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Sample records for adjustable hospital bed

  1. 21 CFR 880.5110 - Hydraulic adjustable hospital bed.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  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... Therapeutic Devices § 880.5110 Hydraulic adjustable hospital bed. (a) Identification. A hydraulic adjustable hospital bed is a device intended for medical purposes that consists of a bed with a hydraulic...

  3. 21 CFR 880.5110 - Hydraulic adjustable hospital bed.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  4. 21 CFR 880.5110 - Hydraulic adjustable hospital bed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hydraulic adjustable hospital bed. 880.5110... Therapeutic Devices § 880.5110 Hydraulic adjustable hospital bed. (a) Identification. A hydraulic adjustable hospital bed is a device intended for medical purposes that consists of a bed with a hydraulic...

  5. 21 CFR 880.5110 - Hydraulic adjustable hospital bed.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  6. 21 CFR 880.5120 - Manual adjustable hospital bed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  7. 21 CFR 880.5120 - Manual adjustable hospital bed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Manual adjustable hospital bed. 880.5120 Section 880.5120 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal...

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

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false AC-powered adjustable hospital bed. 880.5100 Section 880.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Therapeutic Devices § 880.5100 AC-powered adjustable hospital bed. (a) Identification. An...

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

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false AC-powered adjustable hospital bed. 880.5100 Section 880.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Therapeutic Devices § 880.5100 AC-powered adjustable hospital bed. (a) Identification. An...

  10. Cross hospital bed management system.

    PubMed

    Abedian, S; Kazemi, H; Riazi, H; Bitaraf, E

    2014-01-01

    The lack of adequate numbers of hospital beds to accommodate the injured is a main problem in public hospitals. For control of occupancy of bed, we design a dynamic system that announces status of bed when it change with admission or discharge of a patient. This system provide a wide network in country for bed management, especially for ICU and CCU beds that help us to distribute injured patient in the hospitals.

  11. The dynamics of psychiatric bed use in general hospitals

    PubMed Central

    Slade, Eric P; Goldman, Howard H

    2014-01-01

    This study examines general hospitals' adjustments in psychiatric bed utilization practices in response to increases in psychiatric inpatient admissions. Using panel data from 439 hospitals, monthly observations (N=7831) between 2007 and 2010 on psychiatric admissions, psychiatric bed occupancy rates, and average length-of-stay were created for psychiatric inpatients. In fixed-effects regressions, an increase in psychiatric admissions was associated with an increase in the probability of psychiatric bed use exceeding 100% occupancy and with a reduction of mean length-of-stay. These results were confirmed in instrumental variables models. General hospitals may dynamically adjust bed utilization practices in response to changing psychiatric bed needs. An implication of this dynamic adjustment model is that bed shortages are likely to be local, transitory events. PMID:24756929

  12. The dynamics of psychiatric bed use in general hospitals.

    PubMed

    Slade, Eric P; Goldman, Howard H

    2015-03-01

    This study examines general hospitals' adjustments in psychiatric bed utilization practices in response to increases in psychiatric inpatient admissions. Using panel data from 439 hospitals, monthly observations (N = 7,831) between 2007 and 2010 on psychiatric admissions, psychiatric bed occupancy rates, and average length-of-stay were created for psychiatric inpatients. In fixed-effects regressions, an increase in psychiatric admissions was associated with an increase in the probability of psychiatric bed use exceeding 100 % occupancy and with a reduction of mean length-of-stay. These results were confirmed in instrumental variables models. General hospitals may dynamically adjust bed utilization practices in response to changing psychiatric bed needs. An implication of this dynamic adjustment model is that bed shortages are likely to be local, transitory events.

  13. The use of bed distribution and service population indexes for hospital bed allocation.

    PubMed Central

    Bay, K S; Nestman, L J

    1984-01-01

    To provide an empirical base for bed reallocation within a hospital planning jurisdiction in Canada, this article proposes a population-based method to measure the distribution of acute care beds for each district and the service load for each hospital. The measure for the bed distribution (BDI) is the number of beds per 1,000 age-sex-adjusted number of residents in a district, while the service load of a hospital is measured by the number of persons being served per bed (SPI). The number of beds allocated to each district, or the number of persons served by each hospital, was estimated by applying the hospital service population model, which employs both relevance- and commitment-index methods. The method thus proposed was applied to Alberta data. It appears that both BDI and SPI measures are stable across the variation of methods or data sources, yet sensitive enough to detect changes over the years. Using these indexes, potentially over- or underbedded districts and over- or underloaded hospitals can be identified for further investigation so that possible reallocation of acute care beds among the hospitals may take place. PMID:6547418

  14. 21 CFR 880.5140 - Pediatric hospital bed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  15. Particle Dynamics and Gravel-Bed Adjustments

    DTIC Science & Technology

    1993-05-01

    detecteur des movement des sediments fins. Societe hydrotechnique de France. Transport Hydraulique et Decantation des Materiaux Solides. pp3 9 p. 38...Kirkby, MJ. (Eds.) Channel Ndork Hydrology. Wiley. Chichester. pp 129-173. 67. Lapointe, M.F. (1992) Burst-like sediment suspension events in a sand bed...alluvial sand suspension by eddy correlation. Earth Surface Processes & Landforms, 11, (in press). 69. Soulsby, R.L. (1983) The bottom boundary layer of

  16. 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... Inpatient Hospital and Long-Term Care Facility Services Swing-Bed Hospitals § 447.280 Hospital providers of NF services (swing-bed hospitals). (a) General rule. If the State plan provides for NF...

  17. 42 CFR 447.280 - Hospital providers of NF services (swing-bed hospitals).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Hospital providers of NF services (swing-bed... Inpatient Hospital and Long-Term Care Facility Services Swing-Bed Hospitals § 447.280 Hospital providers of NF services (swing-bed hospitals). (a) General rule. If the State plan provides for NF...

  18. 76 FR 49458 - TRICARE; Hospital Outpatient Radiology Discretionary Appeal Adjustments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-10

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

  19. Streambed Deformation and Adjustments in a Gravel-Bed Channel

    NASA Astrophysics Data System (ADS)

    Haschenburger, J. K.

    2005-12-01

    The streambed is the major source of bedload sediment in gravel-bed channels and is necessarily deformed during competent flows. At the local scale, net adjustments to streambeds are well documented through repeated survey of channel cross sections in a wide range of rivers. However, evaluating the end result of sediment transfers provides little insight into how changes occur through scour and fill processes. This research connects the contributions of scour and fill to net adjustments in streambed elevation over a series of flood events. Field observations come from Carnation Creek, British Columbia, where over 100 scour indicators were installed in a 900 m study reach and recovered 15 times during two flood seasons. Peak discharges (Q) ranged from 3.6 to 36.3 m3s-1, the largest representing a return period of about 7 years. The relatively limited coarse surface layer facilitates an active streambed and relatively high sediment transport rates typically under partial transport conditions. The mean bed elevation was relatively stable over the field program, showing only minor degradation in response to the two largest floods. The likelihood of both scour and fill occurring at a given location increases from 0.2 to 0.8 as flow increases. The dominance of only scour when Q<11 m3s-1 gives way to both processes at the higher flows observed. The bed undergoes more numerous and larger net adjustments as flow increases. At flows near incipient motion, the largest net adjustments were 0.5 times the thickness of the coarse surface layer (D90), and at large flows, they reached 5D90 for both net scour and fill. During the largest flood, depths of scour and fill reached 8D90 with 30% of the active locations experiencing depths >2D90. As the likelihood of neither scour nor fill occurring declines with flow, the explanation of stable bed elevations shifts from inactivity toward compensating depths of scour and fill. These results indicate that conditions favorable to both

  20. 21 CFR 880.5140 - Pediatric hospital bed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Pediatric hospital bed. 880.5140 Section 880.5140 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use...

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

    PubMed Central

    Green, L V; Nguyen, V

    2001-01-01

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

  2. Effects of recliner-chair versus traditional hospital bed on postsurgical diagnostic laparoscopic recovery time.

    PubMed

    Agodoa, Shirley E; Holder, Margaret A; Fowler, Sarah M

    2002-10-01

    Little has been documented regarding postoperative nursing interventions that are effective in decreasing postoperative recovery time, improving patient outcomes, or optimizing discharge readiness. A randomized study was conducted to evaluate 2 methods of recovery positioning and to examine factors that affect home readiness (eg, voiding, intake) for postsurgical laparoscopy patients. Participants were randomized into 2 groups. The control group was recovered in traditional hospital beds, while subjects in the experimental group recovered in a "recliner-chair," which was adjustable by the patient for comfort. The results showed that patients who recovered in adjustable recliner-chairs reached home readiness sooner and experienced greater comfort levels than patients who recovered in traditional hospital beds. Furthermore, patients in the recliner-chair group had fewer adverse symptoms such as nausea, severe pain, and delayed voiding. This is a U.S. government work. There are no restrictions on its use.

  3. Hospital, system boards adjust to changing roles.

    PubMed

    Greene, J

    1991-09-02

    A growing number of multihospital systems are flexing their centralized power over individual hospital boards in an attempt to realize the competitive edge that systems were supposed to provide. As a result, governance at the hospital level is becoming more and more advisory. Obviously, trustees in a lot of locales aren't coming quietly into the new relationship. But experts say healthcare's financial climate makes such change just a matter of time.

  4. 42 CFR 412.101 - Special treatment: Inpatient hospital payment adjustment for low-volume hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  5. 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.

  6. 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

  7. Demographic change and the supply of physicians, hospitals, and hospital beds: marketing implications.

    PubMed

    Pol, L G; Tymkiw, D R

    1990-01-01

    Demographic conditions are a major component of the business environment in which health care marketers must compete. The following study assesses the impact of demographic factors on health care supply and finds that population size, population change, age structure, and income are important predictors of physician, hospital, and hospital bed supply. The results are discussed in the context of marketing implications.

  8. A pilot study of risk adjustment for benchmarking antibiotic use between hospitals in Sweden.

    PubMed

    Norberg, Signe; Struwe, Johan; Grunewald, Maria; Ternhag, Anders

    2014-03-01

    There is no established standard for comparing overall antibiotic use between hospitals taking patient characteristics into account. The objective of this study was to investigate whether there is a correlation between surrogate markers for patient morbidity, namely case mix index (CMI), mean length of hospital stay (LoS) and mean cost per admission, and antibiotic use in a sample of Swedish hospitals. All primary and secondary hospitals in three counties with high and three counties with low consumption of antibiotics were selected. Data from 16 hospitals were included. A regression analysis was used to evaluate whether there was a linear trend between defined daily doses (DDD) of antibiotics per 100 bed-days and the surrogate markers for morbidity. No correlation could be found between any of the measures of morbidity and total antibiotic consumption. However, a correlation was found between CMI and the proportion of narrow-spectrum antibiotics: the higher the CMI, the lower the proportional use of β-lactamase-sensitive penicillins. In conclusion, it was found that CMI, mean LoS and mean cost per admission did not appears to be useful factors to adjust for when comparing antibiotic use in this subset of primary and secondary care hospitals. Based on this limited study, we suggest that DDD/100 bed-days can still be used as an appropriate metric to benchmark antibiotic use in primary and secondary hospitals until a better marker for variation of patients and activities is identified.

  9. 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.

  10. 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.

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

    PubMed

    Zwarenstein, M F; Price, M R

    1990-05-05

    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.

  12. Falls from hospital beds as a result of poor mattress design: a case history.

    PubMed

    Shaw, A; Fisher, J

    1979-11-01

    Investigation of a series of falls from hospital beds showed that the cause was the poor design of the particular mattresses. Interior sprung mattresses of this construction are unstable at their edges and are particularly hazardous when used with the modern, rigid base hospital bed.

  13. Stopping the Slide: How Hospital Bed Design Can Minimize Active and Passive Patient Migration.

    PubMed

    Davis, Kermit G; Kotowski, Susan E; Coombs, Matthew T

    Patient migration, or the amount of movement toward the foot of the bed, has been shown to significantly vary because of the mechanical design differences in hospital beds. Previously, the amount of migration was measured immediately following head-of-bed articulation in healthy subjects. This study not only evaluates how much migration occurs immediately after head-of-bed articulation but also measures additional migration during a standard 2-hour repositioning period in subjects with limited mobility.

  14. Estimating Child Sleep From Parent Report of Time in Bed: Development and Evaluation of Adjustment Approaches

    PubMed Central

    Lundahl, Alyssa; Molfese, Dennis L.; Waford, Rachel N.; Roman, Adrienne; Gozal, David; Molfese, Victoria J.; Ferguson, Melissa C.

    2014-01-01

    Objective To develop and evaluate adjustment factors to convert parent-reported time in bed to an estimate of child sleep time consistent with objective measurement. Methods A community sample of 217 children aged 4–9 years (mean age = 6.6 years) wore actigraph wristwatches to objectively measure sleep for 7 days while parents completed reports of child sleep each night. After examining the moderators of the discrepancy between parent reports and actigraphy, 3 adjustment factors were evaluated. Results Parent report of child sleep overestimated nightly sleep duration by ∼24 min per night relative to actigraphy. Child age, gender, and sleep quality all had small or nonsignificant associations with correspondence between parent report and actigraph. Empirically derived adjustment factors significantly reduced the discrepancy between parent report and objective measurement. Conclusions Simple adjustment factors can enhance the correspondence and utility of parent reports of child sleep duration for clinical and research purposes. PMID:24781412

  15. Defining the appropriate use of community hospital beds.

    PubMed Central

    Donald, I P; Jay, T; Linsell, J; Foy, C

    2001-01-01

    BACKGROUND: Patients of GPs who have access to community hospitals (CHs) as well as district general hospitals (DGHs) tend to spend on average more days in hospital each year. Increasing attention is being paid to the efficient management of medical admissions; however, there has been no previous prospective study investigating the appropriateness of CH admissions. AIM: To develop a protocol to assess the clinical appropriateness of admission and length of stay of patients in CHs and to simultaneously compare the appropriateness of admissions to all DGHs and CHs in the county. DESIGN OF STUDY: A protocol named Community Hospital Appropriateness Evaluation Protocol (CHAEP) was developed to assess CH admissions through a process of consultation and a series of pilot studies. The appropriateness evaluation protocol (AEP) was also reviewed and used to assess DGH admissions. SETTING: A prospective cohort of 440 DGH admissions from five DGH sites and 440 CH admissions from nine CHs. METHODS: The admissions were assessed and followed for 28 days. If an admission failed to satisfy any of the criteria then the researcher interviewed the clinician to decide whether it was justified to override the protocol and still classify the admission as appropriate. To assess validity, a proportion of these 'clinical overrides' and the researcher's classifications were reviewed retrospectively by a clinical panel. The kappa statistic was used to assess the level of agreement. RESULTS: Applying the CHAEP, 82% of CH admissions satisfied a criterion for admission and a further 3% were given clinical overrides. A lower intensity of care was required for the majority of the remainder while three admissions required DGH care according to AEP criteria. Sixty-eight per cent of bed days satisfied day-of-care criteria within CHAEP and only a further 2% were given clinical override. These results were similar to those found with the AEP at the DGHs where 75% of admissions (plus 16% given clinical

  16. 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

    ... 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... hospital may request that the intermediary review the classification of the affected costs in its...

  17. 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... hospital may request that the contractor review the classification of the affected costs in its...

  18. 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.

  19. 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…

  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. 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.

  3. 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.

  4. 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...

  5. 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...

  6. 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...

  7. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  8. 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...

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

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... swing-bed hospital. 413.114 Section 413.114 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... swing-bed hospital. (a) Purpose and basis. This section implements section 1883 of the Act, which provides for payment for posthospital SNF care furnished by rural hospitals and CAHs having a...

  10. Ergonomic evaluation of brake pedal and push handle locations on hospital beds.

    PubMed

    Zhou, Jie; Wiggermann, Neal

    2017-04-01

    Transporting patients in hospital beds is a physically demanding activity performed by healthcare workers and bed design may moderate the risk of injury. Nine healthcare workers participated in a study to investigate how brake pedal location affected maximal voluntary exertion (MVE) force and the level of acceptable force for engagement. Preferred and acceptable push heights when maneuvering a bed were also evaluated. The method of limits was used to determine acceptable forces and push heights. Results demonstrated that pedal depth, clearance above, and clearance behind the pedal significantly affected MVE force and acceptable force. Preferred push height was approximately at elbow level and a single height would not accommodate the user population. These findings provide important considerations for hospital bed design. The method of limits was a valid and reliable approach for evaluating user acceptance of design inputs characterized by continuous variables and may be useful in other design evaluations.

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... within the hospital's geographic region; (ii) The date that a hospital learns that a bed is available in... located. The rates are calculated using the regions as defined in section 1886(d)(2)(D) of the...

  12. Korean nurses' adjustment to hospitals in the United States of America.

    PubMed

    Yi, M; Jezewski, M A

    2000-09-01

    Korean nurses' adjustment to hospitals in the United States of America Due to shortage of nurses, more nurses from other countries are employed in health care settings in the United States of America (USA). Little attention has been paid to understanding how culturally different international nurses adjust to USA hospitals. The purpose of this study was to investigate how Korean nurses adjust to USA hospital settings. Grounded theory method was used for sampling procedure, data collection and analysis in order to describe Korean nurses' experiences from their perspective and to develop a substantive theory that explains their process of adjustment. Data were collected using semi-structured formal interviews with a purposive sample of 12 Korean nurses. The interviews were audio-taped and transcribed. Analysis of data, using the constant comparative method, revealed 'adjustment to USA hospitals' as the basic social psychological process. Five categories composed the process: (1) relieving psychological stress; (2) overcoming the language barrier; (3) accepting USA nursing practice; (4) adopting the styles of USA problem-solving strategies; and (5) adopting the styles of USA interpersonal relationships. These five categories capture the essential aspects of the adjustment process and each category contains a set of sub-categories that describe Korean nurses' day-to-day experiences that are critical and also problematic to their adjustment. The process evolves in two stages. In the initial stage, the first three of the five categories greatly influenced the nurses' adjustment. From the perspective of the nurses in the study, the initial stage lasts about 2 to 3 years. The remaining two categories are principal components of the later stage. It takes an additional 5 to 10 years to complete this stage. This model highlights both distress and accomplishments of Korean nurses during their adjustment to USA hospitals. The results of the study may help USA nurses gain

  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. 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

  15. Long-term care provision, hospital bed blocking, and discharge destination for hip fracture and stroke patients.

    PubMed

    Gaughan, James; Gravelle, Hugh; Santos, Rita; Siciliani, Luigi

    2017-02-28

    We examine the relationship between long-term care supply (care home beds and prices) and (i) the probability of being discharged to a care home and (ii) length of stay in hospital for patients admitted to hospital for hip fracture or stroke. Using patient level data from all English hospitals and allowing for a rich set of demographic and clinical factors, we find no association between discharge destination and long-term care beds supply or prices. We do, however, find evidence of bed blocking: hospital length of stay for hip fracture patients discharged to a care home is shorter in areas with more long-term care beds and lower prices. Length of stay is over 30% shorter in areas in the highest quintile of care home beds supply compared to those in the lowest quintile.

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

    PubMed Central

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

    2010-01-01

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

  17. Bed Capacity Planning Using Stochastic Simulation Approach in Cardiac-surgery Department of Teaching Hospitals, Tehran, Iran

    PubMed Central

    TORABIPOUR, Amin; ZERAATI, Hojjat; ARAB, Mohammad; RASHIDIAN, Arash; AKBARI SARI, Ali; SARZAIEM, Mahmuod Reza

    2016-01-01

    Background: To determine the hospital required beds using stochastic simulation approach in cardiac surgery departments. Methods: This study was performed from Mar 2011 to Jul 2012 in three phases: First, collection data from 649 patients in cardiac surgery departments of two large teaching hospitals (in Tehran, Iran). Second, statistical analysis and formulate a multivariate linier regression model to determine factors that affect patient's length of stay. Third, develop a stochastic simulation system (from admission to discharge) based on key parameters to estimate required bed capacity. Results: Current cardiac surgery department with 33 beds can only admit patients in 90.7% of days. (4535 d) and will be required to over the 33 beds only in 9.3% of days (efficient cut off point). According to simulation method, studied cardiac surgery department will requires 41–52 beds for admission of all patients in the 12 next years. Finally, one-day reduction of length of stay lead to decrease need for two hospital beds annually. Conclusion: Variation of length of stay and its affecting factors can affect required beds. Statistic and stochastic simulation model are applied and useful methods to estimate and manage hospital beds based on key hospital parameters. PMID:27957466

  18. 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.

  19. 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

  20. 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

  1. 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

  2. [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.

  3. 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

    ... 10314 of the Affordable Care Act expanded the definition of low-volume hospital and modified the methodology for determining the payment adjustment for hospitals meeting that definition. Specifically, the... Act expanded the definition of low- volume hospital and modified the methodology for determining...

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

    PubMed

    Montalto, Michael

    2010-11-15

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

  5. 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.

  6. Case-mix adjusted hospital mortality is a poor proxy for preventable mortality: a modelling study

    PubMed Central

    Girling, Alan J; Hofer, Timothy P; Wu, Jianhua; Chilton, Peter J; Nicholl, Jonathan P; Mohammed, Mohammed A; Lilford, Richard J

    2012-01-01

    Risk-adjustment schemes are used to monitor hospital performance, on the assumption that excess mortality not explained by case mix is largely attributable to suboptimal care. We have developed a model to estimate the proportion of the variation in standardised mortality ratios (SMRs) that can be accounted for by variation in preventable mortality. The model was populated with values from the literature to estimate a predictive value of the SMR in this context—specifically the proportion of those hospitals with SMRs among the highest 2.5% that fall among the worst 2.5% for preventable mortality. The extent to which SMRs reflect preventable mortality rates is highly sensitive to the proportion of deaths that are preventable. If 6% of hospital deaths are preventable (as suggested by the literature), the predictive value of the SMR can be no greater than 9%. This value could rise to 30%, if 15% of deaths are preventable. The model offers a ‘reality check’ for case mix adjustment schemes designed to isolate the preventable component of any outcome rate. PMID:23069860

  7. 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

  8. 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.

  9. 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

  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

    ... 26 Internal Revenue 15 2010-04-01 2010-04-01 false Adjustments of underpayments of hospital insurance taxes that accrue after March 31, 1986, and before January 1, 1987, with respect to wages of State... of underpayments of hospital insurance taxes that accrue after March 31, 1986, and before January...

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

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 15 2013-04-01 2013-04-01 false Adjustments of underpayments of hospital insurance taxes that accrue after March 31, 1986, and before January 1, 1987, with respect to wages of State... of underpayments of hospital insurance taxes that accrue after March 31, 1986, and before January...

  12. Price adjustment in the hospital sector: how should the NHS discriminate between providers. A comment on Miraldo, Siciliani and Street.

    PubMed

    Mougeot, Michel; Naegelen, Florence

    2012-01-01

    Miraldo et al. (2011) have analyzed the price adjustment policy of a payer implementing a Prospective Payment System in the hospital sector in the presence of exogenous cost differences when no lump-sum transfers are allowed. They focus on deriving conditions for the price adjustment being positive. In this paper, using a result of Miraldo et al., we emphasize whether the price adjustment is larger or smaller than the marginal cost. We show how the discrimination operates against either the low-cost or the high-cost hospitals according to the value of the elasticity of the additional marginal cost with respect to the quantity of services.

  13. Contextual, Ecological and Organizational Variations in Risk-Adjusted COPD and Asthma Hospitalization Rates of Rural Medicare Beneficiaries.

    PubMed

    Wan, Thomas T H; Lin, Yi-Ling; Ortiz, Judith

    2016-01-01

    The purpose of this study is to examine what factors contributing to the variability in chronic obstructive pulmonary disorder (COPD) and asthma hospitalization rates when the influence of patient characteristics is being simultaneously considered by applying a risk adjustment method. A longitudinal analysis of COPD and asthma hospitalization of rural Medicare beneficiaries in 427 rural health clinics (RHCs) was conducted utilizing administrative data and inpatient and outpatient claims from Region 4. The repeated measures of risk-adjusted COPD and asthma admission rate were analyzed by growth curve modeling. A generalized estimating equation (GEE) method was used to identify the relevance of selected predictors in accounting for the variability in risk-adjusted admission rates for COPD and asthma. Both adjusted and unadjusted rates of COPD admission showed a slight decline from 2010 to 2013. The growth curve modeling showed the annual rates of change were gradually accentuated through time. GEE revealed that a moderate amount of variance (marginal R(2) = 0.66) in the risk-adjusted hospital admission rates for COPD and asthma was accounted for by contextual, ecological, and organizational variables. The contextual, ecological, and organizational factors are those associated with RHCs, not hospitals. We cannot infer how the variability in hospital practices in RHC service areas may have contributed to the disparities in admissions. Identification of RHCs with substantially higher rates than an average rate can portray the need for further enhancement of needed ambulatory or primary care services for the specific groups of RHCs. Because the risk-adjusted rates of hospitalization do not very by classification of rural area, future research should address the variation in a specific COPD and asthma condition of RHC patients. Risk-adjusted admission rates for COPD and asthma are influenced by the synergism of multiple contextual, ecological, and organizational factors

  14. Associations between in-hospital bed occupancy and unplanned 72-h revisits to the emergency department: a register study

    PubMed Central

    2014-01-01

    Background A possible downstream effect of high in-hospital bed occupancy is that patients in the emergency department (ED) who would benefit from in-hospital care are denied admission. The present study aimed at evaluating this hypothesis through investigating associations between in-hospital bed occupancy at the time of presentation in the ED and the probability for unplanned 72-hour (72-h) revisits to the ED among patients discharged at index. A second outcome was unplanned 72-h revisits resulting in admission. Methods All visits to the ED of a 420-bed emergency hospital in southern Sweden between 1 January 2011 and 31 December 2012, which did not result in admission, death, or transfer to another hospital were included. Revisiting fractions were computed for in-hospital occupancy intervals <85%, 85% to 90%, 90% to 95%, 95% to 100%, 100% to 105%, and ≥105%. Multivariate models were constructed in an attempt to take confounding factors from, e.g., presenting complaints, age, referral status, and triage priority into account. Results Included in the study are 81,878 visits. The fraction of unplanned 72-h revisits/unplanned 72-h revisits resulting in admission was 5.8%/1.4% overall, 6.2%/1.4% for occupancy <85%, 6.4%/1.5% for occupancy 85% to 90%, 5.8%/1.4% for occupancy 90% to 95%, 6.0%/1.6% for occupancy 95% to 100%, 5.4%/1.6% for occupancy 100% to 105%, and 4.9%/1.4% for occupancy ≥105%. In the multivariate models, a trend to lower probability of unplanned 72-h revisits was observed at occupancy ≥105% compared to occupancy <95% (OR 0.88, CI 0.76 to 1.01). No significant associations between in-hospital occupancy at index and the probability of making unplanned 72-h revisits resulting in admission were observed. Conclusions The lack of associations between in-hospital occupancy and unplanned 72-h revisits does not support the hypothesis that ED patients are inappropriately discharged when in-hospital beds are scarce. The results are reassuring as they

  15. REFINE (REducing Falls in In-patieNt Elderly) using bed and bedside chair pressure sensors linked to radio-pagers in acute hospital care: a randomised controlled trial

    PubMed Central

    Sahota, Opinder; Drummond, Avril; Kendrick, Denise; Grainge, Matthew J.; Vass, Catherine; Sach, Tracey; Gladman, John; Avis, Mark

    2014-01-01

    Background: falls in hospitals are a major problem and contribute to substantial healthcare burden. Advances in sensor technology afford innovative approaches to reducing falls in acute hospital care. However, whether these are clinically effective and cost effective in the UK setting has not been evaluated. Methods: pragmatic, parallel-arm, individual randomised controlled trial of bed and bedside chair pressure sensors using radio-pagers (intervention group) compared with standard care (control group) in elderly patients admitted to acute, general medical wards, in a large UK teaching hospital. Primary outcome measure number of in-patient bedside falls per 1,000 bed days. Results: 1,839 participants were randomised (918 to the intervention group and 921 to the control group). There were 85 bedside falls (65 fallers) in the intervention group, falls rate 8.71 per 1,000 bed days compared with 83 bedside falls (64 fallers) in the control group, falls rate 9.84 per 1,000 bed days (adjusted incidence rate ratio, 0.90; 95% confidence interval [CI], 0.66–1.22; P = 0.51). There was no significant difference between the two groups with respect to time to first bedside fall (adjusted hazard ratio (HR), 0.95; 95% CI: 0.67–1.34; P= 0.12). The mean cost per patient in the intervention group was £7199 compared with £6400 in the control group, mean difference in QALYs per patient, 0.0001 (95% CI: −0.0006–0.0004, P= 0.67). Conclusions: bed and bedside chair pressure sensors as a single intervention strategy do not reduce in-patient bedside falls, time to first bedside fall and are not cost-effective in elderly patients in acute, general medical wards in the UK. Trial registration: isrctn.org identifier: ISRCTN44972300. PMID:24141253

  16. Bed and width oscillations form coherent patterns in a partially confined, regulated gravel-cobble-bedded river adjusting to anthropogenic disturbances

    NASA Astrophysics Data System (ADS)

    Brown, Rocko A.; Pasternack, Gregory B.

    2017-01-01

    Understanding the spatial organization of river systems in light of natural and anthropogenic change is extremely important because it can provide information to assess, manage, and restore them to ameliorate worldwide freshwater fauna declines. For gravel- and cobble-bedded alluvial rivers studies spanning analytical, empirical and numerical domains suggest that at channel-forming flows there is a tendency towards covarying bankfull bed and width undulations amongst morphologic units such as pools and riffles, whereby relatively wide areas have relatively higher minimum bed elevations and relatively narrow areas have relatively lower minimum bed elevations. The goal of this study was to determine whether minimum bed elevation and flow-dependent channel top width are organized in a partially confined, incising gravel-cobbled bed river with multiple spatial scales of anthropogenic and natural landform heterogeneity across a range of discharges. A key result is that the test river exhibited covarying oscillations of minimum bed elevation and channel top width across all flows analyzed. These covarying oscillations were found to be quasiperiodic at channel-forming flows, scaling with the length scales of bars, pools and riffles. Thus, it appears that alluvial rivers organize their topography to have quasiperiodic, shallow and wide or narrow and deep cross section geometry, even despite ongoing, centennial-scale incision. Presumably these covarying oscillations are linked to hydrogeomorphic mechanisms associated with alluvial river channel maintenance. The biggest conclusion from this study is that alluvial rivers are defined more so by variability in topography and flow than mean conditions. Broader impacts of this study are that the methods provide a framework for characterizing longitudinal and flow-dependent variability in rivers for assessing geomorphic structure and aquatic habitat in space, and if repeated, through time.

  17. Availability and Structure of Ambulatory Rehabilitation Services: A Survey of Hospitals with Designated Rehabilitation Beds in Ontario, Canada

    PubMed Central

    Passalent, Laura A.; Cott, Cheryl A.

    2008-01-01

    Purpose: To determine the degree to which ambulatory physical therapy (PT), occupational therapy (OT), and speech language pathology (SLP) services are available in hospitals with designated rehabilitation beds (DRBs) in Ontario, and to explore the structure of delivery and funding among services that exist. Methods: Questions regarding ambulatory services were included in the System Integration and Change (SIC) survey sent to all hospitals participating in the Hospital Report 2005: Rehabilitation initiative. Results: The response rate was 75.9% (41 of 54 hospitals). All hospitals surveyed provide some degree of ambulatory rehabilitation services, but the nature of these services varies according to rehabilitation client groups (RCGs). The majority of hospitals continue to deliver services through their employees rather than by contracting out or by creating for-profit subsidiary clinics, but an increasing proportion is accessing private sources to finance ambulatory services. Conclusions: Most hospitals with DRBs provide some degree of ambulatory rehabilitation services. Privatization of delivery is not widespread in these facilities. PMID:20145757

  18. 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.

  19. 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…

  20. 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.

  1. 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.

  2. 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

  3. 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

    ... (U.S.C.) 1079(j)(2) that TRICARE payment methods for institutional care be determined, to the extent... Hospitals are authorized TRICARE institutional providers under 10 U.S.C. 1079(j)(2) and (4). Under 10 U.S.C. 1079(j)(2), the amount to be paid to hospitals, skilled nursing facilities, and other...

  4. 42 CFR 412.130 - Retroactive adjustments for incorrectly excluded hospitals and units.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  5. 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.

  6. 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.

  7. Large-scale synthesis of monodisperse SiC nanoparticles with adjustable size, stoichiometric ratio and properties by fluidized bed chemical vapor deposition

    NASA Astrophysics Data System (ADS)

    Liu, Rongzheng; Liu, Malin; Chang, Jiaxing

    2017-02-01

    A facile fluidized bed chemical vapor deposition method was proposed for the synthesis of monodisperse SiC nanoparticles by using the single precursor of hexamethyldisilane (HMDS). SiC nanoparticles with average particle size from 10 to 200 nm were obtained by controlling the temperature and the gas ratio. An experimental chemical vapor deposition phase diagram of SiC in the HMDS-Ar-H2 system was obtained and three regions of SiC-Si, SiC and SiC-C can be distinguished. The BET surface area and the photoluminescence properties of the SiC nanoparticles can be adjusted by changing the nanoparticle size. For the SiC nanospheres with free carbon, a novel hierarchical structure with 5 8 nm SiC nanoparticles embedded into the graphite matrix was obtained. The advantages of fluidized bed technology for the preparation of SiC nanoparticles were proposed based on the features of homogenous reaction zone, narrow temperature distribution, ultra-short reactant residence time and mass production.

  8. The barriers to and enablers of providing reasonably adjusted health services to people with intellectual disabilities in acute hospitals: evidence from a mixed-methods study

    PubMed Central

    Tuffrey-Wijne, Irene; Goulding, Lucy; Giatras, Nikoletta; Abraham, Elisabeth; Gillard, Steve; White, Sarah; Edwards, Christine; Hollins, Sheila

    2014-01-01

    Objective To identify the factors that promote and compromise the implementation of reasonably adjusted healthcare services for patients with intellectual disabilities in acute National Health Service (NHS) hospitals. Design A mixed-methods study involving interviews, questionnaires and participant observation (July 2011–March 2013). Setting Six acute NHS hospital trusts in England. Methods Reasonable adjustments for people with intellectual disabilities were identified through the literature. Data were collected on implementation and staff understanding of these adjustments. Results Data collected included staff questionnaires (n=990), staff interviews (n=68), interviews with adults with intellectual disabilities (n=33), questionnaires (n=88) and interviews (n=37) with carers of patients with intellectual disabilities, and expert panel discussions (n=42). Hospital strategies that supported implementation of reasonable adjustments did not reliably translate into consistent provision of such adjustments. Good practice often depended on the knowledge, understanding and flexibility of individual staff and teams, leading to the delivery of reasonable adjustments being haphazard throughout the organisation. Major barriers included: lack of effective systems for identifying and flagging patients with intellectual disabilities, lack of staff understanding of the reasonable adjustments that may be needed, lack of clear lines of responsibility and accountability for implementing reasonable adjustments, and lack of allocation of additional funding and resources. Key enablers were the Intellectual Disability Liaison Nurse and the ward manager. Conclusions The evidence suggests that ward culture, staff attitudes and staff knowledge are crucial in ensuring that hospital services are accessible to vulnerable patients. The authors suggest that flagging the need for specific reasonable adjustments, rather than the vulnerable condition itself, may address some of the barriers

  9. Practice Hospital Bed Safety

    MedlinePlus

    ... between the end of the rail and the side edge of the head or foot board 7. between the head or foot board and the mattress end Get Consumer Updates by E-mail Consumer Updates RSS Feed Download PDF (393 K) On this page: Beware of Entrapment ...

  10. 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.

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT... with the special rules in paragraph (c) of this section for determining the reasonable cost of this... this purpose. Posthospital SNF care furnished in general routine inpatient beds in CAHs is paid...

  12. Development and validation of a continuously age-adjusted measure of patient condition for hospitalized children using the electronic medical record.

    PubMed

    Rothman, Michael J; Tepas, Joseph J; Nowalk, Andrew J; Levin, James E; Rimar, Joan M; Marchetti, Albert; Hsiao, Allen L

    2017-02-01

    Awareness of a patient's clinical status during hospitalization is a primary responsibility for hospital providers. One tool to assess status is the Rothman Index (RI), a validated measure of patient condition for adults, based on empirically derived relationships between 1-year post-discharge mortality and each of 26 clinical measurements available in the electronic medical record. However, such an approach cannot be used for pediatrics, where the relationships between risk and clinical variables are distinct functions of patient age, and sufficient 1-year mortality data for each age group simply do not exist. We report the development and validation of a new methodology to use adult mortality data to generate continuously age-adjusted acuity scores for pediatrics. Clinical data were extracted from EMRs at three pediatric hospitals covering 105,470 inpatient visits over a 3-year period. The RI input variable set was used as a starting point for the development of the pediatric Rothman Index (pRI). Age-dependence of continuous variables was determined by plotting mean values versus age. For variables determined to be age-dependent, polynomial functions of mean value and mean standard deviation versus age were constructed. Mean values and standard deviations for adult RI excess risk curves were separately estimated. Based on the "find the center of the channel" hypothesis, univariate pediatric risk was then computed by applying a z-score transform to adult mean and standard deviation values based on polynomial pediatric mean and standard deviation functions. Multivariate pediatric risk is estimated as the sum of univariate risk. Other age adjustments for categorical variables were also employed. Age-specific pediatric excess risk functions were compared to age-specific expert-derived functions and to in-hospital mortality. AUC for 24-h mortality and pRI scores prior to unplanned ICU transfers were computed. Age-adjusted risk functions correlated well with similar

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

    PubMed Central

    2014-01-01

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

  14. Educational intervention together with an on-line quality control program achieve recommended analytical goals for bedside blood glucose monitoring in a 1200-bed university hospital.

    PubMed

    Sánchez-Margalet, Víctor; Rodriguez-Oliva, Manuel; Sánchez-Pozo, Cristina; Fernández-Gallardo, María Francisca; Goberna, Raimundo

    2005-01-01

    Portable meters for blood glucose concentrations are used at the patients bedside, as well as by patients for self-monitoring of blood glucose. Even though most devices have important technological advances that decrease operator error, the analytical goals proposed for the performance of glucose meters have been recently changed by the American Diabetes Association (ADA) to reach <5% analytical error and <7.9% total error. We studied 80 meters throughout the Virgen Macarena Hospital and we found most devices with performance error higher than 10%. The aim of the present study was to establish a new system to control portable glucose meters together with an educational program for nurses in a 1200-bed University Hospital to achieve recommended analytical goals, so that we could improve the quality of diabetes care. We used portable glucose meters connected on-line to the laboratory after an educational program for nurses with responsibilities in point-of-care testing. We evaluated the system by assessing total error of the glucometers using high- and low-level glucose control solutions. In a period of 6 months, we collected data from 5642 control samples obtained by 14 devices (Precision PCx) directly from the control program (QC manager). The average total error for the low-level glucose control (2.77 mmol/l) was 6.3% (range 5.5-7.6%), and even lower for the high-level glucose control (16.66 mmol/l), at 4.8% (range 4.1-6.5%). In conclusion, the performance of glucose meters used in our University Hospital with more than 1000 beds not only improved after the intervention, but the meters achieved the analytical goals of the suggested ADA/National Academy of Clinical Biochemistry criteria for total error (<7.9% in the range 2.77-16.66 mmol/l glucose) and optimal total error for high glucose concentrations of <5%, which will improve the quality of care of our patients.

  15. Bed Bugs

    EPA Pesticide Factsheets

    Prevent, identify, and treat bed bug infestations using EPA’s step-by-step guides, based on IPM principles. Find pesticides approved for bed bug control, check out the information clearinghouse, and dispel bed bug myths.

  16. Adding Laboratory Data to Hospital Claims Data to Improve Risk Adjustment of Inpatient/30-Day Postdischarge Outcomes.

    PubMed

    Pine, Michael; Fry, Donald E; Hannan, Edward L; Naessens, James M; Whitman, Kay; Reband, Agnes; Qian, Feng; Schindler, Joseph; Sonneborn, Mark; Roland, Jaclyn; Hyde, Linda; Dennison, Barbara A

    Numerical laboratory data at admission have been proposed for enhancement of inpatient predictive modeling from administrative claims. In this study, predictive models for inpatient/30-day postdischarge mortality and for risk-adjusted prolonged length of stay, as a surrogate for severe inpatient complications of care, were designed with administrative data only and with administrative data plus numerical laboratory variables. A comparison of resulting inpatient models for acute myocardial infarction, congestive heart failure, coronary artery bypass grafting, and percutaneous cardiac interventions demonstrated improved discrimination and calibration with administrative data plus laboratory values compared to administrative data only for both mortality and prolonged length of stay. Improved goodness of fit was most apparent in acute myocardial infarction and percutaneous cardiac intervention. The emergence of electronic medical records should make the addition of laboratory variables to administrative data an efficient and practical method to clinically enhance predictive modeling of inpatient outcomes of care.

  17. 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.

  18. Recurrent Hospitalization Among Patients With Atrial Fibrillation Undergoing Intracoronary Stenting Treated With 2 Treatment Strategies of Rivaroxaban or a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy

    PubMed Central

    Pinto, Duane S.; Chi, Gerald; Arbetter, Douglas; Yee, Megan; Mehran, Roxana; Bode, Christoph; Halperin, Jonathan; Verheugt, Freek W.A.; Wildgoose, Peter; Burton, Paul; van Eickels, Martin; Korjian, Serge; Daaboul, Yazan; Jain, Purva; Lip, Gregory Y.H.; Cohen, Marc; Peterson, Eric D.; Fox, Keith A.A.

    2017-01-01

    Background: Patients with atrial fibrillation who undergo intracoronary stenting traditionally are treated with a vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT), yet this treatment leads to high risks of bleeding. We hypothesized that a regimen of rivaroxaban plus a P2Y12 inhibitor monotherapy or rivaroxaban plus DAPT could reduce bleeding and thereby have a favorable impact on all-cause mortality and the need for rehospitalization. Methods: Stented subjects with nonvalvular atrial fibrillation (n=2124) were randomized 1:1:1 to administration of reduced-dose rivaroxaban 15 mg daily plus a P2Y12 inhibitor for 12 months (group 1); rivaroxaban 2.5 mg twice daily with stratification to a prespecified duration of DAPT of 1, 6, or 12 months (group 2); or the reference arm of dose-adjusted VKA daily with a similar DAPT stratification (group 3). The present post hoc analysis assessed the end point of all-cause mortality or recurrent hospitalization for an adverse event, which was further classified as the result of bleeding, a cardiovascular cause, or another cause blinded to treatment assignment. Results: The risk of all-cause mortality or recurrent hospitalization was 34.9% in group 1 (hazard ratio=0.79; 95% confidence interval, 0.66–0.94; P=0.008 versus group 3; number needed to treat=15), 31.9% in group 2 (hazard ratio=0.75; 95% confidence interval, 0.62–0.90; P=0.002 versus group 3; number needed to treat=10), and 41.9% in group 3 (VKA+DAPT). Both all-cause death plus hospitalization potentially resulting from bleeding (group 1=8.6% [P=0.032 versus group 3], group 2=8.0% [P=0.012 versus group 3], and group 3=12.4%) and all-cause death plus rehospitalization potentially resulting from a cardiovascular cause (group 1=21.4% [P=0.001 versus group 3], group 2=21.7% [P=0.011 versus group 3], and group 3=29.3%) were reduced in the rivaroxaban arms compared with the VKA arm, but other forms of rehospitalization were not. Conclusions: Among patients with

  19. Determinants of hospital closure in South Korea: use of a hierarchical generalized linear model.

    PubMed

    Noh, Maengseok; Lee, Youngjo; Yun, Sung-Cheol; Lee, Sang-Il; Lee, Moo-Song; Khang, Young-Ho

    2006-11-01

    Understanding causes of hospital closure is important if hospitals are to survive and continue to fulfill their missions as the center for health care in their neighborhoods. Knowing which hospitals are most susceptible to closure can be of great use for hospital administrators and others interested in hospital performance. Although prior studies have identified a range of factors associated with increased risk of hospital closure, most are US-based and do not directly relate to health care systems in other countries. We examined determinants of hospital closure in a nationally representative sample: 805 hospitals established in South Korea before 1996 were examined-hospitals established in 1996 or after were excluded. Major organizational changes (survival vs. closure) were followed for all South Korean hospitals from 1996 through 2002. With the use of a hierarchical generalized linear model, a frailty model was used to control correlation among repeated measurements for risk factors for hospital closure. Results showed that ownership and hospital size were significantly associated with hospital closure. Urban hospitals were less likely to close than rural hospitals. However, the urban location of a hospital was not associated with hospital closure after adjustment for the proportion of elderly. Two measures for hospital competition (competitive beds and 1-Hirshman--Herfindalh index) were positively associated with risk of hospital closure before and after adjustment for confounders. In addition, annual 10% change in competitive beds was significantly predictive of hospital closure. In conclusion, yearly trends in hospital competition as well as the level of hospital competition each year affected hospital survival. Future studies need to examine the contribution of internal factors such as management strategies and financial status to hospital closure in South Korea.

  20. 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

  1. 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.

  2. 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.

  3. 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

  4. Emergency Department Crowding and the Use of Nontraditional Beds

    PubMed Central

    McNaughton, Candace; Self, Wesley H.; Jones, Ian D.; Arbogast, Patrick G.; Chen, Ning; Dittus, Robert S.; Russ, Stephan

    2014-01-01

    Background and Objectives In an effort to compensate for crowding, many emergency departments (EDs) evaluate and treat patients in nontraditional settings such as gurneys in hallways and conference rooms. The impact of this practice on ED evaluation time is unknown. Research Design and Subjects An historical cohort of adult ED visits to an academic hospital between 8/1/2009 and 8/1/2010 was used to evaluate the relationship between ED bed assignment (traditional, hallway, or conference room bed) and mean ED evaluation time, defined as the time spent in an ED bed before admission or discharge. Chief complaints were categorized into the five most frequent categories: abdominal/genitourinary, joint/muscle, general (fever, malaise), head/neck, and other. Multiple linear regression and marginal prediction were used to calculate mean ED evaluation times for each bed type, overall and by chief complaint category. Results During the study period, 15,073 patient visits met inclusion criteria. After adjustment for patient and ED factors, assignments to hallway and conference room beds were associated with increases in mean ED evaluation time of 13.3 minutes (95% confidence interval 13.2, 13.3) and 10.9 minutes (95% CI 10.8, 10.9), respectively, compared to the traditional bed ED evaluation time. This varied by chief complaint category. Conclusions Use of nontraditional beds is associated with increases in mean ED evaluation time; however, these increases are small and may be further minimized by restricting use of nontraditional beds to patients with specific chief complaints. Nontraditional beds may have a role in improving ED throughput during times of crowding. PMID:22386355

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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.

  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. 21 CFR 880.6060 - Medical disposable bedding.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical disposable bedding. 880.6060 Section 880...) 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...

  13. Bed bugs in healthcare settings.

    PubMed

    Munoz-Price, L Silvia; Safdar, Nasia; Beier, John C; Doggett, Stephen L

    2012-11-01

    Infestations caused by bed bugs have resurfaced during the past decade across all continents. Even though bed bugs primarily cause skin manifestations in humans, a major stigma is placed upon people or institutions found to carry them. It is important for healthcare facilities to be prepared for this pest by implementing policies, carefully selecting materials used for hospital furniture, and educating providers on early identification and control.

  14. Novel non-contact control system of electric bed for medical healthcare.

    PubMed

    Lo, Chi-Chun; Tsai, Shang-Ho; Lin, Bor-Shyh

    2017-03-01

    A novel non-contact controller of the electric bed for medical healthcare was proposed in this study. Nowadays, the electric beds are widely used for hospitals and home-care, and the conventional control method of the electric beds usually involves in the manual operation. However, it is more difficult for the disabled and bedridden patients, who might totally depend on others, to operate the conventional electric beds by themselves. Different from the current controlling method, the proposed system provides a new concept of controlling the electric bed via visual stimuli, without manual operation. The disabled patients could operate the electric bed by focusing on the control icons of a visual stimulus tablet in the proposed system. Besides, a wearable and wireless EEG acquisition module was also implemented to monitor the EEG signals of patients. The experimental results showed that the proposed system successfully measured and extracted the EEG features related to visual stimuli, and the disabled patients could operate the adjustable function of the electric bed by themselves to effectively reduce the long-term care burden.

  15. Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds

    PubMed Central

    Teno, Joan M.; Gozalo, Pedro; Khandelwal, Nita; Curtis, J. Randall; Meltzer, David; Engelberg, Ruth; Mor, Vincent

    2016-01-01

    IMPORTANCE Mechanical ventilation may be lifesaving, but in certain persons, such as those with advanced dementia, it may prolong patient suffering without a clear survival benefit. OBJECTIVE To describe the use and outcomes of mechanical ventilation and its association with the increasing numbers of intensive care unit (ICU) beds in the United States for patients with advanced dementia residing in a nursing home 120 days before that hospital admission. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study evaluated Medicare beneficiaries with advanced dementia hospitalized from January 1, 2000, to December 31, 2013, using the Minimum Data Set assessments linked with Medicare part A claims. A hospital fixed-effect, multivariable logistic regression model examined the effect of changes in ICU beds within individual hospitals and the likelihood of receiving mechanical ventilation, controlling for patients’ demographic characteristics, function, and comorbidities. MAIN OUTCOMES AND MEASURES Mechanical ventilation. RESULTS From 2000 to 2013, a total of 635 008 hospitalizations of 380 060 eligible patients occurred (30.5% male and 69.5% female; mean [SD] age, 84.4 [7.4] years). Use of mechanical ventilation increased from 39 per 1000 hospitalizations in 2000 to 78 per 1000 hospitalizations in 2013 (P < .001, test of linear trend). As the number of ICU beds in a hospital increased over time, patients with advanced dementia were more likely to receive mechanical ventilation (ie, adjusted odds ratio per 10 ICU bed increase, 1.06; 95% CI, 1.05–1.07). In 2013, hospitals in the top decile in the number of ICU beds were reimbursed $9611.89 per hospitalization compared with $8050.24 per hospitalization in the lower decile (P < .001) without an improvement in 1-year mortality (65.2% vs 64.6%; P = 54). CONCLUSIONS AND RELEVANCE Among hospitalized nursing home residents with advanced dementia, we found an increase in the use of mechanical ventilation over time

  16. 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

  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

    2016-06-09

    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.

  18. 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

  19. Capping risk adjustment?

    PubMed

    Eugster, Patrick; Sennhauser, Michèle; Zweifel, Peter

    2010-07-01

    When premiums are community-rated, risk adjustment (RA) serves to mitigate competitive insurers' incentive to select favorable risks. However, unless fully prospective, it also undermines their incentives for efficiency. By capping its volume, one may try to counteract this tendency, exposing insurers to some financial risk. This in term runs counter the quest to refine the RA formula, which would increase RA volume. Specifically, the adjuster, "Hospitalization or living in a nursing home during the previous year" will be added in Switzerland starting 2012. This paper investigates how to minimize the opportunity cost of capping RA in terms of increased incentives for risk selection.

  20. Chiropractic Adjustment

    MedlinePlus

    ... structural alignment and improve your body's physical function. Low back pain, neck pain and headache are the most common ... treated. Chiropractic adjustment can be effective in treating low back pain, although much of the research done shows only ...

  1. Adjustment disorder

    MedlinePlus

    ... from other people Skipped heartbeats and other physical complaints Trembling or twitching To have adjustment disorder, you ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  2. 21 CFR 880.6070 - Bed board.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Bed board. 880.6070 Section 880.6070 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Miscellaneous Devices §...

  3. 21 CFR 880.6070 - Bed board.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  4. 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.

  5. Variation in management of community-acquired pneumonia requiring admission to Alberta, Canada hospitals.

    PubMed Central

    Jin, Y.; Marrie, T. J.; Carriere, K. C.; Predy, G.; Houston, C.; Ness, K.; Johnson, D. H.

    2003-01-01

    Previous studies have shown small area variation in the rate of admission to hospital for patients with community-acquired pneumonia. We determined the rates of admission and length of stay for patients with community-acquired pneumonia in Alberta and the factors influencing admission rates and length of stay. Using hospital abstracts, hospital admissions for community-acquired pneumonia from 1 April 1994 to 31 March 1999 were compared. We classified Alberta hospitals according to geographical regions, by the number of beds, and by number of community-acquired pneumonia cases. There were 12,000 annual hospital discharges for community-acquired pneumonia costing over $40 million per year. The overall in-hospital mortality rate was 12% and the 1 year mortality rate was 26%. Compared with rural hospitals, regional and metropolitan hospitals admitted patients with greater severity of illness as demonstrated by greater in-hospital mortality, cost per case and comorbidity. Age-sex adjusted hospital discharge rates were significantly below the provincial average in both urban regions. Hospital discharge rates for residents in all rural regions and 4 of 5 regions with a regional hospital were significantly higher than the provincial average. After adjusting for comorbidity, the relative risk for a longer length of stay was 22% greater in regional hospitals and about 30% greater in urban hospitals compared to rural hospitals. Seasonal variation in the admission rate was evident, with higher rates in the winter of each year. We conclude that rural hospitals would be likely to benefit from a protocol to help with the admission decision and urban hospitals from a programme to reduce length of stay. PMID:12613744

  6. 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 ...

  7. 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.

  8. 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.

  9. 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,…

  10. 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.

  11. 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

  12. 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.

  13. A new method for adjusting the lateral transfer hollow retroreflector

    NASA Astrophysics Data System (ADS)

    Ershov, Alexandr G.

    2013-05-01

    A new method for adjusting the lateral transfer hollow retroreflector is presented. It allows in a simple way to adjust the hollow retroreflectors with a lateral shifting. It enables to make the manufacturing process of adjustable lateral hollow retroreflectors easier and cheaper. The testing optical bed of this method is displayed. The evaluation of uncertainties and a limit value for this method are given.

  14. 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

  15. 42 CFR 412.316 - Geographic adjustment factors.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for Capital-Related Costs § 412.316 Geographic adjustment factors. (a) Local cost variation. CMS adjusts for local cost variation based on the hospital wage index value that is applicable to the hospital under subpart D of...

  16. Hospital competition and inpatient services efficiency in Taiwan: a longitudinal study.

    PubMed

    Chu, Chiao-Lee; Chiang, Tung-Liang; Chang, Ray-E

    2011-10-01

    There is no consistent evidence of the relationship between market competition and hospital efficiency. Some studies indicated that more competition led to a faster patient turnover rate, higher hospital costs, and lower hospital efficiency. Since the 1980s some studies found market competition could increase the efficiency of inpatient services. However, there were few studies testing the market competition during a hospital's earlier stages on its efficiency during later stages, or the dynamic of efficiency. In this study, we examined the effect of early-stage market competition on later-stage hospital efficiency in Taiwan, and we determine the efficiency change using longitudinal study design. The data for the analysis came from the annual national hospital survey of 1996 and 2001 provided by the Department of Health. There were 102 teaching hospital be analysed. The results show that no evidence supports the proposition that higher market competition would improve the efficiency of hospitals in delivering inpatient services in Taiwan. Importantly, neither was the inefficiency score nor the Malmquist productivity index of inpatient services associated with the level of hospital market competition, regardless of the adjustment for hospital characteristics. However, the results may be related with the hospital increasing beds investment behavior.

  17. 7 CFR 2902.15 - Bedding, bed linens, and towels.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  18. 7 CFR 3201.15 - Bedding, bed linens, and towels.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

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

  19. 7 CFR 3201.15 - Bedding, bed linens, and towels.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

  20. 7 CFR 2902.15 - Bedding, bed linens, and towels.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  1. 7 CFR 3201.15 - Bedding, bed linens, and towels.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

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

  2. Summary of mental disorder hospitalizations, active and reserve components, U.S. Armed Forces, 2000-2012.

    PubMed

    2013-07-01

    Mental disorders are the leading cause of hospital bed days and the second leading cause of medical encounters for active component service members in the U.S. military. Mental disorder-related hospitalizations among military members have increased in both number and duration since 2006; mental disorders are the only illness/injury category for which hospitalization rates have markedly increased during the first 11 years of the Iraq and Afghanistan wars. Between 2000 and 2012, 159,107 active component service members experienced 192,317 mental disorder hospitalizations. There were approximately 87 percent more mental disorder-related hospitalizations in 2011 (n=21,646) than in 2000 (n=11,604); in 2012, this number declined slightly (n=21,360). The overall increase since 2006 was largely due to sharp increases in hospitalizations for post-traumatic stress disorder (PTSD), depression, alcohol abuse and dependence, and adjustment disorder (% increases in hospitalizations, 2006-2012: PTSD: 192%; depression: 66%; alcohol abuse and dependence: 110%; adjustment disorders: 52%). Similar rates of increase occured among members of the reserve component. The percentage of mental disorder hospitalization records with a second (concurrent) mental disorder diagnosis increased during the surveillance period; more than half of all service members hospitalized for a mental disorder have a second mental disorder diagnosis documented during the same hospitalization.

  3. 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.

  4. Frequent manual repositioning and incidence of pressure ulcers among bed-bound elderly hip fracture patients.

    PubMed

    Rich, Shayna E; Margolis, David; Shardell, Michelle; Hawkes, William G; Miller, Ram R; Amr, Sania; Baumgarten, Mona

    2011-01-01

    Frequent manual repositioning is an established part of pressure ulcer prevention, but there is little evidence for its effectiveness. This study examined the association between repositioning and pressure ulcer incidence among bed-bound elderly hip fracture patients, using data from a 2004-2007 cohort study in nine Maryland and Pennsylvania hospitals. Eligible patients (n=269) were age ≥ 65 years, underwent hip fracture surgery, and were bed-bound at index study visits (during the first 5 days of hospitalization). Information about repositioning on the days of index visits was collected from patient charts; study nurses assessed presence of stage 2+ pressure ulcers 2 days later. The association between frequent manual repositioning and pressure ulcer incidence was estimated, adjusting for pressure ulcer risk factors using generalized estimating equations and weighted estimating equations. Patients were frequently repositioned (at least every 2 hours) on only 53% (187/354) of index visit days. New pressure ulcers developed at 12% of visits following frequent repositioning vs. 10% following less frequent repositioning; the incidence rate of pressure ulcers per person-day did not differ between the two groups (incidence rate ratio 1.1, 95% confidence interval 0.5-2.4). No association was found between frequent repositioning of bed-bound patients and lower pressure ulcer incidence, calling into question the allocation of resources for repositioning.

  5. 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.

  6. 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.

  7. 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.

  8. Bed material agglomeration during fluidized bed combustion

    SciTech Connect

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

    1993-02-01

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

  9. Bed Bugs and Schools

    EPA Pesticide Factsheets

    Bed bugs have long been a pest – feeding on blood, causing itchy bites and generally irritating their human hosts. They are successful hitchhikers, and can move from an infested site to furniture, bedding, baggage, boxes, and clothing.

  10. Bed rest during pregnancy

    MedlinePlus

    ... on the inferior vena cava. How Can I Deal with Discomfort from Bed Rest? Bed rest can ... Group Health Cooperative, Bellevue, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the ...

  11. Introduction to Bed Bugs

    EPA Pesticide Factsheets

    The common bed bug (Cimex lectularius) is a pest – feeding on blood, causing itchy bites and generally irritating their human hosts. EPA and other agencies all consider bed bugs a public health pest, but bed bugs are not known to transmit disease.

  12. 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.

  13. 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

  14. An Analysis of a Program to Identify and Quantify Standards of Performance for U.S. Army Hospital Food Services for the Purpose of Quality Assurance

    DTIC Science & Technology

    1982-08-01

    the wards. 3. Silas B. Hays Army Cormnunity Hospital is located at Fort Ord, California. The hospital has 169 operating beds . A number of specialties... Hospital is a 238 bed hospital located at Fort Leonard Wood, Missouri. The majority of patients seen are basic trainees with relatively minor injuries...home of the Army Command and General Staff College and the Army Detention Facility. The hospital is a 46 bed hospital averaging about 34 occupied beds

  15. Collaborative Strategy on Bed Bugs

    EPA Pesticide Factsheets

    The Collaborative Strategy on Bed Bugs was developed by the Federal Bed Bug Workgroup to clarify the federal role in bed bug control and highlight ways that government, community, academia and private industry can work together on bed bug issues.

  16. Going to the Hospital

    MedlinePlus

    ... taking care of you — to explain. continue Your Room Once you're in the hospital, you may have a room all to yourself or you might share one with another kid. Your room will have a bed, usually with buttons to ...

  17. Who knows the bed bug? Knowledge of adult bed bug appearance increases with people's age in three counties of Great Britain.

    PubMed

    Reinhardt, Klaus; Harder, Anton; Holland, Stephanie; Hooper, Jennifer; Leake-Lyall, Clark

    2008-09-01

    The current reemergence of bed bugs in the western world has a multitude of causes. One of them may be low early detection rate of emerging infestations because of a current poor knowledge among the population of what bed bugs look like. In a survey conducted in three counties of the United Kingdom, 10% of 358 individuals recognized the bed bug when presented with a live adult. Older people were more likely to correctly identify the bed bug. If an increasing knowledge of the bed bug appearance facilitates early detection of infestations, the hospitality and travel industry may benefit from educating their staff on the bed bug appearance.

  18. 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.

  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. 21 CFR 880.6060 - Medical disposable bedding.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... intended for medical purposes to be used by one patient for a period of time and then discarded. This... 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...

  1. 21 CFR 880.2400 - Bed-patient monitor.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Bed-patient monitor. 880.2400 Section 880.2400 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use...

  2. Rate of spontaneous voiding recovery after acute urinary retention due to bed rest in the hospital setting in a non-urological population clinical study of the relationship between lower limbs and bladder function

    PubMed Central

    Rodrigues, Paulo; Hering, Flávio; Cieli, Eli; Campagnari, João Carlos

    2016-01-01

    Abstract Objectives To understand the clinical relationship between lower limbs functions and the recovery of spontaneous voiding after an acute urinary retention (AUR) in older patients admitted to hospitals for non-urological causes using clinical parameters. Materials and Methods 56 adult patients (32 men; mean age: 77.9 ± 8.3 and 24 women; mean age 82.1 ± 4.6) with AUR were prospectively followed with validated Physical Performance Mobility Exam (PPME) instrument to evaluate the relationship between the recovery of mobility capacity and spontaneous voiding. After a short period of permanent bladder drainage patients started CIC along evaluation by PPME during hospitalization and at 7, 15, 30 60, 90, and 180 days of discharge. Mann-Whitney U, chi-square test and ANOVA tests were used. Results All patients were hospitalized for at least 15 days (Median 26.3 ± 4.1 days). Progressive improvement on mobility scale measured by PPME was observed after leaving ICU and along the initial 7 days of hospitalization but with a deterioration if hospitalization extends beyond 15 days (p<0.03). Prolonged hospital stay impairs mobility in all domains (p<0.05) except step-up and transfer skills (p<0.02) although a recovery rate on spontaneous voiding persistented. Restoration of spontaneous voiding was accompanied by improvement on mobility scale (p<0.02). Recovery of spontaneous voiding was markedly observed after discharging the hospital. All patients recovered spontaneous voiding until 6 months of follow-up. Conclusions Recovery to spontaneous voiding after acute urinary retention in the hospital setting may be anticipated by evaluation of lower limbs function measured by validated instruments. PMID:27532117

  3. Fluidized-bed boilers

    SciTech Connect

    Makansi, J.; Schwieger, B.

    1982-08-01

    This report reviews the current state of atmospheric fluidized-bed combustion. The fundamentals of fluidized-bed combustion and design considerations are first discussed. Tables provide details of manufacturers, worldwide, and of the boilers now installed. Eight plants in various countries and burning a variety of fuels, are described more fully.

  4. 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.

  5. Bed Bugs FAQs

    MedlinePlus

    ... allow them to fit into the smallest of spaces and stay there for long periods of time, even without a blood meal. Bed bugs are usually transported from place to place as people travel. The bed bugs travel in the seams and ...

  6. Awareness campaign. Orthopedic Hospital of Oklahoma launches awareness campaign.

    PubMed

    2007-01-01

    The Orthopedic Hospital of Oklahoma is a 25-bed inpatient and outpatient center with one focus: Orthopedics. To acquaint people with its services and build brand awareness to drive market share, the hospital launched a print campaign featuring actual patients.

  7. 75 FR 34614 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-17

    ..., 2010 unless otherwise footnoted).'' c. Third column, the title, ``Table 4J.--Out-Migration Adjustment...) Out-Migration Adjustment for Acute Care Hospitals--FY 2010 (April 1, 2010 through September 30, 2010...: Table 4J--(Abbreviated) Out-Migration Adjustment for Acute Care Hospitals--FY 2010 (April 1,...

  8. Turning patients over in bed

    MedlinePlus

    Roll patients in bed ... following steps should be followed: Explain to the patient what you are planning to do so the ... Stand on the side of the bed the patient will be turning towards and lower the bed ...

  9. Bed Bug Information Clearinghouse

    EPA Pesticide Factsheets

    Its purpose is to help states, communities, and consumers in efforts to prevent and control bed bug infestations. Currently includes only reviewed material from federal/state/local government agencies, extension services, and universities.

  10. Bed Bug Tips

    EPA Pesticide Factsheets

    How to deal with bed bugs in one printable page. Ten tips include ensuring correct insect identification, reducing clutter, understand integrated pest management, using mattress and box spring encasements, and heat treatment.

  11. 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.

  12. Particle fuel bed tests

    SciTech Connect

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

    1985-01-01

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

  13. Moving-bed sorbents

    SciTech Connect

    Ayala, R.E.; Gupta, R.P.; Chuck, T.

    1995-12-01

    The objective of this program is to develop mixed-metal oxide sorbent formulations that are suitable for moving-bed, high-temperature, desulfurization of coal gas. Work continues on zinc titanates formulations and Z-sorb III sorbent.

  14. The comparative economic performance of investor-owned chain and not-for-profit hospitals.

    PubMed

    Watt, J M; Derzon, R A; Renn, S C; Schramm, C J; Hahn, J S; Pillari, G D

    1986-01-09

    We examined the differences in the economic performance of 80 matched pairs of investor-owned chain and not-for-profit hospitals in eight states during 1978 and 1980, and considered how their operating strategies might affect their relative success in a more price-conscious market. We found that total charges (adjusted for case mix) and net revenues per case were both significantly higher in the investor-owned chain hospitals, mainly because of higher charges for ancillary services; there were no significant differences between the two groups of hospitals in regard to patient-care costs per case (adjusted for case mix), but the investor-owned hospitals had significantly higher administrative overhead costs; investor-owned hospitals were more profitable; investor-owned hospitals had fewer employees per occupied bed but paid more per employee; investor-owned hospitals had funded more of their capital through debt and had significantly higher capital costs in proportion to their operating costs; and the two groups did not differ in patient mix, as measured by their Medicare case-mix indexes or the proportions of their patients covered by Medicare or Medicaid. We conclude that investor-owned chain hospitals generated higher profits through more aggressive pricing practices rather than operating efficiencies - a result not unexpected in view of past cost-based reimbursement policies. Recent changes in these policies are creating new pressures for cost control and moderation in charges, to which both types of hospitals must adapt. Neither type has a clear-cut advantage in the ability to make the necessary changes.

  15. 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

  16. 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.

  17. 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.

  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. 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.

  20. 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.

  1. 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.

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

    PubMed Central

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

    1985-01-01

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

  3. Anomalous Sinking of Spheres due to Local Fluidization of Apparently Fixed Powder Beds.

    PubMed

    Oshitani, Jun; Sasaki, Toshiki; Tsuji, Takuya; Higashida, Kyohei; Chan, Derek Y C

    2016-02-12

    The sinking of an intruder sphere into a powder bed in the apparently fixed bed regime exhibits complex behavior in the sinking rate and the final depth when the sphere density is close to the powder bed density. Evidence is adduced that the intruder sphere locally fluidizes the apparently fixed powder bed, allowing the formation of voids and percolation bubbles that facilitates spheres to sink slower but deeper than expected. By adjusting the air injection rate and the sphere-to-powder bed density ratio, this phenomenon provides the basis of a sensitive large particle separation mechanism.

  4. EPA-Registered Bed Bug Products

    MedlinePlus

    ... Pest Bed Bugs EPA Registered Bed Bug Products EPA-Registered Bed Bug Products Resources Bed Bug Main ... Bugs Tips Joint Statement on Bed Bug Control EPA has developed a search tool that can help ...

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

    PubMed

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

    1992-08-01

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

  6. Changes in woody debris and bed material texture in a gravel-bed channel

    NASA Astrophysics Data System (ADS)

    Haschenburger, Judith K.; Rice, Stephen P.

    2004-06-01

    This study investigated the response of bed material texture under two distinct periods of log jam conditions in a 900-m study reach of Carnation Creek, Vancouver Island, BC. A field program extending over seven flood seasons, coupled with existing streamflow records, channel maps, and low-altitude aerial photography, provides observations of jam stability and permeability, surface and subsurface grain-size, as well as bed material fluxes, sediment supply calibre, streambed stability, and sediment exchange near jams. All jams functioned as partial dams throughout the field program, but the overall perturbation of sediment transfers decreased when two jams were breached. Bed material texture exhibited the largest differences over the study reach during a period when log jams exerted a stronger influence over the passage of water and sediment. At individual gravel bars, most adjustments in surface and subsurface grain-size constituted less than a 20% change in percentile values. Larger changes occurred primarily in subsurface sediment. Temporal patterns in bed material texture exhibited variation between bars, but downstream of breached jams, surface sediment conformed to the expected fining trend, while the subsurface sediment increased in size. Surface and subsurface sediments evolved in the same direction only 64% of the time, and the different magnitudes of adjustment caused local armor ratios to vary over time. Results highlight that the temporal dynamism of large woody debris (LWD) should be coupled with spatial considerations for effective stream restoration and management of streambed sediment.

  7. An Adjustment for Nonresponse in Sample Surveys.

    ERIC Educational Resources Information Center

    Daniel, Wayne W.; And Others

    1982-01-01

    To test the use of Bayes's theorem to adjust for nonresponse bias, 600 hospitals were used in a simulated sample survey. On the basis of known information on five variables, Bayes's formula correctly predicted the status of 92 of the 100 "nonrespondents" relative to a sixth variable. (Author/BW)

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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

  13. 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

  14. 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

  15. 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.

  16. An analysis of the inpatient charge and length of stay for patients with joint diseases in Korea: specialty versus small general hospitals.

    PubMed

    Kim, Sun Jung; Park, Eun-Cheol; Jang, Sung In; Lee, Minjee; Kim, Tae Hyun

    2013-11-01

    In 2011, the Korean government designated hospitals with certain structural characteristics as specialty hospitals. This study compared the inpatient charges and length of stay of patients with joint diseases treated at these specialty hospitals with those of patients treated at small general hospitals. In addition, the study investigated whether the designation of certain hospitals as specialty hospitals had an effect on inpatient charges and length of stay. Multi-level models were used to perform regression analyses on inpatient claims data (N=268,809) for 2010-2012 because of the hierarchical structure of the data. The inpatient charge at specialty hospitals was 19% greater than that at small general hospitals, but the length of stay was 21% shorter. After adjusting for patient and hospital level confounders, specialty hospitals had a higher inpatient charge (34.6%) and a reduced length of stay (31.7%). However, the effect of specialty hospital designation on inpatient charge (2.7% higher) and length of stay (2.3% longer) was relatively smaller. Among the patient characteristics, female gender, age, and severity of illness were positively associated with inpatient charge and length of stay. In terms of location, hospitals in metropolitan area had higher inpatient charges (5.5%), but much shorter length of stay (-14%). Several structural factors, such as occupancy rate, bed size, number of outpatients and nurses were positively associated with both inpatient charges and length of stay. However, number of specialists was positively associated with inpatient charges, but negatively associated with length of stay. In sum, this study found that specialty hospitals treating joint diseases tend to incur higher charges but produce shorter length of stay, compared to their counterparts. Specialty hospitals' overcharging behaviors, although shorter length of stay, suggest that policy makers could introduce bundled payments for the joint procedures. To promote a successful

  17. Distributor for multistage fluidized beds

    SciTech Connect

    Wormser, A.

    1992-06-16

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

  18. 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.

  19. 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.

  20. 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.

  1. 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

  2. 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.

  3. Virtual Test Bed

    DTIC Science & Technology

    2016-06-07

    project is to develop a benchmark system for evaluating models for predicting the characteristics of ocean wind waves. SCIENTIFIC OBJECTIVES A...to be assembled within the virtual test bed. Wind fields for running these tests will be obtained from Oceanweather, Inc. from a separate ONR

  4. Bed Bug Myths

    EPA Pesticide Factsheets

    Learn the truth about bed bugs, such as how easy they are to see with the naked eye, their preferred habitat, whether they transmit diseases, their public health effects, and whether pesticides are the best way to deal with an infestation.

  5. MULTISTAGE FLUIDIZED BED REACTOR

    DOEpatents

    Jonke, A.A.; Graae, J.E.A.; Levitz, N.M.

    1959-11-01

    A multistage fluidized bed reactor is described in which each of a number of stages is arranged with respect to an associated baffle so that a fluidizing gas flows upward and a granular solid downward through the stages and baffles, whereas the granular solid stopsflowing downward when the flow of fluidizing gas is shut off.

  6. Norovirus - hospital

    MedlinePlus

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

  7. 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

  8. Observations of event-based streambed deformation in a gravel bed channel

    NASA Astrophysics Data System (ADS)

    Haschenburger, Judith K.

    2006-11-01

    The streambed is the major source of bed load sediment in gravel bed channels and is necessarily deformed during floods that mobilize sediment. This study uses observations of scour and fill from Carnation Creek, Canada, to articulate at-a-point relations of the occurrence and magnitude of bed deformation and the resulting adjustments in bed configuration over a series of flood events. The likelihood of local bed deformation by scour, fill, or both depends on flow magnitude. At most locations, there is an imbalance of scour and fill that leads to adjustments in bed elevation, and these imbalances increase with flow. Persistent deformation of locations in lower portions of the bed topography tend to produce larger total exchanges between bed and mobile sediment over the flood series but locations that experience similar frequencies of bed deformation do not produce unique depth distributions. These results underscore the importance of understanding the coupling of scour and fill that produces streambed adjustment when modeling streambed evolution and managing river habitat.

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

    NASA Astrophysics Data System (ADS)

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

    2013-04-01

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

  10. Bed Bug Clearinghouse by Topic

    EPA Pesticide Factsheets

    This information is intended to help states, communities, and consumers prevent and control bed bug infestations. Topics include bed bug biology and behavior, detection and monitoring, non-chemical techniques such as heat treatment, and pesticides.

  11. Width adjustment: relative dominance in unstable alluvial streams

    USGS Publications Warehouse

    Simon, Andrew

    1994-01-01

    The mechanisms that control the relative dominance of width adjustment in unstable streams are described. Specifically, the role of the following factors affecting the fluvial environment were investigated: vertical processes and fluvial action, bed-material particle, cohesive strength of bank material, and riparian vegetation.

  12. 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.

  13. Debris-bed friction of hard-bedded glaciers

    NASA Astrophysics Data System (ADS)

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

    2005-06-01

    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.

  14. Debris-Bed Friction of Hard-Bedded Glaciers

    NASA Astrophysics Data System (ADS)

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

    2004-12-01

    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 non-rotating spherical rock particles are held in frictional contact with the bed by bed-normal ice flow can account for these measurements if ice is Newtonian. Numerical calculations of the bed-normal drag force on a sphere in contact with a flat bed 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 200~m thick glacier sliding at 20~m a-1 with a geothermally induced melt rate of 0.006~m a-1 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.

  15. 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.

  16. Fluidized-bed boilers

    SciTech Connect

    Makansi, J.; Schwieger, B.

    1982-08-01

    Discusses atmospheric fluidized-bed (AFB) boilers with regard to designs available, manufacturers involved, and operating experience. Proven fuel flexibility and satisfactory SO/sub 2/ control without scrubbers make AFB boilers a viable option for industrial steam generation worldwide. Technical concepts on which AFB application is based are a departure from the more familiar methods of burning solid fuels. Behind US thrust for AFB development is the need to burn coal within pollution regulations.

  17. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Payment System for Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data. CMS... number of inpatient days in the acute inpatient area of the hospital by the number of days in the...

  18. 42 CFR 412.316 - Geographic adjustment factors.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... adjustment under this section is based on a hospital's location for the purpose of receiving payment under....316 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System...

  19. 42 CFR 412.320 - Disproportionate share adjustment factor.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., the payment adjustment under this section is based on a hospital's location, for the purpose of... Section 412.320 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective...

  20. 42 CFR 412.316 - Geographic adjustment factors.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... adjustment under this section is based on a hospital's location for the purpose of receiving payment under....316 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System...

  1. Combustion in fluidized beds

    SciTech Connect

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

    1990-07-01

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

  2. Spotlight on free beds.

    PubMed

    Bailey, W

    1991-01-01

    What happens in today's hospitals when keeping the faith with donors clashes with fiscal politics? An enterprising assistant attorney general asked that question and turned up some disquieting answers.

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

    SciTech Connect

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

    2007-06-01

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

  4. Capitation pricing: Adjusting for prior utilization and physician discretion

    PubMed Central

    Anderson, Gerard F.; Cantor, Joel C.; Steinberg, Earl P.; Holloway, James

    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

  5. Empty threat: Hospitals could see more vacancies as demand for outpatient care grows and financial pressure builds to curb inpatient admissions.

    PubMed

    Evans, Melanie

    2012-03-26

    Markets with too many hospital beds could see trouble as providers seek to control spending and avoid expensive hospitalizations. "You'll need a lot fewer hospitals and hospital beds" because providers will do more to keep patients healthy enough not to need them, says Frank Trembulak, of Geisinger Health System.

  6. 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.

  7. Adjustable Pitot Probe

    NASA Technical Reports Server (NTRS)

    Ashby, George C., Jr.; Robbins, W. Eugene; Horsley, Lewis A.

    1991-01-01

    Probe readily positionable in core of uniform flow in hypersonic wind tunnel. Formed of pair of mating cylindrical housings: transducer housing and pitot-tube housing. Pitot tube supported by adjustable wedge fairing attached to top of pitot-tube housing with semicircular foot. Probe adjusted both radially and circumferentially. In addition, pressure-sensing transducer cooled internally by water or other cooling fluid passing through annulus of cooling system.

  8. 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.

  9. 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

  10. 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.

  11. 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).

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. Biparticle fluidized bed reactor

    DOEpatents

    Scott, Charles D.; Marasco, Joseph A.

    1995-01-01

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

  17. Biparticle fluidized bed reactor

    DOEpatents

    Scott, 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.

  18. 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.

  19. 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.

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

    PubMed Central

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

    2015-01-01

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

  1. 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

  2. Understanding hospitality.

    PubMed

    Patten, C S

    1994-03-01

    Bridging patient/"customer" issues and business aspects can be aided through developing a specific nursing basis for hospitality. The ancient practice of hospitality has evolved into three distinct levels: public, personal and therapeutic. Understanding these levels is helpful in integrating various dimensions of guest relations programs in hospitals into a more comprehensive vision. Hospitality issues must become a greater part of today's nursing management.

  3. Surge Capacity: Analysis of Census Fluctuations to Estimate the Number of Intensive Care Unit Beds Needed

    PubMed Central

    Olafson, Kendiss; Ramsey, Clare; Yogendran, Marina; Fransoo, Randall; Chrusch, Carla; Forget, Evelyn; Garland, Allan

    2015-01-01

    Objective To compare methods of characterizing intensive care unit (ICU) bed use and estimate the number of beds needed. Study Setting Three geographic regions in the Canadian province of Manitoba. Study Design Retrospective analysis of population-based data from April 1, 2000, to March 31, 2007. Methods We compared three methods to estimate ICU bed requirements. Method 1 analyzed yearly patient-days. Methods 2 and 3 analyzed day-to-day fluctuations in patient census; these differed by whether each hospital needed to independently fulfill its own demand or this resource was shared across hospitals. Principal Findings Three main findings were as follows: (1) estimates based on yearly average usage generally underestimated the number of beds needed compared to analysis of fluctuations in census, especially in the smaller regions where underestimation ranged 25–58 percent; (2) 4–29 percent fewer beds were needed if it was acceptable for demand to exceed supply 18 days/year, versus 4 days/year; and (3) 13–36 percent fewer beds were needed if hospitals within a region could effectively share ICU beds. Conclusions Compared to using yearly averages, analyzing day-to-day fluctuations in patient census gives a more accurate picture of ICU bed use. Failing to provide adequate “surge capacity” can lead to demand that frequently and severely exceeds supply. PMID:25040848

  4. 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

  5. Hospital advertising in California, 1991-1997.

    PubMed

    Town, Robert J; Currim, Imran

    2002-01-01

    This paper examines the advertising behavior of California hospitals from 1991 to 1997. Using highly detailed hospital-level information, we found that hospital advertising in California increased dramatically: annual spending on advertising grew (inflation adjusted) more than sixfold over the period. In addition, advertising expenditures varied significantly across hospitals. We found that hospital advertising increased with market concentration; with the number of nearby potential patients; with the percentage of nearby patients insured through Medicare, health maintenance organizations (HMOs), and indemnity insurance; and with chain affiliation. For-profit hospitals were not found to advertise more than their not-for-profit counterparts.

  6. 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.

  7. 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.

  8. Impact on Granular Beds

    NASA Astrophysics Data System (ADS)

    van der Meer, Devaraj

    2017-01-01

    The impact of an object on a granular solid is an ubiquitous phenomenon in nature, the scale of which ranges from the impact of a raindrop onto sand all the way to that of a large asteroid on a planet. Despite the obvious relevance of these impact events, the study of the underlying physics mechanisms that guide them is relatively young, with most work concentrated in the past decade. Upon impact, an object starts to interact with a granular bed and experiences a drag force from the sand. This ultimately leads to phenomena such as crater formation and the creation of a transient cavity that upon collapse may cause a jet to appear from above the surface of the sand. This review provides an overview of research that targets these phenomena, from the perspective of the analogous but markedly different impact of an object on a liquid. It successively addresses the drag an object experiences inside a granular bed, the expansion and collapse of the cavity created by the object leading to the formation of a jet, and the remarkable role played by the air that resides within the pores between the grains.

  9. 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.

  10. Fluidized bed boiler feed system

    DOEpatents

    Jones, Brian C.

    1981-01-01

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

  11. Recirculating valve lash adjuster

    SciTech Connect

    Stoody, R.R.

    1987-02-24

    This patent describes an internal combustion engine with a valve assembly of the type including overhead valves supported by a cylinder head for opening and closing movements in a substantially vertical direction and a rotatable overhead camshaft thereabove lubricated by engine oil pumped by an engine oil pump. A hydraulic lash adjuster with an internal reservoir therein is solely supplied with run-off lubricating oil from the camshaft which oil is pumped into the internal reservoir of the lash adjuster by self-pumping operation of the lash adjuster produced by lateral forces thereon by the rotative operation of the camshaft comprising: a housing of the lash adjuster including an axially extending bore therethrough with a lower wall means of the housing closing the lower end thereof; a first plunger member being closely slidably received in the bore of the housing and having wall means defining a fluid filled power chamber with the lower wall means of the housing; and a second plunger member of the lash adjuster having a portion being loosely slidably received and extending into the bore of the housing for reciprocation therein. Another portion extends upwardly from the housing to operatively receive alternating side-to-side force inputs from operation of the camshaft.

  12. Hospital Analgesia Practices and Patient-reported Pain After Colorectal Resection

    PubMed Central

    Regenbogen, Scott E.; Mullard, Andrew J.; Peters, Nanette; Brooks, Shannon; Englesbe, Michael J.; Campbell, Darrell A.; Hendren, Samantha

    2016-01-01

    Objective The aim of the study was to characterize patient-reported outcomes of analgesia practices in a population-based surgical collaborative. Background Pain control among hospitalized patients is a national priority and effective multimodal pain management is an essential component of postoperative recovery, but there is little understanding of the degree of variation in analgesia practice and patient-reported pain between hospitals. Methods We evaluated patient-reported pain scores after colorectal operations in 52 hospitals in a state-wide collaborative. We stratified hospitals by quartiles of average pain scores, identified hospital characteristics, pain management practices, and clinical outcomes associated with highest and lowest case-mix-adjusted pain scores, and compared against Hospital Consumer Assessment of Healthcare Providers and Systems pain management metrics. Results Hospitals with the lowest pain scores were larger (503 vs 452 beds; P<0.001), higher volume (196 vs 112; P=0.005), and performed more laparoscopy (37.7% vs 27.2%; P<0.001) than those with highest scores. Their patients were more likely to receive local anesthesia (31.1% vs 12.9%; P<0.001), nonsteroidal anti-inflammatory drugs (33.5% vs 14.4%; P<0.001), and patient-controlled analgesia (56.5% vs 22.8%; P<0.001). Adverse postoperative outcomes were less common in hospitals with lowest pain scores, including complications (20.3% vs 26.4%; P<0.001), emergency department visits (8.2% vs 15.8%; P<0.001), and readmissions (11.3% vs 16.2%; P=0.01). Conclusions Pain management after colorectal surgery varies widely and predicts significant differences in patient-reported pain and clinical outcomes. Enhanced postoperative pain management requires dissemination of multimodal analgesia practices. Attention to patient-reported outcomes often omitted from surgical outcomes registries is essential to improving quality from the patient's perspective. PMID:26756749

  13. 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.

  14. 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.

  15. 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.

  16. [Hospital solid waste: quantification. Bacteriological analyses--case of hospital Ibn Sina].

    PubMed

    Bahri, Meriem; Belkhadir, Rachid; Benzakour, Mohammed; Idrissi, Larbi; Khadri, Abdelhamid

    2006-01-01

    Hospital waste represent, by their nature and their constitution, a big threat to health in the intra and extra hospital area. and a source of pollution for the environment. A 12-day campaign of weighing of the waste produced by the hospital Ibn Sina of Rabat-Morocco should an average of 1.75 kg/bed/day. In order to identify the hospital pathogenic germs as well as their sensitivities to antibiotics, some bacteriological analyses have been done on the percolat waste of this hospital. The results of these analyses put in evidence the presence of Pseudomonas aeruginosa and Staphylococcus aureus and their resistance to some antibiotics.

  17. [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.

  18. 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.

  19. 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.

  20. Dynamic bed reactor

    SciTech Connect

    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.

  1. Managing the University/Training Hospital Interface: The Situation at the University of Liege.

    ERIC Educational Resources Information Center

    Kulbertus, Henri; Doppagne, Philippe

    1991-01-01

    Most of the hospital beds available to the University of Liege (France) for training purposes are in a public teaching hospital with an autonomous legal structure and privileged relationship with the university. Other beds are in other facilities. The financing, supervision, and management structure integrates the institutions and supports medical…

  2. Psychological Adjustment and Homosexuality.

    ERIC Educational Resources Information Center

    Gonsiorek, John C.

    In this paper, the diverse literature bearing on the topic of homosexuality and psychological adjustment is critically reviewed and synthesized. The first chapter discusses the most crucial methodological issue in this area, the problem of sampling. The kinds of samples used to date are critically examined, and some suggestions for improved…

  3. 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.

  4. 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.

  5. Bed Bug Laws and Regulations

    EPA Pesticide Factsheets

    21 states have some level of regulation with regard to bed bugs. Most of these requirements focus on hotels and landlords or other property managers. The Department of Housing and Urban Development has guidance on controlling bed bugs in public housing.

  6. 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.

  7. SMART NAS Test Bed Overview

    NASA Technical Reports Server (NTRS)

    Palopo, Kee

    2016-01-01

    These slides presents an overview of SMART NAS Test Bed. The test bed is envisioned to be connected to operational systems and to allow a new concept and technology to be evaluated in its realistic environment. Its role as an accelerator of concepts and technologies development, its use-case-driven development approach, and its state are presented.

  8. Effectiveness of Bed Bug Pesticides

    EPA Pesticide Factsheets

    Before EPA allows a bed bug claim on a label, the product must be supported by data showing it will kill bed bugs when applied according to the label. Also take into accounts factors such as extent of infestation, site preparation, and insect life stages.

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

    PubMed

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

    2008-08-01

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

  10. Hospice agencies' hospital contract status and differing levels of hospice care.

    PubMed

    Chung, Kyusuk; Richards, Nicole; Burke, Sloane

    2015-05-01

    In response to a 2011 finding that approximately 27% of Medicare-certified hospices do not provide a single day of general inpatient care (GIP), the authors explored the extent to which hospices have contracts with hospitals for GIP. Using the 2007 National Home and Hospice Care Survey, we estimated that 1119 (32%) agencies had no contract with any hospitals in 2007 and half of those with no contract did not have a contract with a skilled nursing facility (SNF) either. As a result, these hospices were unable to provide GIP referrals for those in need of inpatient care for acute pain and symptom management. More importantly, not having a contract with a hospital was just one of the factors influencing GIP provision. In the multivariate logistic model, after controlling for contract status with a hospital and other hospice characteristics, agencies in the second quartile of hospice patient census (12-29 vs 73 or more, adjusted odds ratio = 14.10; 95% confidence interval 4.26-46.62) were independently related to providing only routine home care. These hospices are more likely to rely solely on scatter beds for GIP provision. Given that a significant portion of hospices do not have a contract with a hospital, policy makers need to understand barriers to contracts with a hospital/SNF for GIP and consider a hospice's contract status as one of the standards for hospice certification. In addition, further research is necessary to understand why hospices that do have a contract with a hospital do not make GIP referral.

  11. 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

  12. [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

  13. 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.

  14. 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.

  15. 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.

  16. Multiple Layer Closure of Myoma Bed in Laparoscopic Myomectomy

    PubMed Central

    Jain, Nutan

    2011-01-01

    Objective: To assess the feasibility and outcome of laparoscopic myomectomy and multiple layer closure of the myoma bed, for management of myomas, at a tertiary care hospital. Materials and Methods: From September 2005 to September 2010, 417 patients, with large and moderate size myomas, were managed by laparoscopic myomectomy. Indications were subfertility, menorrhagia, and abdominal mass. Preoperative evaluation included history, clinical examination, and sonographic mapping. The myomas were enucleated and retrieved laparoscopically. Myoma beds were sutured in multiple layers by endoscopic intracorporeal suturing. Results: Three hundred and fifteen patients presented with subfertility, 45 with menorrhagia, and 57 with abdominal mass. The average maximum diameter of a myoma was 9 cm. The mean duration of surgery was 120 minutes. The mean postoperative stay was 24 hours. No intraoperative complication occurred and the hospital course was uncomplicated. In one case, a minilap incision was performed for retrieval of the myoma with suturing of the bed. Two patients had minor delayed wound healing of the morcellator port site. The patients did not report any complaints during the follow-up, except one patient who developed omental hernia at the morcellator port site. There was no rupture of the scar and very low adhesion scores in the subsequent cesarean sections or second-look scopies. Conclusion: With proper multilayer closure of the myoma bed, laparoscopic myomectomy was feasible for moderate and even large myomas and had excellent outcomes. PMID:22442535

  17. Multiple Layer Closure of Myoma Bed in Laparoscopic Myomectomy

    PubMed Central

    Jain, Nutan; Sahni, Priyanka

    2011-01-01

    Objective: To assess the feasibility and outcome of laparoscopic Myomectomy and multiple layer closure of myoma bed for management of myomas at a tertiary care hospital. Materials and Methods: Four hundred and seventeen patients from September 2005 to September 2010 with large and moderate size myomas were managed by laparoscopic Myomectomy. Indications were subfertility, menorrhagia and abdominal mass. Pre-operative evaluation included history, clinical examination and sonographic mapping. Myomas were enucleated and retrieved laparoscopically. Myoma beds were sutured in multiple layers by endoscopic intracorporeal suturing. Results: Three hundred and fifteen patients presented with subfertility, 45 with menorrhagia and 57 with abdominal mass. The average maximum diameter of myoma was 9 cm. The mean duration of surgery was 120 min. The mean post-operative stay was 24 h. No intra-operative complication occurred and hospital course was uncomplicated. In one case, minilap incision was given for retrieval of myoma and suturing of the bed. Two patients had minor delayed wound healing of the morcellator port site. The patients did not report any complaints during follow-up except one patient who developed omental hernia at morcellator port site. There was no rupture of scar and very low adhesion scores in subsequent caesarian sections or second look scopies. Conclusion: With proper multilayer closure of the myoma bed, laparoscopic Myomectomy is feasible for moderate and even large myomas and has excellent outcomes. PMID:26085750

  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. Community-level risk factors for depression hospitalizations.

    PubMed

    Fortney, John; Rushton, Gerard; Wood, Scott; Zhang, Lixun; Xu, Stan; Dong, Fran; Rost, Kathryn

    2007-07-01

    This study measured geographic variation in depression hospitalizations and identified community-level risk factors. Depression hospitalizations were identified from the Statewide Inpatient Database. The dependent variable was specified as the indirectly standardized hospitalization rate. County-level data for 14 states were collected from federal agencies. The Bayesian spatial regression model included socio-demographic, economic, and health system characteristics as independent variables. There were 8.5 depression hospitalizations per 1,000 residents. 8.8% of counties had hospitalization rates 33% greater than the standardized rate. Significant risk factors included unemployment, poverty, physician supply, and hospital bed supply. Significant protective factors included rurality, economic dependence, and housing stress.

  20. Multiple gestation: side effects of antepartum bed rest.

    PubMed

    Maloni, Judith A; Margevicius, Seunghee Park; Damato, Elizabeth G

    2006-10-01

    The birth rate for higher order multiples has dramatically increased in recent decades. Multiple gestation pregnancies are considered to be at high obstetric risk. Antepartum bed rest is often prescribed to offset complications despite the lack of evidence for its effectiveness in preventing complications. This longitudinal repeated-measures study identified side effects of antepartum bed rest treatment for 31 hospitalized women with twin or triplet gestation. Maternal weight gain and infant birth weight were recorded. Antepartum stressors were measured by the Antepartum Stressors Hospital Inventory, and depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Antepartum and post-partum side effects of bed rest were also assessed by the Antepartum and Postpartum Symptom Checklists. The weekly rate of maternal weight gain during hospitalization was significantly less than recent recommendations for multiple gestation weight gain (t = - 2.14, p = .04). Infant birth weights were appropriate for gestational age. There were fewer than expected small-for-gestational-age infants. Concerns regarding family status and separation from family were the major antepartum stressors. Women reported a high number of symptoms during bed rest (M = 22), which did not significantly change across 2 weeks. CES-D scores for depressive symptoms were high on antepartum hospital admission. Postpartum symptoms were initially high but had significantly declined by 6 weeks: F(1, 27) = 15.68, p = .00. These findings suggest that interventions are needed to reduce antepartum maternal weight loss, stress, physiologic and psychosocial symptoms, and depressive symptoms, as well as reduce postpartum symptoms of maternal morbidity.

  1. 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.

  2. National survey of hospital patients.

    PubMed Central

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

    1994-01-01

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

  3. Effects of the performance management information system in improving performance: an empirical study in Shanghai Ninth People's Hospital.

    PubMed

    Cui, Yinghui; Wu, Zhengyi; Lu, Yao; Jin, Wenzhong; Dai, Xing; Bai, Jinxi

    2016-01-01

    Improving the performance of clinical departments is not only the significant content of the healthcare system reform in China, but also the essential approach to better satisfying the Chinese growing demand for medical services. Performance management is vital and meaningful to public hospitals in China. Several studies are conducted in hospital internal performance management, but almost none of them consider the effects of informational tools. Therefore, we carried out an empirical study on effects of using performance management information system in Shanghai Ninth People's Hospital. The main feature of the system is that it provides a real-time query platform for users to analyze and dynamically monitor the key performance indexes, timely detect problems and make adjustments. We collected pivotal medical data on 35 clinical departments of this hospital from January 2013 until December 2014, 1 year before and after applying the performance management information system. Comparative analysis was conducted by statistical methods. The results show that the system is beneficial to improve performance scores of clinical departments and lower the proportion of drug expenses, meanwhile, shorten the average hospitalized days and increase the bed turnover rate. That is to say, with the increasing medical services, the quality and efficiency is greatly improved. In a word, application of the performance management information system has a positive effect on improving performance of clinical departments.

  4. 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

  5. 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.

  6. Hospital CEO raises awareness through blog.

    PubMed

    Jacobs, Nick

    2007-01-01

    Four years ago, Nick Jacobs didn't know what the term "blogging" meant. As the president and CEO of the Windber (PA) Research Institute and the Windber Medical Center, that's not surprising. But this not-so-typical hospital president changed all that by launching his own blog three years ago and putting his small, 82-bed facility on the map.

  7. 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…

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

    PubMed

    2007-01-01

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

  9. Print a Bed Bug Card

    EPA Pesticide Factsheets

    Two sets of business card-sized lists of tips for prevention of bed bug infestations, one for general use around home, the other for travelers. Print a single card or a page of cards for distribution.

  10. Getting Rid of Bed Bugs

    MedlinePlus

    Jump to main content US EPA United States Environmental Protection Agency Search Search Bed Bugs Share Facebook Twitter ... integrated pest management. Preparing for control is very important whether you are considering hiring a professional or ...

  11. 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 ...

  12. 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

  13. Bed Bug Clearinghouse by Audience

    EPA Pesticide Factsheets

    This information is intended to help states, communities, and consumers prevent and control bed bug infestations. Find materials for emergency and health facilities, hotels, housing authorities, landlords, schools, pest management professionals, and more.

  14. Pulsed atmospheric fluidized bed combustion

    SciTech Connect

    Not Available

    1992-10-01

    The design of the Pulsed Atmospheric Fluidized Bed Combustor (PAFBC) as described in the Quarterly Report for the period April--June, 1992 was reviewed and minor modifications were included. The most important change made was in the coal/limestone preparation and feed system. Instead of procuring pre-sized coal for testing of the PAFBC, it was decided that the installation of a milling system would permit greater flexibility in the testing with respect to size distributions and combustion characteristics in the pulse combustor and the fluid bed. Particle size separation for pulse combustor and fluid bed will be performed by an air classifier. The modified process flow diagram for the coal/limestone handling system is presented in Figure 1. The modified process flow diagrams of the fluidized bed/steam cycle and ash handling systems are presented in Figures 2 and 3, respectively.

  15. Bed Bugs: The Australian Response.

    PubMed

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

    2011-04-15

    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.

  16. Adjustable Reeds For Weaving

    NASA Technical Reports Server (NTRS)

    Farley, Gary L.

    1994-01-01

    Local characteristics of fabrics varied to suit special applications. Adjustable reed machinery proposed for use in weaving fabrics in various net shapes, widths, yarn spacings, and yarn angles. Locations of edges of fabric and configuration of warp and filling yarns varied along fabric to obtain specified properties. In machinery, reed wires mounted in groups on sliders, mounted on lengthwise rails in reed frame. Mechanisms incorporated to move sliders lengthwise, parallel to warp yarns, by sliding them along rails; move sliders crosswise by translating reed frame rails perpendicular to warp yarns; and crosswise by spreading reed rails within group. Profile of reed wires in group on each slider changed.

  17. Biomechanical evaluation of injury severity associated with patient falls from bed.

    PubMed

    Bowers, Bonnie; Lloyd, John; Lee, W; Powell-Cope, G; Baptiste, A

    2008-01-01

    This study investigated the severity of injuries associated with falling from bed and the effectiveness of injury-prevention strategies. Injury criteria were calculated for head- and feet-first falls from six bed heights onto a tiled surface and floor mat. These values indicated a 25% chance of experiencing a serious head injury as a result of falling feet-first from a bed height of 97.5 cm onto a tiled surface. Risk of injury increased to 40% when extrapolated for the height added by bedrails. Using a floor mat decreased this risk to less than 1% for bedrail height for feet-first falls. Calculated impact forces indicated a risk of skull fracture when hitting the tiled surface. Floor mats and height-adjustable beds positioned to the lowest height should be used to decrease the risk of injury associated with falling from bed.

  18. 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.

  19. 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.

  20. 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.

  1. 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

  2. Helping survivors to adjust after cancer.

    PubMed

    Harmer, Victoria

    The concept of "cancer survivorship" has received considerable attention over the past three years as increasing numbers of people live with and beyond cancer. Previously, attention may have focused more on treatments for cancer and the likelihood of their success. In recent years, interest has moved to the after-effects of treatment, and how people can return to their lives while recovering. This article discusses the various ways in which cancer and its treatment may affect survivors, and how nurses, in both hospital and the community, can help them to adjust and recover.

  3. Continuously adjustable Pulfrich spectacles

    NASA Astrophysics Data System (ADS)

    Jacobs, Ken; Karpf, Ron

    2011-03-01

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

  4. 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.

  5. 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.

  6. Using return on equity and total profit margin to evaluate hospital performance in the U.S.: a piecewise regression analysis.

    PubMed

    Younis, Mustafa Z; Forgione, Dana A

    2005-01-01

    We investigated hospital profitability by comparing Total Profit Margin (TPM) and Return on Equity (ROE) as measures of profitability, while controlling for inflation and other salient factors. We controlled for variables such as, Disproportionate Share Hospital status, location, type of ownership control, teaching status, conversion to or from nonprofit status, Critical Access Hospital status, sole Medicare provider status, case mix adjusted patient length of stay, bed size, number of employees, and occupancy rate. We allowed for nonlinearities in our model, and used 1996 and 1998 data in our analysis to bridge potential effects of the Balanced Budget Act of 1997. Most of the hospitals we examined were nonprofit organizations that did not convert their type of ownership control. As a consequence, we found TPM to be a better measure of profitability than ROE, and profitability was mainly influenced by location, size, occupancy rate, volume of Medicare and Medicaid patients, and teaching status. Our results clarify the primary factors associated with profitability for our sample hospitals, and will assist creditors, managers and regulators in their assessments of comparative hospital financial performance.

  7. Death-bed prophecy.

    PubMed

    Leslie, Mitch

    2006-06-28

    What's left to learn about aging? The burning question for many researchers is whether life-stretching pathways and genes from model organisms boost human life span. Researchers might be able to track down additional genes and pathways that adjust longevity by studying a broader range of organisms or by tracking the evolution of genes that promote aging. An alternative way to extend our lives might be to identify the genes behind late-life killers such as heart disease and diabetes. Lab animals last longer on a very low-cal diet, and scientists are probing whether humans can benefit from this austerity. Or better yet, perhaps researchers can design molecules that deliver the gain of calorie reduction without the pain. Scientists are also focusing on which parts of the cell incur damage as we age and how growth and reproduction tie in to longevity. The speed of the next round of advances will depend on whether movers and shakers in funding organizations recognize the importance of the research and are willing to pay for it.

  8. 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.

  9. 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.

  10. Hospital characteristics: can an audit be predicted?

    PubMed

    Chang, C F; Tuckman, H P

    1993-01-01

    Each year Medicare-participant hospitals submit a cost report to the Health Care Financing Administration (HCFA) to settle their reimbursement claims. These reports are subject to audit, and a decision by HCFA to audit can be costly to the auditee. This article uses data from 6,270 cost reports filed in 1986 to explore the factors related to the probability of an audit. Logistic regression equations are estimated to examine how hospital characteristics influence the chance of audit. The results suggest that audit probability can be predicted with reasonable accuracy by a hospital's bed size, ownership type, teaching status, function, proportion of Medicare inpatient days, and geographic location.

  11. A Study to Establish Baseline Data on the Retiree Population’s Perceptions of Access and Health Care Delivered through Outpatient Services at Ireland Army Community Hospital

    DTIC Science & Technology

    1987-04-01

    dissatisfied patients before they could begin to fill unused hospital beds and cut the costs of CHAMPUS, the civilian health care alternative for...organizations’ programs to be utilized and their hospitalsbeds to be filled. Instead, the proponents of health care marketing contend that it is the...its tax-funded programs is emphasized by estimates that the United States has some 130,000 excess hospital beds , costing 2 billion dollars a 16 year

  12. Bed mobility: A Key Linkage Between Channel Condition and Lotic Ecosystems

    NASA Astrophysics Data System (ADS)

    Lisle, T. E.

    2005-05-01

    Bed mobility is a key linkage between the physical dynamics of stream channels and lotic and riparian ecosystems over a range of scale. The depth, extent, and frequency of mobilization of bed material affect the variation of conditions providing the requirements of life stages of organisms living in and along the stream channel. Bed mobility thereby helps to define habitat patches supporting communities of organisms. At a larger scale, the rate of channel evolution and creation of new channel and riparian surfaces are governed by the ability of the channel to deform during sediment transport. Bed mobility is partly regulated by the tendency of coarse particles to interact to form structures (e.g., steps, clusters, cells) and sort themselves into coarse surface layers that resist transport. The capacity of the arrangement of bed particles to influence bed mobility generally declines with channels that have gentler slopes and better sorted (finer) bed material. But within channels having a common range of slope and bed material size, bed mobility can adjust to temporary changes in the caliber and rate of sediment supply. Thus bed mobility can be used as an integrative measure of physical habitat condition. Classification of the mobility of the surface of a gravel-bed stream channel is offered as an organizing framework to examine the influence of sediment supply and flow on benthic habitats. Degrees of bed activity can be related to particular `mobility fields' that are quantified by Shields stress (ratio of impelling to resisting forces acting on bed particles). Mobility fields are classified on the basis of the fraction of surface particles moved and the depth of bed mobilization, which limit the scale and severity of bed disturbance. As an approximation, the surface remains stable at Shields<0.03, is partially mobile at 0.030.12. Only fully mobile beds are capable of significant evolution

  13. 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.

  14. Reforming the hospital service structure to improve efficiency: urban hospital specialization.

    PubMed

    Lee, Kwang-soo; Chun, Ki-Hong; Lee, Jung-Soo

    2008-07-01

    The objective of this study is to explain the relationship between the case-mix specialization index and efficiency of inpatient hospital care services. Hospital specialization was measured using the information theory index constructed from diagnosis-related group numbers of hospitals in Seoul, Korea, in 2004. Hospital performance was measured by technical efficiency scores computed by data envelopment analysis for 2004. Multiple regression analysis models were applied to identify the internal and external factors that affected the extent of hospital specialization status as well as the efficiency of hospitals. The data envelopment analysis showed that input variables such as the number of beds, doctors and nurses were related to hospital efficiency. Hospitals had different levels of specialization in patient services, and more specialized hospitals were more likely to be efficient (odds ratio=25.95). Internal characteristics of providers had more significant effects on the extent of specialization than market conditions. These findings help to explain the relationship among hospitals, specialization, market conditions and provider performance. The study results related to the rearrangement of hospital services in a city. Further study including hospitals from other regions will increase the generalizability of results, and policy makers can use the information in making policy for the specialized hospital industry in Korea.

  15. Differences in sleep complaints in adults with varying levels of bed days residing in extended care facilities for chronic disease management.

    PubMed

    Fox, Mary T; Sidani, Souraya; Brooks, Dina

    2010-05-01

    This cohort study examined differences in perceived insomnia and daytime sleepiness in 67 adults residing in extended care facilities for chronic disease management who had varying levels of bed days. One bed day was defined as spending 24 hours in bed. Planned pairwise comparisons, using Bonferroni adjustment, were made between participants who spent 0 (n = 21), 2 to 4 (n = 23), and 5 to 7 (n = 23) days in bed during 1 week of monitoring. Participants who spent 5 to 7 days in bed had significantly greater insomnia than those who spent 2 to 4 days in bed. No group differences were found in daytime sleepiness. Based on the findings, nurses may assess subjective insomnia and explore sleep hygiene strategies, such as increasing time out of bed with patients who have high levels of 5 to 7 bed days.

  16. 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.

  17. 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

    ... beds in intensive care type inpatient units (for eligibility of hospitals with distinct parts electing...-term care services (âswing-bedsâ). 482.66 Section 482.66 Public Health CENTERS FOR MEDICARE & MEDICAID... providers of long-term care services (“swing-beds”). A hospital that has a Medicare provider agreement...

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

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... beds in intensive care type inpatient units (for eligibility of hospitals with distinct parts electing...-term care services (âswing-bedsâ). 482.66 Section 482.66 Public Health CENTERS FOR MEDICARE & MEDICAID... providers of long-term care services (“swing-beds”). A hospital that has a Medicare provider agreement...

  19. 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...

  20. 34 CFR 74.72 - Subsequent adjustments and continuing responsibilities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 1 2012-07-01 2012-07-01 false Subsequent adjustments and continuing responsibilities. 74.72 Section 74.72 Education Office of the Secretary, Department of Education ADMINISTRATION OF GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER...

  1. 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...

  2. 22 CFR 145.72 - Subsequent adjustments and continuing responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  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. Psychiatric nurses' satisfaction: the effects of closure of a hospital.

    PubMed

    Sammut, R G

    1997-07-01

    A survey by questionnaire was carried out to examine the level of nursing staff satisfaction with the acute psychiatric services. Comparisons were made between views of older psychiatric hospitals and newer district general hospital units, and before and after the closure of Friern Barnet Hospital, London, England when the service was reorganized to include fewer beds. The importance of nurses having their say is emphasized, and areas in which improvements can be made are suggested.

  5. 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.

  6. 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.

  7. Predictors of Clostridium difficile colitis infections in hospitals

    PubMed Central

    RICCIARDI, R.; HARRIMAN, K.; BAXTER, N. N.; HARTMAN, L. K.; TOWN, R. J.; VIRNIG, B. A.

    2008-01-01

    SUMMARY Hospital-level predictors of high rates of ‘Clostridium difficile-associated disease’ (CDAD) were evaluated in over 2300 hospitals across California, Arizona, and Minnesota. American Hospital Association data were used to determine hospital characteristics associated with high rates of CDAD. Significant correlations were found between hospital rates of CDAD, common infections and other identified pathogens. Hospitals in urban areas had higher average rates of CDAD; yet, irrespective of geographic location, hospital rates of CDAD were associated with other infections. In addition, hospitals with ‘high CDAD’ rates had slower turnover of beds and were more likely to offer transplant services. These results reveal large differences in rates of CDAD across regions. Hospitals with high rates of CDAD have high rates of other common infections, suggesting a need for broad infection control policies. PMID:17686193

  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.

  9. 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

  10. Risk factors of all-cause in-hospital mortality among Korean elderly bacteremic urinary tract infection (UTI) patients.

    PubMed

    Chin, Bum Sik; Kim, Myung Soo; Han, Sang Hoon; Shin, So Youn; Choi, Hee Kyung; Chae, Yun Tae; Jin, Sung Joon; Baek, Ji-Hyeon; Choi, Jun Yong; Song, Young Goo; Kim, Chang Oh; Kim, June Myung

    2011-01-01

    Urinary tract infection (UTI) is the most frequent cause of bacteremia/sepsis in elderly people and increasing antimicrobial resistance in uropathogens has been observed. To describe the characteristics of bacteremic UTI in elderly patients and to identify the independent risk factors of all-cause in-hospital mortality, a retrospective cohort study of bacteremic UTI patients of age over 65 was performed at a single 2000-bed tertiary hospital. Bacteremic UTI was defined as the isolation of the same organism from both urine and blood within 48 h. Eighty-six elderly bacteremic UTI patients were enrolled. Community-acquired infection was the case for most patients (79.1%), and Escherichia coli accounted for 88.6% (70/79) among Gram-negative organisms. Non-E. coli Gram-negative organisms were more frequent in hospital-acquired cases and male patients while chronic urinary catheter insertion was related with Gram-positive urosepsis. The antibiotic susceptibility among Gram-negative organisms was not different depending on the source of bacteremic UTI, while non-E. coli Gram-negative organisms were less frequently susceptible for cefotaxime, cefoperazone/sulbactam, and aztreonam. All-cause in-hospital mortality was 11.6%, and functional dependency (adjusted hazard ratio=HR=10.9, 95% confidence interval=95%CI=2.2-54.6) and low serum albumin (adjusted HR=27.0, 95%CI=2.0-361.2) were independently related with increased all-cause in-hospital mortality.

  11. Estimation and Propagation of Errors in Ice Sheet Bed Elevation Measurements

    NASA Astrophysics Data System (ADS)

    Johnson, J. V.; Brinkerhoff, D.; Nowicki, S.; Plummer, J.; Sack, K.

    2012-12-01

    This work is presented in two parts. In the first, we use a numerical inversion technique to determine a "mass conserving bed" (MCB) and estimate errors in interpolation of the bed elevation. The MCB inversion technique adjusts the bed elevation to assure that the mass flux determined from surface velocity measurements does not violate conservation. Cross validation of the MCB technique is done using a subset of available flight lines. The unused flight lines provide data to compare to, quantifying the errors produced by MCB and other interpolation methods. MCB errors are found to be similar to those produced with more conventional interpolation schemes, such as kriging. However, MCB interpolation is consistent with the physics that govern ice sheet models. In the second part, a numerical model of glacial ice is used to propagate errors in bed elevation to the kinematic surface boundary condition. Initially, a control run is completed to establish the surface velocity produced by the model. The control surface velocity is subsequently used as a target for data inversions performed on perturbed versions of the control bed. The perturbation of the bed represents the magnitude of error in bed measurement. Through the inversion for traction, errors in bed measurement are propagated forward to investigate errors in the evolution of the free surface. Our primary conclusion relates the magnitude of errors in the surface evolution to errors in the bed. By linking free surface errors back to the errors in bed interpolation found in the first part, we can suggest an optimal spacing of the radar flight lines used in bed acquisition.

  12. Comparative Analysis of Hospital Costs of Open and Endovascular Thoracic Aortic Repair

    PubMed Central

    Arnaoutakis, George J.; Hundt, John A.; Shah, Ashish S.; Cameron, Duke E.; Black, James H.

    2011-01-01

    Background Endovascular technologies represent major advancements in treating descending thoracic aortic aneurysms(DTAA). We compared hospital charges of open thoracic aortic replacement(OTAR) with endovascular repair of thoracic aortic aneurysms(TEVAR). Methods Retrospective analysis of hospital charges related to repair of DTAA(2000–2009). Charges were inflation-adjusted for dollars in 2009. Results There were 50 OTAR and 50 TEVAR patients. OTAR charges were $64,531(IQR:49,000–108,515) versus $61,909(IQR:41,307–92,109) for TEVAR(p = 0.4). 10 patients(10%) died before discharge, with zero TEVAR deaths(p<0.05). For OTAR, supply charges($9,167) accounted for 13% of total charges versus 56% for TEVAR($40,468), p <.01. OTAR LOS was 12d(6d ICU stay); bed charges comprised 40% of total charges. TEVAR had lower LOS(5d with 2d ICU stay, p <0.001). Conclusions DTAA repair remains a formidable operation with significant resource utilization. TEVAR does not significantly reduce overall hospital charges due to device costs, but demonstrates improved mortality, ICU and total LOS. PMID:20829240

  13. Strategic planning for clinical services: St. Joseph Hospital and Health Care Center.

    PubMed

    Linggi, A; Pelham, L D

    1986-09-01

    A pharmacy department at a 340-bed community hospital based its strategic plan for developing patient-oriented services on a sound drug distribution system, a credible work-measurement program, and fiscal responsibility. In 1982 the department of pharmacy and i.v. therapy implemented a strategic plan for improving pharmaceutical services. The plan involved developing goals and objectives for the department; marketing the department's services and fiscal management to hospital administrators, medical staff, and nursing staff; building teamwork among the pharmacy staff; and improving the drug distribution system before instituting clinical services. Hiring of additional pharmacy staff was justified on the basis of work-measurement data. By adjusting staffing levels every two weeks based on work-measurement data, the department increased the efficiency of drug distribution activities; the pharmacy also implemented cost-saving programs like selection of therapeutic alternates and formulary restrictions. The savings were then reinvested in labor-intensive patient-oriented pharmaceutical services. A staff development program using staff pharmacists as preceptors expanded the breadth and depth of pharmacists' clinical skills. The planning efforts were successful because the needs of hospital administrators, the pharmacy department, and staff members were addressed.

  14. 42 CFR 424.13 - Requirements for inpatient services of hospitals other than psychiatric hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... of the patient for medical treatment or medically required inpatient diagnostic study; or (ii) Special or unusual services for cost outlier cases (under the prospective payment system set forth in... hospitalization if the physician finds that the patient could receive proper treatment in a SNF but no bed...

  15. Staged cascade fluidized bed combustor

    DOEpatents

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

    1984-01-01

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

  16. Delay Adjusted Incidence

    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.

  17. Nonlinear Hydrostatic Adjustment.

    NASA Astrophysics Data System (ADS)

    Bannon, Peter R.

    1996-12-01

    The final equilibrium state of Lamb's hydrostatic adjustment problem is found for finite amplitude heating. Lamb's problem consists of the response of a compressible atmosphere to an instantaneous, horizontally homogeneous heating. Results are presented for both isothermal and nonisothermal atmospheres.As in the linear problem, the fluid displacements are confined to the heated layer and to the region aloft with no displacement of the fluid below the heating. The region above the heating is displaced uniformly upward for heating and downward for cooling. The amplitudes of the displacements are larger for cooling than for warming.Examination of the energetics reveals that the fraction of the heat deposited into the acoustic modes increases linearly with the amplitude of the heating. This fraction is typically small (e.g., 0.06% for a uniform warming of 1 K) and is essentially independent of the lapse rate of the base-state atmosphere. In contrast a fixed fraction of the available energy generated by the heating goes into the acoustic modes. This fraction (e.g., 12% for a standard tropospheric lapse rate) agrees with the linear result and increases with increasing stability of the base-state atmosphere.The compressible results are compared to solutions using various forms of the soundproof equations. None of the soundproof equations predict the finite amplitude solutions accurately. However, in the small amplitude limit, only the equations for deep convection advanced by Dutton and Fichtl predict the thermodynamic state variables accurately for a nonisothermal base-state atmosphere.

  18. 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).

  19. A ’Smart’ Molecular Sieve Oxygen Concentrator with Continuous Cycle Time Adjustment.

    DTIC Science & Technology

    1996-04-01

    A ’smart’ molecular sieve oxygen concentrator (MSOC) is controlled by a set of computer algorithms . The ’smart’ system automatically adjusts...determine if concentrator performance could be controlled by computer algorithms which continuously adjust concentrator cycle time. A two-bed... Computer algorithms or decision process were developed which allowed the software to control concentrator cycle time. Step changes in product flow from 5

  20. 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.…

  1. Hospital finance.

    PubMed

    Herman, M J

    1998-01-01

    This article summarizes key areas of focus for the analysis of risk in the hospital segment of the health care industry. The article is written from a commercial bank lending perspective. Both for-profit (C-corporations) and 501 (c)(3) not-for-profit segments are addressed.

  2. 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…

  3. 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

  4. 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

  5. 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.

  6. 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.

  7. How to Find Bed Bugs

    EPA Pesticide Factsheets

    Find and correctly identify an infestation early before it becomes widespread. Look for rusty or reddish stains and pinpoint dark spots on bed sheets or mattresses, and search for bugs near the piping, seams and tags of the mattress and box spring.

  8. 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...

  9. 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.

  10. Electromechanics of packed granular beds

    SciTech Connect

    Robinson, K.S.

    1982-01-01

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

  11. 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.

  12. 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

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

    NASA Astrophysics Data System (ADS)

    Prancevic, Jeff P.; Lamb, Michael P.

    2015-03-01

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

  14. Videos, Webinars, Blogs Related to Bed Bugs

    EPA Pesticide Factsheets

    These tools provide practical insight on issues such as integrated pest management (IPM) for schools, bed bug bites, how carpet beetles can help, bed bugs as hitchhikers, and preventing and controlling infestations.

  15. Pulling a patient up in bed

    MedlinePlus

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

  16. Find a Bed Bug Pesticide Product

    EPA Pesticide Factsheets

    Introduces the Bed Bug Product Search Tool, to help consumers find EPA-registered pesticides for bed bug infestation control. Inclusion in this database is not an endorsement. Always follow label directions carefully.

  17. 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...

  18. Bed Bug Guidance for School Nurses

    EPA Pesticide Factsheets

    School nurses are often called upon to provide vital information to students, parents, teachers, and administrators. These tips on identifying, managing and preventing bed bugs will help you to effectively respond if bed bugs appear in your school.

  19. 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

  20. 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

  1. 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)

  2. 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…

  3. Medical waste production at hospitals and associated factors.

    PubMed

    Cheng, Y W; Sung, F C; Yang, Y; Lo, Y H; Chung, Y T; Li, K-C

    2009-01-01

    This study was conducted to evaluate the quantities of medical waste generated and the factors associated with the generation rate at medical establishments in Taiwan. Data on medical waste generation at 150 health care establishments were collected for analysis in 2003. General medical waste and infectious waste production at these establishments were examined statistically with the potential associated factors. These factors included the types of hospital and clinic, reimbursement payment by National Health Insurance, total number of beds, bed occupancy, number of infectious disease beds and outpatients per day. The average waste generation rates ranged from 2.41 to 3.26kg/bed/day for general medical wastes, and 0.19-0.88kg/bed/day for infectious wastes. The total average quantity of infectious wastes generated was the highest from medical centers, or 3.8 times higher than that from regional hospitals (267.8 vs. 70.3Tons/yr). The multivariate regression analysis was able to explain 92% of infectious wastes and 64% of general medical wastes, with the amount of insurance reimbursement and number of beds as significant prediction factors. This study suggests that large hospitals are the major source of medical waste in Taiwan. The fractions of medical waste treated as infectious at all levels of healthcare establishments are much greater than that recommended by the USCDC guidelines.

  4. Monitoring fluidized bed drying of pharmaceutical granules.

    PubMed

    Briens, Lauren; Bojarra, Megan

    2010-12-01

    Placebo granules consisting of lactose monohydrate, corn starch, and polyvinylpyrrolidone were prepared using de-ionized water in a high-shear mixer and dried in a conical fluidized bed dryer at various superficial gas velocities. Acoustic, vibration, and pressure data obtained over the course of drying was analyzed using various statistical, frequency, fractal, and chaos techniques. Traditional monitoring methods were also used for reference. Analysis of the vibration data showed that the acceleration levels decreased during drying and reached a plateau once the granules had reached a final moisture content of 1–2 wt.%; this plateau did not differ significantly between superficial gas velocities, indicating a potential criterion to support drying endpoint identification. Acoustic emissions could not reliably identify the drying endpoint. However, high kurtosis values of acoustic emissions measured in the filtered air exhaust corresponded to high entrainment rates. This could be used for process control to adjust the fluidization gas velocity to allow drying to continue rapidly while minimizing entrainment and possible product losses.

  5. 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.

  6. Antibiotic consumption at 46 VINCat hospitals from 2007 to 2009, stratified by hospital size and clinical services.

    PubMed

    Grau, Santiago; Fondevilla, Esther; Mojal, Sergi; Palomar, Mercedes; Vallès, Jordi; Gudiol, Francesc

    2012-06-01

    The aim of the study was to assess the evolution of antibiotic consumption in acute care hospitals in Catalonia (population 7.5 million), according to hospital size and department, during the period 2007-2009. The methodology used for monitoring antibiotic consumption was the ATC/DDD system, and the unit of measurement was DDD/100 occupied bed-days (DDD/100 OBD). Hospitals were stratified according to size: I) large university hospitals (with more than 500 beds); II) medium-sized hospitals (between 200 and 500 beds); and III) small hospitals (fewer than 200 beds). The consumption was also analyzed and stratified according to department: medical, surgical and intensive care unit (ICU). Specific training in data management on antibiotic consumption was given to all participant hospitals before the implementation of the program. The mean antibiotic (J01) consumption, calculated in DDD/100 OBD, increased although without statistical significance (p=0.640): 74.68 (2007), 75.13 (2008) and 78.04 (2009). The values of the medians expressed in DDD/100 OBD in group I were 83.27 (in 2007), 82.16 (2008) and 86.93 (2009), in group II 72.60 (2007), 70.78 (2008) and 75.17 (2009) and in group III 65.66 (2007), 69.32 (2008) and 72.39 (2009). Antibiotic consumption was higher in large hospitals than in medium-sized or small hospitals. Catalan hospitals recorded an increase of 4.49% from 2007 to 2009, especially due to the rising use of carbapenems, cephalosporins, monobactams and the other antibiotic groups.

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. Characteristics of fluidized-packed beds

    NASA Technical Reports Server (NTRS)

    Gabor, J. D.; Mecham, W. J.

    1968-01-01

    Study of fluidized-packed bed includes investigation of heat transfer, solids-gas mixing, and elutriation characteristics. A fluidized-packed bed is a system involving the fluidization of small particles in the voids of a packed bed of larger nonfluidized particles.

  13. Is the maturity of hospitals' quality improvement systems associated with measures of quality and patient safety?

    PubMed Central

    2011-01-01

    Background Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. Methods The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. Results Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. Conclusions We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement

  14. 42 CFR 419.43 - Adjustments to national program payment and beneficiary copayment amounts.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... factor, so that estimated aggregate payments under the OPPS for such calendar year are not affected by... payment rates for hospital outpatient department services and determines a wage adjustment factor to...)(1). (c) Wage index factor.—(1) CMS uses the hospital inpatient prospective payment system wage...

  15. 42 CFR 419.43 - Adjustments to national program payment and beneficiary copayment amounts.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... factor, so that estimated aggregate payments under the OPPS for such calendar year are not affected by... payment rates for hospital outpatient department services and determines a wage adjustment factor to...)(1). (c) Wage index factor.—(1) CMS uses the hospital inpatient prospective payment system wage...

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... factor, so that estimated aggregate payments under the OPPS for such calendar year are not affected by... payment rates for hospital outpatient department services and determines a wage adjustment factor to...)(1). (c) Wage index factor.—(1) CMS uses the hospital inpatient prospective payment system wage...

  17. 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.)

  18. A Cost Analysis Comparing CHAMPUS to Treatment Provided within Ireland Army Community Hospital

    DTIC Science & Technology

    1992-09-01

    care programs. At one 562 bed hospital. high-cost DRGs were examined prior and after the initiation of managed care. Average length of stay dropped...that an average bed day cost the government $660.45. By identifying all patients who received a cholelithasis, their average length - of - stay could be

  19. 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.

  20. 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.

  1. [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

  2. The effect of urban hospital closure on markets.

    PubMed

    Lindrooth, Richard C; Lo Sasso, Anthony T; Bazzoli, Gloria J

    2003-09-01

    We measure the effect of urban hospital closure on the operating efficiency of the remaining hospitals in the local market. Closure of a hospital other than the least efficient can be detrimental to social welfare because treatment costs will be higher at surviving hospitals. The results show that hospital closure has led to an evolutionary increase in efficiency in urban markets. The hospitals that closed were less efficient at baseline, and after closure their competitors realized lower costs per adjusted admission through an increase in inpatient admissions and emergency room visits. Overall, we estimate that costs per adjusted admission declined by 2-4% for all patients and about 6-8% for patients who would have been treated at the closed hospital.

  3. 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.

  4. 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.

  5. Scaling of pressurized fluidized beds

    SciTech Connect

    Guralnik, S.; Glicksman, L.R.

    1994-10-01

    The project has two primary objectives. The first is to verify a set of hydrodynamic scaling relationships for commercial pressurized fluidized bed combustors (PFBC). The second objective is to investigate solids mixing in pressurized bubbling fluidized beds. American Electric Power`s (AEP) Tidd combined-cycle demonstration plant will provide time-varying pressure drop data to serve as the basis for the scaling verification. The verification will involve demonstrating that a properly scaled cold model and the Tidd PFBC exhibit hydrodynamically similar behavior. An important issue in PFBC design is the spacing of fuel feed ports. The feed spacing is dictated by the fuel distribution and the mixing characteristics within the bed. After completing the scaling verification, the cold model will be used to study the characteristics of PFBCs. A thermal tracer technique will be utilized to study mixing both near the fuel feed region and in the far field. The results allow the coal feed and distributor to be designed for optimal heating.

  6. 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.

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

    PubMed Central

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

    2011-01-01

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

  8. Elevated Plasma Vitamin B12 Concentrations Are Independent Predictors of In-Hospital Mortality in Adult Patients at Nutritional Risk.

    PubMed

    Cappello, Silvia; Cereda, Emanuele; Rondanelli, Mariangela; Klersy, Catherine; Cameletti, Barbara; Albertini, Riccardo; Magno, Daniela; Caraccia, Marilisa; Turri, Annalisa; Caccialanza, Riccardo

    2016-12-23

    Background: Elevated plasma vitamin B12 concentrations were identified as predictors of mortality in patients with oncologic, hepatic and renal diseases, and in elderly and critically ill medical patients. The association between vitamin B12 concentrations and in-hospital mortality in adult patients at nutritional risk has not been assessed. Methods: In this five-year prospective study, we investigated whether high vitamin B12 concentrations (>1000 pg/mL) are associated with in-hospital mortality in 1373 not-bed-ridden adult patients at nutritional risk (Nutrition Risk Index <97.5), admitted to medical and surgical departments. Results: Three hundred and ninety-six (28.8%) patients presented vitamin B12 > 1000 pg/mL. Two hundred and four patients died in the hospital (14.9%). The adjusted odds ratio of in-hospital mortality in patients with high vitamin B12 was 2.20 (95% CI, 1.56-3.08; p < 0.001); it was independent of age, gender, body mass index, six-month previous unintentional weight loss, admission ward, presence of malignancy, renal function, C-reactive protein and prealbumin. Patients with high vitamin B12 also had a longer length of stay (LOS) than those with normal concentrations (median 25 days, (IQR 15-41) versus 23 days (IQR 14-36); p = 0.014), and elevated vitamin B12 was an independent predictor of LOS (p = 0.027). Conclusions: An independent association between elevated vitamin B12 concentrations, mortality and LOS was found in our sample of hospitalized adult patients at nutritional risk. Although the underlying mechanisms are still unknown and any cause-effect relation cannot be inferred, clinicians should be aware of the potential negative impact of high vitamin B12 concentrations in hospitalized patients at nutritional risk and avoid inappropriate vitamin supplementation.

  9. Elevated Plasma Vitamin B12 Concentrations Are Independent Predictors of In-Hospital Mortality in Adult Patients at Nutritional Risk

    PubMed Central

    Cappello, Silvia; Cereda, Emanuele; Rondanelli, Mariangela; Klersy, Catherine; Cameletti, Barbara; Albertini, Riccardo; Magno, Daniela; Caraccia, Marilisa; Turri, Annalisa; Caccialanza, Riccardo

    2016-01-01

    Background: Elevated plasma vitamin B12 concentrations were identified as predictors of mortality in patients with oncologic, hepatic and renal diseases, and in elderly and critically ill medical patients. The association between vitamin B12 concentrations and in-hospital mortality in adult patients at nutritional risk has not been assessed. Methods: In this five-year prospective study, we investigated whether high vitamin B12 concentrations (>1000 pg/mL) are associated with in-hospital mortality in 1373 not-bed-ridden adult patients at nutritional risk (Nutrition Risk Index <97.5), admitted to medical and surgical departments. Results: Three hundred and ninety-six (28.8%) patients presented vitamin B12 > 1000 pg/mL. Two hundred and four patients died in the hospital (14.9%). The adjusted odds ratio of in-hospital mortality in patients with high vitamin B12 was 2.20 (95% CI, 1.56–3.08; p < 0.001); it was independent of age, gender, body mass index, six-month previous unintentional weight loss, admission ward, presence of malignancy, renal function, C-reactive protein and prealbumin. Patients with high vitamin B12 also had a longer length of stay (LOS) than those with normal concentrations (median 25 days, (IQR 15–41) versus 23 days (IQR 14–36); p = 0.014), and elevated vitamin B12 was an independent predictor of LOS (p = 0.027). Conclusions: An independent association between elevated vitamin B12 concentrations, mortality and LOS was found in our sample of hospitalized adult patients at nutritional risk. Although the underlying mechanisms are still unknown and any cause-effect relation cannot be inferred, clinicians should be aware of the potential negative impact of high vitamin B12 concentrations in hospitalized patients at nutritional risk and avoid inappropriate vitamin supplementation. PMID:28025528

  10. Incidence and trends of blastomycosis-associated hospitalizations in the United States.

    PubMed

    Seitz, Amy E; Younes, Naji; Steiner, Claudia A; Prevots, D Rebecca

    2014-01-01

    We used the State Inpatient Databases from the United States Agency for Healthcare Research and Quality to provide state-specific age-adjusted blastomycosis-associated hospitalization incidence throughout the entire United States. Among the 46 states studied, states within the Mississippi and Ohio River valleys had the highest age-adjusted hospitalization incidence. Specifically, Wisconsin had the highest age-adjusted hospitalization incidence (2.9 hospitalizations per 100,000 person-years). Trends were studied in the five highest hospitalization incidence states. From 2000 to 2011, blastomycosis-associated hospitalizations increased significantly in Illinois and Kentucky with an average annual increase of 4.4% and 8.4%, respectively. Trends varied significantly by state. Overall, 64% of blastomycosis-associated hospitalizations were among men and the median age at hospitalization was 53 years. This analysis provides a complete epidemiologic description of blastomycosis-associated hospitalizations throughout the endemic area in the United States.

  11. Average length of stay in hospitals.

    PubMed

    Egawa, H

    1984-03-01

    The average length of stay is essentially an important and appropriate index for hospital bed administration. However, from the position that it is not necessarily an appropriate index in Japan, an analysis is made of the difference in the health care facility system between the United States and Japan. Concerning the length of stay in Japanese hospitals, the median appeared to better represent the situation. It is emphasized that in order for the average length of stay to become an appropriate index, there is need to promote regional health, especially facility planning.

  12. 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.

  13. [Problems and prospects of improving hospital care planning in the USSR].

    PubMed

    Korchagin, V P; Kravchenko, N A; Epifantsev, V I; Matveev, E N

    1989-01-01

    The necessity of planning the hospital network (bed capacity and its structure) in combination with social security institutions is validated. Thus, planning of the hospital network should be carried out in combination with social security institutions, the degree of development of other forms of medical services (hospitals at home, day hospitals, curative and diagnostic complexes, etc.) being taken into account. By preliminary estimates the demand for hospital beds is 127 per 10,000, 13 for chronic patients and the elderly in medicosocial facilities, 38.9 in social security institutions. Realization of the principles of differentiated hospital treatment of patients according to the degree of its intensity enables one to use hospital resources more effectively and to raise the quality of inpatient care. It is recommended to differentiate specific investments in hospital construction (25,000-70,000 rubles per a bed) according to the demand in hospital beds at different stages of treatment intensity and hierarchial level of medical care organization. Equal possibilities in the provision of inpatient care for the whole population can be achieved within the framework of unified regional models of the network of health care facilities, based on the standard target approach to the utilization of hospital resources.

  14. 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.

  15. [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.

  16. Hospital resource intensity and cirrhosis mortality in United States

    PubMed Central

    Mathur, Amit K; Chakrabarti, Apurba K; Mellinger, Jessica L; Volk, Michael L; Day, Ryan; Singer, Andrew L; Hewitt, Winston R; Reddy, Kunam S; Moss, Adyr A

    2017-01-01

    AIM To determine whether hospital characteristics predict cirrhosis mortality and how much variation in mortality is attributable to hospital differences. METHODS We used data from the 2005-2011 Nationwide Inpatient Sample and the American Hospital Association Annual survey to identify hospitalizations for decompensated cirrhosis and corresponding facility characteristics. We created hospital-specific risk and reliability-adjusted odds ratios for cirrhosis mortality, and evaluated patient and facility differences based on hospital performance quintiles. We used hierarchical regression models to determine the effect of these factors on mortality. RESULTS Seventy-two thousand seven hundred and thirty-three cirrhosis admissions were evaluated in 805 hospitals. Hospital mean cirrhosis annual case volume was 90.4 (range 25-828). Overall hospital cirrhosis mortality rate was 8.00%. Hospital-adjusted odds ratios (aOR) for mortality ranged from 0.48 to 1.89. Patient characteristics varied significantly by hospital aOR for mortality. Length of stay averaged 6.0 ± 1.6 days, and varied significantly by hospital performance (P < 0.001). Facility level predictors of risk-adjusted mortality were higher Medicaid case-mix (OR = 1.00, P = 0.029) and LPN staffing (OR = 1.02, P = 0.015). Higher cirrhosis volume (OR = 0.99, P = 0.025) and liver transplant program status (OR = 0.83, P = 0.026) were significantly associated with survival. After adjusting for patient differences, era, and clustering effects, 15.3% of variation between hospitals was attributable to differences in facility characteristics. CONCLUSION Hospital characteristics account for a significant proportion of variation in cirrhosis mortality. These findings have several implications for patients, providers, and health care delivery in liver disease care and inpatient health care design. PMID:28348492

  17. The Optimal Feasible Method of Collecting and utilizing Army Hospital Meal Accounting Data

    DTIC Science & Technology

    1982-08-01

    hospital food services performe in-house are evaluated for p6 sible contracting out to commercial services. This study attempts to determine the optimal...complicates the process of military-civilian comparisons. Hospital food services are being subject to Commercial Activities requirements of potentially...hospital beds -investor-owned or not -for- profit -government or nongovernment -accredited or nonaccredited -hospital’s position in terms of the New

  18. Bed Bug Infestations in an Urban Environment

    PubMed Central

    Svoboda, Tomislav J.; De Jong, Iain J.; Kabasele, Karl J.; Gogosis, Evie

    2005-01-01

    Until recently, bed bugs have been considered uncommon in the industrialized world. This study determined the extent of reemerging bed bug infestations in homeless shelters and other locations in Toronto, Canada. Toronto Public Health documented complaints of bed bug infestations from 46 locations in 2003, most commonly apartments (63%), shelters (15%), and rooming houses (11%). Pest control operators in Toronto (N = 34) reported treating bed bug infestations at 847 locations in 2003, most commonly single-family dwellings (70%), apartments (18%), and shelters (8%). Bed bug infestations were reported at 20 (31%) of 65 homeless shelters. At 1 affected shelter, 4% of residents reported having bed bug bites. Bed bug infestations can have an adverse effect on health and quality of life in the general population, particularly among homeless persons living in shelters. PMID:15829190

  19. 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.

  20. 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.

  1. [Positive end-expiratory pressure : adjustment in acute lung injury].

    PubMed

    Bruells, C S; Dembinski, R

    2012-04-01

    Treatment of patients suffering from acute lung injury is a challenge for the treating physician. In recent years ventilation of patients with acute hypoxic lung injury has changed fundamentally. Besides the use of low tidal volumes, the most beneficial setting of positive end-expiratory pressure (PEEP) has been in the focus of researchers. The findings allow adaption of treatment to milder forms of acute lung injury and severe forms. Additionally computed tomography techniques to assess the pulmonary situation and recruitment potential as well as bed-side techniques to adjust PEEP on the ward have been modified and improved. This review gives an outline of recent developments in PEEP adjustment for patients suffering from acute hypoxic and hypercapnic lung injury and explains the fundamental pathophysiology necessary as a basis for correct treatment.

  2. Origin of Subglacial Debris-bed Friction

    NASA Astrophysics Data System (ADS)

    Cohen, D. O.; Byers, J.; Iverson, N. R.

    2011-12-01

    Numerical models of glaciers sliding on hard beds assume that basal flow resistance is controlled entirely by viscous drag on bedrock bumps. However, observations and measurements indicate that basal ice can contain large concentrations of rock debris that exert significant frictional resistance: for example, locally high shear stress (˜500 kPa) was measured below 200 m of ice on a smooth rock tablet at the bed of Engabreen, Norway. This value of shear stress is an order of magnitude greater than estimated by leading theories. To better understand the origin of debris-bed friction, we built a new laboratory apparatus that recorded the contact force between a clast and a hard bed as a function of ice velocity toward the bed. An independent experiment with the same apparatus in which the clast is isolated from the bed was used to obtain the ice viscosity. After correcting for cavity formation and ice flow geometry, results indicate that the contact force between a clast and a hard bed is about twice the drag force on the same clast estimated using Stokes's law. This value is insufficient to explain the high debris-bed friction measured beneath Engabreen. An alternative explanation is that longitudinal ice extension caused by ice flowing over the rough topography near the smooth rock tablet increased the rate of ice convergence with the bed by a factor of 5. Our measurements confirm that debris-bed friction is controlled by contact forces caused by flow of ice towards the bed due to basal melting and longitudinal ice extension. This form of frictional drag has yet to be included in models of ice flow. Inclusion of debris-bed friction may prove important to properly estimating rates of basal sliding, energy dissipation and meltwater production at the bed, and, more importantly, to quantifying the stick-slip behavior of hard-bedded glaciers.

  3. 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.

  4. 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.

  5. Maintaining Continuity of Care for Nursing Home Residents: Effect of States’ Medicaid Bed-Hold Policies and Reimbursement Rates

    PubMed Central

    Intrator, Orna; Schleinitz, Mark; Grabowski, David C; Zinn, Jacqueline; Mor, Vincent

    2009-01-01

    Objective Recent public concern in response to states’ intended repeal of Medicaid bed-hold policies and report of their association with higher hospitalization rates prompts examination of these policies in ensuring continuity of care within the broader context of Medicaid policies. Data Sources/Study Design Minimum Data Set assessments of long-stay nursing home residents in April–June 2000 linked to Medicare claims enabled tracking residents’ hospitalizations during the ensuing 5 months and determining hospital discharge destination. Multinomial multilevel models estimated the effect of state policies on discharge destination controlling for resident, hospitalization, nursing home, and market characteristics. Results Among 77,955 hospitalizations, 5,797 (7.4 percent) were not discharged back to the baseline nursing home. Bed-hold policies were associated with lower odds of transfer to another nursing home (AOR=0.55, 95 percent CI 0.52–0.58) and higher odds of hospitalization (AOR=1.36), translating to 9.5 fewer nursing home transfers and 77.9 more hospitalizations per 1,000 residents annually, and costing Medicaid programs about $201,311. Higher Medicaid reimbursement rates were associated with lower odds of transfer. Conclusions Bed-hold policies were associated with greater continuity of NH care; however, their high cost compared with their small impact on transfer but large impact on increased hospitalizations suggests that they may not be effective. PMID:18783452

  6. Real time measurements of sediment transport and bed morphology during channel altering flow and sediment transport events

    NASA Astrophysics Data System (ADS)

    Curran, Joanna Crowe; Waters, Kevin A.; Cannatelli, Kristen M.

    2015-09-01

    Real-time measurements of bed changes over a reach are a missing piece needed to link bed morphology with sediment transport processes during unsteady flows when the bed adjusts quickly to changing transport rates or visual observation of the bed is precluded by fine sediment in the water column. A new technique is presented that provides continuous measurement of sediment movement over the length of a flume. A bedload monitoring system (BLMS) was developed that makes use of pressure pillows under a false flume bottom to measure sediment and water weights over discrete flume channel sections throughout a flow event. This paper details the construction of the BLMS and provides examples of its use in a laboratory setting to reconstruct bed slopes during unsteady flows and to create a real-time record of sediment transport rates across the flume channel bed during a sediment transporting flow. Data gathered from the BLMS compared well against techniques commonly in use in flume studies. When the BLMS was analyzed in conjunction with bed surface DEMs and differenced DEMs, a complete transport and bed adjustment picture was constructed. The difference DEMs provided information on the spatial extent of bed morphology changes. The BLMS supplied the data record necessary to reconstruct sediment transport records through the downstream channel, including locations and time periods of temporary sediment storage and supply. The BLMS makes it possible to construct a continuous record of the spatial distribution of sediment movement through the flume, including areas of temporary aggradation and degradation. Exciting implications of future research that incorporates a BLMS include a more informed management of river systems as a result of improved temporal predictions of sediment movement and the associated changes in channel slope and bed morphology.

  7. [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.

  8. 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.

  9. 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

  10. 75 FR 54911 - Certain Adjustable-Height Beds and Components Thereof; Notice of Investigation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-09

    ... the United States, the sale for importation, and the sale within the United States after importation... of U.S. Patent No. 6,983,495 (``the '495 patent''); U.S. Patent No. 6,997,082 (``the '082 patent''); U.S. Patent No. 7,302,716 (``the '716 patent''); and U.S. Patent No. 7,441,289 (``the '289...

  11. 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.

  12. Modeling a dynamically varying mixed sediment bed with erosion, deposition, bioturbation, consolidation, and armoring

    NASA Astrophysics Data System (ADS)

    Sanford, Lawrence P.

    2008-10-01

    Erosion and deposition of bottom sediments reflect a continual, dynamic adjustment between the fluid forces applied to a sediment bed and the condition of the bed itself. Erosion of fine and mixed sediment beds depends on their composition, their vertical structure, their disturbance/recovery history, and the biota that inhabit them. This paper presents a new one-dimensional (1D), multi-layer sediment bed model for simulating erosion and deposition of fine and mixed sediments subject to consolidation, armoring, and bioturbation. The distinguishing characteristics of this model are a greatly simplified first-order relaxation treatment for consolidation, a mud erosion formulation that adapts to both Type I and II erosion behavior and is based directly on observations, a continuous deposition formulation for mud that can mimic exclusive erosion and deposition behavior, and straightforward inclusion of bioturbation effects. Very good agreement with two laboratory data sets on consolidation effects is achieved by adjusting only the first-order consolidation rate r c. Full model simulations of three idealized cases based on upper Chesapeake Bay, USA observations are presented. In the mud only case, fluid stresses match mud critical stresses at maximum erosion. A consolidation lag results in higher suspended sediment concentrations after erosional events. Erosion occurs only during accelerating currents and deposition does not occur until just before slack water. In the mixed mud and sand case without bioturbation, distinct layers of high and low sand content form and mud suspension is strongly limited by sand armoring. In the mixed mud and sand case with bioturbation, suspended mud concentrations are greater than or equal to either of the other cases. Low surface critical stresses are mixed down into the bed, constrained by the tendency to return towards equilibrium. Sand layers and the potential for armoring of the bed develop briefly, but mix rapidly. This model offers

  13. Estimating the effect of hospital closure on areawide inpatient hospital costs: a preliminary model and application.

    PubMed Central

    Shepard, D S

    1983-01-01

    A preliminary model is developed for estimating the extent of savings, if any, likely to result from discontinuing a specific inpatient service. By examining the sources of referral to the discontinued service, the model estimates potential demand and how cases will be redistributed among remaining hospitals. This redistribution determines average cost per day in hospitals that receive these cases, relative to average cost per day of the discontinued service. The outflow rate, which measures the proportion of cases not absorbed in other acute care hospitals, is estimated as 30 percent for the average discontinuation. The marginal cost ratio, which relates marginal costs of cases absorbed in surrounding hospitals to the average costs in those hospitals, is estimated as 87 percent in the base case. The model was applied to the discontinuation of all inpatient services in the 75-bed Chelsea Memorial Hospital, near Boston, Massachusetts, using 1976 data. As the precise value of key parameters is uncertain, sensitivity analysis was used to explore a range of values. The most likely result is a small increase ($120,000) in the area's annual inpatient hospital costs, because many patients are referred to more costly teaching hospitals. A similar situation may arise with other urban closures. For service discontinuations to generate savings, recipient hospitals must be low in costs, the outflow rate must be large, and the marginal cost ratio must be low. PMID:6668181

  14. 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.

  15. 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.

  16. 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

  17. Prognosis after Hospitalization for Erythroderma.

    PubMed

    Egeberg, Alexander; Thyssen, Jacob P; Gislason, Gunnar H; Skov, Lone

    2016-11-02

    Erythrodermic psoriasis (EP) and erythroderma exfoliativa (EE) are acute and potentially life-threatening inflammatory reactions. We estimated hazard ratios (HRs) of 3-year mortality following hospitalization for EP or EE compared with general population controls, patients hospitalized for psoriasis vulgaris, and toxic epidermal necrolysis (TEN), respectively. We identified 26 and 48 patients with a first-time hospitalization (1997-2010) for EP and EE, respectively (10 matched population-controls for each patient), 1,998 patients with psoriasis vulgaris, and 60 patients with TEN. During follow-up, 8 (30.8%) patients with EP, 19 (39.6%) patients with EE, and 34 (56.7%) patients with TEN died. Compared with population-controls, adjusted HRs were 4.40 (95% CI 1.66-11.70) for EP and 2.16 (1.21-3.82) for EE. Compared with psoriasis vulgaris, adjusted HRs were 1.83 (0.90-3.73) for EP, and 1.28 (1.01-1.63) for EE. The risk was significantly lower in EP (0.38 (0.16-0.91)) and in EE (0.50 (0.36-0.71)), compared with TEN. Mortality in EP and EE is high, and close follow-up is advised.

  18. An analysis of surgical cases in a Nigerian mission hospital.

    PubMed

    WARD, R V

    1963-08-24

    Approximately 315 major surgical cases were treated in one year in a one-doctor 80-bed mission hospital in Nigeria. The hospital serves a population of 137,000. One hundred and forty-three of the cases were herniorrhaphies: 19 of these cases were strangulated, of which seven required bowel resection. A case of a strangulated inguinal hernia containing uterus, Fallopian tubes and ovaries is reported. Other interesting surgical cases are also discussed.

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

    PubMed Central

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

    2011-01-01

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

  20. Advances in the optimization of moving bed Sasol-Lurgi gasifiers

    SciTech Connect

    Ranwell, P.; Greyvenstein, G.P.

    1998-12-31

    During the past ten years there have been significant advances in the development of the Sasol Lurgi gasifier. In 1987 some of the Mark IV Gasifiers in Sasolburg, South Africa were decommissioned and flushed with water, the coal and ash bed were then excavated from the top, layer by layer, in order to examine the three dimensional profile of the ash bed at the bottom of the gasifier. These excavations showed that the ash bed and oxidation zone have an axial symmetric ``W`` shape if viewed from the side. It was argued that this shape played an important role by influencing the stable operation of the gasifier. Most studies and modifications that followed were attempts to correct or adjust this particular shape to a more homogeneous and flat ash bed. In this paper the mechanism that determines the three dimensional shape of the ash bed were investigated. A computational fluid dynamic model was used to study the chemical reacting flow of gas in a packed coal bed. With this model it was possible to determine the key parameters that influences the shape of the oxidation zone and therefore the operation of the gasifier.

  1. Pressurized fluidized-bed combustion

    SciTech Connect

    Not Available

    1980-10-01

    The US DOE pressurized fluidized bed combustion (PFBC) research and development program is designed to develop the technology and data base required for the successful commercialization of the PFBC concept. A cooperative program with the US, West Germany, and the UK has resulted in the construction of the 25 MWe IEA-Grimethorpe combined-cycle pilot plant in England which will be tested in 1981. A 13 MWe coal-fired gas turbine (air cycle) at Curtis-Wright has been designed and construction scheduled. Start-up is planned to begin in early 1983. A 75 MWe pilot plant is planned for completion in 1986. Each of these PFBC combined-cycle programs is discussed. The current status of PFB technology may be summarized as follows: turbine erosion tolerance/hot gas cleanup issues have emerged as the barrier technology issues; promising turbine corrosion-resistant materials have been identified, but long-term exposure data is lacking; first-generation PFB combustor technology development is maturing at the PDU level; however, scale-up to larger size has not been demonstrated; and in-bed heat exchanger materials have been identified, but long-term exposure data is lacking. The DOE-PFB development plan is directed at the resolution of these key technical issues. (LCL)

  2. Physiology of prolonged bed rest

    NASA Technical Reports Server (NTRS)

    Greenleaf, J. E.

    1988-01-01

    Bed rest has been a normal procedure used by physicians for centuries in the treatment of injury and disease. Exposure of patients to prolonged bed rest in the horizontal position induces adaptive deconditioning responses. While deconditioning responses are appropriate for patients or test subjects in the horizontal position, they usually result in adverse physiological responses (fainting, muscular weakness) when the patient assume the upright posture. These deconditioning responses result from reduction in hydrostatic pressure within the cardiovascular system, virtual elimination of longitudinal pressure on the long bones, some decrease in total body metabolism, changes in diet, and perhaps psychological impact from the different environment. Almost every system in the body is affected. An early stimulus is the cephalic shift of fluid from the legs which increases atrial pressure and induces compensatory responses for fluid and electrolyte redistribution. Without countermeasures, deterioration in strength and muscle function occurs within 1 wk while increased calcium loss may continue for months. Research should also focus on drug and carbohydrate metabolism.

  3. Adjusting to Chronic Health Conditions.

    PubMed

    Helgeson, Vicki S; Zajdel, Melissa

    2017-01-03

    Research on adjustment to chronic disease is critical in today's world, in which people are living longer lives, but lives are increasingly likely to be characterized by one or more chronic illnesses. Chronic illnesses may deteriorate, enter remission, or fluctuate, but their defining characteristic is that they persist. In this review, we first examine the effects of chronic disease on one's sense of self. Then we review categories of factors that influence how one adjusts to chronic illness, with particular emphasis on the impact of these factors on functional status and psychosocial adjustment. We begin with contextual factors, including demographic variables such as sex and race, as well as illness dimensions such as stigma and illness identity. We then examine a set of dispositional factors that influence chronic illness adjustment, organizing these into resilience and vulnerability factors. Resilience factors include cognitive adaptation indicators, personality variables, and benefit-finding. Vulnerability factors include a pessimistic attributional style, negative gender-related traits, and rumination. We then turn to social environmental variables, including both supportive and unsupportive interactions. Finally, we review chronic illness adjustment within the context of dyadic coping. We conclude by examining potential interactions among these classes of variables and outlining a set of directions for future research.

  4. Suicide following an infestation of bed bugs

    PubMed Central

    Burrows, Stephanie; Perron, Stéphane; Susser, Stephanie

    2013-01-01

    Patient: Male, 62 Final Diagnosis: Bipolar disorder Symptoms: Bordeline personality disorder Medication: — Clinical Procedure: Bed bug infestation Specialty: Psychiatry Objective: Unusual clinical course Background: In the past decade, bed bug infestations have been increasingly common in high income countries. Psychological consequences of these infestations are rarely examined in the scientific literature. Case Report: We present a case, based on a coroner’s investigation report, of a woman with previous psychiatric morbidity who jumped to her death following repeated bed bug infestations in her apartment. Our case report shows that the bed bug infestations were the likely trigger for the onset a negative psychological state that ultimately led to suicide. Conclusions: Given the recent surge in infestations, rapid action needs to be taken not only in an attempt to control and eradicate the bed bugs but also to adequately care for those infested by bed bugs. PMID:23826461

  5. [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

  6. 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

  7. 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.

  8. Evaluation of a clay-based acidic bedding conditioner for dairy cattle bedding.

    PubMed

    Proietto, R L; Hinckley, L S; Fox, L K; Andrew, S M

    2013-02-01

    This study investigated the effects of a clay-based acidic bedding conditioner on sawdust bedding pH, dry matter (DM), environmental pathogen counts, and environmental bacterial counts on teat ends of lactating dairy cows. Sixteen lactating Holstein cows were paired based on parity, days in milk, milk yield, and milk somatic cell count, and were negative for the presence of an intramammary pathogen. Within each pair, cows were randomly assigned to 1 of 2 treatments with 3-wk periods in a crossover design. Treatment groups consisted of 9 freestalls per group bedded with either untreated sawdust or sawdust with a clay-based acidic bedding conditioner, added at 3- to 4-d intervals over each 21-d period. Bedding and teat ends were aseptically sampled on d 0, 1, 2, 7, 14, and 21 for determination of environmental bacterial counts. At the same time points, bedding was sampled for DM and pH determination. The bacteria identified in the bedding material were total gram-negative bacteria, Streptococcus spp., and coliform bacteria. The bacteria identified on the teat ends were Streptococcus spp., coliform bacteria, and Klebsiella spp. Teat end score, milk somatic cell count, and intramammary pathogen presence were measured weekly. Bedding and teat cleanliness, environmental high and low temperatures, and dew point data were collected daily. The bedding conditioner reduced the pH, but not the DM, of the sawdust bedding compared with untreated sawdust. Overall environmental bacterial counts in bedding were lower for treated sawdust. Total bacterial counts in bedding and on teat ends increased with time over both periods. Compared with untreated sawdust, the treated bedding had lower counts of total gram-negative bacteria and streptococci, but not coliform counts. Teat end bacterial counts were lower for cows bedded on treated sawdust for streptococci, coliforms, and Klebsiella spp. compared with cows bedded on untreated sawdust. The clay-based acidic bedding conditioner

  9. Adjustable forming of thermoplastic composites for orthopaedic applications.

    PubMed

    Hou, M; Friedrich, K

    1998-02-01

    The present study was focused on the development of a special thermoforming technique for manufacturing of continuous fibre reinforced thermoplastic composite parts with complex surface contours. In particular, a stamp forming process was modified to investigate the potential manufacturing advantages of thermoplastic composites in orthopaedic applications. An apparatus was designed which allowed the thermoforming procedure to be fully automatic, i.e. a cold pre-consolidated laminate panel, as the feed material, was heated up in an infrared heating zone and then transferred into a cold mould system, where it was stamp formed. Both halves of the mould were made of many tiny round metal sticks in a metal frame. This needle-bed mould allowed one to copy any contour by pushing it slightly on spring fixed sticks. The desired position of these sticks could then be adjusted by forcing the side plates of the metal frame together. To prevent any press mark of stick-tops on the composite, i.e. to achieve smooth surfaces of the themoformed composite parts, flexible rubber pads were needed to cover the mould surfaces. Experimental results showed that the surface profile of CF/PP and GF/PP composites formed by the needle-bed mould reproduced fairly well the contour of a saddle shaped, complex model sample. Unique properties of this needle-bed mould are that it can be repeatedly used, and that it can copy any complex surface contours, for example a bone surface, by simply adjusting the stick positions according to the special surface requirements.

  10. Solar energy assisted fluidized bed fruit drying

    NASA Astrophysics Data System (ADS)

    Kilkis, B.

    The possibility of using the fluidized-bed principle for solar drying of fruits economically and simply is explored. With the aid of computerized design methods, an optimized fluidized bed/packed bed combination was achieved, that in addition functions as a solar air heater. Based on this configuration, a novel aparatus was designed in Turkey for drying Turkish grapes. Comparisons with comparable systems are made.

  11. Fluidized Bed Boiler Assessment for Navy Applications

    DTIC Science & Technology

    1986-11-01

    inertia and latent heat stored in the bed material allow newly added fuel to ignite quickly and evenly; even wet or low-quality fuels can be burned...about 97% inert bed material (e.g., sand) and 3% fuel. The upper bed is composed of finely ground sulfur sorbent and is where desulfurization of...can be burned without the need of the expensive back-end desulfurization equipment. In fact, most FBC boilers can practically burn all combustible

  12. Fuel bed characteristics of Sierra Nevada conifers

    USGS Publications Warehouse

    van Wagtendonk, J.W.; Benedict, J.M.; Sydoriak, W.M.

    1998-01-01

    A study of fuels in Sierra Nevada conifer forests showed that fuel bed depth and fuel bed weight significantly varied by tree species and developmental stage of the overstory. Specific values for depth and weight of woody, litter, and duff fuels are reported. There was a significant positive relationship between fuel bed depth and weight. Estimates of woody fuel weight using the planar intercept method were significantly related to sampled values. These relationships can be used to estimate fuel weights in the field.

  13. Battery using a metal particle bed electrode

    SciTech Connect

    Evans, James V.; Savaskan, Gultekin

    1991-01-01

    A zinc-air battery in a case including a zinc particle bed supported adjacent the current feeder and diaphragm on a porous support plate which holds the particles but passes electrolyte solution. Electrolyte is recycled through a conduit between the support plate and top of the bed by convective forces created by a density of differential caused by a higher concentration of high density discharge products in the interstices of the bed than in the electrolyte recycle conduit.

  14. Battery using a metal particle bed electrode

    SciTech Connect

    Evans, J.V.; Savaskan, G.

    1991-04-09

    A zinc-air battery in a case is described including a zinc particle bed supported adjacent the current feeder and diaphragm on a porous support plate which holds the particles but passes electrolyte solution. Electrolyte is recycled through a conduit between the support plate and top of the bed by convective forces created by a density of differential caused by a higher concentration of high density discharge products in the interstices of the bed than in the electrolyte recycle conduit. 7 figures.

  15. Updraft Fixed Bed Gasification Aspen Plus Model

    SciTech Connect

    2007-09-27

    The updraft fixed bed gasification model provides predictive modeling capabilities for updraft fixed bed gasifiers, when devolatilization data is available. The fixed bed model is constructed using Aspen Plus, process modeling software, coupled with a FORTRAN user kinetic subroutine. Current updraft gasification models created in Aspen Plus have limited predictive capabilities and must be "tuned" to reflect a generalized gas composition as specified in literature or by the gasifier manufacturer. This limits the applicability of the process model.

  16. Gas distributor for fluidized bed coal gasifier

    DOEpatents

    Worley, Arthur C.; Zboray, James A.

    1980-01-01

    A gas distributor for distributing high temperature reaction gases to a fluidized bed of coal particles in a coal gasification process. The distributor includes a pipe with a refractory reinforced lining and a plurality of openings in the lining through which gas is fed into the bed. These feed openings have an expanding tapered shape in the downstream or exhaust direction which aids in reducing the velocity of the gas jets as they enter the bed.

  17. Achieving equity in Medicare disproportionate share payments to rural hospitals: an assessment of the financial impact of recent and proposed changes to the disproportionate share hospital payment formula.

    PubMed

    Sutton, Janet P; Stensland, Jeffrey; Zhao, Lan; Cheng, Michael

    2002-01-01

    Historically, the Medicare Disproportionate Share Hospital (DSH) payment program has been less favorable to rural hospitals: eligibility thresholds were higher and the payment adjustment was smaller for rural than for urban hospitals. Although the Medicare, Medicaid, and SCHIP Benefit Improvement and Protection Act (BIPA) of 2000 established a uniform low-income threshold and increased the magnitude of the adjustment for certain small and rural hospitals as a means to promote payment equity, the DSH distribution formula continues to vary by location. This study examines how the DSH revisions mandated under BIPA are likely to affect rural hospitals' financial performance and simulates the financial impact of implementing a uniform DSH payment adjustment. Using data from the 1998 Medicare cost report and impact files, this study found that two-thirds of both rural and urban hospitals would have qualified for DSH payments following BIPA compared with only one-fifth of rural hospitals and one-half of urban hospitals prior to BIPA. Although the impact of BIPA revisions on rural hospitals' total margins were found to be modest, the financial impact of a uniform payment adjustment would be somewhat greater: rural hospitals' average total margins would have increased by 1.6 percentage points. Importantly, 20% of rural hospitals with negative total margins would have been "in the black" if rural and urban hospitals were reimbursed using the same DSH formula. These findings suggest that elimination of rural and urban disparities in DSH payment could strengthen the rural health care safety net.

  18. Magistral drugs in hospitalized newborns and children

    PubMed Central

    Pereira, Agueda Cabral de Souza; Miranda, Elaine Silva; de Castilho, Selma Rodrigues; Futuro, Débora Omena; Teixeira, Lenise Arneiro; de Paula, Geraldo Renato

    2016-01-01

    Abstract Objective: Study the use of magistral oral solutions and suspensions in infants and children at a university hospital. Methods: This is a descriptive study based on the analysis of the assessed hospital's magistral drug request forms regarding the patients in the neonatal ICU, Obstetrics, Pediatrics and Pediatric Emergency from January 2012 to December 2013. The frequency of drug requests and dispensation was evaluated and the consumption of each active ingredient of the preparations was expressed as number of “infant defined daily dose” (iDDD) and of iDDD/100 bed-days. Results: A total of 657 forms were analyzed - a monthly average of 27 pediatric preparations. The neonatal ICU accounted for 69.6% of these requests. Twenty-one drug items were used, of which the most common were folinic acid (88 requests), sulfadiazine (85) and captopril (73). The consumption of the active principle in these preparations varied in number of iDDD, from 7.5 (hydralazine) to 16,520.0 (folic acid), and in number of iDDD/100 bed-days in the neonatal ICU, from 0.1 (zinc sulfate) to 146.1 (folic acid). Conclusions: The constant consumption of magistral oral solutions and suspensions by newborns and children of the assessed hospital indicates the need for such preparations as a pediatric therapeutic alternative in this hospital. PMID:27131897

  19. Impact of lightning strikes on hospital functions.

    PubMed

    Mortelmans, Luc J M; Van Springel, Gert L J; Van Boxstael, Sam; Herrijgers, Jan; Hoflacks, Stefaan

    2009-01-01

    Two regional hospitals were struck by lightning during a one-month period. The first hospital, which had 236 beds, suffered a direct strike to the building. This resulted in a direct spread of the power peak and temporary failure of the standard power supply. The principle problems, after restoring standard power supply, were with the fire alarm system and peripheral network connections in the digital radiology systems. No direct impact on the hardware could be found. Restarting the servers resolved all problems. The second hospital, which had 436 beds, had a lightning strike on the premises and mainly experienced problems due to induction. All affected installations had a cable connection from outside in one way or another. The power supplies never were endangered. The main problem was the failure of different communication systems (telephone, radio, intercom, fire alarm system). Also, the electronic entrance control went out. During the days after the lightening strike, multiple software problems became apparent, as well as failures of the network connections controlling the technical support systems. There are very few ways to prepare for induction problems. The use of fiber-optic networks can limit damage. To the knowledge of the authors, these are the first cases of lightning striking hospitals in medical literature.

  20. MCCB warm adjustment testing concept

    NASA Astrophysics Data System (ADS)

    Erdei, Z.; Horgos, M.; Grib, A.; Preradović, D. M.; Rodic, V.

    2016-08-01

    This paper presents an experimental investigation in to operating of thermal protection device behavior from an MCCB (Molded Case Circuit Breaker). One of the main functions of the circuit breaker is to assure protection for the circuits where mounted in for possible overloads of the circuit. The tripping mechanism for the overload protection is based on a bimetal movement during a specific time frame. This movement needs to be controlled and as a solution to control this movement we choose the warm adjustment concept. This concept is meant to improve process capability control and final output. The warm adjustment device design will create a unique adjustment of the bimetal position for each individual breaker, determined when the testing current will flow thru a phase which needs to trip in a certain amount of time. This time is predetermined due to scientific calculation for all standard types of amperages and complies with the IEC 60497 standard requirements.

  1. Comparable-Worth Adjustments: Yes--Comparable-Worth Adjustments: No.

    ERIC Educational Resources Information Center

    Galloway, Sue; O'Neill, June

    1985-01-01

    Two essays address the issue of pay equity and present opinions favoring and opposing comparable-worth adjustments. Movement of women out of traditionally female jobs, the limits of "equal pay," fairness of comparable worth and market-based wages, implementation and efficiency of comparable worth system, and alternatives to comparable…

  2. Combined fluidized bed retort and combustor

    DOEpatents

    Shang, Jer-Yu; Notestein, John E.; Mei, Joseph S.; Zeng, Li-Wen

    1984-01-01

    The present invention is directed to a combined fluidized bed retorting and combustion system particularly useful for extracting energy values from oil shale. The oil-shale retort and combustor are disposed side-by-side and in registry with one another through passageways in a partition therebetween. The passageways in the partition are submerged below the top of the respective fluid beds to preclude admixing or the product gases from the two chambers. The solid oil shale or bed material is transported through the chambers by inclining or slanting the fluidizing medium distributor so that the solid bed material, when fluidized, moves in the direction of the downward slope of the distributor.

  3. Packed fluidized bed blanket for fusion reactor

    DOEpatents

    Chi, John W. H.

    1984-01-01

    A packed fluidized bed blanket for a fusion reactor providing for efficient radiation absorption for energy recovery, efficient neutron absorption for nuclear transformations, ease of blanket removal, processing and replacement, and on-line fueling/refueling. The blanket of the reactor contains a bed of stationary particles during reactor operation, cooled by a radial flow of coolant. During fueling/refueling, an axial flow is introduced into the bed in stages at various axial locations to fluidize the bed. When desired, the fluidization flow can be used to remove particles from the blanket.

  4. Conceptual design of ECLSS microgravity test beds

    NASA Technical Reports Server (NTRS)

    Kolodney, Matt; Dall-Bauman, Liese

    1992-01-01

    Conceptual designs were prepared for Space Station Freedom ECLSS test beds for both the Air Revitalization Subsystem (ARS) and the Water Recovery and Management Subsystem (WRMS), which will allow extended testing of equipment under microgravity conditions. The separate designs for the ARS and the WRMS include storage tanks, plumbing, and limited instrumentation that would be expected to be common to all air or water treatment equipment of interest. The beds are designed to recycle process fluids to the greatest extent possible, thus minimizing the spacecraft/test bed interface requirements. Schematic diagrams of both the ARS and the WRMS test beds are included.

  5. Fluidized bed regenerators for Brayton cycles

    NASA Technical Reports Server (NTRS)

    Nichols, L. D.

    1975-01-01

    A recuperator consisting of two fluidized bed regenerators with circulating solid particles is considered for use in a Brayton cycle. These fluidized beds offer the possibility of high temperature operation if ceramic particles are used. Calculations of the efficiency and size of fluidized bed regenerators for typical values of operating parameters were made and compared to a shell and tube recuperator. The calculations indicate that the fluidized beds will be more compact than the shell and tube as well as offering a high temperature operating capability.

  6. 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

  7. A survey of patients with bed bugs in the emergency department.

    PubMed

    Sheele, Johnathan M; Gaines, Stephanie; Maurer, Nicholas; Coppolino, Katirina; Li, Jennifer S; Pound, Amy; Luk, Jeffrey H; Mandac, Ed

    2017-01-03

    Bed bugs are one of the most important human ectoparasites in the United States, and a growing problem in the emergency department. We evaluated 40 emergency department (ED) patients found with a bed bug. The data show that ED patients with bed bugs are statistically more likely to be male, older, more likely to be admitted to the hospital, have higher triage emergency severity index (ESI) scores, and arrive by ambulance than the general ED patient population (p<0.05). On average bed bugs were found 108min after a patient arrived to the ED, after 35% of subjects had already received a blood draw, and after 23% had already received a radiology study; putting other ED patients and staff at risk for acquiring the infestation. We found that 13% and 18% of subjects had wheezing and a papular rash, respectively on physical exam. Of those patients found with a bed bug in the ED, 42% reported having bed bugs at home and 21% reporting having a possible home infestation.

  8. Hereford Hospital: a 65 m Pounds PFI development project.

    PubMed

    2002-08-01

    The new 340-bed acute general hospital at Hereford is one of a growing number of innovative PFI healthcare projects where Sodexho is a leading consortium member. The company is an equity partner with a 30-year contract to provide support services.

  9. 42 CFR 412.79 - Determination of the hospital-specific rate for inpatient operating costs for Medicare-dependent...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... amount (target amount) for a particular covered discharge. (f) Notice of hospital-specific rate. The... adjustment to the hospital-specific rate to ensure that changes to the DRG classifications and...

  10. CERTS Microgrid Laboratory Test Bed

    SciTech Connect

    Eto, Joe; Lasseter, Robert; Schenkman, Ben; Stevens, John; Klapp, Dave; Volkommer, Harry; Linton, Ed; Hurtado, Hector; Roy, Jean

    2009-06-18

    The objective of the CERTS Microgrid Test Bed project was to enhance the ease of integrating energy sources into a microgrid. The project accomplished this objective by developing and demonstrating three advanced techniques, collectively referred to as the CERTS Microgrid concept, that significantly reduce the level of custom field engineering needed to operate microgrids consisting of generating sources less than 100kW. The techniques comprising the CERTS Microgrid concept are: 1) a method for effecting automatic and seamless transitions between grid-connected and islanded modes of operation, islanding the microgrid's load from a disturbance, thereby maintaining a higher level of service, without impacting the integrity of the utility's electrical power grid; 2) an approach to electrical protection within a limited source microgrid that does not depend on high fault currents; and 3) a method for microgrid control that achieves voltage and frequency stability under islanded conditions without requiring high-speed communications between sources. These techniques were demonstrated at a full-scale test bed built near Columbus, Ohio and operated by American Electric Power. The testing fully confirmed earlier research that had been conducted initially through analytical simulations, then through laboratory emulations,and finally through factory acceptance testing of individual microgrid components. The islanding and resychronization method met all Institute of Electrical and Electronics Engineers Standard 1547 and power quality requirements. The electrical protection system was able to distinguish between normal and faulted operation. The controls were found to be robust under all conditions, including difficult motor starts and high impedance faults. The results from these tests are expected to lead to additional testing of enhancements to the basic techniques at the test bed to improve the business case for microgrid technologies, as well to field demonstrations

  11. Different bed surface and flow resistance characteristics for gravel and sand bed

    NASA Astrophysics Data System (ADS)

    Fan, N.; Yang, K.; Nie, R.; Liu, X.

    2014-12-01

    Bed forms affect both bed load transport and flow resistance strongly and change their shapes and sizes depending on underlying grain size distribution and shear stress. A series of flume experiments were conducted at the Saint Anthony Falls Laboratory to study the effect of bed form dynamics on flow turbulence and sediment transport with both gravel and sand as bed material and different flow conditions. From the experimental data, the spectrum of bed elevation time series, the PDFs of bed elevation increments and the flow resistance characteristics are all analyzed. The wavelet-based spectral analysis shows that the slopes of the elevation spectrums are -2 and -3 for gravel and sand bed surfaces, respectively. The slope -3 indicates that the surface is self-similar, in another words, the ratios of bed form heights and lengths for different bed forms are the same; however, the slope of -2 indicates that the surface is self-affine, and in such case (-2) the ratios of bed form heights and lengths for different bed forms are not correlated at all. We interpret that the relative size of grain and boundary layer affects the bed form characteristics significantly, e.g., grain size of sand is of the same scale as the thickness of boundary layer, but both are much smaller than the grain size of gravel. Our results suggest that the PDFs of bed elevation increments for both gravel and sand beds can be fitted well with two-sided asymmetric exponential function. Furthermore, we show that the flow resistance (Darcy-Weisbach coefficients f) are much higher for sand bed than gravel bed, and the former is contributed by form drags, which is much larger than grain drags. For gravel bed, f and the skewness of bed elevation increments increases with flow discharge whereas for the sand bed, both f and the skewness of bed elevation increments decreases which corresponds to the transition in hydraulic conditions for dune to dynamic flat surface in our experiments. The analysis

  12. Filmless in 60 days: the impact of picture archiving and communications systems within a large urban hospital.

    PubMed

    Hayt, D B; Alexander, S; Drakakis, J; Berdebes, N

    2001-06-01

    Many large urban hospitals converting to filmless radiography use a phased approach for digital imaging implementation. In fact, this strategy often is recommended by picture archival communication systems (PACS) experts and vendors alike for large, busy hospitals installing PACS in existing physical facilities. The concern is that comprehensive conversion from film-based to digital imaging may be too overwhelming an adjustment in operations for a medical staff to effectively handle without serious disruption of workflow for patient treatment and care. Elmhurst Hospital Center is a 543-bed hospital located in the Borough of Queens in New York City. Owned by the New York City Health and Hospitals Corporation, this municipal teaching hospital provides services to a patient mix that is 38% indigent with no insurance, 50% covered by Medicaid or Medicare, and 12% affiliated with HMOs. Most inpatients are admitted through the emergency department. Forty-five percent of all radiology procedures conducted are for emergency patients. Historically, up to 25% of all diagnostic imaging examinations were never reported formally by radiologists. Report turnaround time for the remaining 75% was unacceptable, with only 3% of all imaging examinations reported within a 12-hour period in 1996. Both situations existed in great part because physicians and residents who felt they needed access to films simply took them. Many were never located or returned days after they were taken. In 1998, Elmhurst Hospital Center replaced its RIS and added voice recognition dictation capabilities in January 1999. A hospitalwide PACS was deployed 10 months later. With the exception of mammography, the hospital converted to filmless radiography within 60 days. The critical objectives to maintain control of films and radically improve the reporting process were achieved immediately. Over 99% of all examinations now are formally reviewed and reported. Only 7% of all reports take 1 or more days to

  13. Weekend physiotherapy practice in community hospitals in Canada.

    PubMed

    Ottensmeyer, C Andrea; Chattha, Sanmeet; Jayawardena, Shemayi; McBoyle, Kelly; Wrong, Christine; Ellerton, Cindy; Mathur, Sunita; Brooks, Dina

    2012-01-01

    Purpose: To analyze weekend physiotherapy services in acute-care community hospitals across Canada. Method: Questionnaires were mailed to acute-care community hospitals (institutions with >100 inpatient beds, excluding psychiatric, mental health, paediatric, rehabilitation, tertiary, and long-term care facilities) across Canada from January to April 2010. The questionnaire collected information on patient referral criteria, staffing, workload, and compensation for weekend physiotherapy services and on the availability of other rehabilitation health professionals. Results: Of 146 community hospitals deemed eligible, 104 (71%) responded. Weekend physiotherapy was offered at 69% of hospitals across Canada, but this rate varied: ≥75% in all regions except Quebec (30%). Hospitals with a high proportion of acute-care beds were more likely to offer weekend physiotherapy services (logistic regression, p=0.021). Services differed among Saturdays, Sundays, and holidays in terms of the numbers of both physiotherapists and physiotherapy assistants working (Kruskal–Wallis, p<0.02 for each). Physiotherapists were predominantly compensated via time off in lieu. Of hospitals not offering weekend physiotherapy, 53% reported that it would benefit patients; most perceived staffing and financial barriers. Social-work services were offered on the weekend at 24% of hospitals and occupational therapy at 16%. Conclusions: Substantial regional variation exists in access to weekend physiotherapy services in acute-care community hospitals. To address the importance of this variation, research on the efficacy and cost-effectiveness of such services is required.

  14. 75 FR 33379 - Railroad Cost Recovery Procedures-Productivity Adjustment; Quarterly Rail Cost Adjustment Factor

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-11

    ... Surface Transportation Board Railroad Cost Recovery Procedures--Productivity Adjustment; Quarterly Rail... Railroads that the Board restate the previously published productivity adjustment for the 2003-2007 averaging period (2007 productivity adjustment) so that it tracks the 2007 productivity adjustment...

  15. Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study

    PubMed Central

    Dancer, Stephanie J; White, Liza F; Lamb, Jim; Girvan, E Kirsty; Robertson, Chris

    2009-01-01

    Background Increasing hospital-acquired infections have generated much attention over the last decade. There is evidence that hygienic cleaning has a role in the control of hospital-acquired infections. This study aimed to evaluate the potential impact of one additional cleaner by using microbiological standards based on aerobic colony counts and the presence of Staphylococcus aureus including meticillin-resistant S. aureus. Methods We introduced an additional cleaner into two matched wards from Monday to Friday, with each ward receiving enhanced cleaning for six months in a cross-over design. Ten hand-touch sites on both wards were screened weekly using standardised methods and patients were monitored for meticillin-resistant S. aureus infection throughout the year-long study. Patient and environmental meticillin-resistant S. aureus isolates were characterised using molecular methods in order to investigate temporal and clonal relationships. Results Enhanced cleaning was associated with a 32.5% reduction in levels of microbial contamination at hand-touch sites when wards received enhanced cleaning (P < 0.0001: 95% CI 20.2%, 42.9%). Near-patient sites (lockers, overbed tables and beds) were more frequently contaminated with meticillin-resistant S. aureus/S. aureus than sites further from the patient (P = 0.065). Genotyping identified indistinguishable strains from both hand-touch sites and patients. There was a 26.6% reduction in new meticillin-resistant S. aureus infections on the wards receiving extra cleaning, despite higher meticillin-resistant S. aureus patient-days and bed occupancy rates during enhanced cleaning periods (P = 0.032: 95% CI 7.7%, 92.3%). Adjusting for meticillin-resistant S. aureus patient-days and based upon nine new meticillin-resistant S. aureus infections seen during routine cleaning, we expected 13 new infections during enhanced cleaning periods rather than the four that actually occurred. Clusters of new meticillin-resistant S. aureus

  16. 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.

  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. Hospital financial performance: does IT governance make a difference?

    PubMed

    Burke, Darrell; Randeree, Ebrahim; Menachemi, Nir; Brooks, Robert G

    2008-01-01

    This study examined whether information technology (IT) governance, a term describing the decision authority and reporting structures of the chief information officer (CIO), is related to the financial performance of hospitals. The study was conducted using a combination of primary survey data regarding health care IT adoption and reporting structures of Florida acute care hospitals, with secondary data on hospital financial performance. Multiple regression models were used to evaluate the relationship of the 3 most commonly identified reporting structures. Outcome variables included measures of operating revenue and operating expense. All models controlled for overall IT adoption, ownership, membership in a hospital system, case mix, and hospital bed size. The results suggest that IT governance matters when it comes to hospital financial performance. Reporting to the chief financial officer brings positive outcomes; reporting to the chief executive officer has a mixed financial result; and reporting to the chief operating officer was not associated with discernible financial impact.

  19. Can hospitals compete on quality? Hospital competition.

    PubMed

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

    2015-09-01

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

  20. Relationship between Patient Safety and Hospital Surgical Volume

    PubMed Central

    Hernandez-Boussard, Tina; Downey, John R; McDonald, Kathryn; Morton, John M

    2012-01-01

    Objective To examine the relationship between hospital volume and in-hospital adverse events. Data Sources Patient safety indicator (PSI) was used to identify hospital-acquired adverse events in the Nationwide Inpatient Sample database in abdominal aortic aneurysm, coronary artery bypass graft, and Roux-en-Y gastric bypass from 2005 to 2008. Study Design In this observational study, volume thresholds were defined by mean year-specific terciles. PSI risk-adjusted rates were analyzed by volume tercile for each procedure. Principal Findings Overall, hospital volume was inversely related to preventable adverse events. High-volume hospitals had significantly lower risk-adjusted PSI rates compared to lower volume hospitals (p < .05). Conclusion These data support the relationship between hospital volume and quality health care delivery in select surgical cases. This study highlights differences between hospital volume and risk-adjusted PSI rates for three common surgical procedures and highlights areas of focus for future studies to identify pathways to reduce hospital-acquired events. PMID:22091561

  1. 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.

  2. Can utilization review criteria be used to determine appropriate pediatric patient placement for a critical care bed expansion?

    PubMed

    Jamieson, Donna; Mikhailov, Theresa A; Maletta, Kristyn; Kuhn, Evelyn M; Giuliani, Lauren; Musolf, Jeanne; Fischer, Kay; Collins, Maureen

    2011-01-01

    The rising trend in critical care utilization has led to the expansion of critical care beds in many hospitals across the country. Traditional models of estimating bed capacity requirements use administrative data such as inpatient admissions, length of stay, and case mix index. The use of such data has been limited in quantifying the complexities of demand variables in critical care bed needs. Mathematical modeling is another method for estimating numbers of beds required. It captures the dynamic changes in the management of critically ill patients that occur when units become full. Depending on data analysis methods used, bed need underestimation or overestimation can occur. In our study, we used utilization review criteria to understand changes in level of care (LOC) during the course of patients' stays and to validate critical care bed expansion needs. Using LOC criteria, we studied the proportion of our intermediate care patients in an acute care unit that met acute, intermediate, or critical care criteria. We also evaluated whether these proportions were related to specific factors such as census ratios, staffing proportions, or severity of illness. Using LOC criteria was helpful in validating our critical care bed projection, which was previously derived from mathematical modeling. The findings also validated our assessment for additional specialty acute care beds.

  3. Flue gas desulfurization by rotating beds

    SciTech Connect

    Gardner, N.; Keyvani, M.; Coskundeniz, A.

    1992-01-01

    The operating and mass transfer characteristics of rotating foam metal beds were studied to determine the potential for flue gas desulfurization. This is a final technical report on the work supported by DOE [number sign]FG22-87-PC79924. The report is divided into two sections, Part 1 deals primarily with the operating characteristics of rotating beds, and Part 2 covers the mass transfer characteristics of S0[sub 2] absorption in water-lime slurries. Rotating foam metal beds are in essence packed towers operated in high gravitational fields. The foam metal bed is in the form of a cylindrical donut, or torus, and is rotated to produced the high centrifugal forces. The liquid phase enters the bed at the inner surface of the torus and is pulled by the field through the bed. Gas flows countercurrent to the liquid. The bed packing can have a very large specific surface areas and not flood. Possible benefits include much smaller height of a transfer unit resulting in smaller equipment and supporting structures, reduced solvent inventory, faster response with improved process control, reduced pressure drop, and shorter startup and shut-down times. This work is concerned broadly with the operating characteristics of rotating beds, the objectives being to (1) determine the pressure drop through the rotating bed; (2) determine the power required to operate the beds, (3) investigate the residence time distribution of the liquid phase in the beds; and (4) determine the mass transfer coefficients of S0[sub 2] absorption. Three packings of differing specific surface areas were studied, with areas ranging from 656 to 2952 m[sub 2]/m[sub 3]. Liquid flow rates to 36 kg/s*m[sub 2], gas flow rate to 2.2 kg/s*m[sub 2], and gravitational fields to 300 g were covered in this study.

  4. Fluidized bed coal combustion reactor

    NASA Technical Reports Server (NTRS)

    Moynihan, P. I.; Young, D. L. (Inventor)

    1981-01-01

    A fluidized bed coal reactor includes a combination nozzle-injector ash-removal unit formed by a grid of closely spaced open channels, each containing a worm screw conveyor, which function as continuous ash removal troughs. A pressurized air-coal mixture is introduced below the unit and is injected through the elongated nozzles formed by the spaces between the channels. The ash build-up in the troughs protects the worm screw conveyors as does the cooling action of the injected mixture. The ash layer and the pressure from the injectors support a fluidized flame combustion zone above the grid which heats water in boiler tubes disposed within and/or above the combustion zone and/or within the walls of the reactor.

  5. CERTS Microgrid Laboratory Test Bed

    SciTech Connect

    ETO, J.; LASSETER, R.; SCHENKMAN, B.; STEVENS, J.; KLAPP, D.; VOLKOMMER, H.; LINTON, E.; HURTADO, H.; ROY, J.

    2010-06-08

    The objective of the CERTS Microgrid Test Bed project was to enhance the ease of integrating energy sources into a microgrid. The project accomplished this objective by developing and demonstrating three advanced techniques, collectively referred to as the CERTS Microgrid concept, that significantly reduce the level of custom field engineering needed to operate microgrids consisting of generating sources less than 100kW. The techniques comprising the CERTS Microgrid concept are: 1 a method for effecting automatic and seamless transitions between grid-connected and islanded modes of operation, islanding the microgrid's load from a disturbance, thereby maintaining a higher level of service, without impacting the integrity of the utility's electrical power grid; 2 an approach to electrical protection within a limited source microgrid that does not depend on high fault currents; and 3 a method for microgrid control that achieves voltage and frequency stability under islanded conditions without requiring high-speed communications between sources.

  6. Fluidized bed heat treating system

    DOEpatents

    Ripley, Edward B; Pfennigwerth, Glenn L

    2014-05-06

    Systems for heat treating materials are presented. The systems typically involve a fluidized bed that contains granulated heat treating material. In some embodiments a fluid, such as an inert gas, is flowed through the granulated heat treating medium, which homogenizes the temperature of the heat treating medium. In some embodiments the fluid may be heated in a heating vessel and flowed into the process chamber where the fluid is then flowed through the granulated heat treating medium. In some embodiments the heat treating material may be liquid or granulated heat treating material and the heat treating material may be circulated through a heating vessel into a process chamber where the heat treating material contacts the material to be heat treated. Microwave energy may be used to provide the source of heat for heat treating systems.

  7. Advanced expander test bed program

    NASA Technical Reports Server (NTRS)

    Riccardi, D. P.; Mitchell, J. C.

    1993-01-01

    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, investigate system interactions, and conduct investigations 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. Contract work began 27 Apr. 1990. During 1992, a major milestone was achieved with the review of the final design of the oxidizer turbopump in Sep. 1992.

  8. Building Controls Virtual Test Bed

    SciTech Connect

    Wetter, Michael; Haves, Philip; Coffey, Brian

    2008-04-01

    The Building Controls Virtual Test Bed (BCVTB) is a modular software environment that is based on the Ptolemy II software environment. The BCVTB can be used for design and analysis of heterogenous systems, such as building energy and controls systems. Our additions to Ptolemy II allow users to Couple to Ptolemy II simulation software such as EnergyPlus, MATLAB/Simulink or Dymola for data exchange during run-time. Future versions of the BCVTS will also contain an interface to BACnet which is a communication protocol for building Control systems, and interfaces to digital/analog converters that allow communication with controls hardware. Through Ptolemy II, the BCVTB provides a graphical model building environment, synchronizes the exchanged data and visualizes the system evolution during run- time.

  9. Metabolic Resistance in Bed Bugs

    PubMed Central

    Mamidala, Praveen; Jones, Susan C.; Mittapalli, Omprakash

    2011-01-01

    Blood-feeding insects have evolved resistance to various insecticides (organochlorines, pyrethroids, carbamates, etc.) through gene mutations and increased metabolism. Bed bugs (Cimex lectularius) are hematophagous ectoparasites that are poised to become one of the major pests in households throughout the United States. Currently, C. lectularius has attained a high global impact status due to its sudden and rampant resurgence. Resistance to pesticides is one factor implicated in this phenomenon. Although much emphasis has been placed on target sensitivity, little to no knowledge is available on the role of key metabolic players (e.g., cytochrome P450s and glutathione S-transferases) towards pesticide resistance in C. lectularius. In this review, we discuss different modes of resistance (target sensitivity, penetration resistance, behavioral resistance, and metabolic resistance) with more emphasis on metabolic resistance. PMID:26467498

  10. Hospital volume, hospital teaching status, patient socioeconomic status, and outcomes in patients hospitalized with sickle cell disease

    PubMed Central

    McCavit, Timothy L.; Lin, Hua; Zhang, Song; Ahn, Chul; Quinn, Charles T.; Flores, Glenn

    2014-01-01

    Sickle cell disease (SCD) accounts for ~100,000 hospitalizations in the US annually. Quality of care for hospitalized SCD patients has been insufficiently studied. Therefore, we aimed to examine whether four potential determinants of quality care, [1] hospital volume, [2] hospital teaching status, [3] patient socioeconomic status (SES), and [4] patient insurance status are associated with three quality indicators for patients with SCD: [1] mortality, [2] length of stay (LOS), and [3] hospitalization costs. We conducted an analysis of the 2003–2005 Nationwide Inpatient Sample (NIS) datasets. We identified cases using all ICD-9CM codes for SCD. Both overall and SCD-specific hospital volumes were examined. Multivariable analyses included mixed linear models to examine LOS and costs, and logistic regression to examine mortality. About 71,481 SCD discharges occurred from 2003 to 2005. Four hundred and twenty five patients died, yielding a mortality rate of 0.6%. Multivariable analyses revealed that SCD patients admitted to lower SCD-specific volume hospitals had [1] increased adjusted odds of mortality (quintiles 1–4 vs. quintile 5: OR, 1.36; 95% CI, 1.05, 1.76) and [2] decreased LOS (quintiles 1–4 vs. quintile 5, effect estimate −0.08; 95% CI, −0.12, −0.04). These are the first data describing associations between lower SCD-specific hospital volumes and poorer outcomes. PMID:21442644

  11. Changing hospital payments: implications for teaching hospitals.

    PubMed

    Bentley, J D

    1983-09-01

    Hospitals cannot continue to view themselves only as social institutions whose performance will be assessed on the good they do. Teaching hospitals, in particular, cannot view themselves simply as distinctive combinations of social and educational institutions. Under Medicare's prospective pricing system, the hospital's role as production system is enhanced, and all hospitals must learn to balance the new economic realities as they work with their medical staff to adapt to a changed future.

  12. Adjustable Optical-Fiber Attenuator

    NASA Technical Reports Server (NTRS)

    Buzzetti, Mike F.

    1994-01-01

    Adjustable fiber-optic attenuator utilizes bending loss to reduce strength of light transmitted along it. Attenuator functions without introducing measurable back-reflection or insertion loss. Relatively insensitive to vibration and changes in temperature. Potential applications include cable television, telephone networks, other signal-distribution networks, and laboratory instrumentation.

  13. Dyadic Adjustment: An Ecosystemic Examination.

    ERIC Educational Resources Information Center

    Wilson, Stephan M.; Larson, Jeffry H.; McCulloch, B. Jan; Stone, Katherine L.

    1997-01-01

    Examines the relationship of background, individual, and family influences on dyadic adjustment, using an ecological perspective. Data from 102 married couples were used. Age at marriage for husbands, emotional health for wives, and number of marriage and family problems as well as family life satisfaction for both were related to dyadic…

  14. Problems of Adjustment to School.

    ERIC Educational Resources Information Center

    Bartolini, Leandro A.

    This paper, one of several written for a comprehensive policy study of early childhood education in Illinois, examines and summarizes the literature on the problems of young children in adjusting to starting school full-time and describes the nature and extent of their difficulties in relation to statewide educational policy. The review of studies…

  15. Economic Pressures and Family Adjustment.

    ERIC Educational Resources Information Center

    Haccoun, Dorothy Markiewicz; Ledingham, Jane E.

    The relationships between economic stress on the family and child and parental adjustment were examined for a sample of 199 girls and boys in grades one, four, and seven. These associations were examined separately for families in which both parents were present and in which mothers only were at home. Economic stress was associated with boys'…

  16. Pulsed atmospheric fluidized bed combustion

    SciTech Connect

    Not Available

    1989-11-01

    In order to verify the technical feasibility of the MTCI Pulsed Atmospheric Fluidized Bed Combustor technology, a laboratory-scale system was designed, built and tested. Important aspects of the operational and performance parameters of the system were established experimentally. A considerable amount of the effort was invested in the initial task of constructing an AFBC that would represent a reasonable baseline against which the performance of the PAFBC could be compared. A summary comparison of the performance and emissions data from the MTCI 2 ft {times} 2 ft facility (AFBC and PAFBC modes) with those from conventional BFBC (taller freeboard and recycle operation) and circulating fluidized bed combustion (CFBC) units is given in Table ES-1. The comparison is for typical high-volatile bituminous coals and sorbents of average reactivity. The values indicated for BFBC and CFBC were based on published information. The AFBC unit that was designed to act as a baseline for the comparison was indeed representative of the larger units even at the smaller scale for which it was designed. The PAFBC mode exhibited superior performance in relation to the AFBC mode. The higher combustion efficiency translates into reduced coal consumption and lower system operating cost; the improvement in sulfur capture implies less sorbent requirement and waste generation and in turn lower operating cost; lower NO{sub x} and CO emissions mean ease of site permitting; and greater steam-generation rate translates into less heat exchange surface area and reduced capital cost. Also, the PAFBC performance generally surpasses those of conventional BFBC, is comparable to CFBC in combustion and NO{sub x} emissions, and is better than CFBC in sulfur capture and CO emissions even at the scaled-down size used for the experimental feasibility tests.

  17. Efficiency and optimal size of hospitals: Results of a systematic search

    PubMed Central

    Guglielmo, Annamaria

    2017-01-01

    Background National Health Systems managers have been subject in recent years to considerable pressure to increase concentration and allow mergers. This pressure has been justified by a belief that larger hospitals lead to lower average costs and better clinical outcomes through the exploitation of economies of scale. In this context, the opportunity to measure scale efficiency is crucial to address the question of optimal productive size and to manage a fair allocation of resources. Methods and findings This paper analyses the stance of existing research on scale efficiency and optimal size of the hospital sector. We performed a systematic search of 45 past years (1969–2014) of research published in peer-reviewed scientific journals recorded by the Social Sciences Citation Index concerning this topic. We classified articles by the journal’s category, research topic, hospital setting, method and primary data analysis technique. Results showed that most of the studies were focussed on the analysis of technical and scale efficiency or on input / output ratio using Data Envelopment Analysis. We also find increasing interest concerning the effect of possible changes in hospital size on quality of care. Conclusions Studies analysed in this review showed that economies of scale are present for merging hospitals. Results supported the current policy of expanding larger hospitals and restructuring/closing smaller hospitals. In terms of beds, studies reported consistent evidence of economies of scale for hospitals with 200–300 beds. Diseconomies of scale can be expected to occur below 200 beds and above 600 beds. PMID:28355255

  18. Going to the Hospital

    MedlinePlus

    ... Happens in the Operating Room? Going to the Hospital KidsHealth > For Kids > Going to the Hospital Print ... you flowers, balloons, or other treats! previous continue Hospital People You'll meet lots of people in ...

  19. 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

  20. Measurement of the bed material of gravel-bed rivers

    USGS Publications Warehouse

    Milhous, R.T.; ,

    2002-01-01

    The measurement of the physical properties of a gravel-bed river is important in the calculation of sediment transport and physical habitat values for aquatic animals. These properties are not always easy to measure. One recent report on flushing of fines from the Klamath River did not contain information on one location because the grain size distribution of the armour could not be measured on a dry river bar. The grain size distribution could have been measured using a barrel sampler and converting the measurements to the same as would have been measured if a dry bar existed at the site. In another recent paper the porosity was calculated from an average value relation from the literature. The results of that paper may be sensitive to the actual value of porosity. Using the bulk density sampling technique based on a water displacement process presented in this paper the porosity could have been calculated from the measured bulk density. The principle topics of this paper are the measurement of the size distribution of the armour, and measurement of the porosity of the substrate. The 'standard' method of sampling of the armour is to do a Wolman-type count of the armour on a dry section of the river bed. When a dry bar does not exist the armour in an area of the wet streambed is to sample and the measurements transformed analytically to the same type of results that would have been obtained from the standard Wolman procedure. A comparison of the results for the San Miguel River in Colorado shows significant differences in the median size of the armour. The method use to determine the porosity is not 'high-tech' and there is a need improve knowledge of the porosity because of the importance of porosity in the aquatic ecosystem. The technique is to measure the in-situ volume of a substrate sample by measuring the volume of a frame over the substrate and then repeated the volume measurement after the sample is obtained from within the frame. The difference in the

  1. Erosion of sand from a gravel bed

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Cleaning of fine sediment out of gravel stream beds has become an important method to restore impacted stream habitats. Introducing the increased flows needed to entrain fine sediments without eroding the coarser fractions of the bed and potentially destroying its usefulness as a habitat requires c...

  2. Particle Pressures in Fluidized Beds. Final report

    SciTech Connect

    Campbell, C.S.; Rahman, K.; Jin, C.

    1996-09-01

    This project studies the particle pressure, which may be thought of as the force exerted by the particulate phase of a multiphase mixture, independently of that exerted by other phases. The project is divided into two parts, one concerning gas and the other liquid fluidized beds. Previous work on gas fluidized beds had suggested that the particle pressures are generated by bubbling action. Thus, for these gas fluidized bed studies, the particle pressure is measured around single bubbles generated in 2-D fluidized beds, using special probes developed especially for this purpose. Liquid beds are immune from bubbling and the particle pressures proved too small to measure directly. However, the major interest in particle pressures in liquid beds lies in their stabilizing effect that arises from the effective elasticity (the derivative of the particle pressure with respect to the void fraction): they impart to the bed. So rather than directly measure the particle pressure, we inferred the values of the elasticity from measurements of instability growth in liquid beds the inference was made by first developing a generic stability model (one with all the normally modeled coefficients left undetermined)and then working backwards to determine the unknown coefficients, including the elasticity.

  3. Particle pressures in fluidized beds. Final report

    SciTech Connect

    Campbell, C.S.; Rahman, K.; Jin, C.

    1996-09-01

    This project studies the particle pressure, which may be thought of as the force exerted by the particulate phase of a multiphase mixture, independently of that exerted by other phases. The project is divided into two parts, one concerning gas and the other liquid fluidized beds. Previous work on gas fluidized beds had suggested that the particle pressures are generated by bubbling action. Thus, for these gas fluidized bed studies, the particle pressure is measured around single bubbles generated in 2-D fluidized beds, using special probes developed especially for this purpose. Liquid beds are immune from bubbling and the particle pressures proved too small to measure directly. However, the major interest in particle pressures in liquid beds lies in their stabilizing effect that arises from the effective elasticity (the derivative of the particle pressure with respect to the void fraction), they impart to the bed. So rather than directly measure the particle pressure, the authors inferred the values of the elasticity from measurements of instability growth in liquid beds; the inference was made by first developing a generic stability model (one with all the normally modeled coefficients left undetermined) and then working backwards to determine the unknown coefficients, including the elasticity.

  4. Print a Bed Bug Card - (Single Cards)

    EPA Pesticide Factsheets

    Two sets of business-card-sized lists of tips for recognizing bed bugs and the signs of an infestation, including a photo of bed bugs to assist identification. One card is for general use around home or office, the other for travelers.

  5. Bed Bugs: Clinical Relevance and Control Options

    PubMed Central

    Dwyer, Dominic E.; Peñas, Pablo F.; Russell, Richard C.

    2012-01-01

    Summary: Since the late 1990s, bed bugs of the species Cimex lectularius and Cimex hemipterus have undergone a worldwide resurgence. These bed bugs are blood-sucking insects that readily bite humans. Cutaneous reactions may occur and can start out as small macular lesions that can develop into distinctive wheals of around 5 cm in diameter, which are accompanied by intense itching. Occasionally, bullous eruptions may result. If bed bugs are numerous, the patient can present with widespread urticaria or eythematous rashes. Often, bites occur in lines along the limbs. Over 40 pathogens have been detected in bed bugs, but there is no definitive evidence that they transmit any disease-causing organisms to humans. Anemia may result when bed bugs are numerous, and their allergens can trigger asthmatic reactions. The misuse of chemicals and other technologies for controlling bed bugs has the potential to have a deleterious impact on human health, while the insect itself can be the cause of significant psychological trauma. The control of bed bugs is challenging and should encompass a multidisciplinary approach utilizing nonchemical means of control and the judicious use of insecticides. For accommodation providers, risk management procedures should be implemented to reduce the potential of bed bug infestations. PMID:22232375

  6. International Standardization of Bed Rest Standard Measures

    NASA Technical Reports Server (NTRS)

    Cromwell, Ronita L.

    2010-01-01

    This slide presentation gives an overview of the standardization of bed rest measures. The International Countermeasures Working Group attempted to define and agree internationally on standard measurements for spaceflight based bed rest studies. The group identified the experts amongst several stakeholder agencys. It included information on exercise, muscle, neurological, psychological, bone and cardiovascular measures.

  7. Prevalence, Knowledge, and Concern About Bed Bugs.

    PubMed

    Kaylor, Mary Beth; Wenning, Paul; Eddy, Christopher

    2015-01-01

    Recent research suggests that the resurgence of bed bugs in the U.S. has occurred at an alarming rate. Assumptions have been made that socioeconomic status is not associated with the prevalence of bed bug infestations. Little information is available at the local level, however, about the prevalence of bed bugs in private homes. The authors' pilot study aimed to identify prevalence, knowledge, and concern about bed bugs in one higher income village in Ohio utilizing survey methodology. Responses from 96 individuals who completed the Prevalence, Knowledge, and Concern About Bed Bugs survey were utilized for analysis. The majority of the sample respondents were white and 95% reported that they owned their residence. Only 6% knew someone with bed bugs. Additionally, 52% reported they were somewhat concerned about bed bugs. About 46% reported that they had changed their behavior. For a higher income area, the prevalence was dissimilar to the rate reported in the general public (about 20%). This suggests that bed bugs may be an environmental issue effecting low-income populations disproportionately. Further research is needed in areas of differing socioeconomic levels.

  8. Bed bugs: clinical relevance and control options.

    PubMed

    Doggett, Stephen L; Dwyer, Dominic E; Peñas, Pablo F; Russell, Richard C

    2012-01-01

    Since the late 1990s, bed bugs of the species Cimex lectularius and Cimex hemipterus have undergone a worldwide resurgence. These bed bugs are blood-sucking insects that readily bite humans. Cutaneous reactions may occur and can start out as small macular lesions that can develop into distinctive wheals of around 5 cm in diameter, which are accompanied by intense itching. Occasionally, bullous eruptions may result. If bed bugs are numerous, the patient can present with widespread urticaria or eythematous rashes. Often, bites occur in lines along the limbs. Over 40 pathogens have been detected in bed bugs, but there is no definitive evidence that they transmit any disease-causing organisms to humans. Anemia may result when bed bugs are numerous, and their allergens can trigger asthmatic reactions. The misuse of chemicals and other technologies for controlling bed bugs has the potential to have a deleterious impact on human health, while the insect itself can be the cause of significant psychological trauma. The control of bed bugs is challenging and should encompass a multidisciplinary approach utilizing nonchemical means of control and the judicious use of insecticides. For accommodation providers, risk management procedures should be implemented to reduce the potential of bed bug infestations.

  9. Modeling of fluidized bed silicon deposition process

    NASA Technical Reports Server (NTRS)

    Kim, K.; Hsu, G.; Lutwack, R.; PRATURI A. K.

    1977-01-01

    The model is intended for use as a means of improving fluidized bed reactor design and for the formulation of the research program in support of the contracts of Silicon Material Task for the development of the fluidized bed silicon deposition process. A computer program derived from the simple modeling is also described. Results of some sample calculations using the computer program are shown.

  10. Fluidized-bed copper oxide process

    SciTech Connect

    Shah, P.P.; Takahashi, G.S.; Leshock, D.G.

    1991-10-14

    The fluidized-bed copper oxide process was developed to simultaneously remove sulfur dioxide and nitrogen oxide contaminants from the flue gas of coal-fired utility boilers. This dry and regenerable process uses a copper oxide sorbent in a fluidized-bed reactor. Contaminants are removed without generating waste material. (VC)

  11. Critical Access Hospitals (CAH)

    MedlinePlus

    ... use requirements for Critical Access Hospitals related to Electronic Health Records (EHRs)? Critical Access Hospital (CAH) are eligible for Electronic Health Record (EHR) incentive payments and can receive ...

  12. Recurrence of inguinal hernias repaired in a large hernia surgical specialty hospital and general hospitals in Ontario, Canada

    PubMed Central

    Malik, Atiqa; Bell, Chaim M.; Stukel, Thérèse A.; Urbach, David R.

    2016-01-01

    Background The effect of hospital specialization on the risk of hernia recurrence after inguinal hernia repair is not well described. Methods We studied Ontario residents who had primary elective inguinal hernia repair at an Ontario hospital between 1993 and 2007 using population-based, administrative health data. We compared patients from a large hernia specialty hospital (Shouldice Hospital) with those from general hospitals to determine the risk of recurrence. Results We studied 235 192 patients, 27.7% of whom had surgery at Shouldice hospital. The age-standardized proportion of patients who had a recurrence ranged from 5.21% (95% confidence interval [CI] 4.94%–5.49%) among patients who had surgery at the lowest volume general hospitals to 4.79% (95% CI 4.54%–5.04%) who had surgery at the highest volume general hospitals. In contrast, patients who had surgery at the Shouldice Hospital had an age-standardized recurrence risk of 1.15% (95% CI 1.05%–1.25%). Compared with patients who had surgery at the lowest volume hospitals, hernia recurrence among those treated at the Shouldice Hospital was significantly lower after adjustment for the effects of age, sex, comorbidity and income level (adjusted hazard ratio 0.21, 95% CI 0.19–0.23, p < 0.001). Conclusion Inguinal hernia repair at Shouldice Hospital was associated with a significantly lower risk of subsequent surgery for recurrence than repair at a general hospital. While specialty hospitals may have better outcomes for treatment of common surgical conditions than general hospitals, these benefits must be weighed against potential negative impacts on clinical care and the financial sustainability of general hospitals. PMID:26574701

  13. Peering inside the granular bed: illuminating feedbacks between bed-load transport and bed-structure evolution

    NASA Astrophysics Data System (ADS)

    Houssais, M.; Jerolmack, D. J.; Martin, R. L.

    2013-12-01

    The threshold of motion is perhaps the most important quantity to determine for understanding rates of bed load transport, however it is a moving target. Decades of research show that it changes in space and in time within a river, and is highly variable among different systems; however, these differences are not mechanistically understood. Recent researchers have proposed that the critical Shields stress is strongly dependent on the local configuration of the sediment bed [Frey and Church, 2011]. Critical Shields stress has been observed to change following sediment-transporting flood events in natural rivers [e.g., Turowski et al., 2011], while small-scale laboratory experiments have produced declining bed load transport rates associated with slow bed compaction [Charru et al., 2004]. However, no direct measurements have been made of the evolving bed structure under bed load transport, so the connection between granular controls and the threshold of motion remains uncertain. A perspective we adopt is that granular effects determine the critical Shields stress, while the fluid supplies a distribution of driving stresses. In order to isolate the granular effect, we undertake laminar bed load transport experiments using plastic beads sheared by a viscous oil in a small, annular flume. The fluid and beads are refractive index matched, and the fluid impregnated with a fluorescing powder. When illuminated with a planar laser sheet, we are able to image slices of the granular bed while also tracking the overlying sediment transport. We present the first results showing how bed load transport influences granular packing, and how changes in packing influence the threshold of motion to feed back on bed load transport rates. This effect may account for much of the variability observed in the threshold of motion in natural streams, and by extension offers a plausible explanation for hysteresis in bed load transport rates observed during floods. Charru, F., H. Mouilleron, and

  14. Focus on: Watsonville Community Hospital Biomedical Engineering Department.

    PubMed

    Shugart, B L

    1986-01-01

    The Journal of Clinical Engineering is pleased to present this FOCUS on the Biomedical Engineering Department of Watsonville Community Hospital (Watsonville, CA). Since the Department's inception in 1983, the growth of the hospital and the surrounding area has resulted in the expansion of the Department and its duties. This paper describes the responsibilities of the two-man Biomedical Engineering Department, which serves this 130-bed hospital and oversees the preventive maintenance and repair of approximately 800 pieces of equipment. In addition, the Department is involved with staff education, equipment inventory control, new equipment purchases, technical consultations, and special projects.

  15. Solar heated fluidized bed gasification system

    NASA Technical Reports Server (NTRS)

    Qader, S. A. (Inventor)

    1981-01-01

    A solar-powered fluidized bed gasification system for gasifying carbonaceous material is presented. The system includes a solar gasifier which is heated by fluidizing gas and steam. Energy to heat the gas and steam is supplied by a high heat capacity refractory honeycomb which surrounds the fluid bed reactor zone. The high heat capacity refractory honeycomb is heated by solar energy focused on the honeycomb by solar concentrator through solar window. The fluid bed reaction zone is also heated directly and uniformly by thermal contact of the high heat capacity ceramic honeycomb with the walls of the fluidized bed reactor. Provisions are also made for recovering and recycling catalysts used in the gasification process. Back-up furnace is provided for start-up procedures and for supplying heat to the fluid bed reaction zone when adequate supplies of solar energy are not available.

  16. Does bedding affect the airway and allergy?

    PubMed

    Siebers, R W; Crane, J

    2011-04-01

    Various cross-sectional and longitudinal studies have suggested that synthetic bedding is associated with asthma, allergic rhinitis and eczema while feather bedding seems to be protective. Synthetic bedding items have higher house dust mite allergen levels than feather bedding items. This is possibly the mechanism involved although fungal and bacterial proinflammatory compounds and volatile organic compounds may play a role. In this review we present and discuss the epidemiological evidence and suggest possible mechanisms. Primary intervention studies are required to show whether feather bedding is protective for the development of childhood asthma and allergic diseases while secondary intervention studies are required to potentially reduce symptoms and medication use in subjects with established disease.

  17. Fluidized bed heating process and apparatus

    NASA Technical Reports Server (NTRS)

    McHale, Edward J. (Inventor)

    1981-01-01

    Capacitive electrical heating of a fluidized bed enables the individual solid particles within the bed to constitute the hottest portion thereof. This effect is achieved by applying an A. C. voltage potential between dielectric coated electrodes, one of which is advantageously the wall of the fluidized bed rejection zone, sufficient to create electrical currents in said particles so as to dissipate heat therein. In the decomposition of silane or halosilanes in a fluidized bed reaction zone, such heating enhances the desired deposition of silicon product on the surface of the seed particles within the fluidized bed and minimizes undesired coating of silicon on the wall of the reaction zone and the homogeneous formation of fine silicon powder within said zone.

  18. Bed bugs: they are back! The role of the school nurse in bed bug management.

    PubMed

    Sciscione, Patricia

    2012-09-01

    Recently there has been a resurgence of bed bugs in all facets of our society. Bed bugs have even been found in schools, causing unnecessary exclusion of students and unfounded hysteria. School nurses are again called upon to be front-line sources of information to quell the hysteria and confusion related to this unsavory condition. By arming themselves with the best evidence regarding proper identification of bed bugs and their bites and information about integrated prevention measures to control transmission of infestations, school nurses can contribute to the control and management of bed bugs and aid in the overall battle against this "new and improved" invasion of the bed bugs.

  19. 12 CFR 19.240 - Inflation adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Inflation adjustments. 19.240 Section 19.240... PROCEDURE Civil Money Penalty Inflation Adjustments § 19.240 Inflation adjustments. (a) The maximum amount of each civil money penalty within the OCC's jurisdiction is adjusted in accordance with the...

  20. 12 CFR 19.240 - Inflation adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Inflation adjustments. 19.240 Section 19.240... PROCEDURE Civil Money Penalty Inflation Adjustments § 19.240 Inflation adjustments. (a) The maximum amount... Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note) as follows: ER10NO08.001 (b)...