in their distribution among the nine regions of Shiraz. PMID:27579284

  9. Risk-Adjusted Models for Adverse Obstetric Outcomes and Variation in Risk Adjusted Outcomes Across Hospitals

    PubMed Central

    Bailit, Jennifer L.; Grobman, William A.; Rice, Madeline Murguia; Spong, Catherine Y.; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M.; Leveno, Kenneth J.; Caritis, Steve N.; Shubert, Phillip J.; Tita, Alan T. N.; Saade, George; Sorokin, Yoram; Rouse, Dwight J.; Blackwell, Sean C.; Tolosa, Jorge E.; Van Dorsten, J. Peter

    2014-01-01

    Objective Regulatory bodies and insurers evaluate hospital quality using obstetrical outcomes, however meaningful comparisons should take pre-existing patient characteristics into account. Furthermore, if risk-adjusted outcomes are consistent within a hospital, fewer measures and resources would be needed to assess obstetrical quality. Our objective was to establish risk-adjusted models for five obstetric outcomes and assess hospital performance across these outcomes. Study Design A cohort study of 115,502 women and their neonates born in 25 hospitals in the United States between March 2008 and February 2011. Hospitals were ranked according to their unadjusted and risk-adjusted frequency of venous thromboembolism, postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite neonatal adverse outcome. Correlations between hospital risk-adjusted outcome frequencies were assessed. Results Venous thromboembolism occurred too infrequently (0.03%, 95% CI 0.02% – 0.04%) for meaningful assessment. Other outcomes occurred frequently enough for assessment (postpartum hemorrhage 2.29% (95% CI 2.20–2.38), peripartum infection 5.06% (95% CI 4.93–5.19), severe perineal laceration at spontaneous vaginal delivery 2.16% (95% CI 2.06–2.27), neonatal composite 2.73% (95% CI 2.63–2.84)). Although there was high concordance between unadjusted and adjusted hospital rankings, several individual hospitals had an adjusted rank that was substantially different (as much as 12 rank tiers) than their unadjusted rank. None of the correlations between hospital adjusted outcome frequencies was significant. For example, the hospital with the lowest adjusted frequency of peripartum infection had the highest adjusted frequency of severe perineal laceration. Conclusions Evaluations based on a single risk-adjusted outcome cannot be generalized to overall hospital obstetric performance. PMID:23891630

  10. Risk-adjusted antibiotic consumption in 34 public acute hospitals in Ireland, 2006 to 2014.

    PubMed

    Oza, Ajay; Donohue, Fionnuala; Johnson, Howard; Cunney, Robert

    2016-08-11

    As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed. PMID:27541730

  11. 42 CFR 412.101 - Special treatment: Inpatient hospital payment adjustment for low-volume hospitals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... adjustment for low-volume hospitals. 412.101 Section 412.101 Public Health CENTERS FOR MEDICARE & MEDICAID... Inpatient Operating Costs § 412.101 Special treatment: Inpatient hospital payment adjustment for low-volume... payment to a qualifying hospital for the higher incremental costs associated with a low volume...

  12. 42 CFR 412.101 - Special treatment: Inpatient hospital payment adjustment for low-volume hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... adjustment for low-volume hospitals. 412.101 Section 412.101 Public Health CENTERS FOR MEDICARE & MEDICAID... Inpatient Operating Costs § 412.101 Special treatment: Inpatient hospital payment adjustment for low-volume... payment to a qualifying hospital for the higher incremental costs associated with a low volume...

  13. 42 CFR 412.101 - Special treatment: Inpatient hospital payment adjustment for low-volume hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... adjustment for low-volume hospitals. 412.101 Section 412.101 Public Health CENTERS FOR MEDICARE & MEDICAID... Inpatient Operating Costs § 412.101 Special treatment: Inpatient hospital payment adjustment for low-volume... payment to a qualifying hospital for the higher incremental costs associated with a low volume...

  14. 42 CFR 412.101 - Special treatment: Inpatient hospital payment adjustment for low-volume hospitals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... adjustment for low-volume hospitals. 412.101 Section 412.101 Public Health CENTERS FOR MEDICARE & MEDICAID... Inpatient Operating Costs § 412.101 Special treatment: Inpatient hospital payment adjustment for low-volume... payment to a qualifying hospital for the higher incremental costs associated with a low volume...

  15. 42 CFR 412.101 - Special treatment: Inpatient hospital payment adjustment for low-volume hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... adjustment for low-volume hospitals. 412.101 Section 412.101 Public Health CENTERS FOR MEDICARE & MEDICAID... Inpatient Operating Costs § 412.101 Special treatment: Inpatient hospital payment adjustment for low-volume... payment to a qualifying hospital for the higher incremental costs associated with a low volume...

  16. Impact of long-stay beds on the performance of a tertiary hospital in emergencies

    PubMed Central

    Pazin, Antonio; de Almeida, Edna; Cirilo, Leni Peres; Lourençato, Frederica Montanari; Baptista, Lisandra Maria; Pintyá, José Paulo; Capeli, Ronaldo Dias; da Silva, Sonia Maria Pirani Felix; Wolf, Claudia Maria; Dinardi, Marcelo Marcos; Scarpelini, Sandro; Damasceno, Maria Cecília

    2015-01-01

    ABSTRACT OBJECTIVE To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. METHODS For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. RESULTS Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index – 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) – the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days. CONCLUSIONS Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors. PMID:26603353

  17. Judging hospitals by severity-adjusted mortality rates: the influence of the severity-adjustment method.

    PubMed Central

    Iezzoni, L I; Ash, A S; Shwartz, M; Daley, J; Hughes, J S; Mackiernan, Y D

    1996-01-01

    OBJECTIVES: This research examined whether judgments about a hospital's risk-adjusted mortality performance are affected by the severity-adjustment method. METHODS: Data came from 100 acute care hospitals nationwide and 11880 adults admitted in 1991 for acute myocardial infarction. Ten severity measures were used in separate multivariable logistic models predicting in-hospital death. Observed-to-expected death rates and z scores were calculated with each severity measure for each hospital. RESULTS: Unadjusted mortality rates for the 100 hospitals ranged from 4.8% to 26.4%. For 32 hospitals, observed mortality rates differed significantly from expected rates for 1 or more, but not for all 10, severity measures. Agreement between pairs of severity measures on whether hospitals were flagged as statistical mortality outliers ranged from fair to good. Severity measures based on medical records frequently disagreed with measures based on discharge abstracts. CONCLUSIONS: Although the 10 severity measures agreed about relative hospital performance more often than would be expected by chance, assessments of individual hospital mortality rates varied by different severity-adjustment methods. PMID:8876505

  18. Behavioral adjustment of psychiatric hospital patients and helping behavior.

    PubMed

    Tipton, R M; Bland, R E

    1975-03-01

    This study investigated the relationship between behavioral adjustment of mental hospital patients and helping behavior in two distinctly different controlled situations. Forty hospitalized male patients between the ages of 20 and 45 were assigned to two groups of equal size according to ratings they received on the MACC Behavioral Adjustment Scale. Each subject was exposed to two separate and independent experimental situations calling for helping behavior. Helping in the first situation was defined as offering a confederate the use of an extra pencil, while in the second it was defined as offering to help a confederate in the hallway to pick up a box of pencils that had just been dropped. The results of both experiments confirmed the hypothesis that persons suffering more severe levels of disturbance and maladjustment perform significantly fewer helpful acts. Results were discussed in terms of empathy, self-concern, and response cost. Also some implications for treatment were discussed. PMID:1159641

  19. Fast-tracking acute hospital care--from bed crisis to bed crisis.

    PubMed

    Rae, Brendon; Busby, Wendy; Millard, Peter H

    2007-02-01

    We describe here the results of a continuous quality improvement (CQI) project, the Delayed Discharge Project, in a general medicine service in a New Zealand teaching hospital. Average length of stay (ALOS) dropped by 2.6 days (6.5 to 3.9), readmission rates did not rise, costs of service delivery dropped by US dollars 2.4 million, patient numbers increased by 145 (2445 to 2590), while bed numbers reduced from 56 to 32 and ward outliers all but disappeared, suggesting success. However, 2 years after the successful cost-saving measures were introduced the new system crashed as a result of additional bed closures and organisational restructures. PMID:17266488

  20. 42 CFR 413.83 - Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital-specific rate. 413.83 Section 413.83 Public Health CENTERS... Direct GME payments: Adjustment of a hospital's target amount or prospective payment...

  1. Channel adjustments to a succession of water pulses in gravel bed rivers

    NASA Astrophysics Data System (ADS)

    Ferrer-Boix, Carles; Hassan, Marwan A.

    2015-11-01

    Gravel bed rivers commonly exhibit a coarse surface armor resulting from a complex history of interactions between flow and sediment supply. The evolution of the surface texture under single storm events or under steady flow conditions has been studied by a number of researchers. However, the role of successive floods on the surface texture evolution is still poorly understood. An experimental campaign in an 18 m-long 1 m-wide flume has been designed to study these issues. Eight consecutive runs, each one consisting of a low-flow period of variable duration followed by a sudden flood (water pulse) lasting 1.5 h, have been conducted. The total duration of the experiment was 46 h. The initial bed surface was created during a 280 h-long experiment focused on the influence of episodic sediment supply on channel adjustments. Our experiments represent a realistic armored and structured beds found in mountain gravel bed rivers. The armor surface texture persists over the duration of the experiment. The experiment exhibits downstream fining of the bed-surface texture. It was found that sorting processes were affected by the duration of low-flow between flood pulses. Since bed load transport is influenced by sediment sorting, the evolution of bed load transport is impacted by the frequency of the water pulses: short interpulse durations reduce the time over which fine material (transported as bed load) can be winnowed. This, in turn, contributes to declining reduction of the bed load transport over time while the sediment storage increases.

  2. Channel bed adjustment along mine-affected rivers of northeast Tasmania

    NASA Astrophysics Data System (ADS)

    Knighton, A. D.

    1991-10-01

    Forty million m 3 and 1 million m 3 of mining waste are estimated to have been supplied respectively to the Ringarooma and George Rivers between 1875 and 1984. Given the volumes involved and the fact that much of the input was less than 5 mm in diameter, the size composition of the bed material changed from gravel to sand as the rivers progressively aggraded their beds downstream. Increases in bed height of over 10 m and 1 m are predicted respectively for the two rivers, with change becoming more gradual further downstream. With upstream supplies becoming depleted first, degradation followed the same pattern as aggradation — progressing downstream. Maximum rates of almost 0.5 m yr -1 were measured. Degradation has returned the George River to its pre-1875 level but has yet to reach the downstream reaches of the Ringarooma, where sediment waves continue to pass over a slightly aggrading bed. Where degradation has been occurring long enough, the bed material has again become gravelly through re-exposure of the original bed and/or lag concentration of coarser fractions within the introduced load. Such armouring should improve bed stability and slow the rate of degradation. However, at Herrick, which is representative of intermediate reaches with only a thin gravel veneer, the annual amount of degradation is reasonably well correlated with flow conditions, suggesting that high discharges can strip the surface armour and continue to degrade actively. Incision has not only changed the vertical position of the rivers but also their planimetric and cross-sectional geometry. In particular, non-uniform lowering of the bed has narrowed the channel by up to 60%, changes which can be predicted quite accurately by Chang's quantitative model of channel adjustment. At least another 50 years will be needed for degradation to cleanse the Ringarooma of mining debris.

  3. Temporal adjustments of bed surface texture and sediment mobility to a variable sediment supply regime

    NASA Astrophysics Data System (ADS)

    von Flotow, C. M.; Hassan, M. A.

    2012-12-01

    Mountain streams tend to alternate between supply-limited and transport-limited situations. In a supply-limited situation, fine sediment winnows out of the streambed and surface armor structures develop. Armor structures influence the nature of turbulence in water and thereby mobility of bed sediment. Bed surface evolution under conditions of sediment starvation followed by large sediment loading events is relatively unexplored in an experimental setting. The objective of this research is to evaluate temporal adjustments of a streambed surface due to changes in sediment supply regimes. To achieve our goals, we conducted laboratory experiments in an 18 meter long, one meter wide flume with a three percent slope. The bed was brought to an armored state by running water with no sediment feed before releasing a sequence of sediment pulses. Water discharge and grain size distribution of the sediment feed were held constant over the set of experiments while supply input rates varied. Sediment flux at the outlet of the flume was continuously measured. At a given time interval, flow resistance, bed surface structure, grain size, and bed elevation were measured in detail over a two meter section of the flume bed. Instantaneous three-dimensional observations of flow velocities were made using an Acoustic Doppler Velocimeter in order to calculate Reynolds shear stresses and turbulence intensities. We will present results on temporal changes of the bed surface state, flow properties, and sediment mobility in response to variable rates of sediment input. Flume results will be linked to a 10-year record of observations made in a riffle pool field reach following flood and large sediment input events. Together the data will be used to develop a model for the prediction of bed surface evolution in mountain streams.

  4. Exploring Reasons for Bed Pressures in Winnipeg Acute Care Hospitals

    ERIC Educational Resources Information Center

    Menec, Verena H.; Bruce, Sharon; MacWilliam, Leonard R.

    2005-01-01

    Hospital overcrowding has plagued Winnipeg and other Canadian cities for years. This study explored factors related to overcrowding. Hospital files were used to examine patterns of hospital use from fiscal years 1996/1997 to 1999/2000. Chart reviews were conducted to examine appropriateness of admissions and hospital stays during one pressure…

  5. Testing the Bed-Blocking Hypothesis: Does Nursing and Care Home Supply Reduce Delayed Hospital Discharges?

    PubMed Central

    Gaughan, James; Gravelle, Hugh; Siciliani, Luigi

    2015-01-01

    Hospital bed-blocking occurs when hospital patients are ready to be discharged to a nursing home, but no place is available, so that hospital care acts as a more costly substitute for long-term care. We investigate the extent to which greater supply of nursing home beds or lower prices can reduce hospital bed-blocking using a new Local Authority (LA) level administrative data from England on hospital delayed discharges in 2009–2013. The results suggest that delayed discharges respond to the availability of care home beds, but the effect is modest: an increase in care home beds by 10% (250 additional beds per LA) would reduce social care delayed discharges by about 6–9%. We also find strong evidence of spillover effects across LAs: more care home beds or fewer patients aged over 65 years in nearby LAs are associated with fewer delayed discharges. © 2015 The Authors. Health Economics Published by John Wiley & Sons Ltd. PMID:25760581

  6. Adjusted hospital death rates: a potential screen for quality of medical care.

    PubMed Central

    Dubois, R W; Brook, R H; Rogers, W H

    1987-01-01

    Increased economic pressure on hospitals has accelerated the need to develop a screening tool for identifying hospitals that potentially provide poor quality care. Based upon data from 93 hospitals and 205,000 admissions, we used a multiple regression model to adjust the hospitals crude death rate. The adjustment process used age, origin of patient from the emergency department or nursing home, and a hospital case mix index based on DRGs (diagnostic related groups). Before adjustment, hospital death rates ranged from 0.3 to 5.8 per 100 admissions. After adjustment, hospital death ratios ranged from 0.36 to 1.36 per 100 (actual death rate divided by predicted death rate). Eleven hospitals (12 per cent) were identified where the actual death rate exceeded the predicted death rate by more than two standard deviations. In nine hospitals (10 per cent), the predicted death rate exceeded the actual death rate by a similar statistical margin. The 11 hospitals with higher than predicted death rates may provide inadequate quality of care or have uniquely ill patient populations. The adjusted death rate model needs to be validated and generalized before it can be used routinely to screen hospitals. However, the remaining large differences in observed versus predicted death rates lead us to believe that important differences in hospital performance may exist. PMID:3113272

  7. Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time.

    PubMed

    Lockwood, Ashley M; Perez, Katherine K; Musick, William L; Ikwuagwu, Judy O; Attia, Engie; Fasoranti, Oyejoke O; Cernoch, Patricia L; Olsen, Randall J; Musser, James M

    2016-04-01

    OBJECTIVE To assess the impact of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) mass spectrometry for rapid pathogen identification directly from early-positive blood cultures coupled with an antimicrobial stewardship program (ASP) in two community hospitals. Process measures and outcomes prior and after implementation of MALDI-TOF/ASP were evaluated. DESIGN Multicenter retrospective study. SETTING Two community hospitals in a system setting, Houston Methodist (HM) Sugar Land Hospital (235 beds) or HM Willowbrook Hospital (241 beds). PATIENTS Patients ≥ 18 years of age with culture-proven Gram-negative bacteremia. INTERVENTION Blood cultures from both hospitals were sent to and processed at our central microbiology laboratory. Clinical pharmacists at respective hospitals were notified of pathogen ID and susceptibility results. RESULTS We evaluated 572 patients for possible inclusion. After pre-defined exclusion criteria, 151 patients were included in the pre-intervention group and 242 were included in the intervention group. After MALDI-TOF/ASP implementation, the mean identification time after culture positivity was significantly reduced from 32 hours (±16 hours) to 6.5 hours (±5.4 hours) (P<.001); mean time to susceptibility results was significantly reduced from 48 (±22) hours to 23 (±14) hours (P<.001); and time to therapy adjustment was significantly reduced from 75 (±59) hours to 30 (±30) hours (P<.001). Mean hospital costs per patient were $3,411 less in the intervention group compared with the pre-intervention group ($18,645 vs $15,234; P=.04). CONCLUSION This study is the first to analyze the impact of MALDI-TOF coupled with an ASP in a community hospital setting. Time to results significantly differed with the use of MALDI-TOF, and time to appropriate therapy was significantly improved with the addition of ASP. PMID:26738993

  8. From Modern Push-Button Hospital-beds to 20th Century Mechatronic Beds: A Review

    NASA Astrophysics Data System (ADS)

    Ghersi, I.; Mariño, M.; Miralles, M. T.

    2016-04-01

    The aim of this work is to present the different aspects of modern high complexity electric beds of the period 1940 until 2000 exclusively. The chronology of the product has been strictly divided into three big stages: electric and semi-electric beds (until the 90’s), mechatronic beds (90’s until 2000) and, mechatronic intelligent beds of the last 15 years. The latter are not considered in this work due to the extension for its analysis. The justification for classifying the product is presented under the concepts of medical, assistive and mobility devices. Relevant aspects of common immobility problems of the different types of patients for which the beds are mainly addressed are shown in detail. The basic functioning of the patient’s movement generator and the implementation of actuators, together with IT programs, specific accessories and connectivity means and network-communication shown in this work, were those that gave origin to current mechatronic beds. We present the historical evolution of high complexity electric beds by illustrating cases extracted from a meticulous time line, based on patents, inventions and publications in newspapers and magazines of the world. The criteria adopted to evaluate the innovation were: characteristics of controls; accessories (mattresses, lighting, siderails, etc.), aesthetic and morphologic properties and outstanding functionalities.

  9. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Defense, Public Health Service or other Federal hospitals with beds allocated to the Department of... AFFAIRS MEDICAL Use of Department of Defense, Public Health Service Or Other Federal Hospitals § 17.50 Use of Department of Defense, Public Health Service or other Federal hospitals with beds allocated to...

  10. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Defense, Public Health Service or other Federal hospitals with beds allocated to the Department of... AFFAIRS MEDICAL Use of Department of Defense, Public Health Service Or Other Federal Hospitals § 17.50 Use of Department of Defense, Public Health Service or other Federal hospitals with beds allocated to...

  11. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Defense, Public Health Service or other Federal hospitals with beds allocated to the Department of... AFFAIRS MEDICAL Use of Department of Defense, Public Health Service Or Other Federal Hospitals § 17.50 Use of Department of Defense, Public Health Service or other Federal hospitals with beds allocated to...

  12. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Defense, Public Health Service or other Federal hospitals with beds allocated to the Department of... AFFAIRS MEDICAL Use of Department of Defense, Public Health Service Or Other Federal Hospitals § 17.50 Use of Department of Defense, Public Health Service or other Federal hospitals with beds allocated to...

  13. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Defense, Public Health Service or other Federal hospitals with beds allocated to the Department of... AFFAIRS MEDICAL Use of Department of Defense, Public Health Service Or Other Federal Hospitals § 17.50 Use of Department of Defense, Public Health Service or other Federal hospitals with beds allocated to...

  14. Can electric beds aid pressure sore prevention in hospitals?

    PubMed

    Hampton, S

    The purchase, cleaning and maintenance of air mattresses can be an expensive part of pressure sore prevention and repositioning of patients can be time consuming and costly in terms of possible nursing injuries. The King's Fund bed has been a friend to the health service for many years but the time has come to look for an alternative system that will support patient comfort and independence, will assist nurses in implementation of a no-lifting policy and aid pressure sore prevention policies. This article describes a study that was undertaken in two medical wards to assess the value of electrically controlled beds in relation to the prevention of pressure sores, implementation of a no-lifting policy and quality of patient care. A total of 782 patients took part in the study over a 6-month period and 726 replies were obtained from nurses. The ward had similar profiles of patients' medical conditions and age; they were being medically managed by the same consultants. Results showed that patients experienced greater comfort on beds with the electric facility, produced less pressure sores, mobilized easily and pressure sore prevention costs could be reduced. There is a need to be proactive in prevention of pressure sores and not reactive to a pressure sore that is already developing. PMID:9830895

  15. Evaluating hospital readmission rates in dialysis facilities; adjusting for hospital effects.

    PubMed

    He, Kevin; Kalbfleisch, Jack D; Li, Yijiang; Li, Yi

    2013-10-01

    Motivated by the national evaluation of readmission rates among kidney dialysis facilities in the United States, we evaluate the impact of including discharging hospitals on the estimation of facility-level standardized readmission ratios (SRRs). The estimation of SRRs consists of two steps. First, we model the dependence of readmission events on facilities and patient-level characteristics, with or without an adjustment for discharging hospitals. Second, using results from the models, standardization is achieved by computing the ratio of the number of observed events to the number of expected events assuming a population norm and given the case-mix in that facility. A challenging aspect of our motivating example is that the number of parameters is very large and estimation of high-dimensional parameters is troublesome. To solve this problem, we propose a structured Newton-Raphson algorithm for a logistic fixed effects model and an approximate EM algorithm for the logistic mixed effects model. We consider a re-sampling and simulation technique to obtain p-values for the proposed measures. Finally, our method of identifying outlier facilities involves converting the observed p-values to Z-statistics and using the empirical null distribution, which accounts for overdispersion in the data. The finite-sample properties of proposed measures are examined through simulation studies. The methods developed are applied to national dialysis data. It is our great pleasure to present this paper in honor of Ross Prentice, who has been instrumental in the development of modern methods of modeling and analyzing life history and failure time data, and in the inventive applications of these methods to important national data problem. PMID:23709309

  16. Using baseline data to address the lack of hospital beds during mass-casualty incidents.

    PubMed

    Hadef, Hysham; Bartier, Jean-Claude; Delplancq, Herve; Dupeyron, Jean-Pierre

    2008-01-01

    The management of victims during mass-casualty incidents (MCIs) is improving. In many countries, physicians and paramedics are well-trained to manage these incidents. A problem that has been encountered during MCIs is the lack of adequate numbers of hospital beds to accommodate the injured. In Europe, hospitals are crowded. One solution for the lack of beds is the creation of baseline data systems that could be consulted by medical personnel in all European countries. A MCI never has occurred in northeastern Europe, but such an event remains a possibility. This paper describes how the use of SAGEC 67, a free-access, information database concerning the availability of beds should help the participating countries, initially France, Germany, and Switzerland, respond to a MCI by dispatching each patient to an appropriate hospital and informing their families and physicians using their own language. Baseline data for more than 20 countries, and for hospitals, especially those in Germany, Switzerland, and France, were collected. Information about the number of beds and their availability hour-by-hour was included. In the case of MCIs, the baseline data program is opened and automatically connects to all of the countries. In case of a necessary hospital evacuation, the required beds immediately are occupied in one of these three countries. Questions and conversations among medical staff or family members can be accomplished between hospitals through computer, secured-line chatting that automatically translates into appropriate language. During the patient evacuation phase of a MCI, respondents acknowledged that a combination of local, state, and private resources and international cooperation eventually would be needed to meet the demand. Patient evacuation is optimized through the use of SAGEC 67, a free baseline database. PMID:18935955

  17. Small-scale Testing of RFID in a Hospital Setting: RFID as Bed Trigger

    PubMed Central

    Kannry, Joseph; Emro, Susan; Blount, Marion; Ebling, Maria

    2007-01-01

    RFID technology shows significant potential for transforming healthcare, yet few studies assess this potential. Our study measured the effectiveness of using RFID as a bed trigger: a tool to accelerate identification of empty beds. We made a small alteration in the discharge process to associate RFID tags with patients and created an RFID-based system that automatically determined discharge time. For each patient, we evaluated the difference in the discharge times recorded manually by the current process and the RFID-based system. The study was conducted on 86 patients over 2 months in 2 physically separate multi-specialty units. Compared to the preexisting process, the RFID-based system identified empty beds >20 minutes earlier 67% of the time with an average of 25 minutes and median of 9 minutes earlier. Hospital leadership defined an improvement of ~10 minutes as significant. With minimal investment, our small-scale study lead hospital leadership to begin planning RFID deployment. PMID:18693863

  18. Analysis of Information Security Management Systems at 5 Domestic Hospitals with More than 500 Beds

    PubMed Central

    Park, Woo-Sung; Son, Seung-Sik; Lee, Mee-Jeong; Kim, Shin-Hyo; Choi, Eun-Mi; Bang, Ji-Eon; Kim, Yea-Eun; Kim, Ok-Nam

    2010-01-01

    Objectives The information security management systems (ISMS) of 5 hospitals with more than 500 beds were evaluated with regards to the level of information security, management, and physical and technical aspects so that we might make recommendations on information security and security countermeasures which meet both international standards and the needs of individual hospitals. Methods The ISMS check-list derived from international/domestic standards was distributed to each hospital to complete and the staff of each hospital was interviewed. Information Security Indicator and Information Security Values were used to estimate the present security levels and evaluate the application of each hospital's current system. Results With regard to the moderate clause of the ISMS, the hospitals were determined to be in compliance. The most vulnerable clause was asset management, in particular, information asset classification guidelines. The clauses of information security incident management and business continuity management were deemed necessary for the establishment of successful ISMS. Conclusions The level of current ISMS in the hospitals evaluated was determined to be insufficient. Establishment of adequate ISMS is necessary to ensure patient privacy and the safe use of medical records for various purposes. Implementation of ISMS which meet international standards with a long-term and comprehensive perspective is of prime importance. To reflect the requirements of the varied interests of medical staff, consumers, and institutions, the establishment of political support is essential to create suitable hospital ISMS. PMID:21818429

  19. US hospital payment adjustments for innovative technology lag behind those in Germany, France, and Japan.

    PubMed

    Hernandez, John; Machacz, Susanne F; Robinson, James C

    2015-02-01

    Medicare pioneered add-on payments to facilitate the adoption of innovative technologies under its hospital prospective payment system. US policy makers are now experimenting with broader value-based payment initiatives, but these have not been adjusted for innovation. This article examines the structure, processes, and experience with Medicare's hospital new technology add-on payment program since its inception in 2001 and compares it with analogous payment systems in Germany, France, and Japan. Between 2001 and 2015 CMS approved nineteen of fifty-three applications for the new technology add-on payment program. We found that the program resulted in $201.7 million in Medicare payments in fiscal years 2002-13-less than half the level anticipated by Congress and only 34 percent of the amount projected by CMS. The US program approved considerably fewer innovative technologies, compared to analogous technology payment mechanisms in Germany, France and Japan. We conclude that it is important to adjust payments for new medical innovations within prospective and value-based payment systems explicitly as well as implicitly. The most straightforward method to use in adjusting value-based payments is for the insurer to retrospectively adjust spending targets to account for the cost of new technologies. If CMS made such retrospective adjustments, it would not financially penalize hospitals for adopting beneficial innovations. PMID:25646106

  20. Distribution of hospital beds in Tehran Province based on Gini coefficient and Lorenz curve from 2010 to 2012

    PubMed Central

    Asl, Iravan Masoudi; Abolhallaje, Masoud; Raadabadi, Mehdi; Nazari, Hamed; Nazari, Aslan; Salimi, Mohammad; Javani, Ali

    2015-01-01

    Introduction Fair distribution of hospital beds across various regions is a controversial subject. Resource allocation in health systems rarely has focused on those who need it most and, in addition, is often influenced by political interests. The study assesses the distribution of hospital beds in different regions in Tehran, Iran, during 2010–2012. Methods This cross-sectional study was conducted in all regions of Tehran (22 regions) during 2010 to 2012. All hospital beds in these regions are included in the study. Data regarding populations of each region were obtained from the Statistics Center of Iran. According to the data, the total number of beds (N.B) and population (P) in 2010 (N.B=19075, P= 7585000), 2011 (N.B=21632, P= 9860500), and 2012 (N.B=21808, P=12818650). The instrument was a form, including the name of the hospital, the district in which the hospital was located, the number of staffed beds, the name of each region, and its population. Data analysis was performed using DASP software version 2.3. Results The results demonstrate that the Gini coefficient of distributed beds in 22 regions of Tehran was 0.46 in all three years and specifically calculated 0.4666 in 2010, 0.4658 in 2011 and 0.4652 in 2012. The Gini coefficient of beds in 22 regions of Tehran is not fair in comparison with the population of each region during the years 2010 to 2012. Conclusion The results demonstrate that the distribution of beds in regions in Tehran is not fair in relation to the population of each region—and some regions had no hospitals. Therefore, it is essential for policymakers to frequently monitor this issue and investigate the fair distribution of hospital beds. PMID:26813480

  1. Improving hospital bed occupancy and resource utilization through queuing modeling and evolutionary computation.

    PubMed

    Belciug, Smaranda; Gorunescu, Florin

    2015-02-01

    Scarce healthcare resources require carefully made policies ensuring optimal bed allocation, quality healthcare service, and adequate financial support. This paper proposes a complex analysis of the resource allocation in a hospital department by integrating in the same framework a queuing system, a compartmental model, and an evolutionary-based optimization. The queuing system shapes the flow of patients through the hospital, the compartmental model offers a feasible structure of the hospital department in accordance to the queuing characteristics, and the evolutionary paradigm provides the means to optimize the bed-occupancy management and the resource utilization using a genetic algorithm approach. The paper also focuses on a "What-if analysis" providing a flexible tool to explore the effects on the outcomes of the queuing system and resource utilization through systematic changes in the input parameters. The methodology was illustrated using a simulation based on real data collected from a geriatric department of a hospital from London, UK. In addition, the paper explores the possibility of adapting the methodology to different medical departments (surgery, stroke, and mental illness). Moreover, the paper also focuses on the practical use of the model from the healthcare point of view, by presenting a simulated application. PMID:25433363

  2. A review on equipped hospital beds with wireless sensor networks for reducing bedsores.

    PubMed

    Ajami, Sima; Khaleghi, Lida

    2015-10-01

    At present, the solutions to prevent bedsore include using various techniques for movement and displacement of patients, which is not possible for some patients or dangerous for some of them while it also poses problems for health care providers. On the other hand, development of information technology in the health care system including application of wireless sensor networks (WSNs) has led to easy and quick service-providing. It can provide a solution to prevent bedsore in motionless and disabled patients. Hence, the aim of this article was first to introduce WSNs in hospital beds and second, to identify the benefits and challenges in implementing this technology. This study was a nonsystematic review. The literature was searched for WSNs to reduce and prevent bedsores with the help of libraries, databases (PubMed, SCOPUS, and EMBASE), and also searches engines available at Google Scholar including during 1974-2014 while the inclusion criteria were applied in English and Persian. In our searches, we employed the following keywords and their combinations: "wireless sensor network," "smart bed," "information technology," "smart mattress," and "bedsore" in the searching areas of titles, keywords, abstracts, and full texts. In this study, more than 45 articles and reports were collected and 37 of them were selected based on their relevance. Therefore, identification and implementation of this technology will be a step toward mechanization of traditional procedures in providing care for hospitalized patients and disabled people. The smart bed and mattress, either alone or in combination with the other technologies, should be capable of providing all of the novel features while still providing the comfort and safety features usually associated with traditional and hospital mattresses. It can eliminate the expense of bedsore in the intensive care unit (ICU) department in the hospital and save much expense there. PMID:26929768

  3. A review on equipped hospital beds with wireless sensor networks for reducing bedsores

    PubMed Central

    Ajami, Sima; Khaleghi, Lida

    2015-01-01

    At present, the solutions to prevent bedsore include using various techniques for movement and displacement of patients, which is not possible for some patients or dangerous for some of them while it also poses problems for health care providers. On the other hand, development of information technology in the health care system including application of wireless sensor networks (WSNs) has led to easy and quick service-providing. It can provide a solution to prevent bedsore in motionless and disabled patients. Hence, the aim of this article was first to introduce WSNs in hospital beds and second, to identify the benefits and challenges in implementing this technology. This study was a nonsystematic review. The literature was searched for WSNs to reduce and prevent bedsores with the help of libraries, databases (PubMed, SCOPUS, and EMBASE), and also searches engines available at Google Scholar including during 1974-2014 while the inclusion criteria were applied in English and Persian. In our searches, we employed the following keywords and their combinations: “wireless sensor network,” “smart bed,” “information technology,” “smart mattress,” and “bedsore” in the searching areas of titles, keywords, abstracts, and full texts. In this study, more than 45 articles and reports were collected and 37 of them were selected based on their relevance. Therefore, identification and implementation of this technology will be a step toward mechanization of traditional procedures in providing care for hospitalized patients and disabled people. The smart bed and mattress, either alone or in combination with the other technologies, should be capable of providing all of the novel features while still providing the comfort and safety features usually associated with traditional and hospital mattresses. It can eliminate the expense of bedsore in the intensive care unit (ICU) department in the hospital and save much expense there. PMID:26929768

  4. Chute Formation and Iterative Adjustment in Large, Sand-Bed Meandering Rivers

    NASA Astrophysics Data System (ADS)

    Grenfell, M. C.; Aalto, R. E.; Nicholas, A.

    2011-12-01

    The meandering-braided continuum is a planform manifestation of excess available river energy; a balance between the energy of flow (commonly quantified as unit steam power or shear stress), and dynamic resistance due to bed material calibre and bank strength. Single-thread meandering rivers plot in part of the continuum defined by low excess available river energy, while braided rivers plot in part of the continuum defined by high excess available river energy. Planform patterns that are transitional between single-thread meandering and braided occur where chute channel formation is prolific. In this presentation we will elucidate the morphodynamic implications of chute formation for sinuosity and planform pattern in large, sand-bed meandering rivers. We draw on the results of recent research that applied binary logistic regression analysis to determine the possibility of predicting chute initiation based on attributes of meander bend character and dynamics (Grenfell et al., accepted, ESP&L). Regression models developed for the Strickland River, Papua New Guinea (54 bends), the lower Paraguay River, Paraguay/Argentina (45 bends), and the Beni River, Bolivia (114 bends), revealed that the probability of chute initiation at a meander bend is a function of the bend extension rate (the rate at which a bend elongates). Image analyses of all rivers and field observations from the Strickland suggest that the majority of chute channels form during scroll-slough development. Rapid extension is shown to favour chute initiation by breaking the continuity of point bar deposition and vegetation encroachment at the inner bank, resulting in widely-spaced scrolls with intervening sloughs that are positively aligned with primary over-bar flow. The rivers plot in order of increasing chute activity on an empirical meandering-braided pattern continuum (Kleinhans and van den Berg, 2011, ESP&L 36) defined by potential specific stream power (ωpv) and bedload calibre (D50). Increasing

  5. Impact of implementing an Internal Bed Regulation Committee on administrative and care indicators at a teaching hospital

    PubMed Central

    Rodrigues, Luciane Cristine Ribeiro; Juliani, Carmen Maria Casquel Monti

    2015-01-01

    Objective To compare hospital indicators before and after implementing an Internal Bed Regulation Committee at a reference hospital. Methods It is an quantitative, evaluation, exploratory, descriptive and cross-sectional research. The data was gathered from the hospital administrative reports for the period 2008-2013, provided by the Information Technology Center of the Complexo FAMEMA. Results The indicators improved after implementation of the Internal Bed Regulation Committee. Conclusion The individuals involved in the process acknowledged the improvement. It is necessary to carry on the regulatory actions, especially in a comprehensive and complex healthcare system, such as the brazilian Sistema Único de Saúde. PMID:25993075

  6. Width adjustment in experimental gravel-bed channels in response to overbank flows

    NASA Astrophysics Data System (ADS)

    Pitlick, John; Marr, Jeff; Pizzuto, Jim

    2013-06-01

    We conducted a series of flume experiments to investigate the response of self-formed gravel-bed channels to floods of varying magnitude and duration. Floods were generated by increasing the discharge into a channel created in sand- and gravel-sized sediment with a median grain size of 2 mm. Flooding increased the Shields stress along the channel perimeter, causing bank erosion and rapid channel widening. The sediment introduced to the channel by bank erosion was not necessarily deposited on the channel bed, but was rather transported downstream, a process likely facilitated by transient fining of the bed surface. At the end of each experiment, bank sediments were no longer in motion, "partial bed load transport" characterized the flat-bed portion of the channel, and the Shields stress approached a constant value of 0.056, about 1.2 times the critical Shields stress for incipient motion. Furthermore, the discharge was entirely accommodated by flow within the channel: the creation of a stable channel entirely eliminated overbank flows. We speculate that similar processes may occur in nature, but only where bank sediments are non-cohesive and where channel-narrowing processes cannot counteract bank erosion during overbank flows. We also demonstrate that a simple model of lateral bed load transport can reproduce observed channel widening rates, suggesting that simple methods may be appropriate for predicting width increases in channels with non-cohesive, unvegetated banks, even during overbank flows. Last, we present a model for predicting the equilibrium width and depth of a stable gravel-bed channel with a known channel-forming Shields stress.

  7. Self-adjustment of stream bed roughness and flow velocity in a steep mountain channel

    NASA Astrophysics Data System (ADS)

    Schneider, Johannes M.; Rickenmann, Dieter; Turowski, Jens M.; Kirchner, James W.

    2015-10-01

    Understanding how channel bed morphology affects flow conditions (and vice versa) is important for a wide range of fluvial processes and practical applications. We investigated interactions between bed roughness and flow velocity in a steep, glacier-fed mountain stream (Riedbach, Ct. Valais, Switzerland) with almost flume-like boundary conditions. Bed gradient increases along the 1 km study reach by roughly 1 order of magnitude (S = 3-41%), with a corresponding increase in streambed roughness, while flow discharge and width remain approximately constant due to the glacial runoff regime. Streambed roughness was characterized by semivariograms and standard deviations of point clouds derived from terrestrial laser scanning. Reach-averaged flow velocity was derived from dye tracer breakthrough curves measured by 10 fluorometers installed along the channel. Commonly used flow resistance approaches (Darcy-Weisbach equation and dimensionless hydraulic geometry) were used to relate the measured bulk velocity to bed characteristics. As a roughness measure, D84 yielded comparable results to more laborious measures derived from point clouds. Flow resistance behavior across this large range of steep slopes agreed with patterns established in previous studies for both lower-gradient and steep reaches, regardless of which roughness measures were used. We linked empirical critical shear stress approaches to the variable power equation for flow resistance to investigate the change of bed roughness with channel slope. The predicted increase in D84 with increasing channel slope was in good agreement with field observations.

  8. Tuberculosis Hospitalization Fees and Bed Utilization in China from 1999 to 2009: The Results of a National Survey of Tuberculosis Specialized Hospitals

    PubMed Central

    Ma, Yan; Mi, Fengling; Liu, Yuhong; Li, Liang

    2015-01-01

    Background China is transitioning towards concentrating tuberculosis (TB) diagnostic and treatment services in hospitals, while the Centers of Disease Control and Prevention (CDC) system will retain important public health functions. Patient expenditure incurred through hospitalization may lead to barriers to TB care or interruption of treatment. Methodology/Principal Findings We conducted a national survey of TB specialized hospitals to determine hospitalization fees and hospital bed utilization in 1999, 2004, and 2009. Hospitalization of TB patients increased 185.3% from 1999 to 2009. While the average hospitalization fees also increased, the proportion of those fees in relation to GDP per capita decreased. Hospitalization fees differed across the three regions (eastern, central, and western). Using a least standard difference (LSD) paired analysis, in 2004, the difference in hospitalization fees was significant when comparing eastern and central provinces (p<0.001) as well as to western provinces (p<0.001). In 2009, the difference remained statistically significant when comparing eastern province hospitalization fees with central provinces (p<0.001) and western provinces (p = 0.008). In 2004 and 2009, the cost associated with hospitalization as a proportion of GDP per capita was highest in the western region. The average in-patient stay decreased from 33 days in 1999 to 26 and 27 days in 2004 and 2009 respectively. Finally, hospital bed utilization in all three regions increased over this period. Conclusions/Significance Our findings show that both the total number of in-patients and hospitalization fees increased from 1999 to 2009, though the proportion of hospitalization fees to GDP per capita decreased. As diagnostic services move to hospitals, regulatory and monitoring mechanisms should be established, and hospitals should make use of the experience garnered by the CDC system through continued strong collaborations. Infrastructure and social protection

  9. The 500-bed hospital that isn't there: the Victorian Department of Health review of the Hospital in the Home program.

    PubMed

    Montalto, Michael

    2010-11-15

    The Victorian Department of Health reviewed its Hospital in the Home (HIH) program in 2009, for the first time in a decade. Annual reimbursements to all Victorian hospitals for HIH care had reached $110 million. Nearly all Victorian hospitals have an HIH program. Collectively, these units recorded 32,462 inpatient admissions in 2008-09, representing 2.5% of all inpatient admissions, 5.3% of multiday admissions and 5% of all bed-days in Victoria. If HIH were a single entity, it would be a 500-bed hospital. Treatment of many patients with acute community- and hospital-acquired infections or venous thromboembolism has moved into HIH. There is still capacity for growth in clinical conditions that can be appropriately managed at home. The review found evidence of gaming by hospitals through deliberate blurring of boundaries between acute HIH care and postacute care. The Victorian HIH program is a remarkable success that has significantly expanded the overall capacity of the hospital system, with lower capital resources. It suggests HIH with access to equivalent hospital remuneration is necessary for a successful HIH policy. Hospitals should invest in HIH medical leadership and supervision to expand their HIH services, including teaching. HIH is a challenge to the traditional vision of a hospital. Greater community awareness of HIH could assist in its continued growth. PMID:21077817

  10. Bifurcations and complex dynamics of an SIR model with the impact of the number of hospital beds

    NASA Astrophysics Data System (ADS)

    Shan, Chunhua; Zhu, Huaiping

    2014-09-01

    In this paper we establish an SIR model with a standard incidence rate and a nonlinear recovery rate, formulated to consider the impact of available resource of the public health system especially the number of hospital beds. For the three dimensional model with total population regulated by both demographics and diseases incidence, we prove that the model can undergo backward bifurcation, saddle-node bifurcation, Hopf bifurcation and cusp type of Bogdanov-Takens bifurcation of codimension 3. We present the bifurcation diagram near the cusp type of Bogdanov-Takens bifurcation point of codimension 3 and give epidemiological interpretation of the complex dynamical behaviors of endemic due to the variation of the number of hospital beds. This study suggests that maintaining enough number of hospital beds is crucial for the control of the infectious diseases.

  11. Cost of comprehensive pharmaceutical services in a 45-bed rural hospital.

    PubMed

    Nelson, A A; Tindall, W N; Gourley, D R; Arrigo, J; Anderson, R J

    1976-11-01

    The financial impact of a comprehensive pharmacy program on patient charges and hospital operating costs in a 45-bed community hospital was studied. Data were collected retrospectively for the fiscal year prior to initiating pharmacy services (FY73), the fiscal year during program development (FY74) and the fiscal year following full operations (FY75). The total cost of pharmacy services increased 75% from FY73 to FY75, with the largest dollar increase being in pharmacy salaries. Large increases among other cost items also were noted. The average total cost for pharmacy services increased from $3.28 per patient day in FY73 to $6.04 in FY75 (84%). Total hospital cost per patient day increased by approximately $35 from FY73 to FY75 (5%). The pharmaceutical services fee per dose of medication administered did not change from FY73 to FY75. Patient charges per day for medications and pharmaceutical services increased $0.55 (9.8%) from FY73 to FY75. There was a 55% reduction in the number of items carried in pharmacy inventory from FY73 to FY74 following the initiation of a formulary and a unit dose drug distribution system. PMID:998632

  12. Atmospheric fluidized-bed combustion (AFBC) co-firing of coal and hospital waste. Environmental Assessment

    SciTech Connect

    Not Available

    1993-02-01

    The proposed project involves co-firing of coal and medical waste (including infectious medical waste) in an atmospheric fluidized-bed combustor (AFBC) to safely dispose of medical waste and produce steam for hospital needs. Combustion at the design temperature and residence time (duration) in the AFBC has been proven to render infectious medical waste free of disease producing organisms. The project would be located at the Veterans Affairs (VA) Medical Center in Lebanon, Pennsylvania. The estimated cost of the proposed AFBC facility is nearly $4 million. It would be jointly funded by DOE, Veterans Affairs, and Donlee Technologies, Inc., of York, Pennsylvania, under a cooperative agreement between DOE and Donlee. Under the terms of this agreement, $3.708 million in cost-shared financial assistance would be jointly provided by DOE and the Veterans Affairs (50/50), with $278,000 provided by Donlee. The purposes of the proposed project are to: (1) provide the VA Medical Center and the Good Samaritan Hospital (GSH), also of Lebanon, Pennsylvania, with a solution for disposal of their medical waste; and (2) demonstrate that a new coal-burning technology can safely incinerate infectious medical waste, produce steam to meet hospital needs, and comply with environmental regulations.

  13. Improving adjustments for older age in pre-hospital assessment and care.

    PubMed

    Rehn, Marius

    2013-01-01

    Population estimates projects a significant increase in the geriatric population making elderly trauma patients more common. The geriatric trauma patients experience higher incidence of pre-existing medical conditions, impaired age-dependent physiologic reserve, use potent drugs and suffer from trauma system related shortcomings that influence outcomes. To improve adjustments for older age in pre-hospital assessment and care, several initiatives should be implemented. Decision-makers should make system revisions and introduce advanced point-of-care initiatives to improve outcome after trauma for the elderly. PMID:23343340

  14. Do diagnosis-related group-based payments incentivise hospitals to adjust output mix?

    PubMed

    Liang, Li-Lin

    2015-04-01

    This study investigates whether the diagnosis-related group (DRG)-based payment method motivates hospitals to adjust output mix in order to maximise profits. The hypothesis is that when there is an increase in profitability of a DRG, hospitals will increase the proportion of that DRG (own-price effects) and decrease those of other DRGs (cross-price effects), except in cases where there are scope economies in producing two different DRGs. This conjecture is tested in the context of the case payment scheme (CPS) under Taiwan's National Health Insurance programme over the period of July 1999 to December 2004. To tackle endogeneity of DRG profitability and treatment policy, a fixed-effects three-stage least squares method is applied. The results support the hypothesised own-price and cross-price effects, showing that DRGs which share similar resources appear to be complements rather substitutes. For-profit hospitals do not appear to be more responsive to DRG profitability, possibly because of their institutional characteristics and bonds with local communities. The key conclusion is that DRG-based payments will encourage a type of 'product-range' specialisation, which may improve hospital efficiency in the long run. However, further research is needed on how changes in output mix impact patient access and pay-outs of health insurance. PMID:24519749

  15. Psychiatric Hospital Bed Numbers and Prison Population Sizes in 26 European Countries: A Critical Reconsideration of the Penrose Hypothesis

    PubMed Central

    Blüml, Victor; Waldhör, Thomas; Kapusta, Nestor D.; Vyssoki, Benjamin

    2015-01-01

    Background Recently, there has been a revived interest in the validity of the Penrose hypothesis, which was originally postulated over 75 years ago. It suggests an inverse relationship between the numbers of psychiatric hospital beds and the sizes of prison population. This study aims to investigate the association between psychiatric hospital beds and prison populations in a large sample of 26 European countries between 1993 and 2011. Methods The association between prison population sizes and numbers of psychiatric hospital beds was assessed by means of Spearman correlations and modeled by a mixed random coefficient regression model. Socioeconomic variables were considered as covariates. Data were retrieved from Eurostat, the statistical office of the European Union. Outcomes Mean Spearman correlation coefficients between psychiatric beds and prison population showed a significant negative association (-0.35; p = <0.01). However, in the mixed regression model including socioeconomic covariates there were no significant fixed parameter estimates. Meanwhile, the covariance estimates for the random coefficients psychiatric beds (σ2 = 0.75, p = <0.01) and year (σ2 = 0.0007, p = 0.03) yielded significant results. Interpretation These findings do not support the general validity of the Penrose hypothesis. Notably, the results of the mixed-model show a significant variation in the magnitude and direction of the association of psychiatric hospital bed numbers and the prison population sizes between countries. In this sense, our results challenge the prevalent opinion that a reduction of psychiatric beds subsequently leads to increasing incarcerations. These findings also work against the potential stigmatization of individuals suffering from mental disorders as criminals, which could be an unintentional byproduct of the Penrose hypothesis. PMID:26529102

  16. Achievement of USP Chapter 797 Compliance By A 35-Bed Rural Hospital: A Case Study.

    PubMed

    Peters, Gregory F; McKeon, Marghi R; Nerburn, Richard G

    2007-01-01

    To comply with pharmacy-practice and occupational safety standards and guidelines ("the standards") for the compounding of sterile preparations, a small community hospital that had an extended care unit as part of its facility had to make improvements to its pharmacy. The typical financial, staffing, and space constraints of the smaller institution had to be accommodated in a comprehensive plan for the low-cost conceptualization, qualification, design, construction, cerification, operation, and maintenance of a modern compounded sterile preparation pharmacy. Pharmacy demographic data were collected and a marketing survey completed to identify projected hospital service areas, population trends, and compounded sterile preparation needs. On the basis of this survey, a facility and process were designed to ensure uncongested operations in the short, intermediate, and long terms. As part of the master plan, facility and process design, installation, operational, and performance qualifications were developed. The facility was then built in accordance with the qualifications, and operative personnel were selected and trained and their technique verified. Complete standard operating procedures and a comprehensive information technology data-management system were installed and made operational. In August 2006, the hospital's compounded sterile preparation pharmacy and program were inspected by the Joint Commission on Accreditation of Healthcare Organizations, with no exceptions noted. In April 2007, the State of Wisconsin Board of Pharmacy completed its final review of the complete compounded sterile preapration pharmacy design upgrade, and the hospital's pharmacy was unconditionally approved for continued operation. Correct design and implementation of a low-cost plan to modernize the pharmacy operations of a 35-bed rural hopsital resulted in a compounded sterile prepartion pharmacy and process designed, built, and qualified in compliance with the standards, and the

  17. Decision support for hospital bed management using adaptable individual length of stay estimations and shared resources

    PubMed Central

    2013-01-01

    Background Elective patient admission and assignment planning is an important task of the strategic and operational management of a hospital and early on became a central topic of clinical operations research. The management of hospital beds is an important subtask. Various approaches have been proposed, involving the computation of efficient assignments with regard to the patients’ condition, the necessity of the treatment, and the patients’ preferences. However, these approaches are mostly based on static, unadaptable estimates of the length of stay and, thus, do not take into account the uncertainty of the patient’s recovery. Furthermore, the effect of aggregated bed capacities have not been investigated in this context. Computer supported bed management, combining an adaptable length of stay estimation with the treatment of shared resources (aggregated bed capacities) has not yet been sufficiently investigated. The aim of our work is: 1) to define a cost function for patient admission taking into account adaptable length of stay estimations and aggregated resources, 2) to define a mathematical program formally modeling the assignment problem and an architecture for decision support, 3) to investigate four algorithmic methodologies addressing the assignment problem and one base-line approach, and 4) to evaluate these methodologies w.r.t. cost outcome, performance, and dismissal ratio. Methods The expected free ward capacity is calculated based on individual length of stay estimates, introducing Bernoulli distributed random variables for the ward occupation states and approximating the probability densities. The assignment problem is represented as a binary integer program. Four strategies for solving the problem are applied and compared: an exact approach, using the mixed integer programming solver SCIP; and three heuristic strategies, namely the longest expected processing time, the shortest expected processing time, and random choice. A baseline approach

  18. Vegetation control of gravel-bed channel morphology and adjustment: the case of Carex nudata

    NASA Astrophysics Data System (ADS)

    McDowell, P. F.

    2010-12-01

    In the high energy, gravel- to cobble-bed Middle Fork John Day River of eastern Oregon, C. nudata (torrent sedge) germinates on gravel bars and forms tussocks 0.5 m across by 0.3m high or larger, with dense, tough root masses that are very resistant to erosion. Tussocks may be uprooted during floods (probably >Q-5yr), travel as boulder-sized masses, and may re-root where deposited. Individual tussocks, however, commonly persist for more than a decade in one position. When established, these tussocks behave more like channel obstructions than typical stream side sedges. Lines of C. nudata tussocks form on the stream side margin of former bare gravel bars, creating a secondary flow path and an eroding bank on their landward side. C. nudata also forms small mid-channel islets with bed scour at their base and occasional lee depositional zones. Chains of mid-channel islets can anchor pool boundaries. Observations in the field and from aerial photo time sequences suggest the following evolutionary model for channels with C. nudata. C. nudata establishes on a bare gravel bar, and can stabilize the bar surface or create erosional forms as described above. C. nudata fosters weaker sedges and other species that help extend stabilization of the bar surface. Mid-channel islets form through selective uprooting of tussocks. Observations of a reach where cattle grazing was eliminated in 2000 show that C. nudata has expanded. It has stabilized some formerly active bar surfaces but is now causing bank erosion and channel widening in some locations. In this case, C. nudata mediated the potentially stabilizing effects of management change by increasing channel instability in some respects.

  19. The Relationship of Medicaid Payment Rates, Bed Constraint Policies, and Risk-Adjusted Pressure Ulcers

    PubMed Central

    Grabowski, David C; Angelelli, Joseph J

    2004-01-01

    Objective To examine the effect of Medicaid reimbursement rates on nursing home quality in the presence of certificate-of-need (CON) and construction moratorium laws. Data Sources/Study Setting A single cross-section of Medicaid certified nursing homes in 1999 (N=13,736). Study Design A multivariate regression model was used to examine the effect of Medicaid payment rates and other explanatory variables on risk-adjusted pressure ulcer incidence. The model is alternatively considered for all U.S. nursing home markets, those most restrictive markets, and those high-Medicaid homes to isolate potentially resource-poor environments. Data Extraction Methods A merged data file was constructed with resident-level information from the Minimum Data Set, facility-level information from the On-Line, Survey, Certification, and Reporting (OSCAR) system and market- and state-level information from various published sources. Principal Findings In the analysis of all U.S. markets, there was a positive relationship between the Medicaid payment rate and nursing home quality. The results from this analysis imply that a 10 percent increase in Medicaid payment was associated with a 1.5 percent decrease in the incidence of risk-adjusted pressure ulcers. However, there was a limited association between Medicaid payment rates and quality in the most restrictive markets. Finally, there was a strong relationship between Medicaid payment and quality in high-Medicaid homes providing strong evidence that the level of Medicaid payment is especially important within resource poor facilities. Conclusions These findings provide support for the idea that increased Medicaid reimbursement may be an effective means toward improving nursing home quality, although CON and moratorium laws may mitigate this relationship. PMID:15230928

  20. The effect of alternative case-mix adjustments on mortality differences between municipal and voluntary hospitals in New York City.

    PubMed Central

    Shapiro, M F; Park, R E; Keesey, J; Brook, R H

    1994-01-01

    OBJECTIVE. This study investigated how mortality differences between groups of municipal versus voluntary hospitals are affected by case-mix adjustment methods. DATA SOURCES AND STUDY SETTING. We sampled about 10,000 random admissions from administrative data for patients hospitalized with each of six conditions in hospitals in New York City during 1984-1987. STUDY DESIGN. We developed logistic regression models adjusting for age and gender, for principal diagnosis, for "limited other diagnoses" (secondary diagnoses that were very unlikely to result from care received), for "full other diagnoses" (all secondary diagnoses irrespective of whether they might have been due to care received), for previous diagnoses, and for other variables. PRINCIPAL FINDINGS. For five of the six conditions, when the limited other diagnoses adjustment was used there was higher mortality in the municipal hospitals (p < .05), with 3.3 additional deaths/100 admissions for myocardial infarction, 1.2 for pneumonia, 8.3 for stroke, 2.8 for head trauma, and 0.8 for hip repair. However, when the full other diagnoses adjustment was used, differences remained significant only for stroke (4.3 additional deaths/100 admissions) and head trauma (1.3) (p < .05). CONCLUSIONS. Estimates of mortality differences between New York City municipal and voluntary hospitals are substantially affected by which secondary diagnoses are used in case-mix adjustment. Judgments of quality should not be based on administrative data unless models can be developed that validly capture level of sickness at admission. PMID:8163382

  1. Biodegradation of pharmaceuticals in hospital wastewater by staged Moving Bed Biofilm Reactors (MBBR).

    PubMed

    Casas, Mònica Escolà; Chhetri, Ravi Kumar; Ooi, Gordon; Hansen, Kamilla M S; Litty, Klaus; Christensson, Magnus; Kragelund, Caroline; Andersen, Henrik R; Bester, Kai

    2015-10-15

    Hospital wastewater represents a significant input of pharmaceuticals into municipal wastewater. As Moving Bed Biofilm Reactors (MBBRs) appear to remove organic micro-pollutants, hospital wastewater was treated with a pilot plant consisting of three MBBRs in series. The removal of pharmaceuticals was studied in two experiments: 1) A batch experiment where pharmaceuticals were spiked to each reactor and 2) a continuous flow experiment at native concentrations. DOC removal, nitrification as well as removal of pharmaceuticals (including X-ray contrast media, β-blockers, analgesics and antibiotics) occurred mainly in the first reactor. In the batch experiment most of the compounds followed a single first-order kinetics degradation function, giving degradation rate constants ranged from 5.77 × 10(-3) to 4.07 h(-1), from -5.53 × 10(-3) to 9.24 × 10(-1) h(-1) and from 1.83 × 10(-3) to 2.42 × 10(-1) h(-1) for first, second and third reactor respectively. Generally, the highest removal rate constants were found in the first reactor while the lowest were found in the third one. This order was inverted for most compounds, when the removal rate constants were normalized to biomass, indicating that the last tank had the most effective biofilms. In the batch experiment, 21 out of 26 compounds were assessed to be degraded with more than 20% within the MBBR train. In the continuous flow experiment the measured removal rates were lower than those estimated from the batch experiments. PMID:26164801

  2. Cardiovascular and Body Fluid Adjustments During Bed Rest and Space Flight

    NASA Technical Reports Server (NTRS)

    Greenleaf, John E.; Tomko, David L. (Technical Monitor)

    1995-01-01

    Although a few scientific bed rest (BR) studies were conducted soon after World War II, advent of the space program provided impetus for utilizing prolonged (days-months) BR, which employed the horizontal or 6 degree head-down tilt (HDT) body positions, to simulate responses of healthy people to microgravity. Shorter (hours) HDT protocols were used to study initial mechanisms of the acclimation-deconditioning (reduction of physical fitness) syndromes. Of the major physiological factors modified during BR, reduced force on bones, ligaments, and muscles, and greatly reduced hydrostatic pressure within the cardiovascular system, the latter: which involves shifts of blood from the lower extremities into the upper body, increase in central venous pressure, and diuresis, appears to be the initial stimulus for acclimation. Increase in central venous pressure occurs in subjects during weightless parabolic flight, but not in astronauts early during orbital flight. But significant reduction in total body water (hypohydration) and plasma volume (hypovolemia) occurs in subjects during both BR and microgravity. Response of interstitial fluid volume is not as clear, It has been reported to increase during BR, and it may have increased in Skylab II and IV astronauts. Reduction of total body water, and greater proportional reduction of extracellular volume, indicates increased cellular volume which may contribute to inflight cephalic edema. Cerebral pressure abates after a few days of HDT, but not during flight. accompanied by normal (eugravity) blood constituent concentrations suggesting some degree of acclimation had occurred. But during reentry, with moderately increased +Gz (head-to-foot) acceleration and gravitational force, the microgravity "euhydration" becomes functional progressive dehydration contributing to the general reentry syndrome (GRS) which, upon landing the Shuttle, can and often results in gastrointestinal distress, disorientation, vertigo, fatigue, and

  3. Improved hospital-level risk adjustment for surveillance of healthcare-associated bloodstream infections: a retrospective cohort study

    PubMed Central

    2009-01-01

    Background To allow direct comparison of bloodstream infection (BSI) rates between hospitals for performance measurement, observed rates need to be risk adjusted according to the types of patients cared for by the hospital. However, attribute data on all individual patients are often unavailable and hospital-level risk adjustment needs to be done using indirect indicator variables of patient case mix, such as hospital level. We aimed to identify medical services associated with high or low BSI rates, and to evaluate the services provided by the hospital as indicators that can be used for more objective hospital-level risk adjustment. Methods From February 2001-December 2007, 1719 monthly BSI counts were available from 18 hospitals in Queensland, Australia. BSI outcomes were stratified into four groups: overall BSI (OBSI), Staphylococcus aureus BSI (STAPH), intravascular device-related S. aureus BSI (IVD-STAPH) and methicillin-resistant S. aureus BSI (MRSA). Twelve services were considered as candidate risk-adjustment variables. For OBSI, STAPH and IVD-STAPH, we developed generalized estimating equation Poisson regression models that accounted for autocorrelation in longitudinal counts. Due to a lack of autocorrelation, a standard logistic regression model was specified for MRSA. Results Four risk services were identified for OBSI: AIDS (IRR 2.14, 95% CI 1.20 to 3.82), infectious diseases (IRR 2.72, 95% CI 1.97 to 3.76), oncology (IRR 1.60, 95% CI 1.29 to 1.98) and bone marrow transplants (IRR 1.52, 95% CI 1.14 to 2.03). Four protective services were also found. A similar but smaller group of risk and protective services were found for the other outcomes. Acceptable agreement between observed and fitted values was found for the OBSI and STAPH models but not for the IVD-STAPH and MRSA models. However, the IVD-STAPH and MRSA models successfully discriminated between hospitals with higher and lower BSI rates. Conclusion The high model goodness-of-fit and the higher

  4. The Effect of Bed Rest on Bone Turnover in Young Women Hospitalized for Anorexia Nervosa: A Pilot Study

    PubMed Central

    DiVasta, Amy D.; Feldman, Henry A.; Quach, Ashley E.; Balestrino, Maria; Gordon, Catherine M.

    2009-01-01

    Context: Malnourished adolescents with anorexia nervosa (AN) requiring medical hospitalization are at high risk for skeletal insults. Even short-term bed rest may further disrupt normal patterns of bone turnover. Objective: The objective of the study was to determine the effect of relative immobilization on bone turnover in adolescents hospitalized for AN. Design: This was a short-term observational study. Setting: The study was conducted at a tertiary care pediatric hospital. Study Participants: Twenty-eight adolescents with AN, aged 13–21 yr with a mean body mass index of 15.9 ± 1.8 kg/m2, were enrolled prospectively on admission. Intervention: As per standard care, all subjects were placed on bed rest and graded nutritional therapy. Main Outcome Measure: Markers of bone formation (bone specific alkaline phosphatase), turnover (osteocalcin), and bone resorption (urinary N-telopeptides NTx) were measured. Results: During the 5 d of hospitalization, serum osteocalcin increased by 0.24 ± 0.1 ng/ml · d (P = 0.02). Urine N-telopeptides reached a nadir on d 3, declining −6.9 ± 2.8 nm bone collagen equivalent per millimole creatinine (P = 0.01) but returned to baseline by d 5 (P > 0.05). Bone-specific alkaline phosphatase exhibited a decline that was strongly age dependent, being highly significant for younger subjects only [age 14 yr: −0.42 ± 0.11 (P = 0.0002); age 18 yr: −0.03 ± 0.08 (P = 0.68)]. Age had no effect on other outcome measures. Conclusion: Limitation of physical activity during hospitalization for patients with AN is associated with suppressed bone formation and resorption and an imbalance of bone turnover. Future interventional studies involving mechanical stimulation and/or weight-bearing activity are needed to determine whether medical protocols prescribing strict bed rest are appropriate. PMID:19223524

  5. 78 FR 14689 - Medicare Program; Extension of the Payment Adjustment for Low-volume Hospitals and the Medicare...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-07

    ...) of the Act, we refer readers to the FY 2013 IPPS/LTCH PPS final rule (77 FR 53406 through 53408... Affordable Care Act in the FY 2011 IPPS/LTCH PPS final rule (75 FR 50238 through 50275 and 50414). In... for requesting and obtaining the low-volume hospital payment adjustment for FY 2011 (75 FR 50240)....

  6. The Occupational Mix Adjustment to the Medicare Hospital Wage Index: Why the Rural Impact Is Less than Expected

    ERIC Educational Resources Information Center

    Reiter, Kristin L.; Slifkin, Rebecca; Holmes, George M.

    2008-01-01

    Context: Rural hospitals are heavily dependent on Medicare for their long-term financial solvency. A recent change to Medicare prospective payment system reimbursement--the occupational mix adjustment (OMA) to the wage index--has attracted a great deal of attention in rural policy circles. Purpose: This paper explores variation in the OMA across…

  7. 42 CFR 413.83 - Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Specific Categories of Costs § 413.83... hospital may request that the intermediary review the classification of the affected costs in its rate-of... issue. (2) Request for review. The hospital must request review of the classification of its...

  8. 42 CFR 413.83 - Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Specific Categories of Costs § 413.83... hospital may request that the intermediary review the classification of the affected costs in its rate-of... issue. (2) Request for review. The hospital must request review of the classification of its...

  9. 42 CFR 413.83 - Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Specific Categories of Costs § 413.83... hospital may request that the intermediary review the classification of the affected costs in its rate-of... issue. (2) Request for review. The hospital must request review of the classification of its...

  10. 42 CFR 413.83 - Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Specific Categories of Costs § 413.83... hospital may request that the contractor review the classification of the affected costs in its rate-of... issue. (2) Request for review. The hospital must request review of the classification of its...

  11. Treating Long-Stay Patients in Acute Hospital Beds: An Economic Diagnosis.

    ERIC Educational Resources Information Center

    Hochstein, Alan

    1985-01-01

    A study of 105 medical files from three Montreal hospitals suggests that long-stay patients are inactive users of many hospital services; estimated reduction in cost per day for these patients due to their earlier discharge is only about 24-30 percent of the hospital's per diem.

  12. Bed leasing program helps hospitals discharge hard-to-place patients.

    PubMed

    2015-12-01

    UCLA Health's program that pays a negotiated daily rate to skilled nursing facilities to hold beds for patients who otherwise would stay in an acute care bed saved a total of 2,516 acute care days from June 2014 to July 2015. UCLA Health pays a negotiated daily rate if the beds are occupied or not. The rate covers boarding, nursing care, medications, and physical therapy and occupational therapy Nurse practitioners are embedded in the participating nursing homes and provide care for UCLA Health's patients every day, often treating problems that might cause a readmission. The program helps with emergency department throughput and frees up acute care beds for patients who need them. PMID:26642611

  13. 42 CFR 412.130 - Retroactive adjustments for incorrectly excluded hospitals and units.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... the inpatient population the hospital planned to treat during that cost reporting period, if the inpatient population actually treated in the hospital during that cost reporting period did not meet the... under § 412.29(c) regarding the inpatient population the hospital planned to treat in that unit...

  14. The relationship between adult sexual adjustment and childhood experiences regarding exposure to nudity, sleeping in the parental bed, and parental attitudes toward sexuality.

    PubMed

    Lewis, R J; Janda, L H

    1988-08-01

    The relationship between adult sexual functioning and childhood experiences with exposure to nudity, sleeping in the parents' bed, and parental attitudes toward sexuality was examined. Although a variety of experts have provided their opinion on this issue, empirical research on this topic has been lacking. In this study, male and female college students were asked to retrospectively report on the frequency of sleeping in the parental bed as a child, the frequency of seeing others nude during childhood, and parental attitudes regarding sexuality. Information on current sexual functioning and adjustment was also obtained. The results suggest that childhood experiences with exposure to nudity and sleeping in the parental bed are not adversely related to adult sexual functioning and adjustment. In fact, there is modest support that these childhood experiences are positively related to indices of adjustment. Results also suggest that a positive attitude toward sexuality can be beneficial for a child's comfort with his/her sexuality. Finally, examination of gender differences revealed that male and female experience paternal attitudes toward sexuality differently but are similar in their perceptions of maternal attitudes. PMID:3421828

  15. Spatio-temporal dependencies between hospital beds, physicians and health expenditure using visual variables and data classification in statistical table

    NASA Astrophysics Data System (ADS)

    Medyńska-Gulij, Beata; Cybulski, Paweł

    2016-06-01

    This paper analyses the use of table visual variables of statistical data of hospital beds as an important tool for revealing spatio-temporal dependencies. It is argued that some of conclusions from the data about public health and public expenditure on health have a spatio-temporal reference. Different from previous studies, this article adopts combination of cartographic pragmatics and spatial visualization with previous conclusions made in public health literature. While the significant conclusions about health care and economic factors has been highlighted in research papers, this article is the first to apply visual analysis to statistical table together with maps which is called previsualisation.

  16. Exponentially weighted moving average charts to compare observed and expected values for monitoring risk-adjusted hospital indicators.

    PubMed

    Cook, D A; Coory, M; Webster, R A

    2011-06-01

    OBJECTIVE To introduce a new type of risk-adjusted (RA) exponentially weighted moving average (EWMA) chart and to compare it to a commonly used type of variable life adjusted display chart for analysis of patient outcomes. DATA Routine inpatient data on mortality following admission for acute myocardial infarction, from all public and private hospitals in Queensland, Australia. METHODS The RA-EWMA plots the EWMA of the observed and predicted values. Predicted values were obtained from a logistic regression model for all hospitals in Queensland. The EWMA of the predicted values is a moving centre line, reflecting current patient case mix at a particular hospital. Thresholds around this moving centre line provide a scale by which to assess the importance of trends in the EWMA of the observed values. RESULTS The RA-EWMA chart can be designed to have equivalent performance, in terms of average run lengths, as variable life adjusted display chart. The advantages of the RA-EWMA are that it communicates information about the current level of an indicator in a direct and understandable way, and it explicitly displays information about the current patient case mix. Also, because it is not reset, the RA-EWMA is a more natural chart to use in health, where it is exceedingly rare to stop or dramatically and abruptly alter a process of care. CONCLUSION The RA-EWMA chart is a direct and intuitive way to display information about an indicator while accounting for differences in case mix. PMID:21209145

  17. 42 CFR 412.130 - Retroactive adjustments for incorrectly excluded hospitals and units.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... part regarding the inpatient population the hospital planned to treat during that cost reporting period, if the inpatient population actually treated in the hospital during that cost reporting period did... October 1, 1991, based on a certification under § 412.30(a) regarding the inpatient population...

  18. The rate and pattern of bed incision and bank adjustment on the Colorado River in Glen Canyon downstream from Glen Canyon Dam, 1956-2000

    USGS Publications Warehouse

    Grams, P.E.; Schmidt, J.C.; Topping, D.J.

    2007-01-01

    Closure of Glen Canyon Dam in 1963 transformed the Colorado River by reducing the magnitude and duration of spring floods, increasing the magnitude of base flows, and trapping fine sediment delivered from the upper watershed. These changes caused the channel downstream in Glen Canyon to incise, armor, and narrow. This study synthesizes over 45 yr of channel-change measurements and demonstrates that the rate and style of channel adjustment are directly related to both natural processes associated with sediment deficit and human decisions about dam operations. Although bed lowering in lower Glen Canyon began when the first cofferdam was installed in 1959, most incision occurred in 1965 in conjunction with 14 pulsed high flows that scoured an average of 2.6 m of sediment from the center of the channel. The average grain size of bed material has increased from 0.25 mm in 1956 to over 20 mm in 1999. The magnitude of incision at riffles decreases with distance downstream from the dam, while the magnitude of sediment evacuation from pools is spatially variable and extends farther downstream. Analysis of bed-material mobility indicates that the increase in bed-material grain size and reduction in reach-average gradient are consistent with the transformation of an adjustable-bed alluvial river to a channel with a stable bed that is rarely mobilized. Decreased magnitude of peak discharges in the post-dam regime coupled with channel incision and the associated downward shifts of stage-discharge relations have caused sandbar and terrace erosion and the transformation of previously active sandbars and gravel bars to abandoned deposits that are no longer inundated. Erosion has been concentrated in a few pre-dam terraces that eroded rapidly for brief periods and have since stabilized. The abundance of abandoned deposits decreases downstream in conjunction with decreasing magnitude of shift in the stage-discharge relations. In the downstream part of the study area where riffles

  19. Casemix-based funding of Northern Territory public hospitals: adjusting for severity and socio-economic variations.

    PubMed

    Beaver, C; Zhao, Y; McDermid, S; Hindle, D

    1998-02-01

    The Northern Territory intends to make use of Australian National Diagnosis Related Groups (DRGs) and their cost relativities as the basis for the allocation of budgets among public hospitals. The study reported here attempted to assess the extent to which there are variations in severity of illness and socio-economic status which are not adequately explained by DRG alone and, if so, to develop a DRG payment adjustment index by use of routinely available data items. The investigation was undertaken by use of a database containing all discharges between July 1992 and June 1995. Hospital length of stay was used as a proxy for cost. Multivariate analysis was undertaken and it was found that several variables were associated with cost variations within DRGs. Stepwise multiple linear regression was used to develop a model in which 14 variables were able to explain 45% of the variations. Index values were subsequently computed from the regression model for each of eight categories of admitted patient episodes which are the intersections of three binary variables: Aborigine or non-Aborigine, rural or urban usual place of residence of the patient and hospital type (teaching or other). It is intended that these index values will be used to compute differential funding rates for each hospital in the Territory. PMID:9541084

  20. StratBAM: A Discrete-Event Simulation Model to Support Strategic Hospital Bed Capacity Decisions.

    PubMed

    Devapriya, Priyantha; Strömblad, Christopher T B; Bailey, Matthew D; Frazier, Seth; Bulger, John; Kemberling, Sharon T; Wood, Kenneth E

    2015-10-01

    The ability to accurately measure and assess current and potential health care system capacities is an issue of local and national significance. Recent joint statements by the Institute of Medicine and the Agency for Healthcare Research and Quality have emphasized the need to apply industrial and systems engineering principles to improving health care quality and patient safety outcomes. To address this need, a decision support tool was developed for planning and budgeting of current and future bed capacity, and evaluating potential process improvement efforts. The Strategic Bed Analysis Model (StratBAM) is a discrete-event simulation model created after a thorough analysis of patient flow and data from Geisinger Health System's (GHS) electronic health records. Key inputs include: timing, quantity and category of patient arrivals and discharges; unit-level length of care; patient paths; and projected patient volume and length of stay. Key outputs include: admission wait time by arrival source and receiving unit, and occupancy rates. Electronic health records were used to estimate parameters for probability distributions and to build empirical distributions for unit-level length of care and for patient paths. Validation of the simulation model against GHS operational data confirmed its ability to model real-world data consistently and accurately. StratBAM was successfully used to evaluate the system impact of forecasted patient volumes and length of stay in terms of patient wait times, occupancy rates, and cost. The model is generalizable and can be appropriately scaled for larger and smaller health care settings. PMID:26310949

  1. 78 FR 48303 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-08

    ..., 2011 (76 FR 39043), DoD published for public comment a Proposed Rule regarding an inpatient payment.... G. CAH GTMCPA On August 31, 2009, we published in the Federal Register a Final Rule (74 FR 44752... FR 39043), also proposed a CAH GTMCPA for TRICARE network hospitals deemed essential for...

  2. Safety climate and motivation toward patient safety among Japanese nurses in hospitals of fewer than 250 beds.

    PubMed

    Kudo, Yasushi; Kido, Shigeri; Taruzuka Shahzad, Machiko; Saegusa, Yoichi; Satoh, Toshihiko; Aizawa, Yoshiharu

    2009-01-01

    A questionnaire survey was done to examine the associations between the dimensions of safety climate and the nurses' motivation toward patient safety. Excluding nursing directors, a total of 371 full-time female Japanese nurses (registered nurses and licensed practical nurses) working in 6 hospitals of fewer than 250 beds were analyzed. The average age was 35.6 yr (range, 20-69). For the safety climate, factor analysis (the principal factor method and promax rotation) was performed, and factors with an eigenvalue of>or=1 were extracted. Seven dimensions were extracted by factor analysis as follows: "Opportunities for nursing education", "Reporting", "Fatigue reduction", "Superiors' attitudes", "Nursing conditions", "Communications with physicians", and "Relationships among nurses". We subsequently examined the associations between the dimensions of the safety climate and "Nurses' motivation to prevent mistakes". Multiple linear regression analysis showed that "Nurses' motivation to prevent mistakes" was significantly associated with "Reporting", "Nursing conditions", and "Communications with physicians". It is necessary to improve the reporting system in hospitals. It is also necessary to improve on reducing improper communications with physicians. And appropriate nursing conditions must be actualized and maintained. PMID:19218760

  3. Respiratory hospitalizations of children living near a hazardous industrial site adjusted for prevalent dust: a case-control study.

    PubMed

    Nirel, Ronit; Maimon, Nimrod; Fireman, Elizabeth; Agami, Sarit; Eyal, Arnona; Peretz, Alon

    2015-03-01

    The Neot Hovav Industrial Park (IP), located in southern Israel, hosts 23 chemical industry facilities and the national site for treatment of hazardous waste. Yet, information about its impact on the health of local population has been mostly ecological, focused on Bedouins and did not control for possible confounding effect of prevalent dust storms. This case-control study examined whether living near the IP could lead to increased risk of pediatric hospitalization for respiratory diseases. Cases (n=3608) were residents of the Be'er Sheva sub-district aged 0-14 years who were admitted for respiratory illnesses between 2004 and 2009. These were compared to children admitted for non-respiratory conditions (n=3058). Home addresses were geocoded and the distances from the IP to the child's residence were calculated. The association between hospitalization and residential distance from the IP was examined for three age groups (0-1, 2-6, 7-14) by logistic regressions adjusting for gender, socioeconomic status, urbanity and temperature. We found that infants in the first year of life who lived within 10 km of the IP had increased risk of respiratory hospitalization when compared with those living >20 km from the IP (adjusted odds ratio, OR=2.07, 95% confidence interval, CI: 1.19-3.59). In models with both distance from the IP and particulate matter with aerodynamic diameter <10 μm (PM(10)) the estimated risk was modestly attenuated (OR=1.96, 95% CI: 1.09-3.51). Elevated risk was also observed for children 2-5 years of age but with no statistical significance (OR=1.16, 95% CI: 0.76-1.76). Our findings suggest that residential proximity to a hazardous industrial site may contribute to early life respiratory admissions, beyond that of prevailing PM(10). PMID:25547415

  4. A wind tunnel study of flow structure adjustment on deformable sand beds containing a surface-mounted obstacle

    NASA Astrophysics Data System (ADS)

    McKenna Neuman, Cheryl; Bédard, OttO

    2015-09-01

    Roughness elements of varied scale and geometry commonly appear on the surfaces of sedimentary deposits in a wide range of planetary environments. They perturb the local fluid flow so that the entrainment, transport, and deposition of particles surrounding each element are fundamentally altered. Fluid dynamists have expended much effort in examining the flow structures surrounding idealized elements mounted on fixed, planar walls. However self-regulation occurs in sedimentary systems as a result of the bed surface undergoing rapid topographic modification with sediment transport, until it reaches a stable form that enhances the net physical roughness. The present wind tunnel study examines how the flow pattern surrounding an isolated cylinder, a problem extensively studied in classical fluid mechanics, is altered through morphodynamic development of a deep well that envelopes the windward face and sidewalls of the roughness element. Spatial patterns in the fluid velocity, turbulence intensity, and Reynolds stress obtained from laser Doppler anemometer measurements suggest that the flow structures surrounding such a cylinder are fundamentally altered through self-regulation of the bed topography as it reaches steady state. For example, flow stagnation and the turbulent dissipation of momentum are substantially increased at selected points surrounding the upwind face and sidewalls of the cylinder, respectively. Along the center line of the wake flow to the rear of the cylinder, several structures arising from flow separation are annihilated by strong upwelling of the airflow exhausted from the terminus of the well. Feedback plays a complex, time-dependent role in this system.

  5. Using linked birth, notification, hospital and mortality data to examine false-positive meningococcal disease reporting and adjust disease incidence estimates for children in New South Wales, Australia.

    PubMed

    Gibson, A; Jorm, L; McIntyre, P

    2015-09-01

    Meningococcal disease is a rare, rapidly progressing condition which may be difficult to diagnose, disproportionally affects children, and has high morbidity and mortality. Accurate incidence estimates are needed to monitor the effectiveness of vaccination and treatment. We used linked notification, hospital, mortality and birth data for all children of an Australian state (2000-2007) to estimate the incidence of meningococcal disease. A total of 595 cases were notified, 684 cases had a hospital diagnosis, and 26 cases died from meningococcal disease. All deaths were notified, but only 68% (466/684) of hospitalized cases. Of non-notified hospitalized cases with more than one clinical admission, most (90%, 103/114) did not have meningococcal disease recorded as their final diagnosis, consistent with initial 'false-positive' hospital meningococcal disease diagnosis. After adjusting for false-positive rates in hospital data, capture-recapture estimation suggested that up to four cases of meningococcal disease may not have been captured in either notification or hospital records. The estimated incidence of meningococcal disease in NSW-born and -resident children aged 0-14 years was 5·1-5·4 cases/100 000 child-years at risk, comparable to international estimates using similar methods, but lower than estimates based on hospital data. PMID:25573266

  6. The probability of patients being admitted from the emergency department is negatively correlated to in-hospital bed occupancy – a registry study

    PubMed Central

    2014-01-01

    suboptimal care in outpatient settings at times of high in-hospital occupancy. A second interpretation is that physicians admit patients who could be managed safely in the outpatient setting, in times of good in-hospital bed availability. Physicians thereby expose patients to healthcare-associated infections and other hazards, in addition to consuming resources better needed by others. PMID:24499660

  7. Disparity of risk-adjusted inpatient outcomes among African American and white patients hospitalized with community-acquired pneumonia.

    PubMed

    Dickerson, Justin B; Smith, Matthew Lee

    2012-08-01

    The objectives of this study were to examine the associations between inpatient pneumonia outcomes, health care factors, and sociodemographics with an emphasis on race. African American and white patients from the 2008 National Hospital Discharge Survey who were admitted to nonprofit and for-profit hospitals with a principal diagnosis of pneumonia were sampled (n=1924). Three outcomes were measured: length of hospital stay, discharge to home, and deceased at discharge. Length of hospital stay was measured with negative binomial regression including incidence rate ratios (IRRs), while the remaining 2 outcomes were measured with logistic regression including odds ratios (ORs). Patients with longer hospital stays relative to peers were likely older (IRR=1.01, 95% confidence interval [CI]=1.01-1.01, P<0.001) and African American (IRR=1.19, 95% CI=1.10-1.30, P<0.001), but had fewer comorbidities (IRR=0.97, 95% CI=0.94-0.99, P=0.016). Patients were less likely to be discharged to home if they were older (OR=0.96, 95% CI=0.95-0.96, P<0.001), African American (OR=0.68, 95% CI=0.52-0.90, P=0.006), and had government insurance (OR=0.59, 95% CI=0.44-0.79, P<0.001). Patients deceased at discharge were more likely to be older (OR=1.03, 95% CI=1.01-1.05, P=0.001), African American (OR=1.97, 95% CI=1.10-3.53, P=0.023), and to have fewer comorbidities (OR=0.71, 95% CI=0.57-0.88, P=0.002). African Americans with pneumonia experience inequitable inpatient pneumonia-related outcomes relative to whites. Hospital interventions addressing equity are needed. PMID:22401151

  8. 42 CFR 413.114 - Payment for posthospital SNF care furnished by a swing-bed hospital.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for posthospital SNF care furnished by a... NURSING FACILITIES Specific Categories of Costs § 413.114 Payment for posthospital SNF care furnished by a... provides for payment for posthospital SNF care furnished by rural hospitals and CAHs having a...

  9. 42 CFR 413.114 - Payment for posthospital SNF care furnished by a swing-bed hospital.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Payment for posthospital SNF care furnished by a... NURSING FACILITIES Specific Categories of Costs § 413.114 Payment for posthospital SNF care furnished by a... provides for payment for posthospital SNF care furnished by rural hospitals and CAHs having a...

  10. 42 CFR 413.114 - Payment for posthospital SNF care furnished by a swing-bed hospital.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Payment for posthospital SNF care furnished by a... NURSING FACILITIES Specific Categories of Costs § 413.114 Payment for posthospital SNF care furnished by a... provides for payment for posthospital SNF care furnished by rural hospitals and CAHs having a...

  11. 42 CFR 413.114 - Payment for posthospital SNF care furnished by a swing-bed hospital.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Payment for posthospital SNF care furnished by a... NURSING FACILITIES Specific Categories of Costs § 413.114 Payment for posthospital SNF care furnished by a... provides for payment for posthospital SNF care furnished by rural hospitals and CAHs having a...

  12. 42 CFR 413.114 - Payment for posthospital SNF care furnished by a swing-bed hospital.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Payment for posthospital SNF care furnished by a... NURSING FACILITIES Specific Categories of Costs § 413.114 Payment for posthospital SNF care furnished by a... provides for payment for posthospital SNF care furnished by rural hospitals and CAHs having a...

  13. ‘Are decisions about discharge of elderly hospital patients mainly about freeing blocked beds?’ A qualitative observational study

    PubMed Central

    Ekdahl, Anne Wissendorff; Linderholm, Märit; Hellström, I; Andersson, Lars; Friedrichsen, Maria

    2012-01-01

    Objective To explore the interactions concerning the frail and elderly patients having to do with discharge from acute hospital wards and their participation in medical decision-making. The views of the patients and the medical staff were both investigated. Design A qualitative observational and interview study using the grounded theory. Setting and participants The setting was three hospitals in rural and urban areas of two counties in Sweden of which one was a teaching hospital. The data comprised observations, healthcare staff interviews and patient interviews. The selected patients were all about to be informed that they were going to be discharged. Results The patients were seldom invited to participate in the decision-making regarding discharge. Generally, most communications regarding discharge were between the doctor and the nurse, after which the patient was simply informed about the decision. It was observed that the discharge information was often given in an indirect way as if other, albeit absent, people were responsible for the decision. Interviews with the healthcare staff revealed their preoccupation with the need to free up beds: ‘thinking about discharge planning all the time’ was the core category. This focus not only failed to fulfil the complex needs of elderly patients, it also generated feelings of frustration and guilt in the staff, and made the patients feel unwelcome. Conclusions Frail elderly patients often did not participate in the medical decision-making regarding their discharge from hospital. The staff was highly focused on patients getting rapidly discharged, which made it difficult to fulfil the complex needs of these patients. PMID:23166138

  14. Bed sharing and the sudden infant death syndrome.

    PubMed Central

    Klonoff-Cohen, H.; Edelstein, S. L.

    1995-01-01

    OBJECTIVE--To determine whether infants who died of the sudden infant death syndrome routinely shared their parents' bed more commonly than control infants. DESIGN--Case-control study. SETTING--Southern California. SUBJECTS--200 white, African-American, Latin American, and Asian infants who died and 200 living controls, matched by birth hospital, date of birth, sex, and race. MAIN OUTCOME MEASURES--Routine bedding (for example, crib, cradle), day and night time sleeping arrangement (for example, alone or sharing a bed); for cases only, sleeping arrangement at death. Differences in bed sharing practices among races. RESULTS--Of the infants who died of the syndrome, 45 (22.4%) were sharing a bed. Daytime bed sharing was more common in African-American (P < 0.001) and Latin American families (P < 0.001) than in white families. The overall adjusted odds ratio for the syndrome and routine bed sharing in the daytime was 1.38 (95% confidence interval 0.59 to 3.22) and for night was 1.21 (0.59 to 2.48). These odds ratios were adjusted for routine sleep position, passive smoking, breast feeding, intercom use, infant birth weight, medical conditions at birth, and maternal age and education. There was no interaction between bed sharing and passive smoking or alcohol use by either parent. CONCLUSIONS--Although there was a significant difference between bed sharing among African-American and Latin American parents compared with white parents, there was no significant relation between routine bed sharing and the sudden infant death syndrome. PMID:7496236

  15. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

    PubMed

    2015-08-17

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

  16. Improving Results of Elective Abdominal Aortic Aneurysm Repair at a Low-Volume Hospital by Risk-Adjusted Selection of Treatment in the Endovascular Era

    SciTech Connect

    Wibmer, Andreas; Meyer, Bernhard; Albrecht, Thomas; Buhr, Heinz-Johannes; Kruschewski, Martin

    2009-09-15

    open repair was reduced from 8.5% to 3.7% (p = 0.414). In conclusion, by risk-adjusted selection of treatment and frequent application of EVAR, it is possible to improve perioperative outcome of elective AAA repair at a low-volume hospital. Mortality figures are similar to those of recent trials at high-volume centers, as reported in the literature.

  17. Physicians lead the way at America's top hospitals.

    PubMed

    Weber, D O

    2001-01-01

    The 100 Top hospitals are selected annually based on seven critical parameters for each of the 6,200-plus U.S. hospitals with 25 or more beds. They include the previous year's risk-adjusted patient mortality and complication rates, severity-adjusted average patient lengths of stay, expenses, profitability, proportional outpatient revenue, and asset turnover ratio (a measure of facility and technological pace-keeping ability). The winners are selected from five comparable size groupings--small, medium, large community, teaching, and large academic hospitals. Conspicuous among the winners at every level are physician-led organizations. Even in the majority of hospitals headed by non-physician administrators, however, the managerial capabilities of medical directors are the key to success. The most common characteristic of these award-winning hospitals is that the leadership is working together and communicating the institution's goals effectively to all levels of the organization. PMID:11387891

  18. Associations of hospital characteristics with nosocomial pneumonia after cardiac surgery can impact on standardized infection rates.

    PubMed

    Sanagou, M; Leder, K; Cheng, A C; Pilcher, D; Reid, C M; Wolfe, R

    2016-04-01

    To identify hospital-level factors associated with post-cardiac surgical pneumonia for assessing their impact on standardized infection rates (SIRs), we studied 43 691 patients in a cardiac surgery registry (2001-2011) in 16 hospitals. In a logistic regression model for pneumonia following cardiac surgery, associations with hospital characteristics were quantified with adjustment for patient characteristics while allowing for clustering of patients by hospital. Pneumonia rates varied from 0·7% to 12·4% across hospitals. Seventy percent of variability in the pneumonia rate was attributable to differences in hospitals in their long-term rates with the remainder attributable to within-hospital differences in rates over time. After adjusting for patient characteristics, the pneumonia rate was found to be higher in hospitals with more registered nurses (RNs)/100 intensive-care unit (ICU) admissions [adjusted odds ratio (aOR) 1·2, P = 0·006] and more RNs/available ICU beds (aOR 1·4, P < 0·001). Other hospital characteristics had no significant association with pneumonia. SIRs calculated on the basis of patient characteristics alone differed substantially from the same rates calculated on the basis of patient characteristics and the hospital characteristic of RNs/100 ICU admissions. Since SIRs using patient case-mix information are important for comparing rates between hospitals, the additional allowance for hospital characteristics can impact significantly on how hospitals compare. PMID:26449769

  19. Bed bugs.

    PubMed

    Foulke, Galen T; Anderson, Bryan E

    2014-09-01

    The term bed bug is applied to 2 species of genus Cimex: lectularius describes the common or temperate bed bug, and hemipterus its tropical cousin. Cimex lectularius is aptly named; its genus and species derive from the Latin words for bug and bed, respectively. Though the tiny pest is receiving increased public attention and scrutiny, the bed bug is hardly a new problem. PMID:25577850

  20. 21 CFR 880.6070 - Bed board.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bed board. 880.6070 Section 880.6070 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Miscellaneous Devices § 880.6070 Bed board. (a) Identification. A...

  1. 21 CFR 880.6060 - Medical disposable bedding.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Medical disposable bedding. 880.6060 Section 880...) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Miscellaneous Devices § 880.6060 Medical disposable bedding. (a) Identification. Medical disposable bedding is a...

  2. 21 CFR 892.1350 - Nuclear scanning bed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nuclear scanning bed. 892.1350 Section 892.1350...) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1350 Nuclear scanning bed. (a) Identification. A nuclear scanning bed is an adjustable bed intended to support a patient during a nuclear...

  3. 21 CFR 892.1350 - Nuclear scanning bed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nuclear scanning bed. 892.1350 Section 892.1350...) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1350 Nuclear scanning bed. (a) Identification. A nuclear scanning bed is an adjustable bed intended to support a patient during a nuclear...

  4. Effect of the Diagnosis of Inflammatory Bowel Disease on Risk-Adjusted Mortality in Hospitalized Patients with Acute Myocardial Infarction, Congestive Heart Failure and Pneumonia

    PubMed Central

    Ehrenpreis, Eli D.; Zhou, Ying; Alexoff, Aimee; Melitas, Constantine

    2016-01-01

    Introduction Measurement of mortality in patients with acute myocardial infarction (AMI), congestive heart failure (CHF) and pneumonia (PN) is a high priority since these are common reasons for hospitalization. However, mortality in patients with inflammatory bowel disease (IBD) that are hospitalized for these common medical conditions is unknown. Methods A retrospective review of the 2005–2011 National Inpatient Sample (NIS), (approximately a 20% sample of discharges from community hospitals) was performed. A dataset for all patients with ICD-9-CM codes for primary diagnosis of acute myocardial infarction, pneumonia or congestive heart failure with a co-diagnosis of IBD, Crohn’s disease (CD) or ulcerative colitis (UC). 1:3 propensity score matching between patients with co-diagnosed disease vs. controls was performed. Continuous variables were compared between IBD and controls. Categorical variables were reported as frequency (percentage) and analyzed by Chi-square tests or Fisher’s exact test for co-diagnosed disease vs. control comparisons. Propensity scores were computed through multivariable logistic regression accounting for demographic and hospital factors. In-hospital mortality between the groups was compared. Results Patients with IBD, CD and UC had improved survival after AMI compared to controls. 94/2280 (4.1%) of patients with IBD and AMI died, compared to 251/5460 (5.5%) of controls, p = 0.01. This represents a 25% improved survival in IBD patients that were hospitalized with AMI. There was a 34% improved survival in patients with CD and AMI. There was a trend toward worsening survival in patients with IBD and CHF. Patients with CD and PN had improved survival compared to controls. 87/3362 (2.59%) patients with CD and PN died, compared to 428/10076 (4.25%) of controls, p < .0001. This represents a 39% improved survival in patients with CD that are hospitalized for PN. Conclusion IBD confers a survival benefit for patients hospitalized with AMI. A

  5. Poverty, race, and hospitalization for childhood asthma.

    PubMed Central

    Wissow, L S; Gittelsohn, A M; Szklo, M; Starfield, B; Mussman, M

    1988-01-01

    This study uses Maryland hospital discharge data for the period 1979-82 to determine whether Black children are more likely to be hospitalized for asthma and whether this difference persists after adjustment for poverty. The average annual asthma discharge rate was 1.95/1000 children aged 1-19; 3.75/1000 for Black children, and 1.25/1000 for White. Medicaid-enrolled children of both races had increased discharge rates for asthma compared to those whose care was paid for by other sources: 5.68/1000 vs 2.99/1000 for Blacks, and 3.10/1000 vs 1.11/1000 for Whites. When ecologic analyses were performed, populations of Black and White children had nearly equal asthma discharge rates after adjustment for poverty. The statewide adjusted rate was 2.70/1000 (95% CL = 1.93, 3.78) for Black children and 2.10/1000 (1.66, 2.66) for White children. Among Maryland counties and health planning districts, variation in asthma discharge rates was not associated with the supply of hospital beds or the population to primary-care physician ratio. We conclude that Black children are at increased risk of hospitalization for asthma, but that some or all of this increase is related to poverty rather than to race. PMID:3381951

  6. A profile of hospitals with leadership development programs.

    PubMed

    Thompson, Jon M; Kim, Tae Hyun

    2013-01-01

    Community hospitals face increasing organizational and environmental complexities that challenge effective leadership. Hospitals are embracing leadership development programs in efforts to ensure leadership talent. While prior literature has described the intent and availability of these programs, the characteristics and performance of hospitals having such programs and their associated market characteristics have not been fully addressed. This article identifies significant differences in organizational, operational, performance, and market factors that are associated with hospitals offering a leadership development program, compared with those hospitals lacking such a program. The authors used American Hospital Association Survey data for 2008, the Area Resource File, and Centers for Medicare & Medicaid data to identify hospitals with and without leadership development programs and analyzed the differences for a number of organizational, operational, performance, and market variables. Findings indicate that hospitals having leadership development programs were large-bed-size facilities, had not-for-profit ownership, were system affiliated, were located in metropolitan statistical areas, and were teaching affiliated facilities. These hospitals also generated higher patient discharges, had higher occupancy, and had a longer average length of stay, compared with hospitals without such programs. In addition, these hospitals had higher net patient revenue per adjusted discharge and higher total profit margins relative to the comparison group. PMID:23629041

  7. Use of a Sampling Area-Adjusted Adenosine Triphosphate Bioluminescence Assay Based on Digital Image Quantification to Assess the Cleanliness of Hospital Surfaces.

    PubMed

    Ho, Yu-Huai; Wang, Lih-Shinn; Jiang, Hui-Li; Chang, Chih-Hui; Hsieh, Chia-Jung; Chang, Dan-Chi; Tu, Hsin-Yu; Chiu, Tan-Yun; Chao, Huei-Jen; Tseng, Chun-Chieh

    2016-01-01

    Contaminated surfaces play an important role in the transmission of pathogens. We sought to establish a criterion that could indicate "cleanliness" using a sampling area-adjusted adenosine triphosphate (ATP) assay. In the first phase of the study, target surfaces were selected for swab sampling before and after daily cleaning; then, an aerobic colony count (ACC) plate assay of bacteria and antibiotic-resistant bacteria was conducted. ATP swabs were also tested, and the ATP readings were reported as relative light units (RLUs). The results of the ACC and ATP assays were adjusted according to the sampling area. During the second phase of the study, a new cleaning process employing sodium dichloroisocyanurate (NaDCC) was implemented for comparison. Using the criterion of 2.5 colony-forming units (CFU)/cm², 45% of the sampled sites were successfully cleaned during phase one of the study. During phase two, the pass rates of the surface samples (64%) were significantly improved, except under stringent (5 RLU/cm²) and lax (500 RLU) ATP criteria. Using receiver-operating characteristic curve analysis, the best cut-off point for an area-adjusted ATP level was 7.34 RLU/cm², which corresponded to culture-assay levels of <2.5 CFU/cm². An area adjustment of the ATP assay improved the degree of correlation with the ACC-assay results from weak to moderate. PMID:27294944

  8. Use of a Sampling Area-Adjusted Adenosine Triphosphate Bioluminescence Assay Based on Digital Image Quantification to Assess the Cleanliness of Hospital Surfaces

    PubMed Central

    Ho, Yu-Huai; Wang, Lih-Shinn; Jiang, Hui-Li; Chang, Chih-Hui; Hsieh, Chia-Jung; Chang, Dan-Chi; Tu, Hsin-Yu; Chiu, Tan-Yun; Chao, Huei-Jen; Tseng, Chun-Chieh

    2016-01-01

    Contaminated surfaces play an important role in the transmission of pathogens. We sought to establish a criterion that could indicate “cleanliness” using a sampling area–adjusted adenosine triphosphate (ATP) assay. In the first phase of the study, target surfaces were selected for swab sampling before and after daily cleaning; then, an aerobic colony count (ACC) plate assay of bacteria and antibiotic-resistant bacteria was conducted. ATP swabs were also tested, and the ATP readings were reported as relative light units (RLUs). The results of the ACC and ATP assays were adjusted according to the sampling area. During the second phase of the study, a new cleaning process employing sodium dichloroisocyanurate (NaDCC) was implemented for comparison. Using the criterion of 2.5 colony-forming units (CFU)/cm2, 45% of the sampled sites were successfully cleaned during phase one of the study. During phase two, the pass rates of the surface samples (64%) were significantly improved, except under stringent (5 RLU/cm2) and lax (500 RLU) ATP criteria. Using receiver-operating characteristic curve analysis, the best cut-off point for an area-adjusted ATP level was 7.34 RLU/cm2, which corresponded to culture-assay levels of <2.5 CFU/cm2. An area adjustment of the ATP assay improved the degree of correlation with the ACC-assay results from weak to moderate. PMID:27294944

  9. Penrose's law revisited: the relationship between mental institution beds, prison population and crime rate.

    PubMed

    Hartvig, Pål; Kjelsberg, Ellen

    2009-01-01

    In 1939, Lionel Penrose published a cross-sectional study from 18 European countries, including the Nordic, in which he demonstrated an inverse relationship between the number of mental hospital beds and the number of prisoners. He also found strong negative correlations between the number of mental hospital beds and the number of deaths attributed to murder. He argued that by increasing the number of mental institution beds, a society could reduce serious crimes and imprisonment rates. The aim of the study was to test Penrose's theories longitudinally by monitoring the capacity of all psychiatric institutions and prisons in a society over time. From official statistics, we collected and systematized all relevant information regarding the number of mental institution beds and prisoners in Norway during the years 1930-2004, along with major crime statistics for the same period. During the years 1930-59, there was a 2% population-adjusted increase in mental institution beds and a 30% decrease in the prison population. During 1960-2004, there was a 74% population-adjusted decrease in mental institution beds and a 52% increase in the prison population. The same period saw a 500% increase in overall crime and a 900% increase in violent crimes, with a concurrent 94% increase in the size of the country's police force. Penrose's law proved remarkably robust in the longitudinal perspective. As opposed to Penrose, however, we argue that the rise in crime rates only to a very limited extent can be attributed to mental health de-institutionalization. PMID:18985517

  10. Hospital Library Development. Hospital Library Handbooks No. 2.

    ERIC Educational Resources Information Center

    Cramer, Anne

    Addressed to the administrator of the hospital as well as the librarian, this handbook covers aspects of library service policy and long-range planning. While hospitals of all sizes are discussed, a special effort is made to cover problems of small hospitals (17 to 100 beds) in sparsely-settled regions. Contents: The library as a clinical service,…

  11. Adjustment disorder

    MedlinePlus

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, Va: American Psychiatric Publishing. 2013. Powell AD. Grief, bereavement, and adjustment disorders. In: Stern TA, Rosenbaum ...

  12. Delayed transfer of care from NHS secondary care to primary care in England: its determinants, effect on hospital bed days, prevalence of acute medical conditions and deaths during delay, in older adults aged 65 years and over

    PubMed Central

    Jasinarachchi, Krishantha H; Ibrahim, Ibrahim R; Keegan, Breffni C; Mathialagan, Rajaratnam; McGourty, John C; Phillips, James RN; Myint, Phyo K

    2009-01-01

    Background The delay in discharge or transfer of care back to the community following an acute admission to the hospital in older adults has long been a recognized challenge in the UK. We examined the determinants and outcomes of delayed transfer of care in older adults. Methods A prospective observational study was conducted in a district general hospital with a catchment population of 250,000 in England, UK. Those >= 65 years admitted to two care of the elderly wards during February 2007 were identified and prospectively followed-up till their discharge. Data was presented descriptively. Results 36.7% (58/158) of patients had a delay in transfer of care. They tended to be older, had poorer pre-morbid mobility, and were more likely to be confused at the time of admission. Compared to the 2003 National Audit Report, a significantly higher percentage (29.3%vs.17%) awaited therapist assessments or (27.6%vs.9%) domiciliary care, with a lower percentage (< 1%vs.14%) awaiting further NHS care. Of 18 in-patient deaths, five occurred during the delay. Seven patients developed medical conditions during the delay making them unfit for discharge. The number of extra bed days attributable to delayed discharges in this study was 682 (mean = 4.8) days. Conclusion Awaiting therapy and domiciliary care input were significant contributing factors in delayed transfer of care. Similar local assessments could provide valuable information in identifying areas for improvement. Based on available current evidence, efficacy driven changes to the organisation and provision of support, for example rapid response delayed discharge services at the time of "fit to discharge" may help to improve the situation. PMID:19161614

  13. Bed Bugs FAQs

    MedlinePlus

    ... Tropical Diseases Laboratory Diagnostic Assistance [DPDx] Parasites Home Bed Bugs FAQs Recommend on Facebook Tweet Share Compartir On ... are bed bugs treated and prevented? What are bed bugs? Bed bugs ( Cimex lectularius ) are small, flat, parasitic ...

  14. An Analysis of Organizational Performance Based on Hospital Specialization Level and Strategy Type

    PubMed Central

    Kim, Han-Sung; Kim, Young-Hoon; Woo, Jung-Sik; Hyun, Sook-Jung

    2015-01-01

    Introduction Hospitals are studying the focused factory concept and attempting to increase their power in a competitive industry by becoming more specialized. Methodology This study uses the information theory index (ITI) and the Herfindahl-Hirschman index (HHI) to analyze the extent of specialization by Korean hospitals that receive national health insurance reimbursements. Hierarchical regression analysis is used to assess the impact of hospital specialization on the following four aspects of operational performance: productivity, profitability, efficiency and quality of care. Study Results The results show that a focused strategy (high HHI) improves the income and adjusted number of patients per specialist through the efficient utilization of human resources. However, a diversified strategy (high ITI) improves the hospital utilization ratio, income per bed and adjusted number of patients per bed (controlling for material resources such as beds). In addition, as the concentration index increases, case-mix mortality rates and referral rates decrease, indicating that specialization has a positive relationship with quality of care. PMID:26218570

  15. Adjustable microforceps.

    PubMed

    Bao, J Y

    1991-04-01

    The commonly used microforceps have a much greater opening distance and spring resistance than needed. A piece of plastic ring or rubber band can be used to adjust the opening distance and reduce most of the spring resistance, making the user feel more comfortable and less fatigued. PMID:2051437

  16. 42 CFR 419.43 - Adjustments to national program payment and beneficiary copayment amounts.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) Payment adjustment for certain cancer hospitals.—(1) General rule. CMS provides for a payment adjustment... (PCR) before the cancer hospital payment adjustment (as determined by the Secretary at cost report...-cost ratio (PCR) before the cancer hospital payment adjustment (as determined by the Secretary at...

  17. 42 CFR 419.43 - Adjustments to national program payment and beneficiary copayment amounts.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) Payment adjustment for certain cancer hospitals.—(1) General rule. CMS provides for a payment adjustment... (PCR) before the cancer hospital payment adjustment (as determined by the Secretary at cost report...-cost ratio (PCR) before the cancer hospital payment adjustment (as determined by the Secretary at...

  18. Shaft adjuster

    DOEpatents

    Harry, Herbert H.

    1989-01-01

    Apparatus and method for the adjustment and alignment of shafts in high power devices. A plurality of adjacent rotatable angled cylinders are positioned between a base and the shaft to be aligned which when rotated introduce an axial offset. The apparatus is electrically conductive and constructed of a structurally rigid material. The angled cylinders allow the shaft such as the center conductor in a pulse line machine to be offset in any desired alignment position within the range of the apparatus.

  19. Packed Bed Reactor Experiment

    NASA Video Gallery

    The purpose of the Packed Bed Reactor Experiment in low gravity is to determine how a mixture of gas and liquid flows through a packed bed in reduced gravity. A packed bed consists of a metal pipe ...

  20. Origin of hysteresis in bed form response to unsteady flows

    NASA Astrophysics Data System (ADS)

    Martin, Raleigh L.; Jerolmack, Douglas J.

    2013-03-01

    Field and laboratory studies indicate that changes in riverbed morphology often lag changes in water discharge. This lagged response produces hysteresis in the relationship between water discharge and bed form geometry. To understand these phenomena, we performed flume experiments to observe the response of a sand bed to step increases and decreases in water discharge. For an abrupt rise in discharge, we observed that bed forms grew rapidly by collision and merger of bed forms migrating with different celerities. Growth rate slowed as bed forms approached equilibrium with the higher discharge regime. After an abrupt discharge drop, bed form decay occurred through formation of smaller secondary bed forms, in equilibrium with the lower discharge, which cannibalized the original, relict features. We present a simple model framework to quantitatively predict time scales of bed form adjustment to flow changes, based on equilibrium bed form heights, lengths, and celerities at low and high flows. For rising discharge, the model assumes that all bed form collisions result in irreversible merger, due to a dispersion of initial celerities. For falling discharge, we derive a diffusion model for the decay of relict high-stage features. Our models predict the form and time scale of experimental bed form adjustments. Additional experiments applying slow and fast triangular flood waves show that bed form hysteresis occurs only when the time scale of flow change is faster than the modeled (and measured) bed form adjustment time. We show that our predicted adjustment time scales can also be used to predict the occurrence of bed form hysteresis in natural floods.

  1. Increasing ICU bed capacity cuts diversions.

    PubMed

    2006-09-01

    A new study demonstrates a real dollar cost to diversions, which can give ED managers added ammunition when lobbying administration for increased bed capacity hospitalwide. Here are some strategies you can use: Point out the demonstrated link between increased bed capacity in the intensive care unit and reduced diversions. Emphasize the fact that when patients are boarded, staff morale is negatively affected. Because your ED may represent 30% of your hospital's volume, note the connection between improved flow and patient satisfaction. PMID:16981481

  2. The distance to community medical care and the likelihood of hospitalization: is closer always better?

    PubMed Central

    Goodman, D C; Fisher, E; Stukel, T A; Chang, C

    1997-01-01

    OBJECTIVES: This study examined the influence that distance from residence to the nearest hospital had on the likelihood of hospitalization and mortality. METHODS: Hospitalizations were studied for Maine. New Hampshire, and Vermont during 1989 (adults) and for 1985 through 1989 (children) and for mortality (1989) in Medicare enrollees. RESULTS: After other known predictors of hospitalization (age, sex, bed supply, median household income, rural residence, academic medical center, and presence of nursing home patients) were controlled for, the adjusted rate ratio of medical hospitalization for residents living more than 30 minutes away was 0.85 (95% confidence interval [CI] = 0.82, 0.88) for adults and 0.78 (95% CI = 0.74, 0.81) for children, compared with those living in a zip code with a hospital. Similar effects were seen for the four most common diagnosis-related groups for both adults and children. The likelihood of hospitalization for conditions usually requiring hospitalization and for mortality in the elderly did not differ by distance. CONCLUSIONS: Distance to the hospital exerts an important influence on hospitalization rates that is unlikely to be explained by illness rates. PMID:9240104

  3. Using HL7 in hospital staff assignments.

    PubMed

    Unluturk, Mehmet S

    2014-02-01

    Hospital staff assignments are the instructions that allocate the hospital staff members to the hospital beds. Currently, hospital administrators make the assignments without accessing the information regarding the occupancy of the hospital beds and the acuity of the patient. As a result, administrators cannot distinguish between occupied and unoccupied beds, and may therefore assign staff to unoccupied beds. This gives rise to uneven and inefficient staff assignments. In this paper, the hospital admission-discharge-transfer (ADT) system is employed both as a data source and an assignment device to create staff assignments. When the patient data is newly added or modified, the ADT system updates the assignment software client with the relevant data. Based on the relevant data, the assignment software client is able to construct staff assignments in a more efficient way. PMID:24480165

  4. Determinants of hospital utilization in the Netherlands.

    PubMed

    van der Gaag, J; Rutten, F F; van Praag, B M

    1975-01-01

    Hospital use in the Netherlands is examined in a cross-section analysis of 1969 and 1971 data for 120 service regions. Elasticities of admissions with respect to bed supply and supply of general practitioners are calculated, and the substitutability of first level care (by general practitioners) for hospital care is considered. Substitution effects found indicate that the Dutch government's plan to reduce the ratio of hospital beds to population is feasible. PMID:1225868

  5. Hospital Waste Management in Nonteaching Hospitals of Lucknow City, India

    PubMed Central

    Manar, Manish Kumar; Sahu, Krishna Kumar; Singh, Shivendra Kumar

    2014-01-01

    Objective: To assess hospital waste management in nonteaching hospitals of Lucknow city. Materials and Methods: A cross-sectional, descriptive study was conducted on the staffs of nonteaching hospitals of Lucknow from September 2012 to March 2013. A total of eight hospitals were chosen as the study sample size. Simple random sampling technique was used for the selection of the nonteaching hospitals. A pre-structured and pre-tested interview questionnaire was used to collect necessary information regarding the hospitals and biomedical waste (BMW) management of the hospitals. The general information about the selected hospitals/employees of the hospitals was collected. Results: Mean hospital waste generated in the eight nonteaching hospitals of Lucknow was 0.56 kg/bed/day. About 50.5% of the hospitals did not have BMW department and colored dustbins. In 37.5% of the hospitals, there were no BMW records and segregation at source. Incinerator was used only by hospital A for treatment of BMW. Hospital G and hospital H had no facilities for BMW treatment. Conclusion: There is a need for appropriate training of staffs, strict implementation of rules, and continuous surveillance of the hospitals of Lucknow to improve the BMW management and handling practices. PMID:25657950

  6. 42 CFR 424.13 - Requirements for inpatient services of hospitals other than psychiatric hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... hospitalization when a SNF bed is not available. (1) A physician may certify or recertify need for continued hospitalization if the physician finds that the patient could receive proper treatment in a SNF but no bed is available in a participating SNF. (2) If this is the basis for the physician's certification...

  7. Union Density and Hospital Outcomes.

    PubMed

    Koys, Daniel J; Martin, Wm Marty; LaVan, Helen; Katz, Marsha

    2015-01-01

    The authors address the hospital outcomes of patient satisfaction, healthcare quality, and net income per bed. They define union density as the percentage of a hospital's employees who are in unions, healthcare quality as its 30-day acute myocardial infraction (AMI; heart attack) mortality rate, and patient satisfaction as its overall Hospital Consumer Assessment of Healthcare Providers and Systems score. Using a random sample of 84 union and 84 nonunion hospitals from across the United States, multiple regression analyses show that union density is negatively related to patient satisfaction. Union density is not related to healthcare quality as measured by the AMI mortality rate or to net income per bed. This implies that unions per se are not good or bad for hospitals. The authors suggest that it is better for hospital administrators to take a Balanced Scorecard approach and be concerned about employee satisfaction, patient satisfaction, healthcare quality, and net income. PMID:26652043

  8. Supporting Calculations For Submerged Bed Scrubber Condensate Disposal Preconceptual Study

    SciTech Connect

    Pajunen, A. J.; Tedeschi, A. R.

    2012-09-18

    This document provides supporting calculations for the preparation of the Submerged Bed Scrubber Condensate Disposal Preconceptual Study report The supporting calculations include equipment sizing, Hazard Category determination, and LAW Melter Decontamination Factor Adjustments.

  9. 7 CFR 3201.15 - Bedding, bed linens, and towels.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 15 2012-01-01 2012-01-01 false Bedding, bed linens, and towels. 3201.15 Section 3201... PROCUREMENT Designated Items § 3201.15 Bedding, bed linens, and towels. (a) Definition. (1) Bedding is that..., bedspreads, comforters, and quilts. (2) Bed linens are woven cloth sheets and pillowcases used in bedding....

  10. 7 CFR 3201.15 - Bedding, bed linens, and towels.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 15 2013-01-01 2013-01-01 false Bedding, bed linens, and towels. 3201.15 Section 3201... PROCUREMENT Designated Items § 3201.15 Bedding, bed linens, and towels. (a) Definition. (1) Bedding is that..., bedspreads, comforters, and quilts. (2) Bed linens are woven cloth sheets and pillowcases used in bedding....

  11. 7 CFR 2902.15 - Bedding, bed linens, and towels.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Bedding, bed linens, and towels. 2902.15 Section 2902... PROCUREMENT Designated Items § 2902.15 Bedding, bed linens, and towels. (a) Definition. (1) Bedding is that..., bedspreads, comforters, and quilts. (2) Bed linens are woven cloth sheets and pillowcases used in bedding....

  12. 7 CFR 2902.15 - Bedding, bed linens, and towels.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 15 2011-01-01 2011-01-01 false Bedding, bed linens, and towels. 2902.15 Section 2902... PROCUREMENT Designated Items § 2902.15 Bedding, bed linens, and towels. (a) Definition. (1) Bedding is that..., bedspreads, comforters, and quilts. (2) Bed linens are woven cloth sheets and pillowcases used in bedding....

  13. 7 CFR 3201.15 - Bedding, bed linens, and towels.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Bedding, bed linens, and towels. 3201.15 Section 3201... PROCUREMENT Designated Items § 3201.15 Bedding, bed linens, and towels. (a) Definition. (1) Bedding is that..., bedspreads, comforters, and quilts. (2) Bed linens are woven cloth sheets and pillowcases used in bedding....

  14. Sorbent-Bed Crop-Drying System

    NASA Technical Reports Server (NTRS)

    Roberts, Barry C.

    1992-01-01

    Proposed aeration system helps reduce spoilage of stored grain or other crop stored in bulk. Air circulates through bin, sorbent bed, and heat exchanger. Outside air cools circulating air in heat exchanger. Sensors measure temperature and humidity, and adjust dampers to obtain requisite temperature and humidity. Suitable for grain bins and shipping barges.

  15. Control of a Circulating Fluidized Bed

    SciTech Connect

    Shim, Hoowang; Rickards, Gretchen; Famouri, Parviz; Turton, Richard; Sams, W. Neal; Koduro, Praveen; Patankar, Amol; Davari, Assad; Lawson, Larry; Boyle, Edward J.

    2001-11-06

    Two methods for optimally controlling the operation of a circulating fluidized bed are being investigated, neural network control and Kalman filter control. The neural network controls the solids circulation rate by adjusting the flow of move air in the non-mechanical valve. Presented is the method of training the neural network from data generated by the circulating fluidized bed (CFB), the results of a sensitivity study indicating that adjusting the move air can control solids flow, and the results of controlling solids circulation rate. The Kalman filter approach uses a dynamic model and a measurement model of the standpipe section of the CFB. Presented are results showing that a Kalman filter can successfully find the standpipe bed height.

  16. 42 CFR 419.43 - Adjustments to national program payment and beneficiary copayment amounts.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... corresponding calendar year. (2) Limitation. Any reduction to a hospital's adjustment to its conversion factor... hospital outpatient department services and determines a wage adjustment factor to adjust the portion of... index factor.—(1) CMS uses the hospital inpatient prospective payment system wage index established...

  17. Hospital financial position and the adoption of electronic health records.

    PubMed

    Ginn, Gregory O; Shen, Jay J; Moseley, Charles B

    2011-01-01

    The objective of this study was to examine the relationship between financial position and adoption of electronic health records (EHRs) in 2442 acute care hospitals. The study was cross-sectional and utilized a general linear mixed model with the multinomial distribution specification for data analysis. We verified the results by also running a multinomial logistic regression model. To measure our variables, we used data from (1) the 2007 American Hospital Association (AHA) electronic health record implementation survey, (2) the 2006 Centers for Medicare and Medicaid Cost Reports, and (3) the 2006 AHA Annual Survey containing organizational and operational data. Our dependent variable was an ordinal variable with three levels used to indicate the extent of EHR adoption by hospitals. Our independent variables were five financial ratios: (1) net days revenue in accounts receivable, (2) total margin, (3) the equity multiplier, (4) total asset turnover, and (5) the ratio of total payroll to total expenses. For control variables, we used (1) bed size, (2) ownership type, (3) teaching affiliation, (4) system membership, (5) network participation, (6) fulltime equivalent nurses per adjusted average daily census, (7) average daily census per staffed bed, (8) Medicare patients percentage, (9) Medicaid patients percentage, (10) capitation-based reimbursement, and (11) nonconcentrated market. Only liquidity was significant and positively associated with EHR adoption. Asset turnover ratio was significant but, unexpectedly, was negatively associated with EHR adoption. However, many control variables, most notably bed size, showed significant positive associations with EHR adoption. Thus, it seems that hospitals adopt EHRs as a strategic move to better align themselves with their environment. PMID:21991681

  18. Future looks bleak for many Ontario hospitals

    PubMed Central

    Gray, Charlotte

    1995-01-01

    Ontario will soon begin to experience some of the hospital closures that are already well known in many other provinces. A recent report called for the closure of 12 hospitals in Metropolitan Toronto and a 13% cut in the number of hospital beds. Strong campaigns against some of the proposed closures are already being mounted.

  19. Hybrid fluidized bed combuster

    DOEpatents

    Kantesaria, Prabhudas P.; Matthews, Francis T.

    1982-01-01

    A first atmospheric bubbling fluidized bed furnace is combined with a second turbulent, circulating fluidized bed furnace to produce heat efficiently from crushed solid fuel. The bed of the second furnace receives the smaller sizes of crushed solid fuel, unreacted limestone from the first bed, and elutriated solids extracted from the flu gases of the first bed. The two-stage combustion of crushed solid fuel provides a system with an efficiency greater than available with use of a single furnace of a fluidized bed.

  20. 42 CFR 419.43 - Adjustments to national program payment and beneficiary copayment amounts.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) Payment adjustment for certain cancer hospitals—(1) General rule. CMS provides for a payment adjustment... (PCR) before the cancer hospital payment adjustment (as determined by the Secretary at cost report...-cost ratio (PCR) before the cancer hospital payment adjustment (as determined by the Secretary at...

  1. Bed material agglomeration during fluidized bed combustion

    SciTech Connect

    Brown, R.C.; Dawson, M.R.; Noble, S.

    1993-02-01

    The purpose of this project is to determine the physical and chemical reactions which led to the undesired agglomeration of bed material during fluidized bed combustion and to relate these reactions to specific causes. Survey of industrial-scale fluidized bed combustors is being conducted to determine the occurrence of bed agglomeration and the circumstances under which agglomeration took place. This task should be finished by the end of February. Samples of bed material, agglomerate material, and boiler deposits are being requested from boiler operators as part of the survey. Once received, these sample will be analyzed to determine chemical and mineralogic composition. The bulk chemical determination will be performed using x-ray fluorescence and inductively coupled plasma-optical emission (ICP). Mineralogy will be detected by x-ray diffraction (XRD). Chemical and mineral reactions will be determined by scanning electron microscopy, optical microscopy, and electron microprobe.

  2. Long hospital stays and need for alternate level of care at discharge. Does family make a difference for elderly patients?

    PubMed Central

    McClaran, J.; Berglas, R. T.; Franco, E. D.

    1996-01-01

    OBJECTIVE: To determine whether parental and marital status of elderly patients admitted to acute care affect the likelihood of a need for long hospital stay or alternate level of care (nursing home) at discharge. DESIGN: A 1-year descriptive study was carried out prospectively on elderly hospitalized patients. Marital status and parental status were treated as risk factors for resource use, as were sex, age, admitting service, and diagnosis. SETTING: A 672-bed university hospital. PATIENTS: We studied 495 patients aged 65 years or more sequentially admitted over a 1-year period. Excluded from study were critically ill patients, patients admitted to intensive care, and patients with whom we could not communicate on the day were considered for the study. MAIN OUTCOME MEASURES: Whether acute hospital stay exceed 44 days and need for alternate level of care at discharge. RESULTS: Many (43.4%) of the patients had no spouse and 19.4% had no children; 32.9% stayed 45 days or more and 6.9% required alternate level of care at discharge. Predictive of a long hospital stay were being without children (adjusted RR = 1.85), having a neurologic or psychiatric diagnosis (adjusted RR = 3.39), and having surgery unrelated to reason for admission (adjusted RR = 5.88). Predictive of need for alternate level of care at discharge were increasing age (adjusted RR = 1.08), having no spouse (adjusted RR = 2.59), having no children (adjusted RR = 3.27), and having a neurologic or psychiatric diagnosis (adjusted RR = 7.56). PMID:8616285

  3. Fluidized bed combustion

    SciTech Connect

    Sowards, N.K.; Murphy, M.L.

    1992-04-07

    This patent describes a method of incinerating a fuel containing difficult to remove tramp comprising wire. It comprises placing of a fluid bed within a downwardly and inwardly tapered centrally hollow air distributor disposed within a lower portion of a vessel; introducing fuel comprising combustible material and tramp comprising wire into the fluid bed; incinerating the combustible material in the fluid bed accommodating downward migration within the fluid bed of the wire without a central obstruction to such migration; in the course of performing the incinerating step, fluidizing the bed solely by introducing inwardly at several tiered locations directed air into the bed only around the tapered periphery along the lower portion of the vessel from a plurality of inwardly and downwardly parallel sites as causing the bed material and tramp to migrate downwardly and inwardly without central bed obstruction toward a discharge site.

  4. Enuresis (Bed-Wetting)

    MedlinePlus

    ... their development. Bed-wetting is more common among boys than girls. What causes bed-wetting? A number of things ... valves in boys or in the ureter in girls or boys Abnormalities in the spinal cord A small bladder ...

  5. Channel Bed Response to an Increased Sediment Supply

    NASA Astrophysics Data System (ADS)

    Podolak, C.; Wilcock, P.

    2012-12-01

    This project presents a suite of field observations, flume measurements, and numerical models investigating the response of channel beds to an increased sediment supply. When the sediment and water supply to a river reach are altered, as might happen from a dam removal, the balance between supply and transport capacity is also changed and the channel will adjust. There is a need to be able to predict these changes that may occur as a result of management actions. Monitoring the Sandy River, Oregon following removal of the Marmot Dam provides measurements of response to a five-fold sediment supply increase. Where supply increase was the greatest, bed slope became steeper and bed topography became less variable. Reaches with less aggradation responded primarily with bed surface fining. During the initial stages of deposition the bed configuration bore little resemblance to the pre-removal configuration, however, after one year, the planform regained the pre-removal pattern. In a recirculating field-scale flume with alternate bar topography, sediment supply was increased by manually augmenting the sediment supply in two steps such that the final bed transported three times as much as the initial bed. The initial and final bed topography and texture were very similar and included long stationary alternate bars. The transient bed was very different, dominated by several scales of shorter wavelength migrating bedforms. Further, the adjustment in topographic and textural patterns continued after the bed slope and mean sediment transport had approached steady state. A one-dimensional (1-D) morphodynamic model predicted steady state slope and transport rates for the flume experiments, but it over-predicted the rate of adjustment. Comparison of 1-D model results with flume observations demonstrated the importance of 2-D adjustments related to the spatial variability of topography and texture. The ensemble of field, flume, and numerical models results demonstrate four bed

  6. Time for Bed Game

    MedlinePlus

    ... a Friend Who Cuts? Babysitting: Time for Bed Game KidsHealth > For Teens > Babysitting: Time for Bed Game Print A A A Text Size What Kids ... kids to bed can be tough sometimes! This game introduces children to the concept of getting enough ...

  7. Making a Bed

    ERIC Educational Resources Information Center

    Wexler, Anthony; Stein, Sherman

    2005-01-01

    The origins of this paper lay in making beds by putting pieces of plywood on a frame: If beds need to be 4 feet 6 inches by 6 feet 3 inches, and plywood comes in 4-foot by 8-foot sheets, how should one cut the plywood to minimize waste (and have stable beds)? The problem is of course generalized.

  8. Fluidized bed quenching technology

    SciTech Connect

    Reynoldson, R.

    1996-12-31

    The use of fluidized beds for quenching ferrous materials is outlined and compared with the more traditional techniques commonly used in the heat treatment industry. The use of fluidized bed quenching to control distortion of metal parts is also discussed. A case study is provided to illustrate a practical application of fluidized bed quenching.

  9. 42 CFR 412.316 - Geographic adjustment factors.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Geographic adjustment factors. 412.316 Section 412.316 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... part. The adjustment factor equals the hospital wage index value applicable to the hospital raised...

  10. 42 CFR 412.316 - Geographic adjustment factors.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Geographic adjustment factors. 412.316 Section 412.316 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... part. The adjustment factor equals the hospital wage index value applicable to the hospital raised...

  11. 42 CFR 412.316 - Geographic adjustment factors.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Geographic adjustment factors. 412.316 Section 412.316 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... part. The adjustment factor equals the hospital wage index value applicable to the hospital raised...

  12. 42 CFR 412.316 - Geographic adjustment factors.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Geographic adjustment factors. 412.316 Section 412.316 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... part. The adjustment factor equals the hospital wage index value applicable to the hospital raised...

  13. 42 CFR 412.534 - Special payment provisions for long-term care hospitals within hospitals and satellites of long...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... hospital inpatient prospective payment system cost of living adjustment factors; (iii) Includes, where applicable, adjustments for indirect medical education costs and the costs of serving a disproportionate... inpatient prospective payment system adjustments for indirect medical education costs and the costs...

  14. Getting Rid of Bed Bugs

    MedlinePlus

    ... Bed Bugs — Do-it-yourself Bed Bug Control — Pesticides to Control Bed Bugs Bed Bug Information Clearinghouse ... Greener Living Health and Safety Land and Cleanup Pesticides Waste Water Science & Technology Air Climate Change Ecosystems ...

  15. Introduction to hospital information systems.

    PubMed

    Vegoda, P R

    1987-01-01

    The phrase, 'hospital information system', is frequently used in discussions about the flow of information throughout a hospital with the assumption that everybody has the same concept in mind. Closer examination shows that this is not necessarily the case. The author draws on his experience as the Chief Information Officer at University Hospital at Stony Brook to define a hospital information system in terms of the implementation at Stony Brook. The University Hospital Information System at University Hospital (UHIS), has received international acclaim and was recently selected by the IBM Quarterly of Australia as the world leader in hospital information systems. This paper answers four questions: What is a hospital information system? How does a hospital information system work? How do you implement a hospital information system? After the system is operational, where do you go, e.g., critical care data management, physician's office management? University Hospital at Stony Brook is located on eastern Long Island and is the tertiary care referral hospital for approximately 1.4 million people. Nothing in the hospital happens without computers. Doctors, nurses, administrators and staff at all levels rely on the system daily. The system operates 24 hours per day, seven days per week. Access to the system is through 300 terminals and 128 printers throughout the hospital. In addition to the UHIS terminals, the critical care management system which is called Patient Data Management System, (PDMS), is available at over 90 ICU beds and in the operating rooms. PMID:3585130

  16. 21 CFR 880.6060 - Medical disposable bedding.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical disposable bedding. 880.6060 Section 880.6060 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use...

  17. Unit Cost of Medical Services at Different Hospitals in India

    PubMed Central

    Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

    2013-01-01

    Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates

  18. Racial Differences in Length of Stay for Patients Who Leave Against Medical Advice from U.S. General Hospitals.

    PubMed

    Tawk, Rima; Dutton, Matthew

    2016-01-01

    There is a paucity of published literature on the length of hospital stays (LOS) for patients who leave against medical advice (AMA) and on the factors that predict their LOS. The purpose of the study is to examine the relationship between race and the LOS for AMA patients after adjusting for patient and hospital characteristics. National Hospital Discharge Survey (NHDS) data were used to describe LOS for AMA patients aged 18 years or older. Patient characteristics included age, sex, race, marital status, insurance, and diagnosis (ICD-9-CM). Hospital characteristics consisted of ownership, region and bed size. LOS was the major outcome measure. Using data from all years 1988-2006, the expected time to AMA discharge was first examined as a function of race, then adjusting for year terms, patient and hospital characteristics, and major medical diagnoses and mental illness. The unadjusted effect of race on the expected time of leaving AMA was about twice the adjusted effect. After controlling for the other covariates, the expected time to AMA discharge is 20% shorter for Blacks than Whites. The most significant predictors included age, insurance coverage, mental illness, gender, and region. Factors identified in this study offer insights into directions for evidence based- health policy to reduce AMA discharges. PMID:26729149

  19. Racial Differences in Length of Stay for Patients Who Leave Against Medical Advice from U.S. General Hospitals

    PubMed Central

    Tawk, Rima; Dutton, Matthew

    2015-01-01

    There is a paucity of published literature on the length of hospital stays (LOS) for patients who leave against medical advice (AMA) and on the factors that predict their LOS. The purpose of the study is to examine the relationship between race and the LOS for AMA patients after adjusting for patient and hospital characteristics. National Hospital Discharge Survey (NHDS) data were used to describe LOS for AMA patients aged 18 years or older. Patient characteristics included age, sex, race, marital status, insurance, and diagnosis (ICD-9-CM). Hospital characteristics consisted of ownership, region and bed size. LOS was the major outcome measure. Using data from all years 1988–2006, the expected time to AMA discharge was first examined as a function of race, then adjusting for year terms, patient and hospital characteristics, and major medical diagnoses and mental illness. The unadjusted effect of race on the expected time of leaving AMA was about twice the adjusted effect. After controlling for the other covariates, the expected time to AMA discharge is 20% shorter for Blacks than Whites. The most significant predictors included age, insurance coverage, mental illness, gender, and region. Factors identified in this study offer insights into directions for evidence based- health policy to reduce AMA discharges. PMID:26729149

  20. Assessing the operating efficiencies of teaching hospitals by an enhancement of the AHA/AAMC method. American Hospital Association/Association of American Medical Colleges.

    PubMed

    Morey, R C; Retzlaff-Roberts, D L; Fine, D J; Loree, S W

    2000-01-01

    In the ongoing effort to control costs, comparisons among hospitals' efficiency levels, if valid, can help identify "best practices" across institutions and uncover situations that need corrective intervention. The authors present an extension of the "adjusted cost per equivalent discharge" approach, which incorporates case-mix-severity differences, regional labor cost differentials, and inpatient/outpatient mix, but does not take into account such factors as the differences in hospital sizes, extents of the teaching mission, or quality of care delivered. The alternative approach yields information that suggests where an institution's total operating costs might be reduced with no change in any of the hospital's outputs or operating environment, through comparison with a "peer group" of other hospitals, matched according to the subject hospital's number of beds, the quality of care the hospital delivers, the extent of medical education carried out, the level of case-mix-adjusted discharges, and outpatient activities. A difficulty with this approach (as with others) is that measurement of some of the additional facets (e.g., quality of care) is still evolving, so its main contribution at this time is to provide a construct and method capable of incorporating these important added considerations. Hospital rankings achieved by applying the current and alternative approaches to a real set of teaching hospitals operating in FY 1987 are compared. While the rankings produced by the two approaches are loosely similar, the authors show that some significant differences do appear and can be at least partially explained by the incorporation of the additional factors mentioned above. PMID:10667873

  1. Burning waste with FBC. [Fluidized Bed Combustion

    SciTech Connect

    Salaff, S.

    1991-11-01

    This article examines fluidized bed combustion as a method of choice for disposing for waste economically and within the bounds of rigid environmental standards. The topics discussed in the article include technology scaleup, wood and fossil wastes, municipal and hospital wastes, fuel flexibility, and a sidebar on the fluidized bed combustion technology. The waste fuels of major interest are various low grade liquid and solid residues from the coal, oil, forest products and automotive industries, as well as post-harvest biomass and municipal refuse.

  2. Fluidized bed combustor modeling

    NASA Technical Reports Server (NTRS)

    Horio, M.; Rengarajan, P.; Krishnan, R.; Wen, C. Y.

    1977-01-01

    A general mathematical model for the prediction of performance of a fluidized bed coal combustor (FBC) is developed. The basic elements of the model consist of: (1) hydrodynamics of gas and solids in the combustor; (2) description of gas and solids contacting pattern; (3) kinetics of combustion; and (4) absorption of SO2 by limestone in the bed. The model is capable of calculating the combustion efficiency, axial bed temperature profile, carbon hold-up in the bed, oxygen and SO2 concentrations in the bubble and emulsion phases, sulfur retention efficiency and particulate carry over by elutriation. The effects of bed geometry, excess air, location of heat transfer coils in the bed, calcium to sulfur ratio in the feeds, etc. are examined. The calculated results are compared with experimental data. Agreement between the calculated results and the observed data are satisfactory in most cases. Recommendations to enhance the accuracy of prediction of the model are suggested.

  3. Fluidized bed combustion

    SciTech Connect

    Sowards, N.K.; Murphy, M.L.

    1991-10-29

    This patent describes a vessel. It comprises a fluid bed for continuously incinerating fuel comprising tire segments and the like which comprise metallic wire tramp and for concurrently removing tramp and bed materials at a bottom effluent exit means of the vessel, the vessel further comprising static air distributor means at the periphery of the bed comprising a substantially centrally unobstructed relatively large central region in which the fluid bed and fuel only are disposed and through which bed material and tramp migrate without obstruction to and through the effluent exit means, downwardly and inwardly stepped lower vessel wall means and a plurality of peripherally located centrally directed vertically and horizontally offset spaced air influent means surrounding the central region and associated with the stepped lower vessel wall means by which the bed is supported and fluidized.

  4. The trade-off between hospital cost and quality of care. An exploratory empirical analysis.

    PubMed

    Morey, R C; Fine, D J; Loree, S W; Retzlaff-Roberts, D L; Tsubakitani, S

    1992-08-01

    The debate concerning quality of care in hospitals, its "value" and affordability, is increasingly of concern to providers, consumers, and purchasers in the United States and elsewhere. We undertook an exploratory study to estimate the impact on hospital-wide costs if quality-of-care levels were varied. To do so, we obtained costs and service output data regarding 300 U.S. hospitals, representing approximately a 5% cross section of all hospitals operating in 1983; both inpatient and outpatient services were included. The quality-of-care measure used for the exploratory analysis was the ratio of actual deaths in the hospital for the year in question to the forecasted number of deaths for the hospital; the hospital mortality forecaster had earlier (and elsewhere) been built from analyses of 6 million discharge abstracts, and took into account each hospital's actual individual admissions, including key patient descriptors for each admission. Such adjusted death rates have increasingly been used as potential indicators of quality, with recent research lending support for the viability of that linkage. The authors then utilized the economic construct of allocative efficiency relying on "best practices" concepts and peer groupings, built using the "envelopment" philosophy of Data Envelopment Analysis and Pareto efficiency. These analytical techniques estimated the efficiently delivered costs required to meet prespecified levels of quality of care. The marginal additional cost per each death deferred in 1983 was estimated to be approximately $29,000 (in 1990 dollars) for the average efficient hospital. Also, over a feasible range, a 1% increase in the level of quality of care delivered was estimated to increase hospital cost by an average of 1.34%. This estimated elasticity of quality on cost also increased with the number of beds in the hospital. PMID:1640765

  5. Poor Self-Rated Health Influences Hospital Service Use in Hospitalized Inpatients With Chronic Conditions in Taiwan

    PubMed Central

    Isaac, Vivian; McLachlan, Craig S.; Baune, Bernhard T.; Huang, Chun-Ta; Wu, Chia-Yi

    2015-01-01

    Abstract Our aim was to investigate the association between self-rated health (SRH) and use of hospital services (ie, medical outpatient department, emergency department, and general ward. admissions). Cross-sectional study data were collected from 230 consecutive patients admitted to medical departments of a 2000-bed academic medical center in Taiwan using standardized operating procedures for data collection of SRH (ie, a single-item question inquiring overall perceived health status), medical disorders, depressive symptoms, and combined service utilization over a 1-year period (ie, number of visits to outpatient department, number of visits to emergency department, and number of hospitalizations). Electronic medical records were retrieved, with self-reported external medical visits added to in-hospital frequencies of service use to provide better estimation of health service utilization. Fifty-two percent of study patients rated their health as poor or very poor. Poor SRH was associated with more visits to medical outpatient department, emergency department, and hospital admission. Multivariate logistic regression demonstrated an independent association between poor SRH and services utilization after adjustment for age, gender, hypertension, diabetes, metastatic cancer, number of chronic illness, life-threatening event, life-time suicidal ideation, and depression. SRH may be a useful research tool to model medical service use for inpatients with chronic conditions. PMID:26356706

  6. Poor Self-Rated Health Influences Hospital Service Use in Hospitalized Inpatients With Chronic Conditions in Taiwan.

    PubMed

    Isaac, Vivian; McLachlan, Craig S; Baune, Bernhard T; Huang, Chun-Ta; Wu, Chia-Yi

    2015-09-01

    Our aim was to investigate the association between self-rated health (SRH) and use of hospital services (ie, medical outpatient department, emergency department, and general ward. admissions). Cross-sectional study data were collected from 230 consecutive patients admitted to medical departments of a 2000-bed academic medical center in Taiwan using standardized operating procedures for data collection of SRH (ie, a single-item question inquiring overall perceived health status), medical disorders, depressive symptoms, and combined service utilization over a 1-year period (ie, number of visits to outpatient department, number of visits to emergency department, and number of hospitalizations). Electronic medical records were retrieved, with self-reported external medical visits added to in-hospital frequencies of service use to provide better estimation of health service utilization. Fifty-two percent of study patients rated their health as poor or very poor. Poor SRH was associated with more visits to medical outpatient department, emergency department, and hospital admission. Multivariate logistic regression demonstrated an independent association between poor SRH and services utilization after adjustment for age, gender, hypertension, diabetes, metastatic cancer, number of chronic illness, life-threatening event, life-time suicidal ideation, and depression. SRH may be a useful research tool to model medical service use for inpatients with chronic conditions. PMID:26356706

  7. Association of hospital volume with readmission rates: a retrospective cross-sectional study

    PubMed Central

    Lin, Zhenqiu; Herrin, Jeph; Bernheim, Susannah; Drye, Elizabeth E; Krumholz, Harlan M; Ross, Joseph S

    2015-01-01

    Objective To examine the association of hospital volume (a marker of quality of care) with hospital readmission rates. Design Retrospective cross-sectional study. Setting 4651US acute care hospitals. Study data 6 916 644 adult discharges, excluding patients receiving psychiatric or medical cancer treatment. Main outcome measures We used Medicare fee-for-service data from 1 July 2011 to 30 June 2012 to calculate observed-to-expected, unplanned, 30 day, standardized readmission rates for hospitals and for specialty cohorts medicine, surgery/gynecology, cardiorespiratory, cardiovascular, and neurology. We assessed the association of hospital volume by quintiles with 30 day, standardized readmission rates, with and without adjustment for hospital characteristics (safety net status, teaching status, geographic region, urban/rural status, nurse to bed ratio, ownership, and cardiac procedure capability. We also examined associations with the composite outcome of 30 day, standardized readmission or mortality rates. Results Mean 30 day, standardized readmission rate among the fifth of hospitals with the lowest volume was 14.7 (standard deviation 5.3) compared with 15.9 (1.7) among the fifth of hospitals with the highest volume (P<0.001). We observed the same pattern of lower readmission rates in the lowest versus highest volume hospitals in the specialty cohorts for medicine (16.6 v 17.4, P<0.001), cardiorespiratory (18.5 v 20.5, P<0.001), and neurology (13.2 v 14.0, p=0.01) cohorts; the cardiovascular cohort, however, had an inverse association (14.6 v 13.7, P<0.001). These associations remained after adjustment for hospital characteristics except in the cardiovascular cohort, which became non-significant, and the surgery/gynecology cohort, in which the lowest volume fifth of hospitals had significantly higher standardized readmission rates than the highest volume fifth (difference 0.63 percentage points (95% confidence interval 0.10 to 1.17), P=0.02). Mean 30 day

  8. Fluidized bed calciner apparatus

    DOEpatents

    Owen, Thomas J.; Klem, Jr., Michael J.; Cash, Robert J.

    1988-01-01

    An apparatus for remotely calcining a slurry or solution feed stream of toxic or hazardous material, such as ammonium diurante slurry or uranyl nitrate solution, is disclosed. The calcining apparatus includes a vertical substantially cylindrical inner shell disposed in a vertical substantially cylindrical outer shell, in which inner shell is disposed a fluidized bed comprising the feed stream material to be calcined and spherical beads to aid in heat transfer. Extending through the outer and inner shells is a feed nozzle for delivering feed material or a cleaning chemical to the beads. Disposed in and extending across the lower portion of the inner shell and upstream of the fluidized bed is a support member for supporting the fluidized bed, the support member having uniform slots for directing uniform gas flow to the fluidized bed from a fluidizing gas orifice disposed upstream of the support member. Disposed in the lower portion of the inner shell are a plurality of internal electric resistance heaters for heating the fluidized bed. Disposed circumferentially about the outside length of the inner shell are a plurality of external heaters for heating the inner shell thereby heating the fluidized bed. Further, connected to the internal and external heaters is a means for maintaining the fluidized bed temperature to within plus or minus approximately 25.degree. C. of a predetermined bed temperature. Disposed about the external heaters is the outer shell for providing radiative heat reflection back to the inner shell.

  9. Volunteer Shelter Bed Programs.

    ERIC Educational Resources Information Center

    Little (Arthur D.), Inc., Washington, DC.

    The volunteer shelter bed program development guidelines in this booklet are offered as a community-based alternative to the institutionalization of status offenders. The volunteer shelter bed program is described as a nonsecure residential alternative for status offenders, which can be implemented without the creation of new facilities or the…

  10. 42 CFR 419.43 - Adjustments to national program payment and beneficiary copayment amounts.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... hospital outpatient department services and determines a wage adjustment factor to adjust the portion of... index factor. CMS uses the hospital inpatient prospective payment system wage index established in... applied before calculating outlier payments. (h) Applicable adjustments to conversion factor for CY...

  11. Costs of surgical procedures in Indian hospitals

    PubMed Central

    Chatterjee, Susmita; Laxminarayan, Ramanan

    2013-01-01

    Objective Despite a growing volume of surgical procedures in low-income and middle-income countries, the costs of these procedures are not well understood. We estimated the costs of 12 surgical procedures commonly conducted in five different types of hospitals in India from the provider perspective, using a microcosting method. Design Cost and utilisation data were collected retrospectively from April 2010 to March 2011 to avoid seasonal variability. Setting For this study, we chose five hospitals of different types: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed district hospital, a 655-bed private teaching hospital and a 778-bed tertiary care teaching hospital based on their willingness to cooperate and data accessibility. The hospitals were from four states in India. The private, charitable and tertiary care hospitals serve urban populations, the district hospital serves a semiurban area and the private teaching hospital serves a rural population. Results Costs of conducting lower section caesarean section ranged from rupees 2469 to 41 087; hysterectomy rupees 4124 to 57 622 and appendectomy rupees 2421 to 3616 (US$1=rupees 52). We computed the costs of conducting lap and open cholecystectomy (rupees 27 732 and 44 142, respectively); hernia repair (rupees 13 204); external fixation (rupees 8406); intestinal obstruction (rupees 6406); amputation (rupees 5158); coronary artery bypass graft (rupees 177 141); craniotomy (rupees 75 982) and functional endoscopic sinus surgery (rupees 53 398). Conclusions Estimated costs are roughly comparable with rates of reimbursement provided by the Rashtriya Swasthya Bima Yojana (RSBY)—India's government-financed health insurance scheme that covers 32.4 million poor families. Results from this type of study can be used to set and revise the reimbursement rates. PMID:23794591

  12. 42 CFR 424.13 - Requirements for inpatient services of hospitals other than psychiatric hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... for posthospital care, if appropriate. (b) Certification of need for hospitalization when a SNF bed is... physician finds that the patient could receive proper treatment in a SNF but no bed is available in a participating SNF. (2) If this is the basis for the physician's certification or recertification, the...

  13. 42 CFR 424.13 - Requirements for inpatient services of hospitals other than psychiatric hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... for posthospital care, if appropriate. (b) Certification of need for hospitalization when a SNF bed is... physician finds that the patient could receive proper treatment in a SNF but no bed is available in a participating SNF. (2) If this is the basis for the physician's certification or recertification, the...

  14. Norovirus - hospital

    MedlinePlus

    Gastroenteritis - norovirus; Colitis - norovirus; Hospital acquired infection - norovirus ... fluids ( dehydration ). Anyone can become infected with norovirus. Hospital patients who are very old, very young, or ...

  15. The Impact of Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) Flags on Hospital Operations.

    PubMed

    Shenoy, Erica S; Lee, Hang; Hou, Taige; Ware, Winston; Ryan, Erin E; Hooper, David C; Walensky, Rochelle P

    2016-07-01

    OBJECTIVE To determine the impact of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus (MRSA/VRE) designations, or flags, on selected hospital operational outcomes. DESIGN Retrospective cohort study of inpatients admitted to the Massachusetts General Hospital during 2010-2011. METHODS Operational outcomes were time to bed arrival, acuity-unrelated within-hospital transfers, and length of stay. Covariates considered included demographic and clinical characteristics: age, gender, severity of illness on admission, admit day of week, residence prior to admission, hospitalization within the prior 30 days, clinical service, and discharge destination. RESULTS Overall, 81,288 admissions were included. After adjusting for covariates, patients with a MRSA/VRE flag at the time of admission experienced a mean delay in time to bed arrival of 1.03 hours (9.63 hours [95% CI, 9.39-9.88] vs 8.60 hours [95% CI, 8.47-8.73]). These patients had 1.19 times the odds of experiencing an acuity-unrelated within-hospital transfer [95% CI, 1.13-1.26] and a mean length of stay 1.76 days longer (7.03 days [95% CI, 6.82-7.24] vs 5.27 days [95% CI, 5.15-5.38]) than patients with no MRSA/VRE flag. CONCLUSIONS MRSA/VRE designation was associated with delays in time to bed arrival, increased likelihood of acuity-unrelated within-hospital transfers and extended length of stay. Efforts to identify patients who have cleared MRSA/VRE colonization are critically important to mitigate inefficient use of resources and to improve inpatient flow. Infect Control Hosp Epidemiol 2016;37:782-790. PMID:27019995

  16. Impact of administrative technology on acute care bed need.

    PubMed Central

    Martin, J B; Dahlstrom, G A; Johnston, C M

    1985-01-01

    This article reports an evaluation of the impact of three administrative technologies--Admission Scheduling (AS) Systems, Outpatient Surgery (OPS) Programs, and Preadmission Testing (PAT) Programs--on the number of acute care beds required by a hospital. The evaluation mechanism reported here is called the ADTECH Computerized Planning Model. ADTECH uses parameters of each technology, identified from previous literature and discussions with health care professionals, to predict the changes in bed requirements resulting from implementation of these programs. Data from eight hospitals of various characteristics and sizes were run to test the ADTECH model. The results from these test runs indicate that the proper implementation of AS, OPS, and PAT can significantly influence a hospital's required bed complement. PMID:3988530

  17. A Bed Load Monitoring System for Real Time Sediment Transport and Bed Morphology during Channel Altering Events

    NASA Astrophysics Data System (ADS)

    Curran, J. C.; Waters, K. A.; Cannatelli, K.

    2014-12-01

    A new technique is presented that provides continuous measurement of sediment movement over the length of a flume. Real-time measurements of bed changes over a reach are a missing piece needed to link bed morphology with sediment transport processes during unsteady flows when the bed adjusts quickly to changing transport rates or visual observation of the bed is precluded by fine sediment in the water column. A bed load monitoring system (BLMS) was developed that records the sediment and water loads over discrete bed lengths throughout a flow event. It was designed for laboratory application where controlled measurement methods are possible. Upon data processing, the BLMS provides a continuous measure of the sediment load across the bed from which sediment movement rates through the reach, including areas of temporary aggradation or degradation, can be reconstructed. Examples are provided of how the bed load monitoring system has been applied during sediment feed and sediment recirculation experiments to further the interpretation of channel processes occurring during large flows. We detail the use of the BLMS to measure bed slopes during unsteady flows and to measure the movement of sediment downstream following different methods of dam removal. We evaluate the BLMS for use where DEM differencing was also applied to illustrate the information provided by each measurement method. Exciting implications of future research that incorporates a BLMS include a more informed management of river systems as a result of improved temporal predictions of sediment movement and the associated changes in channel slope and morphology.

  18. ADJUSTABLE DOUBLE PULSE GENERATOR

    DOEpatents

    Gratian, J.W.; Gratian, A.C.

    1961-08-01

    >A modulator pulse source having adjustable pulse width and adjustable pulse spacing is described. The generator consists of a cross coupled multivibrator having adjustable time constant circuitry in each leg, an adjustable differentiating circuit in the output of each leg, a mixing and rectifying circuit for combining the differentiated pulses and generating in its output a resultant sequence of negative pulses, and a final amplifying circuit for inverting and square-topping the pulses. (AEC)

  19. Adjustable sutures in children.

    PubMed

    Engel, J Mark; Guyton, David L; Hunter, David G

    2014-06-01

    Although adjustable sutures are considered a standard technique in adult strabismus surgery, most surgeons are hesitant to attempt the technique in children, who are believed to be unlikely to cooperate for postoperative assessment and adjustment. Interest in using adjustable sutures in pediatric patients has increased with the development of surgical techniques specific to infants and children. This workshop briefly reviews the literature supporting the use of adjustable sutures in children and presents the approaches currently used by three experienced strabismus surgeons. PMID:24924284

  20. Risk-adjusted outcomes in Medicare inpatient nephrectomy patients.

    PubMed

    Fry, Donald E; Pine, Michael; Nedza, Susan M; Locke, David G; Reband, Agnes M; Pine, Gregory

    2016-09-01

    Without risk-adjusted outcomes of surgical care across both the inpatient and postacute period of time, hospitals and surgeons cannot evaluate the effectiveness of current performance in nephrectomy and other operations, and will not have objective metrics to gauge improvements from care redesign efforts.We compared risk-adjusted hospital outcomes following elective total and partial nephrectomy to demonstrate differences that can be used to improve care. We used the Medicare Limited Dataset for 2010 to 2012 for total and partial nephrectomy for benign and malignant neoplasms to create prediction models for the adverse outcomes (AOs) of inpatient deaths, prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day relevant readmissions. From the 4 prediction models, total predicted adverse outcomes were determined for each hospital in the dataset that met a minimum of 25 evaluable cases for the study period. Standard deviations (SDs) for each hospital were used to identify specific z-scores. Risk-adjusted adverse outcomes rates were computed to permit benchmarking each hospital's performance against the national standard. Differences between best and suboptimal performing hospitals defined the potential margin of preventable adverse outcomes for this operation.A total of 449 hospitals with 23,477 patients were evaluated. Overall AO rate was 20.8%; 17 hospitals had risk-adjusted AO rates that were 2 SDs poorer than predicted and 8 were 2 SDs better. The top performing decile of hospitals had a risk-adjusted AO rate of 10.2% while the lowest performing decile had 32.1%. With a minimum of 25 cases for each study hospital, no statistically valid improvement in outcomes was seen with increased case volume.Inpatient and 90-day postdischarge risk-adjusted adverse outcomes demonstrated marked variability among study hospitals and illustrate the opportunities for care improvement. This analytic design is applicable for comparing provider

  1. Particle fuel bed tests

    SciTech Connect

    Horn, F.L.; Powell, J.R.; Savino, J.M.

    1985-01-01

    Gas-cooled reactors, using packed beds of small diameter coated fuel particles have been proposed for compact, high-power systems. The particulate fuel used in the tests was 800 microns in diameter, consisting of a thoria kernel coated with 200 microns of pyrocarbon. Typically, the bed of fuel particles was contained in a ceramic cylinder with porous metallic frits at each end. A dc voltage was applied to the metallic frits and the resulting electric current heated the bed. Heat was removed by passing coolant (helium or hydrogen) through the bed. Candidate frit materials, rhenium, nickel, zirconium carbide, and zirconium oxide were unaffected, while tungsten and tungsten-rhenium lost weight and strength. Zirconium-carbide particles were tested at 2000 K in H/sub 2/ for 12 hours with no visible reaction or weight loss.

  2. Bed rest during pregnancy

    MedlinePlus

    ... provider before you start any activity: Squeezing stress balls Pressing your hands and feet against the bed ... limit yourself from doing any of these: Cooking Light chores Walking Bathing or showering Driving Having sex ...

  3. Tapered bed bioreactor

    DOEpatents

    Scott, Charles D.; Hancher, Charles W.

    1977-01-01

    A vertically oriented conically shaped column is used as a fluidized bed bioreactor wherein biologically catalyzed reactions are conducted in a continuous manner. The column utilizes a packing material a support having attached thereto a biologically active catalytic material.

  4. Test Bed For Telerobots

    NASA Technical Reports Server (NTRS)

    Matijevic, Jacob R.; Zimmerman, Wayne F.; Dolinsky, Shlomo

    1990-01-01

    Assembly of electromechanical and electronic equipment (including computers) constitutes test bed for development of advanced robotic systems for remote manipulation. Combines features not found in commercial systems. Its architecture allows easy growth in complexity and level of automation. System national resource for validation of new telerobotic technology. Intended primarily for robots used in outer space, test bed adapted to development of advanced terrestrial telerobotic systems for handling radioactive materials, dangerous chemicals, and explosives.

  5. Bed rest and immunity

    NASA Astrophysics Data System (ADS)

    Sonnenfeld, Gerald; Aviles, Hernan; Butel, Janet S.; Shearer, William T.; Niesel, David; Pandya, Utpal; Allen, Christopher; Ochs, Hans D.; Blancher, Antoine; Abbal, Michel

    2007-02-01

    Space flight has been shown to result in altered immune responses. The current study was designed to investigate this possibility by using the bed rest model of some space flight conditions. A large number of women are included as subjects in the study. The hypothesis being tested is: 60 days head-down tilt bed rest of humans will affect the immune system and resistance to infection. Blood, urine and saliva samples will be obtained from bed rest subjects prior to, at intervals during, and after completion of 60 days of head-down tilt bed rest. Leukocyte blastogenesis, cytokine production and virus reactivation will be assessed. The ability of the subjects to respond appropriately to immunization with the neoantigen bacteriophage φX-174 will also be determined. Bed rest is being carried out at MEDES, Toulouse France, and the University of Texas Medical Branch, Galveston, TX. The studies to be carried out in France will also allow assessment of the effects of muscle/bone exercise and nutritional countermeasures on the immune system in addition to the effects of bed rest.

  6. Control of bed height in a fluidized bed gasification system

    DOEpatents

    Mehta, Gautam I.; Rogers, Lynn M.

    1983-12-20

    In a fluidized bed apparatus a method for controlling the height of the fdized bed, taking into account variations in the density of the bed. The method comprises taking simultaneous differential pressure measurements at different vertical elevations within the vessel, averaging the differential pressures, determining an average fluidized bed density, then periodically calculating a weighting factor. The weighting factor is used in the determination of the actual bed height which is used in controlling the fluidizing means.

  7. Hospital mission and cost differences.

    PubMed

    Sorrentino, E A

    1989-01-01

    The results show no significant differences on average length of stay, cost per patient day, or cost per admission among non-profit, government, and for-profit hospitals when controlling for bed capacities, occupancy rates, number of Medicare/Medicaid days, and hospitals without nurseries. For-profit hospital manhours per patient day were significantly lower than non-profit and government hospitals. This is an important finding because patient-care delivery is labor-intensive. A majority of for-profit hospitals do not have nurseries, which means that they should have more manhours per patient day. As indicated earlier, the manhours for hospitals with nurseries are higher than those for hospitals without nurseries. This indicates cost-cutting behavior on the part of a majority of for-profit hospitals. This method of limiting expenditures by decreasing labor costs associated with certain services is consistent with profit-maximization. The findings of this study with regard to cost differences among non-profit and for-profit hospitals contradict previous research. However, a recent study by Kralewski, Gifford and Porter (1988) noted that whereas ownership, when considered alone, differentiates hospitals, when evaluated within each community, most of the investor-owned and non-for-profit hospital differences disappear. Similar questions have been raised as to whether non-profit hospitals truly differ from for-profit hospitals (Pauly 1987). Caution needs to be exercised in attempting to extrapolate the findings of this study, because of the dynamic health care environment. Hospital ownership changes over time, reimbursement rules affect behavior, and internal factors in organizational operation affect outcomes. These should be considered in future studies exploring organizational mission and cost differences. PMID:10293600

  8. Benzodiazepine prescription and length of hospital stay at a Japanese university hospital

    PubMed Central

    Nakao, Mutsuhiro; Sato, Mikiya; Nomura, Kyoko; Yano, Eiji

    2009-01-01

    Background The relationship between bed days and benzodiazepine prescription (BDZ) in Western countries is inconclusive, and no hospital-based report has documented this phenomenon in Japan. This study was done to assess the association between bed days and BDZ in a Japanese hospital. Methods 21,489 adult patients (55.1% men, mean age 59.9 years old) hospitalized between April, 2005 and December, 2006 were enrolled in the study. Patient age, sex, ICD-10 diagnosis, prescription profile, and days of hospital stay were assessed in 13 non-psychiatric departments using a computer ordering system. Patients prescribed a benzodiazepine during hospitalization were defined as positive. Results Of the total sample, 19.9% were allocated to the benzodiazepine (+) group. Female sex and older age were significant factors associated with benzodiazepine prescription. The median number of bed days was 13, and the likelihood of BDZ significantly increased with the number of bed days, even after controlling for the effects of age, gender, and ICD-10 diagnosis. For example, when the analysis was limited to patients with 50 bed days or longer, the percentage of BDZ (32.7%) was equivalent to that of a report from France. Conclusion Irrespective of department or disease, patients prescribed benzodiazepine during their hospital stay tended to have a higher number of bed days in the hospital. The difference in the prevalence of BDZ between this study and previous Western studies might be attributed to the relatively short length of hospital stay in this study. Because BDZs are often reported to be prescribed to hospitalized patients without appropriate documentation for the indications for use, it is important to monitor the rational for prescriptions of benzodiazepine carefully, for both clinical and economical reasons. PMID:19818119

  9. Cognitive Functioning in Long Duration Head-down Bed Rest

    NASA Technical Reports Server (NTRS)

    Seaton, Kimberly A.; Slack, Kelley J.; Sipes, Walter A.; Bowie, Kendra

    2008-01-01

    The Space Flight Cognitive Assessment Tool for Windows (WinSCAT) is a self-administered battery of tests used on the International Space Station for evaluating cognitive functioning. Here, WinSCAT was used to assess cognitive functioning during extended head-down bed rest. Thirteen subjects who participated in 60 or 90 days of 6 deg head-down bed rest took WinSCAT during the pre-bed rest phase, the in-bed rest phase, and the post-bed rest (reconditioning) phase of study participation. After adjusting for individual baseline performance, 12 off-nominal scores were observed out of 351 total observations during bed rest and 7 of 180 during reconditioning. No evidence was found for systematic changes in off-nominal incidence as time in bed rest progressed, or during the reconditioning period. Cognitive functioning does not appear to be adversely affected by long duration head-down bed rest. Individual differences in underlying cognitive ability and motivation level are likely explanations for the current findings.

  10. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Indirect medical education adjustment factor. 412... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective... Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data....

  11. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Indirect medical education adjustment factor. 412... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective... Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data....

  12. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Indirect medical education adjustment factor. 412... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective... Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data....

  13. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Indirect medical education adjustment factor. 412... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective... Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data....

  14. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Payment System for Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data. CMS... 42 Public Health 2 2010-10-01 2010-10-01 false Indirect medical education adjustment factor....

  15. Access, quality, and costs of care at physician owned hospitals in the United States: observational study

    PubMed Central

    Orav, E John; Jena, Anupam B; Dudzinski, David M; Le, Sidney T; Jha, Ashish K

    2015-01-01

    Objective To compare physician owned hospitals (POHs) with non-POHs on metrics around patient populations, quality of care, costs, and payments. Design Observational study. Setting Acute care hospitals in 95 hospital referral regions in the United States, 2010. Participants 2186 US acute care hospitals (219 POHs and 1967 non-POHs). Main outcome measures Proportions of patients using Medicaid and those from ethnic and racial minority groups; hospital performance on patient experience metrics, care processes, risk adjusted 30 day mortality, and readmission rates; costs of care; care payments; and Medicare market share. Results The 219 POHs were more often small (<100 beds), for profit, and in urban areas. 120 of these POHs were general (non-specialty) hospitals. Compared with patients from non-POHs, those from POHs were younger (77.4 v 78.4 years, P<0.001), less likely to be admitted through an emergency department (23.2% v. 29.0%, P<0.001), equally likely to be black (5.1% v 5.5%, P=0.85) or to use Medicaid (14.9% v 15.4%, P=0.75), and had similar numbers of chronic diseases and predicted mortality scores. POHs and non-POHs performed similarly on patient experience scores, processes of care, risk adjusted 30 day mortality, 30 day readmission rates, costs, and payments for acute myocardial infarction, congestive heart failure, and pneumonia. Conclusion Although POHs may treat slightly healthier patients, they do not seem to systematically select more profitable or less disadvantaged patients or to provide lower value care. PMID:26333819

  16. In Vivo measurement of human body composition. [during continuous bed rest

    NASA Technical Reports Server (NTRS)

    Pace, N.; Grunbaum, B. W.; Kodama, A. M.; Price, D. C.

    1975-01-01

    Physiological changes in human beings were studied during a 21 day bed rest regime. Results of blood analyses indicated clearly that major metabolic adjustments occurred during prolonged bed rest. However, urinary metabolic analyses showed variances attributed to specimen collection inaccuracies and the small number of test subjects.

  17. Does reengineering really work? An examination of the context and outcomes of hospital reengineering initiatives.

    PubMed Central

    Walston, S L; Burns, L R; Kimberly, J R

    2000-01-01

    OBJECTIVE: To examine the effect of reengineering on the competitive position of hospitals. Although many promises have been made regarding outcomes of process reengineering, little or no research has examined this issue. This article provides an initial exploration of the direct effects of reengineering on the competitive cost position of hospitals and the modifying effects of implementation factors. DATA SOURCES/STUDY SETTING: Obtained for primary data from a 1996/1997 national survey of hospital restructuring and reengineering sponsored by the American Hospital Association and the Leonard Davis Institute for Health Economics. Responses from approximately 30 percent of all U.S. acute care hospitals with 100 or more inpatient beds in metropolitan service areas were combined with American Hospital Association annual survey and InterStudy HMO data in this study. STUDY DESIGN: A first-difference multivariate regression was utilized to examine the effects of reengineering and other explanatory variables on the change in the cost position of a hospital's expenses per adjusted patient day relative to its market's costs per adjusted patient day. DATA COLLECTION/EXTRACTION METHODS: The survey of hospital restructuring and reengineering was mailed to hospital chief executive officers. The CEOs identified reengineering and restructuring hospital activities over the previous five years. The extensiveness and components of reengineering and internal restructuring were identified and used in the empirical analysis. PRINCIPAL FINDINGS: Results suggest that reengineering without integrative and coordinative efforts may damage an organization's cost position. The use of steering committees, project teams, codification of the change process, and executive involvement in core changes modifies the results of reengineering to improve an organization's competitive position. CONCLUSIONS: In a national sample of hospitals, reengineering alone was not found to improve the relative cost

  18. Treatment bed microbiological control

    NASA Technical Reports Server (NTRS)

    Janauer, Gilbert E.; Fitzpatrick, Timothy W.; Kril, Michael B.; Wilber, Georgia A.; Sauer, Richard L.

    1987-01-01

    The effects of microbial fouling on treatment bed (TB) performance are being studied. Fouling of activated carbon (AC) and ion exchange resins (IEX) by live and devitalized bacteria can cause decreased capacity for selected sorbates with AC and IEX TB. More data are needed on organic species removal in the trace region of solute sorption isotherms. TB colonization was prevented by nonclassical chemical disinfectant compositions (quaternary ammonium resins) applied in suitable configurations. Recently, the protection of carbon beds via direct disinfectant impregnation has shown promise. Effects (of impregnation) upon bed sorption/removal characteristics are to be studied with representative contaminants. The potential need to remove solutes added or produced during water disinfection and/or TB microbiological control must be investigated.

  19. Fluidized bed coal desulfurization

    NASA Technical Reports Server (NTRS)

    Ravindram, M.

    1983-01-01

    Laboratory scale experiments were conducted on two high volatile bituminous coals in a bench scale batch fluidized bed reactor. Chemical pretreatment and posttreatment of coals were tried as a means of enhancing desulfurization. Sequential chlorination and dechlorination cum hydrodesulfurization under modest conditions relative to the water slurry process were found to result in substantial sulfur reductions of about 80%. Sulfur forms as well as proximate and ultimate analyses of the processed coals are included. These studies indicate that a fluidized bed reactor process has considerable potential for being developed into a simple and economic process for coal desulfurization.

  20. Rancho flotation bed.

    PubMed

    Reswick, J B; Nickel, V L; Simoes, N

    1977-04-01

    The Rancho Flotation Bed provides hydrostatic support with maximum pressures over bony prominences of 15 to 25 mm Hg (measured with a pneumatic pressure transducer). This is generally below the levels normally quoted as conducive to the development of ischaemia. Clinical experience has shown the bed to be a successful aid to nursing by eliminating the need to turn the patients for pressure reasons, allowing patients with pressure sores to remain in a position which is more comfortable and more suitable for other nursing care. It also makes it easier for nurses to handle patients in order to care for the pressure sores. PMID:615987

  1. Staged fluidized bed

    DOEpatents

    Mallon, R.G.

    1983-05-13

    The invention relates to oil shale retorting and more particularly to staged fluidized bed oil shale retorting. Method and apparatus are disclosed for narrowing the distribution of residence times of any size particle and equalizing the residence times of large and small particles in fluidized beds. Particles are moved up one fluidized column and down a second fluidized column with the relative heights selected to equalize residence times of large and small particles. Additional pairs of columns are staged to narrow the distribution of residence times and provide complete processing of the material.

  2. Effects of Fourteen-Day Bed Rest on Trunk Stabilizing Functions in Aging Adults

    PubMed Central

    Sarabon, Nejc; Rosker, Jernej

    2015-01-01

    Bed rest has been shown to have detrimental effects on structural and functional characteristics of the trunk muscles, possibly affecting trunk and spinal stability. This is especially important in populations such as aging adults with often altered trunk stabilizing functions. This study examined the effects of a fourteen-day bed rest on anticipatory postural adjustments and postural reflex responses of the abdominal wall and back muscles in sixteen adult men. Postural activation of trunk muscles was measured using voluntary quick arm movement and sudden arm loading paradigm. Measurements were conducted prior to the bed rest, immediately after, and fourteen days after the bed rest. Immediately after the bed rest, latencies of anticipatory postural adjustments showed significant shortening, especially for the obliquus internus and externus muscles. After a fourteen-day recuperation period, anticipatory postural adjustments reached a near to complete recovery. On the contrary, reactive response latencies increased from pre-bed-rest to both post-bed-rest measurement sessions. Results indicate an important effect of bed rest on stabilizing functions of the trunk muscles in elderly adults. Moreover, there proved to be a significant deterioration of postural reactive responses that outlasted the 14-day post-bed-rest rehabilitation. PMID:26601104

  3. Global- and local-scale characterisation of bed surface structure in coarse-grained alluvial rivers

    NASA Astrophysics Data System (ADS)

    Powell, Mark; Ockelford, Annie; Nguyen, Thao; Wood, Jo; Rice, Steve; Reid, Ian; Tate, Nick

    2013-04-01

    It is widely recognised that adjustments in bed surface grain size (texture) and grain arrangement (structure) exert significant controls on the stability of coarse-grained alluvial rivers. Modifications to bed surface texture and structure occur during active sediment transport and are mediated by the process of mobile armouring which concentrates coarser-than-average particles on the surface and organises them into a variety of grain- and bedform-scale configurations. Textural aspects of surface armouring are well understood to the extent that sediment transport models can be used to predict the size distribution of armours that develop under different sediment supply regimes and shear stresses. Research has also found that the adjustment of bed surface grain size is often patchy and that the development of finer-grained and coarser-grained areas of the bed has important implications for both the rate and grain size of transported sediment. The structural aspects of stream-bed armouring, however, are less well understood, largely because of the difficulty of recognising and characterising bedforms and bed-structures that have dimensions similar to their constituent particles. Moreover, bed structure is generally parameterised using global scale descriptors of the bed surface such that information on the spatial heterogeneity of the structure is lost. The aim of this poster is to characterise the structural characteristics of water-worked river gravels, paying particular attention to quantifying the spatial heterogeneity of those characteristics using local scale descriptors. Results reported from a number of flume experiments designed to simulate the spatio-temporal evolution of bed configurations (surface texture and structure) as the system adjusts to a condition of equilibrium transport are used to evaluate the spatial variability of bed surface structure and explore its significance for modelling sediment transport rates in gravel-bed rivers. Keywords: bed

  4. Acoustic bed velocity and bed load dynamics in a large sand bed river

    USGS Publications Warehouse

    Gaeuman, D.; Jacobson, R.B.

    2006-01-01

    Development of a practical technology for rapid quantification of bed load transport in large rivers would represent a revolutionary advance for sediment monitoring and the investigation of fluvial dynamics. Measurement of bed load motion with acoustic Doppler current profiles (ADCPs) has emerged as a promising approach for evaluating bed load transport. However, a better understanding of how ADCP data relate to conditions near the stream bed is necessary to make the method practical for quantitative applications. In this paper, we discuss the response of ADCP bed velocity measurements, defined as the near-bed sediment velocity detected by the instrument's bottom-tracking feature, to changing sediment-transporting conditions in the lower Missouri River. Bed velocity represents a weighted average of backscatter from moving bed load particles and spectral reflections from the immobile bed. The ratio of bed velocity to mean bed load particle velocity depends on the concentration of the particles moving in the bed load layer, the bed load layer thickness, and the backscatter strength from a unit area of moving particles relative to the echo strength from a unit area of unobstructed bed. A model based on existing bed load transport theory predicted measured bed velocities from hydraulic and grain size measurements with reasonable success. Bed velocities become more variable and increase more rapidly with shear stress when the transport stage, defined as the ratio of skin friction to the critical shear stress for particle entrainment, exceeds a threshold of about 17. This transition in bed velocity response appears to be associated with the appearance of longer, flatter bed forms at high transport stages.

  5. Capitation pricing: adjusting for prior utilization and physician discretion.

    PubMed

    Anderson, G F; Cantor, J C; Steinberg, E P; Holloway, J

    1986-01-01

    As the number of Medicare beneficiaries receiving care under at-risk capitation arrangements increases, the method for setting payment rates will come under increasing scrutiny. A number of modifications to the current adjusted average per capita cost (AAPCC) methodology have been proposed, including an adjustment for prior utilization. In this article, we propose use of a utilization adjustment that includes only hospitalizations involving low or moderate physician discretion in the decision to hospitalize. This modification avoids discrimination against capitated systems that prevent certain discretionary admissions. The model also explains more of the variance in per capita expenditures than does the current AAPCC. PMID:10312010

  6. 42 CFR 409.22 - Bed and board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.22 Bed and board. (a) Semiprivate and ward... room if— (i) The patient's condition requires him to be isolated; (ii) The SNF has no semiprivate or ward accommodations; or (iii) The SNF semiprivate and ward accommodations are fully occupied by...

  7. 42 CFR 409.22 - Bed and board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.22 Bed and board. (a) Semiprivate and ward... room if— (i) The patient's condition requires him to be isolated; (ii) The SNF has no semiprivate or ward accommodations; or (iii) The SNF semiprivate and ward accommodations are fully occupied by...

  8. 42 CFR 409.22 - Bed and board.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.22 Bed and board. (a) Semiprivate and ward... room if— (i) The patient's condition requires him to be isolated; (ii) The SNF has no semiprivate or ward accommodations; or (iii) The SNF semiprivate and ward accommodations are fully occupied by...

  9. 42 CFR 409.22 - Bed and board.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.22 Bed and board. (a) Semiprivate and ward... room if— (i) The patient's condition requires him to be isolated; (ii) The SNF has no semiprivate or ward accommodations; or (iii) The SNF semiprivate and ward accommodations are fully occupied by...

  10. 42 CFR 409.22 - Bed and board.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.22 Bed and board. (a) Semiprivate and ward... room if— (i) The patient's condition requires him to be isolated; (ii) The SNF has no semiprivate or ward accommodations; or (iii) The SNF semiprivate and ward accommodations are fully occupied by...

  11. Apparatus for controlling fluidized beds

    DOEpatents

    Rehmat, A.G.; Patel, J.G.

    1987-05-12

    An apparatus and process are disclosed for control and maintenance of fluidized beds under non-steady state conditions. An ash removal conduit is provided for removing solid particulates from a fluidized bed separate from an ash discharge conduit in the lower portion of the grate supporting such a bed. The apparatus and process of this invention is particularly suitable for use in ash agglomerating fluidized beds and provides control of the fluidized bed before ash agglomeration is initiated and during upset conditions resulting in stable, sinter-free fluidized bed maintenance. 2 figs.

  12. Apparatus for controlling fluidized beds

    DOEpatents

    Rehmat, Amirali G.; Patel, Jitendra G.

    1987-05-12

    An apparatus and process for control and maintenance of fluidized beds under non-steady state conditions. An ash removal conduit is provided for removing solid particulates from a fluidized bed separate from an ash discharge conduit in the lower portion of the grate supporting such a bed. The apparatus and process of this invention is particularly suitable for use in ash agglomerating fluidized beds and provides control of the fluidized bed before ash agglomeration is initiated and during upset conditions resulting in stable, sinter-free fluidized bed maintenance.

  13. Fluid bed material transfer method

    DOEpatents

    Pinske, Jr., Edward E.

    1994-01-01

    A fluidized bed apparatus comprising a pair of separated fluid bed enclosures, each enclosing a fluid bed carried on an air distributor plate supplied with fluidizing air from below the plate. At least one equalizing duct extending through sidewalls of both fluid bed enclosures and flexibly engaged therewith to communicate the fluid beds with each other. The equalizing duct being surrounded by insulation which is in turn encased by an outer duct having expansion means and being fixed between the sidewalls of the fluid bed enclosures.

  14. Distributor for multistage fluidized beds

    SciTech Connect

    Wormser, A.

    1992-06-16

    This patent describes a multibed fluidized bed system. It comprises a fluidized bed vessel having a casing surrounding a first distributor and a second distributor downstream from the first distributor; a first bed material placed on the first distributor and a second bed material placed on the second distributor; each of the bed materials having an angle of repose; and wherein the angle formed by the substantially straight elongated tubular passages and the upper surface is less than the angle of repose of the second bed material.

  15. [Ussuriĭsk military hospital celebrates 130th anniversary].

    PubMed

    Kim, A P

    2013-01-01

    On the authority of the order issued by Military Department d.d. 13 September 1882 No 278 since 1 January 1883 in village Nikolskoe of Primorsk territory was established the local hospital with bed capacity--115 beds. In the following years this capacity was being increased. In 1914 hospital was renamed into Nikols-Ussuriysk military hospital. This hospital took part in treatment-and-evacuation supply of wounded and ill soldiers during wars and armed conflicts. In 1982 Nikols-Ussuriysk military hospital awarded the Red Star. Employees of this hospital prepared and defended 25 doctoral and candidate's dissertations. In 2010 hospital was joined 301st District military clinical hospital and became it's branch. PMID:23805630

  16. Economies of scale and scope in Vietnamese hospitals.

    PubMed

    Weaver, Marcia; Deolalikar, Anil

    2004-07-01

    Hospitals consume a large share of health resources in developing countries, but little is known about the efficiency of their scale and scope. The Ministry of Health of Vietnam and World Bank collected data in 1996 from the largest sample ever surveyed in a developing country. The sample included 654 out of 815 public hospitals, six categories of hospitals and a broad range of sizes. These data were used to estimate total variable cost as a function of multiple products, such as admissions and outpatient visits. We report results for two specifications: (1) estimates with a single variable for beds and (2) estimates with interaction terms for beds and the category of hospital. The coefficient estimates were used to calculate marginal costs, short-run returns to the variable factor, economies of scale, and economies of scope for each category of hospital. There were important differences across categories of hospitals. The measure of economies of scale was 1.09 for central general and 1.05 for central specialty hospitals with a mean of 516 and 226 beds, respectively, indicating roughly constant returns to scale. The measure was well below one for both provincial general and specialty hospitals with a mean of 357 and 192 beds, respectively, indicating large diseconomies of scale. The measure was 1.16 for district hospitals and 0.89 other ministry hospitals indicating modest economies and diseconomies of scale, respectively. There were large economies of scope for central and provincial general hospitals. We conclude that in a system of public hospitals in a developing country that followed an administrative structure, the variable cost function differed significantly across categories of hospitals. Economies of scale and scope depended on the category of the hospital in addition to the number of beds and volume of output. PMID:15087154

  17. Adjusting the Chain Gear

    NASA Astrophysics Data System (ADS)

    Koloc, Z.; Korf, J.; Kavan, P.

    The adjustment (modification) deals with gear chains intermediating (transmitting) motion transfer between the sprocket wheels on parallel shafts. The purpose of the adjustments of chain gear is to remove the unwanted effects by using the chain guide on the links (sliding guide rail) ensuring a smooth fit of the chain rollers into the wheel tooth gap.

  18. Adjustment to Recruit Training.

    ERIC Educational Resources Information Center

    Anderson, Betty S.

    The thesis examines problems of adjustment encountered by new recruits entering the military services. Factors affecting adjustment are discussed: the recruit training staff and environment, recruit background characteristics, the military's image, the changing values and motivations of today's youth, and the recruiting process. Sources of…

  19. [General coordination of hospital activity].

    PubMed

    Rodríguez, Paz; Serra, José Antonio

    2005-03-01

    The present article describes the organizational and general coordination measures taken by the hospital management to attend the 325 victims who arrived at our hospital after the terrorist attack on the morning of 11 March. Firstly, we summarize the activity performed by the extra-hospital emergency services and the distribution of the victims in centers. Secondly, we describe in greater detail the interventions performed to initiate the External Emergency Action Plan in our hospital, the triage system and identification of patients who used it, as well as the resources in terms of beds, operating rooms and personnel that were used on that day. Lastly, by way of discussion, we provide a critical analysis of our interventions. PMID:15771833

  20. 38 CFR 3.556 - Adjustment on discharge or release.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... veteran whose award was reduced under § 3.551(b) is placed on non-bed care status or other authorized... hospital benefits. A discharge for disciplinary reasons or because of the patient's refusal to accept, neglect of or obstruction of treatment; refusal to accept transfer, or failure to return from...

  1. Hospital Discharge Planning: A Guide for Families and Caregivers

    MedlinePlus

    ... soft foods only? Certain foods not allowed?) Personal Hygiene Grooming Toileting Transfer (moving from bed to chair) ... for Healthcare Research and Quality, Patient Safety Network "Studies Suggest Ways to Improve the Hospital Discharge Process ...

  2. Technology test bed review

    NASA Astrophysics Data System (ADS)

    McConnaughey, H. V.

    1992-07-01

    The topics are presented in viewgraph form and include the following: (1) Space Shuttle Main Engine (SSME) technology test bed (TTB) history; (2) TTB objectives; (3) TTB major accomplishments; (4) TTB contributions to SSME; (5) major impacts of 3001 testing; (6) some challenges to computational fluid dynamics (CFD); (7) the high pressure fuel turbopump (HPFTP); and (8) 3001 lessons learned in design and operations.

  3. Bed rest during pregnancy

    MedlinePlus

    ... groups, bulletin boards, and chat rooms online for moms-to-be who are also on bed rest. Expect emotional ups and downs. Share your hopes and worries with your partner. Let each other vent if needed. If sex is not allowed, look for other ways to ...

  4. EXPANDED BED BIOLOGICAL TREATMENT

    EPA Science Inventory

    A three-year pilot-scale research investigation at the EPA Lebanon Pilot Plant was conducted to evaluate the feasibility of a unique biological secondary treatment process, designated the Expanded Bed Biological Treatment Process (EBBT). The EBBT process is a three-phase (oxygen/...

  5. Hospital Workers Disaster Management and Hospital Nonstructural: A Study in Bandar Abbas, Iran

    PubMed Central

    Lakbala, Parvin

    2016-01-01

    Introduction: A devastating earthquake is inevitable in the long term and likely in the near future in Iran. The objective of the study was to assess the knowledge of hospital staff to disaster management system in hospital and to determine nonstructural safety assessment in Shahid Mohammadi hospital in Bandar Abbas city of Iran. This hospital is the main referral hospital in Hormozgan province with a capacity of about 450 beds and the highest patient admissions. Methods: The cross-sectional study was conducted in 2013 on 200 healthcare workers at Shahid Mohammadi hospital, in the city of Bandar Abbas, Iran. This hospital is the main referral hospital in Hormozgan province and has a capacity of about 450 beds with highest numbers of patient admissions. Questionnaire and checklist used for assessing health workers knowledge and awareness towards disaster management and nonstructural safety this hospital. Results: This study found that knowledge, awareness, and disaster preparedness of hospital staff need continual reinforcement to improve self efficacy for disaster management. Equipping health care facilities at the time of natural disasters, especially earthquakes are of great importance all over the world, especially in Iran. This requires the national strategies and planning for all health facilities. Conclusion: It seems due to limitations of hospital beds, insufficient of personnel, and medical equipment, health care providers paid greater attention to this issue. Since this hospital is the only educational public hospital in the province, it is essential to pay much attention to the risk management not only to this hospital but at the national level to health facilities. PMID:26573039

  6. General practitioner beds in Finland — lessons for the UK?

    PubMed Central

    Jones, Roger

    1987-01-01

    The Finnish Primary Health Care Act of 1972 aimed to provide comprehensive health care to the population. One consequence was an increase in the number of beds for the use of general practitioners, so that there are now 2.2 general practitioner beds per thousand population. Use of these beds varies with the location of the health station in which they are situated, but in rural areas approximates to that of general practitioner hospitals in the United Kingdom. Despite integration of general practitioner beds into overall planning, some potential benefits of these facilities have not been realized. For the UK, with traditions of personal general practice and continuity of care, the Finnish system offers one model of community care which may have medical and economic advantages. PMID:3668922

  7. Long-duration bed rest as an analog to microgravity.

    PubMed

    Hargens, Alan R; Vico, Laurence

    2016-04-15

    Long-duration bed rest is widely employed to simulate the effects of microgravity on various physiological systems, especially for studies of bone, muscle, and the cardiovascular system. This microgravity analog is also extensively used to develop and test countermeasures to microgravity-altered adaptations to Earth gravity. Initial investigations of bone loss used horizontal bed rest with the view that this model represented the closest approximation to inactivity and minimization of hydrostatic effects, but all Earth-based analogs must contend with the constant force of gravity by adjustment of the G vector. Later concerns about the lack of similarity between headward fluid shifts in space and those with horizontal bed rest encouraged the use of 6 degree head-down tilt (HDT) bed rest as pioneered by Russian investigators. Headward fluid shifts in space may redistribute bone from the legs to the head. At present, HDT bed rest with normal volunteers is the most common analog for microgravity simulation and to test countermeasures for bone loss, muscle and cardiac atrophy, orthostatic intolerance, and reduced muscle strength/exercise capacity. Also, current physiologic countermeasures are focused on long-duration missions such as Mars, so in this review we emphasize HDT bed rest studies with durations of 30 days and longer. However, recent results suggest that the HDT bed rest analog is less representative as an analog for other important physiological problems of long-duration space flight such as fluid shifts, spinal dysfunction and radiation hazards. PMID:26893033

  8. Preventable hospitalizations and socioeconomic status.

    PubMed

    Blustein, J; Hanson, K; Shea, S

    1998-01-01

    "Preventable" hospitalizations have been proposed as indicators of poor health plan performance. In this study of elderly Medicare beneficiaries, however, we found that preventable hospitalizations are also more common among elders of lower socioeconomic status (SES). The relationship persisted even when an up-to-date severity-of-illness adjustment system was used. To the extent that indicators of health plan "performance" reflect enrollees' characteristics, plans will be rewarded for marketing their services to wealthier, healthier, and better-educated patients. Further work is needed to clarify issues of accountability for preventable hospitalizations and other putative indices of health plan performance. PMID:9558796

  9. Epsom General Hospital orthopaedic theatre.

    PubMed

    1992-11-01

    The Surrey Section of the London Branch held a very successful meeting on Wednesday 9th September 1992 at which Mr Stephen Kirby BSc, CEng, Director of Estates, gave a talk and tour of the new Private Ward Unit and Ultra Clean Ventilation Theatre at Epsom General Hospital. The new Northey Ward, is a result of the refurbishment of what was a 31 bed section of the Hospital Surgical Block on the 5th floor. The new Ward provides a total of 18 single bed Wards, each complete with bathroom/WC, the Unit also accommodates a 5 bed Day Ward. All the facilities provided are of extremely high standard, which given the very tight building programme, detailed elsewhere, is indicative of the dedication of both the Designers and Contractors who are congratulated on their achievement. With regard to the UCV Theatre the following information was prepared by Aidan Hardy who is a Project Engineer with Epsom General Hospital. We are delighted to be able to print this report for our readers. PMID:10122458

  10. SLIT ADJUSTMENT CLAMP

    DOEpatents

    McKenzie, K.R.

    1959-07-01

    An electrode support which permits accurate alignment and adjustment of the electrode in a plurality of planes and about a plurality of axes in a calutron is described. The support will align the slits in the electrode with the slits of an ionizing chamber so as to provide for the egress of ions. The support comprises an insulator, a leveling plate carried by the insulator and having diametrically opposed attaching screws screwed to the plate and the insulator and diametrically opposed adjusting screws for bearing against the insulator, and an electrode associated with the plate for adjustment therewith.

  11. CMS Frailty Adjustment Model

    PubMed Central

    Kautter, John; Pope, Gregory C.

    2004-01-01

    The authors document the development of the CMS frailty adjustment model, a Medicare payment approach that adjusts payments to a Medicare managed care organization (MCO) according to the functional impairment of its community-residing enrollees. Beginning in 2004, this approach is being applied to certain organizations, such as Program of All-Inclusive Care for the Elderly (PACE), that specialize in providing care to the community-residing frail elderly. In the future, frailty adjustment could be extended to more Medicare managed care organizations. PMID:25372243

  12. A Spouted Bed Reactor Monitoring System for Particulate Nuclear Fuel

    SciTech Connect

    D. S. Wendt; R. L. Bewley; W. E. Windes

    2007-06-01

    operating temperature data from the spouted bed monitoring system are used to determine the bed operating regime and monitor the particle characteristics. Tests have been conducted to determine the sensitivity of the monitoring system to the different operating regimes of the spouted particle bed. The pressure transducer signal response was monitored over a range of particle sizes and gas flow rates while holding bed height constant. During initial testing, the bed monitoring system successfully identified the spouting regime as well as when particles became interlocked and spouting ceased. The particle characterization capabilities of the bed monitoring system are currently being tested and refined. A feedback control module for the bed monitoring system is currently under development. The feedback control module will correlate changes in the bed response to changes in the particle characteristics and bed spouting regime resulting from the coating and/or conversion process. The feedback control module will then adjust the gas composition, gas flow rate, and run duration accordingly to maintain the bed in the desired spouting regime and produce optimally coated/converted particles.

  13. Remotely Adjustable Hydraulic Pump

    NASA Technical Reports Server (NTRS)

    Kouns, H. H.; Gardner, L. D.

    1987-01-01

    Outlet pressure adjusted to match varying loads. Electrohydraulic servo has positioned sleeve in leftmost position, adjusting outlet pressure to maximum value. Sleeve in equilibrium position, with control land covering control port. For lowest pressure setting, sleeve shifted toward right by increased pressure on sleeve shoulder from servovalve. Pump used in aircraft and robots, where hydraulic actuators repeatedly turned on and off, changing pump load frequently and over wide range.

  14. Fluidized-bed combustion

    SciTech Connect

    Botros, P E

    1990-04-01

    This report describes the activities of the Morgantown Energy Technology Center's research and development program in fluidized-bed combustion from October 1, 1987, to September 30, 1989. The Department of Energy program involves atmospheric and pressurized systems. Demonstrations of industrial-scale atmospheric systems are being completed, and smaller boilers are being explored. These systems include vortex, multi-solid, spouted, dual-sided, air-cooled, pulsed, and waste-fired fluidized-beds. Combustion of low-rank coal, components, and erosion are being studied. In pressurized combustion, first-generation, combined-cycle power plants are being tested, and second-generation, advanced-cycle systems are being designed and cost evaluated. Research in coal devolatilization, metal wastage, tube corrosion, and fluidization also supports this area. 52 refs., 24 figs., 3 tabs.

  15. Weighted triangulation adjustment

    USGS Publications Warehouse

    Anderson, Walter L.

    1969-01-01

    The variation of coordinates method is employed to perform a weighted least squares adjustment of horizontal survey networks. Geodetic coordinates are required for each fixed and adjustable station. A preliminary inverse geodetic position computation is made for each observed line. Weights associated with each observed equation for direction, azimuth, and distance are applied in the formation of the normal equations in-the least squares adjustment. The number of normal equations that may be solved is twice the number of new stations and less than 150. When the normal equations are solved, shifts are produced at adjustable stations. Previously computed correction factors are applied to the shifts and a most probable geodetic position is found for each adjustable station. Pinal azimuths and distances are computed. These may be written onto magnetic tape for subsequent computation of state plane or grid coordinates. Input consists of punch cards containing project identification, program options, and position and observation information. Results listed include preliminary and final positions, residuals, observation equations, solution of the normal equations showing magnitudes of shifts, and a plot of each adjusted and fixed station. During processing, data sets containing irrecoverable errors are rejected and the type of error is listed. The computer resumes processing of additional data sets.. Other conditions cause warning-errors to be issued, and processing continues with the current data set.

  16. Combustion in fluidized beds

    SciTech Connect

    Dry, F.J.; La Nauze, R.D. )

    1990-07-01

    Circulating fluidized-bed (CFB) combustion systems have become popular since the late 1970s, and, given the current level of activity in the area,it is clear that this technology has a stable future in the boiler market. For standard coal combustion applications, competition is fierce with mature pulverized-fuel-based (PF) technology set to maintain a strong profile. CFB systems, however, can be more cost effective than PF systems when emission control is considered, and, as CFB technology matures, it is expected that an ever-increasing proportion of boiler installations will utilize the CFB concept. CFB systems have advantages in the combustion of low-grade fuels such as coal waste and biomass. In competition with conventional bubbling beds, the CFB boiler often demonstrates superior carbon burn-out efficiency. The key to this combustion technique is the hydrodynamic behavior of the fluidized bed. This article begins with a description of the fundamental fluid dynamic behavior of the CFB system. This is followed by an examination of the combustion process in such an environment and a discussion of the current status of the major CFB technologies.

  17. The internal organization of hospitals: a descriptive study.

    PubMed Central

    Sloan, F A

    1980-01-01

    This study presents descriptive information on several dimensions of the internal organization of hospitals, with particular emphasis on medical staff, using data from two unique national surveys. Three alternative theories of hospital behavior by economists are described and evaluated with these data. The study also shows how standard bed size, teaching, and ownership categories relate to important features of hospital organization. In this way, understanding of these standard "control" variables is enhanced. For example, systematic organizational differences between proprietary and other hospitals are reported, holding bed size and teaching status constant. No single theory of hospital behavior emerges as dominant. The tables demonstrate the diversity of hospitals and the likelihood that no single model can adequately describe the behavior of all hospitals. PMID:7204062

  18. Involvement of HMO-based pharmacists in clinical rounds at contract hospitals.

    PubMed

    Yee, D K; Veal, J H; Trinh, B; Bauer, S; Freeman, C H

    1997-03-15

    The contributions of managed care pharmacists who participate in clinical rounds at contract hospitals are described. A program in which pharmacists employed by Kaiser Permanente go on rounds at two contract hospitals as part of a multidisciplinary Kaiser team was implemented in January 1995. The rounding pharmacist reviews patients' charts, assesses optimal drug therapy, intervenes proactively, identifies candidates for home i.v. therapy, facilitates patient discharge, and provides on-the-spot drug information. Other services include therapeutic drug monitoring, dosage-adjustment recommendations, counseling, consultations, detecting adverse drug reactions, and education. The pharmacist documents all services and interventions, and their impact. At one hospital, a 500-bed institution, there were 1097 recommendations for intervention between April 1995 and May 1996. More than 99% of these recommendations were accepted. Over the 14-month period, the Kaiser team saved an estimated $523,907 and cost an estimated $57,643 (not counting benefits) in pharmacist participation. Managed care pharmacists on rounds at contract hospitals influenced enrolled patients' pharmacotherapy and reduced the plan's costs. PMID:9075495

  19. Risk adjustment for pediatric quality indicators.

    PubMed

    Kuhlthau, Karen; Ferris, Timothy G G; Iezzoni, Lisa I

    2004-01-01

    The movement to measure medical care quality has been accelerating, spurred on by evidence of poor quality of care and trials of interventions to improve care. Appropriate measurement of quality of care is an essential aspect of improving the quality of care, yet some quality measures may be influenced by patients' attributes unrelated to quality of care. Risk adjustment is the term commonly applied to those methods that account for patient-related attributes, making measurement of health care quality as comparable as possible across providers or organizations seeing different mixes of patients. The measurement of quality of care for children poses specific challenges. In addition to these measurement challenges, analysts must ensure that quality comparisons among doctors, groups of doctors, hospitals, or health plans are not adversely affected by the likelihood that different types of patients seek care in different places. Although some techniques designed to adjust performance measures for case mix were developed for both adults and children, other systems are specific to childhood circumstances. The theoretical issues involved in risk-adjusting childhood outcomes measures for newborns in the neonatal intensive care unit were reviewed recently. Here, we go beyond the neonatal intensive care unit setting to consider risk adjustment for pediatric quality measures more broadly. In particular, we 1) review the conceptual background for risk-adjusting quality measures, 2) present policy issues related to adjusting pediatric quality measures, and 3) catalog existing risk-adjustment methodologies for pediatric quality measures. We conclude with an overall assessment of the status of risk adjustment for pediatric quality measures and recommendations for additional research and application. PMID:14702503

  20. [The hospital ship Jutlandia].

    PubMed

    Winge, M

    1996-01-01

    The Danish contribution to the United Nations action during the Korean War (1950-52) was the hospital ship "Jutlandia". The motorvessel Jutlandia - 8.500 tons - was built by the Nakskov Shipyard in 1934, and was rebuilt in three months at the same shipyard to a modern hospital ship with 300 beds, 3 operating theatres, a dental clinic, an x-ray department etc. The crew and the hospital staff consisted approximately each of 100 persons. Jutlandia sailed for Korea on Jan. 23. 1951 and the expedition ended in Copenhagen on Oct. 16. 1953. On the first two cruises the ship was stationed at Pusan. During the first period mostly as an "evacuation sick-bay" and during the second period the ship was opened for Korean military and civil patients, and extensive help was given to the local population on shore. While in Denmark between the second and third cruise a helicopter deck was installed and the operating theatre for neuro-surgery was changed to an opthalmic clinic. This time the ship was stationed at the Bay of Ichon so close to the front, that the wounded could be admitted directly from the advanced dressing stations. On the return journeys to Europe patients were sailed to their home countries. Commodore Kai Hammerich was in charge of the expedition and captain Christen Kondrup was in charge of the ship, throughout the whole expedition. PMID:11625136

  1. National survey of hospital patients.

    PubMed Central

    Bruster, S.; Jarman, B.; Bosanquet, N.; Weston, D.; Erens, R.; Delbanco, T. L.

    1994-01-01

    OBJECTIVE--To survey patients' opinions of their experiences in hospital in order to produce data that can help managers and doctors to identify and solve problems. DESIGN--Random sample of 36 NHS hospitals, stratified by size of hospital (number of beds), area (north, midlands, south east, south west), and type of hospital (teaching or non-teaching, trust or directly managed). From each hospital a random sample of, on average, 143 patients was interviewed at home or the place of discharge two to four weeks after discharge by means of a structured questionnaire about their treatment in hospital. SUBJECTS--5150 randomly chosen NHS patients recently discharged from acute hospitals in England. Subjects had been patients on medical and surgical wards apart from paediatric, maternity, psychiatric, and geriatric wards. MAIN OUTCOME MEASURES--Patients' responses to direct questions about preadmission procedures, admission, communication with staff, physical care, tests and operations, help from staff, pain management, and discharge planning. Patients' responses to general questions about their degree of satisfaction in hospitals. RESULTS--Problems were reported by patients, particularly with regard to communication with staff (56% (2824/5020) had not been given written or printed information); pain management (33% (1042/3162) of those suffering pain were in pain all or most of the time); and discharge planning (70% (3599/5124) had not been told about warning signs and 62% (3177/5119) had not been told when to resume normal activities). Hospitals failed to reach the standards of the Patient's Charter--for example, in explaining the treatment proposed and giving patients the option of not taking part in student training. Answers to questions about patient satisfaction were, however, highly positive but of little use to managers. CONCLUSIONS--This survey has highlighted several problems with treatment in NHS hospitals. Asking patients direct questions about what happened

  2. Lower Mortality in Magnet Hospitals

    PubMed Central

    McHugh, Matthew D.; Kelly, Lesly A.; Smith, Herbert L.; Wu, Evan S.; Vanak, Jill M.; Aiken, Linda H.

    2014-01-01

    Background Although there is evidence that hospitals recognized for nursing excellence—Magnet hospitals—are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why. Objectives To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared with non-Magnet hospitals, and to determine the most likely explanations. Method and Study Design Analysis of linked patient, nurse, and hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression models were used to estimate differences in the odds of mortality and failure-to-rescue for surgical patients treated in Magnet versus non-Magnet hospitals, and to determine the extent to which differences in outcomes can be explained by nursing after accounting for patient and hospital differences. Results Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor's degrees and specialty certification. These nursing factors explained much of the Magnet hospital effect on patient outcomes. However, patients treated in Magnet hospitals had 14% lower odds of mortality (odds ratio 0.86; 95% confidence interval, 0.76–0.98; P = 0.02) and 12% lower odds of failure-to-rescue (odds ratio 0.88; 95% confidence interval, 0.77–1.01; P = 0.07) while controlling for nursing factors as well as hospital and patient differences. Conclusions The lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes. PMID:24022082

  3. Lower Mortality in Magnet Hospitals

    PubMed Central

    McHugh, Matthew D.; Kelly, Lesly A.; Smith, Herbert L.; Wu, Evan S.; Vanak, Jill M.; Aiken, Linda H.

    2012-01-01

    Background Although there is evidence that hospitals recognized for nursing excellence— Magnet hospitals—are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why. Objectives To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared to non-Magnet hospitals, and to determine the most likely explanations. Method and Study Design Analysis of linked patient, nurse, and hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression models were used to estimate differences in the odds of mortality and failure-to-rescue for surgical patients treated in Magnet vs. non-Magnet hospitals, and to determine the extent to which differences in outcomes can be explained by nursing after accounting for patient and hospital differences. Results Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor’s degrees and specialty certification. These nursing factors explained much of the Magnet hospital effect on patient outcomes. However, patients treated in Magnet hospitals had 14% lower odds of mortality (OR 0.86, 95% CI 0.76-0.98, p=0.02) and 12% lower odds of failure-to-rescue (OR 0.88, 95% CI 0.77-1.01, p=0.07) while controlling for nursing factors as well as hospital and patient differences. Conclusions Magnet hospitals have lower mortality than is fully accounted for by measured characteristics of nursing. Magnet recognition likely both identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes. PMID:23047129

  4. Partial covariate adjusted regression

    PubMed Central

    Şentürk, Damla; Nguyen, Danh V.

    2008-01-01

    Covariate adjusted regression (CAR) is a recently proposed adjustment method for regression analysis where both the response and predictors are not directly observed (Şentürk and Müller, 2005). The available data has been distorted by unknown functions of an observable confounding covariate. CAR provides consistent estimators for the coefficients of the regression between the variables of interest, adjusted for the confounder. We develop a broader class of partial covariate adjusted regression (PCAR) models to accommodate both distorted and undistorted (adjusted/unadjusted) predictors. The PCAR model allows for unadjusted predictors, such as age, gender and demographic variables, which are common in the analysis of biomedical and epidemiological data. The available estimation and inference procedures for CAR are shown to be invalid for the proposed PCAR model. We propose new estimators and develop new inference tools for the more general PCAR setting. In particular, we establish the asymptotic normality of the proposed estimators and propose consistent estimators of their asymptotic variances. Finite sample properties of the proposed estimators are investigated using simulation studies and the method is also illustrated with a Pima Indians diabetes data set. PMID:20126296

  5. Marketing strategy determinants in rural hospitals.

    PubMed

    Smith, H L; Haley, D; Piland, N F

    1993-01-01

    Rural hospitals confront an inauspicious environment due to changes in patient reimbursement and medical practice. Facing a situation of declining revenues, marketing presents an option for rural hospitals to adapt to the growing constraints. This paper analyzes the determinants of marketing strategy emphasis in rural hospitals. The conceptual model adopted in this study predicts that prior performance and contextual variables explain marketing strategy emphasis. The relationships are examined in a case study of rural New Mexico hospitals. Results suggest that prior performance and several contextual variables explain variations in marketing strategy emphasis. In particular, higher gross patient revenues are associated with more emphasis on television and radio advertising. Furthermore, rural New Mexico hospitals with high numbers of licensed beds and medical staff members, or that are affiliated with a chain organization, place greater emphasis on market research and market planning. The implications for marketing practice in rural hospitals are discussed. PMID:10135505

  6. Hospital fundamentals.

    PubMed

    Althausen, Peter L; Hill, Austin D; Mead, Lisa

    2014-07-01

    Under the current system, orthopaedic trauma surgeons must work in some form of hospital setting as our primary service involves treatment of the trauma patient. We must not forget that just as a trauma center cannot exist without our services, we cannot function without their support. As a result, a clear understanding of the balance between physicians and hospitals is paramount. Historical perspective enables physicians and hospital personnel alike to understand the evolution of hospital-physician relationship. This process should be understood upon completion of this chapter. The relationship between physicians and hospitals is becoming increasingly complex and multiple forms of integration exist such as joint ventures, gain sharing, and co-management agreements. For the surgeon to negotiate well, an understanding of hospital governance and the role of the orthopaedic traumatologist is vital to success. An understanding of the value provided by the traumatologist includes all aspects of care including efficiency, availability, cost effectiveness, and research activities. To create effective and sustainable healthcare institutions, physicians and hospitals must be aligned over a sustained period of time. Unfortunately, external forces have eroded the historical basis for the working relationship between physicians and hospitals. Increased competition and reimbursement cuts, coupled with the increasing demands for quality, efficiency, and coordination and the payment changes outlined in healthcare reform, have left many organizations wondering how to best rebuild the relationship. The principal goal for the physician when partnering with a hospital or healthcare entity is to establish a sustainable model of service line management that protects or advances the physician's ability to make impactful improvements in quality of patient care, decreases in healthcare costs, and improvements in process efficiency through evidence-based practices and protocols. PMID

  7. [Multifunctional Nursing Beds Based on Intelligent Detection and Recovery].

    PubMed

    Jiang, Jiehuil; Pan, Xiaojie; Jiang, Xianbo; Yan, Zhuangzhi

    2016-01-01

    With the advent of the aging society, there will be a wide range of applications if novel intelligent multifunctional nursing beds can be developed for hospitals, bead houses and families at the same time. By listing and analyzing existing products, this paper summarized four function categories for multifunctional nursing beds, including security assurance, treatment aid, comfortability optimization, and human-machine interaction and communication. Finally, by comparing existing functions and potential user requirements, this paper proposed four function development trends, including physiological parameter monitoring, sleep aid, intelligent temperature control, and video communication. PMID:27197499

  8. Campaign supports new name for TX hospital. Effort expands children's hospital's image and increases awareness.

    PubMed

    2007-01-01

    For years, the North Texas Hospital for Children at Medical City in Dallas struggled with its brand awareness. It's long-winded name was largely unknown among the city's 1.2 million residents. The hospital needed a new name and it needed one fast. The year 2005 proved to be both a burden and an opportunity for the 311-bed pediatric hospital. It survived a legal battle with a local competitor for the right to use the word "children's" in its name, created a new identity, and launched a three-year branding initiative to introduce its new name: Medical City Children's Hospital. PMID:17601087

  9. Cost characteristics of hospitals.

    PubMed

    Smet, Mike

    2002-09-01

    Modern hospitals are complex multi-product organisations. The analysis of a hospital's production and/or cost structure should therefore use the appropriate techniques. Flexible functional forms based on the neo-classical theory of the firm seem to be most suitable. Using neo-classical cost functions implicitly assumes minimisation of (variable) costs given that input prices and outputs are exogenous. Local and global properties of flexible functional forms and short-run versus long-run equilibrium are further issues that require thorough investigation. In order to put the results based on econometric estimations of cost functions in the right perspective, it is important to keep these considerations in mind when using flexible functional forms. The more recent studies seem to agree that hospitals generally do not operate in their long-run equilibrium (they tend to over-invest in capital (capacity and equipment)) and that it is therefore appropriate to estimate a short-run variable cost function. However, few studies explicitly take into account the implicit assumptions and restrictions embedded in the models they use. An alternative method to explain differences in costs uses management accounting techniques to identify the cost drivers of overhead costs. Related issues such as cost-shifting and cost-adjusting behaviour of hospitals and the influence of market structure on competition, prices and costs are also discussed shortly. PMID:12220092

  10. Intensive Care in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Freeman, Victoria A.; Walsh, Joan; Rudolf, Matthew; Slifkin, Rebecca T.; Skinner, Asheley Cockrell

    2007-01-01

    Context: Although critical access hospitals (CAHs) have limitations on number of acute care beds and average length of stay, some of them provide intensive care unit (ICU) services. Purpose: To describe the facilities, equipment, and staffing used by CAHs for intensive care, the types of patients receiving ICU care, and the perceived impact of…

  11. Bed drain cover assembly for a fluidized bed

    DOEpatents

    Comparato, Joseph R.; Jacobs, Martin

    1982-01-01

    A loose fitting movable cover plate (36), suitable for the severe service encountered in a fluidized bed combustor (10), restricts the flow of solids into the combustor drain lines (30) during shutdown of the bed. This cover makes it possible to empty spent solids from the bed drain lines which would otherwise plug the piping between the drain and the downstream metering device. This enables use of multiple drain lines each with a separate metering device for the control of solids flow rate.

  12. Bed Rest Muscular Atrophy

    NASA Technical Reports Server (NTRS)

    Greenleaf, John E.

    2000-01-01

    A major debilitating response from prolonged bed rest (BR) is muscle atrophy, defined as a "decrease in size of a part of tissue after full development has been attained: a wasting away of tissue as from disuse, old age, injury or disease". Part of the complicated mechanism for the dizziness, increased body instability, and exaggerated gait in patients who arise immediately after BR may be a result of not only foot pain, but also of muscular atrophy and associated reduction in lower limb strength. Also, there seems to be a close association between muscle atrophy and bone atrophy. A discussion of many facets of the total BR homeostatic syndrome has been published. The old adage that use determines form which promotes function of bone (Wolff's law) also applies to those people exposed to prolonged BR (without exercise training) in whom muscle atrophy is a consistent finding. An extreme case involved a 16-year-old boy who was ordered to bed by his mother in 1932: after 50 years in bed he had "a lily-white frame with limbs as thin as the legs of a ladder-back chair". These findings emphasize the close relationship between muscle atrophy and bone atrophy. In addition to loss of muscle mass during deconditioning, there is a significant loss of muscle strength and a decrease in protein synthesis. Because the decreases in force (strength) are proportionately greater than those in fiber size or muscle cross-sectional area, other contributory factors must be involved; muscle fiber dehydration may be important.

  13. Coal Bed Methane Primer

    SciTech Connect

    Dan Arthur; Bruce Langhus; Jon Seekins

    2005-05-25

    During the second half of the 1990's Coal Bed Methane (CBM) production increased dramatically nationwide to represent a significant new source of income and natural gas for many independent and established producers. Matching these soaring production rates during this period was a heightened public awareness of environmental concerns. These concerns left unexplained and under-addressed have created a significant growth in public involvement generating literally thousands of unfocused project comments for various regional NEPA efforts resulting in the delayed development of public and fee lands. The accelerating interest in CBM development coupled to the growth in public involvement has prompted the conceptualization of this project for the development of a CBM Primer. The Primer is designed to serve as a summary document, which introduces and encapsulates information pertinent to the development of Coal Bed Methane (CBM), including focused discussions of coal deposits, methane as a natural formed gas, split mineral estates, development techniques, operational issues, producing methods, applicable regulatory frameworks, land and resource management, mitigation measures, preparation of project plans, data availability, Indian Trust issues and relevant environmental technologies. An important aspect of gaining access to federal, state, tribal, or fee lands involves education of a broad array of stakeholders, including land and mineral owners, regulators, conservationists, tribal governments, special interest groups, and numerous others that could be impacted by the development of coal bed methane. Perhaps the most crucial aspect of successfully developing CBM resources is stakeholder education. Currently, an inconsistent picture of CBM exists. There is a significant lack of understanding on the parts of nearly all stakeholders, including industry, government, special interest groups, and land owners. It is envisioned the Primer would being used by a variety of

  14. Bed occupancy, turnover interval and MRSA rates in Northern Ireland.

    PubMed

    Cunningham, Joseph B; Kernohan, W George; Rush, Thomas

    The data describe bed turnover intervals (TI), bed percentage occupancy (PO) and methicillin-resistant Staphylococcus aureus (MRSA) rates per 1000 bed days of patient episodes. It was collected from annual hospital statistics in Northern Ireland (NI) and from the Communicable Diseases Surveillance Centre (CDSC) NI. The descriptive data show 6 of the general 11 surgical Trusts, out of a total of 12 Trusts examined, had PO greater than 85%; and all 11 medical facilities in these Trusts had occupancy rates greater than 85%. A significant correlation was established between turnover interval and MRSA per 1000 bed days of patient episodes in acute services beds. The correlation of PO with MRSA rates was 0.49 (ns). The conclusions drawn from the study are that in many Trusts the rates of bed occupancy for general surgery and general medicine is in excess of national guidelines and rapid turnover of patients is related to rates of MRSA infection. The implications for nurses and managers are discussed. PMID:16628168

  15. Biparticle fluidized bed reactor

    DOEpatents

    Scott, C.D.; Marasco, J.A.

    1995-04-25

    A fluidized bed reactor system utilizes a fluid phase, a retained fluidized primary particulate phase, and a migratory second particulate phase. The primary particulate phase is a particle such as a gel bead containing an immobilized biocatalyst. The secondary particulate phase, continuously introduced and removed in either cocurrent or countercurrent mode, acts in a secondary role such as a sorbent to continuously remove a product or by-product constituent from the fluid phase. Introduction and removal of the sorbent phase is accomplished through the use of feed screw mechanisms and multivane slurry valves. 3 figs.

  16. Biparticle fluidized bed reactor

    DOEpatents

    Scott, Charles D.; Marasco, Joseph A.

    1995-01-01

    A fluidized bed reactor system utilizes a fluid phase, a retained fluidized primary particulate phase, and a migratory second particulate phase. The primary particulate phase is a particle such as a gel bead containing an immobilized biocatalyst. The secondary particulate phase, continuously introduced and removed in either cocurrent or countercurrent mode, acts in a secondary role such as a sorbent to continuously remove a product or by-product constituent from the fluid phase. Introduction and removal of the sorbent phase is accomplished through the use of feed screw mechanisms and multivane slurry valves.

  17. Biparticle fluidized bed reactor

    DOEpatents

    Scott, Charles D.; Marasco, Joseph A.

    1996-01-01

    A fluidized bed reactor system which utilizes a fluid phase, a retained fluidized primary particulate phase, and a migratory second particulate phase. The primary particulate phase is a particle such as a gel bead containing an immobilized biocatalyst. The secondary and tertiary particulate phases, continuously introduced and removed simultaneously in the cocurrent and countercurrent mode, act in a role such as a sorbent to continuously remove a product or by-product constituent from the fluid phase. Means for introducing and removing the sorbent phases include feed screw mechanisms and multivane slurry valves.

  18. Biparticle fluidized bed reactor

    DOEpatents

    Scott, Charles D.

    1993-01-01

    A fluidized bed reactor system which utilizes a fluid phase, a retained fluidized primary particulate phase, and a migratory second particulate phase. The primary particulate phase is a particle such as a gel bead containing an immobilized biocatalyst. The secondary particulate phase, continuously introduced and removed in either cocurrent or countercurrent mode, acts in a secondary role such as a sorbent to continuously remove a product or by-product constituent from the fluid phase. Introduction and removal of the sorbent phase is accomplished through the use of feed screw mechanisms and multivane slurry valves.

  19. Biparticle fluidized bed reactor

    DOEpatents

    Scott, C.D.; Marasco, J.A.

    1996-02-27

    A fluidized bed reactor system is described which utilizes a fluid phase, a retained fluidized primary particulate phase, and a migratory second particulate phase. The primary particulate phase is a particle such as a gel bead containing an immobilized biocatalyst. The secondary and tertiary particulate phases, continuously introduced and removed simultaneously in the cocurrent and countercurrent mode, act in a role such as a sorbent to continuously remove a product or by-product constituent from the fluid phase. Means for introducing and removing the sorbent phases include feed screw mechanisms and multivane slurry valves. 3 figs.

  20. Particle bed reactor modeling

    NASA Technical Reports Server (NTRS)

    Sapyta, Joe; Reid, Hank; Walton, Lew

    1993-01-01

    The topics are presented in viewgraph form and include the following: particle bed reactor (PBR) core cross section; PBR bleed cycle; fuel and moderator flow paths; PBR modeling requirements; characteristics of PBR and nuclear thermal propulsion (NTP) modeling; challenges for PBR and NTP modeling; thermal hydraulic computer codes; capabilities for PBR/reactor application; thermal/hydralic codes; limitations; physical correlations; comparison of predicted friction factor and experimental data; frit pressure drop testing; cold frit mask factor; decay heat flow rate; startup transient simulation; and philosophy of systems modeling.

  1. Biparticle fluidized bed reactor

    DOEpatents

    Scott, C.D.

    1993-12-14

    A fluidized bed reactor system which utilizes a fluid phase, a retained fluidized primary particulate phase, and a migratory second particulate phase is described. The primary particulate phase is a particle such as a gel bead containing an immobilized biocatalyst. The secondary particulate phase, continuously introduced and removed in either cocurrent or countercurrent mode, acts in a secondary role such as a sorbent to continuously remove a product or by-product constituent from the fluid phase. Introduction and removal of the sorbent phase is accomplished through the use of feed screw mechanisms and multivane slurry valves. 3 figures.

  2. Hospital Hints

    MedlinePlus

    ... Division of Geriatrics and Clinical Gerontology Division of Neuroscience FAQs Funding Opportunities Intramural Research Program Office of ... have to spend the night in the hospital. Learning more about what to expect and about people ...

  3. Hospital philanthropy.

    PubMed

    Smith, Dean G; Clement, Jan P

    2013-01-01

    It remains an open question whether hospital spending on fundraising efforts to garner philanthropy is a good use of funds. Research and industry reports provide conflicting results. We describe the accounting and data challenges in analysis of hospital philanthropy, which include measurement of donations, measurement of fundraising expenses, and finding the relationships among organizations where these cash flows occur. With these challenges, finding conflicting results is not a surprise. PMID:23614267

  4. Fast fluidized bed steam generator

    DOEpatents

    Bryers, Richard W.; Taylor, Thomas E.

    1980-01-01

    A steam generator in which a high-velocity, combustion-supporting gas is passed through a bed of particulate material to provide a fluidized bed having a dense-phase portion and an entrained-phase portion for the combustion of fuel material. A first set of heat transfer elements connected to a steam drum is vertically disposed above the dense-phase fluidized bed to form a first flow circuit for heat transfer fluid which is heated primarily by the entrained-phase fluidized bed. A second set of heat transfer elements connected to the steam drum and forming the wall structure of the furnace provides a second flow circuit for the heat transfer fluid, the lower portion of which is heated by the dense-phase fluidized bed and the upper portion by the entrained-phase fluidized bed.

  5. Japanese hospitals--culture and competition: a study of ten hospitals.

    PubMed

    Anbäcken, O

    1994-01-01

    Japanese health care is characterized by a pluralistic system with a high degree of private producers. Central government regulates the prices and the financing system. All citizens are covered by a mandatory employment-based health insurance operating on a non-profit basis. The consumer has a free choice of physician and hospital. A comparison between Japan, Sweden and some other countries shows significant dissimilarities in the length of stay, number of treatments per hospital bed and year and the staffing of hospitals. About 80 per cent of the hospitals and 94 per cent of the clinics are privately owned. The typical private hospital owned by a physician has less than 100 beds. In this paper, data collected (1992/93) in an empirical study of Japanese hospitals and their leadership is presented. Also discussed are the hospitals' style of management, tools and strategies for competition and competences--personal and formal skills required of the leadership in the hospital. There follows a study of ten hospitals, among which hospital directors and chief physicians were interviewed. Interviews are also made with key persons in the Ministry of Health and Welfare and other organizations in the health care field. The result is also analysed from a cultural perspective--'what kind of impact does the Japanese culture have on the health care organization?' and/or 'what kind of sub-culture is developed in the Japanese hospitals'. Some comparisons are made with Sweden, USA, Canada and Germany. The different roles of the professions in the hospital are included in the study as well as the incentives for different kinds of strategies--specialization, growing in size, investments in new equipment, different kind of ownership and hospitals. Another issue discussed is the attempt to uncover whether there is an implicit distribution of specialties--silent agreements between hospitals, etc. PMID:10137135

  6. Rural to Urban Adjustment

    ERIC Educational Resources Information Center

    Abramson, Jane A.

    Personal interviews with 100 former farm operators living in Saskatoon, Saskatchewan, were conducted in an attempt to understand the nature of the adjustment process caused by migration from rural to urban surroundings. Requirements for inclusion in the study were that respondents had owned or operated a farm for at least 3 years, had left their…

  7. Self adjusting inclinometer

    DOEpatents

    Hunter, Steven L.

    2002-01-01

    An inclinometer utilizing synchronous demodulation for high resolution and electronic offset adjustment provides a wide dynamic range without any moving components. A device encompassing a tiltmeter and accompanying electronic circuitry provides quasi-leveled tilt sensors that detect highly resolved tilt change without signal saturation.

  8. Self Adjusting Sunglasses

    NASA Technical Reports Server (NTRS)

    1986-01-01

    Corning Glass Works' Serengeti Driver sunglasses are unique in that their lenses self-adjust and filter light while suppressing glare. They eliminate more than 99% of the ultraviolet rays in sunlight. The frames are based on the NASA Anthropometric Source Book.

  9. Capacitively-Heated Fluidized Bed

    NASA Technical Reports Server (NTRS)

    Mchale, E. J.

    1982-01-01

    Fluidized-bed chamber in which particles in bed are capacitively heated produces high yields of polycrystalline silicon for semiconductor devices. Deposition of unrecoverable silicon on chamber wall is reduced, and amount of recoverable silicon depositing on seed particles in bed is increased. Particles also have a size and density suitable for direct handling without consolidation, unlike silicon dust produced in heated-wall chambers.

  10. Fluidized bed boiler feed system

    DOEpatents

    Jones, Brian C.

    1981-01-01

    A fluidized bed boiler feed system for the combustion of pulverized coal. Coal is first screened to separate large from small particles. Large particles of coal are fed directly to the top of the fluidized bed while fine particles are first mixed with recycled char, preheated, and then fed into the interior of the fluidized bed to promote char burnout and to avoid elutriation and carryover.

  11. Pressurized fluidized bed reactor

    DOEpatents

    Isaksson, J.

    1996-03-19

    A pressurized fluid bed reactor power plant includes a fluidized bed reactor contained within a pressure vessel with a pressurized gas volume between the reactor and the vessel. A first conduit supplies primary gas from the gas volume to the reactor, passing outside the pressure vessel and then returning through the pressure vessel to the reactor, and pressurized gas is supplied from a compressor through a second conduit to the gas volume. A third conduit, comprising a hot gas discharge, carries gases from the reactor, through a filter, and ultimately to a turbine. During normal operation of the plant, pressurized gas is withdrawn from the gas volume through the first conduit and introduced into the reactor at a substantially continuously controlled rate as the primary gas to the reactor. In response to an operational disturbance of the plant, the flow of gas in the first, second, and third conduits is terminated, and thereafter the pressure in the gas volume and in the reactor is substantially simultaneously reduced by opening pressure relief valves in the first and third conduits, and optionally by passing air directly from the second conduit to the turbine. 1 fig.

  12. Pressurized fluidized bed reactor

    DOEpatents

    Isaksson, Juhani

    1996-01-01

    A pressurized fluid bed reactor power plant includes a fluidized bed reactor contained within a pressure vessel with a pressurized gas volume between the reactor and the vessel. A first conduit supplies primary gas from the gas volume to the reactor, passing outside the pressure vessel and then returning through the pressure vessel to the reactor, and pressurized gas is supplied from a compressor through a second conduit to the gas volume. A third conduit, comprising a hot gas discharge, carries gases from the reactor, through a filter, and ultimately to a turbine. During normal operation of the plant, pressurized gas is withdrawn from the gas volume through the first conduit and introduced into the reactor at a substantially continuously controlled rate as the primary gas to the reactor. In response to an operational disturbance of the plant, the flow of gas in the first, second, and third conduits is terminated, and thereafter the pressure in the gas volume and in the reactor is substantially simultaneously reduced by opening pressure relief valves in the first and third conduits, and optionally by passing air directly from the second conduit to the turbine.

  13. [The weighted health care unit: a new tool for hospital budgeting].

    PubMed

    Bestard Perelló, J J; Sevilla Pérez, F; Corella Monzón, I; Elola Somoza, J

    1993-01-01

    Hospital budgets must be based on estimated workload in order to fairly distribute available financial resources. A tool to measure hospital production is need to achieve this aim. We present in this article the results of a study on hospital cost which was carried out to design a new unit for measuring intermediate hospital products: the Weighted Health Care Unit (Unidad Ponderada Asistencial: UPA). Thereafter we use multiple regression to find out structure, services and activity variables which explain the variations in expenses per UPA among 64 hospitals of INSALUD. Significant variables include: doctors per hospital bed, hospital staff (sanitary personnel except doctors plus administrative assistants) per bed, hospital size (less than 200 beds), ICU beds percentage, oncology service, UPAs per bed average length of stay. These variables, along with interactions between them, explain 91.4% of the variance of expenses per UPA. The UPA and statistical modeling allow a better understanding of hospital expenses and can be very useful in coordinating budgets to hospital activity taking into account the different characteristics of each hospital. PMID:8169037

  14. Debris-bed friction of hard-bedded glaciers

    USGS Publications Warehouse

    Cohen, D.; Iverson, N.R.; Hooyer, T.S.; Fischer, U.H.; Jackson, M.; Moore, P.L.

    2005-01-01

    [1] Field measurements of debris-bed friction on a smooth rock tablet at the bed of Engabreen, a hard-bedded, temperate glacier in northern Norway, indicated that basal ice containing 10% debris by volume exerted local shear traction of up to 500 kPa. The corresponding bulk friction coefficient between the dirty basal ice and the tablet was between 0.05 and 0.08. A model of friction in which nonrotating spherical rock particles are held in frictional contact with the bed by bed-normal ice flow can account for these measurements if the power law exponent for ice flowing past large clasts is 1. A small exponent (n < 2) is likely because stresses in ice are small and flow is transient. Numerical calculations of the bed-normal drag force on a sphere in contact with a flat bed using n = 1 show that this force can reach values several hundred times that on a sphere isolated from the bed, thus drastically increasing frictional resistance. Various estimates of basal friction are obtained from this model. For example, the shear traction at the bed of a glacier sliding at 20 m a-1 with a geothermally induced melt rate of 0.006 m a-1 and an effective pressure of 300 kPa can exceed 100 kPa. Debris-bed friction can therefore be a major component of sliding resistance, contradicting the common assumption that debris-bed friction is negligible. Copyright 2005 by the American Geophysical Union.

  15. Fluidized bed deposition of diamond

    DOEpatents

    Laia, Jr., Joseph R.; Carroll, David W.; Trkula, Mitchell; Anderson, Wallace E.; Valone, Steven M.

    1998-01-01

    A process for coating a substrate with diamond or diamond-like material including maintaining a substrate within a bed of particles capable of being fluidized, the particles having substantially uniform dimensions and the substrate characterized as having different dimensions than the bed particles, fluidizing the bed of particles, and depositing a coating of diamond or diamond-like material upon the substrate by chemical vapor deposition of a carbon-containing precursor gas mixture, the precursor gas mixture introduced into the fluidized bed under conditions resulting in excitation mechanisms sufficient to form the diamond coating.

  16. Method for packing chromatographic beds

    DOEpatents

    Freeman, David H.; Angeles, Rosalie M.; Keller, Suzanne

    1991-01-01

    Column chromatography beds are packed through the application of static force. A slurry of the chromatography bed material and a non-viscous liquid is filled into the column plugged at one end, and allowed to settle. The column is transferred to a centrifuge, and centrifuged for a brief period of time to achieve a predetermined packing level, at a range generally of 100-5,000 gravities. Thereafter, the plug is removed, other fixtures may be secured, and the liquid is allowed to flow out through the bed. This results in an evenly packed bed, with no channeling or preferential flow characteristics.

  17. A two-dimensional discrete particle model of gravel bed river systems

    NASA Astrophysics Data System (ADS)

    MacVicar, B. J.; Parrott, L.; Roy, A. G.

    2006-09-01

    The formation of bed forms in gravel bed rivers acts as a control on stream ecology and the response of rivers to floods. Available models do not reproduce the range of observed bed forms and do not consider interactions between the bed and flow hydraulics. The model presented here considers a gravel bed river as a complex system in which sediment clasts are represented as discrete elements. Simple and local rules describe the sediment and flow dynamics. Using a trimodal sediment distribution, irregular forms that scale with particle diameter develop without explicit feedback mechanisms because of the tendency of large particles to roll along the bed surface and collect into chains. Feedback mechanisms such as imbrication increase the effective entrainment threshold of groups of large particles and increase the stability of these imbricate forms. A second type of bed form is associated with saltating grains and emerges where particles are transported at a preferred distance. The development and maintenance of larger-scale bed forms require feedback between the bed and flow properties. By allowing mean velocity to adjust to bed morphology and considering the effect of acceleration on turbulence generation and mean velocity profiles we demonstrate the emergence of forms similar in morphology to gravel sheets, dunes, and riffle pools. The model is best used to complement field-based studies and is suitable for testing hypotheses of streambed behavior.

  18. Hospitalization Type and Subsequent Severe Sepsis

    PubMed Central

    Dickson, Robert P.; Rogers, Mary A. M.; Langa, Kenneth M.; Iwashyna, Theodore J.

    2015-01-01

    Rationale: Hospitalization is associated with microbiome perturbation (dysbiosis), and this perturbation is more severe in patients treated with antimicrobials. Objectives: To evaluate whether hospitalizations known to be associated with periods of microbiome perturbation are associated with increased risk of severe sepsis after hospital discharge. Methods: We studied participants in the U.S. Health and Retirement Study with linked Medicare claims (1998–2010). We measured whether three hospitalization types associated with increasing severity of probable dysbiosis (non–infection-related hospitalization, infection-related hospitalization, and hospitalization with Clostridium difficile infection [CDI]) were associated with increasing risk for severe sepsis in the 90 days after hospital discharge. We used two study designs: the first was a longitudinal design with between-person comparisons and the second was a self-controlled case series design using within-person comparison. Measurements and Main Results: We identified 43,095 hospitalizations among 10,996 Health and Retirement Study–Medicare participants. In the 90 days following non–infection-related hospitalization, infection-related hospitalization, and hospitalization with CDI, adjusted probabilities of subsequent admission for severe sepsis were 4.1% (95% confidence interval [CI], 3.8–4.4%), 7.1% (95% CI, 6.6–7.6%), and 10.7% (95% CI, 7.7–13.8%), respectively. The incidence rate ratio (IRR) of severe sepsis was 3.3-fold greater during the 90 days after hospitalizations than during other observation periods. The IRR was 30% greater after an infection-related hospitalization versus a non–infection-related hospitalization. The IRR was 70% greater after a hospitalization with CDI than an infection-related hospitalization without CDI. Conclusions: There is a strong dose–response relationship between events known to result in dysbiosis and subsequent severe sepsis hospitalization that is not present

  19. Variability of bed drag on cohesive beds under wave action

    USGS Publications Warehouse

    Safak, Ilgar

    2016-01-01

    Drag force at the bed acting on water flow is a major control on water circulation and sediment transport. Bed drag has been thoroughly studied in sandy waters, but less so in muddy coastal waters. The variation of bed drag on a muddy shelf is investigated here using field observations of currents, waves, and sediment concentration collected during moderate wind and wave events. To estimate bottom shear stress and the bed drag coefficient, an indirect empirical method of logarithmic fitting to current velocity profiles (log-law), a bottom boundary layer model for combined wave-current flow, and a direct method that uses turbulent fluctuations of velocity are used. The overestimation by the log-law is significantly reduced by taking turbulence suppression due to sediment-induced stratification into account. The best agreement between the model and the direct estimates is obtained by using a hydraulic roughness of 10  m in the model. Direct estimate of bed drag on the muddy bed is found to have a decreasing trend with increasing current speed, and is estimated to be around 0.0025 in conditions where wave-induced flow is relatively weak. Bed drag shows an increase (up to fourfold) with increasing wave energy. These findings can be used to test the bed drag parameterizations in hydrodynamic and sediment transport models and the skills of these models in predicting flows in muddy environments.

  20. Use of Tanning Beds and Incidence of Skin Cancer

    PubMed Central

    Zhang, Mingfeng; Qureshi, Abrar A.; Geller, Alan C.; Frazier, Lindsay; Hunter, David J.; Han, Jiali

    2012-01-01

    Purpose We sought to evaluate the risk effect of tanning bed use on skin cancers among teenage and young adults. We also expected to determine whether a dose-response relationship was evident. Patients and Methods We observed 73,494 female nurses for 20 years (from 1989 to 2009) in a large and well-characterized cohort in the United States and investigated whether frequency of tanning bed use during high school/college and at ages 25 to 35 years were associated with a risk of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. We used Cox proportional hazards models and carefully adjusted for host risk factors, ultraviolet index of residence, and sun exposure behaviors at a young age. Results During follow-up, 5,506 nurses were diagnosed with BCC, 403 with SCC, and 349 with melanoma. The multivariable-adjusted hazard ratio (HR) of skin cancer for an incremental increase in use of tanning beds of four times per year during both periods was 1.15 (95% CI, 1.11 to 1.19; P < .001) for BCC, 1.15 (95% CI, 1.01 to 1.31; P = .03) for SCC, and 1.11 (95% CI, 0.97 to 1.27; P = .13) for melanoma. Compared with tanning bed use at ages 25 to 35 years, we found a significantly higher risk of BCC for use during high school/college (multivariable-adjusted HR for use more than six times per year compared with no use was 1.73 during high school/college v 1.28 at ages 25 to 35 years; P for heterogeneity < .001). Conclusion Our data provide evidence for a dose-response relationship between tanning bed use and the risk of skin cancers, especially BCC, and the association is stronger for patients with a younger age at exposure. PMID:22370316

  1. A bed management strategy for overcrowding in the emergency department.

    PubMed

    Barrett, Lynn; Ford, Suzanne; Ward-Smith, Peggy

    2012-01-01

    In 2006, the Institute of Medicine cited growing visit volumes, hospital closures, financial pressures, and operational inefficiencies as the principal reasons for emergency department (ED) overcrowding and called for regulatory measures to resolve the problem. A Midwest medical center with 59,000 annual ED visits instituted a bed management strategy to decrease the need to board, or hold, admitted hospital patients in the ED awaiting transfer to an inpatient care unit. This strategy was successful in improving the hold time from an average of 216 minutes to 103 minutes, or by 52%. This allowed the staff at the hospital to care for an additional 2,936 patients. During this same time, the overall hospital mortality decreased by 0.07% and patient satisfaction scores improved 1%. The greatest outcome from this intervention was realized in the potential revenue increase of over $2 million. PMID:22558725

  2. AAHKS Risk Adjustment Initiative: Why Is It Important?

    PubMed

    Fehring, Thomas K

    2016-06-01

    Risk adjustment is critical when any comparison of hospital performance or surgeon performance on patient outcomes is being measured. The purpose of risk adjustment is to level the playing field in making comparisons of outcome either against the benchmark or across individual providers, hospitals, or provider groups. The consequences of not leveling the playing field may lead to the inappropriate inference of high quality, that is outcomes are better not because of better quality but because the patients are healthy. Additional consequence of not leveling the playing field is the inappropriate inference of low quality, that is outcomes are worse not because of lower quality but because patients are less healthy at the onset. Therefore, it is critically important that risk adjustment is done properly so that access for the patients with the most severe problems will be maintained. Surgeons and hospitals should not be discouraged from providing care for these individuals for fear of publicly reporting outcomes that are not properly risk adjusted. To that end, American Association of Hip and Knee Surgeons created a Risk Adjustment Task Force to collaborate with Center for Medicare and Medicaid Services in creating a more robust risk adjustment model to take into account clinical factors and severity of orthopedic disease. PMID:27157277

  3. Assessing the performance of freestanding hospitals.

    PubMed

    McCue, Michael J; Diana, Mark L

    2007-01-01

    Freestanding hospitals are becoming less common as more hospitals are joining or establishing relationships with multihospital systems. These associations are driven by factors, such as unrelenting competition in local markets, aging physical plants, increasing labor costs, and higher physician fees, that place a high demand on financial assets. Despite these factors, many freestanding hospitals continue to do well financially, showing increases in total profit margins and total cash flow margins. This article examines which market, management, financial, and mission factors are associated with freestanding hospitals with consistently positive cash flows, relative to those without consistently positive cash flows. The study sample consisted of freestanding, nonfederal, short-term, acute care general hospitals with more than 50 beds and three years of annual cash flow data. Data were taken from the annual surveys of the American Hospital Association, the cost reports of the Centers for Medicare and Medicaid Services, and the Area Resource File of the Health Resources and Services Administration. The data were analyzed using logistic regression to identify those factors associated with a consistently positive cash flow. Freestanding hospitals with positive cash flows were found to have a greater market share and to be located in markets with a higher number of physicians and fewer acute care beds; to have fewer unoccupied beds, higher net revenues, greater liquidity, and less debt on hand; and to treat fewer Medicare patients than those without a positive cash flow. The findings suggest that these hospitals are located in resource-rich environments and that they have strong management teams. PMID:17933186

  4. Dynamic bed reactor

    DOEpatents

    Stormo, Keith E.

    1996-07-02

    A dynamic bed reactor is disclosed in which a compressible open cell foam matrix is periodically compressed and expanded to move a liquid or fluid through the matrix. In preferred embodiments, the matrix contains an active material such as an enzyme, biological cell, chelating agent, oligonucleotide, adsorbent or other material that acts upon the liquid or fluid passing through the matrix. The active material may be physically immobilized in the matrix, or attached by covalent or ionic bonds. Microbeads, substantially all of which have diameters less than 50 microns, can be used to immobilize the active material in the matrix and further improve reactor efficiency. A particularly preferred matrix is made of open cell polyurethane foam, which adsorbs pollutants such as polychlorophenol or o-nitrophenol. The reactors of the present invention allow unidirectional non-laminar flow through the matrix, and promote intimate exposure of liquid reactants to active agents such as microorganisms immobilized in the matrix.

  5. Dynamic bed reactor

    SciTech Connect

    Stormo, K.E.

    1996-07-02

    A dynamic bed reactor is disclosed in which a compressible open cell foam matrix is periodically compressed and expanded to move a liquid or fluid through the matrix. In preferred embodiments, the matrix contains an active material such as an enzyme, biological cell, chelating agent, oligonucleotide, adsorbent or other material that acts upon the liquid or fluid passing through the matrix. The active material may be physically immobilized in the matrix, or attached by covalent or ionic bonds. Microbeads, substantially all of which have diameters less than 50 microns, can be used to immobilize the active material in the matrix and further improve reactor efficiency. A particularly preferred matrix is made of open cell polyurethane foam, which adsorbs pollutants such as polychlorophenol or o-nitrophenol. The reactors of the present invention allow unidirectional non-laminar flow through the matrix, and promote intimate exposure of liquid reactants to active agents such as microorganisms immobilized in the matrix. 27 figs.

  6. [Laennec Hospital].

    PubMed

    Dauphin, A; Mazin-Deslandes, C

    2000-01-01

    When the Laennec Hospital of Paris closed, after 366 years of activities for the patients, the articles about the circumstances of the foundation and the main stapes of the institution which became an very famous university hospital it present the available information of the history of the apothecaries, of the "gagnants-maitrise", pharmacists and the pharmacy's interns who succeeded themselves to create and dispense the medicaments necessary to the patients hospitalized or welcomed in ambulatory. It describes the evolution of the places, of the material, of forms, of the organization, of the medicaments and of the missions of what became the Pharmacy department after the recent individualization of the biological analysis in the biochemistry. PMID:11625687

  7. Precision adjustable stage

    DOEpatents

    Cutburth, Ronald W.; Silva, Leonard L.

    1988-01-01

    An improved mounting stage of the type used for the detection of laser beams is disclosed. A stage center block is mounted on each of two opposite sides by a pair of spaced ball bearing tracks which provide stability as well as simplicity. The use of the spaced ball bearing pairs in conjunction with an adjustment screw which also provides support eliminates extraneous stabilization components and permits maximization of the area of the center block laser transmission hole.

  8. Adjustable Autonomy Testbed

    NASA Technical Reports Server (NTRS)

    Malin, Jane T.; Schrenkenghost, Debra K.

    2001-01-01

    The Adjustable Autonomy Testbed (AAT) is a simulation-based testbed located in the Intelligent Systems Laboratory in the Automation, Robotics and Simulation Division at NASA Johnson Space Center. The purpose of the testbed is to support evaluation and validation of prototypes of adjustable autonomous agent software for control and fault management for complex systems. The AA T project has developed prototype adjustable autonomous agent software and human interfaces for cooperative fault management. This software builds on current autonomous agent technology by altering the architecture, components and interfaces for effective teamwork between autonomous systems and human experts. Autonomous agents include a planner, flexible executive, low level control and deductive model-based fault isolation. Adjustable autonomy is intended to increase the flexibility and effectiveness of fault management with an autonomous system. The test domain for this work is control of advanced life support systems for habitats for planetary exploration. The CONFIG hybrid discrete event simulation environment provides flexible and dynamically reconfigurable models of the behavior of components and fluids in the life support systems. Both discrete event and continuous (discrete time) simulation are supported, and flows and pressures are computed globally. This provides fast dynamic simulations of interacting hardware systems in closed loops that can be reconfigured during operations scenarios, producing complex cascading effects of operations and failures. Current object-oriented model libraries support modeling of fluid systems, and models have been developed of physico-chemical and biological subsystems for processing advanced life support gases. In FY01, water recovery system models will be developed.

  9. Ability of bed bug-detecting canines to locate live bed bugs and viable bed bug eggs.

    PubMed

    Pfiester, Margie; Koehler, Philip G; Pereira, Roberto M

    2008-08-01

    The bed bug, Cimex lectularius L., like other bed bug species, is difficult to visually locate because it is cryptic. Detector dogs are useful for locating bed bugs because they use olfaction rather than vision. Dogs were trained to detect the bed bug (as few as one adult male or female) and viable bed bug eggs (five, collected 5-6 d after feeding) by using a modified food and verbal reward system. Their efficacy was tested with bed bugs and viable bed bug eggs placed in vented polyvinyl chloride containers. Dogs were able to discriminate bed bugs from Camponotus floridanus Buckley, Blattella germanica (L.), and Reticulitermes flavipes (Kollar), with a 97.5% positive indication rate (correct indication of bed bugs when present) and 0% false positives (incorrect indication of bed bugs when not present). Dogs also were able to discriminate live bed bugs and viable bed bug eggs from dead bed bugs, cast skins, and feces, with a 95% positive indication rate and a 3% false positive rate on bed bug feces. In a controlled experiment in hotel rooms, dogs were 98% accurate in locating live bed bugs. A pseudoscent prepared from pentane extraction of bed bugs was recognized by trained dogs as bed bug scent (100% indication). The pseudoscent could be used to facilitate detector dog training and quality assurance programs. If trained properly, dogs can be used effectively to locate live bed bugs and viable bed bug eggs. PMID:18767752

  10. Pulsed atmospheric fluidized bed combustion

    SciTech Connect

    Not Available

    1992-08-01

    The general specifications for a Pulsed Atmospheric Fluidized Bed Combustor Design Report (PAFBC) plant are presented. The design tasks for the PAFBC are described in the following areas: Coal/Limestone preparation and feed system; pulse combustor; fluidized bed; boiler parts; and ash handling system.

  11. LSP Composite Test Bed Design

    NASA Technical Reports Server (NTRS)

    Day, Arthur C.; Griess, Kenneth H.

    2013-01-01

    This document provides standalone information for the Lightning Strike Protection (LSP) Composite Substrate Test Bed Design. A six-sheet drawing set is reproduced for reference, as is some additional descriptive information on suitable sensors and use of the test bed.

  12. How do nonprofit hospitals manage earnings?

    PubMed

    Leone, Andrew J; Van Horn, R Lawrence

    2005-07-01

    We hypothesize that, unlike for-profit firms, nonprofit hospitals have incentives to manage earnings to a range just above zero. We consider two ways managers can achieve this. They can adjust discretionary spending [Hoerger, T.J., 1991. 'Profit' variability in for-profit and not-for-profit hospitals. Journal of Health Economics 10, 259-289.] and/or they can adjust accounting accruals using the flexibility inherent in Generally Accepted Accounting Principles (GAAP). To test our hypothesis we use regressions as well as tests of the distribution of earnings by Burgstahler and Dichev [Burgstahler, D., Dichev, I., 1997. Earnings management to avoid earnings decreases and losses. Journal of Accounting and Economics 24, 99-126.] on a sample of 1,204 hospitals and 8,179 hospital-year observations. Our tests support the use of discretionary spending and accounting accrual management. Like Hoerger (1991), we find evidence that nonprofit hospitals adjust discretionary spending to manage earnings. However, we also find significant use of discretionary accruals (e.g., adjustments to the third-party-allowance, and allowance for doubtful accounts) to meet earnings objectives. These findings have two important implications. First, the previous evidence by Hoerger that nonprofit hospitals show less variation in income may at least partly be explained by an accounting phenomenon. Second, our findings provide guidance to users of these financial statements in predicting the direction of likely bias in reported earnings. PMID:15896858

  13. Trends in Infant Bedding Use: National Infant Sleep Position Study, 1993–2010

    PubMed Central

    Colson, Eve R.; Willinger, Marian; Rybin, Denis V.; Camperlengo, Lena; Corwin, Michael J.

    2015-01-01

    BACKGROUND: Use of potentially hazardous bedding, as defined by the American Academy of Pediatrics (eg, pillows, quilts, comforters, loose bedding), is a modifiable risk factor for sudden infant death syndrome and unintentional sleep-related suffocation. The proportion of US infants sleeping with these types of bedding is unknown. METHODS: To investigate the US prevalence of and trends in bedding use, we analyzed 1993–2010 data from the National Infant Sleep Position study. Infants reported as being usually placed to sleep with blankets, quilts, pillows, and other similar materials under or covering them in the last 2 weeks were classified as bedding users. Logistic regression was used to describe characteristics associated with bedding use. RESULTS: From 1993 to 2010, bedding use declined but remained a widespread practice (moving average of 85.9% in 1993–1995 to 54.7% in 2008–2010). Prevalence was highest for infants of teen-aged mothers (83.5%) and lowest for infants born at term (55.6%). Bedding use was also frequently reported among infants sleeping in adult beds, on their sides, and on a shared surface. The rate of decline in bedding use was markedly less from 2001–2010 compared with 1993–2000. For 2007 to 2010, the strongest predictors (adjusted odds ratio: ≥1.5) of bedding use were young maternal age, non-white race and ethnicity, and not being college educated. CONCLUSIONS: Bedding use for infant sleep remains common despite recommendations against this practice. Understanding trends in bedding use is important for tailoring safe sleep interventions. PMID:25452654

  14. Risk adjustment: where are we now?

    PubMed

    Newhouse, J P

    1998-01-01

    Risk adjustment is intended to minimize selection of patients or enrollees in health plans. Current efforts generally are recognized as inadequate, but improvement is difficult. The greatest short-term gain will come from introducing diagnostic information, though outpatient diagnosis data are unreliable. Initial efforts may use inpatient data, but this creates incentives to hospitalize people. Even exploiting diagnosis information leaves substantial imperfections. Partial capitation, common in behavioral health, reduces incentives to select patients and stent on services, but current policy resists it, perhaps because policymakers misinterpret the lesson of the Prospective Payment System. Theoretically, not paying plans more for providing additional services is optimal only if consumers are well informed. PMID:9719781

  15. Value-Based Purchasing: The Effect of Hospital Ownership and Size.

    PubMed

    Chatfield, J Seth

    2016-01-01

    This research tests the effect of hospital ownership and size on value-based purchasing scores. Representative samples were randomly selected of short-term acute-care hospitals from across the nation and grouped into 3 categories of both ownership and size. The ownership categories are as follows: (1) for-profit, (2) nonprofit, and (3) government. The size categories are as follows: (1) small, 99 beds or fewer; (2) medium, 100 to 249 beds; (3) large, 250 beds or more. Value-based purchasing scores for the 12 process-of-care (PC) measures and the 8 patient experience-of-care (Hospital Consumer Assessment of Healthcare Providers and System [HCAHPS]) measures were calculated and combined into their single total performance score (TPS). The results reveal that for-profit controlled hospitals outperform both nonprofit and government-controlled hospitals in PC measures, HCAHPS measures, and value-based purchasing TPSs. The results also reveal that small hospitals (≤99 beds) outperform both medium hospitals (100-249 beds) and large hospitals (≥250 beds) in PC measures, HCAHPS measures, and TPS. Results are discussed. PMID:27455362

  16. Academic Hospitality

    ERIC Educational Resources Information Center

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

  17. Hospitality Management.

    ERIC Educational Resources Information Center

    College of the Canyons, Valencia, CA.

    A project was conducted at College of the Canyons (Valencia, California) to initiate a new 2-year hospitality program with career options in hotel or restaurant management. A mail and telephone survey of area employers in the restaurant and hotel field demonstrated a need for, interest in, and willingness to provide internships for such a program.…

  18. Unions and hospitals: some unresolved issues.

    PubMed

    Adamache, K W; Sloan, F A

    1982-05-01

    This article investigates the impact of unions on the wages of hospital workers. Our OLS findings agree with previous OLS studies--unions increase registered nurses' (RNs) wages by five percent and by about eight to ten percent for other hospital workers. By contrast, we find (after correcting for selectivity bias in hospital unionization status) a direct union effect of about twenty percent on RN wages and in excess of thirty percent on wages of other hospital workers. While the results based on selectivity bias adjustments make us uneasy, we do not reject them out-of-hand. We also find indirect union effects (up to five percent) by other unionized occupations within a hospital and up to ten percent by other unionized hospitals in the local labor market. Prospective reimbursement programs have a negative impact on the wages of hospital workers but are only significant for non-unionized occupations. Our three empirical tests of monopsony all reject the view that monopsony is a factor in hospital wage-setting. Even considering the large union effects (based on selectivity bias adjustment), we conclude that unions have been a minor contributor to hospital cost inflation. PMID:10263950

  19. An outbreak of bed bug infestation in an office building.

    PubMed

    Baumblatt, Jane A Gwira; Dunn, John R; Schaffner, William; Moncayo, Abelardo C; Stull-Lane, Annica; Jones, Timothy F

    2014-04-01

    Since 2000, resurgence in bed bugs has occurred in the U.S. Reports of infestations of homes, hospitals, hotels, and offices have been described. On September 1, 2011, complaints of itching and bites among workers in an office were reported to the Tennessee Department of Health. A retrospective cohort study and environmental assessments were performed in response to the complaints. Canines certified to detect live bed bugs were used to inspect the office and arthropod samples were collected. Of 76 office workers, 61 (80%) were interviewed; 39 (64%) met the case definition. Pruritic maculopapular lesions were consistent with arthropod bites. One collected arthropod sample was identified as a bed bug by three entomologists. Exposures associated with symptoms included working in a cubicle in which a canine identified bed bugs (risk ratio [RR]: 1.8; 95% confidence interval [CI]: 1.3-3.6), and self-reported seasonal allergies (RR: 1.6, 95% CI: 1.0-2.4). Bed bugs represent a reemerging and challenging environmental problem with clinical, psychological, and financial impacts. PMID:24749221

  20. Feasibility Study of a Lunar Analog Bed Rest Model

    NASA Technical Reports Server (NTRS)

    Cromwell, Ronita L.; Platts, Steven H.; Yarbough, Patrice; Buccello-Stout, Regina

    2010-01-01

    The purpose of this study was to determine the feasibility of using a 9.5deg head-up tilt bed rest model to simulate the effects of the 1/6 g load to the human body that exists on the lunar surface. The lunar analog bed rest model utilized a modified hospital bed. The modifications included mounting the mattress on a sled that rolled on bearings to provide freedom of movement. The weight of the sled was off-loaded using a counterweight system to insure that 1/6 body weight was applied along the long axis (z-axis) of the body. Force was verified through use of a force plate mounted at the foot of the bed. A seating assembly was added to the bed to permit periods of sitting. Subjects alternated between standing and sitting positions throughout the day. A total of 35% of the day was spent in the standing position and 65% was spent sitting. In an effort to achieve physiologic fluid shifts expected for a 1/6 G environment, subjects wore compression stockings and performed unloaded foot and ankle exercises. Eight subjects (3 females and 5 males) participated in this study. Subjects spent 13 days in the pre-bed rest phase, 6 days in bed rest and 3 days post bed rest. Subjects consumed a standardized diet throughout the study. To determine feasibility, measures of subject comfort, force and plasma volume were collected. Subject comfort was assessed using a Likert scale. Subjects were asked to assess level of comfort (0-100) for 11 body regions and provide an overall rating. Results indicated minimal to no discomfort as most subjects reported scores of zero. Force measures were performed for each standing position and were validated against subject s calculated 1/6 body weight (r(sup 2) = 0.993). The carbon monoxide rebreathing technique was used to assess plasma volume during pre-bed rest and on the last day of bed rest. Plasma volume results indicated a significant decrease (p = 0.001) from pre to post bed rest values. Subjects lost on average 8.3% (sd = 6.1%) during the

  1. Union activity in hospitals: past, present, and future.

    PubMed

    Becker, E R; Sloan, F A; Steinwald, B

    1982-06-01

    Between 1970 and 1980, the percentage of hospitals with one or more collective bargaining contracts increased from 15.7 percent to 27.4 percent. A substantial amount of variation exists in the extent of unionism on the basis of hospital ownership, bed size, and location. Employees are more likely to organize when hospitals in the State are regulated by a mandatory rate-setting program. Unions raise hospital employee's wages--a modal estimate for RNs is about 6 percent; the corresponding figure for nonprofessional employees is about 10 percent. Growth of union activity in hospitals has generally not been a major contributor to hospital wage inflation, and less than 10 percent of the increase in real (relative to the Consumer Price Index) spending for hospital care that occurred during the 1970s can be attributed to union growth. We project that between 45 and 50 percent of all hospitals will have at least one union by 1990. PMID:10309636

  2. Union Activity in Hospitals: Past, Present, and Future

    PubMed Central

    Becker, Edmund R.; Sloan, Frank A.; Steinwald, Bruce

    1982-01-01

    Between 1970 and 1980, the percentage of hospitals with one or more collective bargaining contracts increased from 15.7 percent to 27.4 percent. A substantial amount of variation exists in the extent of unionism on the basis of hospital ownership, bed size, and location. Employees are more likely to organize when hospitals in the State are regulated by a mandatory rate-setting program. Unions raise hospital employee's wages—a modal estimate for RNs is about 6 percent; the corresponding figure for nonprofessional employees is about 10 percent. Growth of union activity in hospitals has generally not been a major contributor to hospital wage inflation, and less than 10 percent of the increase in real (relative to the Consumer Price Index) spending for hospital care that occurred during the 1970s can be attributed to union growth. We project that between 45 and 50 percent of all hospitals will have at least one union by 1990. PMID:10309636

  3. Hospitalization in double-occupancy rooms and the risk of hospital-acquired influenza: a prospective cohort study.

    PubMed

    Munier-Marion, E; Bénet, T; Régis, C; Lina, B; Morfin, F; Vanhems, P

    2016-05-01

    Hospitalization in double-occupancy rooms and the risk of hospital-acquired influenza were assessed prospectively. The incidence was 2.0 for 100 patient-days in double- vs. 0.7 in single-occupancy rooms (p 0.028). The adjusted hazard ratio of hospital-acquired influenza was 2.67 (95% confidence interval 1.05-6.76) in patients hospitalized in double- compared to single-occupancy rooms. PMID:26806256

  4. 22 CFR 145.72 - Subsequent adjustments and continuing responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Subsequent adjustments and continuing responsibilities. 145.72 Section 145.72 Foreign Relations DEPARTMENT OF STATE CIVIL RIGHTS GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS...

  5. 22 CFR 145.72 - Subsequent adjustments and continuing responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Subsequent adjustments and continuing responsibilities. 145.72 Section 145.72 Foreign Relations DEPARTMENT OF STATE CIVIL RIGHTS GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS...

  6. 20 CFR 435.72 - Subsequent adjustments and continuing responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Subsequent adjustments and continuing responsibilities. 435.72 Section 435.72 Employees' Benefits SOCIAL SECURITY ADMINISTRATION UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, OTHER...

  7. 42 CFR 412.320 - Disproportionate share adjustment factor.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Section 412.320 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... System for Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for Capital-Related Costs § 412.320 Disproportionate share adjustment factor. (a) Criteria for...

  8. 45 CFR 2543.72 - Subsequent adjustments and continuing responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS After-the-Award Requirements § 2543.72 Subsequent adjustments... audit or other review. (2) The obligation of the recipient to return any funds due as a result of later refunds, corrections, or other transactions. (3) Audit requirements in Section § 2543.26. (4)...

  9. 20 CFR 435.72 - Subsequent adjustments and continuing responsibilities.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Subsequent adjustments and continuing responsibilities. 435.72 Section 435.72 Employees' Benefits SOCIAL SECURITY ADMINISTRATION UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, OTHER...

  10. 20 CFR 435.72 - Subsequent adjustments and continuing responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Subsequent adjustments and continuing responsibilities. 435.72 Section 435.72 Employees' Benefits SOCIAL SECURITY ADMINISTRATION UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, OTHER...

  11. 20 CFR 435.72 - Subsequent adjustments and continuing responsibilities.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Subsequent adjustments and continuing responsibilities. 435.72 Section 435.72 Employees' Benefits SOCIAL SECURITY ADMINISTRATION UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, OTHER...

  12. 20 CFR 435.72 - Subsequent adjustments and continuing responsibilities.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Subsequent adjustments and continuing responsibilities. 435.72 Section 435.72 Employees' Benefits SOCIAL SECURITY ADMINISTRATION UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, OTHER...

  13. Simulation of “a week care unit” organization in an academic hospital

    NASA Astrophysics Data System (ADS)

    Sinnaeve, G.; Beguin, C.; Chevalier, P.; Philippe, M.

    2015-05-01

    Poor bed allocation to each specialty might lead to a surplus of available beds during weekends. The introduction of a “week unit” that is only available during working days may improve the efficiency of bed allocation by uniting the patient flow of two regular units, before converting the regular beds of one unit into week beds. In order to test the possible introduction of this system in three services of the Saint-Luc hospital, we created a simulation model that considers new allocation rules to direct the patients into the right unit.

  14. Continuously adjustable Pulfrich spectacles

    NASA Astrophysics Data System (ADS)

    Jacobs, Ken; Karpf, Ron

    2011-03-01

    A number of Pulfrich 3-D movies and TV shows have been produced, but the standard implementation has inherent drawbacks. The movie and TV industries have correctly concluded that the standard Pulfrich 3-D implementation is not a useful 3-D technique. Continuously Adjustable Pulfrich Spectacles (CAPS) is a new implementation of the Pulfrich effect that allows any scene containing movement in a standard 2-D movie, which are most scenes, to be optionally viewed in 3-D using inexpensive viewing specs. Recent scientific results in the fields of human perception, optoelectronics, video compression and video format conversion are translated into a new implementation of Pulfrich 3- D. CAPS uses these results to continuously adjust to the movie so that the viewing spectacles always conform to the optical density that optimizes the Pulfrich stereoscopic illusion. CAPS instantly provides 3-D immersion to any moving scene in any 2-D movie. Without the glasses, the movie will appear as a normal 2-D image. CAPS work on any viewing device, and with any distribution medium. CAPS is appropriate for viewing Internet streamed movies in 3-D.

  15. Subsea adjustable choke valves

    SciTech Connect

    Cyvas, M.K. )

    1989-08-01

    With emphasis on deepwater wells and marginal offshore fields growing, the search for reliable subsea production systems has become a high priority. A reliable subsea adjustable choke is essential to the realization of such a system, and recent advances are producing the degree of reliability required. Technological developments have been primarily in (1) trim material (including polycrystalline diamond), (2) trim configuration, (3) computer programs for trim sizing, (4) component materials, and (5) diver/remote-operated-vehicle (ROV) interfaces. These five facets are overviewed and progress to date is reported. A 15- to 20-year service life for adjustable subsea chokes is now a reality. Another factor vital to efficient use of these technological developments is to involve the choke manufacturer and ROV/diver personnel in initial system conceptualization. In this manner, maximum benefit can be derived from the latest technology. Major areas of development still required and under way are listed, and the paper closes with a tabulation of successful subsea choke installations in recent years.

  16. Avionics test bed development plan

    NASA Technical Reports Server (NTRS)

    Harris, L. H.; Parks, J. M.; Murdock, C. R.

    1981-01-01

    A development plan for a proposed avionics test bed facility for the early investigation and evaluation of new concepts for the control of large space structures, orbiter attached flex body experiments, and orbiter enhancements is presented. A distributed data processing facility that utilizes the current laboratory resources for the test bed development is outlined. Future studies required for implementation, the management system for project control, and the baseline system configuration are defined. A background analysis of the specific hardware system for the preliminary baseline avionics test bed system is included.

  17. What's the Plan? Needing Assistance with Plan of Care Is Associated with In-Hospital Death for ICU Patients Referred for Palliative Care Consultation.

    PubMed

    Kiyota, Ayano; Bell, Christina L; Masaki, Kamal; Fischberg, Daniel J

    2016-08-01

    To inform earlier identification of intensive care unit (ICU) patients needing palliative care, we examined factors associated with in-hospital death among ICU patients (N=260) receiving palliative care consultations at a 542-bed tertiary care hospital (2005-2009). High pre-consultation length of stay (LOS, ≥7 days) (adjusted odds ratio (aOR)=5.0, 95% confidence interval (95% CI)=2.5-9.9, P<.01) and consultations for assistance with plan of care (aOR=11.6, 95% CI=5.6-23.9, P<.01) were independently associated with in-hospital death. Patients with both consultation for plan of care and high pre-consult LOS had the highest odds of in-hospital death (aOR=36.3, 95% CI=14.9-88.5, P<.001), followed by patients with consultation for plan of care and shorter pre-consult LOS (aOR=9.8, 95% CI=4.3-22.1, P<.001), and patients with long pre-consult LOS but no consultation for plan of care (aOR=4.7, 95% CI=1.8-12.4, P=.002). Our findings suggest that ICU patients who require assistance with plan of care need to be identified early to optimize end-of-life care and avoid in-hospital death. PMID:27563500

  18. What's the Plan? Needing Assistance with Plan of Care Is Associated with In-Hospital Death for ICU Patients Referred for Palliative Care Consultation

    PubMed Central

    Kiyota, Ayano; Bell, Christina L; Masaki, Kamal

    2016-01-01

    To inform earlier identification of intensive care unit (ICU) patients needing palliative care, we examined factors associated with in-hospital death among ICU patients (N=260) receiving palliative care consultations at a 542-bed tertiary care hospital (2005–2009). High pre-consultation length of stay (LOS, ≥7 days) (adjusted odds ratio (aOR)=5.0, 95% confidence interval (95% CI)=2.5–9.9, P<.01) and consultations for assistance with plan of care (aOR=11.6, 95% CI=5.6–23.9, P<.01) were independently associated with in-hospital death. Patients with both consultation for plan of care and high pre-consult LOS had the highest odds of in-hospital death (aOR=36.3, 95% CI=14.9–88.5, P<.001), followed by patients with consultation for plan of care and shorter pre-consult LOS (aOR=9.8, 95% CI=4.3–22.1, P<.001), and patients with long pre-consult LOS but no consultation for plan of care (aOR=4.7, 95% CI=1.8–12.4, P=.002). Our findings suggest that ICU patients who require assistance with plan of care need to be identified early to optimize end-of-life care and avoid in-hospital death. PMID:27563500

  19. CEO Compensation and Hospital Financial Performance

    PubMed Central

    Reiter, Kristin L.; Sandoval, Guillermo A.; Brown, Adalsteinn D.; Pink, George H.

    2010-01-01

    Growing interest in pay-for-performance and the level of CEO pay raises questions about the link between performance and compensation in the health sector. This study compares the compensation of non-profit hospital Chief Executive Officers (CEOs) in Ontario, Canada to the three longest reported and most used measures of hospital financial performance. Our sample consisted of 132 CEOs from 92 hospitals between 1999 and 2006. Unbalanced panel data were analyzed using fixed effects regression. Results suggest that CEO compensation was largely unrelated to hospital financial performance. Inflation-adjusted salaries appeared to increase over time independent of hospital performance, and hospital size was positively correlated with CEO compensation. The apparent upward trend in salary despite some declines in financial performance challenges the fundamental assumption underlying this paper, that is, financial performance is likely linked to CEO compensation in Ontario. Further research is needed to understand long-term performance related to compensation incentives. PMID:19605619

  20. 42 CFR 412.536 - Special payment provisions for long-term care hospitals and satellites of long-term care...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... applicable hospital inpatient prospective payment system cost of living adjustment factors; (iii) Includes, where applicable, adjustments for indirect medical education costs and for the costs of serving a... applicable, capital inpatient prospective payment system adjustments for indirect medical education costs...

  1. 77 FR 40387 - Price Adjustment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-09

    ... Price Adjustment AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recently filed Postal Service request to adjust prices for several market dominant products... announcing its intent to adjust prices for several market dominant products within First-Class Mail...

  2. Bed Bugs: The Australian Response

    PubMed Central

    Doggett, Stephen L.; Orton, Christopher J.; Lilly, David G.; Russell, Richard C.

    2011-01-01

    Australia has experienced a sudden and unexpected resurgence in bed bug infestations from both Cimex lectularius L. and Cimex hemipterus F. A survey in 2006 revealed that infestations had increased across the nation by an average of 4,500% since the start of the decade. In response, a multi-disciplinary approach to combat the rise of this public health pest was implemented and involved the coordinated efforts of several organizations. The key components of the strategy included the introduction of a pest management standard ‘A Code of Practice for the Control of Bed Bug Infestations in Australia’ that defines and promotes ‘best practice’ in bed bug eradication, the development of a policy and procedural guide for accommodation providers, education of stakeholders in best management practices, and research. These strategies continue to evolve with developments that lead to improvements in ‘best practice’ while bed bugs remain problematic in Australia. PMID:26467616

  3. Flight Analogs (Bed Rest Research)

    NASA Video Gallery

    Flight Analogs / Bed Rest Research Projects provide NASA with a ground based research platform to complement space research. By mimicking the conditions of weightlessness in the human body here on ...

  4. Turning patients over in bed

    MedlinePlus

    ... so the person is not at risk of rolling out of the bed. The patient's bottom arm ... M, et al. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American ...

  5. 42 CFR 412.525 - Adjustments to the Federal prospective payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... its estimated costs for a patient exceed the adjusted LTC-MS-DRG payment plus a fixed-loss amount. For...-term care hospital prospective payment system payment year, as defined in § 412.503, using the...

  6. Performance evaluation of hospitals that provide care in the public health system, Brazil

    PubMed Central

    Ramos, Marcelo Cristiano de Azevedo; da Cruz, Lucila Pedroso; Kishima, Vanessa Chaer; Pollara, Wilson Modesto; de Lira, Antônio Carlos Onofre; Couttolenc, Bernard François

    2015-01-01

    OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System. METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimento s de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction. RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed. CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals. PMID:26247385

  7. Performance evaluation of hospitals that provide care in the public health system, Brazil.

    PubMed

    Ramos, Marcelo Cristiano de Azevedo; da Cruz, Lucila Pedroso; Kishima, Vanessa Chaer; Pollara, Wilson Modesto; de Lira, Antônio Carlos Onofre; Couttolenc, Bernard François

    2015-01-01

    OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System. METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction. RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed. CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals. PMID:26247385

  8. Rural hospitals under PPS: a five-year study.

    PubMed

    Davis, R G; Zeddies, T C; Zimmerman, M K; McLean, R A

    1990-07-01

    This research examines the impact of prospective payment (PPS) on the financial performance of Kansas hospitals, which are predominantly rural. Financial ratios are presented and regressed on bed size and year. The data suggest that bed size has the strongest effect on financial viability. There are indications of a delayed effect of PPS on the rural, smallest hospitals (fewer than 25 beds), suggesting that non-operating sources of revenue (local property tax mill levies) are being used to subsidize them in the short term. Small hospitals appear to be delaying all capital and long-term costs to survive. The research suggests that the effect of PPS may be long term. PMID:10105940

  9. Dual Fluidized Bed Biomass Gasification

    SciTech Connect

    2005-09-30

    The dual fluidized bed reactor is a recirculating system in which one half of the unit operates as a steam pyrolysis device for biomass. The pyrolysis occurs by introducing biomass and steam to a hot fluidized bed of inert material such as coarse sand. Syngas is produced during the pyrolysis and exits the top of the reactor with the steam. A crossover arm, fed by gravity, moves sand and char from the pyrolyzer to the second fluidized bed. This sand bed uses blown air to combust the char. The exit stream from this side of the reactor is carbon dioxide, water and ash. There is a second gravity fed crossover arm to return sand to the pyrolysis side. The recirculating action of the sand and the char is the key to the operation of the dual fluidized bed reactor. The objective of the project was to design and construct a dual fluidized bed prototype reactor from literature information and in discussion with established experts in the field. That would be appropriate in scale and operation to measure the relative performance of the gasification of biomass and low ranked coals to produce a high quality synthesis gas with no dilution from nitrogen or combustion products.

  10. Hospital choice by rural medicare beneficiaries: does hospital ownership matter?--a Colorado case.

    PubMed

    Roh, Chul-Young; Lee, Keon-Hyung

    2006-01-01

    About 45 percent of rural patients in Colorado bypassed their local rural hospitals during the 1990s. The effect of this phenomenon is a reduction in occupancy rates and a decrease in the competitiveness of rural hospitals, thereby ultimately causing rural hospitals to close and adversely affecting the communities that they were designed to serve. This study tests whether hospital ownership affects hospital choice by patients after controlling for institutional and individual dimensions. A conditional logistic regression is used to analyze Colorado Inpatient Discharge Data (CIDD) on 85,529 patients in addition to hospital data. Rural Medicare beneficiaries are influenced to choose a particular hospital by a combination of hospital characteristics (the number of beds, the number of services, accreditation, ownership type, and distance from patient residence) and patient characteristics (medical condition, age, gender, race, and total charge for services). Increasing rural hospitals' survivability, collaborating with other rural hospitals, expanding the number of available services, making strategic alliance with other providers are possible strategies that may help ward off encroachment by urban competitors. PMID:16583743

  11. Organizational Culture and Its Relationship with Hospital Performance in Public Hospitals in China

    PubMed Central

    Zhou, Ping; Bundorf, Kate; Chang, Ji; Huang, Jin Xin; Xue, Di

    2011-01-01

    Objective To measure perceptions of organizational culture among employees of public hospitals in China and to determine whether perceptions are associated with hospital performance. Data Sources Hospital, employee, and patient surveys from 87 Chinese public hospitals conducted during 2009. Study Design Developed and administered a tool to assess organizational culture in Chinese public hospitals. Used factor analysis to create measures of organizational culture. Analyzed the relationships between employee type and perceptions of culture and between perceptions of culture and hospital performance using multivariate models. Principal Findings Employees perceived the culture of Chinese public hospitals as stronger in internal rules and regulations, and weaker in empowerment. Hospitals in which employees perceived that the culture emphasized cost control were more profitable and had higher rates of outpatient visits and bed days per physician per day but also had lower levels of patient satisfaction. Hospitals with cultures perceived as customer-focused had longer length of stay but lower patient satisfaction. Conclusions Managers in Chinese public hospitals should consider whether the culture of their organization will enable them to respond effectively to their changing environment. PMID:22092228

  12. [Hospital comparison--status quo and prospects].

    PubMed

    Betzler, M; Haun, P

    1998-12-01

    Hospitals are competing with each other for the limited financial resources available in the health care sector. Comparison of hospitals is legally required (BPf1V section 5) to improve financial efficiency in the health care sector and make competition between hospitals keener, while also objectivizing it. If comparison of the hospitals is really to enhance profitability or efficiency, and not just to reduce the prices for hospital stays regardless of quality, it must extend to far more than the global figures in the compilation summarizing performance and calculation and the hospital statistics (no. of cases, days of care, length of stay, case lump sums and special fees). Documentation of particular features of the patient population, the potentials of the hospital and description of the treatment processes yield valuable information on capacity and performance level. With rising costs, the danger is growing that the quality and risk dimension of the actual medical treatment will not be promoted with the same enthusiasm by those offering the service. Hospital audit does not only allow a check on the hospital's own situation with regard to performance, quality, efficiency and patient satisfaction, but can also provide a basis of structural planning. The fact is that all efforts made and steps taken by the responsible persons in the hospital to improve the quality of structures, processes and results can only be successful if they are also perceived by the patients, the doctors who refer them and the visitors. If hospital audit is restricted to the bed occupancy and the invoicing data, it is only realistic to expect cuts in performance level. This would be bad for the patient and, in view of the consequent costs, also for the overall costs in the health care sector. Against the backdrop of a future performance-related system of remuneration instead of the principle of covering one's own costs that has been in place hitherto, openness about treatment results gains

  13. Europe's first children's hospital in a park.

    PubMed

    Baillie, Jonathan

    2015-09-01

    Just a year after the centenary of the completion of the 1914-built children's hospital which it will soon replace, this autumn will see the opening of a new Alder Hey Children's Hospital in Liverpool, dubbed Alder Hey in the Park thanks to its attractive parkland setting. The 270-bedded hospital, designed by architects, landscape architects, and interior designers, BDP, and built by Laing O'Rourke, is located in Springfield Park on Liverpool's northern fringes, and features a highly striking external design, with the three distinctive 'fingers' housing the wards bordered by extensive greenery, and the buildings topped by green undulating roofs. All the inpatient bedrooms, and indeed many other internal spaces, will enjoy parkland views. The new hospital will also reportedly offer some of Europe's most advanced children's healthcare. HEJ editor, Jonathan Baillie, reports on the construction of this stunning new healthcare facility, where children's views were key in shaping the design. PMID:26548125

  14. Primary Casualty Reception Ship: the hospital within--Operation Granby.

    PubMed

    Dewar, E P

    1992-01-01

    As the build-up of Operation Granby forces developed in the Gulf, casualty estimates indicated the need for a 100-bed hospital facility to care for the possible maritime casualties. RFA Argus, the Air Training Ship, was identified as the potential Primary Casualty Reception Ship (PCRS) and at the end of September 1990 plans were drawn up to convert the forward hangar into a two-storey 100-bed hospital in collective protection (COLPRO). In the three weeks prior to deployment, the hospital was designed, built, equipped and staffed. Argus arrived in the Gulf in mid-November as the PCRS with, all in COLPRO, a 10-bed intensive care unit (ICU), a 14-bed high dependency unit (HDU), a 76-bed low dependency unit (LDU) plus four operating tables in two theatres with full support services. The hospital was staffed by a medical team of 136 personnel and supported by the Air department with four casualty evacuation helicopters, an RN Party and the staff of the RFA. One hundred and five patients were treated of which 78 were returned to duty. Argu as PCRS spent longer in the northern Persian Gulf than any other ship, UK or US. PMID:1460595

  15. The public hospital of the future.

    PubMed

    Zajac, Jeffrey D

    2003-09-01

    Public hospitals designed for the past are not changing rapidly enough to meet the needs of the future. Changing work practices, increased pressure on bed occupancy, and greater numbers of patients with complex diseases and comorbidities will determine the functions of future hospitals. To maximise the use of resources, hospital "down times" on weekends and public holidays will be a distant memory. Elective surgery will increase in the traditionally "quiet times", such as summer, and decrease in the busy winter period. The patient will be the focus of an efficient information flow, streamlining patient care in hospital and enhancing communication between hospitals and community-based health providers. General and specialty units will need to work more efficiently together, as general physicians take on the role of patient case managers for an increasing proportion of patients. Funding needs to be adequate, and system management should involve clinicians. Safety will be enshrined in hospital systems and procedures, as well as in the minds of hospital staff. If these changes are not implemented successfully, public hospitals will not survive in the future. PMID:12924972

  16. Association of Opioids and Sedatives with Increased Risk of In-Hospital Cardiopulmonary Arrest from an Administrative Database

    PubMed Central

    Overdyk, Frank J.; Dowling, Oonagh; Marino, Joseph; Qiu, Jiejing; Chien, Hung-Lun; Erslon, Mary; Morrison, Neil; Harrison, Brooke; Dahan, Albert; Gan, Tong J.

    2016-01-01

    Background While opioid use confers a known risk for respiratory depression, the incremental risk of in-hospital cardiopulmonary arrest, respiratory arrest, or cardiopulmonary resuscitation (CPRA) has not been studied. Our aim was to investigate the prevalence, outcomes, and risk profile of in-hospital CPRA for patients receiving opioids and medications with central nervous system sedating side effects (sedatives). Methods A retrospective analysis of adult inpatient discharges from 2008–2012 reported in the Premier Database. Patients were grouped into four mutually exclusive categories: (1) opioids and sedatives, (2) opioids only, (3) sedatives only, and (4) neither opioids nor sedatives. Results Among 21,276,691 inpatient discharges, 53% received opioids with or without sedatives. A total of 96,554 patients suffered CPRA (0.92 per 1000 hospital bed-days). Patients who received opioids and sedatives had an adjusted odds ratio for CPRA of 3.47 (95% CI: 3.40–3.54; p<0.0001) compared with patients not receiving opioids or sedatives. Opioids alone and sedatives alone were associated with a 1.81-fold and a 1.82-fold (p<0.0001 for both) increase in the odds of CPRA, respectively. In opioid patients, locations of CPRA were intensive care (54%), general care floor (25%), and stepdown units (15%). Only 42% of patients survived CPRA and only 22% were discharged home. Opioid patients with CPRA had mean increased hospital lengths of stay of 7.57 days and mean increased total hospital costs of $27,569. Conclusions Opioids and sedatives are independent and additive risk factors for in-hospital CPRA. The impact of opioid sparing analgesia, reduced sedative use, and better monitoring on CPRA incidence deserves further study. PMID:26913753

  17. Evaluation of Automated Hospital Data Management Systems (AHDMS)

    PubMed Central

    Young, Edward M.; Brian, Earl W.; Hardy, Dorcas R.; Kaplan, Alan; Childerston, James K.

    1980-01-01

    The introduction of advanced minicomputer technology has made a wide variety of information processing applications available to hospitals which could not previously afford the resources needed to develop and implement such systems. The impact of such systems on the operation of hospitals in the 100-300 bed size range is not fully understood. A preliminary examination of the type of system available to and implemented by hospitals of this size has revealed some system characteristics which have implications both for the ultimate evaluation of such systems and for the use of automated information systems in hospitals in general.

  18. The response of bedforms and bed elevation to hydrodynamics changes

    NASA Astrophysics Data System (ADS)

    Hu, Hao; Parsons, Daniel; Ockelford, Annie; Hardy, Richard; Ashworth, Philip; Best, Jim

    2016-04-01

    To date the majority of research concerning bedform dynamics has been conducted under steady flow conditions in laboratory controlled flumes. However, all fluvial, estuarine and coastal environments exhibit temporal variations in hydrodynamics, that alter the physical interactions between flows and sediment transport, resulting in adjustment of bedforms. Such interactions also introduce time lags and hysteresis between the flow and the bed response to changing conditions. Our research is based on two series (sudden and gradual changes of hydraulic conditions) in a range of controlled flume experiments. These are used to investigate how bedforms respond to changes in hydrodynamics (velocities and water depths). The results confirm the effect of water discharge (both water depth and velocity) on changes in bedform height and length under steady flow conditions. They also reveal a range of hysteresis based relations between the changes and the response of the bed. Previous investigations mainly focus on relationship between water discharge and bedform dimensions. However, our results reveal the dynamical sediment transport response to impose flow changes and show that a partitioning between bedload and suspended bedload transport is key in driving the response of the bed to changes in flow. Our results, therefore, provide a more detailed comprehension on interactions between hydrodynamics, sediment transport and bedform adjustment, which may help to improve geomorphic module of numerical models.

  19. Rapid ignition of fluidized bed boiler

    DOEpatents

    Osborn, Liman D.

    1976-12-14

    A fluidized bed boiler is started up by directing into the static bed of inert and carbonaceous granules a downwardly angled burner so that the hot gases cause spouting. Air is introduced into the bed at a rate insufficient to fluidize the entire bed. Three regions are now formed in the bed, a region of lowest gas resistance, a fluidized region and a static region with a mobile region at the interface of the fluidized and static regions. Particles are transferred by the spouting action to form a conical heap with the carbonaceous granules concentrated at the top. The hot burner gases ignite the carbonaceous matter on the top of the bed which becomes distributed in the bed by the spouting action and bed movement. Thereafter the rate of air introduction is increased to fluidize the entire bed, the spouter/burner is shut off, and the entire fluidized bed is ignited.

  20. The Growth of Palliative Care in U.S. Hospitals: A Status Report

    PubMed Central

    Dumanovsky, Tamara; Augustin, Rachel; Rogers, Maggie; Lettang, Katrina; Meier, Diane E.

    2016-01-01

    Abstract Background: Palliative care is expanding rapidly in the United States. Objective: To examine variation in access to hospital palliative care. Methods: Data were obtained from the American Hospital Association (AHA) Annual Surveys™ for Fiscal Years 2012 and 2013, the National Palliative Care Registry™, the Dartmouth Atlas of Healthcare, the American Census Bureau's American Community Survey (ACS), web searches, and telephone interviews of hospital administrators and program directors. Multivariable logistic regression was used to examine predictors of hospital palliative care programs. Results: Sixty-seven percent of hospitals with 50 or more total facility beds reported a palliative care program. Institutional characteristics were strongly associated with the presence of a hospital palliative care program. Ninety percent of hospitals with 300 beds or more were found to have palliative care programs as compared to 56% of hospitals with fewer than 300 beds. Tax status was also a significant predictor. Not-for-profit hospitals and public hospitals were, respectively, 4.8 times and 7.1 times more likely to have a palliative care program as compared to for-profit hospitals. Palliative care penetration was highest in the New England (88% of hospitals), Pacific (77% of hospitals), and mid-Atlantic (77% of hospitals) states and lowest in the west south central (43% of hospitals) and east south central (42% of hospitals) states. Conclusions: This study demonstrates continued steady growth in the number of hospital palliative care programs in the United States, with almost universal access to services in large U.S. hospitals and academic medical centers. Nevertheless access to palliative care remains uneven and depends on accidents of geography and hospital ownership. PMID:26417923

  1. Delay Adjusted Incidence Infographic

    Cancer.gov

    This Infographic shows the National Cancer Institute SEER Incidence Trends. The graphs show the Average Annual Percent Change (AAPC) 2002-2011. For Men, Thyroid: 5.3*,Liver & IBD: 3.6*, Melanoma: 2.3*, Kidney: 2.0*, Myeloma: 1.9*, Pancreas: 1.2*, Leukemia: 0.9*, Oral Cavity: 0.5, Non-Hodgkin Lymphoma: 0.3*, Esophagus: -0.1, Brain & ONS: -0.2*, Bladder: -0.6*, All Sites: -1.1*, Stomach: -1.7*, Larynx: -1.9*, Prostate: -2.1*, Lung & Bronchus: -2.4*, and Colon & Rectum: -3/0*. For Women, Thyroid: 5.8*, Liver & IBD: 2.9*, Myeloma: 1.8*, Kidney: 1.6*, Melanoma: 1.5, Corpus & Uterus: 1.3*, Pancreas: 1.1*, Leukemia: 0.6*, Brain & ONS: 0, Non-Hodgkin Lymphoma: -0.1, All Sites: -0.1, Breast: -0.3, Stomach: -0.7*, Oral Cavity: -0.7*, Bladder: -0.9*, Ovary: -0.9*, Lung & Bronchus: -1.0*, Cervix: -2.4*, and Colon & Rectum: -2.7*. * AAPC is significantly different from zero (p<.05). Rates were adjusted for reporting delay in the registry. www.cancer.gov Source: Special section of the Annual Report to the Nation on the Status of Cancer, 1975-2011.

  2. YACHIYO HOSPITAL; Center of SUPER CARE MIX--Comprehensive Care from Emergency to Home for the community.

    PubMed

    Matsumoto, Takatoshi; Iyomasa, Shinsuke; Fukatsu, Atsushi

    2016-01-01

    Anjo City has two general hospitals. Kosei Hospital, a central medical center for advanced care, and our Yachiyo Hospital for regional care. Recently, Kosei Hospital faced over-capacity problem because of overflow in emergency visits and congested wards due to shortage of post-acute beds. We planned a project to ease the congestion of the central hospital and manage post-acute patients. PMID:27180467

  3. 42 CFR 424.13 - Requirements for inpatient services of hospitals other than inpatient psychiatric facilities.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) Certification of need for hospitalization when a SNF bed is not available. (1) The physician may certify or... treatment in a SNF but no bed is available in a participating SNF. (2) If this is the basis for the... physician is expected to continue efforts to place the patient in a participating SNF as soon as a...

  4. 42 CFR 424.13 - Requirements for inpatient services of hospitals other than inpatient psychiatric facilities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) Certification of need for hospitalization when a SNF bed is not available. (1) The physician may certify or... treatment in a SNF but no bed is available in a participating SNF. (2) If this is the basis for the... physician is expected to continue efforts to place the patient in a participating SNF as soon as a...

  5. Assessing geomorphic sensitivity in relation to river capacity for adjustment

    NASA Astrophysics Data System (ADS)

    Reid, H. E.; Brierley, G. J.

    2015-12-01

    River sensitivity describes the nature and rate of channel adjustments. An approach to analysis of geomorphic river sensitivity outlined in this paper relates potential sensitivity based on the expected capacity of adjustment for a river type to the recent history of channel adjustment. This approach was trialled to assess low, moderate and high geomorphic sensitivity for four different types of river (10 reaches in total) along the Lower Tongariro River, North Island, New Zealand. Building upon the River Styles framework, river types were differentiated based upon valley setting (width and confinement), channel planform, geomorphic unit assemblages and bed material size. From this, the behavioural regime and potential for adjustment (type and extent) were determined. Historical maps and aerial photographs were geo-rectified and the channel planform digitised to assess channel adjustments for each reach from 1928 to 2007. Floodplain width controlled by terraces, exerted a strong influence upon reach scale sensitivity for the partly-confined, wandering, cobble-bed river. Although forced boundaries occur infrequently, the width of the active channel zone is constrained. An unconfined braided river reach directly downstream of the terrace-confined section was the most geomorphically sensitive reach. The channel in this reach adjusted recurrently to sediment inputs that were flushed through more confined, better connected upstream reaches. A meandering, sand-bed river in downstream reaches has exhibited negligible rates of channel migration. However, channel narrowing in this reach and the associated delta indicate that the system is approaching a threshold condition, beyond which channel avulsion is likely to occur. As this would trigger more rapid migration, this reach is considered to be more geomorphically sensitive than analysis of its low migration rate alone would indicate. This demonstrates how sensitivity is fashioned both by the behavioural regime of a reach

  6. A method for estimating the mean bed load flux in braided rivers

    NASA Astrophysics Data System (ADS)

    Bertoldi, W.; Ashmore, P.; Tubino, M.

    2009-02-01

    Prediction of bed load flux remains a significant problem in understanding braided river morphodynamics for geomorphic and engineering applications. Two sets of data from laboratory experiments on braided networks performed at the University of Trento (Italy) and at the University of Alberta (Canada) provide the basis for development of a dimensionless bed load function and for testing a simple predictive model. Measured total sediment transport rates (time-averaged) at equilibrium channel configuration collapse to a single dimensionless relationship based on dimensionless stream power. Bed load fluxes predicted by the Parker and Bagnold functions and cross-section average hydraulic parameters under-predict the bed load flux, particularly at low shear stress. This is consistent with previous observation and theory demonstrating the significant influence of transverse variability of the hydraulic parameters in controlling and predicting bed load flux. A simple method for adjusting for this lateral variation is proposed for computing the sediment transport rate using topographic cross-sections of braided rivers. Results show good agreement with the measured values, suggesting that simple assumptions combined with the mean morphology of the channel may be sufficient to estimate mean bed load flux. Model predictions also highlight the significance of active bed width, rather than bed shear stress, as a fundamental ingredient in the prediction of the bed load rate and therefore, as an important morphological property to be modelled. The model also predicts similar behaviour in the at-a-station variability of bed load and in the importance of variation of active width, relative to bed shear stress, in the transport process.

  7. Relation between Severity of Chronic Illness and Adjustment in Children and Adolescents with Sickle Cell Disease.

    ERIC Educational Resources Information Center

    Hurtig, Anita Landau; And Others

    1989-01-01

    The study with 70 children and adolescents with sickle cell disease did not support the hypothesis that illness severity (measured by frequency of hospitalization) would affect adjustment (measured by IQ, self-esteem, social and personal adjustment, behavioral problems, school performance, and peer relations). (Author/DB)

  8. A Conceptual Framework for Improving Critical Care Patient Flow and Bed Use

    PubMed Central

    Long, Elisa F.

    2015-01-01

    Rationale: High demand for intensive care unit (ICU) services and limited bed availability have prompted hospitals to address capacity planning challenges. Simulation modeling can examine ICU bed assignment policies, accounting for patient acuity, to reduce ICU admission delays. Objectives: To provide a framework for data-driven modeling of ICU patient flow, identify key measurable outcomes, and present illustrative analysis demonstrating the impact of various bed allocation scenarios on outcomes. Methods: A description of key inputs for constructing a queuing model was outlined, and an illustrative simulation model was developed to reflect current triage protocol within the medical ICU and step-down unit (SDU) at a single tertiary-care hospital. Patient acuity, arrival rate, and unit length of stay, consisting of a “service time” and “time to transfer,” were estimated from 12 months of retrospective data (n = 2,710 adult patients) for 36 ICU and 15 SDU staffed beds. Patient priority was based on acuity and whether the patient originated in the emergency department. The model simulated the following hypothetical scenarios: (1) varied ICU/SDU sizes, (2) reserved ICU beds as a triage strategy, (3) lower targets for time to transfer out of the ICU, and (4) ICU expansion by up to four beds. Outcomes included ICU admission wait times and unit occupancy. Measurements and Main Results: With current bed allocation, simulated wait time averaged 1.13 (SD, 1.39) hours. Reallocating all SDU beds as ICU decreased overall wait times by 7.2% to 1.06 (SD, 1.39) hours and increased bed occupancy from 80 to 84%. Reserving the last available bed for acute patients reduced wait times for acute patients from 0.84 (SD, 1.12) to 0.31 (SD, 0.30) hours, but tripled subacute patients’ wait times from 1.39 (SD, 1.81) to 4.27 (SD, 5.44) hours. Setting transfer times to wards for all ICU/SDU patients to 1 hour decreased wait times for incoming ICU patients, comparable to building

  9. A variable-radius measure of local hospital market structure.

    PubMed Central

    Phibbs, C S; Robinson, J C

    1993-01-01

    OBJECTIVE. To provide a radius measure of the structure of local hospital markets that varies with hospital characteristics and is available for all hospitals in the United States. DATA SOURCES. 1982 American Hospital Association (AHA) Survey of Hospitals, 1982 Area Resource File (ARF), and 1983 California Office of Statewide Health Planning and Development (OSHPD) discharge abstracts. STUDY DESIGN. The OSHPD data were used to measure the radii necessary to capture 75 percent and 90 percent of each hospital's admissions. These radii were used as the dependent variables in regression models in which the independent variables were from the AHA and ARF. To estimate predicted market radii, the estimated parameters from the California models were applied to all nonfederal, short-term, general hospitals in the continental United States. These radii were used to define each hospital's service area, and all other hospitals within the calculated radii were considered potential competitors. Using this definition, we calculated two measures of local market structure: the number of other hospitals within the radius and a Herfindahl-Hirschman Index based on the distribution of hospital bed shares in the market. DATA EXTRACTION METHODS. These measures were calculated for all nonfederal, short-term, acute care hospitals in the continental United States for whom complete data were available (N = 4,884). CONCLUSIONS. These measures are available from the authors on computer-readable diskette, matched to hospital identifiers. PMID:8344822

  10. Clinical physiology of bed rest

    NASA Technical Reports Server (NTRS)

    Greenleaf, John E.

    1993-01-01

    Maintenance of optimal health in humans requires the proper balance between exercise, rest, and sleep as well as time in the upright position. About one-third of a lifetime is spent sleeping; and it is no coincidence that sleeping is performed in the horizontal position, the position in which gravitational influence on the body is minimal. Although enforced bed rest is necessary for the treatment of some ailments, in some cases it has probably been used unwisely. In addition to the lower hydrostatic pressure with the normally dependent regions of the cardiovascular system, body fuid compartments during bed rest in the horizontal body position, and virtual elimination of compression on the long bones of the skeletal system during bed rest (hypogravia), there is often reduction in energy metabolism due to the relative confinement (hypodynamia) and alteration of ambulatory circadian variations in metabolism, body temperature, and many hormonal systems. If patients are also moved to unfamiliar surroundings, they probably experience some feelings of anxiety and some sociopsychological problems. Adaptive physiological responses during bed rest are normal for that environment. They are attempts by the body to reduce unnecessary energy expenditure, to optimize its function, and to enhance its survival potential. Many of the deconditioning responses begin within the first day or two of bed rest; these early responses have prompted physicians to insist upon early resumption of the upright posture and ambulation of bedridden patients.

  11. Space station propulsion test bed

    NASA Technical Reports Server (NTRS)

    Briley, G. L.; Evans, S. A.

    1989-01-01

    A test bed was fabricated to demonstrate hydrogen/oxygen propulsion technology readiness for the intital operating configuration (IOC) space station application. The test bed propulsion module and computer control system were delivered in December 1985, but activation was delayed until mid-1986 while the propulsion system baseline for the station was reexamined. A new baseline was selected with hydrogen/oxygen thruster modules supplied with gas produced by electrolysis of waste water from the space shuttle and space station. As a result, an electrolysis module was designed, fabricated, and added to the test bed to provide an end-to-end simulation of the baseline system. Subsequent testing of the test bed propulsion and electrolysis modules provided an end-to-end demonstration of the complete space station propulsion system, including thruster hot firings using the oxygen and hydrogen generated from electrolysis of water. Complete autonomous control and operation of all test bed components by the microprocessor control system designed and delivered during the program was demonstrated. The technical readiness of the system is now firmly established.

  12. 42 CFR 419.70 - Transitional adjustments to limit decline in payments.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... hospital outpatient services furnished by a hospital or a community mental health center (CMHC) in a year... 42 Public Health 3 2013-10-01 2013-10-01 false Transitional adjustments to limit decline in payments. 419.70 Section 419.70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT...

  13. Hospital and patient characteristics of uncompensated hospital care: policy implications.

    PubMed

    Saywell, R M; Zollinger, T W; Chu, D K; MacBeth, C A; Sechrist, M E

    1989-01-01

    For this study, a sample of 1,689 patients classified as "charity" and "bad debt" cases in 1986 were identified from 27 general acute care hospitals and one tertiary hospital in Indiana. Half of the hospitals were in rural areas and 57 percent were small (less than 150 beds). Most of the patients (87.2 percent) incurred uncompensated amounts under $2,500, and 40 percent of the cases were below $500. About 72 percent of the patients with uncompensated care were from the same county as the location of the hospital (range from 30.9% to 100.0%). The majority of the cases (79.4 percent) with over $5,000 in uncompensated care were treated in urban hospitals. The average age of these patients was 27.2 years. Fifty-four percent of the patients were single, 60.7 percent were female, and nearly all (83.0 percent) were discharged to home care. Only 44.6 percent of the patients with uncompensated care had no insurance; 46.8 percent had some form of commercial insurance which covered part of the charges for care. The most common diagnosis for these patients was pregnancy and childbirth (22.8 percent), with injury and poisoning second (10.7 percent). The cases with $5,000 or more in bad debt (about 4 percent of the cases) account for 28.3 percent of the total uncollected amount. Bad debt represents a cost of doing business. Any national effort to contain health care costs must address this problem. PMID:2738351

  14. Hospitals for sale.

    PubMed

    Costello, Michael M; West, Daniel J; Ramirez, Bernardo

    2011-01-01

    The pace of hospital merger and acquisition activity reflects the economic theory of supply and demand: Publicly traded hospital companies, private equity funds, and large nonprofit hospital systems are investing capital to purchase and operate freestanding community hospitals at a time when many of those hospitals find themselves short of capital reserves and certain forms of management expertise. But the sale of those community hospitals also raises questions about the impact of absentee ownership on the communities which those hospitals serve. PMID:21864058

  15. Staged cascade fluidized bed combustor

    DOEpatents

    Cannon, Joseph N.; De Lucia, David E.; Jackson, William M.; Porter, James H.

    1984-01-01

    A fluid bed combustor comprising a plurality of fluidized bed stages interconnected by downcomers providing controlled solids transfer from stage to stage. Each stage is formed from a number of heat transfer tubes carried by a multiapertured web which passes fluidizing air to upper stages. The combustor cross section is tapered inwardly from the middle towards the top and bottom ends. Sorbent materials, as well as non-volatile solid fuels, are added to the top stages of the combustor, and volatile solid fuels are added at an intermediate stage.

  16. Out-of-Hospital Cardiac Arrest –Optimal Management

    PubMed Central

    Frõhlich, Georg M.; Lyon, Richard M; Sasson, Comilla; Crake, Tom; Whitbread, Mark; Indermuehle, Andreas; Timmis, Adam; Meier, Pascal

    2013-01-01

    Out-of-hospital cardiac arrest (OHCA) has attracted increasing attention over the past years because outcomes have improved impressively lately. The changes for neurological intact outcomes has been poor but several areas have achieved improving survival rates after adjusting their cardiac arrest care. The pre-hospital management is certainly key and decides whether a cardiac arrest patient can be brought back into a spontaneous circulation. However, the whole chain of resuscitation including the in-hospital care have improved also. This review describes aetiologies of OHCA, risk and potential protective factors and recent advances in the pre-hospital and in-hospital management of these patients. PMID:23228073

  17. The Influence of Primary Care and Hospital Supply on Ambulatory Care–Sensitive Hospitalizations Among Adults in Brazil, 1999–2007

    PubMed Central

    de Oliveira, Veneza B.; Turci, Maria A.; Guanais, Frederico C.; Bonolo, Palmira F.; Lima-Costa, Maria F.

    2011-01-01

    Objectives. We assessed the influence of changes in primary care and hospital supply on rates of ambulatory care–sensitive (ACS) hospitalizations among adults in Brazil. Methods. We aggregated data on nearly 60 million public sector hospitalizations between 1999 and 2007 to Brazil's 558 microregions. We modeled adult ACS hospitalization rates as a function of area-level socioeconomic factors, health services supply, Family Health Program (FHP) availability, and health needs by using dynamic panel estimation techniques to control for endogenous explanatory variables. Results. The ACS hospitalization rates declined by more than 5% annually. When we controlled for other factors, FHP availability was associated with lower ACS hospitalization rates, whereas private or nonprofit hospital beds were associated with higher rates. Areas with highest predicted ACS hospitalization rates were those with the highest private or nonprofit hospital bed supply and with low (< 25%) FHP coverage. The lowest predicted rates were seen for areas with high (> 75%) FHP coverage and very few private or nonprofit hospital beds. Conclusions. These results highlight the contribution of the FHP to improved health system performance and reflect the complexity of the health reform processes under way in Brazil. PMID:21330584

  18. Disposable products in the hospital waste stream.

    PubMed Central

    Gilden, D. J.; Scissors, K. N.; Reuler, J. B.

    1992-01-01

    Use of disposable products in hospitals continues to increase despite limited landfill space and dwindling natural resources. We analyzed the use and disposal patterns of disposable hospital products to identify means of reducing noninfectious, nonhazardous hospital waste. In a 385-bed private teaching hospital, the 20 disposable products of which the greatest amounts (by weight) were purchased, were identified, and total hospital waste was tabulated. Samples of trash from three areas were sorted and weighed, and potential waste reductions from recycling and substituting reusable items were calculated. Business paper, trash liners, diapers, custom surgical packs, paper gowns, plastic suction bottles, and egg-crate pads were among the 20 top items and were analyzed individually. Data from sorted trash documented potential waste reductions through recycling and substitution of 78, 41, and 18 tonnes per year (1 tonne = 1,000 kg = 1.1 tons) from administration, the operating room, and adult wards, respectively (total hospital waste was 939 tonnes per year). We offer specific measures to substantially reduce nonhazardous hospital waste through substitution, minimization, and recycling of select disposable products. Images PMID:1595242

  19. Trends and initiatives in hospital ambulatory care.

    PubMed

    Burns, L A

    1982-05-01

    Changes in the financing and delivery of hospital ambulatory care are discussed. Ambulatory care encompasses a wide spectrum of clinical services provided to patients who are not confined overnight to an institutional bed as inpatients. There are a large and growing number of ways hospitals and physicians cooperate to provide ambulatory-care services. Technological advancements, which have spurred changes in other sectors of medicine, have also changed patterns of medical practice in ambulatory care. Some of the reasons why hospitals develop and expand ambulatory-care programs relate to the changing demand for health services, the shifting preferences of third-party payers and regulators, competitive influences, diversification of risk, and use of such programs as feeders for inpatient services and as teaching and research settings. Although outpatient revenues are a small portion of total hospital revenues, they are growing more rapidly than inpatient revenues. Changes in the health industry that offer opportunities to hospitals are described, such as the increasing physician supply and the formation of group practices, the climate of cost consciousness and price competition, and the trend toward new corporate structures for hospitals. These changes portend changes for hospital pharmacists and give them the opportunity to increase their clinical roles in providing ambulatory care. PMID:7081250

  20. Discrete element modelling of bed load transport

    NASA Astrophysics Data System (ADS)

    Maurin, Raphael; Chareyre, Bruno; Chauchat, Julien; Frey, Philippe

    2013-04-01

    turbulent and supercritical water flow down a steep channel with a mobile bed. The particle diameters were 4 and 6mm, the channel width 6.5mm (slightly above the coarse particle diameter) and the channel inclination was typically 10%. The water flow rate and the particle rate were kept constant at the upstream entrance and adjusted to obtain bedload transport equilibrium. Flows were filmed from the side by a high-speed camera. Using image processing algorithms made it possible to determine the position, velocity and trajectory of both smaller and coarser particles. The comparison between numerical and experimental results focused on streamwise velocity, concentration and sediment rate normal profiles. For bidisperse mixture, a particular attention was given to the segregation phenomenon. We observed in both cases a fair agreement between DEM and experiments.

  1. Trends in managed care contracting among U.S. hospitals.

    PubMed

    Gautam, K; Campbell, C; Arrington, B

    1995-01-01

    This article describes the changing profile of hospitals initiating managed care contracts as of 1992. Based on statistical tests, early contractors rank higher on profitability, case mix, bed size, affiliation, and urban location. In contrast, recent and noncontractors are predominantly rural, freestanding hospitals with low case mix, low profitability, high subacute services, and government ownership. A number of lessons for the future are drawn and a stage-by-stage approach to studying managed care issues is proposed. PMID:8820299

  2. Association of Hospital Prices for Coronary Artery Bypass Grafting With Hospital Quality and Reimbursement.

    PubMed

    Giacomino, Bria D; Cram, Peter; Vaughan-Sarrazin, Mary; Zhou, Yunshu; Girotra, Saket

    2016-04-01

    Although prices for medical services are known to vary markedly between hospitals, it remains unknown whether variation in hospital prices is explained by differences in hospital quality or reimbursement from major insurers. We obtained "out-of-pocket" price estimates for coronary artery bypass grafting (CABG) from a random sample of US hospitals for a hypothetical patient without medical insurance. We compared hospital CABG price to (1) "fair price" estimate from Healthcare Bluebook data using each hospital's zip code and (2) Society of Thoracic Surgeons composite CABG quality score and risk-adjusted mortality rate. Of 101 study hospitals, 53 (52.5%) were able to provide a complete price estimate for CABG. The mean price for CABG was $151,271 and ranged from $44,824 to $448,038. Except for geographic census region, which was weakly associated with price, hospital CABG price was not associated with other structural characteristics or CABG volume (p >0.10 for all). Likewise, there was no association between a hospital's price for CABG with average reimbursement from major insurers within the same zip code (ρ = 0.07, p value = 0.6), Society of Thoracic Surgeoncomposite quality score (ρ = 0.08, p value = 0.71), or risk-adjusted CABG mortality (ρ = -0.03 p value = 0.89). In conclusion, the price of CABG varied more than 10-fold across US hospitals. There was no correlation between price information obtained from hospitals and the average reimbursement from major insurers in the same market. We also found no evidence to suggest that hospitals that charge higher prices provide better quality of care. PMID:26993975

  3. Long Term Patients in Acute Care Beds: Is There a Cure?

    ERIC Educational Resources Information Center

    Shapiro, Evelyn; And Others

    1980-01-01

    Alternatives to long-stay patient back-ups include building more beds of all types, changes in placement policies, and continuing hospital care for older adults. Manitoba's policies have resulted in redistributing the health dollar towards the geriatric patient. (JAC)

  4. Apparatus and process for controlling fluidized beds

    DOEpatents

    Rehmat, Amirali G.; Patel, Jitendra G.

    1985-10-01

    An apparatus and process for control and maintenance of fluidized beds under non-steady state conditions. An ash removal conduit is provided for removing solid particulates from a fluidized bed separate from an ash discharge conduit in the lower portion of the grate supporting such a bed. The apparatus and process of this invention is particularly suitable for use in ash agglomerating fluidized beds and provides control of the fluidized bed before ash agglomeration is initiated and during upset conditions resulting in stable, sinter-free fluidized bed maintenance.

  5. Development and refinement of test bed simulations

    NASA Technical Reports Server (NTRS)

    Dravid, Narayan V.; Miller, Dean R.; Patterson, Alex G.; Gombos, Frank J.

    1989-01-01

    Lewis Research Center of NASA, with support from Rocketdyne, was engaged in non-real time computer simulation effort for the Space Station Freedom Electric Power System (EPS) EASY5, a simulation package, is used as the primary tool for this activity. Early in the design of the EPS, two test beds were set up at Lewis. The Integrated Test Bed (ITB), that combines and upgrades these test beds, is in the planning stage. The test beds are designed to functionally represent many of the components of the EPS and their interconnections. The simulation effort is primarily directed towards these test beds. Model verification is performed using test bed data.

  6. 78 FR 62712 - Rate Adjustment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-22

    ... Rate Adjustment AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recent Postal Service filing seeking postal rate adjustments based on exigent circumstances... On September 26, 2013, the Postal Service filed an exigent rate request with the Commission...

  7. Adjustable holder for transducer mounting

    NASA Technical Reports Server (NTRS)

    Deotsch, R. C.

    1980-01-01

    Positioning of acoustic sensor, strain gage, or similar transducer is facilitated by adjustable holder. Developed for installation on Space Shuttle, it includes springs for maintaining uniform load on transducer with adjustable threaded cap for precisely controlling position of sensor with respect to surrounding structure.

  8. Spousal Adjustment to Myocardial Infarction.

    ERIC Educational Resources Information Center

    Ziglar, Elisa J.

    This paper reviews the literature on the stresses and coping strategies of spouses of patients with myocardial infarction (MI). It attempts to identify specific problem areas of adjustment for the spouse and to explore the effects of spousal adjustment on patient recovery. Chapter one provides an overview of the importance in examining the…

  9. Mood Adjustment via Mass Communication.

    ERIC Educational Resources Information Center

    Knobloch, Silvia

    2003-01-01

    Proposes and experimentally tests mood adjustment approach, complementing mood management theory. Discusses how results regarding self-exposure across time show that patterns of popular music listening among a group of undergraduate students differ with initial mood and anticipation, lending support to mood adjustment hypotheses. Describes how…

  10. Establishing an acute care nursing bed unit size: employing a decision matrix framework.

    PubMed

    Ritchey, Terry; Pati, Debajyoti

    2008-01-01

    Determining the number of patient rooms for an acute care (medical-surgical) patient unit is a challenge for both healthcare architects and hospital administrators when renovating or designing a new patient tower or wing. Discussions on unit bed size and its impact on hospital operations in healthcare design literature are isolated, and clearly there is opportunity for more extensive research. Finding the optimal solution for unit bed size involves many factors, including the dynamics of the site and existing structures. This opinion paper was developed using a "balanced scorecard" concept to provide decision makers a framework for assessing and choosing a customized solution during the early planning and conceptual design phases. The context of a healthcare balanced scorecard with the quadrants of quality, finance, provider outcomes, and patient outcomes is used to compare the impact of these variables on unit bed size. PMID:22973617

  11. [Calmette Hospital, Phnom Penh, Cambodia. Assessment of the implementation of the Medical Information System (SIM). Global analysis of the 1998 results].

    PubMed

    Fabre-Teste, B; Sokha, O

    1999-01-01

    Calmette is a national university hospital with 220 adult beds. It has emergency, surgical, medical and gynecology and obstetrics departments, along with a radiology unit, a laboratory for medical analyses, a central pharmacy and an outpatient clinic. This hospital has an unusual statute, with managerial autonomy and a system of cost recovery that currently provides 64% of the hospital's income. Since 1994, it has benefited from a French cooperation program. The French NGO, Médecins du Monde, has been present at Calmette since 1990, providing support for , the indigent sector of the medical department. The aim of the Medical Information System (SIM) is to develop a simple, reliable and reproducible system so that, for every action undertaken at the hospital (hospitalization, day hospital and outpatient clinic) the following pieces of information are recorded: 1) the disease; 2) the type of patient; 3) the type of management; 4) the means used to treat the patient; 5) the cost. Data are collected and analyzed using programs created with EPIINFO software (CDC, WHO), using the EPIGLUE module. In 1998, 10,814 admissions were recorded at Calmette Hospital, 7,811 (72.2%) of which were to the Emergency Department and 3,003 (27.2%) of which were direct admissions to other wards. We analyzed 10,603 (95%) computerized medical summaries (RMI). About 50% of beds were occupied in the maternity and gynecology ward whereas almost 90% of beds were occupied in the surgical and emergency wards. AIDS and tuberculosis were the conditions most frequently treated by the medical department, despite a marked increase in more specialized areas of medicine such as cardiology and diabetology. The surgical department reflected the concentration on emergency services of the hospital, with cranial traumatism the primary reason for admission for the hospital as a whole. The mean age of patients was 27 years for the maternity ward and 49 years for the medicine A ward. The mortality

  12. Skilled nursing facility quality and hospital readmissions

    PubMed Central

    Neuman, Mark D.; Wirtalla, Christopher; Werner, Rachel M.

    2014-01-01

    Importance Hospital readmissions are common, costly, and potentially preventable. Little is known about the association between available SNF performance measures and the risk of hospital readmission. Objective To measure the association between SNF performance measures and hospital readmissions among Medicare beneficiaries receiving post-acute care at U.S. SNFs. Design Using national Medicare data, we examined the association between SNF performance on publicly available metrics (SNF staffing intensity, performance on required facility site inspections, and the percentages of SNF patients with delirium, moderate-to-severe pain, and new or worsening pressure ulcers) and the risk of readmission or death 30 days after discharge to a SNF. Adjusted analyses controlled for patient case-mix, SNF facility factors, and the discharging hospital. Participants Fee-for-service Medicare beneficiaries discharged to a SNF following an acute-care hospitalization between September 1, 2009 and August 31, 2010. Main outcomes and measures Readmission to an acute-care hospital or death within 30 days of the index hospital discharge. Results Out of 1,530,824 discharges, 357,752 (23.4%;99% CI: 23.3%, 23.5%) were readmitted or died within 30 days; 4.7% (72,472 discharges) died within 30 days (99% CI: 4.7%, 4.8%), and 21.0%(N=321,709) were readmitted (99% CI: 20.9%, 21.1%). The unadjusted risk of readmission or death was lower at SNFs with better staffing ratings (lowest (19.2% of SNFs) vs. highest (6.7% of SNFs): 25.5%; 99% CI: 25.3%, 25.8% vs 19.8%; 99% CI: 19.5%, 20.1%, p<0.001) and better facility inspection ratings (lowest (20.1% of SNFs) vs. highest (9.8% of SNFs): 24.9%; 99% CI: 24.7%,25.1%; vs. 21.5%; 99% CI: 21.2%, 21.7%; p<0.001). Adjustment for patient factors, SNF facility factors, and the discharging hospital attenuated these associations; we observed small differences in the adjusted risk of readmission or death according to SNF facility inspection ratings (lowest vs. highest

  13. Hospital capacity planning: from measuring stocks to modelling flows.

    PubMed

    Rechel, Bernd; Wright, Stephen; Barlow, James; McKee, Martin

    2010-08-01

    The metric of "bed numbers" is commonly used in hospital planning, but it fails to capture key aspects of how hospital services are delivered. Drawing on a study of innovative hospital projects in Europe, we argue that hospital capacity planning should not be based on beds, but rather on the ability to deliver processes. We propose using approaches that are based on manufacturing theory such as "lean thinking" that focuses on the value that different processes add for the primary customer, i.e. the patient. We argue that it is beneficial to look at the hospital, not from the perspective of beds or specialties, but rather from the path taken by the patients who are treated in them, the respective processes delivered by health professionals and the facilities appropriate to those processes. Systematized care pathways seem to offer one avenue for achieving these goals. However, they need to be underpinned by a better understanding of the flows of patients, work and goods within a hospital, the bottlenecks that occur, and translation of this understanding into new capacity planning tools. PMID:20680129

  14. A Comparison of Free-Standing versus Co-Located Long-Term Acute Care Hospitals

    PubMed Central

    Kahn, Jeremy M.; Barnato, Amber E.; Lave, Judith R.; Pike, Francis; Weissfeld, Lisa A.; Le, Tri Q.; Angus, Derek C.

    2015-01-01

    Background Long-term acute care hospitals (LTACs) provide specialized treatment for patients with chronic critical illness. Increasingly LTACs are co-located within traditional short-stay hospitals rather than operated as free-standing facilities, which may affect LTAC utilization patterns and outcomes. Methods We compared free-standing and co-located LTACs using 2005 data from the United States Centers for Medicare & Medicaid Services. We used bivariate analyses to examine patient characteristics and timing of LTAC transfer, and used propensity matching and multivariable regression to examine mortality, readmissions, and costs after transfer. Results Of 379 LTACs in our sample, 192 (50.7%) were free-standing and 187 (49.3%) were co-located in a short-stay hospital. Co-located LTACs were smaller (median bed size: 34 vs. 66, p <0.001) and more likely to be for-profit (72.2% v. 68.8%, p = 0.001) than freestanding LTACs. Co-located LTACs admitted patients later in their hospital course (average time prior to transfer: 15.5 days vs. 14.0 days) and were more likely to admit patients for ventilator weaning (15.9% vs. 12.4%). In the multivariate propensity-matched analysis, patients in co-located LTACs experienced higher 180-day mortality (adjusted relative risk: 1.05, 95% CI: 1.00–1.11, p = 0.04) but lower readmission rates (adjusted relative risk: 0.86, 95% CI: 0.75–0.98, p = 0.02). Costs were similar between the two hospital types (mean difference in costs within 180 days of transfer: -$3,580, 95% CI: -$8,720 –$1,550, p = 0.17). Conclusions Compared to patients in free-standing LTACs, patients in co-located LTACs experience slightly higher mortality but lower readmission rates, with no change in overall resource use as measured by 180 day costs. PMID:26440102

  15. Variable feed rate mechanism for fluidized bed asbestos generators

    SciTech Connect

    Sussman, R.G.; Gearhart, J.M.; Lippmann, M.

    1985-01-01

    A simple and inexpensive dust feed mechanism has been designed for use with a two-phase fluidized bed generator (FBG). The mechanism is especially useful for generating asbestos aerosols, but may be used with other dusts as well. Using this system, a steady state concentration (39.1 fibers/cc > 5 ..mu..m in length +/- 6.2%) of asbestos aerosol was maintained in an inhalation chamber for five hours. In addition, FBG output concentration was easily adjusted and quickly equilibrated (within 10 minutes). The system provides a good technique for generating asbestos aerosols for day-long animal exposures.

  16. Physiology Of Prolonged Bed Rest

    NASA Technical Reports Server (NTRS)

    Greenleaf, John E.

    1991-01-01

    Report describes physiological effects of prolonged bed rest. Rest for periods of 24 hours or longer deconditions body to some extent; healing proceeds simultaneously with deconditioning. Report provides details on shifts in fluid electrolytes and loss of lean body mass, which comprises everything in body besides fat - that is, water, muscle, and bone. Based on published research.

  17. Fluidized-Bed Reactor System

    NASA Technical Reports Server (NTRS)

    Morrison, A. D.

    1985-01-01

    Gas pyrolysis in hot fluidized beds minimized by use of selectively filtered radiation and parabolic cavity. Reactor is parabolic cavity of two or more axes in which light emanating from one axis bounces off walls of cavity and passes through object axis to heat sample.

  18. Char binder for fluidized beds

    DOEpatents

    Borio, Richard W.; Accortt, Joseph I.

    1981-01-01

    An arrangement that utilizes agglomerating coal as a binder to bond coal fines and recycled char into an agglomerate mass that will have suitable retention time when introduced into a fluidized bed 14 for combustion. The simultaneous use of coal for a primary fuel and as a binder effects significant savings in the elimination of non-essential materials and processing steps.

  19. Review: granulation and fluidized beds

    SciTech Connect

    Kono, H.

    1981-01-01

    The history of granulation techniques is very long; however, the systematic study of the granulation phenomenon began only after 1950. The first, distinguished paper treating the fundamental binding mechanism of granules was published by Rumpf in 1958. Although there are several binding forces, the discussion in this paper is confined to granulation involving the capillary energy of a liquid-particle system. This technique has been applied widely and successfully to various fields of powder technology because of its advantages of simplicity and economy (ref. 2). Granules with diameters larger than 5 mm can be prepared efficiently by rotating-type granulators, such as a pan or a trommel (ref. 3, 4, 5). On the other hand, the purpose of fluidized-bed granulators (hereafter abbreviated as FBG) is to produce small granules with diameters from 0.3 to 3 mm (ref. 6). Because it contains a small amount of liquid, a fluidized-bed granulator has a fluidization state differing significantly from that of an ordinary fluidized bed. The dispersion of liquid and powder in the bed plays an important role in the granulation mechanism. This mechanism is compared to that of pan granulators, and the differences in characteristics are discussed.

  20. Laboratory rearing of bed bugs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The resurgence of bed bugs Cimex lectularius L. in the United States and worldwide has resulted in an increase in research by university, government, and industry scientists directed at the biology and control of this blood-sucking pest. A need has subsequently arisen for producing sufficient biolog...

  1. Electromechanics of packed granular beds

    SciTech Connect

    Robinson, K.S.

    1982-01-01

    Strong, electrical, interparticle forces are induced by applied electric fields within packed beds of dielectric particles. Proposed applications utilizing electropacked beds (EPBs) or electrofluidized beds (EFBs) include air filtration and gas clean-up, fine particle separation, commercial drying and coating processes, heat and mass transfer, and bulk bed control. A new distributed circuit model of the electrical interparticle force is presented that identifies the role of surface roughness as determining the interparticle spacing. The dc steady state force is predicted to increase nearly linearly with the applied electric field and is theoretically independent of particle surface conductivity. The electric stress is found to vary nearly linearly with the applied electric field. Data are generally consistent with the theoretical contention that increased surface roughness decreases electromechanical effects. Surface conductivity variations of three to four times have no measurable effect on the dc steady state electric stress. The electric stress is insensitive to the dielectric properties of the interstitial gas eliminating Townsend discharge as a candidate for the nonlinear charge transport process thought to occur near interparticle contacts. The theoretical upper bound of the electric stress calculated using the distributed circuit model falls within the scatter of the data if a limit on the electric field in the interparticle gap which models nonlinear charge transport is in the range of 1 to 6 x 10/sup 7/ V/m. Estimates of the charge relaxation time using transient angle of repose experiments are somewhat smaller but comparable with theoretical values calculated by ignoring nonlinear charge transport.

  2. Utility of Recycled Bedding for Laboratory Rodents

    PubMed Central

    Miyamoto, Toru; Li, Zhixia; Kibushi, Tomomi; Okano, Shinya; Yamasaki, Nakamichi; Kasai, Noriyuki

    2009-01-01

    Animal facilities generate a large amount of used bedding containing excrement as medical waste. We developed a recycling system for used bedding that involves soft hydrothermal processing. In this study, we examined the effects of bedding type on growth, hematologic and serum biochemical values, and organ weights of female and male mice reared on either recycled or fresh bedding from 3 to 33 wk of age. Neither growth nor physiology differed between mice housed on recycled bedding compared with fresh bedding. When 14-wk-old mice were bred, litter size and total number of weaned pups showed no significant differences between animals raised on recycled or fresh bedding. Because bedding type influences the environment within cages and animal rooms, we evaluated particulate and ammonia data from cages and animal rooms. Values were significantly lower from cages and rooms that used recycled bedding than from those using fresh bedding, thus indicating that recycled bedding has the potential to improve the environment within both cages and animal rooms. Overall, this study revealed that recycled bedding is an excellent material for use in housing laboratory rodents. Specifically, recycled bedding may reduce medical waste and maintain healthy environments within cages and animal rooms. PMID:19653951

  3. Isolation usage in a pediatric hospital.

    PubMed

    Kim, M H; Mindorff, C; Patrick, M L; Gold, R; Ford-Jones, E L

    1987-05-01

    In a prospective 12-month study at a university-affiliated pediatric hospital, isolation usage was quantitated by ward/service, season, isolation category and type of infection (community-acquired vs nosocomial). Such information may be helpful in designing hospitals, recognizing time utilization of the pediatric infection control nurse, and defining educational and isolation needs. Hospitals with multiple bed rooms and inadequate numbers of single rooms may be unable to meet current federal isolation guidelines. The mean number of isolation days was 153 per 1000 patient days or 15.3% of bed days used. This ranged from 18.5% on the infant/toddler/preschool medical ward to 2.8% on child/teenage orthopedic surgery. Isolation requirements vary seasonally and rose to 32% in winter on one ward. Proportional frequencies of isolation category included enteric--29%, protective--28%, strict--16%, barrier (contact)--10%, multiply resistant organism (MRO)--8%, wound--5%, pregnant women (careful handwashing)--3%, blood and body fluid precautions--1%. Isolation of patients with and contacts of nosocomial infections account for 32% of isolation usage. During one third of the 365-day year, the hospital is unable to provide adequate numbers of single rooms for one to 20 patients. PMID:3647940

  4. Unraveling bed slope from relative roughness in initial sediment motion

    NASA Astrophysics Data System (ADS)

    Prancevic, Jeff P.; Lamb, Michael P.

    2015-03-01

    Understanding incipient sediment transport is crucial for predicting landscape evolution, mitigating flood hazards, and restoring riverine habitats. Observations show that the critical Shields stress increases with increasing channel bed slope, and proposed explanations for this counterintuitive finding include enhanced form drag from bed forms, particle interlocking across the channel width, and large bed sediment relative to flow depth (relative roughness). Here we use scaled flume experiments with variable channel widths, bed slopes, and particle densities to separate these effects which otherwise covary in natural streams. The critical Shields stress increased with bed slope for both natural gravel (ρs = 2.65 g/cm3) and acrylic particles (ρs = 1.15 g/cm3), and adjusting channel width had no significant effect. However, the lighter acrylic particles required a threefold higher critical Shields stress for mobilization relative to the natural gravel at a fixed slope, which is unexpected because particle density is accounted for directly in the definition of Shields stress. A comparison with model predictions indicates that changes in local velocity and turbulence associated with increasing relative roughness for lighter materials are responsible for increasing the critical Shields stress in our experiments. These changes lead to concurrent changes in the hydraulic resistance and a nearly constant critical stream power value at initial motion. Increased relative roughness can explain much of the observed heightened critical Shields stresses and reduced sediment transport rates in steep channels and also may bias paleohydraulic reconstructions in environments with exotic submerged densities such as iron ore, pumice, or ice clasts on Titan.

  5. Using a case-mix-adjusted pressure sore incidence study in a surgical directorate to improve patient outcomes in pressure ulcer prevention.

    PubMed

    Watret, L

    1999-10-01

    The Glasgow Acute Clinical Audit Sub-Committee on Pressure Sores has previously carried out studies of incidence of pressure ulcers in the medical directorates and case-mix-adjusted the figures for length of hospital stay and risk assessment score. Case-mix classification is 'classification of people or treatment placed into groups using characteristics associated with condition, treatment or outcome that can be used to predict need, resource, use of outcomes'. In this instance, crude pressure ulcer incidence figures may be adjusted for length of hospital stay and pressure sore risk assessment score, and stratified into groups, which allows like to be compared with like. The value in case-mix-adjusted figures lies in repeating the exercise, thus determining the trend for individual areas and assessing whether improvement in the quality of care is being achieved. This is more positive than creation of 'league tables' comparing simultaneous studies in a number of areas. The figures showed that there was no statistically significant difference between surgical directorates in trusts with regard to risk assessment scores and length of hospital stay. Gathering data on the incidence of pressure ulcer development allows us to identify where new sores are occurring, but does not critically analyse the nursing intervention taken in individual cases, which identifies preventive strategies. The Glasgow group's primary aim was to gather data on case-mix-adjusted incidence of pressure damage; the secondary objectives were to scrutinize the data to gather more general information on intrinsic and extrinsic factors which may predispose to pressure ulcer development. The study was carried out in the surgical directorate. Findings showed that incidence was low (1.1%), with the majority of sores being superficial. There was a correlation between pressure ulcer development and incontinence, evidence of under-utilization of moving and handling aids for prevention of pressure ulcers

  6. The NASA Bed Rest Project

    NASA Technical Reports Server (NTRS)

    Rhodes, Bradley; Meck, Janice

    2005-01-01

    NASA s National Vision for Space Exploration includes human travel beyond low earth orbit and the ultimate safe return of the crews. Crucial to fulfilling the vision is the successful and timely development of countermeasures for the adverse physiological effects on human systems caused by long term exposure to the microgravity environment. Limited access to in-flight resources for the foreseeable future increases NASA s reliance on ground-based analogs to simulate these effects of microgravity. The primary analog for human based research will be head-down bed rest. By this approach NASA will be able to evaluate countermeasures in large sample sizes, perform preliminary evaluations of proposed in-flight protocols and assess the utility of individual or combined strategies before flight resources are requested. In response to this critical need, NASA has created the Bed Rest Project at the Johnson Space Center. The Project establishes the infrastructure and processes to provide a long term capability for standardized domestic bed rest studies and countermeasure development. The Bed Rest Project design takes a comprehensive, interdisciplinary, integrated approach that reduces the resource overhead of one investigator for one campaign. In addition to integrating studies operationally relevant for exploration, the Project addresses other new Vision objectives, namely: 1) interagency cooperation with the NIH allows for Clinical Research Center (CRC) facility sharing to the benefit of both agencies, 2) collaboration with our International Partners expands countermeasure development opportunities for foreign and domestic investigators as well as promotes consistency in approach and results, 3) to the greatest degree possible, the Project also advances research by clinicians and academia alike to encourage return to earth benefits. This paper will describe the Project s top level goals, organization and relationship to other Exploration Vision Projects, implementation

  7. Can hospitals compete on quality? Hospital competition.

    PubMed

    Sadat, Somayeh; Abouee-Mehrizi, Hossein; Carter, Michael W

    2015-09-01

    In this paper, we consider two hospitals with different perceived quality of care competing to capture a fraction of the total market demand. Patients select the hospital that provides the highest utility, which is a function of price and the patient's perceived quality of life during their life expectancy. We consider a market with a single class of patients and show that depending on the market demand and perceived quality of care of the hospitals, patients may enjoy a positive utility. Moreover, hospitals share the market demand based on their perceived quality of care and capacity. We also show that in a monopoly market (a market with a single hospital) the optimal demand captured by the hospital is independent of the perceived quality of care. We investigate the effects of different parameters including the market demand, hospitals' capacities, and perceived quality of care on the fraction of the demand that each hospital captures using some numerical examples. PMID:25711185

  8. [Length of hospital stay due to DRG reimbursement].

    PubMed

    Bartkowski, Rolf

    2012-01-01

    The introduction of DRG systems causes a paradigm shift in consideration of length of hospital stay. A daily rate for a hospital bed is an inventive to lengthen hospital stay as long as possible. In a DRG system it would be lucrative to release a patient from hospital as soon as possible and tenable. If DRGs are calculated properly, based on a valid statistical analysis of average length of stay, hospital reimbursement will be ensured in the average of one year. Not cost-effective cases will be compensated with profitable patients. There is no economic need to release or transfer patients from hospital earlier than necessary or tenable. To have sufficient control over the economic situation in each individual patient it is necessary and recommended to build up a cost unit accounting. PMID:22198932

  9. Small rural hospitals: an example of market segmentation analysis.

    PubMed

    Mainous, A G; Shelby, R L

    1991-01-01

    In recent years, market segmentation analysis has shown increased popularity among health care marketers, although marketers tend to focus upon hospitals as sellers. The present analysis suggests that there is merit to viewing hospitals as a market of consumers. Employing a random sample of 741 small rural hospitals, the present investigation sought to determine, through the use of segmentation analysis, the variables associated with hospital success (occupancy). The results of a discriminant analysis yielded a model which classifies hospitals with a high degree of predictive accuracy. Successful hospitals have more beds and employees, and are generally larger and have more resources. However, there was no significant relationship between organizational success and number of services offered by the institution. PMID:10111266

  10. [110 years--University Obstetrics and Gynecology Hospital "Maichin dom"].

    PubMed

    Zlatkov, V

    2014-01-01

    The first specialized Obstetrics and Gynecology Hospital in Bulgaria was founded based on the idea of Queen Maria Luisa (1883). Construction began in 1896 and the official opening of the hospital took place on November 19, 1903. What is unique about the University Obstetrics and Gynecology Hospital "Maichin dom" is above all the fact that the Bulgarian school of obstetrics and gynecology was founded within its institution. Currently, the hospital has nearly 400 beds and 600 employees who work at nine clinics and six laboratories, covering the entire spectrum of obstetric and gynecological activities. Its leading specialists still continue to embody the highest level of professionalism and dedication. The future development of the hospital is chiefly associated with the renovation of facilities, resources and equipment and with the enhancement of the professional competence of the staff and of the quality of hospital products to improve the health and satisfaction of the patients. PMID:24919335

  11. A More Detailed Understanding Of Factors Associated With Hospital Profitability.

    PubMed

    Bai, Ge; Anderson, Gerard F

    2016-05-01

    To identify the characteristics of the most profitable US hospitals, we examined the profitability of acute care hospitals in fiscal year 2013, measured as net income from patient care services per adjusted discharge. Based on Medicare Cost Reports and Final Rule Data, the median hospital lost $82 for each such discharge. Forty-five percent of hospitals were profitable, with 2.5 percent earning more than $2,475 per adjusted discharge. The ten most profitable hospitals, seven of which were nonprofit, each earned more than $163 million in total profits from patient care services. Hospitals with for-profit status, higher markups, system affiliation, or regional power, as well as those located in states with price regulation, tended to be more profitable than other hospitals. Hospitals that treated a higher proportion of Medicare patients, had higher expenditures per adjusted discharge, were located in counties with a high proportion of uninsured patients, or were located in states with a dominant insurer or greater health maintenance organization (HMO) penetration had lower profitability than hospitals that did not have these characteristics. These findings can inform policy reforms, while providing a baseline against which to measure the impact of any subsequent reforms. PMID:27140996

  12. Hospital-acquired pneumonia

    MedlinePlus

    ... tends to be more serious than other lung infections because: People in the hospital are often very sick and cannot fight off ... prevent pneumonia. Most hospitals have programs to prevent hospital-acquired infections.

  13. EVALUATING MULTICOMPONENT COMPETITIVE ADSORPTION IN FIXED BEDS

    EPA Science Inventory

    An equilibrium column model (ECM) was developed to evaluate multicomponent competition in fixed-bed adsorption columns. The model ignores mass transfer resistances and uses ideal adsorbed solution theory to predict the competitive effects in multicomponent mixtures. The bed capac...

  14. EMERGING TECHNOLOGY BULLETIN: SPOUTED BED REACTOR

    EPA Science Inventory

    The Spouted Bed Reactor (SBR) technology utilizes the unique attributes of the "spouting " fluidization regime, which can provide heat transfer rates comparable to traditional fluid beds, while providing robust circulation of highly heterogeneous solids, concurrent with very agg...

  15. Pulling a patient up in bed

    MedlinePlus

    Moving a patient in bed ... takes at least two people to safely move a patient up in bed. Friction from rubbing can ... A slide sheet is the best way to prevent friction. If you do not have one, you ...

  16. Pulling a patient up in bed

    MedlinePlus

    Moving a patient in bed ... takes at least 2 people to safely move a patient up in bed. Friction from rubbing can ... A slide sheet is the best way to prevent friction. If you do not have one, you ...

  17. Variation in the reference Shields stress for bed load transport in gravel-bed streams and rivers

    USGS Publications Warehouse

    Mueller, E.R.; Pitlick, J.; Nelson, J.M.

    2005-01-01

    The present study examines variations in the reference shear stress for bed load transport (??r) using coupled measurements of flow and bed load transport in 45 gravel-bed streams and rivers. The study streams encompass a wide range in bank-full discharge (1-2600 m3/s), average channel gradient (0.0003-0.05), and median surface grain size (0.027-0.21 m). A bed load transport relation was formed for each site by plotting individual values of the dimensionless transport rate W* versus the reach-average dimensionless shear stress ??*. The reference dimensionless shear stress ??r* was then estimated by selecting the value of ??* corresponding to a reference transport rate of W* = 0.002. The results indicate that the discharge corresponding to ?? r* averages 67% of the bank-full discharge, with the variation independent of reach-scale morphologic and sediment properties. However, values of ??r* increase systematically with average channel gradient, ranging from 0.025-0.035 at sites with slopes of 0.001-0.006 to values greater than 0.10 at sites with slopes greater than 0.02. A corresponding relation for the bank-full dimensionless shear stress ??bf*, formulated with data from 159 sites in North America and England, mirrors the relation between ??r* and channel gradient, suggesting that the bank-full channel geometry of gravel- and cobble-bedded streams is adjusted to a relatively constant excess shear stress, ??bf* - ??r*, across a wide range of slopes. Copyright 2005 by the American Geophysical Union.

  18. Development of an assistive patient mobile system for hospital environments.

    PubMed

    Nguyen, Huy Hoang; Nguyen, Tuan Nghia; Clout, Raymont; Gibson, Alexander; Nguyen, Hung T

    2013-01-01

    This paper presents an assistive patient mobile system for hospital environments, which focuses on transferring the patient without nursing help. The system is a combination of an advanced hospital bed and an autonomous navigating robot. This intelligent bed can track the robot and routinely navigates and communicates with the bed. The work centralizes in building a structure, hardware design and robot detection and tracking algorithms by using laser range finder. The assistive patient mobile system has been tested and the real experiments are shown with a high performance of reliability and practicality. The accuracy of the method proposed in this paper is 91% for the targeted testing object with the error rate of classification by 6%. Additionally, a comparison between our method and a related one is also described including the comparison of results. PMID:24110232

  19. Critical Care Medicine Beds, Use, Occupancy, and Costs in the United States: A Methodological Review.

    PubMed

    Halpern, Neil A; Pastores, Stephen M

    2015-11-01

    This article is a methodological review to help the intensivist gain insights into the classic and sometimes arcane maze of national databases and methodologies used to determine and analyze the ICU bed supply, use, occupancy, and costs in the United States. Data for total ICU beds, use, and occupancy can be derived from two large national healthcare databases: the Healthcare Cost Report Information System maintained by the federal Centers for Medicare and Medicaid Services and the proprietary Hospital Statistics of the American Hospital Association. Two costing methodologies can be used to calculate U.S. ICU costs: the Russell equation and national projections. Both methods are based on cost and use data from the national hospital datasets or from defined groups of hospitals or patients. At the national level, an understanding of U.S. ICU bed supply, use, occupancy, and costs helps provide clarity to the width and scope of the critical care medicine enterprise within the U.S. healthcare system. This review will also help the intensivist better understand published studies on administrative topics related to critical care medicine and be better prepared to participate in their own local hospital organizations or regional critical care medicine programs. PMID:26308432

  20. Recurrence of inguinal hernias repaired in a large hernia surgical specialty hospital and general hospitals in Ontario, Canada

    PubMed Central

    Malik, Atiqa; Bell, Chaim M.; Stukel, Thérèse A.; Urbach, David R.

    2016-01-01

    Background The effect of hospital specialization on the risk of hernia recurrence after inguinal hernia repair is not well described. Methods We studied Ontario residents who had primary elective inguinal hernia repair at an Ontario hospital between 1993 and 2007 using population-based, administrative health data. We compared patients from a large hernia specialty hospital (Shouldice Hospital) with those from general hospitals to determine the risk of recurrence. Results We studied 235 192 patients, 27.7% of whom had surgery at Shouldice hospital. The age-standardized proportion of patients who had a recurrence ranged from 5.21% (95% confidence interval [CI] 4.94%–5.49%) among patients who had surgery at the lowest volume general hospitals to 4.79% (95% CI 4.54%–5.04%) who had surgery at the highest volume general hospitals. In contrast, patients who had surgery at the Shouldice Hospital had an age-standardized recurrence risk of 1.15% (95% CI 1.05%–1.25%). Compared with patients who had surgery at the lowest volume hospitals, hernia recurrence among those treated at the Shouldice Hospital was significantly lower after adjustment for the effects of age, sex, comorbidity and income level (adjusted hazard ratio 0.21, 95% CI 0.19–0.23, p < 0.001). Conclusion Inguinal hernia repair at Shouldice Hospital was associated with a significantly lower risk of subsequent surgery for recurrence than repair at a general hospital. While specialty hospitals may have better outcomes for treatment of common surgical conditions than general hospitals, these benefits must be weighed against potential negative impacts on clinical care and the financial sustainability of general hospitals. PMID:26574701

  1. Technical efficiency and productivity of Chinese county hospitals: an exploratory study in Henan province, China

    PubMed Central

    Cheng, Zhaohui; Tao, Hongbing; Cai, Miao; Lin, Haifeng; Lin, Xiaojun; Shu, Qin; Zhang, Ru-ning

    2015-01-01

    Objectives Chinese county hospitals have been excessively enlarging their scale during the healthcare reform since 2009. The purpose of this paper is to examine the technical efficiency and productivity of county hospitals during the reform process, and to determine whether, and how, efficiency is affected by various factors. Setting and participants 114 sample county hospitals were selected from Henan province, China, from 2010 to 2012. Outcome measures Data envelopment analysis was employed to estimate the technical and scale efficiency of sample hospitals. The Malmquist index was used to calculate productivity changes over time. Tobit regression was used to regress against 4 environmental factors and 5 institutional factors that affected the technical efficiency. Results (1) 112 (98.2%), 112 (98.2%) and 104 (91.2%) of the 114 sample hospitals ran inefficiently in 2010, 2011 and 2012, with average technical efficiency of 0.697, 0.748 and 0.790, respectively. (2) On average, during 2010–2012, productivity of sample county hospitals increased by 7.8%, which was produced by the progress in technical efficiency changes and technological changes of 0.9% and 6.8%, respectively. (3) Tobit regression analysis indicated that government subsidy, hospital size with above 618 beds and average length of stay assumed a negative sign with technical efficiency; bed occupancy rate, ratio of beds to nurses and ratio of nurses to physicians assumed a positive sign with technical efficiency. Conclusions There was considerable space for technical efficiency improvement in Henan county hospitals. During 2010–2012, sample hospitals experienced productivity progress; however, the adverse change in pure technical efficiency should be emphasised. Moreover, according to the Tobit results, policy interventions that strictly supervise hospital bed scale, shorten the average length of stay and coordinate the proportion among physicians, nurses and beds, would benefit hospital efficiency

  2. Bed Bug Education for School Maintenance

    ERIC Educational Resources Information Center

    Henriksen, Missy

    2012-01-01

    Bed bugs are a growing problem, not only in homes and hotels, but also in schools and colleges. Facility administrators and staff need to understand the bed bug resurgence and develop best practices to deal with an infestation. In this article, the author offers tips for preventing and treating bed bugs in school and university settings.

  3. 21 CFR 868.5180 - Rocking bed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Rocking bed. 868.5180 Section 868.5180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5180 Rocking bed. (a) Identification. A rocking bed is a...

  4. 21 CFR 868.5180 - Rocking bed.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Rocking bed. 868.5180 Section 868.5180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5180 Rocking bed. (a) Identification. A rocking bed is a...

  5. 21 CFR 868.5180 - Rocking bed.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Rocking bed. 868.5180 Section 868.5180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5180 Rocking bed. (a) Identification. A rocking bed is a...

  6. 21 CFR 868.5180 - Rocking bed.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Rocking bed. 868.5180 Section 868.5180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5180 Rocking bed. (a) Identification. A rocking bed is a...

  7. 21 CFR 868.5180 - Rocking bed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Rocking bed. 868.5180 Section 868.5180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5180 Rocking bed. (a) Identification. A rocking bed is a...

  8. Fluidization quality analyzer for fluidized beds

    DOEpatents

    Daw, C.S.; Hawk, J.A.

    1995-07-25

    A control loop and fluidization quality analyzer for a fluidized bed utilizes time varying pressure drop measurements. A fast-response pressure transducer measures the overall bed pressure drop, or over some segment of the bed, and the pressure drop signal is processed to produce an output voltage which changes with the degree of fluidization turbulence. 9 figs.

  9. Fluidization quality analyzer for fluidized beds

    DOEpatents

    Daw, C. Stuart; Hawk, James A.

    1995-01-01

    A control loop and fluidization quality analyzer for a fluidized bed utilizes time varying pressure drop measurements. A fast-response pressure transducer measures the overall bed pressure drop, or over some segment of the bed, and the pressure drop signal is processed to produce an output voltage which changes with the degree of fluidization turbulence.

  10. 42 CFR 412.108 - Special treatment: Medicare-dependent, small rural hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... of beds increases to more than 100. (B) Its geographic classification changes. (iii) An MDH must... days from the date it receives the hospital's request and all other necessary information. (iii) The... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL...

  11. Hospital capacity during an influenza pandemic-Buenos Aires, Argentina, 2009.

    PubMed

    Meites, Elissa; Farias, Daniel; Raffo, Lucrecia; Albalak, Rachel; Carlino, Oreste Luis; McDonald, L Clifford; Widdowson, Marc-Alain

    2011-01-01

    At a major referral hospital in the Southern Hemisphere, the 2009 influenza A (H1N1) pandemic brought increased critical care demand and more unscheduled nursing absences. Because of careful preparedness planning, including rapid expansion and redistribution of the numbers of available beds and staff, hospital surge capacity was not exceeded. PMID:21087127

  12. The effect of competition on reserve capacity: The case of California hospitals in the late 1990s.

    PubMed

    Santerre, Rexford E; Adams, Ammon S

    2002-09-01

    This paper empirically investigates how competitive forces have affected bed capacity in the California hospital services industry using a data set for the late 1990s. The empirical results offer several conclusions about the effect of different types of competition on bed capacity during a period characterized by heightened price consciousness. In contrast to earlier periods, hospitals are found to continuously react to increased inter-hospital competition by reducing the supply of beds relative to patient demand. Similar to earlier periods, the empirical results suggest that increased physician/supplier competition leads to a reduction in bed capacity. Finally and in contrast to earlier studies, findings indicate that increased payer competition, as measured by the percentage of managed care patients in the market area, causes less bed capacity up to a point. PMID:14625941

  13. [Authorization, institutional services, hospital-based practices and cooperation in the hospital--from the point of view of the hospital owners].

    PubMed

    Kersting, Thomas

    2003-11-01

    Structural changes in the financing of hospital-based health care in Germany make a revision of the currently existing strict separation between ambulatory and stationary patient care inevitable. The present monopolist situation of office-based physicians (organised in private practices without any legal or financial relation to a hospital) will be amended by the participation of hospitals and hospital-employed doctors in ambulatory services of a different kind. These may include the institutional authorization of hospitals to participate in ambulatory services, especially in the case of emergencies and first aid, and co-operations between doctors in private practices and hospitals. Such co-operations are now legally enabled to provide "integrated services", but still lacking acceptance by the parties involved in the health care services. Ambulatory medical care is an already huge and now rapidly growing market, whereas the classical hospital services represent a declining product. Therefore hospitals will have to act accordingly or they will even forfeit the opportunity to use the ambulatory care sector to improve the intensity of utilisation of their hospital beds. In addition, hospitals will have to accept that office-based doctors are their customers and have to be treated as such. The establishment of regional networks may be a solution to this problem. Integrated services can only be established if new ways of co-operation and knowledge transfer are introduced into this area step by step. The present article provides practical examples of co-operation models. PMID:14710650

  14. Hospitalization for Hypoglycemia in Japanese Diabetic Patients

    PubMed Central

    Sako, Akahito; Yasunaga, Hideo; Matsui, Hiroki; Fushimi, Kiyohide; Hamasaki, Hidetaka; Katsuyama, Hisayuki; Tsujimoto, Tetsuro; Goto, Atsushi; Yanai, Hidekatsu

    2015-01-01

    Abstract We aimed to elucidate the epidemiology, patient demographics, and clinical outcomes of hospitalization for hypoglycemia in diabetic patients using a Japanese large-scale database. We conducted a retrospective study using a national inpatient database of acute care hospitals in Japan. Diabetic patients ages ≥15 years with hypoglycemia as a main diagnosis for hospitalization were eligible. We estimated the annual number of hospitalizations in Japan and compared the annual admission rate by age and treatment groups. We also analyzed the association between patient characteristics and in-hospital mortality. Among 22.7 million discharge records from July 2008 and March 2013, a total of 25,071 patients were eligible. The mean age was 73.4 years, and the mean body mass index (BMI) was 22.3 kg/m2. The estimated annual hospitalization for hypoglycemia in Japan was ∼20,000. Annual admission rates for hypoglycemia per 1000 diabetic patients and 1000 diabetic patients receiving insulin or oral hypoglycemic agents were 2.1 and 4.1, respectively. Patients <40 years and >70 years old were at a higher risk of hospitalization. In-hospital mortality was 3.8%, and risk factors associated with poor survival were male sex, older age, lower bed capacity, community hospital, low BMI, coma at admission, and higher Charlson Comorbidity Index. To prevent severe hypoglycemia that leads to death and complications, individualized and careful glycemic control are important, especially in very old or young patients and in those with comorbid conditions or low BMI. PMID:26107672

  15. Adjustable Induction-Heating Coil

    NASA Technical Reports Server (NTRS)

    Ellis, Rod; Bartolotta, Paul

    1990-01-01

    Improved design for induction-heating work coil facilitates optimization of heating in different metal specimens. Three segments adjusted independently to obtain desired distribution of temperature. Reduces time needed to achieve required temperature profiles.

  16. Pulsed atmospheric fluidized bed combustion

    SciTech Connect

    Not Available

    1992-05-01

    During this first quarter, a lab-scale water-cooled pulse combustor was designed, fabricated, and integrated with old pilot-scale PAFBC test systems. Characterization tests on this pulse combustor firing different kinds of fuel -- natural gas, pulverized coal and fine coal -- were conducted (without fluidized bed operation) for the purpose of finalizing PAFBC full-scale design. Steady-state tests were performed. Heat transfer performance and combustion efficiency of a coal-fired pulse combustor were evaluated.

  17. Method and apparatus for a combination moving bed thermal treatment reactor and moving bed filter

    SciTech Connect

    Badger, Phillip C.; Dunn, Jr., Kenneth J.

    2015-09-01

    A moving bed gasification/thermal treatment reactor includes a geometry in which moving bed reactor particles serve as both a moving bed filter and a heat carrier to provide thermal energy for thermal treatment reactions, such that the moving bed filter and the heat carrier are one and the same to remove solid particulates or droplets generated by thermal treatment processes or injected into the moving bed filter from other sources.

  18. NIH Clinical Center: There’s No Other Hospital Like It | NIH MedlinePlus the Magazine

    MedlinePlus

    ... Center houses 240 inpatient beds, 82 day-hospital stations, and more than 1,600 laboratories that conduct ... steps away from the NIH Clinical Center, providing space for solitude, family meetings, and supportive fellowship. Training ...

  19. Agglomeration-Free Distributor for Fluidized Beds

    NASA Technical Reports Server (NTRS)

    Ouyang, F.; Sinica, A.; Levenspiel, O.

    1986-01-01

    New gas distributor for fluidized beds prevents hot particles from reacting on it and forming hard crust. In reduction of iron ore in fluidized bed, ore particles do not sinter on distributor and perhaps clog it or otherwise interfere with gas flow. Distributor also relatively cool. In fluidized-bed production of silicon, inflowing silane does not decompose until within bed of hot silicon particles and deposits on them. Plates of spiral distributor arranged to direct incoming gas into spiral flow. Turbulence in flow reduces frequency of contact between fluidized-bed particles and distributor.

  20. Clinical skills: bed making and patient positioning.

    PubMed

    Pellatt, Glynis Collis

    Providing a clean, comfortable bed and positioning a patient in the optimum posture for prevention of complications and to enable maximum independence are fundamental nursing skills. Bed-making is a daily routine that requires practical and technical skills. Selecting the correct posture for a patient in bed or in a chair is essential for physiological functioning and recovery. In this article bed-making is described, as are positioning and re-positioning in relation to patients in bed, armchairs and wheelchairs. Infection control and moving and handling issues are also considered. PMID:17505378

  1. Patterning the Renal Vascular Bed

    PubMed Central

    Herzlinger, Doris; Hurtado, Romulo

    2015-01-01

    The renal vascular bed has a stereotypic architecture that is essential for the kidney’s role in excreting metabolic waste and regulating the volume and composition of body fluids. The kidney’s excretory functions are dependent on the delivery of the majority of renal blood flow to the glomerular capillaries, which filter plasma removing from it metabolic waste, as well as vast quantities of solutes and fluids. The renal tubules reabsorb from the glomerular filtrate solutes and fluids required for homeostasis, while the post-glomerular capillary beds return these essential substances back into the systemic circulation. Thus, the kidney’s regulatory functions are dependent on the close proximity or alignment of the post-glomerular capillary beds with the renal tubules. This review will focus on our current knowledge of the mechanisms controlling the embryonic development of the renal vasculature. An understanding of this process is critical for developing novel therapies to prevent vessel rarefaction and will be essential for engineering renal tissues suitable for restoring kidney function to the ever-increasing population of patients with end stage renal disease. PMID:25128732

  2. Scaling of pressurized fluidized beds

    SciTech Connect

    Guralnik, S.; Glicksman, L.R.

    1994-10-01

    The project has two primary objectives. The first is to verify a set of hydrodynamic scaling relationships for commercial pressurized fluidized bed combustors (PFBC). The second objective is to investigate solids mixing in pressurized bubbling fluidized beds. American Electric Power`s (AEP) Tidd combined-cycle demonstration plant will provide time-varying pressure drop data to serve as the basis for the scaling verification. The verification will involve demonstrating that a properly scaled cold model and the Tidd PFBC exhibit hydrodynamically similar behavior. An important issue in PFBC design is the spacing of fuel feed ports. The feed spacing is dictated by the fuel distribution and the mixing characteristics within the bed. After completing the scaling verification, the cold model will be used to study the characteristics of PFBCs. A thermal tracer technique will be utilized to study mixing both near the fuel feed region and in the far field. The results allow the coal feed and distributor to be designed for optimal heating.

  3. Rivesville multicell fluidized bed boiler

    SciTech Connect

    Not Available

    1981-03-01

    One objective of the experimental MFB at Rivesville, WV, was the evaluation of alternate feed systems for injecting coal and limestone into a fluidized bed. A continuous, uniform feed flow to the fluid bed is essential in order to maintain stable operations. The feed system originally installed on the MFB was a gravity feed system with an air assist to help overcome the back pressure created by the fluid bed. The system contained belt, vibrating, and rotary feeders which have been proven adequate in other material handling applications. This system, while usable, had several operational and feeding problems during the MFB testing. A major portion of these problems occurred because the coal and limestone feed control points - a belt feeder and rotary feeder, respectively - were pressurized in the air assist system. These control points were not designed for pressurized service. An alternate feed system which could accept feed from the two control points, split the feed into six equal parts and eliminate the problems of the pressurized system was sought. An alternate feed system designed and built by the Fuller Company was installed and tested at the Rivesville facility. Fuller feed systems were installed on the north and south side of C cell at the Rivesville facility. The systems were designed to handle 10,000 lb/hr of coal and limestone apiece. The systems were installed in late 1979 and evaluated from December 1979 to December 1980. During this time period, nearly 1000 h of operating time was accumulated on each system.

  4. Real time measurements of sediment transport and bed morphology during channel altering flow and sediment transport events

    NASA Astrophysics Data System (ADS)

    Curran, Joanna Crowe; Waters, Kevin A.; Cannatelli, Kristen M.

    2015-09-01

    Real-time measurements of bed changes over a reach are a missing piece needed to link bed morphology with sediment transport processes during unsteady flows when the bed adjusts quickly to changing transport rates or visual observation of the bed is precluded by fine sediment in the water column. A new technique is presented that provides continuous measurement of sediment movement over the length of a flume. A bedload monitoring system (BLMS) was developed that makes use of pressure pillows under a false flume bottom to measure sediment and water weights over discrete flume channel sections throughout a flow event. This paper details the construction of the BLMS and provides examples of its use in a laboratory setting to reconstruct bed slopes during unsteady flows and to create a real-time record of sediment transport rates across the flume channel bed during a sediment transporting flow. Data gathered from the BLMS compared well against techniques commonly in use in flume studies. When the BLMS was analyzed in conjunction with bed surface DEMs and differenced DEMs, a complete transport and bed adjustment picture was constructed. The difference DEMs provided information on the spatial extent of bed morphology changes. The BLMS supplied the data record necessary to reconstruct sediment transport records through the downstream channel, including locations and time periods of temporary sediment storage and supply. The BLMS makes it possible to construct a continuous record of the spatial distribution of sediment movement through the flume, including areas of temporary aggradation and degradation. Exciting implications of future research that incorporates a BLMS include a more informed management of river systems as a result of improved temporal predictions of sediment movement and the associated changes in channel slope and bed morphology.

  5. US Hospitals Are Still Using Chargemaster Markups To Maximize Revenues.

    PubMed

    Bai, Ge; Anderson, Gerard F

    2016-09-01

    Many hospital executives and economists have suggested that since Medicare adopted a hospital prospective payment system in 1985, prices on the hospital chargemaster (an exhaustive list of the prices for all hospital procedures and supplies) have become irrelevant. However, using 2013 nationally representative hospital data from Medicare, we found that a one-unit increase in the charge-to-cost ratio (chargemaster price divided by Medicare-allowable cost) was associated with $64 higher patient care revenue per adjusted discharge. Furthermore, hospitals appeared to systematically adjust their charge-to-cost ratios: The average ratio ranged between 1.8 and 28.5 across patient care departments, and for-profit hospitals were associated with a 2.30 and a 2.07 higher charge-to-cost ratio than government and nonprofit hospitals, respectively. We also found correlation between the proportion of uninsured patients, a hospital's system affiliation, and its regional power with the charge-to-cost ratio. These findings suggest that hospitals still consider the chargemaster price to be an important way to enhance revenue. Policy makers might consider developing additional policy tools that improve markup transparency to protect patients from unexpectedly high charges for specific services. PMID:27605648

  6. Bed bug aggregation pheromone finally identified.

    PubMed

    Gries, Regine; Britton, Robert; Holmes, Michael; Zhai, Huimin; Draper, Jason; Gries, Gerhard

    2015-01-19

    Bed bugs have become a global epidemic and current detection tools are poorly suited for routine surveillance. Despite intense research on bed bug aggregation behavior and the aggregation pheromone, which could be used as a chemical lure, the complete composition of this pheromone has thus far proven elusive. Here, we report that the bed bug aggregation pheromone comprises five volatile components (dimethyl disulfide, dimethyl trisulfide, (E)-2-hexenal, (E)-2-octenal, 2-hexanone), which attract bed bugs to safe shelters, and one less-volatile component (histamine), which causes their arrestment upon contact. In infested premises, a blend of all six components is highly effective at luring bed bugs into traps. The trapping of juvenile and adult bed bugs, with or without recent blood meals, provides strong evidence that this unique pheromone bait could become an effective and inexpensive tool for bed bug detection and potentially their control. PMID:25529634

  7. Effect of Wound Classification on Risk-Adjustment in American College of Surgeons NSQIP

    PubMed Central

    Ju, Mila H.; Cohen, Mark E.; Bilimoria, Karl Y.; Latus, Melissa S.; Scholl, Lisa M.; Schwab, Bradley J.; Byrd, Claudia M.; Ko, Clifford Y.; Dellinger, E. Patchen; Hall, Bruce L.

    2014-01-01

    Background Surgical wound classification has been used in risk-adjustment models. However, it can be subjective and potentially improperly bias hospital quality comparisons. The objective is to examine the effect of wound classification on hospital performance risk-adjustment models. Study Design Retrospective review of the 2011 ACS NSQIP database was conducted for wound classification categories: clean, clean/contaminated, contaminated, and dirty/infected. To assess the influence of wound classification on risk-adjustment, two models were developed for each outcome: one including and one excluding wound classification. For each model, hospital postoperative complications were estimated using hierarchical multivariable regression methods. Absolute changes in hospital rank, correlations of odds-ratios, and outlier status agreement between models were examined. Results Of the 442,149 cases performed in 315 hospitals: 53.6% were classified as clean; 34.2% clean/contaminated; 6.7% contaminated; and 5.5% dirty/infected. The surgical site infection (SSI) rate was highest in dirty/infected (8.5%) and lowest in clean (1.8%) cases. For overall SSI, the absolute change in risk-adjusted hospital performance rank between models including vs. excluding wound classification was minimal (mean 4.5 out of 315 positions). The correlations between odds ratios of the two performance models were nearly perfect (R=0.9976, P<0.0001), and outlier status agreement was excellent (Kappa=0.9508, P<0.0001). Similar findings were observed in models of subgroups of SSI and other postoperative outcomes. Conclusions In circumstances where alternate information is available for risk-adjustment, there appear to be minimal differences in performance models that include vs. exclude wound classification. Therefore, ACS NSQIP is critically evaluating the continued use of wound classification in hospital performance risk-adjustment models. PMID:25053222

  8. A cost sensitive inpatient bed reservation approach to reduce emergency department boarding times.

    PubMed

    Qiu, Shanshan; Chinnam, Ratna Babu; Murat, Alper; Batarse, Bassam; Neemuchwala, Hakimuddin; Jordan, Will

    2015-03-01

    Emergency departments (ED) in hospitals are experiencing severe crowding and prolonged patient waiting times. A significant contributing factor is boarding delays where admitted patients are held in ED (occupying critical resources) until an inpatient bed is identified and readied in the admit wards. Recent research has suggested that if the hospital admissions of ED patients can be predicted during triage or soon after, then bed requests and preparations can be triggered early on to reduce patient boarding time. We propose a cost sensitive bed reservation policy that recommends optimal bed reservation times for patients. The policy relies on a classifier that estimates the probability that the ED patient will be admitted using the patient information collected and readily available at triage or right after. The policy is cost sensitive in that it accounts for costs associated with patient admission prediction misclassification as well as costs associated with incorrectly selecting the reservation time. Results from testing the proposed bed reservation policy using data from a VA Medical Center are very promising and suggest significant cost saving opportunities and reduced patient boarding times. PMID:24811547

  9. Hospital Library Administration.

    ERIC Educational Resources Information Center

    Cramer, Anne

    The objectives of a hospital are to improve patient care, while the objectives of a hospital library are to improve services to the staff which will support their efforts. This handbook dealing with hospital administration is designed to aid the librarian in either implementing a hospital library, or improving services in an existing medical…

  10. Measuring Rural Hospital Quality

    ERIC Educational Resources Information Center

    Moscovice, Ira; Wholey, Douglas R.; Klingner, Jill; Knott, Astrid

    2004-01-01

    Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities. This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive…

  11. Hospital marketing revisited.

    PubMed

    Costello, M M

    1987-05-01

    With more hospitals embracing the marketing function in their organizational management over the past decade, hospital marketing can no longer be considered a fad. However, a review of hospital marketing efforts as reported in the professional literature indicates that hospitals must pay greater attention to the marketing mix elements of service, price and distribution channels as their programs mature. PMID:10283019

  12. 7 CFR 251.7 - Formula adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 4 2010-01-01 2010-01-01 false Formula adjustments. 251.7 Section 251.7 Agriculture... GENERAL REGULATIONS AND POLICIES-FOOD DISTRIBUTION THE EMERGENCY FOOD ASSISTANCE PROGRAM § 251.7 Formula adjustments. Formula adjustments. (a) Commodity adjustments. The Department will make annual adjustments...

  13. 12 CFR 1209.80 - Inflation adjustments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 10 2014-01-01 2014-01-01 false Inflation adjustments. 1209.80 Section 1209.80... PROCEDURE Civil Money Penalty Inflation Adjustments § 1209.80 Inflation adjustments. The maximum amount of... thereafter adjusted in accordance with the Inflation Adjustment Act, on a recurring four-year cycle, is...

  14. 12 CFR 1209.80 - Inflation adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 9 2012-01-01 2012-01-01 false Inflation adjustments. 1209.80 Section 1209.80... PROCEDURE Civil Money Penalty Inflation Adjustments § 1209.80 Inflation adjustments. The maximum amount of... thereafter adjusted in accordance with the Inflation Adjustment Act, on a recurring four-year cycle, is...

  15. 12 CFR 1209.80 - Inflation adjustments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 9 2013-01-01 2013-01-01 false Inflation adjustments. 1209.80 Section 1209.80... PROCEDURE Civil Money Penalty Inflation Adjustments § 1209.80 Inflation adjustments. The maximum amount of... thereafter adjusted in accordance with the Inflation Adjustment Act, on a recurring four-year cycle, is...

  16. Management of wastes from hospitals: A case study in Pakistan.

    PubMed

    Ali, Mustafa; Wang, Wenping; Chaudhry, Nawaz

    2016-01-01

    Proper management of hospital waste is a critical concern in many countries of the world. Pakistan is the sixth most populous country in the world, with one of the highest urbanisation and population growth rates in South Asia. Data and analyses regarding hospital waste management practices in Pakistan are scarce in scientific literature. This study was meant to determine waste management practices at selected hospitals in a major city in Pakistan, Gujranwala. A total of 12 different hospitals were selected for the survey, which involved quantification of waste generation rates and investigation of waste management practices. The results were analysed using linear regression. The weighted average total, general and infectious hospital waste generation rates were found to be 0.667, 0.497 and 0.17 kg bed-day(-1), respectively. Of the total, 73.85% consisted of general, 25.8% consisted of hazardous infectious and 0.87% consisted of sharps waste. The general waste consisted of 15.76% paper, 13.41% plastic, 21.77% textiles, 6.47% glass, 1.99% rubber, 0.44% metal and 40.17% others. Linear regression showed that waste generation increased with occupancy and decreased with number of beds. Small, private and specialised hospitals had relatively greater waste generation rates. Poor waste segregation, storage and transportation practices were observed at all surveyed hospitals. PMID:26628050

  17. Cutting Medicare Hospital Prices Leads to a Spillover Reduction in Hospital Discharges for the Nonelderly

    PubMed Central

    White, Chapin

    2014-01-01

    Objective To measure spillover effects of Medicare inpatient hospital prices on the nonelderly (under age 65). Primary Data Sources Healthcare Cost and Utilization Project State Inpatient Databases (10 states, 1995–2009) and Medicare Hospital Cost Reports. Study Design Outcomes include nonelderly discharges, length of stay and case mix, staffed hospital bed-days, and the share of discharges and days provided to the elderly. We use metropolitan statistical areas as our markets. We use descriptive analyses comparing 1995 and 2009 and panel data fixed-effects regressions. We instrument for Medicare prices using accumulated changes in the Medicare payment formula. Principal Findings Medicare price reductions are strongly associated with reductions in nonelderly discharges and hospital capacity. A 10-percent reduction in the Medicare price is estimated to reduce discharges among the nonelderly by about 5 percent. Changes in the Medicare price are not associated with changes in the share of inpatient hospital care provided to the elderly versus nonelderly. Conclusions Medicare price reductions appear to broadly constrain hospital operations, with significant reductions in utilization among the nonelderly. The slow Medicare price growth under the Affordable Care Act may result in a spillover slowdown in hospital utilization and spending among the nonelderly. PMID:24850524

  18. 42 CFR 482.66 - Special requirements for hospital providers of long-term care services (“swing-beds”).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...-term care services (âswing-bedsâ). 482.66 Section 482.66 Public Health CENTERS FOR MEDICARE & MEDICAID... providers of long-term care services (“swing-beds”). A hospital that has a Medicare provider agreement must... extended care services, as specified in § 409.30 of this chapter, and be reimbursed as a swing-bed...

  19. 42 CFR 482.66 - Special requirements for hospital providers of long-term care services (“swing-beds”).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...-term care services (âswing-bedsâ). 482.66 Section 482.66 Public Health CENTERS FOR MEDICARE & MEDICAID... providers of long-term care services (“swing-beds”). A hospital that has a Medicare provider agreement must... extended care services, as specified in § 409.30 of this chapter, and be reimbursed as a swing-bed...

  20. 42 CFR 482.66 - Special requirements for hospital providers of long-term care services (“swing-beds”).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...-term care services (âswing-bedsâ). 482.66 Section 482.66 Public Health CENTERS FOR MEDICARE & MEDICAID... providers of long-term care services (“swing-beds”). A hospital that has a Medicare provider agreement must... extended care services, as specified in § 409.30 of this chapter, and be reimbursed as a swing-bed...

  1. Linear test bed. Volume 1: Test bed no. 1. [aerospike test bed with segmented combustor

    NASA Technical Reports Server (NTRS)

    1972-01-01

    The Linear Test Bed program was to design, fabricate, and evaluation test an advanced aerospike test bed which employed the segmented combustor concept. The system is designated as a linear aerospike system and consists of a thrust chamber assembly, a power package, and a thrust frame. It was designed as an experimental system to demonstrate the feasibility of the linear aerospike-segmented combustor concept. The overall dimensions are 120 inches long by 120 inches wide by 96 inches in height. The propellants are liquid oxygen/liquid hydrogen. The system was designed to operate at 1200-psia chamber pressure, at a mixture ratio of 5.5. At the design conditions, the sea level thrust is 200,000 pounds. The complete program including concept selection, design, fabrication, component test, system test, supporting analysis and posttest hardware inspection is described.

  2. Design and implementation of picture archiving and communication system in Huadong Hospital

    NASA Astrophysics Data System (ADS)

    Zhang, Jianguo; Zhou, Zheng; Zhuang, Jun; Han, Ruolin; Zhang, Guozhen; Feng, Jie; Wang, Mingpeng; Wang, Chuanfu

    2001-08-01

    Huadong hospital in Shanghai with 700 beds provides health care services for inpatients and outpatients, as well as special senior and VIP patients. In order to move to digital imaging based radiology practice, and also provide better intra-hospital clinical services for senior and VIP patients, we started designing and planning PACS implementation from September of 1999. Based on the radiology service model and current workflow in Huadong hospital, we implemented PACS in three steps.

  3. Adjustable forming of thermoplastic composites for orthopaedic applications.

    PubMed

    Hou, M; Friedrich, K

    1998-02-01

    The present study was focused on the development of a special thermoforming technique for manufacturing of continuous fibre reinforced thermoplastic composite parts with complex surface contours. In particular, a stamp forming process was modified to investigate the potential manufacturing advantages of thermoplastic composites in orthopaedic applications. An apparatus was designed which allowed the thermoforming procedure to be fully automatic, i.e. a cold pre-consolidated laminate panel, as the feed material, was heated up in an infrared heating zone and then transferred into a cold mould system, where it was stamp formed. Both halves of the mould were made of many tiny round metal sticks in a metal frame. This needle-bed mould allowed one to copy any contour by pushing it slightly on spring fixed sticks. The desired position of these sticks could then be adjusted by forcing the side plates of the metal frame together. To prevent any press mark of stick-tops on the composite, i.e. to achieve smooth surfaces of the themoformed composite parts, flexible rubber pads were needed to cover the mould surfaces. Experimental results showed that the surface profile of CF/PP and GF/PP composites formed by the needle-bed mould reproduced fairly well the contour of a saddle shaped, complex model sample. Unique properties of this needle-bed mould are that it can be repeatedly used, and that it can copy any complex surface contours, for example a bone surface, by simply adjusting the stick positions according to the special surface requirements. PMID:15348912

  4. Results of a hospital waste survey in private hospitals in Fars province, Iran

    SciTech Connect

    Askarian, Mehrdad; Vakili, Mahmood; Kabir, Gholamhosein

    2004-07-01

    Hospital waste is considered dangerous because it may possess pathogenic agents and can cause undesirable effects on human health and the environment. In Iran, neither rules have been compiled nor does exact information exist regarding hospital waste management. The survey presented in this article was carried out in all 15 private hospitals of Fars province (Iran) from the total numbers of 50 governmental and private hospitals located in this province, in order to determine the amount of different kinds of waste produced and the present situation of waste management. The results indicated that the waste generation rate is 4.45 kg/bed/day, which includes 1830 kg (71.44%) of domestic waste, 712 kg (27.8%) of infectious waste, and 19.6 kg (0.76%) of sharps. Segregation of the different types of waste is not carried out perfectly. Two (13.3%) of the hospitals use containers without lids for on-site transport of wastes. Nine (60%) of the hospitals are equipped with an incinerator and six of them (40%) have operational problems with the incinerators. In all hospitals municipal workers transport waste outside the hospital premises daily or at the most on alternative days. In the hospitals under study, there aren't any training courses about hospital waste management and the hazards associated with them. The training courses that are provided are either ineffective or unsuitable. Performing extensive studies all over the country, compiling and enacting rules, establishing standards and providing effective personnel training are the main challenges for the concerned authorities and specialists in this field.

  5. Results of a hospital waste survey in private hospitals in Fars province, Iran.

    PubMed

    Askarian, Mehrdad; Vakili, Mahmood; Kabir, Gholamhosein

    2004-01-01

    Hospital waste is considered dangerous because it may possess pathogenic agents and can cause undesirable effects on human health and the environment. In Iran, neither rules have been compiled nor does exact information exist regarding hospital waste management. The survey presented in this article was carried out in all 15 private hospitals of Fars province (Iran) from the total numbers of 50 governmental and private hospitals located in this province, in order to determine the amount of different kinds of waste produced and the present situation of waste management. The results indicated that the waste generation rate is 4.45 kg/bed/day, which includes 1830 kg (71.44%) of domestic waste, 712 kg (27.8%) of infectious waste, and 19.6 kg (0.76%) of sharps. Segregation of the different types of waste is not carried out perfectly. Two (13.3%) of the hospitals use containers without lids for on-site transport of wastes. Nine (60%) of the hospitals are equipped with an incinerator and six of them (40%) have operational problems with the incinerators. In all hospitals municipal workers transport waste outside the hospital premises daily or at the most on alternative days. In the hospitals under study, there aren't any training courses about hospital waste management and the hazards associated with them. The training courses that are provided are either ineffective or unsuitable. Performing extensive studies all over the country, compiling and enacting rules, establishing standards and providing effective personnel training are the main challenges for the concerned authorities and specialists in this field. PMID:15081061

  6. Capital Investment by Independent and System-Affiliated Hospitals.

    PubMed

    Carroll, Nathan W; Smith, Dean G; Wheeler, John R C

    2015-01-01

    Capital expenditures are a critical part of hospitals' efforts to maintain quality of patient care and financial stability. Over the past 20 years, finding capital to fund these expenditures has become increasingly challenging for hospitals, particularly independent hospitals. Independent hospitals struggling to find ways to fund necessary capital investment are often advised that their best strategy is to join a multi-hospital system. There is scant empirical evidence to support the idea that system membership improves independent hospitals' ability to make capital expenditures. Using data from the American Hospital Association and Medicare Cost Reports, we use difference-in-difference methods to examine changes in capital expenditures for independent hospitals that joined multi-hospital systems between 1997 and 2008. We find that in the first 5 years after acquisition, capital expenditures increase by an average of almost $16,000 per bed annually, as compared with non-acquired hospitals. In later years, the difference in capital expenditure is smaller and not statistically significant. Our results do not suggest that increases in capital expenditures vary by asset age or the size of the acquiring system. PMID:26105571

  7. Planned Out-of-Hospital Birth and Birth Outcomes

    PubMed Central

    Snowden, Jonathan M.; Tilden, Ellen L.; Snyder, Janice; Quigley, Brian; Caughey, Aaron B.; Cheng, Yvonne W.

    2016-01-01

    Background The frequency of planned out-of-hospital birth in the United States has increased in recent years. The value of studies assessing the perinatal risks of planned out-of-hospital birth versus hospital birth has been limited by cases in which transfer to a hospital is required and a birth that was initially planned as an out-of-hospital birth is misclassified as a hospital birth. Methods We performed a population-based, retrospective cohort study of all births that occurred in Oregon during 2012 and 2013 using data from newly revised Oregon birth certificates that allowed for the disaggregation of hospital births into the categories of planned in-hospital births and planned out-of-hospital births that took place in the hospital after a woman’s intrapartum transfer to the hospital. We assessed perinatal morbidity and mortality, maternal morbidity, and obstetrical procedures according to the planned birth setting (out of hospital vs. hospital). Results Planned out-of-hospital birth was associated with a higher rate of perinatal death than was planned in-hospital birth (3.9 vs. 1.8 deaths per 1000 deliveries, P = 0.003; odds ratio after adjustment for maternal characteristics and medical conditions, 2.43; 95% confidence interval [CI], 1.37 to 4.30; adjusted risk difference, 1.52 deaths per 1000 births; 95% CI, 0.51 to 2.54). The odds for neonatal seizure were higher and the odds for admission to a neonatal intensive care unit lower with planned out-of-hospital births than with planned in-hospital birth. Planned out-of-hospital birth was also strongly associated with unassisted vaginal delivery (93.8%, vs. 71.9% with planned in-hospital births; P<0.001) and with decreased odds for obstetrical procedures. Conclusions Perinatal mortality was higher with planned out-of-hospital birth than with planned in-hospital birth, but the absolute risk of death was low in both settings. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human

  8. Final RQ adjustments rule issued

    SciTech Connect

    Bergeson, L.L.

    1995-08-01

    On June 12, 1995, the US Environmental Protection Agency (EPA) issued its long awaited final rule adjusting certain reportable quantities (RQs) for hazardous substances under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA). The rule: revises the table of hazardous substances to add 47 individual Clean Air Act (CAA) hazardous air pollutants (HAPs); adjustments their statutory one-pound RQs; adds five other CAA HAPs that are categories of substances and assigns no RQ to the categories; and adjusts RQs for 11 Resource Conservation and Recovery Act (RCRA) listed hazardous wastes. EPA made conforming changes to the Clean Water Act table of hazardous substances and the Emergency Planning and Community Right-to-Know Act (EPCRA) table of extremely hazardous substances. The rule became effective July 12, 1995.

  9. MCCB warm adjustment testing concept

    NASA Astrophysics Data System (ADS)

    Erdei, Z.; Horgos, M.; Grib, A.; Preradović, D. M.; Rodic, V.

    2016-08-01

    This paper presents an experimental investigation in to operating of thermal protection device behavior from an MCCB (Molded Case Circuit Breaker). One of the main functions of the circuit breaker is to assure protection for the circuits where mounted in for possible overloads of the circuit. The tripping mechanism for the overload protection is based on a bimetal movement during a specific time frame. This movement needs to be controlled and as a solution to control this movement we choose the warm adjustment concept. This concept is meant to improve process capability control and final output. The warm adjustment device design will create a unique adjustment of the bimetal position for each individual breaker, determined when the testing current will flow thru a phase which needs to trip in a certain amount of time. This time is predetermined due to scientific calculation for all standard types of amperages and complies with the IEC 60497 standard requirements.

  10. Hospital library resources in Massachusetts: data collection and analysis.

    PubMed Central

    McGrath, P J

    1980-01-01

    Hospitals in the Commonwealth of Massachusetts were surveyed to establish some ranges and baseline statistics for hospital medical information resources. The data were evaluated in terms of theoretical compliance with the Joint Commission on Accreditation of Hospitals standards as well as the more specific proposed appendices to the Canadian Standards for Hospital Libraries. The study quantifies hospital library resources and services in a state with a substantial number of acute care facilities. Of the study universe, 67.6% were judged as meeting either the revised JCAH or the Canadian criteria. The central finding is that the 100- to 299-bed institutions reflect a significant number of deficiencies when evaluated against either quantitative or nonquantitative standards. Further areas of study are suggested. PMID:6934016

  11. Factors associated with lease financing in the hospital industry.

    PubMed

    McCue, Michael J

    2007-01-01

    In contrast to capital leases, which are reported on the balance sheet as debt, operating leases are a form of off-balance sheet financing only reported in the notes to the financial statement and have limited disclosure requirements. Following the perpetuity method of corporate finance, this study developed a capitalized operating lease value for hospitals. Evaluating the substitutability between lease and debt financing, the findings show a marginal displacement of debt by lease financing. Assessing the relationship of market, mission, operating, and financial factors on lease financing for all short-term, acute-care hospitals across the United States, the results indicate that investor-owned hospital management companies and hospitals located in CON markets are less likely to lease and that smaller hospitals with fewer unoccupied beds, higher proportion of government payers, low liquidity, and lower capital expenditures are more likely to lease. PMID:19175234

  12. Mobile technology in rural hospitals: the case of the CT scanner.

    PubMed Central

    Hartley, D; Moscovice, I; Christianson, J

    1996-01-01

    OBJECTIVE. This study evaluates the relationship between hospital and regional characteristics and the prevalence of mobile computed tomography in rural hospitals. DATA SOURCES AND STUDY SETTING. Primary data were gathered from all rural hospitals in eight northwestern states (n = 471) in 1991. Secondary data sources include the AHA Annual Survey, the Area Resource File, and HCFA's PPS data sets for 1987-1990. STUDY DESIGN. Primary data are a single observation taken in the summer of 1991. Key hospital characteristics include patient volume, distance to the nearest referral center, distance to the nearest hospital, financial performance, and medical staff size. Key regional variables include beds per unit area, hospitals per unit area, and physician supply. DATA COLLECTION. A structured telephone interview was conducted with the hospital administrator at each hospital. For many hospitals, detailed information was gathered with additional calls to hospital personnel. PRINCIPAL FINDINGS. Where hospitals are closely spaced, mobile CT suppliers are more readily available, and hospitals are more likely to choose mobile CT than in areas where hospitals are farther apart. Hospitals may realize economies of scale and scope in their decisions about CT adoption. CONCLUSIONS. Transportation costs are an important determinant of hospital decisions about acquiring CT, but may be less important for higher-priced medical technologies. There is no support for the proposition that rural hospitals compete with referral centers for patients by purchasing technological equipment. PMID:8675440

  13. Fluidized bed charcoal particle production system

    SciTech Connect

    Sowards, N.K.

    1985-04-09

    A fluidized bed charcoal particle production system, including apparatus and method, wherein pieces of combustible waste, such as sawdust, fragments of wood, etc., are continuously disposed within a fluidized bed of a pyrolytic vessel. Preferably, the fluidized bed is caused to reach operating temperatures by use of an external pre-heater. The fluidized bed is situated above an air delivery system at the bottom of the vessel, which supports pyrolysis within the fluidized bed. Charcoal particles are thus formed within the bed from the combustible waste and are lifted from the bed and placed in suspension above the bed by forced air passing upwardly through the bed. The suspended charcoal particles and the gaseous medium in which the particles are suspended are displaced from the vessel into a cyclone mechanism where the charcoal particles are separated. The separated charcoal particles are quenched with water to terminate all further charcoal oxidation. The remaining off-gas is burned and, preferably, the heat therefrom used to generate steam, kiln dry lumber, etc. Preferably, the bed material is continuously recirculated and purified by removing tramp material.

  14. Adjustable spacer with rotational lock

    SciTech Connect

    Bowyer, M.L.

    1984-02-28

    A spacing apparatus for tubing conduit in a subterranean well, normally for use with an electric component with a longitudinally extending external electrical cable, permits irrotational adjustment of the length of the tubing conduit. The spacing apparatus comprises telescoping members which are keyed to prevent rotation therebetween. A threaded member, longitudinally fixed relative to one longitudinal member, normally engages threads extending substantially along the entire length of the other telescoping member. Movement of a retaining sleeve permits disengagement of the threaded segments which ratchet along the threads during telescoping movement. The length of the conduit can thus be irrotationally adjusted to remove slack from the electrical cable.

  15. Convective adjustment in baroclinic atmospheres

    NASA Technical Reports Server (NTRS)

    Emanuel, Kerry A.

    1986-01-01

    Local convection in planetary atmospheres is generally considered to result from the action of gravity on small regions of anomalous density. That in rotating baroclinic fluids the total potential energy for small scale convection contains a centrifugal as well as a gravitational contribution is shown. Convective adjustment in such an atmosphere results in the establishment of near adiabatic lapse rates of temperature along suitably defined surfaces of constant angular momentum, rather than in the vertical. This leads in general to sub-adiabatic vertical lapse rates. That such an adjustment actually occurs in the earth's atmosphere is shown by example and the magnitude of the effect for several other planetary atmospheres is estimated.

  16. 75 FR 33379 - Railroad Cost Recovery Procedures-Productivity Adjustment; Quarterly Rail Cost Adjustment Factor

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-11

    ... Surface Transportation Board Railroad Cost Recovery Procedures--Productivity Adjustment; Quarterly Rail... Railroads that the Board restate the previously published productivity adjustment for the 2003-2007 averaging period (2007 productivity adjustment) so that it tracks the 2007 productivity adjustment...

  17. Billing delays cause hassles, but hospitals still have to pay for services provided.

    PubMed

    Decker, R

    1988-06-01

    A hospital has a contract with the manufacturer to maintain and service copying machines owned by the hospital. The contract calls for the hospital to pay a set minimum monthly fee plus a per-copy charge for all copies made over a set amount. The supplier doesn't furnish any paper products. Recently the hospital received an invoice for 17 months' service. When contacted about this large bill, the supplier told the hospital that it had inadvertently dropped the hospital from its billing computer and had failed to bill the hospital each month. The hospital protested the pressure that this billing practice put upon its budget and asked for an adjustment. The supplier refused to make any adjustment in the amount but did agree to accept the arrears in monthly payments over a year with no interest charges. In this dialogue below, Dr. Decker discusses the legal issues involved in this situation. PMID:10287890

  18. The business of pediatric hospital medicine.

    PubMed

    Percelay, Jack M; Zipes, David G

    2014-07-01

    Pediatric hospital medicine (PHM) programs are mission driven, not margin driven. Very rarely do professional fee revenues exceed physician billing collections. In general, inpatient hospital care codes reimburse less than procedures, payer mix is poor, and pediatric inpatient care is inherently time-consuming. Using traditional accounting principles, almost all PHM programs will have a negative bottom line in the narrow sense of program costs and revenues generated. However, well-run PHM programs contribute positively to the bottom line of the system as a whole through the value-added services hospitalists provide and hospitalists' ability to improve overall system efficiency and productivity. This article provides an overview of the business of hospital medicine with emphasis on the basics of designing and maintaining a program that attends carefully to physician staffing (the major cost component of a program) and physician charges (the major revenue component of the program). Outside of these traditional calculations, resource stewardship is discussed as a way to reduce hospital costs in a capitated or diagnosis-related group reimbursement model and further improve profit-or at least limit losses. Shortening length of stay creates bed capacity for a program already running at capacity. The article concludes with a discussion of how hospitalists add value to the system by making other providers and other parts of the hospital more efficient and productive. PMID:24977676

  19. Hospital Costs and Inpatient Mortality among Children Undergoing Surgery for Congenital Heart Disease

    PubMed Central

    Romley, John A; Chen, Alex Y; Goldman, Dana P; Williams, Roberta

    2014-01-01

    Objective To determine the association between hospital costs and risk-adjusted inpatient mortality among children undergoing surgery for congenital heart disease (CHD) in U.S. acute-care hospitals. Data Sources/Study Settings Retrospective cohort study of 35,446 children in 2003, 2006, and 2009 Kids' Inpatient Database (KID). Study Design Cross-sectional logistic regression of risk-adjusted inpatient mortality and hospital costs, adjusting for a variety of patient-, hospital-, and community-level confounders. Data Collection/Extraction Methods We identified relevant discharges in the KID using the AHRQ Pediatric Quality Indicator for pediatric heart surgery mortality, and linked these records to hospital characteristics from American Hospital Association Surveys and community characteristics from the Census. Principal Findings Children undergoing CHD surgery in higher cost hospitals had lower risk-adjusted inpatient mortality (p = .002). An increase from the 25th percentile of treatment costs to the 75th percentile was associated with a 13.6 percent reduction in risk-adjusted mortality. Conclusions Greater hospital costs are associated with lower risk-adjusted inpatient mortality for children undergoing CHD surgery. The specific mechanisms by which greater costs improve mortality merit further exploration. PMID:24138064

  20. Advanced expander test bed program

    NASA Technical Reports Server (NTRS)

    Masters, A. I.; Mitchell, J. C.

    1991-01-01

    The Advanced Expander Test Bed (AETB) is a key element in NASA's Chemical Transfer Propulsion Program for development and demonstration of expander cycle oxygen/hydrogen engine technology component technology for the next space engine. The AETB will be used to validate the high-pressure expander cycle concept, investigate system interactions, and conduct investigations of advanced missions focused components and new health monitoring techniques. The split-expander cycle AETB will operate at combustion chamber pressures up to 1200 psia with propellant flow rates equivalent to 20,000 lbf vacuum thrust.

  1. The Advanced Expander Test Bed

    NASA Technical Reports Server (NTRS)

    Masters, Arthur I.; Tabata, William K.

    1990-01-01

    The principal goals and design concepts of the Advanced Expander Test Bed (AETB) program are briefly reviewed. The AETB is planned as the focal point for the development and demonstration of high-performance oxygen/hydrogen engine technology and advanced component technology for the next space engine. The engine will operate at pressures up to 1200 psia over a wide range of conditions, easily accommodating mission-focused components. The discussion covers design requirements, design approach, conceptual design, the AETB cycle, and the AETB control system.

  2. Advanced expander test bed engine

    NASA Technical Reports Server (NTRS)

    Mitchell, J. P.

    1992-01-01

    The Advanced Expander Test Bed (AETB) is a key element in NASA's Space Chemical Engine Technology Program for development and demonstration of expander cycle oxygen/hydrogen engine and advanced component technologies applicable to space engines as well as launch vehicle upper stage engines. The AETB will be used to validate the high pressure expander cycle concept, study system interactions, and conduct studies of advanced mission focused components and new health monitoring techniques in an engine system environment. The split expander cycle AETB will operate at combustion chamber pressures up to 1200 psia with propellant flow rates equivalent to 20,000 lbf vacuum thrust.

  3. MICROTURBULENCE IN GRAVEL BED STREAMS

    NASA Astrophysics Data System (ADS)

    Papanicolaou, T.; Tsakiris, A. G.; Kramer, C. M.

    2009-12-01

    The overarching objective of this investigation was to evaluate the role of relative submergence on the formation and evolution of cluster microforms in gravel bed streams and its implications to bedload transport. Secondary objectives of this research included (1) a detailed analysis of mean flow measurements around a clast; and (2) a selected number of experimental runs where the mean flow characteristics are linked together with the bed micro-topography observations around a clast. It is hypothesized that the relative submergence is an important parameter in defining the feedback processes between the flow and clasts, which governs the flow patterns around the clasts, thus directly affecting the depositional patterns of the incoming sediments. To examine the validity of the hypothesis and meet the objectives of this research, 19 detailed experimental runs were conducted in a tilting, water recirculating laboratory flume under well-controlled conditions. A fixed array of clast-obstacles were placed atop a well-packed bed with uniform size glass beads. During the runs, multifractional spherical particles were fed upstream of the clast section at a predetermined rate. State-of-the-art techniques/instruments, such as imaging analysis software, Large Scale Particle Velocimeter (LSPIV) and an Acoustic Doppler Velocimetry (ADV) were employed to provide unique quantitative measurements for bedload fluxes, clast/clusters geomorphic patterns, and mean flow characteristics in the vicinity of the clusters. Different flow patterns were recorded for the high relative submergence (HRS) and low relative submergence (LRS) experimental runs. The ADV measurements provided improved insight about the governing flow mechanisms for the HRS runs. These mechanisms were described with flow upwelling at the center of the flume and downwelling occurring along the flume walls. Flow downwelling corresponded to an increase in the free surface velocity. Additionally, the visual observations

  4. Financial management of hospitals.

    PubMed

    Speranzo, A J

    1984-05-01

    The effect of hospital reimbursement systems on the financial management of hospitals is briefly discussed, and the organization of hospital financial operations is reviewed. The implementation of Medicare prospective pricing will change the way in which hospital finances are managed. Health-care managers will be concerned with the profitability of product lines, or diagnosis-related groups, in future strategic planning efforts. The hospital's finance department consists of several traditional areas that exist in almost all financial organizations. The functions and interactions of these various areas are discussed in light of previous and current hospital reimbursement strategies. Staffing of the finance department and the duties of the hospital's chief financial officer are also described. The prospective pricing system of hospital reimbursement and increasing pressure from the business community to stem the rising costs of health care will produce changes in the medical and financial operations of the hospital industry over the next decade. PMID:6375357

  5. Gauging food and nutritional care quality in hospitals

    PubMed Central

    2012-01-01

    Background Food and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals. Methods Investigation of the Hospital Food and Nutrition Service (HFNS) of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ) and hospital food service quality (FSQ). HFNS was also evaluated with respect to human resources per hospital bed and per produced meal. Results Comparison between public and private institutions revealed that there was a statistically significant difference between the number of hospital beds per HFNS staff member (p = 0.02) and per dietitian (p < 0.01). The mean compliance with NCQ criteria in public and private institutions was 51.8% and 41.6%, respectively. The percentage of public and private health institutions in conformity with FSQ criteria was 42.4% and 49.1%, respectively. Most of the actions comprising each corpus, NCQ and FSQ, varied considerably between the two types of institution. NCQ was positively influenced by hospital type (general) and presence of a clinical dietitian. FSQ was affected by institution size: large and medium-sized hospitals were significantly better than small ones. Conclusions Food and nutritional care in hospital is still incipient, and actions concerning both nutritional care and food service take place on an irregular basis. It is clear that the design of food and nutritional care in hospital indicators is mandatory, and that guidelines for the development of actions as well as qualification and assessment of nutritional care are urgent. PMID:22954229

  6. Management of hospitals solid waste in Khartoum State.

    PubMed

    Saad, Suhair A Gayoum

    2013-10-01

    This research had been conducted during year 2012 to review existing data on hospital waste management for some of Khartoum town hospitals and to try to produce appropriate proposals acceptable for waste management and final treatment methods. The overall status of hospital waste management in Khartoum has been assessed through direct visits and designated questionnaires. Eight main hospitals were covered in the study with an overall bed capacity of 2,978. The current waste management practice observed at all studied hospitals was that most of waste, office, general, food, construction debris, and hazardous chemical materials were all mixed together as they are generated, collected, and finally disposed of. Only a small portion of waste in some hospitals (part of potentially infectious, body parts, and sharps) are collected separately and treated in a central incinerator. The estimated value of per bed generation rate in the studied hospitals was found to be 0.87 kg/day, which lies within the range for the low-income countries. In all studied hospitals, it was found that workers were working under very poor unsafe conditions with very low salaries ($35 to $45 per month on average). About 90 % were completely illiterate or had very low education levels. At the national level, no laws considering hospital waste, or even hazardous waste, were found; only some federal general environmental regulations and some procedures from town and city localities for controlling general municipal waste exist. At the hospital level, no policies or rules were found, except in the radiotherapy center, where they manage radioactive wastes under the laws of the Sudanese Atomic Agency. Urgent actions are needed for the remediation and prevention of hazards associated with this type of waste. PMID:23644667

  7. The challenge of corporatisation: the experience of Portuguese public hospitals.

    PubMed

    Rego, Guilhermina; Nunes, Rui; Costa, José

    2010-08-01

    The inability of traditional state organisations to respond to new economic, technological and social challenges and the associated emerging problems has made it necessary to adopt new methods of health management. As a result, new directions have emerged in the reform of Public Administration together with the introduction of innovative models. The aim is to achieve a type of management that focuses on results as well as on effort and efficiency. We intend to analyse to what extent the adoption of business management models by hospital healthcare units can improve their performance, mainly in terms of standards of efficiency. Data envelopment analysis (DEA) was used to investigate the efficiency of a set of public Portuguese hospitals. The aim was to evaluate the impact of business management in Portuguese public hospitals with regards to efficiency, specifically taking into account the fact that lack of resources and increased health care needs are a present and future reality. From a total of 83 public hospitals, a sample of 59 hospitals was chosen, of which 21 are state-owned hospital enterprises (SA) and 38 are traditional public administration sector hospitals (SPA). This study evaluates hospital performance by calculating two efficiency measures associated with two categories of inputs. The first efficiency measures the costs associated with hospital production lines and the number of beds (representing fixed capacity) as inputs. The annual costs generated by the hospitals in the consumption of capital and work (direct and indirect costs) are used. A second measure of efficiency is calculated separately. This measure includes in the inputs the number of beds as well as the human resources available (number of doctors, number of nurses and other personnel) in each hospital. With regard to output, the variables that best reflect the hospital services rendered were considered: number of inpatient days, patients discharged, outpatient visits, emergencies

  8. Hospital pricing: cost shifting and competition.

    PubMed

    Morrisey, M A

    1993-05-01

    The issue of cost shifting has taken on enormous policy implications. It is estimated that unsponsored and undercompensated hospital costs--one measure of cost shifting--has totaled $21.5 billion in 1991. The health services research literature indicates that hospitals set different prices for different payers. However, the empirical evidence on hospitals' ability to raise prices to one payer to make up for unsponsored care or lower payments by other payers is mixed at best. No study has concluded that hospitals have raised prices to fully adjust for such actions. The extent of cost shifting is limited by the market. When a hospital has market power, it is able to set prices above marginal costs. However, when a buyer has enough patient/subscribers and a willingness to direct them to particular providers based on price considerations, hospitals have less flexibility in raising prices above costs. Thus, the extent of cost shifting is limited by the market. Cost shifting is not as easy as it may have been in the past because the nature of hospital and insurer competition has changed radically in the last decade. While hospital quality, services, and amenities still matter, some buyers are increasingly concerned about the price they pay. Evidence from studies of PPO and HMO negotiations with hospitals suggests that hospitals' market power is eroding, at least in some areas. In areas with relatively few hospital competitors and little PPO or HMO activity, Medicaid and Medicare price reductions and uncompensated care burdens will be partially absorbed by higher prices paid by private payers. In more price sensitive markets and in markets in which prices to private payers have risen to those commensurate with the market power of local hospitals, such cost shifting will not occur. A market-based approach in hospital pricing requires an explicit policy for the uninsured. In a competitive market, a hospital that traditionally cared for the uninsured by spending some of its

  9. Suicide following an infestation of bed bugs

    PubMed Central

    Burrows, Stephanie; Perron, Stéphane; Susser, Stephanie

    2013-01-01

    Patient: Male, 62 Final Diagnosis: Bipolar disorder Symptoms: Bordeline personality disorder Medication: — Clinical Procedure: Bed bug infestation Specialty: Psychiatry Objective: Unusual clinical course Background: In the past decade, bed bug infestations have been increasingly common in high income countries. Psychological consequences of these infestations are rarely examined in the scientific literature. Case Report: We present a case, based on a coroner’s investigation report, of a woman with previous psychiatric morbidity who jumped to her death following repeated bed bug infestations in her apartment. Our case report shows that the bed bug infestations were the likely trigger for the onset a negative psychological state that ultimately led to suicide. Conclusions: Given the recent surge in infestations, rapid action needs to be taken not only in an attempt to control and eradicate the bed bugs but also to adequately care for those infested by bed bugs. PMID:23826461

  10. Hospital demand for physicians.

    PubMed

    Morrisey, M A; Jensen, G A

    1990-01-01

    This article develops a derived demand for physicians that is general enough to encompass physician control, simple profit maximization and hospital utility maximization models of the hospital. The analysis focuses on three special aspects of physician affiliations: the price of adding a physician to the staff is unobserved; the physician holds appointments at multiple hospitals, and physicians are not homogeneous. Using 1983 American Hospital Association data, a system of specialty-specific demand equations is estimated. The results are consistent with the model and suggest that physicians should be concerned about reduced access to hospitals, particularly as the stock of hospitals declines. PMID:10104050

  11. Triage of Patients Consulted for ICU Admission During Times of ICU-Bed Shortage

    PubMed Central

    Orsini, Jose; Blaak, Christa; Yeh, Angela; Fonseca, Xavier; Helm, Tanya; Butala, Ashvin; Morante, Joaquin

    2014-01-01

    Background The demand for specialized medical services such as critical care often exceeds availability, thus rationing of intensive care unit (ICU) beds commonly leads to difficult triage decisions. Many factors can play a role in the decision to admit a patient to the ICU, including severity of illness and the need for specific treatments limited to these units. Although triage decisions would be based solely on patient and institutional level factors, it is likely that intensivists make different decisions when there are fewer ICU beds available. The objective of this study is to evaluate the characteristics of patients referred for ICU admission during times of limited beds availability. Methods A single center, prospective, observational study was conducted among consecutive patients in whom an evaluation for ICU admission was requested during times of ICU overcrowding, which comprised the months of April and May 2014. Results A total of 95 patients were evaluated for possible ICU admission during the study period. Their mean APACHE-II score was 16.8 (median 16, range 3 - 36). Sixty-four patients (67.4%) were accepted to ICU, 18 patients (18.9%) were triaged to SDU, and 13 patients (13.7%) were admitted to hospital wards. ICU had no beds available 24 times (39.3%) during the study period, and in 39 opportunities (63.9%) only one bed was available. Twenty-four patients (25.3%) were evaluated when there were no available beds, and eight of those patients (33%) were admitted to ICU. A total of 17 patients (17.9%) died in the hospital, and 15 (23.4%) expired in ICU. Conclusion ICU beds are a scarce resource for which demand periodically exceeds supply, raising concerns about mechanisms for resource allocation during times of limited beds availability. At our institution, triage decisions were not related to the number of available beds in ICU, age, or gender. A linear correlation was observed between severity of illness, expressed by APACHE-II scores, and the

  12. Visual adjustments to temporal blur

    NASA Astrophysics Data System (ADS)

    Bilson, Aaron C.; Mizokami, Yoko; Webster, Michael A.

    2005-10-01

    After observers have adapted to an edge that is spatially blurred or sharpened, a focused edge appears too sharp or blurred, respectively. These adjustments to blur may play an important role in calibrating spatial sensitivity. We examined whether similar adjustments influence the perception of temporal edges, by measuring the appearance of a step change in the luminance of a uniform field after adapting to blurred or sharpened transitions. Stimuli were square-wave alternations (at 1 to 8 Hz) filtered by changing the slope of the amplitude spectrum. A two-alternative-forced-choice task was used to adjust the slope until it appeared as a step change, or until it matched the perceived transitions in a reference stimulus. Observers could accurately set the waveform to a square wave, but only at the slower alternation rates. However, these settings were strongly biased by prior adaptation to filtered stimuli, or when the stimuli were viewed within temporally filtered surrounds. Control experiments suggest that the latter induction effects result directly from the temporal blur and are not simply a consequence of brightness induction in the fields. These results suggest that adaptation and induction adjust visual coding so that images are focused not only in space but also in time.

  13. Self-Adjusting Fluency Therapy.

    ERIC Educational Resources Information Center

    Schneider, Phillip

    1998-01-01

    Presents a rationale and methodology for a self-adjusting "fluency sensitive" approach to working with children who exhibit overt speech-fluency interruptions and a minimal amount of avoidance behavior. The approach emphasizes repeated experiences of volitional increases and decreases in loudness and pauses. Case examples demonstrate how several…

  14. Adjustable Walker for the Handicapped

    NASA Technical Reports Server (NTRS)

    Kitts, R. G.

    1984-01-01

    Front legs adjust at touch of lever for use on stairs or ramps. Spring loaded legs extend when lever is depressed by user. Legs lock in position when lever is released. Lever mounted on either side of walker or on both sides, so legs operated independently.

  15. Adjustable Optical-Fiber Attenuator

    NASA Technical Reports Server (NTRS)

    Buzzetti, Mike F.

    1994-01-01

    Adjustable fiber-optic attenuator utilizes bending loss to reduce strength of light transmitted along it. Attenuator functions without introducing measurable back-reflection or insertion loss. Relatively insensitive to vibration and changes in temperature. Potential applications include cable television, telephone networks, other signal-distribution networks, and laboratory instrumentation.

  16. Adjustable-Angle Drill Block

    NASA Technical Reports Server (NTRS)

    Gallimore, F. H.

    1986-01-01

    Adjustable angular drill block accurately transfers hole patterns from mating surfaces not normal to each other. Block applicable to transfer of nonperpendicular holes in mating contoured assemblies in aircraft industry. Also useful in general manufacturing to transfer mating installation holes to irregular and angular surfaces.

  17. Economic Pressures and Family Adjustment.

    ERIC Educational Resources Information Center

    Haccoun, Dorothy Markiewicz; Ledingham, Jane E.

    The relationships between economic stress on the family and child and parental adjustment were examined for a sample of 199 girls and boys in grades one, four, and seven. These associations were examined separately for families in which both parents were present and in which mothers only were at home. Economic stress was associated with boys'…

  18. Hospitable Classrooms: Biblical Hospitality and Inclusive Education

    ERIC Educational Resources Information Center

    Anderson, David W.

    2011-01-01

    This paper contributes to a Christian hermeneutic of special education by suggesting the biblical concept of hospitality as a necessary characteristic of classroom and school environments in which students with disabilities and other marginalized students can be effectively incorporated into the body of the classroom. Christian hospitality, seen…

  19. Associations of Mild Cognitive Impairment with Hospitalization and Readmission

    PubMed Central

    Callahan, Kathryn E.; Lovato, James F.; Miller, Michael E.; Easterling, Doug; Snitz, Beth; Williamson, Jeff D.

    2016-01-01

    OBJECTIVES To determine whether older adults with mild cognitive impairment (MCI), a condition not previously explored as a risk factor, experience increased hospitalizations and 30-day readmission compared to those with normal cognition. Frequent hospitalizations and unplanned readmissions are recognized as markers of poor quality care for older adults. DESIGN Post-hoc analysis of prospectively gathered data on incident hospitalization and readmission from the Ginkgo Evaluation of Memory Study (GEMS), a randomized double-blind placebo-controlled trial designed to assess the impact of Ginkgo biloba on incidence of dementia. SETTING GEMS was conducted in 5 academic medical centers in the United States. PARTICIPANTS 2742 community-dwelling adults age 75 or older with normal cognition (n=2314) or MCI (n=428) at baseline cognitive testing. MEASUREMENTS Index hospitalization and 30-day hospital readmission, adjusted for age, sex, race, education, clinic site, trial assignment status, comorbidities, number of prescription medications, and living with an identified proxy. RESULTS MCI was associated with a 17% increase in the hazard of index hospitalization as compared with normal cognition (adjusted Hazard Ratio (HR)=1.17 (1.02 – 1.34)). In participants who lived with their proxy, MCI was associated with a 39% increased hazard of index hospitalization (adjusted HR=1.392 (1.169 – 1.657)). Baseline MCI was not associated with increased odds of 30-day hospital readmission (adjusted Odds Ratio=0.90 (0.60 – 1.36)). CONCLUSION MCI may represent a target condition for healthcare providers to coordinate support services in an effort to reduce hospitalization and subsequent disability. PMID:26313420

  20. Gas distributor for fluidized bed coal gasifier

    DOEpatents

    Worley, Arthur C.; Zboray, James A.

    1980-01-01

    A gas distributor for distributing high temperature reaction gases to a fluidized bed of coal particles in a coal gasification process. The distributor includes a pipe with a refractory reinforced lining and a plurality of openings in the lining through which gas is fed into the bed. These feed openings have an expanding tapered shape in the downstream or exhaust direction which aids in reducing the velocity of the gas jets as they enter the bed.