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Sample records for adjustable hospital bed

  1. 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... 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...

  2. 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... (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Therapeutic Devices § 880.5110 Hydraulic adjustable hospital bed. (a) Identification. A hydraulic...

  3. 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... (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Therapeutic Devices § 880.5120 Manual adjustable hospital bed. (a) Identification. A manual...

  4. 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... (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Therapeutic Devices § 880.5100 AC-powered adjustable hospital bed. (a) Identification. An...

  5. 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 ...

  6. [Historical analysis of the hospital bed].

    PubMed

    Fajardo-Ortiz, Guillermo; Fajardo-Dolci, Germán

    2010-01-01

    Until now the bed has been the basic physical resource in hospitals. This type of furniture has served to study and treat patients, through out the centuries it has undergone changes in the materials they are made of dimensions, functionality, accessories, aesthetic, and design. The hospital bed history is not well known, there are thousands of documents about the evolution of hospitals, but not enough is known about hospital beds, a link between the past and the present. The medical, anthropological, technological, social, and economic dynamics and knowledge have produced a variety of beds in general and hospital beds in particular. From instinctive, rustic, poor and irregular "sites" that have differed in shape and size they had evolved into ergonomic equipment. The history of the hospital bed reflects the culture, techniques and human thinking. Current hospital beds include several types: for adults, for children, for labor, for intensive therapy, emergency purposes, census and non census beds etc.

  7. Swing beds: an approach to hospital utilization.

    PubMed

    Henderson, D R; Moomaw, A

    1986-11-01

    The need to use every available space for productive purposes is becoming a major concern for hospitals, especially rural hospitals. This need, coupled with the decline in the building of nursing homes, has given rise to the concept of the swing bed, a hospital bed that can be used to provide care to either acute or long-term care patients. This ability allows an acute care hospital to provide care to patients who might traditionally receive care in a nursing home. PMID:10301065

  8. [From admission team to hospital bed management].

    PubMed

    Pochini, Angelo; Augellone, Elisa; Enei, Rosanna; Gaetani, Laura; Paolucci, Simona; Ursumando, Diana; Mitello, Lucia

    2013-01-01

    Reduction on number of hospital beds i.e. on patients' admission among hospitals in Lazio has lead to a reformulation of health service framework within Lazio indentifying hospital as the only place to go to treat acute and urgent diseases. San Camillo-Forlanini, the largest hospital in Rome, according to the regional health plan, the recovery plan and the redevelopment of network hospital has had a significant reduction of hospital beds leading, as consequence, to the need of an internal reorganization. In order to correctly address this issue, the management of the Hospital started in February 2008 a project, setting up a group made up by nursing coordinators which had as a main aim to manage the number of hospital beds needed for emergencies. This group has been called "Admission Team" and nurses within the group are familiar with hospital policies and organization. The team collaborates daily with physicians and nurses in  emergency room, in order to decide the most appropriate health care protocol for each patient. The project follows a specific methodology i.e. Systemic Analysis. Over the years this project has contributed to the improvement to a number of indicators and more generally to the health care within the hospital together with the enhancement of education of new managerial roles among health professional. In 2009, the Regional Council of Lazio has recognized this project as strategic within private and public hospitals.

  9. 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...) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Therapeutic Devices § 880.5140 Pediatric hospital bed. (a) Identification. A pediatric hospital bed is a...

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. 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... period ] August 1, 2003, to May 1, 2009 (or other appropriate end date for OPPS- exempt hospitals.)...

  16. 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 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... intended for medical purposes that consists of a bed or crib designed for the use of a pediatric...

  17. 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

  18. Cost recovery beds in public hospitals in Indonesia.

    PubMed

    Suwandono, A; Gani, A; Purwani, S; Blas, E; Brugha, R

    2001-12-01

    A policy of allowing public hospitals to provide some better quality, higher priced hospital beds for those able to pay was introduced as government policy in Indonesia after 1993. A study was conducted in 1998 in three public hospitals in East Java to investigate if the policy objective of cost-recovery was being achieved. Hospital revenue from these commercial beds was less than both the recurrent and total costs of providing them in all three hospitals, but exceeded recurrent costs minus staff salaries in two hospitals. One reason for the low cost-recovery ratios was that between 55% and 66% of the revenue was used as staff incentives, mostly to doctors. This was more than the maximum of 40% stipulated in the policy. The high proportions of total revenue going to staff were a result of hospital management having set bed fees too low. The policy may be contributing to the retention of doctors within public sector employment; however, it is not achieving its stated objective, especially over the longer term where full recovery of salaries and investment costs needs to be considered. Public hospitals that wish to invest in commercial beds need effective management and accounting systems so as to be able to monitor and control costs and set fees at levels that recoup the costs incurred. Further research is required to determine if this form of public-private mix has negative effects on equity and access for poorer patients. PMID:11772986

  19. 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

  20. The winter bed crisis--quantifying seasonal effects on hospital bed usage.

    PubMed

    Fullerton, K J; Crawford, V L

    1999-04-01

    Winter bed crises are a common feature in NHS hospitals, and have given rise to great concern. We set out to determine the relative contribution of seasonal effects and other factors to bed occupancy in a large teaching hospital over one year. There were 190,804 occupied bed-days, which we analysed by specialty groupings. There was considerable variability in bed occupancy in each specialty. A significant winter peak occurred for general medicine and orthopaedics together with a significant increase on 'take-in' days. Virtually all specialties showed a significant variation in occupancy between weekdays. Geriatric Medicine had a high and fairly constant occupancy, with some seasonal effect. We conclude that seasonal trends in bed occupancy occur in 'front door' specialties and are predictable. In these specialties, admission policies also make a contribution to bed usage and are amenable to modification. There is no surge in occupancy in the immediate post-Christmas period, except that attributable to the seasonal trend. In the 'elective' specialties, bed occupancy fluctuates widely, with reduced occupancy at weekends and at Christmas. These differences are entirely amenable to modification. More effective bed management would make a very significant contribution to avoiding winter bed crises.

  1. 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

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

    PubMed Central

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

    2016-01-01

    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

  3. 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

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. A randomized trial to evaluate a launderable bed protection system for hospital beds

    PubMed Central

    2012-01-01

    Background Hospital beds are potential reservoirs of bacteria in hospitals. Preventing contamination of the bed and providing a cleaner surface should help prevent hospital-acquired infections (HAIs). Most hospital beds are cleaned between patients (terminal cleaning) using quaternary ammonia compounds (quats). Objective The study had two objectives: identify levels of bacterial contamination on beds (including the mattress and bed deck) and evaluate a new launderable cover. Methods Hospital beds on a bariatric surgery ward were randomized to either receive or not receive a launderable cover (Trinity Guardion, Batesville, IN). Bacterial counts on the surface of the mattress, the bed deck, and the launderable cover were then collected using Petrifilm™ Aerobic Count Plates (Petrifilm™, 3M™, St. Paul, MN, USA) (Petrifilm™) at three time periods (before patient use, after discharge, and after terminal cleaning). Standard hospital linen was used in all rooms. Results The launderable cover (n = 28) was significantly cleaner prior to patient use than were the cleaned mattresses (n = 38) (1.1 CFU/30 cm2 vs. 7.7 CFU/30 cm2; p = 0.0189). The mattresses without launderable covers became significantly contaminated during use (7.7 CFU/30 cm2 on admission vs. 79.1 CFU/30 cm2 after discharge; p < 0.001). The mattresses with launderable covers did not become contaminated (3.0 CFU/30 cm2 on admission vs. 2.5 CFU/30 cm2 at discharge; p = 0.703). After terminal cleaning, the mattress surface contamination decreased to 12.8 CFU/30 cm2 (median 3 CFU/30 cm2; SD 7.8), but the bed deck was more contaminated (6.7 CFU/30 cm2 after discharge compared to 30.9 CFU/30 cm2 after terminal cleaning; p = 0.031). Conclusions Terminal cleaning fails to eliminate bacteria from the surface of the hospital mattress. The launderable cover provides a cleaner surface than does terminal cleaning with quats, and the cover protects the

  9. Monitoring patients in hospital beds using unobtrusive depth sensors.

    PubMed

    Banerjee, Tanvi; Enayati, Moein; Keller, James M; Skubic, Marjorie; Popescu, Mihail; Rantz, Marilyn

    2014-01-01

    We present an approach for patient activity recognition in hospital rooms using depth data collected using a Kinect sensor. Depth sensors such as the Kinect ensure that activity segmentation is possible during day time as well as night while addressing the privacy concerns of patients. It also provides a technique to remotely monitor patients in a non-intrusive manner. An existing fall detection algorithm is currently generating fall alerts in several rooms in the University of Missouri Hospital (MUH). In this paper we describe a technique to reduce false alerts such as pillows falling off the bed or equipment movement. We do so by detecting the presence of the patient in the bed for the times when the fall alert is generated. We test our algorithm on 96 hours obtained in two hospital rooms from MUH.

  10. 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

  11. An Intelligent Robotic Hospital Bed for Safe Transportation of Critical Neurosurgery Patients Along Crowded Hospital Corridors.

    PubMed

    Wang, Chao; Savkin, Andrey V; Clout, Ray; Nguyen, Hung T

    2015-09-01

    We present a novel design of an intelligent robotic hospital bed, named Flexbed, with autonomous navigation ability. The robotic bed is developed for fast and safe transportation of critical neurosurgery patients without changing beds. Flexbed is more efficient and safe during the transportation process comparing to the conventional hospital beds. Flexbed is able to avoid en-route obstacles with an efficient easy-to-implement collision avoidance strategy when an obstacle is nearby and to move towards its destination at maximum speed when there is no threat of collision. We present extensive simulation results of navigation of Flexbed in the crowded hospital corridor environments with moving obstacles. Moreover, results of experiments with Flexbed in the real world scenarios are also presented and discussed.

  12. 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

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Special treatment: Inpatient hospital payment adjustment for low-volume hospitals. 412.101 Section 412.101 Public Health CENTERS FOR MEDICARE & MEDICAID... INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective Payment System...

  14. Overutilization of acute-care beds in Veterans Affairs hospitals.

    PubMed

    Smith, C B; Goldman, R L; Martin, D C; Williamson, J; Weir, C; Beauchamp, C; Ashcraft, M

    1996-01-01

    The authors tested the hypothesis that the Department of Veterans Affairs (VA) hospitals would have substantial overutilization of acute care beds and services because of policies that emphasize inpatient care over ambulatory care. Reviewers from 24 randomly selected VA hospitals applied the InterQual ISD* (Intensity, Severity, Discharge) criteria for appropriateness concurrently to a random sample of 2,432 admissions to acute medical, surgical, and psychiatry services. Reliability of hospital reviewers in applying the ISD* criteria was tested by comparing their reviews with those of a small group of expert reviewers. Validity of the ISD* criteria was tested by comparing the assessments of master reviewers with the implicit judgments of panels of nine physicians. The physician panels validated the ISD* admission criteria for medicine and surgery (74% agreement with master reviewers, kappa > 0.4), whereas the psychiatry criteria were not validated (66% agreement, kappa 0.29). Hospital reviewers reliably used all three criteria sets (> 83% agreement with master reviewers, kappa > 0.6). Rates of nonacute admissions to acute medical and surgical services were > 38% as determined by the hospital and master reviewers and by the physician panels. Nonacute rates of continued stay were > 32% for both medicine and surgery services. Similar rates of nonacute admissions and continued stay were found for all 24 hospitals. Reasons for nonacute admissions and continued stay included lack of an ambulatory care alternative, conservative physician practices, delays in discharge planning, and social factors such as homelessness and long travel distances to the hospital. Using criteria that the authors showed to be reliable and valid, substantial overutilization of acute medicine and surgical beds was found in a representative sample of VA hospitals. Correcting this situation will require changes in physician practice patterns, development of ambulatory care alternatives to inpatient

  15. The role of stepdown beds in hospital care.

    PubMed

    Prin, Meghan; Wunsch, Hannah

    2014-12-01

    Stepdown beds provide an intermediate level of care for patients with requirements somewhere between that of the general ward and the intensive care unit. Models of care include incorporation of stepdown beds into intensive care units, stand-alone units, or incorporation of beds into standard wards. Stepdown beds may be used to provide a higher level of care for patients deteriorating on a ward ("step-up"), a lower level of care for patients transitioning out of intensive care ("stepdown") or a lateral transfer of care from a recovery room for postoperative patients. These units are one possible strategy to improve critical care cost-effectiveness and patient flow without compromising quality, but these potential benefits remain primarily theoretical as few patient-level studies provide concrete evidence. This narrative review provides a general overview of the theory of stepdown beds in the care of hospitalized patients and a summary of what is known about their impact on patient flow and outcomes and highlights areas for future research. PMID:25163008

  16. The Role of Stepdown Beds in Hospital Care

    PubMed Central

    Prin, Meghan

    2014-01-01

    Stepdown beds provide an intermediate level of care for patients with requirements somewhere between that of the general ward and the intensive care unit. Models of care include incorporation of stepdown beds into intensive care units, stand-alone units, or incorporation of beds into standard wards. Stepdown beds may be used to provide a higher level of care for patients deteriorating on a ward (“step-up”), a lower level of care for patients transitioning out of intensive care (“stepdown”) or a lateral transfer of care from a recovery room for postoperative patients. These units are one possible strategy to improve critical care cost-effectiveness and patient flow without compromising quality, but these potential benefits remain primarily theoretical as few patient-level studies provide concrete evidence. This narrative review provides a general overview of the theory of stepdown beds in the care of hospitalized patients and a summary of what is known about their impact on patient flow and outcomes and highlights areas for future research. PMID:25163008

  17. Hospital Bed Occupancy and HIV/AIDS in three Major Public Hospitals of Addis Ababa, Ethiopia

    PubMed Central

    Tamiru, Melesse; Haidar, Jemal

    2010-01-01

    Background: In countries like Ethiopia where the spread of HIV infection is extensive, health services are faced with an increased demand for care. The most obvious reflection of this increased demand is through patient load, longer bed occupancy perhaps to the exclusion of patients with other ailments. Objective: The purpose of this study was to describe the bed occupancy rate and the average length of stay of HIV/AIDS inpatients of three major public hospitals. Methods: A Retrospective Cross-sectional study was conducted in three major hospitals of Addis Ababa namely Zewditu Memorial Hospital, Tikure Anbessa Hospital and Saint Paul’s Hospital from February to March 2004. Results: Of the total 453 sampled inpatients, 293 (65 %) were HIV positives. Over half (55.0%) were Males. The most affected age group was between 24 and 56 years. The majority (85.8%) were from Addis Ababa and over half (57.7%) was married. Housewives constituted about a quarter (26.3%) of all the admitted cases. The most common co-morbidities resulted in admission to the medical wards among the HIV-positive cases were Tuberculosis (73.0%) and jirovicii pneumonia (70.3%), and their occurrence was significantly higher among HIV+ than their counter parts (p=0.001). Although numbers of patients admitted in Tikur Anbesa hospital was more than Saint Paul’s and Zewditu Memorial hospitals (ZMH), the proportion of HIV positive cases admitted to ZMH however was higher (49.0%) than Tikur Anbessa (14.0%) and Saint Paul’s hospitals (18.0%). Likewise the number of inpatient days was also higher in ZMH (n=7765) than the other hospitals. The bed occupancy rate was however, higher in ZMH (53.0%) than Tikur Anbessa (12.0%) and Saint Paul’s (12.0%) hospitals. Conclusion: One of the most obvious consequences of HIV/AIDS patients are the increased occupancy of hospitals beds suggesting that only 81.1 % of the beds are for all other afflictions in the hospitals. It appears that there is a lot of concern that

  18. Bedding, not boarding. Psychiatric patients boarded in hospital EDs create crisis for patient care and hospital finances.

    PubMed

    Kutscher, Beth

    2013-11-18

    As the supply of psychiatric beds dwindles, hospitals are devising innovative ways handle psych patients who come through the emergency department. Some collaborate with other hospitals, use separate pysch EDs or refer patients to residential treatment centers.

  19. Do More Hospital Beds Lead to Higher Hospitalization Rates? A Spatial Examination of Roemer’s Law

    PubMed Central

    Delamater, Paul L.; Messina, Joseph P.; Grady, Sue C.; WinklerPrins, Vince; Shortridge, Ashton M.

    2013-01-01

    Background Roemer’s Law, a widely cited principle in health care policy, states that hospital beds that are built tend to be used. This simple but powerful expression has been invoked to justify Certificate of Need regulation of hospital beds in an effort to contain health care costs. Despite its influence, a surprisingly small body of empirical evidence supports its content. Furthermore, known geographic factors influencing health services use and the spatial structure of the relationship between hospital bed availability and hospitalization rates have not been sufficiently explored in past examinations of Roemer’s Law. We pose the question, “Accounting for space in health care access and use, is there an observable association between the availability of hospital beds and hospital utilization?” Methods We employ an ecological research design based upon the Anderson behavioral model of health care utilization. This conceptual model is implemented in an explicitly spatial context. The effect of hospital bed availability on the utilization of hospital services is evaluated, accounting for spatial structure and controlling for other known determinants of hospital utilization. The stability of this relationship is explored by testing across numerous geographic scales of analysis. The case study comprises an entire state system of hospitals and population, evaluating over one million inpatient admissions. Results We find compelling evidence that a positive, statistically significant relationship exists between hospital bed availability and inpatient hospitalization rates. Additionally, the observed relationship is invariant with changes in the geographic scale of analysis. Conclusions This study provides evidence for the effects of Roemer’s Law, thus suggesting that variations in hospitalization rates have origins in the availability of hospital beds. This relationship is found to be robust across geographic scales of analysis. These findings suggest

  20. Testing the bed-blocking hypothesis: does nursing and care home supply reduce delayed hospital discharges?

    PubMed

    Gaughan, James; Gravelle, Hugh; Siciliani, Luigi

    2015-03-01

    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.

  1. Particle mobility and bed surface adjustments on episodic sediment supply experiments

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

    This research aims to explore how episodic sediment supply affects particle mobility and bed surface adjustments in mountain streams. We conducted a set of runs in a 1 m-wide, 18 m-long tilting flume. Seven consecutive runs, each lasting 40 hours, were conducted under constant flow (65 l/s) but varying sediment supply rates for a total duration of 280 hours. The feed rate for the runs was as follow: no feed (runs 1 and 7), constant feed of 2.1 g/m/s (runs 2 and 6), one pulse of 83 g/m/s (run 3), four pulses of 83 g/m/s (run 4) and two pulses of 83 g/m/s (run 5). The total mass of sediment supplied during each of runs 2-6 was 300 kg. The feed texture was identical to that of the original mixture (Dmin = 0.5 mm, Dmax = 64 mm, Dg = 5.65 mm and sg = 3.05) with a bed slope of 0.0218 m/m. Bed surface images of a 2 m-long reach in the middle of the flume were processed. Bed surface areas covered by particle sizes coarser than 5.66 mm were automatically identified. Thus, we can easily obtain fractional particle mobility, i.e. how much bed area covered by a particular grain size changed at a given time. Preliminary analyses of the experiments show that the bed surface texture systematically adjusts to each change in the sediment supply. Thus, (i) bed surface gradually coarsens during no feed runs 1 and 7, (ii) suddenly fines and subsequently coarsens after each episodic sediment supply event (runs 3-5) and (iii) remains approximately constant during runs 2 and 6 under constant feed conditions. Surface coarsening during run 1 was accompanied by the formation of bed structures and particle clusters. However, the amplitude of the changes of the bed surface texture is relatively small compared to the texture obtained after the first 40 h under no feed in run 1. This does not imply that the bed particles remain immobile. Conversely, bed particles on the surface move, bed structures loosen while the bed surface texture maintains, overall, the same grain size distribution

  2. 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

    ... 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 hospital-specific...-increase ceiling or prospective payment base year for purposes of adjusting the hospital's target amount...

  3. 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

    ... 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 hospital-specific...-increase ceiling or prospective payment base year for purposes of adjusting the hospital's target amount...

  4. 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

    ... 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 hospital-specific...-increase ceiling or prospective payment base year for purposes of adjusting the hospital's target amount...

  5. Bed occupancy rates and hospital-acquired infections--should beds be kept empty?

    PubMed

    Kaier, K; Mutters, N T; Frank, U

    2012-10-01

    There is growing evidence that bed occupancy (BO) rates, overcrowding and understaffing influence the spread of hospital-acquired infections (HAIs). In this article, a systematic review of the literature is presented, summarizing the evidence on the adverse effects of high BO rates and overcrowding in hospitals on the incidence of HAIs. A Pubmed database search identified 179 references, of which 44 were considered to be potentially relevant for full-text review. The majority (62.9%) focused on methicillin-resistant Staphylococcus aureus-associated infection or colonization. Only 12 studies were found that provided a statistical analysis of the impact of BO on HAI rates. The median BO rate of the analysed studies was 81.2%. The majority of studies (75%) indicated that BO rates and understaffing directly influence the incidence of HAIs. Only three studies showed no significant association between BO rates and the incidence of HAIs. Interestingly, only one of the included studies detected a seasonal trend in the BO rate. The present review shows an association between BO rates and the spread of HAIs in various settings. Because the evidence on this topic is limited, we conclude that further research is needed in order to analyse the rationale of a threshold BO rate, because keeping beds empty is comparatively costly.

  6. 42 CFR 412.154 - Payment adjustments under the Hospital Readmissions Reduction Program.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Payment adjustments under the Hospital Readmissions... Inpatient Operating Costs Payment Adjustments Under the Hospital Readmissions Reduction Program § 412.154 Payment adjustments under the Hospital Readmissions Reduction Program. (a) Scope. This section sets...

  7. 42 CFR 412.154 - Payment adjustments under the Hospital Readmissions Reduction Program.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Payment adjustments under the Hospital Readmissions... Inpatient Operating Costs Payment Adjustments Under the Hospital Readmissions Reduction Program § 412.154 Payment adjustments under the Hospital Readmissions Reduction Program. (a) Scope. This section sets...

  8. 42 CFR 412.154 - Payment adjustments under the Hospital Readmissions Reduction Program.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Payment adjustments under the Hospital Readmissions... Inpatient Operating Costs Payment Adjustments Under the Hospital Readmissions Reduction Program § 412.154 Payment adjustments under the Hospital Readmissions Reduction Program. (a) Scope. This section sets...

  9. The 1983 distribution of hospitals and hospital beds in the RSA by area, race, ownership and type.

    PubMed

    Zwarenstein, M F; Price, M R

    1990-05-01

    This study used published data to analyse the 1983 distribution of hospitals and hospital beds in South Africa by 'race', geographical area, type of hospital (academic, specialist, general or other) and the nature of ownership (e.g. state, for-profit). Hospitals and hospital beds were found to be inequitably distributed. Overall bed ratios were 150 whites per bed compared with 260 blacks/Asians/coloureds per bed. The distribution of beds by geographical area was 130 people per bed for urban whites, 260 for rural whites and 150, 460 and 300 for urban, rural non-'homeland', and 'homeland' blacks/Asians/coloureds respectively. These differentials are inefficient and unjust, and should be regularly documented to spur their decline. The continued collection of population group information from health service users is required to monitor changes in 'race' disparities. The analysis of distribution by ownership and type suggested that only the public sector is able to provide a hospital service with the appropriate balance of all levels of care for the entire population; but within this sector the dominant position of tertiary care needs to be re-examined. The study highlighted the absence of adequate information on health care resource allocation and utillisation. Appropriate studies in these areas are required and consideration should be given to unifying the planning and management of all hospital resources.

  10. 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...

  11. 42 CFR 412.172 - Payment adjustments under the Hospital-Acquired Condition Reduction Program.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Readmissions Reduction Program under § 412.154 and the adjustment made under the Hospital Value-Based... information available to the public regarding hospital-acquired condition rates of all hospitals under...

  12. Intelligent analysis of acute bed overflow in a tertiary hospital in Singapore.

    PubMed

    Teow, Kiok Liang; El-Darzi, Elia; Foo, Cynthia; Jin, Xin; Sim, Joe

    2012-06-01

    Hospital beds are a scarce resource and always in need. The beds are often organized by clinical specialties for better patient care. When the Accident & Emergency Department (A&E) admits a patient, there may not be an available bed that matches the requested specialty. The patient may be thus asked to wait at the A&E till a matching bed is available, or assigned a bed from a different specialty, which results in bed overflow. While this allows the patient to have faster access to an inpatient bed and treatment, it creates other problems. For instance, nursing care may be suboptimal and the doctors will need to spend more time to locate the overflow patients. The decision to allocate an overflow bed, or to let the patient wait a bit longer, can be a complicated one. While there can be a policy to guide the bed allocation decision, in reality it depends on clinical calls, current supply and waiting list, projected supply (i.e. planned discharges) and demand. The extent of bed overflow can therefore vary greatly, both in time dimension and across specialties. In this study, we extracted hospital data and used statistical and data mining approaches to identify the patterns behind bed overflow. With this insight, the hospital administration can be better equipped to devise strategies to reduce bed overflow and therefore improve patient care. Computational results show the viability of these intelligent data analysis techniques for understanding and managing the bed overflow problem.

  13. 76 FR 26768 - In the Matter of Certain Adjustable-Height Beds and Components Thereof; Notice of Commission...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-09

    ..., 2010, based on a complaint filed by Invacare Corporation of Elyria, Ohio (``Invacare''). 75 FR. 54911... COMMISSION In the Matter of Certain Adjustable-Height Beds and Components Thereof; Notice of Commission... importation of certain adjustable-height beds and components thereof by reason of infringement of...

  14. 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.

  15. Reallocation of Shafa Hospital Beds in Kerman Using Goal Programming Model

    PubMed Central

    Mehrolhasani, Mohammad Hossein; Khosravi, Sajad; Tohidi, Mahya

    2016-01-01

    Introduction In order to improve health, hospital sources such as beds and staffing should be properly allocated and used. The aim of this study is reallocation of Shafa hospital beds in Kerman using a goal-programming model. Methods This study was an applied cross-sectional study, which used the goal programming model and software WinQSB to optimize bed allocation. By review of the literature and interviews with experts, the constraints in beds allocation were identified, and using the collected data the desired model was designed. Results Hospital beds were redistributed based on the constraints of the goal-programming model and objectives. The results showed that there was a shortage of beds in departments such as burns, GICU, HICU, cardiac surgery, emergency, and orthopedics, and excess of beds in the ear, nose, and throat (ENT), ophthalmology, and neurology departments. Conclusion It is anticipated that the optimal allocation of hospital beds, regarding hospital activity indicators, can lead to greater justice in the provision of services and a better distribution of resources. PMID:27757182

  16. Inter-hospital variations in caesarean sections. A risk adjusted comparison in the Valencia public hospitals

    PubMed Central

    Librero, J.; Peiro, S.; Calderon, S. M.

    2000-01-01

    BACKGROUND—The aim of this study was to describe the variability in caesarean rates in the public hospitals in the Valencia Region, Spain, and to analyse the association between caesarean sections and clinical and extra-clinical factors.
METHODS—Analysis of data contained in the Minimum Basic Data Set (MBDS) compiled for all births in 11 public hospitals in Valencia during 1994-1995 (n=36 819). Bivariate and multivariate analyses were used to evaluate the association between caesarean section rates and specific risk factors. The multivariate model was used to construct predictions about caesarean rates for each hospital, for comparison with rates observed.
RESULTS—Caesarean rates were 17.6% (inter-hospital range: 14.7% to 25.0%), with ample variability between hospitals in the diagnosis of maternal-fetal risk factors (particularly dystocia and fetal distress), and the indication for caesarean in the presence of these factors. Multivariate analysis showed that maternal-fetal risk factors correlated strongly with caesarean section, although extra-clinical factors, such as the day of the week, also correlated positively. After adjusting for the risk factors, the inter-hospital variation in caesarean rates persisted.
CONCLUSIONS—Although certain limitations (imprecision of some diagnoses and information biases in the MBDS) make it impossible to establish unequivocal conclusions, results show a high degree of variability among hospitals when opting for caesarean section. This variability cannot be justified by differences in obstetric risks.


Keywords: hospital utilisation; medical practice variation; caesarean section; administrative databases PMID:10890876

  17. Electric versus hydraulic hospital beds: differences in use during basic nursing tasks.

    PubMed

    Capodaglio, Edda Maria

    2013-01-01

    Biomechanical, postural and ergonomic aspects during real patient-assisting tasks performed by nurses using an electric versus a hydraulic hospital bed were observed. While there were no differences in the flexed postures the nurses adopted, longer performance times were recorded when electric beds were used. Subjective effort, force exertion and lumbar shear forces exceeding safety limits proved electric beds were superior. Patients' dependency level seemed to influence the type of nurses' intervention (duration and force actions), irrespective of the bed used. The nurses greatly appreciated the electric bed. Its use seemed to reduce the level of effort perceived during care giving and the postural load during critical subtasks. Ergonomics and organizational problems related to adopting electric beds in hospital wards should be addressed further to make their use more efficient.

  18. 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…

  19. Effectiveness of powered hospital bed movers for reducing physiological strain and back muscle activation.

    PubMed

    Daniell, Nathan; Merrett, Simon; Paul, Gunther

    2014-07-01

    Battery powered bed movers are becoming increasingly common within the hospital setting. The use of powered bed movers is believed to result in reduced physical efforts required by health care workers, which may be associated with a decreased risk of occupation related injuries. However, little work has been conducted assessing how powered bed movers impact on levels of physiological strain and muscle activation for the user. The muscular efforts associated with moving hospital beds using three different methods; powered StaminaLift Bed Mover (PBM1), powered Gzunda Bed Mover (PBM2) and manual pushing were measured on six male subjects. Fourteen muscles were assessed moving a weighted hospital bed along a standardized route in an Australian hospital environment. Trunk inclination and upper spine acceleration were also quantified. Powered bed movers exhibited significantly lower muscle activation levels than manual pushing for the majority of muscles. When using the PBM1, users adopted a more upright posture which was maintained while performing different tasks (e.g. turning a corner, entering a lift), while trunk inclination varied considerably for manual pushing and the PBM2. The reduction in lower back muscular activation levels may result in lower incidence of lower back injury.

  20. Fluidized bed boiler at the Royal Alexandra Hospital for Children, Camperdown.

    PubMed

    Ellis, J W

    1985-03-01

    A fluidized bed boiler has been installed at the Royal Alexandra Hospital for Children, Camperdown, N.S.W. This paper describes the reasons for developing a project to demonstrate that a fluidized bed coal fire combustor can be incorporated with a modern packaged steam boiler. The boiler and combustor are of Australian design as suitable proven designs from overseas were not available.

  1. 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

  2. 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

    ... days after the date of the intermediary's notice of the hospital's base-period average per resident... 42 Public Health 2 2011-10-01 2011-10-01 false Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital-specific rate. 413.83 Section 413.83 Public Health...

  3. Effect of a powered drive on pushing and pulling forces when transporting bariatric hospital beds.

    PubMed

    Wiggermann, Neal

    2017-01-01

    Powered drives designed to assist with moving hospital beds are commercially available but no studies have evaluated whether they reduce the push and pull forces likely contributing to injury in caregivers. This study measured hand forces of 10 caregivers maneuvering a manual and powered bariatric bed through simulated hospital environments (hallway, elevator, and ramp). Peak push and pull forces exceeded previously established psychophysical limits for all activities with the manual bed. For the powered bed, peak forces were significantly (p < 0.05) lower for all tasks, and below psychophysical limits. Powered drive reduced peak forces between 38% (maneuvering into elevator) and 94% (descending ramp). Powered drive also reduced stopping distance by 55%. When maneuvering, the integral of hand force was 34% lower with powered drive, but average forces during straight-line pushing did not differ between beds. Powered drive may reduce the risk of injury or the number of caregivers needed for transport. PMID:27633198

  4. 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.

  5. 76 FR 39043 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-05

    ... Military Contingency Payment Adjustment On August 31, 2009, we published a final rule (74 FR 44752), which... of the Secretary 32 CFR Part 199 TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical Access Hospitals AGENCY: Office of the Secretary, Department of Defense (DoD)....

  6. 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

  7. 42 CFR 412.130 - Retroactive adjustments for incorrectly excluded hospitals and units.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... hospitals and units. 412.130 Section 412.130 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.130 Retroactive adjustments...

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. Fluidized bed boiler at the Royal Alexandra Hospital for Children, Camperdown.

    PubMed

    Ellis, J W

    1985-03-01

    A fluidized bed boiler has been installed at the Royal Alexandra Hospital for Children, Camperdown, N.S.W. This paper describes the reasons for developing a project to demonstrate that a fluidized bed coal fire combustor can be incorporated with a modern packaged steam boiler. The boiler and combustor are of Australian design as suitable proven designs from overseas were not available. PMID:10271052

  13. Risk adjusting survival outcomes of hospitals that treat cancer patients without information on cancer stage

    PubMed Central

    Pfister, David G.; Rubin, David M.; Elkin, Elena B.; Neill, Ushma S.; Duck, Elaine; Radzyner, Mark; Bach, Peter B.

    2016-01-01

    Importance Instituting widespread measurement of outcomes for cancer hospitals using administrative data is difficult due to the lack of cancer specific information such as disease stage. Objective To evaluate the performance of hospitals that treat cancer patients using Medicare data for outcome ascertainment and risk adjustment, and to assess whether hospital rankings based on these measures are influenced by the addition of cancer-specific information. Design Risk adjusted cumulative mortality of patients with cancer captured in Medicare claims from 2005–2009 nationally were assessed at the hospital level. Similar analyses were conducted in the Surveillance, Epidemiology and End Result (SEER)-Medicare data for the subset of the US covered by the SEER program to determine whether the exclusion of cancer specific information (only available in cancer registries) from risk adjustment altered measured hospital performance. Setting Administrative claims data and SEER cancer registry data Participants Sample of 729,279 fee-for-service Medicare beneficiaries treated for cancer in 2006 at hospitals treating 10+ patients with each of the following cancers, according to Medicare claims: lung, prostate, breast, colon. An additional sample of 18,677 similar patients in SEER-Medicare administrative data. Main Outcomes and Measures Risk-adjusted mortality overall and by cancer type, stratified by type of hospital; measures of correlation and agreement between hospital-level outcomes risk adjusted using Medicare data alone and Medicare data with SEER data. Results There were large outcome differences between different types of hospitals that treat Medicare patients with cancer. At one year, cumulative mortality for Medicare-prospective-payment-system exempt hospitals was 10% lower than at community hospitals (18% versus 28%) across all cancers, the pattern persisted through five years of follow-up and within specific cancer types. Performance ranking of hospitals was

  14. A Methodology for Evaluating Hospital Bed Need in Manitoba in 2020

    ERIC Educational Resources Information Center

    Tate, Robert B.; MacWilliam, Leonard R.; Finlayson, Greg

    2005-01-01

    A team of health researchers of the Manitoba Centre for Health Policy at the University of Manitoba was asked to forecast the number of acute care hospital beds that will be required to meet the needs of residents of the province of Manitoba by the year 2020. Methodological considerations for this request included identification of factors…

  15. Anticipating Change: How Many Acute Care Hospital Beds Will Manitoba Regions Need in 2020?

    ERIC Educational Resources Information Center

    Finlayson, Greg; Stewart, David Kenney; Tate, Robert B.; MacWilliam, Leonard R.; Roos, Noralou P.

    2005-01-01

    Being able to anticipate future needs for health services presents a challenge for health planners. Using existing population projections, two models are presented to estimate the demand for hospital beds in regions of Manitoba in 2020. The first, a current-use projection model, simply projects the average use for a recent three-year period into…

  16. 78 FR 51061 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-20

    ... Part 199 RIN 0720-AB41 TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical Access Hospitals; Correction AGENCY: Office of the Secretary, Department of Defense (DoD). ACTION: Final rule; correction. SUMMARY: On Thursday, August 8, 2013 (78 FR 48303-48311),...

  17. 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

    ... eligible under 38 U.S.C. 1710 or 38 CFR 17.44. Care in a Federal facility not operated by the Department of... Defense, Public Health Service or other Federal hospitals with beds allocated to the Department of... of Department of Defense, Public Health Service or other Federal hospitals with beds allocated to...

  18. Laparoscopic common duct exploration in 90-bed rural hospital.

    PubMed

    Shively, Eugene H; Richardson, Malcolm; Romines, Robert; Englund, Graham; Watkins, James

    2010-06-01

    Laparoscopic common bile duct exploration (LCBDE) is an effective procedure when endoscopic retrograde cholangiopancreatography is not available. From January 2004 until December 2009, 1254 patients presented with biliary tract disease. Laparoscopic cholecystectomy was attempted in 1240 (98%) cases and completed in 1232 (98%) cases. Laparoscopic cholangiograms were performed in 627 (50%) cases. LCBDE was carried out in 33 (2.6%) cases. Of the 33 LCBDEs, 29 (2.3%) were via the cystic duct, four (0.32%) through a choledochotomy; eight (0.64%) of the total laparoscopic cholecystectomies were converted to open cholecystectomies. LCBDE can be done safely in small hospitals and is very useful when endoscopic retrograde cholangiopancreatography is not available.

  19. Alternative Level of Care: Canada's Hospital Beds, the Evidence and Options

    PubMed Central

    Sutherland, Jason M.; Crump, R. Trafford

    2013-01-01

    Patients designated as alternative level of care (ALC) are an ongoing concern for healthcare policy makers across Canada. These patients occupy valuable hospital beds and limit access to acute care services. The objective of this paper is to present policy alternatives to address underlying factors associated with ALC bed use. Three alternatives, and their respective limitations and structural challenges, are discussed. Potential solutions may require a mix of policy options proposed here. Inadequate policy jeopardizes new acute care activity-based funding schemes in British Columbia and Ontario. Failure to address this issue could exacerbate pressures on the existing bottlenecks in the community care system in these and other provinces. PMID:23968671

  20. High levels of bed occupancy associated with increased inpatient and thirty-day hospital mortality in Denmark.

    PubMed

    Madsen, Flemming; Ladelund, Steen; Linneberg, Allan

    2014-07-01

    High bed occupancy rates have been considered a matter of reduced patient comfort and privacy and an indicator of high productivity for hospitals. Hospitals with bed occupancy rates of above 85 percent are generally considered to have bed shortages. Little attention has been paid to the impact of these shortages on patients' outcomes. We analyzed all 2.65 million admissions to Danish hospitals' departments of medicine in the period 1995-2012. We found that high bed occupancy rates were associated with a significant 9 percent increase in rates of in-hospital mortality and thirty-day mortality, compared to low bed occupancy rates. Being admitted to a hospital outside of normal working hours or on a weekend or holiday was also significantly associated with increased mortality. The health risks of bed shortages, including mortality, could be better documented as a priority health issue. Resources should be allocated to researching the causes and effects of bed shortages, with the aim of creating greater interest in exploring new methods to avoid or reduce bed shortages. PMID:25006151

  1. High levels of bed occupancy associated with increased inpatient and thirty-day hospital mortality in Denmark.

    PubMed

    Madsen, Flemming; Ladelund, Steen; Linneberg, Allan

    2014-07-01

    High bed occupancy rates have been considered a matter of reduced patient comfort and privacy and an indicator of high productivity for hospitals. Hospitals with bed occupancy rates of above 85 percent are generally considered to have bed shortages. Little attention has been paid to the impact of these shortages on patients' outcomes. We analyzed all 2.65 million admissions to Danish hospitals' departments of medicine in the period 1995-2012. We found that high bed occupancy rates were associated with a significant 9 percent increase in rates of in-hospital mortality and thirty-day mortality, compared to low bed occupancy rates. Being admitted to a hospital outside of normal working hours or on a weekend or holiday was also significantly associated with increased mortality. The health risks of bed shortages, including mortality, could be better documented as a priority health issue. Resources should be allocated to researching the causes and effects of bed shortages, with the aim of creating greater interest in exploring new methods to avoid or reduce bed shortages.

  2. 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

  3. 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.

  4. 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

  5. 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.

  6. 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

  7. 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

  8. 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.

  9. Pre-hospital antibiotic treatment and mortality caused by invasive meningococcal disease, adjusting for indication bias

    PubMed Central

    Perea-Milla, Emilio; Olalla, Julián; Sánchez-Cantalejo, Emilio; Martos, Francisco; Matute-Cruz, Petra; Carmona-López, Guadalupe; Fornieles, Yolanda; Cayuela, Aurelio; García-Alegría, Javier

    2009-01-01

    Background Mortality from invasive meningococcal disease (IMD) has remained stable over the last thirty years and it is unclear whether pre-hospital antibiotherapy actually produces a decrease in this mortality. Our aim was to examine whether pre-hospital oral antibiotherapy reduces mortality from IMD, adjusting for indication bias. Methods A retrospective analysis was made of clinical reports of all patients (n = 848) diagnosed with IMD from 1995 to 2000 in Andalusia and the Canary Islands, Spain, and of the relationship between the use of pre-hospital oral antibiotherapy and mortality. Indication bias was controlled for by the propensity score technique, and a multivariate analysis was performed to determine the probability of each patient receiving antibiotics, according to the symptoms identified before admission. Data on in-hospital death, use of antibiotics and demographic variables were collected. A logistic regression analysis was then carried out, using death as the dependent variable, and pre-hospital antibiotic use, age, time from onset of symptoms to parenteral antibiotics and the propensity score as independent variables. Results Data were recorded on 848 patients, 49 (5.72%) of whom died. Of the total number of patients, 226 had received oral antibiotics before admission, mainly betalactams during the previous 48 hours. After adjusting the association between the use of antibiotics and death for age, time between onset of symptoms and in-hospital antibiotic treatment, pre-hospital oral antibiotherapy remained a significant protective factor (Odds Ratio for death 0.37, 95% confidence interval 0.15–0.93). Conclusion Pre-hospital oral antibiotherapy appears to reduce IMD mortality. PMID:19344518

  10. 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

  11. Funding issues for Victorian hospitals: the risk-adjusted vision beyond casemix funding.

    PubMed

    Antioch, K; Walsh, M

    2000-01-01

    This paper discusses casemix funding issues in Victoria impacting on teaching hospitals. For casemix payments to be acceptable, the average price and cost weights must be set at an appropriate standard. The average price is based on a normative, policy basis rather than benchmarking. The 'averaging principle' inherent in cost weights has resulted in some AN-DRG weights being too low for teaching hospitals that are key State-wide providers of high complexity services such as neurosurgery and trauma. Casemix data have been analysed using international risk adjustment methodologies to successfully negotiate with the Victorian State Government for specified grants for several high complexity AN-DRGs. A risk-adjusted capitation funding model has also been developed for cystic fibrosis patients treated by The Alfred, called an Australian Health Maintenance Organisation (AHMO). This will facilitate the development of similar models by both the Victorian and Federal governments.

  12. 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

    ... for requesting and obtaining the low-volume hospital payment adjustment for FY 2011 (75 FR 50240). For... hospital status for FYs 2011 and 2012 in the FY 2011 IPPS/LTCH PPS final rule (75 FR 20574 through 20575... total payments to IPPS hospitals relative to FY 2012. In the FY 2013 IPPS/LTCH PPS final rule (77...

  13. Reducing hospital bed use by frail older people: results from a systematic review of the literature

    PubMed Central

    Philp, Ian; Mills, Karen A.; Thanvi, Bhomraj; Ghosh, Kris; Long, Judith F.

    2013-01-01

    Introduction Numerous studies have been conducted in developed countries to evaluate the impact of interventions designed to reduce hospital admissions or length of stay (LOS) amongst frail older people. In this study, we have undertaken a systematic review of the recent international literature (2007-present) to help improve our understanding about the impact of these interventions. Methods We systematically searched the following databases: PubMed/Medline, PsycINFO, CINAHL, BioMed Central and Kings Fund library. Studies were limited to publications from the period 2007-present and a total of 514 studies were identified. Results A total of 48 studies were included for full review consisting of 11 meta-analyses, 9 systematic reviews, 5 structured literature reviews, 8 randomised controlled trials and 15 other studies. We classified interventions into those which aimed to prevent admission, interventions in hospital, and those which aimed to support early discharge. Conclusions Reducing unnecessary use of acute hospital beds by older people requires an integrated approach across hospital and community settings. A stronger evidence base has emerged in recent years about a broad range of interventions which may be effective. Local agencies need to work together to implement these interventions to create a sustainable health care system for older people. PMID:24363636

  14. 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

  15. [Hospital efficiency measured by bed space use in a secondary care hospital].

    PubMed

    Moreno-Martínez, Roberto; Martínez-Cruz, Rocío Alejandra

    2015-01-01

    Introducción: reconociendo que los recursos disponibles en las unidades médicas forman parte de los factores que condicionan la atención médica de calidad, resulta de importancia medir su aprovechamiento. El objetivo de este estudio fue determinar la eficiencia hospitalaria a través del recurso cama en un hospital de segundo nivel. Métodos: del Sistema de Información Médico Operativo, se examinaron los cuadros de salida mensuales de julio 2012 a junio 2013 que incluyen variables como egresos, días paciente, porcentaje de ocupación y promedio de días de estancia por especialidad y división, se obtuvieron los resultados por cada indicador estratégico y se relacionaron dichos resultados proponiendo supuestos para valorar la eficiencia hospitalaria. Resultados: de manera global, se identifica una óptima eficiencia hospitalaria, sin embargo el análisis por servicio y división señala una eficiencia deteriorada y baja. El resultado global de los cinco indicadores aplicados ignora la saturación de los servicios al interior de la unidad médica. Sin embargo, el análisis en conjunto revela dicha problemática, demostrando la ventaja de evaluar un mismo escenario desde diferentes perspectivas. Conclusiones: incluir indicadores que midan la eficiencia hospitalaria partiendo del recurso cama, permite considerar deficiencias no identificadas, con lo que se fortalece la toma de decisiones en salud.

  16. 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.

  17. 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.

  18. 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

  19. 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.

  20. Renal Drug Dosage Adjustment According to Estimated Creatinine Clearance in Hospitalized Patients With Heart Failure.

    PubMed

    Altunbas, Gokhan; Yazc, Mehmet; Solak, Yalcin; Gul, Enes E; Kayrak, Mehmet; Kaya, Zeynettin; Akilli, Hakan; Aribas, Alpay; Gaipov, Abduzhappar; Yazc, Raziye; Ozdemir, Kurtulus

    2016-01-01

    It is of clinical importance to determine creatinine clearance and adjust doses of prescribed drugs accordingly in patients with heart failure to prevent untoward effects. There is a scarcity of studies in the literature investigating this issue particularly in patients with heart failure, in whom many have impaired kidney function. The purpose of this study was to determine the degree of awareness of medication prescription as to creatinine clearance in patients hospitalized with heart failure. Patients hospitalized with a diagnosis of heart failure were retrospectively evaluated. Among screened charts, patients with left ventricular ejection fraction <40% and an estimated glomerular filtration rate (eGFR) of ≤50 mL/min were included in the analysis. The medications and respective doses prescribed at discharge were recorded. Medications requiring renal dose adjustment were determined and evaluated for appropriate dosing according to eGFR. A total of 388 patients with concomitant heart failure and renal dysfunction were included in the study. The total number of prescribed medications was 2808 and 48.3% (1357 medications) required renal dose adjustment. Of the 1357 medications, 12.6% (171 medications) were found to be inappropriately prescribed according to eGFR. The most common inappropriately prescribed medications were famotidine, metformin, perindopril, and ramipril. A significant portion of medications used in heart failure requires dose adjustment. Our results showed that in a typical cohort of patients with heart failure, many drugs are prescribed at inappropriately high doses according to creatinine clearance. Awareness should be increased among physicians caring for patients with heart failure to prevent adverse events related to medications.

  1. 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

  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. 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

  4. 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.

  5. 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…

  6. 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

  7. 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.

  8. Development and organization for casualty management on a 1,000-bed hospital ship in the Persian Gulf.

    PubMed

    Ochsner, M G; Harviel, J D; Stafford, P W; Blankenship, C; Bosse, M J; Timberlake, G A; McSwain, N E

    1992-04-01

    A 1,000-bed hospital ship designed for trauma patients was deployed to the Middle East with the objectives of preparing for large numbers of casualties resulting from Operation Desert Storm from conventional, chemical, and biological weapons. Plans for receipt and decontamination of casualties, triage, and optimal utilization of the 1,000-bed facility were developed. Mass casualty drills were conducted, involving all aspects of patient care from the flight deck to the wards. Trauma and critical care registries were developed to collect casualty data that could then be analyzed for specific military purposes and compared with current civilian registries. Attempts were made to identify the advances in shock resuscitation, systems management, and operative treatment from the civilian community that could be applied to care of combat casualties. Difficulties with accomplishing these objectives included limited trauma experience and supplies and poorly defined medical regulating and evacuation policies. The development of these programs, as well as the unique difficulties encountered, are discussed.

  9. 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...

  10. 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.

  11. Implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital

    PubMed Central

    2012-01-01

    Background Antimicrobial stewardship has been promoted as a key strategy for coping with the problems of antimicrobial resistance and Clostridium difficile. Despite the current call for stewardship in community hospitals, including smaller community hospitals, practical examples of stewardship programs are scarce in the reported literature. The purpose of the current report is to describe the implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital employing a core strategy of post-prescriptive audit with intervention and feedback. Methods For one hour twice weekly, an infectious diseases physician and a clinical pharmacist audited medical records of inpatients receiving systemic antimicrobial therapy and made non-binding, written recommendations that were subsequently scored for implementation. Defined daily doses (DDDs; World Health Organization Center for Drug Statistics Methodology) and acquisition costs per admission and per patient-day were calculated monthly for all administered antimicrobial agents. Results The antimicrobial stewardship team (AST) made one or more recommendations for 313 of 367 audits during a 16-month intervention period (September 2009 – December 2010). Physicians implemented recommendation(s) from each of 234 (75%) audits, including from 85 of 115 for which discontinuation of all antimicrobial therapy was recommended. In comparison to an 8-month baseline period (January 2009 – August 2009), there was a 22% decrease in defined daily doses per 100 admissions (P = .006) and a 16% reduction per 1000 patient-days (P = .013). There was a 32% reduction in antimicrobial acquisition cost per admission (P = .013) and a 25% acquisition cost reduction per patient-day (P = .022). Conclusions An effective antimicrobial stewardship program was implemented with limited resources on the medical-surgical service of a 100-bed community hospital. PMID:23043720

  12. 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

  13. Hospital antibiotic use and its relationship to age-adjusted comorbidity and alcohol-based hand rub consumption.

    PubMed

    Aldeyab, M A; McElnay, J C; Scott, M G; Darwish Elhajji, F W; Kearney, M P

    2014-02-01

    The objective of this study was to evaluate the effect of age-adjusted comorbidity and alcohol-based hand rub on monthly hospital antibiotic usage, retrospectively. A multivariate autoregressive integrated moving average (ARIMA) model was built to relate the monthly use of all antibiotics grouped together with age-adjusted comorbidity and alcohol-based hand rub over a 5-year period (April 2005-March 2010). The results showed that monthly antibiotic use was positively related to the age-adjusted comorbidity index (concomitant effect, coefficient 1·103, P = 0·0002), and negatively related to the use of alcohol-based hand rub (2-month delay, coefficient -0·069, P = 0·0533). Alcohol-based hand rub is considered a modifiable factor and as such can be identified as a target for quality improvement programmes. Time-series analysis may provide a suitable methodology for identifying possible predictive variables that explain antibiotic use in healthcare settings. Future research should examine the relationship between infection control practices and antibiotic use, identify other infection control predictive factors for hospital antibiotic use, and evaluate the impact of enhancing different infection control practices on antibiotic use in a healthcare setting. PMID:23657218

  14. 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

  15. 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.

  16. 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

    ... FR 39043), also proposed a CAH GTMCPA for TRICARE network hospitals deemed essential for military..., 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...

  17. 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.

  18. Mediative adjustment of river dynamics: The role of chute channels in tropical sand-bed meandering rivers

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

    This paper examines processes of chute channel formation in four tropical sand-bed meandering rivers; the Strickland and Ok Tedi in Papua New Guinea, the Beni in Bolivia, and the lower Paraguay on the Paraguay/Argentina border. Empirical planform analyses highlight an association between meander bend widening and chute initiation that is consistent with recent physics-based modelling work. GIS analyses indicate that bend widening may be driven by a variety of mechanisms, including scour and cutbank bench formation at sharply-curving bends, point bar erosion due to cutbank impingement against cohesive terrace material, rapid cutbank erosion at rapidly extending bends, and spontaneous mid-channel bar formation. Chute channel initiation is observed to be predominantly associated with two of these widening mechanisms; i) an imbalance between cutbank erosion and point bar deposition associated with rapid bend extension, and ii) bank erosion forced by spontaneous mid-channel bar development. The work extends previous empirical analyses, which highlighted the role of bend extension (elongation) in driving chute initiation, with the observation that the frequency of chute initiation increases once bend extension rates and/or widening ratios exceed a reach-scale threshold. A temporal pattern of increased chute initiation frequency on the Ok Tedi, in response to channel steepening and mid-channel bar development following the addition of mine tailings, mirrors the inter- and intra-reach spatial patterns of chute initiation frequency on the Paraguay, Strickland and Beni Rivers, where increased stream power and sediment load are associated with increased bend extension and chute initiation rates. The process of chute formation is shown to be rate-dependent, and the threshold values of bend extension and widening ratio for chute initiation are shown to scale with measures of river energy, reminiscent of slope-ratio thresholds in river avulsion. Furthermore, Delft3D simulations

  19. 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

  20. Applying risk adjusted cost-effectiveness (RAC-E) analysis to hospitals: estimating the costs and consequences of variation in clinical practice.

    PubMed

    Karnon, Jonathan; Caffrey, Orla; Pham, Clarabelle; Grieve, Richard; Ben-Tovim, David; Hakendorf, Paul; Crotty, Maria

    2013-06-01

    Cost-effectiveness analysis is well established for pharmaceuticals and medical technologies but not for evaluating variations in clinical practice. This paper describes a novel methodology--risk adjusted cost-effectiveness (RAC-E)--that facilitates the comparative evaluation of applied clinical practice processes. In this application, risk adjustment is undertaken with a multivariate matching algorithm that balances the baseline characteristics of patients attending different settings (e.g., hospitals). Linked, routinely collected data are used to analyse patient-level costs and outcomes over a 2-year period, as well as to extrapolate costs and survival over patient lifetimes. The study reports the relative cost-effectiveness of alternative forms of clinical practice, including a full representation of the statistical uncertainty around the mean estimates. The methodology is illustrated by a case study that evaluates the relative cost-effectiveness of services for patients presenting with acute chest pain across the four main public hospitals in South Australia. The evaluation finds that services provided at two hospitals were dominated, and of the remaining services, the more effective hospital gained life years at a low mean additional cost and had an 80% probability of being the most cost-effective hospital at realistic cost-effectiveness thresholds. Potential determinants of the estimated variation in costs and effects were identified, although more detailed analyses to identify specific areas of variation in clinical practice are required to inform improvements at the less cost-effective institutions.

  1. 42 CFR 412.106 - Special treatment: Hospitals that serve a disproportionate share of low-income patients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... qualifies for a payment adjustment include the number of beds, the number of patient days, and the hospital...) For purposes of this section, the number of patient days in a hospital includes only those days... consecutive days. (iii) The hospital's location, in an urban or rural area, is determined in accordance...

  2. 42 CFR 412.106 - Special treatment: Hospitals that serve a disproportionate share of low-income patients.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... qualifies for a payment adjustment include the number of beds, the number of patient days, and the hospital...) For purposes of this section, the number of patient days in a hospital includes only those days... within 24 hours for 30 consecutive days. (iii) The hospital's location, in an urban or rural area,...

  3. Nosocomial infection indicators in Australian hospitals: assessment according to hospital characteristics.

    PubMed

    Ansari, M Z; Collopy, B T

    1997-06-01

    The relationship of bed size and hospital type (private or public) was studied using Hospital-Wide Medical Indicator data on nosocomial infections submitted to the Australian Council on Healthcare Standards Care Evaluation Program by hospitals presenting voluntarily for accreditation in 1993. The aim was to determine if this process could simplify the establishment of hospital peer groups for comparison of risk in the absence of knowledge of patient illness severity indices. After adjusting for potential confounders in a logistic model, hospital type was found to be a significant predictor for the occurrence of infection in clean and contaminated wounds. Bed size was a significant predictor for the occurrence of hospital-acquired bacteraemia in private and public hospitals. The increase in the risk of developing hospital acquired bacteraemia with increasing number of beds was significant as a trend (P < 0.0001) in private as well as public hospitals. The results suggest that hospital type and bed size are initial indices for 'flagging' peer group variation and prompting a more detailed internal review.

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. Association of Premorbid Adjustment with Symptom Profile and Quality of Life in First Episode Psychosis in a Tertiary Hospital in Tehran, Iran

    PubMed Central

    Basirnia, Anahita; Abedi, Neda; Shadloo, Behrang; Jafari, Sara; Salesian, Niloofar; Djalali, Mohsen; Sharifi, Vandad

    2010-01-01

    Objective Poor premorbid adjustment has been reported to be a predictor of more severe psychotic symptoms and poor quality of life in such psychotic disorders as schizophrenia. However, most studies were performed on chronic schizophrenic patients, and proposed the likelihood of recall biases and the effect of chronicity. The aim of this study was to investigate these factors in a sample of first episode psychotic patients, as a part of Roozbeh first episode psychosis project (RooF). Method Premorbid adjustment was assessed using Premorbid Adjustment Scale (PAS) in 48 patients with the first psychotic episode who were admitted to Roozbeh Psychiatric Hospital. The severity of symptoms was measured using Positive and Negative Scale (PANSS) in three subgroups of positive, negative and general subscales. Quality of life was measured using WHO QOL , and Global Assessment of Functioning (GAF) was also measured. Results The mean age was 24 years. Poor Premorbid adjustment in late adolescence was significantly associated with more severe symptoms according to PANSS negative symptoms (p=0.019, r=0.44). Furthermore, sociability and peer relationship domains had a positive correlation with PANSS negative subscale scores (r=0.531, p=0.002 and r=0.385, p=0.03, respectively). There were no significant differences between males and females in premorbid adjustment. Furthermore, this study failed to show any differences between affective and non-affective psychosis in premorbid functioning. Conclusion Our study confirms poor premorbid adjustment association with more severe negative symptoms and poor quality of life in a sample of Iranian first episode psychotic patients. PMID:22952486

  10. 26 CFR 31.6205-2 - Adjustments of underpayments of hospital insurance taxes that accrue after March 31, 1986, and...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... and local government employees. 31.6205-2 Section 31.6205-2 Internal Revenue INTERNAL REVENUE SERVICE..., 1987, with respect to wages of State and local government employees. (a) Adjustments without interest. A State or local government employer who makes, or has made, an undercollection or underpayment...

  11. 26 CFR 31.6205-2 - Adjustments of underpayments of hospital insurance taxes that accrue after March 31, 1986, and...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... and local government employees. 31.6205-2 Section 31.6205-2 Internal Revenue INTERNAL REVENUE SERVICE..., 1987, with respect to wages of State and local government employees. (a) Adjustments without interest. A State or local government employer who makes, or has made, an undercollection or underpayment...

  12. Swing-beds: the Arizona experience.

    PubMed

    Williams, F G; Netting, F E

    1991-06-01

    Swing-beds are acute-care hospital beds temporarily used for long-term care. A demonstration program was developed to evaluate the effectiveness of using swing-beds as catalysts for the expansion of rural hospitals into community health centers to respond better to the needs of older persons in their respective communities. We examined the background and implementation issues of the swing-bed demonstration program in six rural Arizona hospitals.

  13. 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

  14. 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

  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. Critical Care Bed Growth in the United States. A Comparison of Regional and National Trends

    PubMed Central

    Angus, Derek C.; Seymour, Christopher W.; Barnato, Amber E.; Kahn, Jeremy M.

    2015-01-01

    Rationale: Although the number of intensive care unit (ICU) beds in the United States is increasing, it is unknown whether this trend is consistent across all regions. Objectives: We sought to better characterize regional variation in ICU bed changes over time and identify regional characteristics associated with these changes. Methods: We used data from the Centers for Medicare and Medicaid Services and the U.S. Census to summarize the numbers of hospitals, hospital beds, ICU beds, and ICU occupancy at the level of Dartmouth Atlas hospital referral region from 2000 to 2009. We categorized regions into quartiles of bed change over the study interval and examined the relationship between change categories, regional characteristics, and population characteristics over time. Measurements and Main Results: From 2000 to 2009 the national number of ICU beds increased 15%, from 67,579 to 77,809, mirroring population. However, there was substantial regional variation in absolute changes (median, +16 ICU beds; interquartile range, −3 to +51) and population-adjusted changes (median, +0.9 ICU beds per 100,000; interquartile range, −3.8 to +5.9), with 25.0% of regions accounting for 74.8% of overall growth. At baseline, regions with increasing numbers of ICU beds had larger populations, lower ICU beds per 100,000 capita, higher average ICU occupancy, and greater market competition as measured by the Herfindahl-Hirschman Index (P < 0.001 for all comparisons). Conclusions: National trends in ICU bed growth are not uniformly reflected at the regional level, with most growth occurring in a small number of highly populated regions. PMID:25522054

  17. 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.

  18. 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.

  19. Disability-Adjusted Life Years (DALYs) for Injuries Using Death Certificates and Hospital Discharge Survey by the Korean Burden of Disease Study 2012

    PubMed Central

    2016-01-01

    A system for assessing the burdens imposed by disease and injury was developed to meet healthcare, priority setting, and policy planning needs. The first such system, the Global Burden of Disease (GBD), was implemented in 1990. However, problems associated with limited data and assumed disability weightings remain to be resolved. The purpose of the present study was to estimate national burdens of injuries in Korea using more reliable data and disability weightings. The incidences of injuries were estimated using the Korean National Hospital Discharge Survey and the mortality data from the Korean National Statistical Office in 2010. Additionally, durations of injuries and age at injury onset were used to calculate disability-adjusted life years (DALY) using disability weightings derived from the Korean Burden of Disease (KBD) study. Korea had 1,581,072 DALYs resulting from injuries (3,170 per 100,000), which was 22.9% higher than found by the GBD 2010 study. Males had almost twice as heavy an injury burden as females. Road injury, fall, and self-harm ranked 1st, 2nd, and 3rd in terms of burden of injury in 2010. Total injury burden peaked in the forties, while burden per person declined gradually from early adulthood. We hope that this study contributes to the reliable evaluation of injury burden and a better understanding of injury-related health status using nation-specific, dependable data. PMID:27775258

  20. Hospital Case Volume and Outcomes among Patients Hospitalized with Severe Sepsis

    PubMed Central

    Wiener, Renda Soylemez

    2014-01-01

    Rationale: Processes of care are potential determinants of outcomes in patients with severe sepsis. Whether hospitals with more experience caring for patients with severe sepsis also have improved outcomes is unclear. Objectives: To determine associations between hospital severe sepsis caseload and outcomes. Methods: We analyzed data from U.S. academic hospitals provided through University HealthSystem Consortium. We used University HealthSystem Consortium’s sepsis mortality model (c-statistic, 0.826) for risk adjustment. Validated International Classification of Disease, 9th Edition, Clinical Modification algorithms were used to identify hospital severe sepsis case volume. Associations between risk-adjusted severe sepsis case volume and mortality, length of stay, and costs were analyzed using spline regression and analysis of covariance. Measurements and Main Results: We identified 56,997 patients with severe sepsis admitted to 124 U.S. academic hospitals during 2011. Hospitals admitted 460 ± 216 patients with severe sepsis, with median length of stay 12.5 days (interquartile range, 11.1–14.2), median direct costs $26,304 (interquartile range, $21,900–$32,090), and average hospital mortality 25.6 ± 5.3%. Higher severe sepsis case volume was associated with lower unadjusted severe sepsis mortality (R2 = 0.10, P = 0.01) and risk-adjusted severe sepsis mortality (R2 = 0.21, P < 0.001). After further adjustment for geographic region, number of beds, and long-term acute care referrals, hospitals in the highest severe sepsis case volume quartile had an absolute 7% (95% confidence interval, 2.4–11.6%) lower hospital mortality than hospitals in the lowest quartile. We did not identify associations between case volume and resource use. Conclusions: Academic hospitals with higher severe sepsis case volume have lower severe sepsis hospital mortality without higher costs. PMID:24400669

  1. 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

  2. Choosing to convert to critical access hospital status.

    PubMed

    Dalton, Kathleen; Slifkin, Rebecca; Poley, Stephanie; Fruhbeis, Melissa

    2003-01-01

    The authors profile facilities converting to critical access hospitals (CAHs) from 1998-2000, comparing characteristics of their communities, operations, and finances to those of other small rural providers. Counties where CAHs are located are more sparsely populated, but do not have substantially different sociodemographic profiles than other rural counties. Converting hospitals' acute daily census averaged well below the statutory limit of 15, but over one-half reduced unused bed capacity to meet CAH size limitations. The average case-mix adjusted Medicare cost per case was 16-percent higher for CAH converters than for other small hospitals and their financial ratios were substantially worse, although many other operating characteristics were similar.

  3. 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

  4. 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.

  5. 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...

  6. 21 CFR 892.1350 - Nuclear scanning bed.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 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...

  7. 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...

  8. 21 CFR 892.1350 - Nuclear scanning bed.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 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...

  9. 21 CFR 892.1350 - Nuclear scanning bed.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 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...

  10. 21 CFR 880.6060 - Medical disposable bedding.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 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...

  11. 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...

  12. 42 CFR 412.106 - Special treatment: Hospitals that serve a disproportionate share of low-income patients.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... disproportionate share of low-income patients. 412.106 Section 412.106 Public Health CENTERS FOR MEDICARE...-income patients. (a) General considerations. (1) The factors considered in determining whether a hospital qualifies for a payment adjustment include the number of beds, the number of patient days, and the...

  13. 42 CFR 412.106 - Special treatment: Hospitals that serve a disproportionate share of low-income patients.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... disproportionate share of low-income patients. 412.106 Section 412.106 Public Health CENTERS FOR MEDICARE...-income patients. (a) General considerations. (1) The factors considered in determining whether a hospital qualifies for a payment adjustment include the number of beds, the number of patient days, and the...

  14. [Structural adjustment, cultural adjustment?].

    PubMed

    Dujardin, B; Dujardin, M; Hermans, I

    2003-12-01

    Over the last two decades, multiple studies have been conducted and many articles published about Structural Adjustment Programmes (SAPs). These studies mainly describe the characteristics of SAPs and analyse their economic consequences as well as their effects upon a variety of sectors: health, education, agriculture and environment. However, very few focus on the sociological and cultural effects of SAPs. Following a summary of SAP's content and characteristics, the paper briefly discusses the historical course of SAPs and the different critiques which have been made. The cultural consequences of SAPs are introduced and are described on four different levels: political, community, familial, and individual. These levels are analysed through examples from the literature and individual testimonies from people in the Southern Hemisphere. The paper concludes that SAPs, alongside economic globalisation processes, are responsible for an acute breakdown of social and cultural structures in societies in the South. It should be a priority, not only to better understand the situation and its determining factors, but also to intervene and act with strategies that support and reinvest in the social and cultural sectors, which is vital in order to allow for individuals and communities in the South to strengthen their autonomy and identify.

  15. 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

  16. An Evaluation of Rehabilitation Services and the Role of Industry in the Community Adjustment of Psychiatric Patients Following Hospitalization. Final Report.

    ERIC Educational Resources Information Center

    Schmidt, James R.; And Others

    The objectives of this study were to determine the extent to which private enterprise could participate in the vocational rehabilitation of the discharged psychiatric patient and to evaluate the effects of rehabilitation services on the community adjustment of such patients. A total of 202 subjects were randomly assigned to three research groups:…

  17. 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

  18. 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

  19. 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

  20. 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

  1. Bed-exit alarm effectiveness

    PubMed Central

    Capezuti, Elizabeth; Brush, Barbara L.; Lane, Stephen; Rabinowitz, Hannah U.; Secic, Michelle

    2009-01-01

    This study describes the accuracy of two types of bed-exit alarms to detect bed-exiting body movements: pressure-sensitive and a pressure sensitive combined with infrared beam detectors (dual sensor system). We also evaluated the occurrence of nuisance alarms, or alarms that are activated when a participant does not attempt to get out of bed. Fourteen nursing home residents were directly observed for a total of 256 nights or 1,636.5 hours; an average of 18.3 ± 22.3 (± S.D.) nights/participant for an average of 6.4 ± 1.2 hours/night. After adjusting for body movements via repeated measures, Poisson regression modeling, the least squares adjusted means show a marginally significant difference between the type of alarm groups on the number of true positives (mean/S.E.M. = 0.086/1.617) for pressure-sensitive vs. dual sensor alarm (0.593/1.238; p = 0.0599) indicating that the dual sensor alarm may have a higher number of true positives. While the dual sensor bed-exit alarm was more accurate than the pressure sensitive alarm in identifying bed-exiting body movements and reducing the incidence of false alarms, false alarms were not eliminated altogether. Alarms are not a substitute for staff; adequate staff availability is still necessary when residents need or wish to exit bed. PMID:18508138

  2. Bed-exit alarm effectiveness.

    PubMed

    Capezuti, Elizabeth; Brush, Barbara L; Lane, Stephen; Rabinowitz, Hannah U; Secic, Michelle

    2009-01-01

    This study describes the accuracy of two types of bed-exit alarms to detect bed-exiting body movements: pressure-sensitive and a pressure-sensitive combined with infrared (IR) beam detectors (dual sensor system). We also evaluated the occurrence of nuisance alarms, or alarms that are activated when a participant does not attempt to get out of bed. Fourteen nursing home residents were directly observed for a total of 256 nights or 1636.5h; an average of 18.3+/-22.3 (+/-S.D.) nights/participant for an average of 6.4+/-1.2 h/night. After adjusting for body movements via repeated measures, Poisson regression modeling, the least squares adjusted means (LSM) show a marginally significant difference between the type of alarm groups on the number of true positives (NTP) (mean/S.E.M.=0.086/1.617) for pressure-sensitive versus dual sensor alarm (0.593/1.238; p=0.0599) indicating that the dual sensor alarm may have a higher NTP. While the dual sensor bed-exit alarm was more accurate than the pressure-sensitive alarm in identifying bed-exiting body movements and reducing the incidence of false alarms, false alarms were not eliminated altogether. Alarms are not a substitute for staff; adequate staff availability is still necessary when residents need or wish to exit bed.

  3. Santa Barbara Cottage Hospital.

    PubMed

    1984-01-01

    The 465-bed Santa Barbara Cottage Hospital is the largest medical facility on the California coast between Los Angeles and the San Francisco bay area. The hospital dates back to 1888, when a group of local citizens began raising funds to build a "cottage-style" hospital for the growing community. Their original plans called for a complex in which each medical specialty would be housed in a separate bungalow. Even then, however, such a decentralized plan was too costly, so work began instead on a single cottage for all hospital departments. The first Cottage Hospital opened in 1891, with 25 beds housed in a two story Victorian building. Now a hugh medical complex employing some 1,500 people, the hospital continues to be called "Cottage" after the original home-like building. Rodney J. Lamb has been Hospital Administrator for the last 30 years.

  4. 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 ...

  5. Classifying bed inclination using pressure images.

    PubMed

    Baran Pouyan, M; Ostadabbas, S; Nourani, M; Pompeo, M

    2014-01-01

    Pressure ulcer is one of the most prevalent problems for bed-bound patients in hospitals and nursing homes. Pressure ulcers are painful for patients and costly for healthcare systems. Accurate in-bed posture analysis can significantly help in preventing pressure ulcers. Specifically, bed inclination (back angle) is a factor contributing to pressure ulcer development. In this paper, an efficient methodology is proposed to classify bed inclination. Our approach uses pressure values collected from a commercial pressure mat system. Then, by applying a number of image processing and machine learning techniques, the approximate degree of bed is estimated and classified. The proposed algorithm was tested on 15 subjects with various sizes and weights. The experimental results indicate that our method predicts bed inclination in three classes with 80.3% average accuracy.

  6. 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,…

  7. 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

  8. Bed occupancy by diabetic patients.

    PubMed

    Moffitt, P; Fowler, J; Eather, G

    1979-03-24

    The Royal Newcastle Hospital Diabetic Education and Stabilization Centre was instituted primarily to improve diabetics' understanding of their disease and its everyday management. Simultaneously with a five-day education course, stabilization if insulin-dependent diabetics was undertaken on an outpatient basis. In order to disseminate diabetic education as widely as possible, trained nurses from near and far were included in each course. It is believed that these nurses will be able to offer good advice to diabetics who have no other source of reliable information. By actively attempting to reduce hospital bed occupancy by diabetics there has been a reduction of 1400 bed days per year. It is recommended that similar centres be instituted throughout Australia.

  9. Shaft adjuster

    DOEpatents

    Harry, H.H.

    1988-03-11

    Abstract 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. 3 figs.

  10. 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.

  11. 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 ...

  12. Choosing to Convert to Critical Access Hospital Status

    PubMed Central

    Dalton, Kathleen; Slifkin, Rebecca; Poley, Stephanie; Fruhbeis, Melissa

    2003-01-01

    The authors profile facilities converting to critical access hospitals (CAHs) from 1998-2000, comparing characteristics of their communities, operations, and finances to those of other small rural providers. Counties where CAHs are located are more sparsely populated, but do not have substantially different sociodemographic profiles than other rural counties. Converting hospitals' acute daily census averaged well below the statutory limit of 15, but over one-half reduced unused bed capacity to meet CAH size limitations. The average case-mix adjusted Medicare cost per case was 16-percent higher for CAH converters than for other small hospitals and their financial ratios were substantially worse, although many other operating characteristics were similar. PMID:14997697

  13. 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...

  14. 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.

  15. Detection of patient's bed statuses in 3D using a Microsoft Kinect.

    PubMed

    Li, Yun; Berkowitz, Lyle; Noskin, Gary; Mehrotra, Sanjay

    2014-01-01

    Patients spend the vast majority of their hospital stay in an unmonitored bed where various mobility factors can impact patient safety and quality. Specifically, bed positioning and a patient's related mobility in that bed can have a profound impact on risks such as pneumonias, blood clots, bed ulcers and falls. This issue has been exacerbated as the nurse-per-bed (NPB) ratio has decreased in recent years. To help assess these risks, it is critical to monitor a hospital bed's positional status (BPS). Two bed positional statuses, bed height (BH) and bed chair angle (BCA), are of critical interests for bed monitoring. In this paper, we develop a bed positional status detection system using a single Microsoft Kinect. Experimental results show that we are able to achieve 94.5% and 93.0% overall accuracy of the estimated BCA and BH in a simulated patient's room environment.

  16. Associations between Depressive Symptoms and 30-day Hospital Readmission among Older Adults

    PubMed Central

    Berges, Ivonne M.; Amr, Sania; Abraham, Danielle S.; Cannon, Dawn L.; Ostir, Glenn V.

    2015-01-01

    Background Hospital readmissions are common and costly. Our goal was to determine the association between depressive symptoms and readmission within 30 days following hospital discharge in older adults. Methods We analyzed data from a study of 789 persons aged 65 years or older admitted to a 20-bed acute care for elders (ACE) hospital unit from May 2009 to July 2011. Depressive symptoms were recorded within 24-hours of admission to the hospital unit, using the Center for Epidemiologic Studies -Depression (CES-D) Scale. The primary outcome was readmission to hospital within 30 days of discharge. Results The mean age was 77 years; 66% were female, 72% were White, and 59% were unmarried. On average, older patients reported 2.6 comorbid conditions. Sixteen percent were classified with high depressive symptoms (CES-D ≥ 16). The readmission rate within 30 days was 15%. Older patients with high depressive symptoms had more than 1.6 times the odds (OR 1.66; 95% CI: 1.01-2.74) of being readmitted within 30-days, as compared to those with low depressive symptoms (CES-D < 16), after adjustment for age, race/ethnicity, sex, marital status and comorbid conditions. Conclusion High depressive symptoms increased the risk of hospital readmission within 30 days of discharge after adjusting for relevant covariates. In-hospital screening for depressive symptoms may identify older persons at risk for recurrent hospital admissions. PMID:27134802

  17. Needs for special-care beds for the newborn in the Witwatersrand area.

    PubMed

    Cooper, P A; Rothberg, A D; Davies, V A; Herman, A A

    1987-05-16

    The requirements for different levels of neonatal care in the Witwatersrand area were estimated from a review of neonatal unit records of all infants born at Johannesburg Hospital during 1983 and 1984. When extrapolating these figures to the greater population of the Witwatersrand and referral areas, adjustments were made for the increased number of low-birth-weight and complicated deliveries at Johannesburg Hospital. Given the low-birth-weight rate of 8% for this population, it was calculated that 3.3 intermediate-care beds and 1.2 intensive-care beds were justified per 1,000 annual live births. A total of 25 beds for mechanical ventilation of neonates were required over this study period, approximately double the number available. Facilities for other population groups, who have higher rates for low birth weight, were even less adequate. For the country as a whole it is recognised that postneonatal mortality is a greater problem amenable to less costly intervention than neonatal mortality; nevertheless, existing facilities for neonatal care should be used more efficiently, and a co-ordinated regional service for all population groups in the area should be established.

  18. 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.

  19. 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 group of woven cloth products used as coverings on a bed. Bedding includes products such as...

  20. Duration of patients’ visits to the hospital emergency department

    PubMed Central

    2012-01-01

    Background Length of stay is an important indicator of quality of care in Emergency Departments (ED). This study explores the duration of patients’ visits to the ED for which they are treated and released (T&R). Methods Retrospective data analysis and multivariate regression analysis were conducted to investigate the duration of T&R ED visits. Duration for each visit was computed by taking the difference between admission and discharge times. The Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) for 2008 were used in the analysis. Results The mean duration of T&R ED visit was 195.7 minutes. The average duration of ED visits increased from 8 a.m. until noon, then decreased until midnight at which we observed an approximately 70-minute spike in average duration. We found a substantial difference in mean duration of ED visits (over 90 minutes) between Mondays and other weekdays during the transition time from the evening of the day before to the early morning hours. Black / African American patients had a 21.4-minute longer mean duration of visits compared to white patients. The mean duration of visits at teaching hospitals was substantially longer than at non-teaching hospitals (243.8 versus 175.6 minutes). Hospitals with large bed size were associated with longer duration of visits (222.2 minutes) when compared to hospitals with small bed size (172.4 minutes) or those with medium bed size (166.5 minutes). The risk-adjusted results show that mean duration of visits on Mondays are longer by about 4 and 9 percents when compared to mean duration of visits on non-Monday workdays and weekends, respectively. Conclusions The duration of T&R ED visits varied significantly by admission hour, day of the week, patient volume, patient characteristics, hospital characteristics and area characteristics. PMID:23126473

  1. Examination of hospital characteristics and patient quality outcomes using four inpatient quality indicators and 30-day all-cause mortality.

    PubMed

    Carretta, Henry J; Chukmaitov, Askar; Tang, Anqi; Shin, Jihyung

    2013-01-01

    The study objective was to examine hospital mortality outcomes and structure using 2008 patient-level discharges from general community hospitals. Discharges from Florida administrative files were merged to the state mortality registry. A cross-sectional analysis of inpatient mortality was conducted using Inpatient Quality Indicators (IQIs) for acute myocardial infarction (AMI), congestive heart failure (CHF), stroke, pneumonia, and all-payer 30-day postdischarge mortality. Structural characteristics included bed size, volume, ownership, teaching status, and system affiliation. Outcomes were risk adjusted using 3M APR-DRG. Volume was inversely correlated with AMI, CHF, stroke, and 30-day mortality. Similarities and differences in the direction and magnitude of the relationship of structural characteristics to 30-day postdischarge and IQI mortality measures were observed. Hospital volume was inversely correlated with inpatient mortality outcomes. Other hospital characteristics were associated with some mortality outcomes. Further study is needed to understand the relationship between 30-day postdischarge mortality and hospital quality.

  2. 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.

  3. 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.

  4. 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.

  5. 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...

  6. 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 ...

  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. 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

  9. 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

  10. 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 ...

  11. 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

  12. 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.

  13. 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.

  14. 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

  15. Understanding the factors associated with differences in caesarean section rates at hospital level: the case of Latin America.

    PubMed

    Taljaard, Monica; Donner, Allan; Villar, José; Wojdyla, Daniel; Faundes, Anibal; Zavaleta, Nelly; Acosta, Arnaldo

    2009-11-01

    As in many other regions of the world, caesarean section (CS) rates in Latin America are increasing. Studies elsewhere have shown that providing feedback to caregivers regarding their own performance relative to their peers can significantly reduce the rates. Our objectives are to calculate risk-adjusted CS rates for hospitals in Latin America and to identify factors associated with differences among risk-adjusted rates. We included 120 randomly selected institutions in eight countries of Latin America, representing 97 095 pregnancies. We used random-effects models to calculate a risk-adjusted rate for each hospital and to identify hospitals significantly higher or lower than a benchmark rate. We conducted a regression analysis to identify characteristics of hospitals associated with differences among risk-adjusted rates. The overall CS rate was 35%, ranging from 0% to 85%. Risk-adjusted CS rates ranged from 11% to 78%. Three-quarters of hospitals had risk-adjusted rates significantly above the previously identified benchmark of 20%. Characteristics of institutions explained 48% of the variability among risk-adjusted rates, including being a private as opposed to a public institution, having some economic incentive for CS as opposed to no incentive, and having > or = 50 maternity beds. Strategies to halt further increases in CS rates and reduce rates to levels that reflect the best quality of care, are urgently needed worldwide. The involvement of local quality control departments is an essential component in achieving success. Our results can be used to identify institutions that can be targets for further interventions to reduce CS rates.

  16. A simulation study of the winter bed crisis.

    PubMed

    Vasilakis, C; El-Darzi, E

    2001-02-01

    The winter bed crisis is a cyclical phenomenon which appears in British hospitals every year, two or three weeks after Christmas. The crisis is usually attributed to factors such as the bad weather, influenza, older people, geriatricians, lack of cash or nurse shortages. However, a possible alternative explanation could be that beds within the hospital are blocked because of lack of social services for discharge of hospital patients during the Christmas period. Adopting this explanation of why the bed crisis occurs, the problem was considered as a queuing system and discrete event simulation was employed to evaluate the model numerically. The model shows that stopping discharges of rehabilitating patients for 21 days accompanied by a cessation of planned patients for 14 days precipitate a bed crisis when the planned admissions recommence. The extensive "what-if" capabilities of such models could be proved to be crucial to the designing and implementation of possible solutions to the problem.

  17. [Volgograd military hospital--70 years].

    PubMed

    Novikov, V Ia; Alborov, Z Ts

    2012-01-01

    History of the Volgograd military hospital dates back to July 24, 1941, when on the basis of the regional children's bone tuberculosis sanatorium in Krasnodar was transformed into 2150th military hospital consisted of 240 beds. Since May 1944 relocated in the city of Stalingrad became a garrison hospital. Today the hospital is a multidisciplinary health centre of the Russian Defense Ministry. Annually, the hospital performed at least 3000 surgical procedures, including more than 37%--are complex. In surgery, improved endovideosurgical direction, over 31% of emergency operations performed using this method. Since December 2009 the hospital became a structural division of the District Hospital in 1602 in Rostov on Don. The close connection between the branch and district hospital allows for complex diagnostic situations to consult leading experts, including consultation, thus ensuring the most effective treatment results.

  18. 42 CFR 482.66 - Special requirements for hospital providers of long-term care services (“swing-beds”).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 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 hospital... eligibility requirements: (1) The facility has fewer than 100 hospital beds, excluding beds for newborns...

  19. 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.

  20. 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.

  1. Bed rest in pregnancy.

    PubMed

    Bigelow, Catherine; Stone, Joanne

    2011-01-01

    The use of bed rest in medicine dates back to Hippocrates, who first recommended bed rest as a restorative measure for pain. With the formalization of prenatal care in the early 1900s, maternal bed rest became a standard of care, especially toward the end of pregnancy. Antepartum bed rest is a common obstetric management tool, with up to 95% of obstetricians utilizing maternal activity restriction in some way in their practice. Bed rest is prescribed for a variety of complications of pregnancy, from threatened abortion and multiple gestations to preeclampsia and preterm labor. Although the use of bed rest is pervasive, there is a paucity of data to support its use. Additionally, many well-documented adverse physical, psychological, familial, societal, and financial effects have been discussed in the literature. There have been no complications of pregnancy for which the literature consistently demonstrates a benefit to antepartum bed rest. Given the well-documented adverse effects of bed rest, disruption of social relationships, and financial implications of this intervention, there is a real need for scientific investigation to establish whether this is an appropriate therapeutic modality. Well-designed randomized, controlled trials of bed rest versus normal activity for various complications of pregnancy are required to lay this debate to rest once and for all. PMID:21425272

  2. 42 CFR 424.106 - Criteria for determining whether the hospital was the most accessible.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... whether a nonparticipating hospital in a rural area meets the accessibility requirements: (1) The relative... available to these hospitals. (3) The quality of the roads to each hospital. (4) The availability of beds...

  3. Structural determinants of hospital closure.

    PubMed

    Longo, D R; Chase, G A

    1984-05-01

    In a retrospective case-control study, structural characteristics of hospitals that closed during the years 1976-1980 were contrasted with three comparison groups: hospitals that were acquired in a merger; hospitals that joined a multihospital system; and hospitals that remained autonomously opened, to investigate these characteristics as predictors of closure. Characteristics investigated included environmental, structural, and process variables. The independent variables were measured 5 years prior to outcome. Findings indicate that closed hospitals resemble hospitals acquired in a merger ("failure"), and likewise autonomous hospitals resemble hospitals that join a multihospital system ("success"). The most important predictors of hospital failure were the physician-to-population ratio, the East North Central and West North Central census regions, the level of diversification, low occupancy rate, location in a standard metropolitan statistical area, the chief executive officer's lack of affiliation in the American College of Hospital Administrators, profit status, bed size of less than 50, and presence in a state with a rate-setting agency. Surprisingly, this study shows the bed-to-population ratio to be unrelated to closure. In addition, the findings strongly support the open-system perspective, which, unlike the closed-system perspective, is concerned with the vulnerability of the organization to the uncontrollable and often unpredictable influences of the environment.

  4. 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

  5. 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

  6. 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

  7. 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.

  8. Impact of teaching intensity and academic status on medical resource utilization by teaching hospitals in Japan.

    PubMed

    Sato, Daisuke; Fushimi, Kiyohide

    2012-11-01

    Teaching hospitals require excess medical resources to maintain high-quality care and medical education. To evaluate the appropriateness of such surplus costs, we examined the impact of teaching intensity defined as activities for postgraduate training, and academic status as functions of medical research and undergraduate teaching on medical resource utilization. Administrative data for 47,397 discharges from 40 academic and 12 non-academic teaching hospitals in Japan were collected. Hospitals were classified into three groups according to intern/resident-to-bed (IRB) ratio. Resource utilization of medical services was estimated using fee-for-service charge schedules and normalized with case mix grouping. 15-24% more resource utilization for laboratory examinations, radiological imaging, and medications were observed in hospitals with higher IRB ratios. With multivariate adjustment for case mix and academic status, higher IRB ratios were associated with 10-15% more use of radiological imaging, injections, and medications; up to 5% shorter hospital stays; and not with total resource utilization. Conversely, academic status was associated with 21-33% more laboratory examinations, radiological imaging, and medications; 13% longer hospital stays; and 10% more total resource utilization. While differences in medical resource utilization by teaching intensity may not be associated with indirect educational costs, those by academic status may be. Therefore, academic hospitals may need efficiency improvement and financial compensation.

  9. Bathing a patient in bed

    MedlinePlus

    Bed bath; Sponge bath ... Some patients cannot safely leave their beds to bathe. For these people, daily bed baths can help keep their skin healthy, control odor, and increase comfort. If moving the ...

  10. A study of New York City obstetrics units demonstrates the potential for reducing hospital inpatient capacity.

    PubMed

    Green, Linda V; Liu, Nan

    2015-04-01

    Hospitals are under significant pressure from payers to reduce costs. The single largest fixed cost for a hospital is inpatient beds, yet there is significant variation in hospital capacity utilization. We study bed capacity in New York City hospital obstetrics units and find that while many hospitals have an insufficient number of beds to provide timely access to care, overall there is significant excess capacity. Our findings, coupled with current demographic and clinical practice trends, indicate that a large fraction of obstetrics units nationwide could likely reduce their bed capacity while assuring timely access to care, resulting in large savings in capital and staffing costs. Given emerging health care delivery and payment models that will likely decrease demand for other types of hospital beds, our study suggests that data-based methodologies should be used by hospitals and policy makers to identify opportunities for reducing excess bed capacity in other inpatient units as well.

  11. A safe electric medical bed for an acute inpatient behavioral health care setting.

    PubMed

    Wagner, John J; Ingram, Todd N

    2013-01-01

    The purpose of this article is to describe the process of developing a safe electric bed for a traditional acute care adult behavioral health inpatient unit. Many articles and studies exist related to creating a safe environment on acute care psychiatric units, but very few address the use of electric hospital beds. The process of adapting a traditional electric bed for inpatient use by the nursing management team of the Behavioral Health Service at the University of Iowa Hospitals and Clinics is described, including specific safety features in the prototype bed. Policy changes during implementation and safety data after 12 months of bed use on the units are also presented. Results indicate that traditional electric hospital beds can be safely adapted for use on traditional acute care psychiatric units.

  12. 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.

  13. 42 CFR 412.525 - Adjustments to the Federal prospective payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.525 Adjustments to the Federal prospective payment. (a) Adjustments for high-cost outliers. (1) CMS provides for an additional payment to a long-term care hospital...

  14. 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.

  15. 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.

  16. Bed exit alarms.

    PubMed

    2004-09-01

    Bed-exit alarms alert caregivers that a patient who should not get out of bed unassisted is doing so. These alarms can help reduce the likelihood of falls and can promote speedy assistance to patients who have already fallen. But as we described in our May 2004 Guidance Article on bed-exit alarms, they don't themselves prevent falls. They are only effective if used as part of an overall fall-prevention program and with a clear understanding of their limitations. This Evaluation examines the effectiveness of 16 bed-exit alarms from seven suppliers. Our ratings focus primarily on each product's reliability in detecting bed-exit events and alerting caregivers, its ability to minimize nuisance alarms (alarms that sound even though the patient isn't leaving the bed or that sound while a caregiver is helping the patient to leave the bed), and its resistance to deliberate or inadvertent tampering. Twelve of the products use pressure-sensor-activated alarms (mainly sensor pads placed on or under the mattress); three use a cord that can attach to the patient's garment, alarming if the cord is pulled loose from the control unit; and one is a position-sensitive alarm attached to a leg cuff. All the products reliably detect attempted or successful bed exits. But they vary greatly in how effectively they alert staff, minimize nuisance alarms, and resist tampering. Ease of use and battery performance also vary for many units. Of the pressure-sensor units, three are rated Preferred. Those units meet most of our criteria and have no significant disadvantages. Five of the other pressure-sensor products are Acceptable, and the remaining four are Not Recommended. All three cord-activated alarms are rated Acceptable, as is the patient-worn alarm.

  17. 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

  18. 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.

  19. The effects of Medicare Health Management Organizations on hospital operating profit in Florida.

    PubMed

    Large, John T; Sear, Alan M

    2005-02-01

    Between 1992 and 1997, the number of members enrolled in Medicare Health Management Organizations (HMOs) nationwide in the USA more than doubled. During this period, managed care organizations wielded considerable influence over the health care of a large segment of the Medicare population in Florida. This study examined the impact on operational profit of 148 short-term, acute-care Florida hospitals in this period from Medicare HMO patients, as part of a hospital's payer mix. Three measures of hospital profitability were used: operating profit per actual bed, total operating profit with no adjustment for bed size, and operating margins. The multivariate statistical model employed in this study was a linear mixed model with an autoregressive order one (AR[1]) parametric structure on the covariance matrix. The results of the study indicate that Florida hospitals experienced greater profit pressures from Medicare HMO inpatients than from traditional Medicare inpatients. Further, these hospitals could have experienced positive profit effects with greater traditional Medicare participation and negative financial effects with greater Medicare HMO participation. Additionally, Medicare HMO patients appear to have been admitted to hospitals in worse health condition than those in traditional Medicare. Medicare HMO patients were more likely to have used emergency rooms as the source of admission than traditional Medicare patients. Also, Medicare HMO patients were more likely to have been admitted as emergent cases than traditional Medicare patients. Other research has shown that Medicare HMO patients, at the time of enrolment, are probably healthier than traditional Medicare enrollees, but here they appear to have been admitted to hospitals with higher levels of severity of illness. Explanations are offered for these findings.

  20. How feasible was a bed-height alert system?

    PubMed

    Tzeng, Huey-Ming; Prakash, Atul; Brehob, Mark; Anderson, Allison; Devecsery, David Andrew; Yin, Chang-Yi

    2013-08-01

    This qualitative and descriptive study examined the feasibility of a bed-height alert system as a fall-prevention strategy. The alpha prototype was developed to measure and record bed height, and to remind staff to keep patient beds in the lowest position. This pilot project was conducted in a 52-bed adult acute surgical inpatient care unit of a Michigan community hospital. Qualitative and quantitative information was gathered during semistructured interviews of nursing staff (18 RNs and 13 PCAs; January-April 2011). Descriptive content analysis and descriptive analyses were performed. The overall response rate was 44.9%. The mean values of the feasibility questions are all favorable. Staff's comments also support the view that the alert system would promote patient safety and prevent falls. In short, this system was found to be somewhat useful, feasible, appropriate, and accurate. It has the potential to promote patient safety and prevent bed-associated injurious falls in inpatient care settings.

  1. 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)

  2. 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...

  3. 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.

  4. 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

  5. Cogeneration for hospitals

    SciTech Connect

    Not Available

    1985-01-01

    With health care costs on the rise, hospitals are looking for ways to reduce operating expenses-especially utility bills. But hospitals, more than anyone else, need a continuous source of electricity, heating and air conditioning. They cannot turn off medical equipment or climate control systems in the name of energy conservation. Hospital Corporation of America (HCA), with the help of the Gas Research Institute (GRI), has found a way to supply affordable and efficient power to a mid-size hospital in Houston, Texas. A 500-kilowatt (kw) gasfired cogeneration system, sold as a package, is now being field-tested at the Medical Center Del Oro, a 258-bed hospital facility. The cogeneration system, which began operating last month, will supply the medical center with 145 tons of cooling (or 2.3 MMBtu/hour space heating) and 500,000 Btu/hour for water heating, in addition to the 500 kw of electricity. A Caterpillar continuous-duty turbocharged gas-fueled engine serves as the prime mover, and heat is recovered from its exhaust and from water used to cool the engine. A Trane single-effect absorption chiller supplies chilled water for air conditioning the hospital.

  6. Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2007 rates; fiscal year 2007 occupational mix adjustment to wage index; health care infrastructure improvement program; selection criteria of loan program for qualifying hospitals engaged in cancer-related health care and forgiveness of indebtedness; and exclusion of vendor purchases made under the competitive acquisition program (CAP) for outpatient drugs and biologicals under part B for the purpose of calculating the average sales price (ASP). Final rules and interim final rule with comment period.

    PubMed

    2006-08-18

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs to implement changes arising from our continuing experience with these systems, and to implement a number of changes made by the Deficit Reduction Act of 2005 (Pub. L. 109-171). In addition, in the Addendum to this final rule, we describe the changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs. We also are setting forth rate-of-increase limits as well as policy changes for hospitals and hospital units excluded from the IPPS that are paid in full or in part on a reasonable cost basis subject to these limits. These changes are applicable to discharges occurring on or after October 1, 2006. In this final rule, we discuss public comments we received on our proposals to refine the diagnosis-related group (DRG) system under the IPPS to better recognize severity of illness among patients--to use a hospital-specific relative value (HSRV) cost center weighting methodology to adjust DRG relative weights; and to implement consolidated severity-adjusted DRGs or alternative severity adjustment methods. Among the other policy changes that we are making are those changes related to: limited revisions of the reclassification of cases to DRGs; the long-term care (LTC)-DRGs and relative weights; the wage data, including the occupational mix data, used to compute the wage index; applications for new technologies and medical services add-on payments; payments to hospitals for the direct and indirect costs of graduate medical education; submission of hospital quality data; payments to sole community hospitals and Medicare-dependent, small rural hospitals; and provisions governing emergency services under the Emergency Medical Treatment and Labor Act of 1986 (EMTALA). We are responding to requested public comments on a number of other issues that include performance

  7. Risk-adjusted outcomes in Medicare inpatient nephrectomy patients

    PubMed Central

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

    2016-01-01

    Abstract 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

  8. 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

  9. Why urban voluntary hospitals close.

    PubMed Central

    Sager, A

    1983-01-01

    In this paper, we argue for the importance of understanding hospital closings and relocations. Broad descriptive data on closings, relocations, and other reconfigurations of beds in 52 large and mid-size U.S. cities are presented. The period covered is 1937 to 1980. Two contrasting outlooks on hospital closings and relocations are offered. As hypothesized, smaller and less specialized nonteaching hospitals and those located in minority neighborhoods or serving above-average proportions of minority or Medicaid-funded patients were more likely to close. A potentially more effective but more costly and less accessible system of urban health care appears to result. PMID:6360956

  10. 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.

  11. Cooling of debris beds

    SciTech Connect

    Barleon, L.; Thomauske, K.; Werie, H.

    1984-04-01

    The dependence of the dryout heat flux for volume-heated particulate beds on bed height (less than or equal to40 cm), particle diameter (0.06 to 16 mm), stratification and boundary conditions (saturated and subcooled liquid, adiabatic and cooled bottom and sidewalls) has been determined for water and Freon-113. Channel penetration through subcooled layers and ''downward boiling'' due to capillarity effects have been observed. Different types of bed disturbances have been identified, and their effect on dryout has been studied. Using existing theoretical models, which have been verified by the experiments, the upper limit of the thermal load on support structures has been calculated as a function of the particle size and bottom temperature for reactor accident conditions (Pu/U-oxide particles in sodium).

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

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

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Adjustments § 3.556 Adjustment on discharge or release. (a) Temporary Absence—30 days. (1) Where a competent... absence of 30 days or more the full monthly rate, excluding any allowance for regular aid and attendance... date of departure from the hospital unless it is determined that apportionment for a spouse should...

  1. 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

  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. Technology test bed review

    NASA Technical Reports Server (NTRS)

    Mcconnaughey, H. V.

    1992-01-01

    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.

  4. Bed rest during pregnancy

    MedlinePlus

    ... for support 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 ...

  5. Hospital overcrowding: an opportunity for case managers.

    PubMed

    Simmons, Florence M

    2005-01-01

    Hospital overcrowding is primarily a shortage of inpatient beds, not a lack of emergency department capacity, as initially assumed. According to Asplin et al., many factors contribute to overcrowding, including inadequate or inflexible nurse-to-patient staffing ratios, isolation precautions, or delays in cleaning rooms after patient discharge; an overreliance on intensive care or telemetry beds; inefficient diagnostic and ancillary services on inpatient units; and delays in discharging hospitalized patients to postacute-care facilities. Hospital overcrowding presents a challenge for hospital employees and clients, often leading to frustration and dissatisfaction. Overcrowding also has a direct effect on patient care, including compromised patient safety, increased costs, increased length of stay, and increased mortality and morbidity rates. The emergency department is changed from a temporary holding area to an extended patient care unit, decreasing its ability to handle new admissions and to manage a mass casualty. Beds in the critical care units become filled with inappropriate patients if floor beds are not available, making placement of seriously ill patients difficult. Trauma patients may have to be diverted to other hospitals to receive the appropriate level of care. Patients who require specialty services may have to wait for extended periods to obtain a bed in a referral center.

  6. 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.

  7. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective 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....

  8. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective 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....

  9. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective 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....

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective 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....

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective 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....

  12. Laboratory-based surveillance of hospital-acquired catheter-related bloodstream infections in Catalonia. Results of the VINCat Program (2007-2010).

    PubMed

    Almirante, Benito; Limón, Enric; Freixas, Núria; Gudiol, F

    2012-06-01

    The VINCat Program is an institutional surveillance program for hospital-acquired infections developed in the healthcare institutions of Catalonia, Spain. The program includes the monitoring of various components of hospital-acquired infection, among which is catheter-related bloodstream infection (CRBSI). The aim of this study was to describe the frequency of CRBSI in hospitals participating in the VINCat Program over a period of 4 years (2007-2010). The monitoring of the CRBSI component is carried out continuously in all inpatient units by performing a daily assessment of all blood culture results issued by the Microbiology Laboratories. Precise definitions are used for CRBSI, and adjusted rates are expressed per 1,000 days of hospitalization, hospital size and type of catheter. The rates of CRBSI in catheters used for parenteral nutrition are adjusted and expressed per 1,000 days of device use. The aggregate data of the total period are shown in percentiles (10%, 25%, 50% or median, 75%, and 90%). From 2007 to 2010, a total of 2977 episodes of CRBSI were reported in 40 hospitals participating in the VINCat Program. The cumulative incidence of CRBSI has been 0.26 episodes per 1,000 days of hospitalization (CI95% 0.2 to 0.3). The overall incidence varied depending on hospital size: 0.36 ‰ for hospitals in Group I (>500 beds), 0.17 ‰ for Group II (200-500 beds), and 0.09 ‰ for Group III (<200 beds). 76% of the episodes were associated with central venous catheters (CVC), 19% of the episodes with peripheral venous catheters (PVC), and the remaining 5% with peripherally inserted CVCs (PICC). The most common organisms causing CRBSI were staphylococci, the group Klebsiella, Serratia and Enterobacter, Candida spp., and Pseudomonas aeruginosa. There are important differences in the etiology of CRBSI in relation to these variables. During the reporting period, a significant reduction (38.1%, CI95%, 29.0-46.0%) of CRBSI rates have been observed in Group I hospitals

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. 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

  19. 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

  20. Design method for adsorption beds

    NASA Technical Reports Server (NTRS)

    Blakely, R. L.; Jackson, J. K.

    1970-01-01

    Regenerable adsorption beds for long-term life support systems include synthetic geolite to remove carbon dioxide and silica gel to dehumidify the atmospheric gas prior to its passage through the geolite beds. Bed performance is evaluated from adsorption characteristics, heat and mass transfer, and pressure drop.

  1. Norovirus - hospital

    MedlinePlus

    Gastroenteritis - norovirus; Colitis - norovirus; Hospital acquired infection - norovirus ... Symptoms start within 24 to 48 hours of infection, and can last for 1 ... norovirus. Hospital patients who are very old, very young, or ...

  2. 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

  3. 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.

  4. Health information technology and hospital quality of care.

    PubMed

    Furukawa, Michael; Adam, Terrence

    2008-01-01

    This study evaluates the association between health information technology (HIT) implementation and hospital quality of care using nationally representative datasets from HIMSS Analytics and CMS. The results show that the availability of HIT is associated with higher hospital quality of care when adjusted for hospital characteristics and geographic location. The effects varied by specific HIT application and across hospital quality measures.

  5. An approach toward public hospital performance assessment

    PubMed Central

    Nwagbara, Vitalis Chukwudi; Rasiah, Rajah; Aslam, Md. Mia

    2016-01-01

    Abstract Background: Public hospitals have come under heavy scrutiny across the world owing to rising expenditures. However, much of the focus has been on cutting down costs to raise efficiency levels. Although not denying the importance of efficiency measures, this article targets a performance issue that is relevant to address the quality of services rendered in public hospitals. Thus, it is important to focus on the effectiveness of resource utilization in these hospitals. Consequently, this article seeks to examine the impact of average length of stay (ALOS) and bed turnover rates (BTR) on bed occupancy rates (BOR). Methods: Public hospital inpatient utilization records during the period 2006 to 2013 were gathered from the Ministry of Health, Malaysia. A 2-step generalized method of moments (GMM) statistical method was used to analyze the data. BOR was adopted as the dependent variable, whereas BTR and ALOS were used as the explanatory variables. The logarithm of total bed count (BED), admission (ADM), and patient days (PD) was deployed as control variables. Three regression models were developed to explore the correlates of BOR as a hospital performance measure. Ethics committee approval was waived because no patients were identified in the study. Results: The statistical analyses show that ALOS and BTR are inversely correlated with BOR, with both coefficients significant at 1%. The control variables of BED, ADM, and PD had the right positive signs and they were significant in both sets of equations. Hence, reducing ALOS and BTR can help raise performance of public hospitals in Malaysia. Conclusion: In light of the robust results obtained, this study offers implications for improving public hospital performance. It shows a need to reduce ALOS and BTR in public hospitals to improve BOR. PMID:27603363

  6. 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.

  7. Keeping patient beds in a low position: an exploratory descriptive study to continuously monitor the height of patient beds in an adult acute surgical inpatient care setting.

    PubMed

    Tzeng, Huey-Ming; Prakash, Atul; Brehob, Mark; Devecsery, David Andrew; Anderson, Allison; Yin, Chang-Yi

    2012-06-01

    This descriptive study was intended to measure the percentage of the time that patient beds were kept in high position in an adult acute inpatient surgical unit with medical overflow in a community hospital in Michigan, United States. The percentage of the time was calculated for morning, evening, and night shifts. The results showed that overall, occupied beds were in a high position 5.6% of the time: 5.40% in the day shift, 6.88% in the evening shift, and 4.38% in the night shift. It is recognized that this study was unable to differentiate whether those times patient beds being kept in a high position were appropriate for an elevated bed height (e.g., staff were working with the patient). Further research is warranted. Falls committees may conduct high-bed prevalence surveys in a regular basis as a proxy to monitor staff members' behaviors in keeping beds in a high position.

  8. 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.

  9. 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.

  10. 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

  11. [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.

  12. 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.

  13. 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 ...

  14. 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

  15. [70th anniversary of Lainz hospital].

    PubMed

    Luger, A

    1983-06-10

    The Krankenhaus der Stadt Wien-Lainz was the first hospital built and administered by the municipality of Vienna. It was opened on 17th May, 1913 with 8 departments (991 beds) and 3 institutes; now it consists of 14 departments (1,504 beds) and 7 institutes. The main scientific investigational fields are mentioned. 10 research units are supported by the Ludwig Boltzmann-Gesellschaft. Besides these, many other investigations are performed. 3,246 papers, handbook articles and books have been published by the physicians of the hospital during the past decade.

  16. 38 CFR 4.29 - Ratings for service-connected disabilities requiring hospital treatment or observation.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Department of Veterans Affairs or an approved hospital for a period in excess of 21 days or hospital... effective the last day of the month of hospital discharge (regular discharge or release to non-bed care) or... hospital discharge effective the first day of such authorized absence. An authorized absence of 4 days...

  17. 38 CFR 4.29 - Ratings for service-connected disabilities requiring hospital treatment or observation.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Department of Veterans Affairs or an approved hospital for a period in excess of 21 days or hospital... effective the last day of the month of hospital discharge (regular discharge or release to non-bed care) or... hospital discharge effective the first day of such authorized absence. An authorized absence of 4 days...

  18. 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

  19. 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.

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. Fluidized-bed sorbents

    SciTech Connect

    Gangwal, S.K.; Gupta, R.P.

    1994-10-01

    The objectives of this project are to identify and demonstrate methods for enhancing long-term chemical reactivity and attrition resistance of zinc oxide-based mixed metal-oxide sorbents for desulfurization of hot coal-derived gases in a high-temperature, high-pressure (HTHP) fluidized-bed reactor. In this program, regenerable ZnO-based mixed metal-oxide sorbents are being developed and tested. These include zinc ferrite, zinc titanate, and Z-SORB sorbents. The Z-SORB sorbent is a proprietary sorbent developed by Phillips Petroleum Company (PPCo).

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. Does long-term care use within primary health care reduce hospital use among older people in Norway? A national five-year population-based observational study

    PubMed Central

    2011-01-01

    Background Population ageing may threaten the sustainability of future health care systems. Strengthening primary health care, including long-term care, is one of several measures being taken to handle future health care needs and budgets. There is limited and inconsistent evidence on the effect of long-term care on hospital use. We explored the relationship between the total use of long-term care within public primary health care in Norway and the use of hospital beds when adjusting for various effect modifiers and confounders. Methods This national population-based observational study consists of all Norwegians (59% women) older than 66 years (N = 605676) (13.2% of total population) in 2002-2006. The unit of analysis was defined by municipality, age and sex. The association between total number of recipients of long-term care per 1000 inhabitants (LTC-rate) and hospital days per 1000 inhabitants (HD-rate) was analysed in a linear regression model. Modifying and confounding effects of socioeconomic, demographic and geographic variables were included in the final model. We defined a difference in hospitalization rates of more than 1000 days per 1000 inhabitants as clinically important. Results Thirty-one percent of women and eighteen percent of men were long-term care users. Men had higher HD-rates than women. The crude association between LTC-rate and HD-rate was weakly negative. We identified two effect modifiers (age and sex) and two strong confounders (travel time to hospital and mortality). Age and sex stratification and adjustments for confounders revealed a positive statistically significant but not clinically important relationship between LTC-rates and hospitalization for women aged 67-79 years and all men. For women 80 years and over there was a weak but negative relationship which was neither statistically significant nor clinically important. Conclusions We found a weak positive adjusted association between LTC-rates and HD-rates. Opposite to common

  12. [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

  13. [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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. [The development of private hospital in modern Korea, 1885-1960].

    PubMed

    Sihn, Kyu Hwan; Seo, Hong Gwan

    2002-06-01

    Modern hospital in Korea was the space of competition and comprise among different forces such as the state power and social forces, imperialism and nationalism, and the traditional and modern medicine. Hospital in the Japanese colonialism was the object of control for establishing the colonial medical system. Japanese colonialism controlled not only the public hospital but also the private hospital which had to possess more than 10 infectious beds in the isolation building by the Controlling Regulation of Private Hospital. In fact, the private hospital had to possess more than 20 beds for hospital management. As a result, its regulation prevented the independent development of the private hospital. But because the public hospital could not accommodate many graduates of medical school, most of them had to serve as practitioner. Although some practitioners had more than 20 beds in their clinics, they were not officially included in the imperial medicine. By concentrating on the trend of the number of beds in the hospital, this paper differs from most previous studies of the system of hospital, which have argued that the system of hospital was converted the public-centered hospital system under the colonial medical system into the private-centered hospital system under the U. S. medical system after the Liberation in 1945. After Liberation, medical reformers discussed arranging the public and the private hospital. Lee Yong-seol, who was a Health-Welfare minister, disagreed the introduction of the system of state medicine. Worrying about the flooding of practitioners, he did not want to intervene the construction of hospital by state power. Because the private hospital run short of the medical leadership and the fundamental basis, the state still controlled the main disease in the public health and the prevention of epidemics. This means the state also played important part in the general medical examination and treatment. The outbreak of Korean War in 1950 reinforced

  2. Improving Hospital Discharge Time

    PubMed Central

    El-Eid, Ghada R.; Kaddoum, Roland; Tamim, Hani; Hitti, Eveline A.

    2015-01-01

    Abstract Delays in discharging patients can impact hospital and emergency department (ED) throughput. The discharge process is complex and involves setting specific challenges that limit generalizability of solutions. The aim of this study was to assess the effectiveness of using Six Sigma methods to improve the patient discharge process. This is a quantitative pre and post-intervention study. Three hundred and eighty-six bed tertiary care hospital. A series of Six Sigma driven interventions over a 10-month period. The primary outcome was discharge time (time from discharge order to patient leaving the room). Secondary outcome measures included percent of patients whose discharge order was written before noon, percent of patients leaving the room by noon, hospital length of stay (LOS), and LOS of admitted ED patients. Discharge time decreased by 22.7% from 2.2 hours during the preintervention period to 1.7 hours post-intervention (P < 0.001). A greater proportion of patients left their room before noon in the postintervention period (P < 0.001), though there was no statistical difference in before noon discharge. Hospital LOS dropped from 3.4 to 3.1 days postintervention (P < 0.001). ED mean LOS of patients admitted to the hospital was significantly lower in the postintervention period (6.9 ± 7.8 vs 5.9 ± 7.7 hours; P < 0.001). Six Sigma methodology can be an effective change management tool to improve discharge time. The focus of institutions aspiring to tackle delays in the discharge process should be on adopting the core principles of Six Sigma rather than specific interventions that may be institution-specific. PMID:25816029

  3. 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

  4. 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.

  5. Simple, Internally Adjustable Valve

    NASA Technical Reports Server (NTRS)

    Burley, Richard K.

    1990-01-01

    Valve containing simple in-line, adjustable, flow-control orifice made from ordinary plumbing fitting and two allen setscrews. Construction of valve requires only simple drilling, tapping, and grinding. Orifice installed in existing fitting, avoiding changes in rest of plumbing.

  6. 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.

  7. 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…

  8. 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.

  9. 42 CFR 419.43 - Adjustments to national program payment and beneficiary copayment amounts.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... index factor. CMS uses the hospital inpatient prospective payment system wage index established in... cost-to-charge ratio for the hospital or CMHC (as determined by CMS), rather than for specific departments within the hospital. (5) Cost-to-charge ratios for calculating charges adjusted to cost....

  10. 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.

  11. 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.

  12. 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

  13. 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

  14. 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.

  15. 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.

  16. Physician-owned Surgical Hospitals Outperform Other Hospitals in the Medicare Value-based Purchasing Program

    PubMed Central

    Ramirez, Adriana G; Tracci, Margaret C; Stukenborg, George J; Turrentine, Florence E; Kozower, Benjamin D; Jones, R Scott

    2016-01-01

    Background The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals while creating financial incentives for quality improvement and fostering increased transparency. Limited information is available comparing hospital performance across healthcare business models. Study Design 2015 hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Results Of 3089 hospitals with Total Performance Scores (TPS), categories of representative healthcare business models included 104 Physician-owned Surgical Hospitals (POSH), 111 University HealthSystem Consortium (UHC), 14 US News & World Report Honor Roll (USNWR) Hospitals, 33 Kaiser Permanente, and 124 Pioneer Accountable Care Organization affiliated hospitals. Estimated mean TPS for POSH (64.4, 95% CI 61.83, 66.38) and Kaiser (60.79, 95% CI 56.56, 65.03) were significantly higher compared to all remaining hospitals while UHC members (36.8, 95% CI 34.51, 39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included POSH (mean 2.32, p<0.0001), USNWR honorees (mean 2.24, p 0.0140) and UHC members (mean =1.99, p<0.0001) while Kaiser Permanente hospitals had lower case mix value (mean =1.54, p<0.0001). Re-estimation of TPS did not change the original results after adjustment for differences in hospital case mix index. Conclusions The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals may guide value improvement and policy-making decisions for all Medicare Value-Based Purchasing Program Hospitals. PMID:27502368

  17. 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…

  18. 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

  19. 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.

  20. 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

  1. In-hospital Cardiac Arrest at Cork University Hospital.

    PubMed

    O'Sullivan, E; Deasy, C

    2016-01-01

    We describe the incidence and outcomes of in-hospital cardiac arrest (IHCA) at Cork University Hospital over a one year time period (2011), prior to the implementation of national early warning scoring (NEWS) systems. There were 43 217 coded CUH admissions, in 2011, to 518 in-patient beds. The Hospital In-Patient Enquiry Database was used to identify adults (>/= 18 years) who sustained IHCA. Available Utstein variables were collected. Fifty-two patients were found to be incorrectly coded IHCA. 17 of 63 (27.0%) IHCA survived to discharge. IHCA with shockable rhythm had significantly higher survival. IHCA survival was significantly lower on wards versus any other hospital location. Median days of stay prior to arrest were significantly different between survivors and non-survivors. All survivors (n = 17) had intact neurological outcome post-event. Our outcomes from IHCA are poorest on hospital wards when compared to other areas of the hospital. Those that survive have excellent function and one-year survival.

  2. 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

  3. 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.

  4. Adjustable vane windmills

    SciTech Connect

    Ducker, W.L.

    1982-09-14

    A system of rotatably and pivotally mounted radially extended bent supports for radially extending windmill rotor vanes in combination with axially movable radially extended control struts connected to the vanes with semi-automatic and automatic torque and other sensing and servo units provide automatic adjustment of the windmill vanes relative to their axes of rotation to produce mechanical output at constant torque or at constant speed or electrical quantities dependent thereon.

  5. Adjustable vane windmills

    SciTech Connect

    Ducker, W.L.

    1980-01-15

    A system of rotatably and pivotally mounted radially extended bent supports for radially extending windmill rotor vanes in combination with axially movable radially extended control struts connected to the vanes with semi-automatic and automatic torque and other sensing and servo units provide automatic adjustment of the windmill vanes relative to their axes of rotation to produce mechanical output at constant torque or at constant speed or electrical quantities dependent thereon.

  6. Adjustable vane windmills

    SciTech Connect

    Ducker, W.L.

    1982-09-07

    A system of rotatably and pivotally mounted radially extended bent supports for radially extending windmill rotor vanes in combination with axially movable radially extended control struts connected to the vanes with semi-automatic and automatic torque and other sensing and servo units provide automatic adjustment of the windmill vanes relative to their axes of rotation to produce mechanical output at constant torque or at constant speed or electrical quantities dependent thereon.

  7. 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.

  8. Business case for Magnet® in a small hospital.

    PubMed

    Higdon, Karen; Clickner, Deborah; Gray, Frances; Woody, Gina; Shirey, Maria

    2013-02-01

    There is minimal evidence related to Magnet® designation and the benefits in small hospitals. A business strategy for small hospitals (<100 beds) to achieve Magnet designation is presented, including a cost-benefit analysis, outcome measures, and financial impact data.

  9. Hospital study reveals strategies for improving media relations.

    PubMed

    Fitzgerald, P E; Embrey-Wahl, L

    1987-01-01

    A nationwide study revealed that hospital administrators feel inadequate when dealing with the media, and also think the media does not understand the hospital business. Many strategies are available to counter these problems, including some that emphasize issues related to bed size. PMID:3583722

  10. [What should general hospital psychiatry do in a community?].

    PubMed

    Takehisa, Takahashi

    2003-01-01

    Some experiences in Nagano Red Cross hospital and Nagano Prefecture are presented, and the role of general hospital psychiatry (GHP) in a community is discussed. Psychiatric services in Nagano prefecture with population 2.21 million consist of four blocks. Our unit is in north block, providing treatment for acute phase and, in 2000, 1504 cases were new outpatients, daily outpatients were 198 cases and new inpatients were 604 cases including 146 emergency inpatients. In fiscal 2001, 25.6% of notifications of involuntary hospitalization from all psychiatric hospitals were submitted from GHP occupying 12.9% psychiatric beds, and 129 notifications from our unit were largest in Nagano prefecture. Total 7 GHPs with beds are presented by some data, suggesting two types as GHP. One type has relatively many new inpatients by small beds with short-term hospitalization like our GHP, and another type has relatively small new inpatients by large beds with long-term hospitalization like conventional mental hospital. It is necessary for GHP to pursue the former type, and to functionally differentiate from psychiatric hospital. Results of psychiatric emergency system in Nagano prefecture are presented. Designated hospitals are our GHP with 60 beds in north block, Prefectural Hospital with 310 beds in south block, National Sanatorium with 280 beds in east block and rotating 5 psychiatric hospitals with total 968 beds in west block. GHP with 60 beds hospitalized more emergency new cases than other psychiatric hospitals with large beds and discharged 84% of emergency inpatients to their home. Recently, short-term hospitalization of general hospital beds has rapidly progressed, and shared goal settings are needed, and treatment plans with teamwork by various types of experts have started from community-based home care. This teamwork will be expected throughout community psychiatric services. Although until today GHP's ward unit is financially disadvantageous, patients anticipate

  11. Bed-exit alarms. A component (but only a component) of fall prevention.

    PubMed

    2004-05-01

    Patient falls are a common cause of morbidity, nonfatal injuries, and trauma-related hospitalizations in the United States. Sometimes, they're even fatal. Falls typically occur either while the patient is getting into or out of bed or shortly after the patient has exited the bed. One means of helping to reduce the number of patient falls is the bed-exit alarm. Such alarms can be either built-in devices incorporated into the beds themselves or stand-alone units consisting of a portable control unit and a pressure- or position-sensitive sensor. They can serve as an "early warning system" alerting nursing staff when patients attempt to leave their beds unassisted. However, bed-exit alarms do not themselves prevent falls--a fact that is not always clearly understood. To be effective, they need to be implemented with care and with a clear understanding of their limitations. In this article, we describe the types of stand-alone bed-exit alarms currently available on the market and provide guidance to facilities on how to implement them effectively. We also review the elements of an effective fall-prevention program and recount one hospital's success in reducing patient falls. We are in the process of conducting a comparative evaluation of a number of bed-exit alarms, which will be published in an upcoming issue of Health Devices.

  12. Orthopaedic management in a mega mass casualty situation. The Israel Defence Forces Field Hospital in Haiti following the January 2010 earthquake.

    PubMed

    Bar-On, Elhanan; Lebel, Ehud; Kreiss, Yitshak; Merin, Ofer; Benedict, Shaike; Gill, Amit; Lee, Evgeny; Pirotsky, Anatoly; Shirov, Taras; Blumberg, Nehemia

    2011-10-01

    Following the January 2010 earthquake in Haiti, the Israel Defence Forces (IDF) established a field hospital in Port au Prince. The hospital started operating 89 h after the earthquake. We describe the experience of the orthopaedic department in a field hospital operating in an extreme mass casualty situation. The hospital contained 4 operating table and 72 hospitalization beds. The orthopaedic department included 8 orthopaedic surgeons and 3 residents. 1111 patients were treated in the hospital, 1041 of them had adequate records for inclusion. 684 patients were admitted due to trauma with a total of 841 injuries. 320 patients sustained 360 fractures, 18 had joint dislocations and 22 patients were admitted after amputations. 207 patients suffered 315 soft tissue injuries. 221 patients were operated on under general or regional anaesthesia. External fixation was used for stabilization of 48 adult femoral shaft fractures, 24 open tibial fractures and 1 open humeral fracture. All none femoral closed fractures were treated non-operatively. 18 joint reductions and 23 amputations were performed. Appropriate planning, training, operational versatility, and adjustment of therapeutic guidelines according to a constantly changing situation, enabled us to deliver optimal care to the maximal number of patients, in an overwhelming mass trauma situation.

  13. Hospital marketing.

    PubMed

    Carter, Tony

    2003-01-01

    This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation.

  14. 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

  15. Hospital marketing.

    PubMed

    Carter, Tony

    2003-01-01

    This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation. PMID:14753323

  16. Pulling a patient up in bed

    MedlinePlus

    Moving a patient in bed ... You must move or pull someone up in bed the right way to avoid injuring the patient's ... people to safely move a patient up in bed. Friction from rubbing can scrape or tear the ...

  17. [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

  18. Particle pressures in fluidized beds

    SciTech Connect

    Campbell, C.S.; Rahman, K.; Hu, X.; Jin, C.; Potapov, A.V.

    1992-01-01

    This is an experimental project to make detailed measurements of the particle pressures generated in fluidized beds. The focus lies in two principle areas: (1) the particle pressure distribution around single bubbles rising in a two-dimensional gas-fluidized bed and (2) the particle pressures measured in liquid-fluidized beds. This first year has largely been to constructing the experiments The design of the particle pressure probe has been improved and tested. A two-dimensional gas-fluidized bed has been constructed in order to measure the particle pressure generated around injected bubbles. The probe is also being adapted to work in a liquid fluidized bed. Finally, a two-dimensional liquid fluidized bed is also under construction. Preliminary measurements show that the majority of the particle pressures are generated in the wake of a bubble. However, the particle pressures generated in the liquid bed appear to be extremely small. Finally, while not directly associated with the particle pressure studies, some NERSC supercomputer time was granted alongside this project. This is being used to make large scale computer simulation of the flow of granular materials in hoppers.

  19. Cost analysis for efficient management: diabetes treatment at a public district hospital in Thailand.

    PubMed

    Riewpaiboon, Arthorn; Chatterjee, Susmita; Piyauthakit, Piyanuch

    2011-10-01

    OBJECTIVE  The study estimated cost of illness from the provider's perspective for diabetic patients who received treatment during the fiscal year 2008 at Waritchaphum Hospital, a 30-bed public district hospital in Sakhon Nakhon province in northeastern Thailand. METHODS  This retrospective, prevalence-based cost-of-illness study looked at 475 randomly selected diabetic patients, identified by the World Health Organization's International Classification of Diseases, 10th revision, codes E10-E14. Data were collected from the hospital financial records and medical records of each participant and were analysed with a stepwise multiple regression. KEY FINDINGS  The study found that the average public treatment cost per patient per year was US$94.71 at 2008 prices. Drug cost was the highest cost component (25% of total cost), followed by inpatient cost (24%) and outpatient visit cost (17%). A cost forecasting model showed that length of stay, hospitalization, visits to the provincial hospital, duration of disease and presence of diabetic complications (e.g. diabetic foot complications and nephropathy) were the significant predictor variables (adjusted R(2) = 0.689). CONCLUSIONS  According to the fitted model, avoiding nephropathy and foot complications would save US$19 386 and US$39 134 respectively per year. However, these savings are missed savings for the study year and the study hospital only and not projected savings, as that would depend on the number of diabetic patients managed in the year, the ratio of complicated to non-complicated cases and effectiveness of the prevention programmes. Nonetheless, given the high avoidable cost associated with complications of diabetes, healthcare providers in Thailand should focus on initiatives that delay the progression of complications in diabetic patients.

  20. 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

  1. 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

  2. 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.

  3. Securing staff salary adjustments and raises.

    PubMed

    Dilts, Tom

    2002-01-01

    Salary issues have plagued laboratories for as long as there has been a labor shortage, and the situation grows more complicated. At the Virginia Commonwealth University Health System (VCUHS) in Richmond, Virginia, competition for laboratory staff now comes not only from area hospitals and health-care companies but also from non-health-care industries. Shorter shifts, less stress, and better hourly wages offered by fast food chains and retail stores lure away the young workers traditionally hired for entry-level laboratory positions. Clearly, a salary adjustment is necessary. PMID:12506845

  4. 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.

  5. 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

  6. 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

  7. Employing post-DEA cross-evaluation and cluster analysis in a sample of Greek NHS hospitals.

    PubMed

    Flokou, Angeliki; Kontodimopoulos, Nick; Niakas, Dimitris

    2011-10-01

    To increase Data Envelopment Analysis (DEA) discrimination of efficient Decision Making Units (DMUs), by complementing "self-evaluated" efficiencies with "peer-evaluated" cross-efficiencies and, based on these results, to classify the DMUs using cluster analysis. Healthcare, which is deprived of such studies, was chosen as the study area. The sample consisted of 27 small- to medium-sized (70-500 beds) NHS general hospitals distributed throughout Greece, in areas where they are the sole NHS representatives. DEA was performed on 2005 data collected from the Ministry of Health and the General Secretariat of the National Statistical Service. Three inputs -hospital beds, physicians and other health professionals- and three outputs -case-mix adjusted hospitalized cases, surgeries and outpatient visits- were included in input-oriented, constant-returns-to-scale (CRS) and variable-returns-to-scale (VRS) models. In a second stage (post-DEA), aggressive and benevolent cross-efficiency formulations and clustering were employed, to validate (or not) the initial DEA scores. The "maverick index" was used to sort the peer-appraised hospitals. All analyses were performed using custom-made software. Ten benchmark hospitals were identified by DEA, but using the aggressive and benevolent formulations showed that two and four of them respectively were at the lower end of the maverick index list. On the other hand, only one 100% efficient (self-appraised) hospital was at the higher end of the list, using either formulation. Cluster analysis produced a hierarchical "tree" structure which dichotomized the hospitals in accordance to the cross-evaluation results, and provided insight on the two-dimensional path to improving efficiency. This is, to our awareness, the first study in the healthcare domain to employ both of these post-DEA techniques (cross efficiency and clustering) at the hospital (i.e. micro) level. The potential benefit for decision-makers is the capability to examine high

  8. 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

  9. A technological evaluation of the Microsoft Kinect for automated behavioural mapping at bed rest.

    PubMed

    Gibson, Simon; McBride, Simon J; McClelland, Coen; Watson, Marcus

    2013-01-01

    Behavioural mapping (BM) is a long established method of structured observational study used to understand where patients are and what they are doing within a hospital setting. BM is prominent in stroke rehabilitation research, where that research indicates patients spend most of their time at bed rest. We evaluate the technical feasibility of using the Microsoft Kinect to automate patient physical activity classification at bed rest.

  10. 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.

  11. Bed Bugs: The Australian Response.

    PubMed

    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.

  12. 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 ...

  13. 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

  14. Fluid bed oligomerization of olefins

    SciTech Connect

    Harandi, M.N.; Owens, H.

    1991-08-27

    This patent describes a continuous process for upgrading lower olefins to increase gasoline yield and ease of LPG recovery. It comprises separating a C{sub 2}-C{sub 4} cracked olefinic gas into a primary overhead stream containing C{sub 2} hydrocarbons having at least about 10% ethene and a secondary stream comprising a major amount of C{sub 3}-c{sub 4} olefinic hydrocarbons; adding the primary stream containing C{sub 2} hydrocarbons to a primary fluidized reaction zone comprising solid crystalline zeolite catalyst particles in a reactor bed operating under high severity conditions; adding the secondary stream comprising C{sub 3}-C{sub 4} olefinic hydrocarbons to a secondary fluidized bed reaction zone comprising solid crystalline zeolite catalyst particles in a reactor bed operating under turbulent regime low severity conditions; and withdrawing a portion of partially deactivated catalyst particles from the primary high severity fluidized bed reaction zone.

  15. Operating characteristics of rotating beds

    SciTech Connect

    Keyvani, M.; Gardner, N.C.

    1988-01-01

    Vapor-liquid contacting in high gravitational fields offers prospects for significant reductions in the physical size, capital, and operating costs of packed towers. Pressure drops, power requirements, mass transfer coefficients and liquid residence time distributions are reported for a rotating bed separator. The beds studied were rigid, foamed aluminum, with specific surface areas ranging from 650 to 3000 m{sup 2}/m{sup 2}. Gravitational fields were varied from 50 to 300g.

  16. Northern European Satellite Test Bed

    NASA Astrophysics Data System (ADS)

    Schuster-Bruce, Alan; Lawson, James; Quinlan, Michael; McGregor, Andrew

    Satellite Based Augmentation Systems are being developed in Europe (EGNOS), the USA (WAAS), and in Japan (MSAS). As part of their support to EGNOS, NATS and Racal have developed and deployed a prototype SBAS system called the Northern European Satellite Test Bed (NEST Bed). NEST Bed uses GPS L1/L2 reference stations at: Aberdeen, Rotterdam, Ankara, Cadiz, Keflavik, and Bronnoysund. Data is sent to the Master Control Centre at NATS Gatwick Services Management Centre for processing. The resulting 250 bits-per-second message is sent to Goonhilly for up-linking by BT to the Navigation Payload of either the Inmarsat AOR-E or F5 spare satellite. NEST Bed was deployed and commissioned during summer 1998, and flight tests were successfully demonstrated at the September 1998 Farnborough Air Show where approaches were flown to Boscombe Down on the DERA BAC1-11 aircraft. In October 1998, a NATS/FAA flight trial was held in Iceland involving NEST Bed and the FAA NSTB. NEST Bed is also being used for SARPS validation.

  17. 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.

  18. 14 CFR 1260.172 - Subsequent adjustments and continuing responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Subsequent adjustments and continuing responsibilities. 1260.172 Section 1260.172 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION... Agreements With Institutions of Higher Education, Hospitals, and Other Non-Profit Organizations...

  19. 14 CFR 1260.172 - Subsequent adjustments and continuing responsibilities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Subsequent adjustments and continuing responsibilities. 1260.172 Section 1260.172 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION... Agreements With Institutions of Higher Education, Hospitals, and Other Non-Profit Organizations...

  20. 14 CFR 1260.172 - Subsequent adjustments and continuing responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Subsequent adjustments and continuing responsibilities. 1260.172 Section 1260.172 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION... Agreements With Institutions of Higher Education, Hospitals, and Other Non-Profit Organizations...

  1. 14 CFR 1260.172 - Subsequent adjustments and continuing responsibilities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Subsequent adjustments and continuing responsibilities. 1260.172 Section 1260.172 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION... Agreements With Institutions of Higher Education, Hospitals, and Other Non-Profit Organizations...

  2. 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... Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for...

  3. 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...

  4. 42 CFR 412.320 - Disproportionate share adjustment factor.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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...

  5. 42 CFR 412.316 - Geographic adjustment factors.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Geographic adjustment factors. 412.316 Section 412.316 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for...

  6. 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...

  7. 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...

  8. 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... Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for...

  9. 42 CFR 412.320 - Disproportionate share adjustment factor.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 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...

  10. 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... Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for...

  11. 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... Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for...

  12. 42 CFR 412.320 - Disproportionate share adjustment factor.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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...

  13. 42 CFR 412.320 - Disproportionate share adjustment factor.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 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...

  14. Adolescent Mothers' Adjustment to Parenting.

    ERIC Educational Resources Information Center

    Samuels, Valerie Jarvis; And Others

    1994-01-01

    Examined adolescent mothers' adjustment to parenting, self-esteem, social support, and perceptions of baby. Subjects (n=52) responded to questionnaires at two time periods approximately six months apart. Mothers with higher self-esteem at Time 1 had better adjustment at Time 2. Adjustment was predicted by Time 2 variables; contact with baby's…

  15. 42 CFR 412.108 - Special treatment: Medicare-dependent, small rural hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... under § 412.92. (iii) At least 60 percent of the hospital's inpatient days or discharges were... this section, only days and discharges from acute care inpatient hospital stays are counted (including days and discharges from swing beds when used for acute care inpatient hospital services), but...

  16. 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.

  17. 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

  18. Organochlorine pesticide residues in bed sediments of the San Joaquin River, California

    USGS Publications Warehouse

    Gilliom, Robert J.; Clifton, Daphne G.

    1990-01-01

    Bed sediments of the San Joaquin River and its tributaries were sampled during October 7–11, 1985, and analyzed for organochiorine pesticide residues in order to determine their areal distribution and to evaluate and prioritize needs for further study. Residues of DDD, DDE, DDT, and dieldrin are widespread in the fine-grained bed sediments of the San Joaquin River and its tributaries despite little or no use of these pesticides for more than 15 years. The San Joaquin River has among the highest bed-sediment concentrations of DDD, DDE, DDT, and dieldrin residues of major rivers in the United States. Concentrations of all four pesticides were correlated with each other and with the amount of organic carbon and fine-grained particles in the bed sediments. The highest concentrations occurred in bed sediments of westside tributary streams. Potential tributary loads of DDD, DDE, DDT, and dieldrin to the San Joaquin River were computed from bed-sediment concentrations and data on streamfiow and suspended-sediment concentration in order to identify the general magnitude of differences between streams and to determine study priorities. The estimated loads indicate that the most important sources of residues during the study period were Salt Slough because of a high load of fine sediment, and Newman Wasteway, Orestimba Creek, and Hospital Creek because of high bed-sediment concentrations. Generally, the highest estimated loads of DDD, DDE, DDT, and dieldrin were in Orestimba and Hospital Creeks.

  19. 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.…

  20. 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…

  1. 49 CFR 236.336 - Locking bed.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Locking bed. 236.336 Section 236.336 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Instructions § 236.336 Locking bed. The various parts of the locking bed, locking bed supports, and tappet...

  2. 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....6070 Bed board. (a) Identification. A bed board is a device intended for medical purposes that consists of a stiff board used to increase the firmness of a bed. (b) Classification. Class I...

  3. 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.

  4. 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.

  5. 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

  6. 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

  7. Improving Emergency Department flow through optimized bed utilization

    PubMed Central

    Chartier, Lucas Brien; Simoes, Licinia; Kuipers, Meredith; McGovern, Barb

    2016-01-01

    Over the last decade, patient volumes in the emergency department (ED) have grown disproportionately compared to the increase in staffing and resources at the Toronto Western Hospital, an academic tertiary care centre in Toronto, Canada. The resultant congestion has spilled over to the ED waiting room, where medically undifferentiated and potentially unstable patients must wait until a bed becomes available. The aim of this quality improvement project was to decrease the 90th percentile of wait time between triage and bed assignment (time-to-bed) by half, from 120 to 60 minutes, for our highest acuity patients. We engaged key stakeholders to identify barriers and potential strategies to achieve optimal flow of patients into the ED. We first identified multiple flow-interrupting challenges, including operational bottlenecks and cultural issues. We then generated change ideas to address two main underlying causes of ED congestion: unnecessary patient utilization of ED beds and communication breakdown causing bed turnaround delays. We subsequently performed seven tests of change through sequential plan-do-study-act (PDSA) cycles. The most significant gains were made by improving communication strategies: small gains were achieved through the optimization of in-house digital information management systems, while significant improvements were achieved through the implementation of a low-tech direct contact mechanism (a two-way radio or walkie-talkie). In the post-intervention phase, time-to-bed for the 90th percentile of high-acuity patients decreased from 120 minutes to 66 minutes, with special cause variation showing a significant shift in the weekly measurements. PMID:27752312

  8. 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.

  9. 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.

  10. Benchmarking hospital laboratory financial and operational performance.

    PubMed

    Portugal, B

    1993-12-01

    The movement toward more integrated delivery systems requires hospital administrators, medical staffs, and health care network organizations to consider strategies that will meet the future challenges facing laboratory services. Many health care experts predict that the number of hospital inpatient days, staffed acute care beds, and length of stay will continue their precipitous decline, and then stabilize during the next four to five years. Hospitals should carefully evaluate how their laboratories might be affected as a result of the decline in inpatient services and the integration of health care services at all levels. Hospital executive management must find a way to manage staffing levels and technical resources in order to maintain quality patient services in the face of declining test volume. This Special Report discusses relevant benchmarks intended to help hospital administrators and laboratory directors identify "best practices" in hospital laboratories so that comparisons of patterns of care and financial operations can be made. Benchmarking the relative financial and operational performance of hospital laboratories allows health care planners to design the most appropriate laboratory services delivery system for future hospital inpatient and outpatient market demands. Factors influencing financial and operation performance will be investigated, including utilization, testing costs, staffing mix, productivity, and organizational structure. This will be followed by a discussion on the future of laboratories and the trend toward regional laboratories owned by hospital consortiums.

  11. 77 FR 45061 - Hospital Outpatient Prospective and Ambulatory Surgical Center Payment Systems and Quality...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-30

    ... Quality data code QIO Quality Improvement Organization RAC Recovery Audit Contractor RFA Regulatory... budget neutrality adjustments. Classifying hospitals by teaching status or type of ownership...

  12. Deep Space Test Bed

    NASA Technical Reports Server (NTRS)

    Milton, Martha E.; Christl, Mark

    2004-01-01

    , the DSTB facility can adjust for different investigation priorities on successive flights. This flexibility in the DSTB will be applied at several levels; in the distribution of the shared resources for each flight; addressing the payload configuration on a system level for each flight; and utilizing a selection process for investigations that considers yearly flight opportunities as well as the possibility for repeated flights. This approach for operating the DSTB facility will allow it to handle a wide range of investigations.

  13. 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.

  14. Hospital Payroll Costs, Productivity, and Employment Under Prospective Reimbursement

    PubMed Central

    Kidder, David; Sullivan, Daniel

    1982-01-01

    This paper reports preliminary findings from the National Hospital Rate-Setting Study regarding the effects of State prospective reimbursement (PR) programs on measures of payroll costs and employment in hospitals. PR effects were estimated through reduced-form equations, using American Hospital Association Annual Survey data on over 2,700 hospitals from 1969 through 1978. These tests suggest that hospitals responded to PR by lowering payroll expenditures. PR also seems to have been associated with reductions in full-time equivalent staff per adjusted inpatient day. However, tests did not confirm the hypothesis that hospitals reduce payroll per full-time equivalent staff as a result of PR. PMID:10309913

  15. CEO compensation and hospital financial performance.

    PubMed

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

    2009-12-01

    Growing interest in pay-for-performance and the level of chief executive officers' (CEOs') pay raises questions about the link between performance and compensation in the health sector. This study compares the compensation of nonprofit hospital 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 article, 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

  16. 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

  17. Consider nonfouling fluidized bed exchangers

    SciTech Connect

    Klaren, D.G.; Baiiie, R.E. )

    1989-07-01

    Applications for fluidized bed heat exchangers in various industries, their operating principles and a detailed analysis of their suitability for replacing double-pipe scraped-surface heat exchangers in lube oil plants are discussed. Development of the fluidized bed heat exchanger started in the early 70s and was totally dedicated to improvement of the multistage flash evaporator for sea water desalination. This resulted in a demonstration plant with a fluidized bed heat exchanger with a total heat transfer surface of over 1,000 m/sup 2/. Over an operating period of more than 15,000 hours untreated sea water was heated to more than 120{sup 0}C without any fouling in the tubes due to scale deposits.

  18. 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

  19. 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.

  20. 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

  1. 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

  2. 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

  3. 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.

  4. Bed material agglomeration during fluidized bed combustion. Final report

    SciTech Connect

    Brown, R.C.; Dawson, M.R.; Smeenk, J.L.

    1996-01-01

    The purpose of this project is to determine the physical and chemical reactions which lead to the undesired agglomeration of bed material during fluidized bed combustion of coal and to relate these reactions to specific causes. A survey of agglomeration and deposit formation in industrial fluidized bed combustors (FBCs) indicate that at least five boilers were experiencing some form of bed material agglomeration. Deposit formation was reported at nine sites with deposits most commonly at coal feed locations and in cyclones. Other deposit locations included side walls and return loops. Three general types of mineralogic reactions were observed to occur in the agglomerates and deposits. Although alkalies may play a role with some {open_quotes}high alkali{close_quotes} lignites, we found agglomeration was initiated due to fluxing reactions between iron (II) from pyrites and aluminosilicates from clays. This is indicated by the high amounts of iron, silica, and alumina in the agglomerates and the mineralogy of the agglomerates. Agglomeration likely originated in the dense phase of the FBC bed within the volatile plume which forms when coal is introduced to the boiler. Secondary mineral reactions appear to occur after the agglomerates have formed and tend to strengthen the agglomerates. When calcium is present in high amounts, most of the minerals in the resulting deposits are in the melilite group (gehlenite, melilite, and akermanite) and pyroxene group (diopside and augite). During these solid-phase reactions, the temperature of formation of the melilite minerals can be lowered by a reduction of the partial pressure of CO{sub 2} (Diopside + Calcite {r_arrow}Akermanite).

  5. 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)

  6. 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

  7. 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.

  8. Fall prevention in hospitals: an integrative review.

    PubMed

    Spoelstra, Sandra L; Given, Barbara A; Given, Charles W

    2012-02-01

    This article summarizes research and draws overall conclusions from the body of literature on fall prevention interventions to provide nurse administrators with a basis for developing evidence-based fall prevention programs in the hospital setting. Data are obtained from published studies. Thirteen articles are retrieved that focused on fall interventions in the hospital setting. An analysis is performed based on levels of evidence using an integrative review process. Multifactoral fall prevention intervention programs that included fall-risk assessments, door/bed/patient fall-risk alerts, environmental and equipment modifications, staff and patient safety education, medication management targeted to specific types, and additional assistance with transfer and toileting demonstrate reduction in both falls and fall injuries in hospitalized patients. Hospitals need to reduce falls by using multifactoral fall prevention programs using evidence-based interventions to reduce falls and injuries.

  9. Discharging patients from acute care hospitals.

    PubMed

    Goodman, Helen

    2016-02-10

    Planning for patient discharge is an essential element of any admission to an acute setting, but may often be left until the patient is almost ready to leave hospital. This article emphasises why discharge planning is important and lists the essential principles that should be addressed to ensure that patients leave at an optimum time, feeling confident and safe to do so. Early assessment, early planning and co-ordination of all the teams involved in the patient's care are essential. Effective communication between the various teams and with the patient and their family or carer(s) is necessary. Patients should leave hospital with all the information, medications and equipment they require. Appropriate plans should have been developed and communicated to the receiving community or non-acute team. When patient discharge is effective, complications as a result of extended lengths of hospital stay are prevented, hospital beds are used efficiently and readmissions are reduced.

  10. 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

  11. Green 'heart' for new community hospital.

    PubMed

    Baillie, Jonathan

    2013-06-01

    Replacing a healthcare facility first opened in 1908 as a 20-bed cottage hospital, the recently opened 'new' Finchley Memorial Hospital in north-west London was designed by architects, Murphy Philipps, 'to be at the heart of a health campus', surrounded by green space for use by both the hospital itself, and the local community. The 28 million pounds hospital, which has achieved a BREAAM Excellent rating - with an annual energy target of just 35 GJ/100 m3 set by SHINE, the Department of Health-backed learning network for sustainable healthcare buildings - has also featured as one of only 20 projects in the RIBA Health Buildings Exhibition. HEJ editor, Jonathan Baillie, met with lead architect, Marc Levinson, to find out more about the key elements, and the thinking, that went into the design.

  12. 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

  13. 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.

  14. 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.

  15. Berlin Emissivity Database (BED) Archive

    NASA Astrophysics Data System (ADS)

    D'Amore, M.; Helbert, J.; Maturilli, A.

    2009-03-01

    The Berlin Emissivity Database ranges from 3 to 50 µm. BED comprises several grain-sized mineral, up to high temperature, and has a modular structure, to collect in the future Raman measurement, samples pictures, thin section images and so on.

  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. 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...

  18. Contribution of general practitioner hospitals in Scotland.

    PubMed

    Grant, J A

    1984-05-01

    The results of a survey of 64 Scottish general practitioner hospitals showed that in 1980 these hospitals contained 3.3% of available staffed beds in Scotland; 13.6% of the resident population had access for initial hospital care, and 14.5% of Scottish general practitioners were on their staffs. During the year of the survey they discharged 1.8% of all non-surgical patients, treated almost 100 000 patients for accidents and emergencies and 140 000 outpatients, and 4.4% of all deliveries in Scotland were carried out in the hospitals surveyed. Most communities which are served by general practitioner hospitals in Scotland are rural and on average are more than 30 miles from their nearest district general hospital. The contribution that these small hospitals make to the overall hospital workload has not previously been estimated. It has been shown nationally to be small but not inconsiderable . In terms of the contribution to the health care of the communities they serve it cannot and should not be underestimated.

  19. [Incorporation of the hospital into modern technology].

    PubMed

    Foucault, M

    1978-01-01

    This address traces the emergence of the hospital in the 18th century as a facility for combating disease and tending to the sick. Reference is made to the reports of Tenon and Howard on hospitals in several European countries, which instead of considering the hospital as a mere architectural object make recommendations based on the numbers of beds of an institution, its usable space, the dimensions of wards, mortaility rates, etc.; the result is a new functional concept of the medical and physical organization of the hospital. The author delves into the characteristics of the hospital and medical practice in the Middle Ages, the 17th and 18th centuries, and since the middle of the 18th. He brings out the direct relationship of hospital organization to the economic regulations that emerged with mercantilism. He stresses the importance of man for social and military development on the one hand, and, on the other hand, to the application of a technology that could be described as political: the discipline. He is of the view that the introduction of disciplinary mechanisms in the confused environment of the hospital permitted its "medicalization" and the development of the medical-therapeutic hospital.

  20. [The epidemic hospitals in Poland ordered or inspected by Chief extraordinary Epidemic Commissariat to fight against the epidemics (1920-1924)].

    PubMed

    Wieckowska, E

    1999-01-01

    The anti-epidemic compaign in Poland was in the hands of Chief Epidemic Commissariat. The Commissariat was organized on July of 1920y. as a special institution to fight against the acute infectious diseases. In the end of 1920y. it had 188 hospitals with 9,245 beds, with a reserve of 1,185 beds in the Red Cross, military hospitals and so on, it had a total of 12,915 beds. The tables of number 1 and 2 presented the number of the hospitals in Polish department, number of the beds, number of the patients and number of the hospital-days, number of the cases of the typhus, typhoid fever, relapsing fever, dysentery and the other diseases in the first half of 1920y. and in the second half of 1921y. As you see there were the most patients with the typhus. In 1922y. Epidemic Commissariat ordered of 116 hospitals with 10,785 beds. The table of the number 3 presented the number of the cases, deaths and the mortality of the typhus, relapsing fever, typhoid fever, dysentery, variola vera, cholera and the other diseases. In 1923y. Epidemic Commissariat had 112 hospitals with 11,000 beds. The table of number 4 confronted the number of the hospitals, number of the beds and its use in the hospitals ordered or inspected by Commissariat in 1922y. and in 1923y. there were 9 hospitals with 4,050 beds for the repatriates. In the half of 1923y. the repatriation was reduced and Epidemic Commissariat began to liquidate the part of the epidemic hospitals. The Commissariat had in the end of the year 4 hospitals in department of Kielce, 17 hospitals in the department of Bia3ystok, 19 hospitals in the department of Polesie, 11 hospitals in department of Nowogrodek, 14 hospitals in department of Wo3yn, 14 hospitals in department of Wino, 3 hospitals in department of Stanis3wow and 1 hospital with 100 beds in Tarnopol. Medical care of infectious diseases in the epidemic hospitals in 1919-1924 illustrated the table number 5. There were the numbers of the cases, deaths, hospitals, beds and

  1. 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...

  2. 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

  3. 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.

  4. 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…

  5. 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…

  6. 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

  7. 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

  8. Parental Divorce and Children's Adjustment.

    PubMed

    Lansford, Jennifer E

    2009-03-01

    This article reviews the research literature on links between parental divorce and children's short-term and long-term adjustment. First, I consider evidence regarding how divorce relates to children's externalizing behaviors, internalizing problems, academic achievement, and social relationships. Second, I examine timing of the divorce, demographic characteristics, children's adjustment prior to the divorce, and stigmatization as moderators of the links between divorce and children's adjustment. Third, I examine income, interparental conflict, parenting, and parents well-being as mediators of relations between divorce and children's adjustment. Fourth, I note the caveats and limitations of the research literature. Finally, I consider notable policies related to grounds for divorce, child support, and child custody in light of how they might affect children s adjustment to their parents divorce.

  9. 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

  10. 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...

  11. Adjustment versus no adjustment when using adjustable sutures in strabismus surgery

    PubMed Central

    Liebermann, Laura; Hatt, Sarah R.; Leske, David A.; Holmes, Jonathan M.

    2013-01-01

    Purpose To compare long-term postoperative outcomes when performing an adjustment to achieve a desired immediate postoperative alignment versus simply tying off at the desired immediate postoperative alignment when using adjustable sutures for strabismus surgery. Methods We retrospectively identified 89 consecutive patients who underwent a reoperation for horizontal strabismus using adjustable sutures and also had a 6-week and 1-year outcome examination. In each case, the intent of the surgeon was to tie off and only to adjust if the patient was not within the intended immediate postoperative range. Postoperative success was predefined based on angle of misalignment and diplopia at distance and near. Results Of the 89 patients, 53 (60%) were adjusted and 36 (40%) were tied off. Success rates were similar between patients who were simply tied off immediately after surgery and those who were adjusted. At 6 weeks, the success rate was 64% for the nonadjusted group versus 81% for the adjusted group (P = 0.09; difference of 17%; 95% CI, −2% to 36%). At 1 year, the success rate was 67% for the nonadjusted group versus 77% for the adjusted group (P = 0.3; difference of 11%; 95% CI, −8% to 30%). Conclusions Performing an adjustment to obtain a desired immediate postoperative alignment did not yield inferior long-term outcomes to those obtained by tying off to obtain that initial alignment. If patients were who were outside the desired immediate postoperative range had not been not adjusted, it is possible that their long-term outcomes would have been worse, therefore, overall, an adjustable approach may be superior to a nonadjustable approach. PMID:23415035

  12. Bacillus cereus in free-stall bedding.

    PubMed

    Magnusson, M; Svensson, B; Kolstrup, C; Christiansson, A

    2007-12-01

    To increase the understanding of how different factors affect the bacterial growth in deep sawdust beds for dairy cattle, the microbiological status of Bacillus cereus and coliforms in deep sawdust-bedded free stalls was investigated over two 14-d periods on one farm. High counts of B. cereus and coliforms were found in the entire beds. On average, 4.1 log(10) B. cereus spores, 5.5 log(10) B. cereus, and 6.7 log(10) coliforms per gram of bedding could be found in the upper layers of the sawdust likely to be in contact with the cows' udders. The highest counts of B. cereus spores, B. cereus, and coliforms were found in the bedding before fresh bedding was added, and the lowest immediately afterwards. Different factors of importance for the growth of B. cereus in the bedding material were explored in laboratory tests. These were found to be the type of bedding, pH, and the type and availability of nutrients. Alternative bedding material such as peat and mixtures of peat and sawdust inhibited the bacterial growth of B. cereus. The extent of growth of B. cereus in the sawdust was increased in a dose-dependent manner by the availability of feces. Urine added to different bedding material raised the pH and also led to bacterial growth of B. cereus in the peat. In sawdust, a dry matter content greater than 70% was needed to lower the water activity to 0.95, which is needed to inhibit the growth of B. cereus. In an attempt to reduce the bacterial growth of B. cereus and coliforms in deep sawdust beds on the farm, the effect of giving bedding daily or a full replacement of the beds was studied. The spore count of B. cereus in the back part of the free stalls before fresh bedding was added was 0.9 log units lower in stalls given daily bedding than in stalls given bedding twice weekly. No effect on coliform counts was found. Replacement of the entire sawdust bedding had an effect for a short period, but by 1 to 2 mo after replacement, the counts of B. cereus spores in the

  13. [The structural functional analysis of beds stock of curative preventive organizations of the state public health system of the Russian Federation].

    PubMed

    Schepin, V O

    2014-01-01

    The article presents the results of comprehensive scientific analysis of size and structure of beds stock of medical curative preventive organizations of state and municipal health care systems of the Russian Federation. The issues of beds support of population on national, federal okrugs and federation subjects' levels including differentiation on different medical specialties are considered. The main indicators of functioning of hospitals, per capita consumption of hospital medical care and territorial characteristics and differences of these indicators are analyzed In conditions of on-going decrease of size of beds stock and amount of medical care in hospitals and against the background of stability of main indicators of beds use the expressed but not always objectively conditioned differences continue to be present concerning both population support with beds stock and indicators of consumption of medical care in hospitals. All these occurrences undoubtedly impact accessibility of this type of medical care to population and its resource capacity for the government. In 2012, beds support of population decreased from 85.7 to 84.1 beds per 10 000 of population. The value of indicator in federal subjects differs up to 2.9 times. In the structure of beds stock are prevailing specialized beds or groups of beds on such medical specialties as psychiatry, surgery, obstetrics and gynecology and therapy. The per capita use of medical care in hospitals decreased up to 2.609 beds-per-day that is 6.2% lower than standard value from the program of state guarantees of free-of-charge medical care support of citizen. The end values of indicator in federal subjects differ in 2.7 times. In federal subjects indicators of mean number of work of bed per year differ up to 1.2 times, of mean duration of treatment--up to 1.6 times, turn-over of bed--up to 1.6 times, hospital lethality--up to 5.9 times. The results of study confirm necessity of structural functional optimization of

  14. Batch separation of shredded bulky waste by gas-solid fluidized bed at laboratory scale.

    PubMed

    Sekito, Tomoo; Tanaka, Nobutoshi; Matsuto, Toshihiko

    2006-01-01

    A gas-solid fluidized bed separator using various bed materials was used to separate shredded municipal bulky waste (SBW). Using 290 microm glass beads as the bed material, the apparent density of the fluidized bed was 1.5 g/cm(3) and the SBW could be separated into combustibles such as wood, paper and plastics and incombustibles such as metals and glass. The overall efficiency (Newton's efficiency) of the separation was calculated to be 0.93. In order to obtain high efficiency, the superficial velocity must be adjusted so that the fluidized bed is agitated moderately and at the same time there is no weak fluidized region. Using a mixture of particles of nylon shot and 68 microm glass beads, the apparent density of the fluidized mixture bed could be varied between 0.63 and 0.99 g/cm(3) by changing the mixing ratio of the two materials. In the case of a mixing ratio of 20% for glass beads, an apparent density of 0.65 g/cm(3) was produced, in which wood and paper components were recovered while plastics remained in the bed to give a final overall efficiency of 0.88.

  15. 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.

  16. Designs that make a difference: the Cardiac Universal Bed model.

    PubMed

    Johnson, Jackie; Brown, Katherine Kay; Neal, Kelly

    2003-01-01

    Information contained in this article includes some of the findings from a joint research project conducted by Corazon Consulting and Ohio State University Medical Center on national trends in Cardiac Universal Bed (CUB) utilization. This article outlines current findings and "best practice" standards related to the benefits of developing care delivery models to differentiate an organization with a competitive advantage in the highly dynamic marketplace of cardiovascular care. (OSUMC, a Corazon client, is incorporating the CUB into their Ross Heart Hospital slated to open this spring.)

  17. 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.

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  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. Dermatology Residents are Prescribing Tanning Bed Treatment.

    PubMed

    Anderson, Kathryn L; Huang, Karen E; Huang, William W; Feldman, Steven R

    2016-01-01

    Although 90% of dermatologists discourage the use of tanning beds, about half of psoriasis patients report using tanning beds and most of these note improvement. The purpose of this investigation was to determine if dermatology residents are advocating the tanning bed use to their patients. PMID:27617718

  5. 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.

  6. The cost of inefficiency in US hospitals, 1985-1997.

    PubMed

    Shah, Bimal R; Reed, Shelby D; Francis, Jennifer; Ridley, David B; Schulman, Kevin A

    2003-01-01

    We conducted a descriptive analysis of data from the Hospital Cost Report Information System from 1985 through 1997 on nonfederal, short-stay hospitals in the United States with 12-month reporting periods and valid data for the primary outcomes. The main outcome measures were change in number of beds, inpatient days, overhead cost per bed, and overhead cost per inpatient day. Actual outcomes were compared to predicted outcomes from: (1) a scenario holding the ratio of overhead cost per volume constant throughout the study period; and (2) a scenario holding overhead expenditures for 1985 constant as volume changed. The sample contained a mean of 3,605 hospitals per year. Volume declined annually by 2.2 beds (95 percent confidence interval [CI], 2.1 to 2.2; P < .001) and 997 inpatient days (95 percent CI, 992 to 1,003; P < .001). Overhead cost per bed increased by 3,388 dollars annually (95 percent CI, 3,049 to 3,737; P < .001) and overhead cost per inpatient day increased by 40 dollars annually (95 percent CI, 36 to 44; P < .001). In the constant ratio scenario, mean overhead cost per bed increased by 42,523 dollars (32 percent), and mean overhead cost per inpatient day increased by 435 dollars (59 percent). In the constant overhead cost scenario, overhead cost per bed increased 15 percent and overhead cost per inpatient day increased 19 percent. Hospital overhead costs are increasing faster than would be expected if efficiency were the primary goal of hospital management. PMID:12967239

  7. 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.

  8. Avionics test bed development plan

    NASA Technical Reports Server (NTRS)

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

    1981-01-01

    The plan is for a 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. This plan outlines a distributed data processing facility that will utilize the current JSC laboratory resources for the test bed development. The future studies required for implementation, the management system for project control, and the baseline system configuration are described.

  9. 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.

  10. 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

  11. 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

  12. 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.

  13. 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

  14. 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

  15. 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

  16. 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.

  17. 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.

  18. 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

  19. Method and apparatus for a combination moving bed thermal treatment reactor and moving bed filter

    DOEpatents

    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.

  20. 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.

  1. 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.

  2. Time-adjusted variable resistor

    NASA Technical Reports Server (NTRS)

    Heyser, R. C.

    1972-01-01

    Timing mechanism was developed effecting extremely precisioned highly resistant fixed resistor. Switches shunt all or portion of resistor; effective resistance is varied over time interval by adjusting switch closure rate.

  3. 78 FR 62712 - Rate Adjustment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-22

    ... noticing a recent Postal Service filing seeking postal rate adjustments based on exigent circumstances...,'' is ``premised on the recent recession as an exigent event.'' Id. at 1, 2. In Order No. 1059,...

  4. [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

  5. [Current situation of available back-up beds for terminal home care patients].

    PubMed

    Kato, Toshihiko; Takahashi, Osamu; Shimizu, Kazuko; Chiba, Yasuko

    2014-12-01

    The Palliative Care Unit at Heiwa Hospital has 16 beds, and offers inpatient support in general wards, as well as back-up beds in emergencies in collaboration with local home care support clinics. For two years from January 2012 to December 2013, there were 1,213 cases where patients were seen for initial outpatient visits at the Department of Palliative Care. At the time of the initial visit, visiting medical care had been introduced for 25% of the cases. Although 59% of the patients who visited our department are hospitalized, 20% of inpatients have been hospitalized at the request of their home care physician. The availability of back-upbeds offers patients and their families, as well as related medical institutions, a sense of security, and enables home care to continue. The significance of back-upbeds will become even more important in the future.

  6. 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

  7. Bacterial counts associated with recycled newspaper bedding.

    PubMed

    Hogan, J S; Smith, K L; Todhunter, D A; Schoenberger, P S

    1990-07-01

    Bacterial counts associated with recycled newspaper, wood shavings, and pelleted corn cobs used as bedding for lactating dairy cows were compared. Chopped newspaper and pelleted corn cobs had similar gram-negative bacterial, coliform, and streptococcal bedding counts. Staphylococcal counts in pelleted corn cobs were greater than in chopped newspaper. Conversely, gram-negative bacterial, coliform, and staphylococcal counts in chopped newspaper were greater than in wood shavings. Coliform and streptococcal counts did not differ between chopped newspaper and wood shavings bedding materials. Teat swab counts from cows bedded on pelleted corn cobs were greater than those from cows bedded on chopped newspaper for gram-negative bacterial, coliform, Klebsiella species, and staphylococci. Streptococcal teat swab counts did not differ between cows bedded on chopped newspaper and pelleted corn cobs. Cows bedded on chopped newspaper and wood shavings had similar gram-negative bacterial, coliform, and Klebsiella species teat swab counts. Streptococcal and staphylococcal teat swab counts were greater from cows bedded on chopped newspaper than those from cows bedded on wood shavings. Teat swab and bedding counts were correlated. In general, bacterial counts in bedding suggest no advantage in using chopped newspaper over pelleted corn cobs or wood shavings in reducing exposure of teats to environmental mastitis pathogens. PMID:2229587

  8. The effects of different types of automated inclining bed and tilt angle on body-pressure redistribution.

    PubMed

    Yi, Chung-Hwi; Kim, Han-Sung; Yoo, Won-Gyu; Kim, Min-Hee; Kwon, Oh-Yun

    2009-06-01

    The damage caused by pressure in bedridden hospitalized patients is attributable to the body tissues becoming compressed against bony prominences, which results in poor capillary perfusion. Automated inclining beds were developed in this study to assist patients in repositioning, with the aim of quantifying the effects of 3 types of bed (bed 1, 1-axis tilting; bed 2, 1-axis and 2-segment tilting; and bed 3, 2-axis and 3-segment tilting) and 3 tilt angles (10, 15, and 20 degrees upward from the horizontal) on body-pressure redistribution. Twenty healthy subjects (14 men and 6 women) aged 21 to 26 years were recruited from the Yonsei University student population (mean [SD]: height, 164.0 cm [5.5 cm]; weight, 58.7 kg [7.3 kg]). A body-pressure measurement system was used to analyze the pressure distributions of the human body for the different bed types and tilt angles. The results showed that pressure reduction was significantly greater for bed 2 than for beds 1 and 3, and for tilt angles of 15 and 20 degrees upward. The highest pressure reduction was found for bed 2, with a tilt angle of 20 degrees upward from the horizontal.

  9. 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

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

    PubMed Central

    Wright, Stephen; Barlow, James; McKee, Martin

    2010-01-01

    Abstract 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

  11. The relationship between life adjustment and parental bonding in military personnel with adjustment disorder in Taiwan.

    PubMed

    For-Wey, Lung; Fei-Yin, Lee; Bih-Ching, Shu

    2002-08-01

    The aim of the present study was to examine the characteristics of military personnel with adjustment disorder to give them more appropriate treatment. The participants were 36 military personnel who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria of adjustment disorder as diagnosed by a psychiatrist at a teaching hospital in southern Taiwan. Another 24 persons were recruited as an age-matched control group. Each individual completed the clinical interview and the Wechsler Adult Intelligence Scale-Revised and then completed the questionnaires which included demographic information, the Parental Bonding Instrument, the Eysenck Personality Questionnaire, and the Chinese Health Questionnaire. We found statistically significant differences between the case and control groups in personality and parental bonding attitudes. Soldiers with higher neuroticism, lower extraversion, and maternal overprotection had an increased risk of suffering from adjustment disorder. The inclusion of family function and the military environment and such other factors as cultural variables is recommended for future study. The statistical approach of structural equation modeling also should be considered in future studies to determine competing risk factors and mediating effects.

  12. 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

  13. 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.

  14. An alternate approach to hospital cost control: the Rochester project.

    PubMed Central

    Sorensen, A A; Saward, E W

    1978-01-01

    The rapid escalation in health care costs has demonstrated a need to control costs in general and hospital costs in particular. In New York State, efforts at control have followed one of several paths, including reduction of Medicaid program expenditures, elimination of hospital beds, and prospective reimbursement of hospital costs. Although some success has been achieved in each of these areas, hospital costs containment has not been as successful as had been hoped. A new project called MAXICAP, being developed in the Rochester region, seeks to link payment with regional hospital planning. MAXICAP represents a voluntary attempt by hospitals, third party payers, planners, consumers, and governmental agencies to devise a prospective hospital payment system. Under this system community hospital plans in the Rochester region would be integrated and a cap imposed on both revenues and expenses for acute hospital care. The principal advantage of the MAXICAP is that it offers a mechanism for linking hospital planning with payment functions on a regional basis. The principal disadvantage is that the success of the MAXICAP depends upon the voluntary cooperation of the vast majority of the acute care hospitals in the area--hospitals that may be scattered throughout a relatively large region. PMID:98805

  15. 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

  16. America's rural hospitals: a selective review of 1980s research.

    PubMed

    Mick, S S; Morlock, L L

    1990-10-01

    We review 1980s research on American rural hospitals within the context of a decade of increasing restrictiveness in the reimbursement and operating environments. Areas addressed include rural hospital definitions, organizational and financial performance, and strategic management activities. The latter category consists of hospital closure, diversification and vertical integration, swing-bed conversion, sole community provider designation, horizontal integration and multihospital system affiliation, marketing, and patient retention. The review suggests several research needs, including: developing more meaningful definitions of rural hospitals, engaging in methodologically sound work on the effects of innovative programs and strategic management activities--including conversion of the facility itself--on rural hospital performance, and completing studies of the effects of rural hospital closure or conversion on the health of the communities served.

  17. [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.

  18. 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.

  19. Incidence Rate of Needlestick and Sharps Injuries in 67 Japanese Hospitals: A National Surveillance Study

    PubMed Central

    Yoshikawa, Toru; Wada, Koji; Lee, Jong Ja; Mitsuda, Toshihiro; Kidouchi, Kiyoshi; Kurosu, Hitomi; Morisawa, Yuji; Aminaka, Mayumi; Okubo, Takashi; Kimura, Satoshi; Moriya, Kyoji

    2013-01-01

    Background Determining incidence rates of needlestick and sharps injuries (NSIs) using data from multiple hospitals may help hospitals to compare their in-house data with national averages and thereby institute relevant measures to minimize NSIs. We aimed to determine the incidence rate of NSIs using the nationwide EPINet surveillance system. Methodology/Principal Findings Data were analyzed from 5,463 cases collected between April 2009 and March 2011 from 67 Japanese HIV/AIDS referral hospitals that participated in EPINet-Japan. The NSI incidence rate was calculated as the annual number of cases with NSIs per 100 occupied beds, according to the demographic characteristics of the injured person, place, timing, device, and the patients’ infectious status. The NSI incidence rates according to hospital size were analyzed by a non-parametric test of trend. The mean number of cases with NSIs per 100 occupied beds per year was 4.8 (95% confidence interval, 4.1–5.6) for 25 hospitals with 399 or fewer beds, 6.7 (5.9–7.4) for 24 hospitals with 400–799 beds, and 7.6 (6.7–8.5) for 18 hospitals with 800 or more beds (p-trend<0.01). NSIs frequently occurred in health care workers in their 20 s; the NSI incidence rate for this age group was 2.1 (1.6–2.5) for hospitals having 399 or fewer beds, 3.5 (3.0–4.1) for hospitals with 400–799 beds, and 4.5 (3.9–5.0) for hospitals with 800 or more beds (p-trend<0.01). Conclusions/Significance The incidence rate of NSIs tended to be higher for larger hospitals and in workers aged less than 40 years; injury occurrence was more likely to occur in places such as patient rooms and operating rooms. Application of the NSI incidence rates by hospital size, as a benchmark, could allow individual hospitals to compare their NSI incidence rates with those of other institutions, which could facilitate the development of adequate control strategies. PMID:24204856

  20. 42 CFR 412.92 - Special treatment: Sole community hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... hospitals, or it is located in a rural area (as defined in § 412.64) and meets one of the following... new road between itself and a like provider within 35 miles. (C) An increase in the number of beds to... in miles measured over improved roads. An improved road for this purpose is any road that...

  1. 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

  2. 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.

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. Hospital Quality, Efficiency, and Input Slack Differentials

    PubMed Central

    Valdmanis, Vivian G; Rosko, Michael D; Mutter, Ryan L

    2008-01-01

    Objective To use an advance in data envelopment analysis (DEA) called congestion analysis to assess the trade-offs between quality and efficiency in U.S. hospitals. Study Setting Urban U.S. hospitals in 34 states operating in 2004. Study Design and Data Collection Input and output data from 1,377 urban hospitals were taken from the American Hospital Association Annual Survey and the Medicare Cost Reports. Nurse-sensitive measures of quality came from the application of the Patient Safety Indicator (PSI) module of the Agency for Healthcare Research and Quality (AHRQ) Quality Indicator software to State Inpatient Databases (SID) provided by the Healthcare Cost and Utilization Project (HCUP). Data Analysis In the first step of the study, hospitals’ relative output-based efficiency was determined in order to obtain a measure of congestion (i.e., the productivity loss due to the occurrence of patient safety events). The outputs were adjusted to account for this productivity loss, and a second DEA was performed to obtain input slack values. Differences in slack values between unadjusted and adjusted outputs were used to measure either relative inefficiency or a need for quality improvement. Principal Findings Overall, the hospitals in our sample could increase the total amount of outputs produced by an average of 26 percent by eliminating inefficiency. About 3 percent of this inefficiency can be attributed to congestion. Analysis of subsamples showed that teaching hospitals experienced no congestion loss. We found that quality of care could be improved by increasing the number of labor inputs in low-quality hospitals, whereas high-quality hospitals tended to have slack on personnel. Conclusions Results suggest that reallocation of resources could increase the relative quality among hospitals in our sample. Further, higher quality in some dimensions of care need not be achieved as a result of higher costs or through reduced access to health care. PMID:18783457

  8. Community-, Healthcare- and Hospital-Acquired Severe Sepsis Hospitalizations in the University HealthSystem Consortium

    PubMed Central

    Page, David B.; Donnelly, John P.; Wang, Henry E.

    2015-01-01

    Objectives Severe sepsis poses a major burden on the U.S. healthcare system. Previous epidemiologic studies have not differentiated community-acquired severe sepsis from healthcare-associated severe sepsis or hospital-acquired severe sepsis hospitalizations. We sought to compare and contrast community-acquired severe sepsis, healthcare-associated severe sepsis, and hospital-acquired severe sepsis hospitalizations in a national hospital sample. Setting United States Interventions None Measurements & Main Results Prevalence of community-acquired severe sepsis, healthcare-associated severe sepsis, and hospital-acquired severe sepsis, adjusted hospital mortality, length of hospitalization, length of stay in an ICU, and hospital costs. Among 3,355,753 hospital discharges, there were 307,491 with severe sepsis, including 193,081 (62.8%) community-acquired severe sepsis, 79,581 (25.9%) healthcare-associated severe sepsis, and 34,829 (11.3%) hospital-acquired severe sepsis. Hospital-acquired severe sepsis and healthcare-associated severe sepsis exhibited higher in-hospital mortality than community-acquired severe sepsis (hospital-acquired [19.2%] vs healthcare-associated [12.8%] vs community-acquired [8.6%]). Hospital-acquired severe sepsis had greater resource utilization than both healthcare-associated severe sepsis and community-acquired severe sepsis, with higher median length of hospital stay (hospital acquired [17 d] vs healthcare associated [7 d] vs community-acquired [6 d]), median length of ICU stay (hospital-acquired [8 d] vs healthcare-associated [3 d] vs community-acquired [3 d]), and median hospital costs (hospital-acquired [$38,369] vs healthcare-associated [$8,796] vs community-acquired [$7,024]). Conclusions In this series, severe sepsis hospitalizations included CA-SS (62.8%), HCA-SS (25.9%) and HA-SS (11.3%) cases. HA-SS was associated with both higher mortality and resource utilization than CA-SS and HCA-SS. PMID:26110490

  9. 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.

  10. 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.

  11. 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

  12. The Berlin emissivity database (BED)

    NASA Astrophysics Data System (ADS)

    Maturilli, A.; Helbert, J.; Moroz, L.

    2008-03-01

    Remote-sensing infrared spectroscopy is the principal field of investigation for planetary surfaces composition. Past, present and future missions to the solar system bodies include in their payload, instruments measuring the emerging radiation in the infrared range. Apart from measuring the reflected radiance, more and more spacecrafts are equipped with instruments measuring directly the emitted radiation from the planetary surface. The emitted radiation is not only a function of the composition of the material but also of its texture and especially the grain size distribution. For the interpretation of the measured data an emissivity spectral library of planetary analogue materials in grain size fractions appropriate for planetary surfaces is needed. The Berlin emissivity database (BED) presented here is focused on relatively fine-grained size separates, providing thereby a realistic basis for the interpretation of thermal emission spectra of planetary regoliths. The BED is therefore complimentary to existing thermal emission libraries, like the ASU library for example. BED currently contains emissivity spectra of plagioclase and potassium feldspars, low Ca and high Ca pyroxenes, olivine, elemental sulfur, Martian analogue minerals and volcanic soils, and a lunar highland soil sample measured in the wavelength range from 7 to 22 μm as a function of particle size. For each sample we measured the spectra of four particle size separates ranging from <25 to 250 μm. The device we used is built at DLR (Berlin) and is coupled to a Fourier-transform infrared spectrometer Bruker IFS 88 purged with dry air and equipped with a nitrogen-cooled MCT detector. All spectra were acquired with a spectral resolution of 4 cm -1. We are currently working on upgrading our emissivity facility. A new spectrometer (Bruker VERTEX 80 V) and new detectors will allow us to measure the emissivity of samples in the wavelength range from 1 to 50 μm in a vacuum environment. This will be

  13. 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.

  14. [Special beds. Pulmonary therapy system].

    PubMed

    Calixto Rodríguez, Joaquín; Rodríguez Martínez, Xavier; Marín i Vivó, Gemma; Paunellas Albert, Josep

    2008-10-01

    To be bedridden reduces one's capacity to move and produces muscular debility that affects the respiratory system leading to a decreased effectiveness in expectoration, the ability to spit up sputum. The pulmonary therapy system integrated in a bed is the result of applying motorized elements to the articulation points of the bad in order to achieve safe positions at therapeutic angles, which improve the breathing-perfusion (blood flow) relationship. This system also makes it possible to apply vibration waves to the patient which favor the elimination of bronchial-pulmonary secretions, the rehabilitation of the bedridden patient and decrease the work load for nursing personnel.

  15. 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

  16. 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.

  17. A fluidized bed enhances biotreatment

    SciTech Connect

    1996-03-01

    Chlorinated organics such as trichloroethylene (TCE) are often difficult to treat biologically because they degrade into intermediate compounds that are toxic to most microorganisms. But recent advances in fluidized bed biotreatment by Envirex, Inc. (Waukesha, Wis.) indicate that difficult-to-treat wastes like TCE can be successfully biodegraded. The key is to add chemicals (dubbed co-metabolic substrates), which promote the growth of microbes that preferentially degrade the unwanted intermediate compounds. Preliminary field tests using phenol, toluene and methane as the co-metabolic substrate show that TCE levels can be reduced by as much as 95%.

  18. 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

  19. Mental health effects from urban bed bug infestation (Cimex lectularius L.): a cross-sectional study

    PubMed Central

    Susser, Stephanie Rebecca; Perron, Stéphane; Fournier, Michel; Jacques, Louis; Denis, Geoffroy; Tessier, François; Roberge, Pasquale

    2012-01-01

    Objective To assess whether bed bug infestation was linked to sleep disturbances and symptoms of anxiety and depression. Design Exploratory cross-sectional study. Setting Convenience sample of tenants recruited in apartment complexes from Montreal, Canada. Participants 39 bed bug-exposed tenants were compared with 52 unexposed tenants. Main outcome measures The effect of bed bug-exposed tenants on sleep disturbances, anxiety and depression symptoms measured using the Pittsburgh Sleep Quality Index, 5th subscale, Generalised Anxiety Disorder 7-item scale and Patient Health Questionnaire, 9-item, respectively. Results In adjusted models, bed bug infestation was strongly associated with measured anxiety symptoms (OR (95% CI)=4.8 (1.5 to 14.7)) and sleep disturbance (OR (95% CI)=5.0 (1.3–18.8)). There was a trend to report more symptoms of depression in the bed bug-infested group, although this finding was not statistically significant ((OR (95% CI)=2.5(0.8 to 7.3)). Conclusions These results suggest that individuals exposed to bed bug infestations are at risk of experiencing sleep disturbance and of developing symptoms of anxiety and possibly depression. Greater clinical awareness of this problem is needed in order for patients to receive appropriate mental healthcare. These findings highlight the need for undertaking of deeper inquiry, as well as greater collaboration between medical professionals, public health and community stakeholders. PMID:23015597

  20. The Transition from Excess Capacity to Strained Capacity in U.S. Hospitals

    PubMed Central

    Bazzoli, Gloria J; Brewster, Linda R; May, Jessica H; Kuo, Sylvia

    2006-01-01

    After many years of concern about excess hospital capacity, a growing perception exists that the capacity of some hospitals now seems constrained. This article explores the reasons behind this changing perception, looking at the longitudinal data and in-depth interviews for hospitals in four study sites monitored by the Community Tracking Study of the Center for Studying Health System Change. Notwithstanding the differences for individual hospitals, we observed that adjustments to the supply of hospital services tend to be slow and out of sync with changes in the demand for hospital services. Those hospitals reporting capacity problems are often teaching hospitals, located near previously closed facilities or in population growth areas. These findings suggest therefore that approaches to dealing with capacity problems might best focus on better matching individual hospitals' supply and demand adjustments. PMID:16771819