Determinants of foodservice satisfaction for patients in geriatrics/rehabilitation and residents in residential aged care

PubMed Central

Wright, Olivia R. L.; Connelly, Luke B.; Capra, Sandra; Hendrikz, Joan

2011-01-01

Abstract Background  Poor satisfaction with institutional food is a significant moderator of food intake in geriatrics/rehabilitation and residential aged care. Purpose  To quantify the relationship between foodservice satisfaction, foodservice characteristics, demographic and contextual variables in geriatrics/rehabilitation and residential aged care. Methods  The Resident Foodservice Satisfaction Questionnaire was administered to 103 patients of 2 geriatrics/rehabilitation units and 210 residents of nine residential aged care facilities in Brisbane, Australia. Ordered probit regression analysis measured the association of age, gender, ethnicity and appetite, timing and amount of meal choice, menu selectivity, menu cycle, production system, meal delivery system and therapeutic diets with foodservice satisfaction. Results  Patient and resident appetite (P < 0.01), the amount and timing of meal choice (P < 0.01), self‐rated health (P < 0.01), accommodation style (P < 0.05) and age (P < 0.10) significantly moderated foodservice satisfaction. High protein/high energy therapeutic diets (P < 0.01), foodservice production (P < 0.01) and delivery systems (P > 0.01) were significant moderators for those with ‘fair’ self‐rated health. Conclusions  Patient and resident characteristics and structural and systems‐related foodservice variables were more important for influencing foodservice satisfaction than characteristics of food quality. The results suggest modifications to current menu planning and foodservice delivery methods: reducing the time‐lapse between meal choice and consumption, augmenting the number of meals at which choice is offered, and revising food production and delivery systems.It is important that residents in poorer health who are a high risk of under‐nutrition are provided with sufficient high protein/high energy therapeutic diets. Diets that restrict macro‐ and micro‐nutrients should be

HB 1347 and Its Relationship to Foodservice Outsourcing in Illinois Public Schools

ERIC Educational Resources Information Center

Brashear, Gary L.

2012-01-01

This study examined foodservice outsourcing in the State of Illinois. School administrators currently outsourcing foodservice were surveyed about their perceptions of HB1347 and its components. This study looked at HB1347 in Illinois, and its effects on outsourcing in school districts. Data for this study was collected from a survey sent to 100%…

Bacterial biogeographical patterns in a cooking center for hospital foodservice.

PubMed

Stellato, Giuseppina; La Storia, Antonietta; Cirillo, Teresa; Ercolini, Danilo

2015-01-16

Microbial contamination in foodservice environments plays a fundamental role in food quality and safety. In such environments the composition of the microbiota is influenced by the characteristics of the specific surfaces and by food handling and processing and a resident microbiota may be present in each site. In this study, the bacterial biogeographical patterns in a hospital cooking center was studied by 16S rRNA-based culture-independent high-throughput amplicon sequencing in order to provide a comprehensive mapping of the surfaces and tools that come in contact with foods during preparation. Across all area, surface swab-samples from work surfaces of different zones were taken: food pre-processing rooms (dedicated to fish, vegetables, and red and white meat), storage room and kitchen. The microbiota of environmental swabs was very complex, including more than 500 operational taxonomic units (OTUs) with extremely variable relative abundances (0.02-99%) depending on the species. A core microbiota was found that was common to more than 70% of the samples analyzed and that included microbial species that were common across all areas such as Acinetobacter, Chryseobacterium, Moraxellaceae, and Alicyclobacillus, although their abundances were below 10% of the microbiota. Some surfaces were contaminated by high levels of either Pseudomonas, Psychrobacter, Paracoccus, or Kocuria. However, beta diversity analysis showed that, based on the composition of the microbiota, the environmental samples grouped according to the sampling time but not according to the specific area of sampling except for the case of samples from the vegetable pre-processing room that showed a higher level of similarity. The cleaning procedures can have a very strong impact on the spatial distribution of the microbial communities, as the use of the same cleaning tools can be even a possible vector of bacterial diffusion. Most of the microbial taxa found are not those commonly found in food as

Foodservice yield and fabrication times for beef as influenced by purchasing options and merchandising styles.

PubMed

Weatherly, B H; Griffin, D B; Johnson, H K; Walter, J P; De La Zerda, M J; Tipton, N C; Savell, J W

2001-12-01

Selected beef subprimals were obtained from fabrication lines of three foodservice purveyors to assist in the development of a software support program for the beef foodservice industry. Subprimals were fabricated into bone-in or boneless foodservice ready-to-cook portion-sized cuts and associated components by professional meat cutters. Each subprimal was cut to generate mean foodservice cutting yields and labor requirements, which were calculated from observed weights (kilograms) and processing times (seconds). Once fabrication was completed, data were analyzed to determine means and standard errors of percentage yields and processing times for each subprimal. Subprimals cut to only one end point were evaluated for mean foodservice yields and processing times, but no comparisons were made within subprimal. However, those traditionally cut into various end points were additionally compared by cutting style. Subprimals cut by a single cutting style included rib, roast-ready; ribeye roll, lip-on, bone-in; brisket, deckle-off, boneless; top (inside) round; and bottom sirloin butt, flap, boneless. Subprimals cut into multiple end points or styles included ribeye, lip-on; top sirloin, cap; tenderloin butt, defatted; shortloin, short-cut; strip loin, boneless; top sirloin butt, boneless; and tenderloin, full, side muscle on, defatted. Mean yields of portion cuts, and mean fabrication times required to manufacture these cuts differed (P < 0.05) by cutting specification of the final product. In general, as the target portion size of fabricated steaks decreased, the mean number of steaks derived from any given subprimal cut increased, causing total foodservice yield to decrease and total processing time to increase. Therefore, an inverse relationship tended to exist between processing times and foodservice yields. With a method of accurately evaluating various beef purchase options, such as traditional commodity subprimals, closely trimmed subprimals, and pre-cut portion

Associations among School Characteristics and Foodservice Practices in a Nationally Representative Sample of U.S. Schools

PubMed Central

Thomson, Jessica L.; Tussing-Humphreys, Lisa M.; Martin, Corby K.; LeBlanc, Monique M.; Onufrak, Stephen J.

2012-01-01

Objective Determine school characteristics associated with healthy/unhealthy foodservice offerings or healthy food preparation practices. Design Retrospective analysis of cross-sectional data. Setting Nationally representative sample of public and private elementary, middle and high schools. Participants 526 and 520 schools with valid data from the 2006 School Health Policies and Practices Study (SHPPS) Food Service School Questionnaire. Main Outcome Measure(s) Scores for healthy/unhealthy foodservice offerings and healthy food preparation practices. Analysis Multivariable regression to determine significant associations among school characteristics and offerings/preparation practices. Results Public schools and schools participating in USDA Team Nutrition reported more healthy offerings and preparation than private or non-participating schools, respectively. Elementary schools reported less unhealthy offerings than middle or high schools; middle schools reported less unhealthy offerings than high schools. Schools requiring foodservice managers to have a college education reported more healthy preparation while those requiring completion of a foodservice training program reported less unhealthy offerings and more healthy preparation than schools without these requirements. Conclusions and Implications Results suggest the school nutrition environment may be improved by requiring foodservice managers to hold a nutrition-related college degree and/or successfully pass a foodservice training program, and by participating in a school-based nutrition program, such as USDA Team Nutrition. PMID:22963956

Evaluating foodservice software: a suggested approach.

PubMed

Fowler, K D

1986-09-01

In an era of cost containment, the computer has become a viable management tool. Its use in health care has demonstrated accelerated growth in recent years, and a literature review supports an increased trend in this direction. Foodservice, which is a major cost center, is no exception to this predicted trend. Because software has proliferated, foodservice managers and dietitians are experiencing growing concern about how to evaluate the numerous software packages from which to choose. A suggested approach to evaluating software is offered to dietitians and managers alike to lessen the confusion in software selection and to improve the system satisfaction level post-purchase. Steps of the software evaluatory approach include: delineation of goals, assessment of needs, assignment of value weight factors, development of a vendor checklist, survey of vendors by means of the vendor checklist and elimination of inappropriate systems, thorough development of the request for proposal (RFP) for submission to the selected vendors, an analysis of the returned RFPs in terms of system features and cost factors, and selection of the system(s) for implementation.

A new approach to the design of information systems for foodservice management in health care facilities.

PubMed

Matthews, M E; Norback, J P

1984-06-01

An organizational framework for integrating foodservice data into an information system for management decision making is presented. The framework involves the application to foodservice of principles developed by the disciplines of managerial economics and accounting, mathematics, computer science, and information systems. The first step is to conceptualize a foodservice system from an input-output perspective, in which inputs are units of resources available to managers and outputs are servings of menu items. Next, methods of full cost accounting, from the management accounting literature, are suggested as a mechanism for developing and assigning costs of using resources within a foodservice operation. Then matrix multiplication is used to illustrate types of information that matrix data structures could make available for management planning and control when combined with a conversational mode of computer programming.

Improving U.S. Navy Foodservice Management Training. Part 1. Evaluation of the Current System

DTIC Science & Technology

1985-11-01

Experience in civilian foodservice before joining Navy? FAST FOOD FRANCHISE BAKERY RESTAURANT COFFEE SHOP CAFETERIA DELICATESSEN NONE WORKED AS...civilian foodservice since joining Navy? FAST FOOD FRANCHISE 12 8 BAKERY 15 5 RESTAURANT 12 18 COFFEE SHOP 8 — CAFETERIA 8 — DELICATESSEN — NONE...food service before joining the Navy? (PLEASE CHECK l^ THAT APPLY TO WHERE YOU WORKED) Fast Food Franchise Cafeteria Bakery Delieateesan

Measuring School Foodservice Workers’ Perceptions of Organizational Culture

USDA-ARS?s Scientific Manuscript database

School foodservice workers (SFW) are a direct link to children eating school meals. SFW who perceive positive and supportive organizational culture at their school nutrition departments also may perceive that such environments foster their own promotion of healthful food choices by students. To date...

Associations among school characteristics and foodservice practices in a nationally representative sample of United States schools.

PubMed

Thomson, Jessica L; Tussing-Humphreys, Lisa M; Martin, Corby K; LeBlanc, Monique M; Onufrak, Stephen J

2012-01-01

Determine school characteristics associated with healthy/unhealthy food service offerings or healthy food preparation practices. Secondary analysis of cross-sectional data. Nationally representative sample of public and private elementary, middle, and high schools. Data from the 2006 School Health Policies and Practices Study Food Service School Questionnaire, n = 526 for Healthy and Unhealthy Offerings analysis; n = 520 for Healthy Preparation analysis. Scores for healthy/unhealthy foodservice offerings and healthy food preparation practices. Multivariable regression to determine significant associations among school characteristics and offerings/preparation practices. Public schools and schools participating in the United States Department of Agriculture (USDA) Team Nutrition reported more healthy offerings and preparation than private or nonparticipating schools, respectively. Elementary schools reported fewer unhealthy offerings than middle or high schools; middle schools reported fewer unhealthy offerings than high schools. Schools requiring foodservice managers to have a college education reported more healthy preparation, whereas those requiring completion of a foodservice training program reported fewer unhealthy offerings and more healthy preparation than schools without these requirements. Results suggest the school nutrition environment may be improved by requiring foodservice managers to hold a nutrition-related college degree and/or successfully pass a foodservice training program, and by participating in a school-based nutrition program, such as USDA Team Nutrition. Copyright © 2012 Society for Nutrition Education and Behavior. All rights reserved.

Hospital catering: for profit or not for profit?

PubMed

Stephenson, S

1991-10-16

When hospitals today hold budget meetings, the typical foodservice operation contributes more than the coffee and doughnuts. Many have found new dollars as well as positive public relations by offering catering programs. Southwest General Hospital, Cleveland, is one example.

Norovirus outbreak associated with ill food-service workers--Michigan, January-February 2006.

PubMed

2007-11-23

On January 30, 2006, the Barry-Eaton District Health Department (BEDHD) in Michigan was notified of gastrointestinal illness in several members of two dining parties after a meal at an Eaton County restaurant on January 28. An investigation was initiated by BEDHD to identify the source and agent of infection and to determine the scope of illness among patrons and employees of this national chain restaurant. Norovirus genogroup I (GI) was detected in stool specimens submitted by multiple patrons and employees. The investigation revealed that several food-service workers had been ill during January 19-February 3, 2006, and that a line cook had vomited in the restaurant on January 28, possibly increasing environmental contamination and transmission of virus. This report summarizes the findings of the outbreak investigation, which determined that at least 364 restaurant patrons had become ill. The findings underscore the need for 1) ongoing education of food-service workers regarding prevention of norovirus contamination and transmission; 2) enforcement of policies regarding ill and recently ill food-service workers; and 3) environmental decontamination with effective disinfectants to eliminate the presence of norovirus.

School Foodservice Costs: Location Matters. ERS Report Summary

ERIC Educational Resources Information Center

Ollinger, Michael; Ralston, Katherine; Guthrie, Joanne

2011-01-01

This study examines the extent to which location influences school foodservice costs per meal. It does not examine the effects of cost variation on financial solvency of an school food authority (SFA) or the adequacy of the US Department of Agriculture (USDA) meal reimbursements. Higher per meal costs do not necessarily indicate that an SFA is…

Relationships among hygiene indicators in take-away foodservice establishments and the impact of climatic conditions.

PubMed

Djekic, I; Kuzmanović, J; Anđelković, A; Saračević, M; Stojanović, M M; Tomašević, I

2016-09-01

This paper examined the relationships among hygiene indicators in take-away foodservice establishments and the impact of climatic conditions. A total of 7545 samples were collected encompassing 2050 from food handlers' (HF) hands, 3991 from stainless steel food contact surfaces (FCS) and 1504 samples from plastic FCS. The study covered a period of 43 months. Hygiene-indicator bacteria (total plate count, Enterobacteriaceae Staphylococcus) were determined from the samples collected from 559 different take-away establishments. Climatic conditions were evaluated in respect to the outside temperature, pressure, humidity and precipitation. Logistic regression confirmed that the presence of precipitation was associated with an increased likelihood of exhibiting both Enterobacteriaceae and Staphylococcus on HF' hands as well as exhibiting Enterobacteriaceae on both types of FCS. Numerable Enterobacteriaceae and Staphylococcus levels on HF' hands were detected when higher outside temperatures and higher precipitations occurred. Higher outside temperatures were observed when Enterobacteriaceae were detected on both plastics (P < 0·05) and stainless steel (P > 0·05). Higher precipitation was observed when Enterobacteriaceae was detected on stainless steel while in contrast, this indicator was detected on plastics in periods with lower precipitation. This research confirms relationships between hygiene indicators in take-aways and climatic conditions, mostly temperature and precipitation. This study provides another perspective into the possible nature of cross-contamination and foodborne outbreaks originating in foodservice establishments and brings to attention the necessity of analysing various climatic conditions. © 2016 The Society for Applied Microbiology.

Importance of relationship quality and communication on foodservice for the elderly.

PubMed

Seo, Sunhee; Back, Ki Joon; Shanklin, Carol W

2011-02-01

In order to promote foodservice for the elderly, foodservice managers in Continuing Care Retirement Communities (CCRCs) must identify the main factors to enhance the satisfaction and behavioral intentions with food service. The purpose of this study was to investigate the relationships between relationship quality (consisting of trust, commitment, and satisfaction) and communication in the formation of elderly's behavioral intentions with food services at CCRCs. A survey was administered to residents in two CCRCs and a total of 327 residents participated. A tested structural equation model exhibited good model fit and explanatory power of the study construct. Satisfaction directly influenced word-of-mouth and service quality has an influence on commitment. Commitment was a significant determinant of behavioral intentions to eat more often in the dining room. Also, communication showed positive association with trust. The results provided strong evidence for the importance of satisfaction and communication as a consequence of relationship marketing efforts. Suggestions for future research to better understand the elderly' behavioral intention judgments were given.

Importance of relationship quality and communication on foodservice for the elderly

PubMed Central

Back, Ki Joon; Shanklin, Carol W.

2011-01-01

In order to promote foodservice for the elderly, foodservice managers in Continuing Care Retirement Communities (CCRCs) must identify the main factors to enhance the satisfaction and behavioral intentions with food service. The purpose of this study was to investigate the relationships between relationship quality (consisting of trust, commitment, and satisfaction) and communication in the formation of elderly's behavioral intentions with food services at CCRCs. A survey was administered to residents in two CCRCs and a total of 327 residents participated. A tested structural equation model exhibited good model fit and explanatory power of the study construct. Satisfaction directly influenced word-of-mouth and service quality has an influence on commitment. Commitment was a significant determinant of behavioral intentions to eat more often in the dining room. Also, communication showed positive association with trust. The results provided strong evidence for the importance of satisfaction and communication as a consequence of relationship marketing efforts. Suggestions for future research to better understand the elderly' behavioral intention judgments were given. PMID:21487500

76 FR 62341 - Agency Information Collection Activities: Proposed Collection; Comment Request-School Foodservice...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-07

... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Agency Information Collection Activities: Proposed Collection; Comment Request--School Foodservice Indirect Cost Study AGENCY: Food and Nutrition... Analyst, Office of Research and Analysis, Food and Nutrition Service, USDA, 3101 Park Center Drive, Room...

School Foodservice Personnel's Struggle with Using Labels to Identify Whole-Grain Foods

ERIC Educational Resources Information Center

Chu, Yen Li; Orsted, Mary; Marquart, Len; Reicks, Marla

2012-01-01

Objective: To describe how school foodservice personnel use current labeling methods to identify whole-grain products and the influence on purchasing for school meals. Methods: Focus groups explored labeling methods to identify whole-grain products and barriers to incorporating whole-grain foods in school meals. Qualitative analysis procedures and…

Barriers and Opportunities Related to Whole Grain Foods in Minnesota School Foodservice

ERIC Educational Resources Information Center

Hesse, David; Braun, Curtis; Dostal, Allison; Jeffery, Robert; Marquart, Len

2009-01-01

Purpose/Objectives: The purpose of this research was to identify barriers and opportunities associated with the introduction of whole grain foods into school cafeterias. The primary objective was to elicit input from school foodservice personnel (SFP) regarding their experiences in ordering, purchasing, preparing, and serving whole grain foods in…

Educating Immigrant Hispanic Foodservice Workers about Food Safety Using Visual-Based Training

ERIC Educational Resources Information Center

Rajagopal, Lakshman

2013-01-01

Providing food safety training to a diverse workforce brings with it opportunities and challenges that must be addressed. The study reported here provides evidence for benefits of using visual-based tools for food safety training when educating immigrant, Hispanic foodservice workers with no or minimal English language skills. Using visual tools…

Food production and service in UK hospitals.

PubMed

Ahmed, Mohamed; Jones, Eleri; Redmond, Elizabeth; Hewedi, Mahmoud; Wingert, Andreas; Gad El Rab, Mohamed

2015-01-01

The purpose of this paper is to apply value stream mapping holistically to hospital food production/service systems focused on high-quality food. Multiple embedded case study of three (two private-sector and one public-sector) hospitals in the UK. The results indicated various issues affecting hospital food production including: the menu and nutritional considerations; food procurement; food production; foodservice; patient perceptions/expectations. Value stream mapping is a new approach for food production systems in UK hospitals whether private or public hospitals. The paper identifies opportunities for enhancing hospital food production systems. The paper provides a theoretical basis for process enhancement of hospital food production and the provision of high-quality hospital food.

Attitudes of School Foodservice Directors about the Potential Benefits of School Wellness Policies

ERIC Educational Resources Information Center

Longley, Carol; Sneed, Jeannie

2009-01-01

Purpose/Objectives: The Reauthorization Act of 2004 requires schools participating in the National School Lunch and School Breakfast Programs to establish a wellness policy. The purpose of this study was to examine school foodservice directors' attitudes about the potential benefits of the wellness policy. Methods: A survey research design was…

Whole-Grain Continuing Education for School Foodservice Personnel: Keeping Kids from Falling Short

ERIC Educational Resources Information Center

Roth-Yousey, Lori; Barno, Trina; Caskey, Mary; Asche, Kimberly; Reicks, Marla

2009-01-01

Objective: The purpose of this project was to develop and test whole-grain continuing education for school foodservice personnel. Methods: A continuing education program was developed to address planning, purchasing, preparing, and serving whole-grain food in schools. Participants completed a pre-post questionnaire to assess changes in knowledge,…

Food-service establishment wastewater characterization.

PubMed

Lesikar, B J; Garza, O A; Persyn, R A; Kenimer, A L; Anderson, M T

2006-08-01

Food-service establishments that use on-site wastewater treatment systems are experiencing pretreatment system and/or drain field hydraulic and/or organic overloading. This study included characterization of four wastewater parameters (five-day biochemical oxygen demand [BOD5]; total suspended solids [TSS]; food, oil, and grease [FOG]; and flow) from 28 restaurants located in Texas during June, July, and August 2002. The field sampling methodology included taking a grab sample from each restaurant for 6 consecutive days at approximately the same time each day, followed by a 2-week break, and then sampling again for another 6 consecutive days, for a total of 12 samples per restaurant and 336 total observations. The analysis indicates higher organic (BOD5) and hydraulic values for restaurants than those typically found in the literature. The design values for this study for BOD5, TSS, FOG, and flow were 1523, 664, and 197 mg/L, and 96 L/day-seat respectively, which captured over 80% of the data collected.

Diabetes Preparedness in Schools: What Do Foodservice Personnel Need to Know to Respond?

ERIC Educational Resources Information Center

Grenci, Alexandra

2009-01-01

Diabetes is increasing in youth, presenting a serious public health threat. Although type 1 diabetes has historically been more common in children, type 2 diabetes is on the rise, linked to increases in overweight and obesity among American youth, particularly those of high risk racial and ethnic groups. Foodservice personnel, along with other…

Work/Life Practices and the Recruitment and Retention of Large School Districts' Foodservice Professionals

ERIC Educational Resources Information Center

Harrison, Mary Kate

2010-01-01

With the forthcoming retirement of school foodservice directors, the increasing pressures faced by employees at home and work, and the financial constraints of school districts, recruiting and retaining skilled and diverse employees will be challenging. Marketing work/life benefits to potential employees and supporting these policies to current…

School Foodservice Employees' Perceptions of Practice: Differences by Generational Age and Hours Worked

ERIC Educational Resources Information Center

Strohbehn, Catherine; Jun, Jinhyun; Arendt, Susan

2014-01-01

Purpose/Objectives: This study investigated the influences of school foodservice employees' age and average number of hours worked per week on perceived safe food handling practices, barriers, and motivators. Methods: A bilingual survey (English and Spanish) was developed to assess reported food safety practices, barriers, and motivators to…

Collaboration Challenges and Opportunities: A Survey of School Foodservice Directors and Community Health Coalition Members

ERIC Educational Resources Information Center

Mansfield, Jennifer L.; Savaiano, Dennis A.

2018-01-01

Background: The Healthy, Hunger-Free Kids Act (HHFKA) presents challenges for foodservice directors (FSDs) in sourcing and preparing foods that meet nutrition standards. Concurrently, community health coalition members (CHCs) are engaging schools through community and school nutrition initiatives. We hypothesized significant differences in…

Current Practices and Priority Issues Regarding Nutritional Assessment and Patient Satisfaction with Hospital Menus.

PubMed

Greig, Susan; Hekmat, Sharareh; Garcia, Alicia C

2018-06-01

Patient satisfaction with hospital food enhances consumption and adequate intake of nutrients required for recovery from illness/injury and maintenance of health; accordingly, the nutrient content of the menu must balance patient preferences. This study of Ontario hospital foodservice departments collected data on current practices of analyzing the nutritional adequacy and assessing patient satisfaction with menus, and it explored perceptions of priority issues. Foodservice managers/directors from 57 of 140 (41%) hospitals responded to cross-sectional in-depth telephone interviews. Deductive analysis of responses to open-ended questions supplemented quantitative data from closed-ended questions. The hospitals without long-term care facilities (LTCFs) assessed regular (58%), therapeutic (53%), and texture-modified (47%) menus for nutritional adequacy. This differed from hospitals governing LTCFs where there was a higher frequency of assessment of regular (75%), therapeutic (75%), and textured-modified (66%) menus. Most departments (86%-94%) obtained patient satisfaction feedback at the departmental/corporate levels. Many identified budget and labour issues as priorities rather than assessing menus for nutritional adequacy and patient satisfaction. Hospital menus were not consistently assessed for nutritional adequacy and patient satisfaction; common assessment methodologies and standards were absent. Compliance standards seem to increase the frequency of menu assessment as demonstrated by hospitals governing LTCFs.

Out-of-hours medical cover in community hospitals: implications for palliative care.

PubMed

Kerr, Chris; Hawker, Sheila; Payne, Sheila; Lloyd-Williams, Mari; Seamark, David

2006-02-01

The new General Medical Services contract in England means many GPs have transferred out-of hours work to their primary care organization, with implications for continuity of palliative care in community hospitals. To examine existing arrangements for out-of-hours medical cover in community hospitals, focusing on palliative care. Telephone survey of community hospital managers/senior nurses across England and Wales. Interviews (n = 62) revealed nursing staff were satisfied with existing out-of-hours care. Concern was expressed about the future of out-of-hours medical care from GPs as new services will cover larger areas, meaning unknown doctors may attend, taking longer to arrive. Arrangements for out-of-hours medical cover in community hospitals are in transition, threatening the continuity of care for dying patients.

The Possibilities of Reducing Food Choice to Improve the Performance of College Foodservices.

PubMed

Mirosa, Miranda; Loh, Joanne; Spence, Heather

2016-07-01

College administrative and management leaders, foodservice personnel, and student residents value social, nutritional, financial, and environmental sustainability in their dining expectations. Menu choice reduction looks promising as a strategy to achieve these goals. However, foodservice research about dominant attitudes across these stakeholders is limited. To identify qualitative views from all stakeholders about choice reduction to ensure that any changes to the meal service are not to the detriment of consumer satisfaction. A comprehensive list of 74 statements representing the spectrum of attitudes surrounding choice was generated by searching a variety of resources, including academic literature and Internet sites, and by conducting semistructured interviews with stakeholders. A final set of 42 statements resulted from researcher scrutiny for optimum balance, clarity, appropriateness, simplicity, and applicability. A new sample of participants was then asked to sort these 42 statements into a normal distribution grid from "strongly disagree" to "strongly agree." A purposive convenience sample of stakeholders (staff n=5 and residents n=4) was used to identify statements about choice reduction. A second sample of stakeholders (staff n=6 and residents n=29) were recruited to sort the final 42 statements. Q methodology analysis techniques were used. This involved conducting a by-person factor analysis, using the centroid factor extraction method because of the permissiveness it allows for data exploration. A varimax factor rotation to enhance interpretability of the results identified shared viewpoints. Three dominant viewpoints toward the possibility of choice reduction in the meal service were identified. Factor 1 was "health driven" (in which healthiness was paramount). Factor 2 was "variety seekers" (in which choice had instrumental value). Factor 3 was "choice lovers" (in which choice had intrinsic value). Although participants could see a number of

How do the work environment and work safety differ between the dry and wet kitchen foodservice facilities?

PubMed

Chang, Hye-Ja; Kim, Jeong-Won; Ju, Se-Young; Go, Eun-Sun

2012-08-01

In order to create a worker-friendly environment for institutional foodservice, facilities operating with a dry kitchen system have been recommended. This study was designed to compare the work safety and work environment of foodservice between wet and dry kitchen systems. Data were obtained using questionnaires with a target group of 303 staff at 57 foodservice operations. Dry kitchen facilities were constructed after 2006, which had a higher construction cost and more finishing floors with anti-slip tiles, and in which employees more wore non-slip footwear than wet kitchen (76.7%). The kitchen temperature and muscular pain were the most frequently reported employees' discomfort factors in the two systems, and, in the wet kitchen, "noise of kitchen" was also frequently reported as a discomfort. Dietitian and employees rated the less slippery and slip related incidents in dry kitchens than those of wet kitchen. Fryer area, ware-washing area, and plate waste table were the slippery areas and the causes were different between the functional areas. The risk for current leakage was rated significantly higher in wet kitchens by dietitians. In addition, the ware-washing area was found to be where employees felt the highest risk of electrical shock. Muscular pain (72.2%), arthritis (39.1%), hard-of-hearing (46.6%) and psychological stress (47.0%) were experienced by employees more than once a month, particularly in the wet kitchen. In conclusion, the dry kitchen system was found to be more efficient for food and work safety because of its superior design and well managed practices.

How do the work environment and work safety differ between the dry and wet kitchen foodservice facilities?

PubMed Central

Kim, Jeong-Won; Ju, Se-Young; Go, Eun-Sun

2012-01-01

In order to create a worker-friendly environment for institutional foodservice, facilities operating with a dry kitchen system have been recommended. This study was designed to compare the work safety and work environment of foodservice between wet and dry kitchen systems. Data were obtained using questionnaires with a target group of 303 staff at 57 foodservice operations. Dry kitchen facilities were constructed after 2006, which had a higher construction cost and more finishing floors with anti-slip tiles, and in which employees more wore non-slip footwear than wet kitchen (76.7%). The kitchen temperature and muscular pain were the most frequently reported employees' discomfort factors in the two systems, and, in the wet kitchen, "noise of kitchen" was also frequently reported as a discomfort. Dietitian and employees rated the less slippery and slip related incidents in dry kitchens than those of wet kitchen. Fryer area, ware-washing area, and plate waste table were the slippery areas and the causes were different between the functional areas. The risk for current leakage was rated significantly higher in wet kitchens by dietitians. In addition, the ware-washing area was found to be where employees felt the highest risk of electrical shock. Muscular pain (72.2%), arthritis (39.1%), hard-of-hearing (46.6%) and psychological stress (47.0%) were experienced by employees more than once a month, particularly in the wet kitchen. In conclusion, the dry kitchen system was found to be more efficient for food and work safety because of its superior design and well managed practices. PMID:22977692

Food-safety educational goals for dietetics and hospitality students.

PubMed

Scheule, B

2000-08-01

To identify food-safety educational goals for dietetics and hospitality management students. Written questionnaires were used to identify educational goals and the most important food safety competencies for entry-level dietitians and foodservice managers. The sample included all directors of didactic programs in dietetics approved by the American Dietetic Association and baccalaureate-degree hospitality programs with membership in the Council on Hotel, Restaurant, and Institutional Education. Fifty-one percent of the directors responded. Descriptive statistics were calculated. chi 2 analysis and independent t tests were used to compare educators' responses for discrete and continuous variables, respectively. Exploratory factor analysis grouped statements about food safety competence. Internal consistency of factors was measured using Cronbach alpha. Thirty-four percent of dietetics programs and 70% of hospitality programs required or offered food safety certification. Dietetics educators reported multiple courses with food safety information, whereas hospitality educators identified 1 or 2 courses. In general, the educators rated food-safety competencies as very important or essential. Concepts related to Hazard Analysis and Critical Control Points (HAACP), irradiation, and pasteurization were rated less highly, compared with other items. Competencies related to reasons for outbreaks of foodborne illness were rated as most important. Food safety certification of dietitians and an increased emphasis on HAACP at the undergraduate level or during the practice component are suggested. Research is recommended to assess the level of food-safety competence expected by employers of entry-level dietitians and foodservice managers.

Importance-Performance Analysis (IPA) of Foodservice Operation, Dietary Life Education, and Nutrition Counseling Tasks of Nutrition Teachers and Dietitians in Jeju, Korea.

PubMed

Park, Eun A; Chae, In Sook; Jo, Mi Na

2017-10-22

The purpose of this study was to analyze foodservice operation, dietary life education, and nutrition counseling tasks of nutrition teachers and dietitians in elementary, middle, and high schools in Jeju, Korea, and to provide effective ways to implement dietary life education and nutrition counseling in schools. This study surveyed 94 nutrition teachers and 46 dietitians working at elementary, middle, and high schools in Jeju during 7-14 May 2015. The importance and performance of 16 tasks of nutrition teachers and dietitians were measured using questionnaires. The data was analyzed by using the SPSS software and Importance-Performance Analysis (IPA). Importance was ranked in the order of foodservice operation (4.72), dietary life education (4.37), and nutrition counseling (4.24); and performance was ranked in the order of foodservice operation (4.48), dietary life education (3.70), and nutrition counseling (3.22). The importance-performance matrix showed that in Quadrant 4, the "Concentrate Here" item was "nutrition and dietary life education for students", while in Quadrant 2, the "Possible Overkill" item was "cost control and office management". These findings suggest that it is important to reduce unnecessary administrative and office management tasks in order for nutrition teachers and dietitians to implement effective nutrition education, dietary life education, and nutrition counseling programs.

Use of Visuals for Food Safety Education of Spanish-Speaking Foodservice Workers: A Case Study in Iowa

ERIC Educational Resources Information Center

Rajagopal, Lakshman

2012-01-01

Providing food safety training to an audience whose native language is not English is always a challenge. In the study reported here, minimal-text visuals in Spanish were used to train Hispanic foodservice workers about proper handwashing technique and glove use based on the 2005 Food Code requirements. Overall, results indicated that visuals…

Cook/chill foodservice system with a microwave oven: aerobic plate counts from beef loaf, potatoes and frozen green beans.

PubMed

Dahl, C A; Matthews, M E; Marth, E H

1980-06-01

The purpose was to evaluate microbiological quality and end temperature (ET) of portioned food after heating in a microwave oven as used in a hospital cook/chill foodservice system. Beef loaf (15 kg), potatoes (6 kg), and green beans (5 kg) were prepared in a laboratory. After initial cooking to 60 degrees C, and storage (7 degrees C for 24 h), beef loaf (100 g) was microwave heated: 20, 50, 80 or 110 s. Potatoes were reconstituted, stored (7 degrees C for 24 h), portioned (100 g/portion), and microwave-heated: 25, 45, 65 or 84 s. Beans were thawed (7 degrees C for 24 h), portioned (100 g/portion), and microwave-heated: 20, 50, 80 or 110 s. Aerobic plate counts (APC) for foods were obtained throughout product flow. Wide ranges of Et and of APC in foods indicates that research is needed, for greater control of microwave-heating through advanced microwave engineering and food technology, to produce food with constant microbiological quality.

Importance–Performance Analysis (IPA) of Foodservice Operation, Dietary Life Education, and Nutrition Counseling Tasks of Nutrition Teachers and Dietitians in Jeju, Korea

PubMed Central

Park, Eun A; Chae, In Sook; Jo, Mi Na

2017-01-01

The purpose of this study was to analyze foodservice operation, dietary life education, and nutrition counseling tasks of nutrition teachers and dietitians in elementary, middle, and high schools in Jeju, Korea, and to provide effective ways to implement dietary life education and nutrition counseling in schools. This study surveyed 94 nutrition teachers and 46 dietitians working at elementary, middle, and high schools in Jeju during 7–14 May 2015. The importance and performance of 16 tasks of nutrition teachers and dietitians were measured using questionnaires. The data was analyzed by using the SPSS software and Importance–Performance Analysis (IPA). Importance was ranked in the order of foodservice operation (4.72), dietary life education (4.37), and nutrition counseling (4.24); and performance was ranked in the order of foodservice operation (4.48), dietary life education (3.70), and nutrition counseling (3.22). The importance–performance matrix showed that in Quadrant 4, the “Concentrate Here” item was “nutrition and dietary life education for students”, while in Quadrant 2, the “Possible Overkill” item was “cost control and office management”. These findings suggest that it is important to reduce unnecessary administrative and office management tasks in order for nutrition teachers and dietitians to implement effective nutrition education, dietary life education, and nutrition counseling programs. PMID:29065495

Effects of modified foodservice practices in military dining facilities on ad libitum nutritional intake of US army soldiers.

PubMed

Crombie, Aaron P; Funderburk, LesLee K; Smith, Tracey J; McGraw, Susan M; Walker, Leila A; Champagne, Catherine M; Allen, H Raymond; Margolis, Lee M; McClung, Holly L; Young, Andrew J

2013-07-01

Modifying foodservice practices in military dining facilities could influence ad libitum nutritional intake patterns of soldiers. We aimed to determine how changes in foodservice operations consistent with 2005 Dietary Guidelines for Americans affected soldiers' ad libitum nutritional intake in military dining facilities (DFACs). Ten DFACs participated, and the intervention was implemented in five DFACs in an independently sampled, partial crossover design. Nutrient intake of diners was assessed during a test meal using digital photography, and customer satisfaction with foodservice was assessed via surveys at baseline (n=602), and again at 6 months (n=519) and 12 months (n=458) after the intervention was implemented. Volunteers were US Army active duty soldiers recruited from among diners at 10 DFACs on Fort Bragg, NC. Primary outcomes were intakes of energy and total fat, and percent energy from fat and saturated fat. Differences between diners' intakes in control and intervention DFACs were assessed using independent samples t tests. At 6 months after implementing the intervention, diners at intervention DFACs had significantly lower lunchtime intakes of energy (945±338 kcal vs 1,061±380 kcal), total fat (38±19 g vs 47±25 g), percent energy from fat (35%±10% vs 39%±11%) and saturated fat (4.7%±1.7% vs 5.6%±2.3%), discretionary fat (30±18 g vs 39±24 g), and refined grains (2.3±1.7 oz equivalents vs 2.8±2.4 oz equivalents) compared with diners at control DFACs. Further, diners at intervention DFACs rated customer satisfaction higher than diners at control DFACs. These findings suggest that modest changes in military DFAC serving practices to promote healthy eating and food selection can facilitate positive changes in soldiers' nutritional intake. Published by Elsevier Inc.

An Investigation on the Impact of Training on Employees’ Perceptions of Occupational Status and Self-Esteem in the Foodservice Industry

DTIC Science & Technology

2001-12-01

what impacts or changes the perceptions of its occupational status directly relating to self - esteem . Additionally, previous research on occupational... self - esteem may help to keep quality employees in the foodservice industry. Additionally, it may take on the larger task of helping to change society’s

Significant Trends Are Now Reshaping the Industry Training for Foodservice and Hospitality.

ERIC Educational Resources Information Center

Reiman, Tyrus

1984-01-01

The hospitality industry is one that is not adversely affected by the information revolution. As tourism is stimulated by government economic development efforts, opportunities in the food service and hospitality occupations are increasing, both for the young and for the unemployed who need retraining. (SK)

Moderating effects of leader-member exchange (LMX) on job burnout in dietitians and chefs of institutional foodservice

PubMed Central

2011-01-01

The objectives of the study were to investigate job burnout and leader-member exchange (LMX) levels as well as to evaluate buffering effects of LMX on burnout among dietitians and chefs at institutional foodservices. Hypotheses were proposed based on the Job Demands-Resources model and LMX theory. The study population consisted of dietitians and chefs who were in charge of managing unit operations in a nationwide contract management company. Positive/negative affectivity, workload, job burnout, and LMX scales that had been validated in previous research were adopted. A total of 552 questionnaires were distributed and 154 responses were returned. Results indicated that respondents' burnout levels were moderate and emotional exhaustion was greater than cynicism. In terms of LMX, the surveyed dietitians and chefs showed higher respect toward their supervisors than loyalty. When positive affectivity and negative affectivity were controlled, workload influenced emotional exhaustion and professional efficacy significantly. With affectivity and workload controlled, however, LMX did not influence any dimensions of burnout. The moderating effect of LMX on the relationship between workload and cynicism was significant. That is, the effect of workload on cynicism was weak if the dietitians and chefs perceived the relationship with their supervisor positively. Based on the findings and literature reviewed, how to mitigate job burnout among foodservice managers is discussed. PMID:21487501

Institutional Effectiveness Assessment Process, 1992-93. Executive Summary. Hospitality and Service Occupations Division, Food Sciences Department, Food Production Program, Food Production Management Program, Pastry and Specialty Baking Program.

ERIC Educational Resources Information Center

South Seattle Community Coll., Washington.

In the 1992-93 academic year, the Hospitality and Food Sciences Department at South Seattle Community College conducted surveys of current and former students and local foodservice employers to determine the level of satisfaction with Department programs. Specifically, the surveys focused on four key outcomes: determining the extent to which…

Origins of intrusions in children's dietary recalls: data from a validation study concerning retention interval and information from school food-service production records.

PubMed

Baxter, Suzanne Domel; Royer, Julie A; Guinn, Caroline H; Hardin, James W; Smith, Albert F

2009-09-01

To use data from a published validation study concerning retention interval and school food-service production records to examine intrusions (uneaten items reported eaten) in the school-meal parts of 24 h recalls. For that study, children were observed eating two school meals (breakfast, lunch) and interviewed under one of six conditions from two target periods (previous day (PDTP), prior 24 h (24TP)) crossed with three interview times (morning, afternoon (AIT), evening). For the present article, a catalogue was constructed of foods available for that study's school meals. The study's intrusions were classified as stretches (on children's meal trays but uneaten), internal confabulations (in children's school food-service environments for that meal but not on children's trays) or external confabulations (not in children's school food-service environments for that meal). Occurrence, types and amounts of intrusions were investigated. Six schools; sixty fourth-grade children (ten per condition). For breakfast, for the 24TP v. PDTP, reported items were less likely to be intrusions, internal confabulations and external confabulations; and intrusions were more likely to be stretches. For lunch, for the 24TP-AIT condition v. the other five conditions, reported items were less likely to be intrusions and external confabulations. Mean amounts reported eaten were smaller for stretches than for internal confabulations or external confabulations at breakfast, and for stretches than for internal confabulations at lunch. Accuracy was better for the 24TP (with fewer intrusions of which proportionally more were stretches which had smaller amounts reported eaten) than for the PDTP. Studies with 24 h recalls should minimize retention interval to improve accuracy.

Career Progression Systems in the Internal Labor Market of the Foodservice Industry and the Role of the National Restaurant Association. Final Report.

ERIC Educational Resources Information Center

Smith, Leonard; Pezzullo, Caroline

The lack of visible career paths was universally recognized as a major factor leading to the extraordinarily high rate of turnover and absenteeism in the foodservice industry. The report evaluates the potential of a National Trade Association as a vehicle for improvements in this area and focuses on National Restaurant Association (NRA) efforts in…

A Comparison of Student Performance in a National Restaurant Association Foodservice Sanitation Exam by Students Taking versus Those Not Taking a Review Seminar.

ERIC Educational Resources Information Center

Fleury, Ernest

A practicum was conducted to examine and improve the performance of students enrolled in a college of culinary arts on the National Restaurant Association Foodservice (NRAF) sanitation certification examination. Because the pass rate among students retaking the examination was lower than that among students taking the examination for the first…

Colorado Hospital Survey Covering Salaries, Wages, and Selected Personnel Policies and Practices.

ERIC Educational Resources Information Center

Colorado Hospital Association, Denver.

The data presented in this survey were gathered by mailed questionnaires and cover salary data on 28 "key benchmark" job classifications considered to be most representative in Colorado hospitals regardless of size, location, or type. There are tables of selected benefits, personnel policies, and practices together with actual pay rates…

Planning for progress, productivity, and performance.

PubMed

Benedict, J M

1983-10-01

A project is described for the interim renovation of a labor intensive existing foodservice facility. The renovated area will provide effective food management during the hospital's redevelopment period, including a new foodservice. Objectives of the interim project were to conserve labor while emphasizing control and centralization, provide economic foodservices with improved quality, and incorporate one tray distribution system throughout the hospital complex. Immediate measures were necessary in order to generate funds to proceed. Renovations had to occur without disrupting food-service to patients. The project was planned over a three year period and included an ingredient control area, two patient tray service centres, a renewed production kitchen and test kitchen facility. Each phase has been financed on the understanding that the costs of construction and equipment will be repaid within one fiscal year of operating the renovated facility. Positive results are being achieved, attributable to the support and encouragement received from staff during the change process.

Measuring potential access to food stores and food-service places in rural areas in the U.S.

PubMed

Sharkey, Joseph R

2009-04-01

Geographic access to healthy food resources remains a major focus of research that examines the contribution of the built environment to healthful eating. Methods used to define and measure spatial accessibility can significantly affect the results. Considering the implications for marketing, policy, and programs, adequate measurement of the food environment is important. Little of the published work on food access has focused on rural areas, where the burden of nutrition-related disease is greater. This article seeks to expand our understanding of the challenges to measurement of potential spatial access to food resources in rural areas in the U.S. Key challenges to the accurate measurement of the food environment in rural areas include: (1) defining the rural food environment while recognizing that market factors may be changing; (2) describing characteristics that may differentiate similar types of food stores and food-service places; and (3) determining location coordinates for food stores and food-service places. In order to enhance measurements in rural areas, "ground-truthed" methodology, which includes on-site observation and collection of GPS data, should become the standard for rural areas. Measurement must also recognize the emergence of new and changing store formats. Efforts should be made to determine accessibility, in terms of both proximity to a single location and variety of multiple locations within a specified buffer, from origins other than the home, and consider multipurpose trips and trip chaining. The measurement of food access will be critical for community-based approaches to meet dietary needs. Researchers must be willing to take the steps necessary for rigorous measurement of a dynamic food environment.

Food security practice in Kansas schools and health care facilities.

PubMed

Yoon, Eunju; Shanklin, Carol W

2007-02-01

This pilot study investigated perceived importance and frequency of specific preventive measures, and food and nutrition professionals' and foodservice directors' willingness to develop a food defense management plan. A mail questionnaire was developed based on the US Department of Agriculture document, Biosecurity Checklist for School Foodservice Programs--Developing a Biosecurity Management Plan. The survey was sent to food and nutrition professionals and foodservice operators in 151 acute care hospitals, 181 long-term-care facilities, and 450 school foodservice operations. Chemical use and storage was perceived as the most important practice to protect an operation and was the practice implemented most frequently. Results of the study indicate training programs on food security are needed to increase food and nutrition professionals' motivation to implement preventive measures.

Foodservice employees benefit from interventions targeting barriers to food safety.

PubMed

York, Valerie K; Brannon, Laura A; Shanklin, Carol W; Roberts, Kevin R; Howells, Amber D; Barrett, Elizabeth B

2009-09-01

The number of foodborne illnesses traced to improper food handling in restaurants indicates a need for research to improve food safety in these establishments. Therefore, this 2-year longitudinal study investigated the effectiveness of traditional ServSafe (National Restaurant Association Educational Foundation, Chicago, IL) food-safety training and a Theory of Planned Behavior intervention program targeting employees' perceived barriers and attitudes toward important food-safety behaviors. The effectiveness of the training and intervention was measured by knowledge scores and observed behavioral compliance rates related to food-safety practices. Employees were observed for handwashing, thermometer usage, and proper handling of work surfaces at baseline, after receiving ServSafe training, and again after exposure to the intervention targeting barriers and negative attitudes about food-safety practices. Repeated-measures analyses of variance indicated training improved handwashing knowledge, but the intervention was necessary to improve overall behavioral compliance and handwashing compliance. Results suggest that registered dietitians; dietetic technicians, registered; and foodservice managers should implement a combination of training and intervention to improve knowledge and compliance with food-safety behaviors, rather than relying on training alone. Challenges encountered while conducting this research are discussed, and recommendations are provided for researchers interested in conducting this type of research in the future.

Managers' perceptions of customers' satisfactions with their hospital cafeteria services.

PubMed

Johnston, C M; Upton, E M

1991-01-01

It is important that hospital cafeterias deliver products that create customer satisfaction so that financial objectives are met. An exploratory descriptive survey of 12 selected hospital cafeterias used a self-administered questionnaire to determine how satisfied customers were with services provided. It also asked cafeteria managers to give their perceptions of their customers' relative satisfaction/dissatisfaction with the service. Principal components analysis, followed by varimax rotation, identified four underlying constructs of the 15 pre-selected foodservice characteristics used to measure relative satisfaction. A multiple regression model, controlling for country, hospital size and customer demographics, in which the dependent variable was overall rating, found that the independent variables, the underlying rating constructs--food and service--made a much greater impact on overall rating than environment and accessibility. Most cafeteria managers' predictions about their customers' satisfaction were within two standard deviations of their customers' mean scores of satisfaction. While the managers' close association with their service may have accounted for this, it does not necessarily follow that they have the power to implement policy and product improvements.

The influence of a local, media covered hospital incident on public trust in health care.

PubMed

van der Schee, Evelien; de Jong, Judith D; Groenewegen, Peter P

2012-08-01

Incidents in health care happen every now and then. Incidents are often extensively covered by the news media. In this study, we investigated the impact of an incident in a Dutch hospital on public trust in health care in the population living in the vicinity of where the incident took place and in the national population. News media coverage of the incident started in Fall 2008. We collected data in three samples, using a postal questionnaire on public trust in health care. Two samples were a cross-section of the Dutch population; one was questioned in October 2006 and the other in October 2008. The third sample, also questioned in October 2008, consisted of 1000 people living in the surrounding area of the hospital where the incident occurred. The cross-sectional sample of October 2006 was a reference group, and at that time no incidents in health care were covered in the media. In the local population, the incident had a strong impact on public trust in the hospital and among the specialists working there. Also, in the local population, the impact of the incident was generalized to trust in hospitals and specialists in general. In the national population, no impact of the incident on the public's trust was found, despite national news media coverage. Local incidents have an impact on public trust in health care in the local population. However, these incidents do not influence public trust in health care in the national population.

A Survey to Determine if Significant Differences Exist in the Scoring of Select Management Areas for Fast Food and Full Service Restaurant Managers by Two-Year Foodservice Management Students.

ERIC Educational Resources Information Center

Bloom, Thomas A.

A survey was conducted of students in 77 of the 144 two-year foodservice management programs in the United States to assess their knowledge of and attitudes toward fast food restaurant management as compared to full service restaurant management. A total of 1,403 students from 44 programs responded. Results indicated that the food service…

Comparison of the Effect of Plastic Cover and Blanket on Body Temperature of Preterm Infants Hospitalized in NICU: Randomized Clinical Trial

PubMed Central

Valizadeh, Leila; Mahallei, Majid; Safaiyan, Abdolrasoul; Ghorbani, Fatemeh; Peyghami, Maryam

2017-01-01

Introduction: Preterm infants are unable to regulate their body temperature and there are insufficient research evidences on different kinds of covers for hospitalized preterm infants; therefore, the present study was conducted with the aim of comparing the effects of plastic and blanket covers on the body temperature of preterm infants under radiant warmer. Methods: This randomized cross-over clinical trial was carried out upon 80 infants with the gestational age of 28-30 weeks and birth weight of 800- 1250 gr who were in Neonatal Intensive Care Unit on the second day of their hospitalization. The study lasted for two days. In group 1, the plastic cover was used during the first day of the study while the blankets were used during the second day. Infants’ heads were kept out of the cover and coated with a hat. In group 2, the plastic cover was used during the first day of the study while the blanket was used during second day. Digital thermometer was used to measure infants’ axillary temperature. The data was analyzed using SPSS ver 13 and MiniTab software. Descriptive statistics, (Mean (SE), 95%CI) and inferential statistics (Repeated measurement and ANCOVA tests) were used. Results: The mean body temperature of the infants in the group covered with the plastic was calculated to be higher and the warmer was set on low temperature. Conclusion: Using plastic cover during the first few days of hospitalization in NICU resulted in regulation of preterm infants’ body temperature. PMID:28680870

Reliability of the hospital nutrition environment scan for cafeterias, vending machines, and gift shops.

PubMed

Winston, Courtney P; Sallis, James F; Swartz, Michael D; Hoelscher, Deanna M; Peskin, Melissa F

2013-08-01

According to ecological models, the physical environment plays a major role in determining individual health behaviors. As such, researchers have started targeting the consumer nutrition environment of large-scale foodservice operations when implementing obesity-prevention programs. In 2010, the American Hospital Association released a call-to-action encouraging health care facilities to join in this movement and improve their facilities' consumer nutrition environments. The Hospital Nutrition Environment Scan (HNES) for Cafeterias, Vending Machines, and Gift Shops was developed in 2011, and the present study evaluated the inter-rater reliability of this instrument. Two trained raters visited 39 hospitals in southern California and completed the HNES. Percent agreement, kappa statistics, and intraclass correlation coefficients were calculated. Percent agreement between raters ranged from 74.4% to 100% and kappa statistics ranged from 0.458 to 1.0. The intraclass correlation coefficient for the overall nutrition composite scores was 0.961. Given these results, the HNES demonstrated acceptable reliability metrics and can now be disseminated to assess the current state of hospital consumer nutrition environments. Copyright © 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Room Service Improves Nutritional Intake and Increases Patient Satisfaction While Decreasing Food Waste and Cost.

PubMed

McCray, Sally; Maunder, Kirsty; Krikowa, Renee; MacKenzie-Shalders, Kristen

2018-02-01

Room service is a foodservice model that has been increasingly implemented across health care facilities in an effort to improve patient satisfaction and reduce food waste. In 2013, Mater Private Hospital Brisbane, Australia, was the first hospital in Australia to implement room service, with the aim of improving patient nutrition care and reducing costs. The aim of this study was to comprehensively evaluate the nutritional intake, plate waste, patient satisfaction, and patient meal costs of room service compared to a traditional foodservice model. A retrospective analysis of quality-assurance data audits was undertaken to assess patient nutritional intake between a facility utilizing a traditional foodservice model and a facility utilizing room service and in a pre-post study design to assess plate waste, patient satisfaction, and patient meal costs before and after the room service implementation. Audit data were collected for eligible adult inpatients in Mater Private Hospital Brisbane and Mater Hospital Brisbane, Australia, between July 2012 and May 2015. The primary outcome measures were nutritional intake, plate waste, patient satisfaction, and patient meal costs. Independent samples t-tests and χ 2 analyses were conducted between pre and post data for continuous data and categorical data, respectively. Pearson χ 2 analysis of count data for sex and reasons for plate waste for data with counts more than five was used to determine asymptotic (two-sided) significance and n-1 χ 2 used for the plate waste analysis. Significance was assessed at P<0.05. This study reported an increased nutritional intake, improved patient satisfaction, and reduced plate waste and patient meal costs with room service compared to a traditional foodservice model. Comparison of nutritional intake between a traditional foodservice model (n=85) and room service (n=63) showed statistically significant increases with room service in both energy (1,306 kcal/day vs 1,588 kcal/day; P=0

How do we actually put smarter snacks in schools? NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) conversations with food-service directors.

PubMed

Rosenfeld, Lindsay E; Cohen, Juliana Fw; Gorski, Mary T; Lessing, Andrés J; Smith, Lauren; Rimm, Eric B; Hoffman, Jessica A

2017-02-01

In autumn 2012, Massachusetts schools implemented comprehensive competitive food and beverage standards similar to the US Department of Agriculture's Smart Snacks in School standards. We explored major themes raised by food-service directors (FSD) regarding their school-district-wide implementation of the standards. For this qualitative study, part of a larger mixed-methods study, compliance was measured via direct observation of foods and beverages during school site visits in spring 2013 and 2014, calculated to ascertain the percentage of compliant products available to students. Semi-structured interviews with school FSD conducted in each year were analysed for major implementation themes; those raised by more than two-thirds of participating school districts were explored in relationship to compliance. Massachusetts school districts (2013: n 26; 2014: n 21). Data collected from FSD. Seven major themes were raised by more than two-thirds of participating school districts (range 69-100 %): taking measures for successful transition; communicating with vendors/manufacturers; using tools to identify compliant foods and beverages; receiving support from leadership; grappling with issues not covered by the law; anticipating changes in sales of competitive foods and beverages; and anticipating changes in sales of school meals. Each theme was mentioned by the majority of more-compliant school districts (65-81 %), with themes being raised more frequently after the second year of implementation (range increase 4-14 %). FSD in more-compliant districts were more likely to talk about themes than those in less-compliant districts. Identified themes suggest best-practice recommendations likely useful for school districts implementing the final Smart Snacks in School standards, effective July 2016.

Case study:-calender covers in a hospital laundry. Energy Efficiency Office, Department of Energy.

PubMed

1992-01-01

Whipps Cross Hospital laundry is typical of many laundries, both in the commercial sector and NHS, in that it uses old calenders which are substantially less efficient than more modern machines. Although calendering is a relatively efficient method of moisture removal, the quantity of flatwork processed by this laundry means that the calendering section uses a significant proportion of the total laundry energy consumption. In common with many other laundries, the four calenders were producing a great deal of airborne lint which required expensive cleaning at regular intervals, and made the working environment uncomfortable, reducing the performance and morale of the operators. In an effort to improve this situation, covers were fitted to all the calenders in early 1989. These were claimed to improve energy efficiency by reducing the heat losses from the calender's upper surfaces and to improve the local atmosphere by reducing the quantity of lint and moist air escaping into the laundry. This case study examines the savings (both energy savings and others) achieved by the installation of the covers, and assesses any drawbacks which may have become apparent after extended use.

77 FR 65555 - Agency Information Collection Activities; Submission for Office of Management and Budget Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-29

... the initial data collection for select restaurant facility types, followed by the initial data... period data collection survey measurement) period Restaurants Full Service 2013 2016 2019 Restaurants. Fast Food Restaurants. Institutional Foodservice........ Hospitals 2014 2017 2020 Nursing Homes...

Dietary, food service, and mealtime interventions to promote food intake in acute care adult patients.

PubMed

Cheung, Grace; Pizzola, Lisa; Keller, Heather

2013-01-01

Malnutrition is common in acute care hospitals. During hospitalization, poor appetite, medical interventions, and food access issues can impair food intake leading to iatrogenic malnutrition. Nutritional support is a common intervention with demonstrated effectiveness. "Food first" approaches have also been developed and evaluated. This scoping review identified and summarized 35 studies (41 citations) that described and/or evaluated dietary, foodservice, or mealtime interventions with a food first focus. There were few randomized control trials. Individualized dietary treatment leads to improved food intake and other positive outcomes. Foodservices that promote point-of-care food selection are promising, but further research with food intake and nutritional outcomes is needed. Protected mealtimes have had insufficient implementation, leading to mixed results, while mealtime assistance, particularly provided by volunteers or dietary staff, appears to promote food intake. A few innovative strategies were identified but further research to develop and evaluate food first approaches is needed.

Oblique view of southeast and northeast sides with covered walk ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Oblique view of southeast and northeast sides with covered walk to Facility 367, Facility 324 beyond, view facing west - U.S. Naval Base, Pearl Harbor, Naval Hospital, Animal House, Near intersection of Hospital Way & Third Street, Pearl City, Honolulu County, HI

Night emergency cover for ENT in England: a national survey.

PubMed

Biswas, D; Rafferty, A; Jassar, P

2009-08-01

To evaluate the quality of out-of-hours ENT on-call cover by junior doctors, in view of the European Working Time Directive and the recent changes in the National Health Service workforce due to the 'Modernising Medical Careers' initiative, in England. We performed a national survey of first-on-call doctors for ENT, using a telephone questionnaire. Hospital contact details were sourced from the National Health Service website. The inclusion criterion was hospitals providing acute ENT facilities overnight in England. One hundred and nineteen hospitals were contacted; 91 were eligible, and 83 interviews were conducted. The grade of the first-on-call ENT doctor ranged from foundation year two (19 per cent) to registrar level or above (13 per cent). Forty-nine respondents (68 per cent) reported having no previous ENT experience. Fifty-three respondents (74 per cent) covered more than one speciality at night, with seven (10 per cent) covering four or more specialities. The second-on-call doctor was non-resident in 63 cases (88 per cent). Thirty respondents (42 per cent) stated that they did not feel comfortable managing common ENT emergencies as the first doctor on call. Otorhinolaryngology induction courses were offered in 37 of the respondents' hospitals (51 per cent), these courses were of varying duration. Night-time ENT care is often provided by junior doctors with little experience of the speciality, who are often also responsible for covering multiple specialities. Many reported not feeling comfortable managing common ENT emergencies. Structured induction programmes would help to provide basic knowledge and should be mandatory for all doctors covering ENT.

Hospitality Services Reference Book.

ERIC Educational Resources Information Center

Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

This reference book provides information needed by employees in hospitality services occupations. It includes 29 chapters that cover the following topics: the hospitality services industry; professional ethics; organization and management structures; safety practices and emergency procedures; technology; property maintenance and repair; purchasing…

Relationship between occurrence of surgical complications and hospital finances.

PubMed

Eappen, Sunil; Lane, Bennett H; Rosenberg, Barry; Lipsitz, Stuart A; Sadoff, David; Matheson, Dave; Berry, William R; Lester, Mark; Gawande, Atul A

2013-04-17

The effect of surgical complications on hospital finances is unclear. To determine the relationship between major surgical complications and per-encounter hospital costs and revenues by payer type. Retrospective analysis of administrative data for all inpatient surgical discharges during 2010 from a nonprofit 12-hospital system in the southern United States. Discharges were categorized by principal procedure and occurrence of 1 or more postsurgical complications, using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes. Nine common surgical procedures and 10 major complications across 4 payer types were analyzed. Hospital costs and revenue at discharge were obtained from hospital accounting systems and classified by payer type. Hospital costs, revenues, and contribution margin (defined as revenue minus variable expenses) were compared for patients with and without surgical complications according to payer type. Of 34,256 surgical discharges, 1820 patients (5.3%; 95% CI, 4.4%-6.4%) experienced 1 or more postsurgical complications. Compared with absence of complications, complications were associated with a $39,017 (95% CI, $20,069-$50,394; P < .001) higher contribution margin per patient with private insurance ($55,953 vs $16,936) and a $1749 (95% CI, $976-$3287; P < .001) higher contribution margin per patient with Medicare ($3629 vs $1880). For this hospital system in which private insurers covered 40% of patients (13,544), Medicare covered 45% (15,406), Medicaid covered 4% (1336), and self-payment covered 6% (2202), occurrence of complications was associated with an $8084 (95% CI, $4903-$9740; P < .001) higher contribution margin per patient ($15,726 vs $7642) and with a $7435 lower per-patient total margin (95% CI, $5103-$10,507; P < .001) ($1013 vs -$6422). In this hospital system, the occurrence of postsurgical complications was associated with a higher per-encounter hospital contribution margin for patients covered by

Gaining a Professional Edge.

ERIC Educational Resources Information Center

Jonen, Ruth; Griffith, Phyllis

1998-01-01

The American School Food Service Association has two recognition programs: the recently revised School Foodservice and Nutrition Certification Program and the new School Foodservice and Nutrition Specialist Credentialing Program. The credentialing program was created to enhance school food-service professionals' image and improve their management…

Comparison of Cooperative and Noncooperative Purchasing in School Nutrition Programs

ERIC Educational Resources Information Center

Rice, Beth W.; Strohbehn, Catherine; Shelly, Mark C.; Arendt, Susan; Gregoire, Mary

2010-01-01

Purpose/Objectives: The purpose of this study was to compare food cost and public school foodservice directors' satisfaction between districts participating in school foodservice cooperatives or group purchasing arrangements and districts purchasing independently. It also assessed the prevalence of purchasing cooperatives in school foodservice and…

42 CFR 10.21 - Exclusion of orphan drugs for certain covered entities.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) of this section shall only apply to the following covered entities: free-standing cancer hospitals... process. (d) Use of group purchasing organizations by a free-standing cancer hospital. (1) A free-standing cancer hospital enrolled under section 340B(a)(4)(M) must also comply with the prohibition against using...

42 CFR 10.21 - Exclusion of orphan drugs for certain covered entities.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) of this section shall only apply to the following covered entities: free-standing cancer hospitals... process. (d) Use of group purchasing organizations by a free-standing cancer hospital. (1) A free-standing cancer hospital enrolled under section 340B(a)(4)(M) must also comply with the prohibition against using...

The architecture of enterprise hospital information system.

PubMed

Lu, Xudong; Duan, Huilong; Li, Haomin; Zhao, Chenhui; An, Jiye

2005-01-01

Because of the complexity of the hospital environment, there exist a lot of medical information systems from different vendors with incompatible structures. In order to establish an enterprise hospital information system, the integration among these heterogeneous systems must be considered. Complete integration should cover three aspects: data integration, function integration and workflow integration. However most of the previous design of architecture did not accomplish such a complete integration. This article offers an architecture design of the enterprise hospital information system based on the concept of digital neural network system in hospital. It covers all three aspects of integration, and eventually achieves the target of one virtual data center with Enterprise Viewer for users of different roles. The initial implementation of the architecture in the 5-year Digital Hospital Project in Huzhou Central hospital of Zhejiang Province is also described.

Competitive foods sales are associated with a negative effect on school finances.

PubMed

Peterson, Cora

2011-06-01

It is widely presumed that competitive foods-foods offered for sale in schools in addition to reimbursable federal meals programs-provide revenue that is essential to maintain school foodservices. However, evidence is lacking to demonstrate whether competitive foods sales truly improve foodservice financial viability. The aim of this research was to assess whether or not competitive foods sales have an overall positive financial effect on school foodservice finances. DESIGN AND STATISTICAL ANALYSES: This observational study used a multivariate time series analysis of annual foodservice financial data from repeated observations of 344 Minnesota public school districts between 2001 and 2008 (N=2,695). First, revenue from competitive foods was assessed in terms of whether or not such revenue displaced or complemented revenue from reimbursable meals. Second, profit from competitive foods was assessed in terms of whether or not such profit displaced or increased total school foodservice profit. Fixed effects models indicated small but significant negative relationships between competitive foods sales and reimbursable meals revenue, as well as overall foodservice profit. A 10% increase in competitive foods revenue was associated with a 0.1% decrease in reimbursable meals revenue (P<0.05). A 10% increase in competitive foods profit was associated with a 0.7% decrease in overall foodservice profit among schools with profitable competitive sales (P<0.10). Study findings suggest that competitive foods can have a negative effect on school foodservice finances. Better understanding of foodservice finances could influence current approaches to improve school nutrition. Improved recordkeeping may be necessary to ensure that public funds are not used to subsidize schools' competitive offerings. Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

Bidding: Getting the Best Price for School Foodservice.

ERIC Educational Resources Information Center

DiBella, Cecilia M.

1998-01-01

Sharon (Massachusetts) Public Schools developed an alternative procurement process for school food services that complies with state public bidding laws while evading "low-bid" constraints. The new process features evaluative criteria covering nutrition education, community outreach, management expertise, site visits, and price…

The Influence of Internal Wall and Floor Covering Materials and Ventilation Type on Indoor Radon and Thoron Levels in Hospitals of Kermanshah, Iran

PubMed Central

Pirsaheb, Meghdad; Najafi, Farid; Haghparast, Abbas; Hemati, Lida; Sharafi, Kiomars; Kurd, Nematullah

2016-01-01

Background Building materials and the ventilation rate of a building are two main factors influencing indoor radon and thoron levels (two radioactive gases which have the most important role in human natural radiation exposure within dwellings). Objectives This analytical descriptive study was intended to determine the relationship between indoor radon and thoron concentrations and the building materials used in interior surfaces, as well as between those concentrations and the type of ventilation system (natural or artificial). Materials and Methods 102 measurements of radon and thoron levels were taken from different parts of three hospital buildings in the city of Kermanshah in the west of Iran, using an RTM-1688-2 radon meter. Information on the type of building material and ventilation system in the measurement location was collected and then analyzed using Stata 8 software and multivariate linear regression. Results In terms of radon and thoron emissions, travertine and plaster were found to be the most appropriate and inappropriate covering for walls, respectively. Furthermore, granite and travertine were discovered to be inappropriate materials for flooring, while plastic floor covering was found suitable. Natural ventilation performed better for radon, while artificial ventilation worked better for thoron. Conclusions Internal building materials and ventilation type affect indoor radon and thoron concentrations. Therefore, the use of proper materials and adequate ventilation can reduce the potential human exposure to radon and thoron. This is of utmost importance, particularly in buildings with a high density of residents, including hospitals. PMID:28180013

The Influence of Internal Wall and Floor Covering Materials and Ventilation Type on Indoor Radon and Thoron Levels in Hospitals of Kermanshah, Iran.

PubMed

Pirsaheb, Meghdad; Najafi, Farid; Haghparast, Abbas; Hemati, Lida; Sharafi, Kiomars; Kurd, Nematullah

2016-10-01

Building materials and the ventilation rate of a building are two main factors influencing indoor radon and thoron levels (two radioactive gases which have the most important role in human natural radiation exposure within dwellings). This analytical descriptive study was intended to determine the relationship between indoor radon and thoron concentrations and the building materials used in interior surfaces, as well as between those concentrations and the type of ventilation system (natural or artificial). 102 measurements of radon and thoron levels were taken from different parts of three hospital buildings in the city of Kermanshah in the west of Iran, using an RTM-1688-2 radon meter. Information on the type of building material and ventilation system in the measurement location was collected and then analyzed using Stata 8 software and multivariate linear regression. In terms of radon and thoron emissions, travertine and plaster were found to be the most appropriate and inappropriate covering for walls, respectively. Furthermore, granite and travertine were discovered to be inappropriate materials for flooring, while plastic floor covering was found suitable. Natural ventilation performed better for radon, while artificial ventilation worked better for thoron. Internal building materials and ventilation type affect indoor radon and thoron concentrations. Therefore, the use of proper materials and adequate ventilation can reduce the potential human exposure to radon and thoron. This is of utmost importance, particularly in buildings with a high density of residents, including hospitals.

Food Safety Informatics: A Public Health Imperative

PubMed Central

Tucker, Cynthia A.; Larkin, Stephanie N.; Akers, Timothy A.

2011-01-01

To date, little has been written about the implementation of utilizing food safety informatics as a technological tool to protect consumers, in real-time, against foodborne illnesses. Food safety outbreaks have become a major public health problem, causing an estimated 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths in the U.S. each year. Yet, government inspectors/regulators that monitor foodservice operations struggle with how to collect, organize, and analyze data; implement, monitor, and enforce safe food systems. Currently, standardized technologies have not been implemented to efficiently establish “near-in-time” or “just-in-time” electronic awareness to enhance early detection of public health threats regarding food safety. To address the potential impact of collection, organization and analyses of data in a foodservice operation, a wireless food safety informatics (FSI) tool was pilot tested at a university student foodservice center. The technological platform in this test collected data every six minutes over a 24 hour period, across two primary domains: time and temperatures within freezers, walk-in refrigerators and dry storage areas. The results of this pilot study briefly illustrated how technology can assist in food safety surveillance and monitoring by efficiently detecting food safety abnormalities related to time and temperatures so that efficient and proper response in “real time” can be addressed to prevent potential foodborne illnesses. PMID:23569605

Do recommendations for institutional food service result in better food service? A study of compliance in Danish hospitals and nursing homes from 1995 to 2002-2003.

PubMed

Mikkelsen, B E; Beck, A M; Lassen, A

2007-01-01

Since 1995, significant efforts by authorities and researchers have been directed towards addressing the nutritional problems in Danish hospitals and nursing homes. The purpose of this study was to investigate whether the increased focus on nutritional problems in patients and nursing home residents has resulted in measurable progress. A questionnaire-based study was carried out among foodservice managers in Danish hospitals (n=96) and nursing homes (n=898) in 1995 and 2002/3 (n=90) and (n=682), respectively. The study used compliance with selected issues in the official Danish recommendations for institutional food service as an indicator for progress. The issues included: using nutrient calculated recipes/menus, offering menu choice options, using feedback routines on acceptability of menus, maintaining nutritional steering committees, employing food and nutrition contact persons, employing official recommendations and offering choice between three different menu energy levels. Hospitals had a higher compliance compared to nursing homes. In 1995, this was the case for all questions asked and differences were statistically significant. Also in 2002/3, hospitals had a higher compliance, except in the case of established feedback routines. Differences were statistically significant. The results indicate that nutritional care is higher on the agenda in hospital, than in nursing homes. However, very little progress can be seen in compliance when results are analysed over the 8-year period. The only progress for nursing homes was that more homes had implemented feedback routines on acceptability of food service in 2002/3 than in 1995. The difference was statistically significant. For hospitals, however, no progress was found between 1995 and 2002/3. The attempts to improve the nutritional status of hospital patients and nursing home residents seem to have failed. Still, the initiatives taken to improve the situation seem relevant. Especially the nursing homes might

Trends in hospital-based childbirth care: the role of health insurance.

PubMed

Kozhimannil, Katy B; Shippee, Tetyana P; Adegoke, Olusola; Vemig, Beth A

2013-04-01

Childbirth is the leading reason for hospitalization in the United States, and maternity related expenditures are substantial for many health insurance programs, including Medicaid. We studied the relationship between primary payer and trends in hospital-based childbirth care. Retrospective analysis of hospital discharge data from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project, a 20% stratified sample of US hospitals. Data on 6,717,486 hospital-based births for the years 2002 through 2009 came from the NIS. We used generalized estimating equations to measure associations over time between primary payer (Medicaid, private insurance, or self) and cesarean delivery, vaginal birth after cesarean (VBAC), labor induction, and episiotomy. Controlling for clinical, demographic, and hospital factors, births covered by Medicaid had lower odds of cesarean delivery (adjusted odds ratio [AOR], 0.91), labor induction (AOR, 0.73), and episiotomy (AOR, 0.62) and higher odds of VBAC (AOR, 1.20; P <.001 for all AORs) compared with privately insured births. Cesarean rates increased 6% annually among births paid by private insurance (AOR, 1.06; P <.001) and less rapidly (5% annually) among those covered by Medicaid. US hospital-based births covered by private insurance were associated with higher rates of obstetric intervention than births paid for by Medicaid. After controlling for clinical, demographic, and hospital factors, cesarean delivery rates increased more rapidly among births covered by private insurance, compared with Medicaid. Changes in insurance coverage associated with healthcare reform may impact costs and quality of care for women giving birth in US hospitals.

Obstacles to nutrition labeling in restaurants.

PubMed

Almanza, B A; Nelson, D; Chai, S

1997-02-01

This study determined the major obstacles that foodservices face regarding nutrition labeling. Survey questionnaire was conducted in May 1994. In addition to demographic questions, the directors were asked questions addressing willingness, current practices, and perceived obstacles related to nutrition labeling. Sixty-eight research and development directors of the largest foodservice corporations as shown in Restaurants & Institutions magazine's list of the top 400 largest foodservices (July 1993). P tests were used to determine significance within a group for the number of foodservices that were currently using nutrition labeling, perceived impact of nutrition labeling on sales, and perceived responsibility to add nutrition labels. Regression analysis was used to determine the importance of factors on willingness to label. Response rate was 45.3%. Most companies were neutral about their willingness to use nutrition labeling. Two thirds of the respondents were not currently using nutrition labels. Only one third thought that it was the foodservice's responsibility to provide such information. Several companies perceived that nutrition labeling would have a potentially negative effect on annual sales volume. Major obstacles were identified as menu or personnel related, rather than cost related. Menu-related obstacles included too many menu variations, limited space on the menu for labeling, and loss of flexibility in changing the menu. Personnel-related obstacles included difficulty in training employees to implement nutrition labeling, and not enough time for foodservice personnel to implement nutrition labeling. Numerous opportunities will be created for dietetics professionals in helping foodservices overcome these menu- or personnel-related obstacles.

Understanding Hospital Value-Based Purchasing.

PubMed

Brooks, Jo Ann

2016-05-01

This column is designed to provide a nursing perspective on new hospital quality measurements. Future articles will cover the various quality indicators hospitals face and the role of the nurse in meeting mandated benchmarks. Reader responses to this column are welcome and will help to make it more useful to nurses in meeting the challenges posed by health care reform and changing Medicare reimbursement programs.

Covered California: The Impact of Provider and Health Plan Market Power on Premiums.

PubMed

Scheffler, Richard M; Kessell, Eric; Brandt, Margareta

2015-12-01

We explain the establishment of Covered California, California's health insurance marketplace. The marketplace uses an active purchaser model, which means that Covered California can selectively contract with some health plans and exclude others. During the 2014 open-enrollment period, it enrolled 1.3 million people, who are covered by eleven health plans. We describe the market shares of health plans in California and in each of the nineteen rating regions. We examine the empirical relationship between measures of provider market concentration--spanning health plans, hospitals, and medical groups--and rating region premiums. To do this, we analyze premiums for silver and bronze plans for specific age groups. We find both medical group concentration and hospital concentration to be positively associated with premiums, while health plan concentration is not statistically significant. We simulate the impact of reducing hospital concentration to levels that would exist in moderately competitive markets. This produces a predicted overall premium reduction of more than 2 percent. However, in three of the nineteen rating regions, the predicted premium reduction was more than 10 percent. These results suggest the importance of provider market concentration on premiums. Copyright © 2016 by Duke University Press.

Curriculum Guide for Hospitality Education. Part I. Exemplary Project.

ERIC Educational Resources Information Center

Kalani, Henry

A research project was designed to develop a hospitality education program model for Hawaii's community colleges. Primary data were gathered in a survey of the hospitality industry characteristics, manpower requirements, and training needs. This report of the project covers the following information: history and growth of the hospitality industry…

[Covering stoma in anterior rectum resection with TME for rectal cancer in elderly patients].

PubMed

Cirocchi, Roberto; Grassi, Veronica; Barillaro, Ivan; Cacurri, Alban; Koltraka, Bledar; Coccette, Marco; Sciannameo, Francesco

2010-01-01

The aim of our study is to evaluate the advisability of covering stoma in Anterior Rectum Resection with TME in elderly patients. A research of both the Ministry of Health and Terni Hospital databases has been conducted so as to collect information about patients with rectal tumor. Such research allowed to identify the amount of patients diagnosed with rectal cancer, the type of intervention, and the average hospitalization time. Between January 1997 and June 2008, 209 patients have undergone chirurgical surgery at Terni hospital's General and Emergency Surgical Clinic. An Anterior Rectum Resection with TME has been performed in 135 patients out of the sample (64.59%). The average hospitalization time of geriatric patients does not show significant differences compared to that of younger patients. An age-cohort analysis has been performed among patients who have been subject to stomia and those who have not. The former have been further split up between those who underwent ileostomy and those subject to colostomy. While ileostomy patients face a similar hospitalization time across all age cohorts, geriatric colostomy patients face longer hospitalizations than younger patients. Patients subject to Anterior Rectum Resection show no meaningful differences, in terms of hospitalization time, across all age cohorts. In geriatric patients the construction of covering stoma has resulted in longer hospitalizations only when a loop colostomy was executed, as opposed to loop ileostomy.

The impact of payer-specific hospital case mix on hospital costs and revenues for third-party patients.

PubMed

Lee, Keon-Hyung; Roh, M P H Chul-Young

2007-02-01

Competition among hospitals and managed care have forced hospital industry to be more efficient. With higher degrees of hospital competition and managed care penetration, hospitals have argued that the rate of increase in hospital cost is greater than the rate of increase in hospital revenue. By developing a payer-specific case mix index (CMI) for third-party patients, this paper examined the effect of hospital case mix on hospital cost and revenue for third-party patients in California using the hospital financial and utilization data covering 1986-1998. This study found that the coefficients for CMIs in the third-party hospital revenue model were greater than those in the hospital cost model until 1995. Since 1995, however, the coefficients for CMIs in the third-party hospital revenue model have been less than those in hospital cost models. Over time, the differences in coefficients for CMIs in hospital revenue and cost models for third-party patients have become smaller and smaller although those differences are statistically insignificant.

Hospital all-risk emergency preparedness in Ghana.

PubMed

Norman, I D; Aikins, M; Binka, F N; Nyarko, K M

2012-03-01

This paper assessed the emergency preparedness programs of health facilities for all-risks but focused on Road Traffic Accidents, (RTA) resulting in surge demand. It adopted W. H. O checklist covering hospital preparedness, equipment, manpower and surge capacity planning as best practices for the mitigation of public health emergencies. This is a cross-sectional study of purposively selected health facilities. The method used consisted of site visit, questionnaire survey, literature and internet review. The W. H. O. standard for emergency preparedness of health facilities was used to evaluate and assess the nation's hospitals surge capacity programs. The study was conducted between March-June, 2010. A total of 22 district and regional health facilities including teaching hospitals participated in the study. All 10 regions of the country were covered. These were: (1) many of the nation's hospitals were not prepared for large RTA's resulting in surge demands, and did not possess general emergency preparedness programs. (2) The hospitals' respective abilities to handle large scale RTA's were compromised by the lack of competent medical and allied health personnel and adequate supplies. The inadequacies of the hospital system in responding to emergencies raise serious public health concerns. The biggest challenge facing the hospitals in their emergency intervention is the lack of pre-emergency and emergency preparedness plans as well as the coordination of the hospitals response mechanisms. The paper ended with recommendations on how the nation's hospitals and their supervisory agencies could improve emergency preparedness.

Early warning system for financially distressed hospitals via data mining application.

PubMed

Koyuncugil, Ali Serhan; Ozgulbas, Nermin

2012-08-01

The aim of this study is to develop a Financial Early Warning System (FEWS) for hospitals by using data mining. A data mining method, Chi-Square Automatic Interaction Detector (CHAID) decision tree algorithm, was used in the study for financial profiling and developing FEWS. The study was conducted in Turkish Ministry of Health's public hospitals which were in financial distress and in need of urgent solutions for financial issues. 839 hospitals were covered and financial data of the year 2008 was obtained from Ministry of Health. As a result of the study, it was determined that 28 hospitals (3.34%) had good financial performance, and 811 hospitals (96.66%) had poor financial performance. According to FEWS, the covered hospitals were categorized into 11 different financial risk profiles, and it was found that 6 variables affected financial risk of hospitals. According to the profiles of hospitals in financial distress, one early warning signal was detected and financial road map was developed for risk mitigation.

Using the Systems-Practice Framework to Understand Food Allergen Management Practices at College Catering Operations: A Qualitative Study.

PubMed

Verstappen, Jennie; Mirosa, Miranda; Thomson, Carla

2018-03-01

The number of individuals with food allergies or intolerances attending catered university residential colleges is increasing, and safe dining options are required to minimize the risk of allergic reactions and food-induced death. This qualitative research study sought to advance professional knowledge of the factors affecting allergen management practices, particularly pertaining to college foodservices. Three catered residential colleges affiliated with a major university in New Zealand were selected as research sites. The study used an ethnographic approach and systems-practice theory as a framework for data collection and organizing results. Data collection techniques included document analyses (3 hours per site), observations (6 to 8 hours per site), focus groups with foodservice workers (30 to 45 minutes per site, n=16), and interviews with foodservice managers (45 to 90 minutes per interview, n=5). Notes and transcripts were coded through the process of thematic analysis using NVivo for Mac software, version 11.1.1, to identify factors affecting allergen management practices. The main factors affecting allergen management practices at college foodservices included information provided by residents about dietary requirements; communication between residents and foodservice staff; systems for allergen management; attitude of foodservice staff; and college size. Detailed dietary information, effective communication with residents, sufficient resources, clarification of responsibilities, and thorough systems are required for staff to perform safe allergen management practices. Ultimately, successful implementation was predominantly determined by staff attitude. Foodservice managers are advised to identify motivators and address barriers of staff attitudes toward allergen management practices to promote successful implementation. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Latex allergies - for hospital patients

MedlinePlus

... bands used to stop or slow blood flow) Stethoscopes (used to listen to your heart beat and ... the hospital include asking for: Equipment, such as stethoscopes and blood pressure cuffs, to be covered, so ...

24 CFR 242.90 - Eligibility of mortgages covering hospitals in certain neighborhoods.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., except such requirements (other than those relating to labor standards and prevailing wages or... there is a need in the area for an adequate hospital to serve low and moderate income families. (3) That...

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

PubMed

Anbäcken, O

1994-01-01

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

[Economic impact of etanercept and adalimumab biosimilars on hospitals scale covered by PharmAlp'Ain, a hospitals grouping of orders for health products].

PubMed

Berreur, B; Guerin, F; Christophe, B; Limido, G; Paubel, P

2018-01-01

To evaluate the economic impact of future prescriptions of etanercept and adalimumab biosimilars at the territorial scale covered by PharmAlp'Ain, a hospitals grouping of orders for health products. Determination of the number and status of patients (naive or in continuation of treatment) from the National Database "Datamart de Consommation Inter-Régimes" of health insurance, concerned by a dispensation in a pharmacy of etanercept or adalimumab in 2015. Calculation of potential savings in case of biosimilar requirements according to 3 hypotheses: 63% (rate observed in a previous study) of initiations are treated with biosimiliaries and the others by princeps (H 1 ); all initiations under biosimilars and continuation therapy with the princeps (H 2 ) or all patients are treated with biosimilars (H 3 ). The annual savings are estimated at 237,000 € with the H 1 hypothesis. In the case of H 2 , the expected savings would be 376,200 € per year. In the case of H 3 , savings for the community could reach almost 1,282,800 € per year. The arrival of biosimilars allows significant savings for medicines market. According to the French recommendations in 2016, the expected savings are between the H 1 and H 2 hypothesis. The rate of penetration of biosimilars depends on many factors such as the involvement of health professionals, patient adherence, or health authority recommendations. Copyright © 2017 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Reconfiguration of acute care hospitals in post-socialist Serbia: spatial distribution of hospital beds.

PubMed

Matejic, Marko

2017-04-01

In the context of healthcare reforms in post-socialist Serbia, this research analyses the reconfiguration of acute care hospitals from the aspect of the spatial distribution of hospital beds among and within state-owned hospitals. The research builds a relationship between the macro or national level and the micro or hospital level of the spatial distribution of hospital beds. The aim of the study is to point out that a high level of efficiency in hospital functionality is difficult to achieve within the current hospital network and architectural-urban patterns of hospitals, and to draw attention to the necessity of a strategically planned hospital spatial reconfiguration, conducted simultaneously with other segments of the healthcare system reform. The research analyses published and unpublished data presented in tables and diagrams. The theoretical platform of the research covers earlier discussions of the Yugoslav healthcare system, its post-socialist reforms and the experiences of developed countries. The results show that the hospital bed distribution has not undergone significant changes, while the hospital spatial reconfiguration has either not been carried out at all or, if it has, only on a small scale. All this has contributed to overall inadequate, inflexible, inefficient, defragmented and unequal bed distribution. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

A Model Train-The-Trainer Program for HACCP-Based Food Safety Training in the Retail/Food Service Industry: An Evaluation.

ERIC Educational Resources Information Center

Martin, Kenneth E.; Knabel, Steve; Mendenhall, Von

1999-01-01

A survey showed states are adopting higher training and certification requirements for food-service workers. A train-the-trainer model was developed to prepare extension agents, health officers, and food-service managers to train others in food-safety procedures. (SK)

Financial and operational ratios for bond-insured hospitals.

PubMed

McCue, Michael J; McCluer, R Forrest

2008-01-01

Few, if any, researchers have analyzed the performance indicators of companies that offer bond insurance to hospitals and healthcare systems. The authors of this study analyzed the key financial and operational indicators of independent hospitals and hospitals within large multihospital systems that are insured by the 5 major bond insurance companies. The authors examined 87 insured bond issues; the results of this study show that some insurers cover healthcare facilities that have strong operational traits and others focus on financial factors.

Chronology of a Successful Conversion--Contractor Revives School Lunch Program.

ERIC Educational Resources Information Center

Johnston, James B.

1994-01-01

A New York State school district employed a management company to privatize the food-service program with the goal of enticing all students to eat lunch. Expertise in marketing, menu planning, and food-service operation turned the program around. Suggests questions to ask when selecting a management company. (MLF)

Impact of Critical Access Hospital Conversion on Beneficiary Liability

ERIC Educational Resources Information Center

Gilman, Boyd H.

2008-01-01

Context: While the Medicare Critical Access Hospital (CAH) program has improved the financial viability of small rural hospitals and enhanced access to care in rural communities, the program puts beneficiaries at risk for paying a larger share of the cost of services covered under the Medicare part B benefit. Purpose: This paper examines the…

Negotiated Wages and Working Conditions in Ontario Hospitals: 1973.

ERIC Educational Resources Information Center

Ontario Dept. of Labour, Toronto. Research Branch.

This report is a statistical analysis of provisions in collective agreements covering approximately 38,000 full-time employees in 156 hospitals in the Province of Ontario. Part 1 consists of 56 tables giving information on the geographical distribution of hospital contracts, the unions that are party to them, their duration, and the sizes and…

Medicaid Expansion Affects Rural And Urban Hospitals Differently.

PubMed

Kaufman, Brystana G; Reiter, Kristin L; Pink, George H; Holmes, George M

2016-09-01

Rural hospitals differ from urban hospitals in many ways. For example, rural hospitals are more reliant on public payers and have lower operating margins. In addition, enrollment in the health insurance Marketplaces of the Affordable Care Act (ACA) has varied across rural and urban areas. This study employed a difference-in-differences approach to evaluate the average effect of Medicaid expansion in 2014 on payer mix and profitability for urban and rural hospitals, controlling for secular trends. For both types of hospitals, we found that Medicaid expansion was associated with increases in Medicaid-covered discharges. However, the increases in Medicaid revenue were greater among rural hospitals than urban hospitals, and the decrease in the proportion of costs for uncompensated care were greater among urban hospitals than rural hospitals. This preliminary analysis of the early effects of Medicaid expansion suggests that its financial impacts may be different for hospitals in urban and rural locations. Project HOPE—The People-to-People Health Foundation, Inc.

Casemix funding for acute hospital inpatient services in Australia.

PubMed

Duckett, S J

1998-10-19

Casemix funding was introduced first in Victoria in 1993-94, and since then most States have moved towards either casemix funding or using casemix to inform the budget setting process. The five States implementing casemix have adopted some common funding elements: all use AN-DRG-3; all have introduced capping, msot commonly at the hospital level; and all ensure accuracy of diagnosis and procedure coding through coding audits. Two funding models have been developed. The fixed and variable model involves a fixed grant for hospital overhead costs and a payment for each patient treated, covering only variable costs. The integrated model provides an integrated payment to hospitals for each patient treated, covering both the fixed and variable costs. There are different weight setting processes and base prices between the States, which result in marked differences in the price paid for the same type of case treated in similar hospitals. Learning across State boundaries should be encouraged, with knowledge of what is effective and what is ineffective in casemix funding arrangements being used to develop Australian best practice in this area.

Disproportionate-share hospital payment reductions may threaten the financial stability of safety-net hospitals.

PubMed

Neuhausen, Katherine; Davis, Anna C; Needleman, Jack; Brook, Robert H; Zingmond, David; Roby, Dylan H

2014-06-01

Safety-net hospitals rely on disproportionate-share hospital (DSH) payments to help cover uncompensated care costs and underpayments by Medicaid (known as Medicaid shortfalls). The Affordable Care Act (ACA) anticipates that insurance expansion will increase safety-net hospitals' revenues and will reduce DSH payments accordingly. We examined the impact of the ACA's Medicaid DSH reductions on California public hospitals' financial stability by estimating how total DSH costs (uncompensated care costs and Medicaid shortfalls) will change as a result of insurance expansion and the offsetting DSH reductions. Decreases in uncompensated care costs resulting from the ACA insurance expansion may not match the act's DSH reductions because of the high number of people who will remain uninsured, low Medicaid reimbursement rates, and medical cost inflation. Taking these three factors into account, we estimate that California public hospitals' total DSH costs will increase from $2.044 billion in 2010 to $2.363-$2.503 billion in 2019, with unmet DSH costs of $1.381-$1.537 billion. Project HOPE—The People-to-People Health Foundation, Inc.

School Nutrition Facility Planning Guide.

ERIC Educational Resources Information Center

Pannell, Dorothy VanEgmond

This publication is designed to help superintendents, local facilities coordinators, and food-service directors in planning the remodeling of an outdated food-service facility or the building of a new one. The introduction describes the roles of the local facility coordinator, the local child-nutrition director, the architect, the food-service…

Issues Related to Equipment and the Dietary Guidelines for Americans.

ERIC Educational Resources Information Center

Nettles, Mary Frances

A multi-year project was initiated to examine production equipment issues related to implementation of the Dietary Guidelines for Americans (DGA). The purposes of the research project were to determine foodservice directors' opinions regarding use and appropriateness of equipment in school foodservice, to identify the number and variety of menu…

Release of information: are hospitals taking a hit?

PubMed

Bellenghi, G Michael; Coffey, Bonnie; Fournier, Joseph E; McDavid, Jan P

2008-11-01

Outsourcing release-of-information requests helps hospitals alleviate administrative and compliance burdens and expense. Recently, state lawmakers have begun to draft legislation reducing the maximum fee that may be charged for copies of electronically stored records. The reduced fees may not cover expenses. If such legislation makes it difficult for outsourcing companies to make a profit from this service, hospitals ultimately could bear the expense and risk.

48 CFR 831.7001-4 - Medical services and hospital care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... and Procedures 831.7001-4 Medical services and hospital care. (a) VA may pay the customary student... Government. (b) When the customary student's health fee does not cover medical services or hospital care, but... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Medical services and...

Servicescape: physical environment of hospital pharmacies and hospital pharmacists' work outcomes.

PubMed

Lin, Blossom Yen-Ju; Leu, Wen-Jye; Breen, Gerald-Mark; Lin, Wen-Hung

2008-01-01

In health care, architects, interior designers, engineers, and health care administrators need to pay attention to the construction and design of health care facilities. Research is needed to better understand how health professionals and employees perceive their work environment to improve the physical environment in which they work. The purpose of this study was to test the effect of the physical environment of hospital pharmacies on hospital pharmacists' work outcomes. This cross-sectional mailed survey study of individual hospital pharmacists used a structured questionnaire developed to cover perceptions of the ambient conditions and the space/function(s) of pharmacists' work environments. It included aspects such as dispensing areas, pharmaceuticals areas, storage areas, and administrative offices. Work outcomes were job satisfaction, intentions to leave or reduce job working hours, and job-related stress. Hospital pharmacists in Taiwan (n = 182) returned the mailed surveys. Structural equation modeling was performed to validate the construct of the physical environment of a hospital pharmacy and the causal model for testing the effect of the physical environment on pharmacists' work outcomes. For hospital pharmacy workplaces, more favorable perceptions of the workplace's physical environment were positively associated with overall job satisfaction, but such perceptions were also negatively related to intentions to quit employment or to reduce working hours. However, the effect of the physical environment on job stress within the workplace was not supported. The designs of physical environments deserve attention to create more appropriate and healthier environments for hospital pharmacies. Further research should be devoted to trace more psychological responses to the physical environment from a longitudinal perspective.

Hospital characteristics related to the hospital length of stay among inpatients receiving invasive cervical discectomy due to road traffic accidents under automobile insurance in South Korea.

PubMed

Shin, Kyoung Won; Lee, Hyo Jung; Nam, Chung Mo; Moon, Ki Tae; Park, Eun-Cheol

2017-08-16

In South Korea, people injured in road traffic accidents receive compensation for medical costs through their automobile insurance. However, the automobile insurance system appears to manage health care inefficiently. This study aimed to investigate the factors associated with the hospital length of stay (LOS), which was used as an indicator of healthcare utilization, for inpatients covered by automobile insurance and undergoing invasive cervical discectomy. Insurance claims data from 158 hospitals were used. The study included 850 inpatients who were involved in automobile accidents in 2014 and 2015 and who underwent invasive cervical discectomy. Poisson regression analysis was performed to examine the associations between the LOS and hospital-level characteristics. The mean LOS for inpatients covered by automobile insurance was 25.75 days. A higher proportion of inpatients with automobile insurance were associated with a longer LOS (rate ratio [RR]: 1.027 per 1% increase, 95% confidence interval [CI]: 1.012-1.042). A higher hospital volume of invasive cervical discectomy (RR: 0.970 per 10 case increase, 95% CI: 0.945-0.997), bed turnover rate (RR: 0.988 per 1 increase, 95% CI: 0.979-0.997), and number of neurosurgeons or orthopedic specialists (RR: 0.930 per 1/100 beds increase, 95% CI: 0.876-0.987) were associated with a shorter LOS. Our findings suggest that inpatients covered by automobile insurance were associated with a longer LOS when treated at small-sized, low-provider, and low-volume hospitals with high proportions of such patients. Based on these findings, policymakers and healthcare professionals ought to consider improved strategies for efficient management of automobile insurance for inpatients in small-sized hospitals.

Going all digital in a university hospital: a unified large-scale PACS for multiple departments and hospitals

NASA Astrophysics Data System (ADS)

Vogl, Raimund

2001-08-01

In 1997, a large PACS was first introduced at Innsbruck University Hospital in the context of a new traumatology centre. In the subsequent years, this initial PACS setting covering only one department was expanded to most of the hospital campus, with currently some 250 viewing stations attached. Constantly connecting new modalities and viewing stations created the demand for several redesigns from the original PACS configuration to cope with the increasing data load. We give an account of these changes necessary to develop a multi hospital PACS and the considerations that lead us there. Issues of personnel for running a large scale PACS are discussed and we give an outlook to the new information systems currently under development for archiving and communication of general medical imaging data and for simple telemedicine networking between several large university hospitals.

HOSPITAL MANAGERS' NEED FOR INFORMATION ON HEALTH TECHNOLOGY INVESTMENTS.

PubMed

Ølholm, Anne Mette; Kidholm, Kristian; Birk-Olsen, Mette; Christensen, Janne Buck

2015-01-01

There is growing interest in implementing hospital-based health technology assessment (HB-HTA) as a tool to facilitate decision making based on a systematic and multidisciplinary assessment of evidence. However, the decision-making process, including the informational needs of hospital decision makers, is not well described. The objective was to review empirical studies analysing the information that hospital decision makers need when deciding about health technology (HT) investments. A systematic review of empirical studies published in English or Danish from 2000 to 2012 was carried out. The literature was assessed by two reviewers working independently. The identified informational needs were assessed with regard to their agreement with the nine domains of EUnetHTA's Core Model. A total of 2,689 articles were identified and assessed. The review process resulted in 14 relevant studies containing 74 types of information that hospital decision makers found relevant. In addition to information covered by the Core Model, other types of information dealing with political and strategic aspects were identified. The most frequently mentioned types of information in the literature related to clinical, economic and political/strategic aspects. Legal, social, and ethical aspects were seldom considered most important. Hospital decision makers are able to describe their information needs when deciding on HT investments. The different types of information were not of equal importance to hospital decision makers, however, and full agreement between EUnetHTA's Core Model and the hospital decision-makers' informational needs was not observed. They also need information on political and strategic aspects not covered by the Core Model.

Decision making and senior management: the implementation of change projects covering clinical management in SUS hospitals.

PubMed

Pacheco, José Márcio da Cunha; Gomes, Romeu

2016-08-01

This paper analyses the decision making process for senior management in public hospitals that are a part of the National Health Service in Brazil (hereafter SUS) in relation to projects aimed at changing clinical management. The methodological design of this study is qualitative in nature taking a hermeneutics-dialectics perspective in terms of results. Hospital directors noted that clinical management projects changed the state of hospitals through: improving their organizations, mobilizing their staff in order to increase a sense of order and systemizing actions and available resources. Technical rationality was the principal basis used in the decision making process for managers. Due to the reality of many hospitals having fragmented organizations, this fact impeded the use of aspects related to rationality, such as economic and financial factors in the decision making process. The incremental model and general politics also play a role in this area. We concluded that the decision making process embraces a large array of factors including rational aspects such as the use of management techniques and the ability to analyze, interpret and summarize. It also incorporates subjective elements such as how to select values and dealing with people's working experiences. We recognized that management problems are wide in scope, ambiguous, complex and do not come with a lot of structure in practice.

Indian hospitals and government in the colonial Andes.

PubMed

Ramos, Gabriela

2013-04-01

This article examines the reception of the early modern hospital among the indigenous people of the Andes under Spanish colonial rule. During the period covered by this study (sixteenth to mid-eighteenth centuries), the hospital was conceived primarily as a manifestation of the sovereign’s paternalistic concern for his subjects’ spiritual well being. Hospitals in the Spanish American colonies were organised along racial lines, and those catering to Indians were meant to complement the missionary endeavour. Besides establishing hospitals in the main urban centres, Spanish colonial legislation instituted hospitals for Indians in provincial towns and in small rural jurisdictions throughout the Peruvian viceroyalty. Indian hospitals often met with the suspicion and even hostility of their supposed beneficiaries, especially indigenous rulers. By conceptualising the Indian hospital as a tool of colonial government, this article investigates the reasons behind its negative reception, the work of adaptation that allowed a few of them to thrive, and the eventual failure of most of these institutions.

[Evaluation of financial status of public hospitals considering the updated costs of their services].

PubMed

Cid P, Camilo; Bastías S, Gabriel

2014-02-01

In 2011 the Chilean National Health Fund (FONASA) commissioned a study to assess the costs of the 120 most relevant hospital care services with an established fee, in a large sample of public hospitals. We herein report the cost evaluation results of such study, considering the financial condition of those hospitals in the year of the study. Based on the premise that the expenses derived from the provision of institutional and appraised hospital services should be identical to the billing of hospitals to FONASA, the prices are undervalued, since they cover only 56% of billing, generating a gap between expenses and invoicing. This gap shows an important limitation of tariffs, since their prices do not cover the real costs. However not all hospitals behave in the same way. While the provision of services of some hospitals is even higher than their billing, most hospitals do not completely justify their invoicing. These assumptions would imply that, generally speaking, hospital debts are justified by the costs incurred. However, hospitals have heterogeneous financial situations that need to be analyzed carefully. In particular, nothing can be said about their relative efficiency if cost estimations are not adjusted by the complexity of patients attended and comparison groups are not defined.

Not-for-profit hospitals fight tax-exempt challenges.

PubMed

Hudson, T

1990-10-20

The message being sent by local tax boards, state agencies, and the Internal Revenue Service is clear: Not-for-profit hospitals will have to justify their tax-exempt status. But complying with this demand can be a costly administrative burden. Just ask the executives who have been through the experience. CEO Richard Anderson, of St. Luke's Hospital, Bethlehem, PA, is luckier than some executives who have faced tax-exempt challenges. He won his hospital's case. But he still faces a yearly battle: The hospital must prove its compliance annually to the county board of assessors. Other executives report similar experiences. Our cover story takes an in-depth look at how administrators faced challenges to their hospital's tax status and what they learned about their relationship with their communities, as well as a complete state and federal legislative outlook for future developments.

Patient Handoffs: Is Cross Cover or Night Shift Better?

PubMed

Higgins, Alanna; Brannen, Melissa L; Heiman, Heather L; Adler, Mark D

2017-06-01

Studies show singular handoffs between health care providers to be risky. Few describe sequential handoffs or compare handoffs from different provider types. We investigated the transfer of information across 2 handoffs using a piloted survey instrument. We compared cross-cover (every fourth night call) with dedicated night-shift residents. Surveys assessing provider knowledge of hospitalized patients were administered to pediatric residents. Primary teams were surveyed about their handoff upon completion of daytime coverage of a patient. Night-shift or cross-covering residents were surveyed about their handoff of the same patient upon completion of overnight coverage. Pediatric hospitalists rated the consistency of information between the surveys. Absolute difference was calculated between the 2 providers' rating of a patient's (a) complexity and (b) illness severity. Scores were compared across provider type. Fifty-nine complete handoff pairs were obtained. Fourteen and 45 handoff surveys were completed by a cross-covering and a night-shift provider, respectively. There was no significant difference in information consistency between primary and night-shift (median, 4.0; interquartile range [IQR], 3-4) versus primary and cross-covering providers (median, 4.0; IQR, 3-4). There was no significant difference in median patient complexity ratings (night shift, 3.0; IQR, 1-5, versus cross cover, 3.5; IQR, 1-5) or illness severity ratings (night shift, 2.0; IQR, 1-4, versus cross-cover, 3.0; IQR, 1-6) when comparing provider types giving a handoff. We did not find a difference in physicians' transfer of information during 2 handoffs among providers taking traditional call or on night shift. Development of tools to measure handoff consistency is needed.

Survey alerts hospital to needs of consumers.

PubMed

Schoenfeldt, R C; Seale, W B; Hale, A W

1987-09-01

Because of rapidly changing developments in the healthcare field, more emphasis is being placed on marketing of hospital services. A hospital's success will depend more and more on strategic planning based on timely and accurate information. In light of this, Lourdes Hospital, Paducah, KY, undertook a survey to evaluate its current performance and to determine a path for the future. The survey found, among other discoveries, that patients want more voice in determining their own treatment; they prefer outpatient treatment when possible, even if it is not covered by insurance; and stress management and health assessment clinics are the most popular extra services a hospital could offer. Physicians surveyed said they wanted more input into the evaluation of new services and equipment at the hospital. The survey also found that most patients either select a hospital in conjunction with their physician or have their physician choose the hospital. The findings led to some major changes at the hospital, including a restructuring of the planning process to get physicians more involved, a new marketing strategy to enhance communication with consumers, and increased outpatient services. The results have given direction to the hospital administration, helped shape advertising, and provided support for certificate-of-need requests.

38 CFR 17.55 - Payment for authorized public or private hospital care.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., not to exceed the full DRG rate as provided in paragraph (a) of this section. The hospital that... section. (c) VA shall pay the providing facility the full DRG-based rate or reasonable cost, without... each discharge, an amount to cover the non-Federal hospital's capital-related costs, kidney, heart and...

38 CFR 17.55 - Payment for authorized public or private hospital care.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., not to exceed the full DRG rate as provided in paragraph (a) of this section. The hospital that... section. (c) VA shall pay the providing facility the full DRG-based rate or reasonable cost, without... each discharge, an amount to cover the non-Federal hospital's capital-related costs, kidney, heart and...

38 CFR 17.55 - Payment for authorized public or private hospital care.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., not to exceed the full DRG rate as provided in paragraph (a) of this section. The hospital that... section. (c) VA shall pay the providing facility the full DRG-based rate or reasonable cost, without... each discharge, an amount to cover the non-Federal hospital's capital-related costs, kidney, heart and...

38 CFR 17.55 - Payment for authorized public or private hospital care.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., not to exceed the full DRG rate as provided in paragraph (a) of this section. The hospital that... section. (c) VA shall pay the providing facility the full DRG-based rate or reasonable cost, without... each discharge, an amount to cover the non-Federal hospital's capital-related costs, kidney, heart and...

38 CFR 17.55 - Payment for authorized public or private hospital care.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., not to exceed the full DRG rate as provided in paragraph (a) of this section. The hospital that... section. (c) VA shall pay the providing facility the full DRG-based rate or reasonable cost, without... each discharge, an amount to cover the non-Federal hospital's capital-related costs, kidney, heart and...

Antimicrobial Stewardship: The Need to Cover All Bases

PubMed Central

Friedman, N. Deborah

2013-01-01

Increasing antimicrobial resistance has necessitated an approach to guide the use of antibiotics. The necessity to guide antimicrobial use via stewardship has never been more urgent. The decline in anti-infective innovation and the failure of currently available antimicrobials to treat some serious infections forces clinicians to change those behaviors that drive antimicrobial resistance. The majority of antimicrobial stewardship (AMS) programs function in acute-care hospitals, however, hospitals are only one setting where antibiotics are prescribed. Antimicrobial use is also high in residential aged care facilities and in the community. Prescribing in aged care is influenced by the fact that elderly residents have lowered immunity, are susceptible to infection and are frequently colonized with multi-resistant organisms. While in the community, prescribers are faced with public misconceptions about the effectiveness of antibiotics for many upper respiratory tract illnesses. AMS programs in all of these locations must be sustainable over a long period of time in order to be effective. A future with effective antimicrobials to treat bacterial infection will depend on AMS covering all of these bases. This review discusses AMS in acute care hospitals, aged care and the community and emphasizes that AMS is critical to patient safety and relies on government, clinician and community engagement. PMID:27029310

Indirect costs of teaching in Canadian hospitals.

PubMed Central

MacKenzie, T A; Willan, A R; Cox, M A; Green, A

1991-01-01

We sought to determine whether there are indirect costs of teaching in Canadian hospitals. To examine cost differences between teaching and nonteaching hospitals we estimated two cost functions: cost per case and cost per patient-day (dependent variables). The independent variables were number of beds, occupancy rate, teaching ratio (number of residents and interns per 100 beds), province, urbanicity (the population density of the county in which the hospital was situated) and wage index. Within each hospital we categorized a random sample of patient discharges according to case mix and severity of illness using age and standard diagnosis and procedure codes. Teaching ratio and case severity were each highly correlated positively with the dependent variables. The other variables that led to higher costs in teaching hospitals were wage rates and number of beds. Our regression model could serve as the basis of a reimbursement system, adjusted for severity and teaching status, particularly in provinces moving toward introducing case-weighting mechanisms into their payment model. Even if teaching hospitals were paid more than nonteaching hospitals because of the difference in the severity of illness there should be an additional allowance to cover the indirect costs of teaching. PMID:1898870

Looking at hospitalized persons throughout the prism of the handicap.

PubMed

Giral, M; Boussat, B; Lombard, F; Stempfle, S; François, P; Pérennou, D

2018-01-01

To describe the disability status of non-selected hospitalized persons. We conducted a cross-sectional survey to assess activity limitations of every person older than 18 years hospitalized in a regional university hospital covering all medical fields. Evaluators rated, on a scale from 0 to 4, 22 selected items of the International Classification of Functioning (ICF), covering the 6 following domains: learning and applying knowledge, general tasks and demands, communication, mobility, self-care, and interpersonal interactions and relationships. Univariate and multivariate analyses were performed to analyze the prevalence, severity and profile of the handicap in terms of sociodemographic characteristics and care pathways. Among 1572 eligible persons, 1267 (81%) were surveyed (mean age 62.7±20.4years; 655 males [51.7%]). Overall, 82% showed at least one activity limitation. For 52%, disability was severe or total for at least one ICF item. Prevalence of disabilities was higher for mobility (75%) and self-care domains (63%). Disability was strongly related to age: age older than 80years versus 18 to 44years (OR=12.8 95% CI 6.4-27.9]; P<0.01). Disability was associated with hospitalization in rehabilitation units (96%; OR=4.3 [95% CI 2.2-5.3]; P<0.01). Severe disability was associated with hospitalization in critical care units (OR=6.7 [CI 3.2-15.1]; P<0.001) and psychiatry units (OR=5.3 [CI 2.7-11.4]; P<0.001). Handicap was common in hospitalized persons, involving all 6 tested ICF activity domains, particularly mobility and self-care. This study alerts care givers, hospital administrators, and in general, people influencing health policies about the need to plan actions to reduce activity limitations of hospitalized persons, whatever the cause of the hospitalization. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Smoke-free laws, gender, and reduction in hospitalizations for acute myocardial infarction.

PubMed

Hahn, Ellen J; Rayens, Mary Kay; Burkhart, Patricia V; Moser, Debra K

2011-01-01

We examined gender differences in the incidence of acute myocardial infarction (AMI) after the passage of a smoke-free law in Lexington, Kentucky. The initial legislation had exemptions not covering manufacturing facilities and government buildings, which may have put men at greater risk for AMI. We examined the effect of Lexington's smoke-free public places law on hospitalizations for AMI (i.e., heart attack) among men and women 40 months prior to and 32 months after enactment of the law. We used the statewide administrative database (Comp Data) for all hospital billing records for the four health-care systems in Lexington-Fayette County. Cases were included in the analysis if (1) the patient was $35 years of age; (2) the patient had a primary discharge diagnosis of AMI, with an International Classification of Diseases, Ninth Revision code in the range of 410.00 to 410.99; and (3) the date of service was between January 1, 2001, and December 31, 2006. Among women, AMI hospitalizations declined 23% after the law took effect. The rate of AMI events among men did not change significantly. There was an overrepresentation of women in the hospitality industry and a disproportionate number of men working in manufacturing facilities and government worksites not mandated by the law. We found gender differences in the reduction of AMI hospitalizations following implementation of a smoke-free law that covered only some sectors of the workforce. Enacting smoke-free laws that cover all places of employment and strengthening existing partial laws may extend protection against AMIs to female and male workers.

Measuring patient-perceived quality of care in US hospitals using Twitter.

PubMed

Hawkins, Jared B; Brownstein, John S; Tuli, Gaurav; Runels, Tessa; Broecker, Katherine; Nsoesie, Elaine O; McIver, David J; Rozenblum, Ronen; Wright, Adam; Bourgeois, Florence T; Greaves, Felix

2016-06-01

Patients routinely use Twitter to share feedback about their experience receiving healthcare. Identifying and analysing the content of posts sent to hospitals may provide a novel real-time measure of quality, supplementing traditional, survey-based approaches. To assess the use of Twitter as a supplemental data stream for measuring patient-perceived quality of care in US hospitals and compare patient sentiments about hospitals with established quality measures. 404 065 tweets directed to 2349 US hospitals over a 1-year period were classified as having to do with patient experience using a machine learning approach. Sentiment was calculated for these tweets using natural language processing. 11 602 tweets were manually categorised into patient experience topics. Finally, hospitals with ≥50 patient experience tweets were surveyed to understand how they use Twitter to interact with patients. Roughly half of the hospitals in the US have a presence on Twitter. Of the tweets directed toward these hospitals, 34 725 (9.4%) were related to patient experience and covered diverse topics. Analyses limited to hospitals with ≥50 patient experience tweets revealed that they were more active on Twitter, more likely to be below the national median of Medicare patients (p<0.001) and above the national median for nurse/patient ratio (p=0.006), and to be a non-profit hospital (p<0.001). After adjusting for hospital characteristics, we found that Twitter sentiment was not associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings (but having a Twitter account was), although there was a weak association with 30-day hospital readmission rates (p=0.003). Tweets describing patient experiences in hospitals cover a wide range of patient care aspects and can be identified using automated approaches. These tweets represent a potentially untapped indicator of quality and may be valuable to patients, researchers, policy makers and hospital

How DSH payments might mislead the financial assessment of government-owned hospitals.

PubMed

McCue, Michael J; Draper, Debra A

2004-01-01

Hospitals are eligible for and receive Medicaid disproportionate share hospital (DSH) payments for caring for the indigent/uninsured; however, county hospitals may also be obligated to transfer these funds to the state. These transfers occur in order for state governments to utilize these funds to receive federal matching funds. Thus, not only do gross DSH payments overstate how much county-owned hospitals have available to cover their financial obligations, they may also overstate the hospital's financial condition. Using detailed California Office of Statewide Health Planning and Development (OSHPD) financial data, this study demonstrates how hospital revenue, profit, and credit measures are overvalued because they do not include the outflow of DSH funds through the intergovernmental transfers (IGTs).

An organizational metamodel for hospital emergency departments.

PubMed

Kaptan, Kubilay

2014-10-01

I introduce an organizational model describing the response of the hospital emergency department. The hybrid simulation/analytical model (called a "metamodel") can estimate a hospital's capacity and dynamic response in real time and incorporate the influence of damage to structural and nonstructural components on the organizational ones. The waiting time is the main parameter of response and is used to evaluate the disaster resilience of health care facilities. Waiting time behavior is described by using a double exponential function and its parameters are calibrated based on simulated data. The metamodel covers a large range of hospital configurations and takes into account hospital resources in terms of staff and infrastructures, operational efficiency, and the possible existence of an emergency plan; maximum capacity; and behavior both in saturated and overcapacitated conditions. The sensitivity of the model to different arrival rates, hospital configurations, and capacities and the technical and organizational policies applied during and before a disaster were investigated. This model becomes an important tool in the decision process either for the engineering profession or for policy makers.

[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.

Hatch cover

NASA Technical Reports Server (NTRS)

Allton, Charles S. (Inventor); Okane, James H. (Inventor)

1989-01-01

This invention relates to a hatch and more particularly to a hatch for a space vehicle where the hatch has a low volume sweep and can be easily manipulated from either side of the hatch. The hatch system includes an elliptical opening in a bulkhead and an elliptical hatch member. The hatch cover system includes an elliptical port opening in a housing and an elliptical cover member supported centrally by a rotational bearing for rotation about a rotational axis normal to the cover member and by pivot pins in a gimbal member for pivotal movement about axes perpendicular to the rotational axis. Arm members support the gimbal member pivotally by pivot members so that upon rotation and manipulation the cover member can be articulatedly moved from a closed position to the port opening to an out of the way position with a minimum of volume sweep by the cover member.

Estimating Cloud Cover

ERIC Educational Resources Information Center

Moseley, Christine

2007-01-01

The purpose of this activity was to help students understand the percentage of cloud cover and make more accurate cloud cover observations. Students estimated the percentage of cloud cover represented by simulated clouds and assigned a cloud cover classification to those simulations. (Contains 2 notes and 3 tables.)

Hospital quality measures: are process indicators associated with hospital standardized mortality ratios in French acute care hospitals?

PubMed

Ngantcha, Marcus; Le-Pogam, Marie-Annick; Calmus, Sophie; Grenier, Catherine; Evrard, Isabelle; Lamarche-Vadel, Agathe; Rey, Grégoire

2017-08-22

Results of associations between process and mortality indicators, both used for the external assessment of hospital care quality or public reporting, differ strongly across studies. However, most of those studies were conducted in North America or United Kingdom. Providing new evidence based on French data could fuel the international debate on quality of care indicators and help inform French policy-makers. The objective of our study was to explore whether optimal care delivery in French hospitals as assessed by their Hospital Process Indicators (HPIs) is associated with low Hospital Standardized Mortality Ratios (HSMRs). The French National Authority for Health (HAS) routinely collects for each hospital located in France, a set of mandatory HPIs. Five HPIs were selected among the process indicators collected by the HAS in 2009. They were measured using random samples of 60 to 80 medical records from inpatients admitted between January 1st, 2009 and December 31, 2009 in respect with some selection criteria. HSMRs were estimated at 30, 60 and 90 days post-admission (dpa) using administrative health data extracted from the national health insurance information system (SNIIR-AM) which covers 77% of the French population. Associations between HPIs and HSMRs were assessed by Poisson regression models corrected for measurement errors with a simulation-extrapolation (SIMEX) method. Most associations studied were not statistically significant. Only two process indicators were found associated with HSMRs. Completeness and quality of anesthetic records was negatively associated with 30 dpa HSMR (0.72 [0.52-0.99]). Early detection of nutritional disorders was negatively associated with all HSMRs: 30 dpa HSMR (0.71 [0.54-0.95]), 60 dpa HSMR (0.51 [0.39-0.67]) and 90 dpa HSMR (0.52 [0.40-0.68]). In absence of gold standard of quality of care measurement, the limited number of associations suggested to drive in-depth improvements in order to better determine associations

[Clinical cost analysis of balloon kyphoplasty--is there a possibility of cost-covering treatment?].

PubMed

Chmielnicki, M; McDougall, A M; Prokop, A

2014-06-01

Financial pressure on hospitals has been a major issue in the health care system of the past years and the financial situation is often what decides about the future of the hospitals. Therefore today the economic feasibility of patient treatment in hospitals is more important than ever before. After the degradation of the case-based lump sum of I09D to I09F on a one and two level kyphoplasty we took that as motivation to do a cost analysis on 10 randomised cases. The average age of the patients was 75 years (m : f = 2 : 8), the average stay in hospital was 8 days (3-12 d). The analysis was done by a searching of documents in cooperation with the firm GFG-Beratungsgesellschaft mbH (Mönchengladbach, Germany). We found that the average overall cost which includes the cost of hospital stay and the expenditure on material was 7512.53 € and the average earnings of the cases was 7610,97 €, the difference and in that way the proceeds was 98.44 €. On that result performance of a one-level kyphoplasty especially after the degradation of the case-based lump sum in 2013 is possible in a cost-covering way, an increase in profit may be possible by a decrement of hospital stay. In 2014 one- and two-stage kyphoplasty once underwent a reduction of G-DRG from I09F to I09E. At the same time the cost weight of lump compensation I09E was increased by 0.071 with the result that in 2014, with an increased federal base value of 3156.82 € (in 2013 the federal base rate value was 3068.37 €), additional proceeds of 404,92 € can be realised in the field of one- and two-stage kyphoplasty compared to in 2013. On that result a one-level kyphoplasty especially after the degradation of the case-based lump sum in 2013 and in 2014 is possible in a cost-covering manner, an increase in profit may be possible by a decrement of hospital stay. Georg Thieme Verlag KG Stuttgart · New York.

42 CFR 102.50 - Medical records necessary to establish that a covered injury was sustained.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Medical records necessary to establish that a... Eligible § 102.50 Medical records necessary to establish that a covered injury was sustained. (a) In order... requester must submit the following medical records: (1) All physician, clinic, or hospital outpatient...

Cover/Frequency (CF)

Treesearch

John F. Caratti

2006-01-01

The FIREMON Cover/Frequency (CF) method is used to assess changes in plant species cover and frequency for a macroplot. This method uses multiple quadrats to sample within-plot variation and quantify statistically valid changes in plant species cover, height, and frequency over time. Because it is difficult to estimate cover in quadrats for larger plants, this method...

The effect of North Carolina hospital payor mix on dental-related pediatric emergency room utilization.

PubMed

Hom, Jacqueline M; Burgette, Lane F; Lee, Jessica Y

2013-01-01

We examined the effect of hospital payor mix on the proportion of pediatric emergency department (ED) visits that were dental related. We used the North Carolina (NC) Emergency Room Discharge Database from 2007 to 2009 to estimate the relationship between the percent of pediatric ED patients that were covered by Medicaid and the percent of pediatric ED visits that were dental related. Hospital-level fixed effects controlled for unobserved hospital-level characteristics. Discharge claims from 110 ED facilities in NC were analyzed over the 3-year study period. Claims were limited to individuals under 18 years old with dental disease-related International Classification of Diseases, Ninth Edition, Clinical Modification diagnostic codes, 520.00-530.00. Using 327 hospital-years of data, 62 percent of ED visits for pediatric dental reasons were covered by Medicaid, a proportion over two times greater than for pediatric reasons overall, 26 percent. Hospitals with a greater proportion of Medicaid payors had a greater proportion of pediatric dental ED visits (P < 0.01). Hospitals serving a large population of children on Medicaid should be prepared to provide emergency dental services. Public health administrators should prioritize oral health resources at hospital communities with a high proportion of Medicaid payors. © 2013 American Association of Public Health Dentistry.

Cancer patient experience, hospital performance and case mix: evidence from England.

PubMed

Abel, Gary A; Saunders, Catherine L; Lyratzopoulos, Georgios

2014-01-01

  This study aims to explore differences between crude and case mix-adjusted estimates of hospital performance with respect to the experience of cancer patients. This study analyzed the English 2011/2012 Cancer Patient Experience Survey covering all English National Health Service hospitals providing cancer treatment (n = 160). Logistic regression analysis was used to predict hospital performance for each of the 64 evaluative questions, adjusting for age, gender, ethnic group and cancer diagnosis. The degree of reclassification was explored across three categories (bottom 20%, middle 60% and top 20% of hospitals). There was high concordance between crude and adjusted ranks of hospitals (median Kendall's τ = 0.84; interquartile range: 0.82-0.88). Across all questions, a median of 5.0% (eight) of hospitals (interquartile range: 3.8-6.4%; six to ten hospitals) moved out of the extreme performance categories after case mix adjustment. In this context, patient case mix has only a small impact on measured hospital performance for cancer patient experience.

ENVIRONMENTAL AUDITING: Environmental Auditing in Hospitals: First Results in a University Hospital.

PubMed

Dettenkofer; Kuemmerer; Schuster; Mueller; Muehlich; S; Daschner

2000-01-01

/ While medical audit in infection control today is one important element in the quality assurance of health care, environmental auditing, approved in 1993 by the Council of the European Communities for the industrial sector, so far has not been used as a tool to control and reduce environmental pollution caused by medical care. The aim of this study was to investigate whether environmental auditing according to the European Eco-Management and Audit Scheme (EMAS) can be implemented in hospitals as a process of improvement in protection of the environment. In a prior publication the methodological issues and the organizational steps that had to be taken were described. An environmental review of the activities of the Freiburg University Hospital and an ecoanalysis of the input and output were performed. The results of this analysis, published in an environmental report, provide a fundamental data set for the consumption of energy, water, materials, and the burdens of major pollutants and waste. Regarding the organizational structure of the hospital, the first steps towards an integrating environmental management system as demanded by EMAS could be taken. Beside supporting advantages, e.g., improvement of environmental safety, public image and staff contentment, and potential economic benefits such as less cost to be paid for energy and water consumption, there are important restrictions of environmental auditing in hospitals. Examples are the lack of basic environmental data, staff motivation (especially of physicians), cooperation of the organizational substructures, and funds for prefinancing urgently needed improvements in ecology. Based on the study findings, a textbook on environmental auditing in hospitals, including checklists covering all important environmental objectives, has been published to support hospitals in their efforts to achieve an optimized and sustainable practice of providing health care.

Evapotranspiration (ET) covers.

PubMed

Rock, Steve; Myers, Bill; Fiedler, Linda

2012-01-01

Evapotranspiration (ET) cover systems are increasingly being used at municipal solid waste (MSW) landfills, hazardous waste landfills, at industrial monofills, and at mine sites. Conventional cover systems use materials with low hydraulic permeability (barrier layers) to minimize the downward migration of water from the surface to the waste (percolation), ET cover systems use water balance components to minimize percolation. These cover systems rely on soil to capture and store precipitation until it is either transpired through vegetation or evaporated from the soil surface. Compared to conventional membrane or compacted clay cover systems, ET cover systems are expected to cost less to construct. They are often aesthetic because they employ naturalized vegetation, require less maintenance once the vegetative system is established, including eliminating mowing, and may require fewer repairs than a barrier system. All cover systems should consider the goals of the cover in terms of protectiveness, including the pathways of risk from contained material, the lifecycle of the containment system. The containment system needs to be protective of direct contact of people and animals with the waste, prevent surface and groundwater water pollution, and minimize release of airborne contaminants. While most containment strategies have been based on the dry tomb strategy of keeping waste dry, there are some sites where adding or allowing moisture to help decompose organic waste is the current plan. ET covers may work well in places where complete exclusion of precipitation is not needed. The U.S. EPA Alternative Cover Assessment Program (ACAP), USDOE, the Nuclear Regulatory Commission, and others have researched ET cover design and efficacy, including the history of their use, general considerations in their design, performance, monitoring, cost, current status, limitations on their use, and project specific examples. An on-line database has been developed with information

Severe and fatal complications after diagnostic and therapeutic ERCP: a prospective series of claims to insurance covering public hospitals.

PubMed

Trap, R; Adamsen, S; Hart-Hansen, O; Henriksen, M

1999-02-01

Increasing numbers of patients are undergoing endoscopic retrograde cholangiopancreatography (ERCP) prior to laparoscopic cholecystectomy, and more departments and doctors are performing ERCP, while new data from large prospective series have documented the risks of both diagnostic and therapeutic ERCP. The establishment in Denmark of a Patient Insurance Association, which has covered injury caused during investigation and treatment in public hospitals since July 1992, has made it possible to collect and analyze a large prospective series of ERCP complications for which compensation has been claimed. Thirty-nine consecutive claims for compensation due to complications after ERCP occurring between 1 July 1992 and 31 December 1996 were investigated. Case notes were reviewed, along with laboratory reports and radiographs. The complications were classified according to the international consensus. Claims for compensation were made in 39 cases from 25 hospitals. The indication for ERCP was appropriate in 31. Precut papillotomy for access had been performed in seven. The severity of the complications was mild in one patient, moderate in three patients, severe in 24, and fatal in nine; in two cases, the severity was not classifiable. The complications were: pancreatitis in 23 patients (seven cases fatal, one of which had involved a precut procedure), bleeding in two, perforation in nine (six had a precut procedure, one died), and other reasons in five (including one fatal case). Among the nine fatal cases, cannulation had not been achieved in two and the endoscopic retrograde cholangiogram was normal in four, one of whom underwent a sphincterotomy. One patient with a previous adenoma had an endoprosthesis removed, developed gangrenous cholecystitis afterward, and died. Thirty patients were eligible for compensation. The rejected cases included mild and moderate pancreatitis, a case of fatal hemorrhagic pancreatitis in which the patient had refused blood transfusion, and

Hospital solid waste management practices in Limpopo Province, South Africa: A case study of two hospitals

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nemathaga, Felicia; Maringa, Sally; Chimuka, Luke

2008-07-01

The shortcomings in the management practices of hospital solid waste in Limpopo Province of South Africa were studied by looking at two hospitals as case studies. Apart from field surveys, the generated hospital waste was weighed to compute the generation rates and was followed through various management practices to the final disposal. The findings revealed a major policy implementation gap between the national government and the hospitals. While modern practices such as landfill and incineration are used, their daily operations were not carried according to minimum standards. Incinerator ash is openly dumped and wastes are burned on landfills instead ofmore » being covered with soil. The incinerators used are also not environmentally friendly as they use old technology. The findings further revealed that there is no proper separation of wastes according to their classification as demanded by the national government. The mean percentage composition of the waste was found in the following decreasing order: general waste (60.74%) > medical waste (30.32%) > sharps (8.94%). The mean generation rates were found to be 0.60 kg per patient per day.« less

Exploring the networking behaviors of hospital organizations.

PubMed

Di Vincenzo, Fausto

2018-05-08

Despite an extensive body of knowledge exists on network outcomes and on how hospital network structures may contribute to the creation of outcomes at different levels of analysis, less attention has been paid to understanding how and why hospital organizational networks evolve and change. The aim of this paper is to study the dynamics of networking behaviors of hospital organizations. Stochastic actor-based model for network dynamics was used to quantitatively examine data covering six-years of patient transfer relations among 35 hospital organizations. Specifically, the study investigated about determinants of patient transfer evolution modeling partner selection choice as a combination of multiple organizational attributes and endogenous network-based processes. The results indicate that having overlapping specialties and treating patients with the same case-mix decrease the likelihood of observing network ties between hospitals. Also, results revealed as geographical proximity and membership of the same LHA have a positive impact on the networking behavior of hospitals organizations, there is a propensity in the network to choose larger hospitals as partners, and to transfer patients between hospitals facing similar levels of operational uncertainty. Organizational attributes (overlapping specialties and case-mix), institutional factors (LHA), and geographical proximity matter in the formation and shaping of hospital networks over time. Managers can benefit from the use of these findings by clearly identifying the role and strategic positioning of their hospital with respect to the entire network. Social network analysis can yield novel information and also aid policy makers in the formation of interventions, encouraging alliances among providers as well as planning health system restructuring.

[Suggestions for buying medical equipment in hospitals].

PubMed

Trontzos, Christos

2004-01-01

TO THE EDITOR: Both in Greece and in other European countries there are plans to buy more medical equipment. If the whole procedure is not effective, it may result to a large deficit in the hospital budget. The total hospital deficit now in Greece is about 2.5 billion euros. It is suggested that in every hospital, the Authorized Committee for Medical Equipment Purchasing, should include the following: One Director of a Medical Department related to the equipment to be bought and another Director of a Medical Department, unrelated. One accountant. One legal advisor specialized in hospital affairs. One economical advisor specialized in banking who will be able to suggest leasing or other means of financing the purchase of the relevant equipment. A cost accounting analysis described by a detailed report, should be provided to secure that the equipment to be bought should be cost-effective and leaving a reasonable surplus after not more than 10 years from the time it is installed. Finally, the possibility of using one expensive equipment to cover the needs of more than one hospitals either by moving the equipment (i.e. the PET/CT camera by a large vehicle) or by transferring the patients to a central hospital, may be provided by the above Authorized Committee.

Recycling steel. Conducting a waste audit.

PubMed

Crawford, G

1996-01-01

This is the second in a series of three articles regarding steel can recycling from foodservice operations of healthcare facilities. This article highlights the basic methods of recycling steel cans, and includes information on conducting a waste audit and negotiating with a hauler regarding the benefits of recycling. The previous article discussed how steel is recycled across the country. The next article will convey a case history of actual foodservice recycling practice from a healthcare facility.

Steel can recycling: how to cut costs and support the environment.

PubMed

Crawford, G

1995-01-01

This is the first in a series of three articles regarding steel can recycling from foodservice operations of healthcare facilities. This article highlights the benefits of recycling and how steel is recycled across the country; the second will focus on the basic methods of recycling steel cans, and will include information on conducting a waste audit and negotiating with a hauler; the final article will convey a case history of actual foodservice recycling practice from a healthcare facility.

Multiple layer insulation cover

DOEpatents

Farrell, James J.; Donohoe, Anthony J.

1981-11-03

A multiple layer insulation cover for preventing heat loss in, for example, a greenhouse, is disclosed. The cover is comprised of spaced layers of thin foil covered fabric separated from each other by air spaces. The spacing is accomplished by the inflation of spaced air bladders which are integrally formed in the cover and to which the layers of the cover are secured. The bladders are inflated after the cover has been deployed in its intended use to separate the layers of the foil material. The sizes of the material layers are selected to compensate for sagging across the width of the cover so that the desired spacing is uniformly maintained when the cover has been deployed. The bladders are deflated as the cover is stored thereby expediting the storage process and reducing the amount of storage space required.

Healthy Eating Exploratory Program for the Elderly: Low Salt Intake in Congregate Meal Service.

PubMed

Seo, S; Kim, O Y; Ahn, J

2016-03-01

This study reported on an exploratory program to help the low income elderly improve healthy eating behavior, specifically by reducing salt intake. We conducted an exploratory program for 4 weeks for this study. The exploratory program involved offering menus with reduced salt and providing education on healthy eating. After the exploratory program, a survey of the elderly and in-depth interviews allowed us to evaluate the program for foodservice providers (dietitian, social workers, and volunteer workers). This study included both foodservice workers and elderly who actually used the foodservice in a congregate meal service system. This is a unique approach. A congregate meal service center in Seoul, Korea. Seventy four elderly in a congregate meal service center. Demographics were collected, and the healthy eating program and healthy eating education for elderly respondents were evaluated. The elderly showed high satisfaction with the exploratory program for healthy eating. We found no significant differences in satisfaction with the program between the elderly who attended education sessions and those who did not, but more of the elderly from the education sessions showed positive behavioral change intentions. The exploratory program influenced to reduce the salt intake of the elderly in congregate meal service. This study suggests cooperation of foodservice providers and the support of administrators is critical to the success of such programs.

Physician practice management companies: implications for hospital-based integrated delivery systems.

PubMed

Burns, L R; Robinson, J C

1997-01-01

Physician practice management companies (PPMCs) are one of the most visible entrants into the industry of managing physician practices, and anywhere from 100-150 are already in operation. Although PPMCs and hospital-based integrated delivery systems (IDSs) differ from each other in many ways, they share a number of common features, including the pursuit of capitation contracts from payors. As a result, PPMCs pose a growing, direct threat to hospital systems in competing for managed care contracts that cover physician service. PPMCs also provide an alternative to hospital-based IDSs at the local market level for physician group consolidation. This article looks at the structure, operation, and strategy of PPMCs and examines what implications their growth will have for hospital-based IDSs.

Making Safe Surgery Affordable: Design of a Surgical Drill Cover System for Scale.

PubMed

Buchan, Lawrence L; Black, Marianne S; Cancilla, Michael A; Huisman, Elise S; Kooyman, Jeremy J R; Nelson, Scott C; OʼHara, Nathan N; OʼBrien, Peter J; Blachut, Piotr A

2015-10-01

Many surgeons in low-resource settings do not have access to safe, affordable, or reliable surgical drilling tools. Surgeons often resort to nonsterile hardware drills because they are affordable, robust, and efficient, but they are impossible to sterilize using steam. A promising alternative is to use a Drill Cover system (a sterilizable fabric bag plus surgical chuck adapter) so that a nonsterile hardware drill can be used safely for surgical bone drilling. Our objective was to design a safe, effective, affordable Drill Cover system for scale in low-resource settings. We designed our device based on feedback from users at Mulago Hospital (Kampala, Uganda) and focused on 3 main aspects. First, the design included a sealed barrier between the surgical field and hardware drill that withstands pressurized fluid. Second, the selected hardware drill had a maximum speed of 1050 rpm to match common surgical drills and reduce risk of necrosis. Third, the fabric cover was optimized for ease of assembly while maintaining a sterile technique. Furthermore, with the Drill Cover approach, multiple Drill Covers can be provided with a single battery-powered drill in a "kit," so that the drill can be used in back-to-back surgeries without requiring immediate sterilization. The Drill Cover design presented here provides a proof-of-concept for a product that can be commercialized, produced at scale, and used in low-resource settings globally to improve access to safe surgery.

Outreach: the western New York Hospital Library Services Program, 1985-1989.

PubMed Central

Birkinbine, L A; Bertuca, C A

1991-01-01

The Hospital Library Services Program (HLSP) in western New York, during the period covered by its first five-year plan, 1984-1989, is recounted and described. This ongoing program is funded annually by a New York State grant and hospital participation fees. It is designed to support access to biomedical information for health care professionals through a grant program for hospitals with staffed libraries and a circuit program for hospitals without library staffing or without libraries. Hospitals participating in the grant program contribute funds and receive grants for collection development. Hospitals participating in the circuit program pay a participation fee and receive regularly scheduled, documented, circuit librarian visits; a collection development grant; and a grant for contract library services. The program contracts with the State University of New York at Buffalo's (UB) Health Sciences Library to provide computerized literature searches; interlibrary loan (ILL) of journal articles, books, and audiovisuals; and ILL referrals. PMID:1958912

A study of hospital and medical libraries in Riyadh, Kingdom of Saudi Arabia.

PubMed Central

al-Ogla, S

1998-01-01

The study reported examined the status of hospital libraries, their sponsoring organizations, their staff, the academic qualifications of the head of the library, collection size, available space, buildings, and services. The study was limited to the hospitals with libraries for staff in Riyadh, the capital of Saudi Arabia. The data were collected through questionnaires sent to a sample of fifteen hospitals with medical libraries. Twelve libraries responded. This is the first study of its kind in Saudi Arabia, and it is hoped that similar surveys will be done covering the whole kingdom. PMID:9549013

Mekong Land Cover Dasboard: Regional Land Cover Mointoring Systems

NASA Astrophysics Data System (ADS)

Saah, D. S.; Towashiraporn, P.; Aekakkararungroj, A.; Phongsapan, K.; Triepke, J.; Maus, P.; Tenneson, K.; Cutter, P. G.; Ganz, D.; Anderson, E.

2016-12-01

SERVIR-Mekong, a USAID-NASA partnership, helps decision makers in the Lower Mekong Region utilize GIS and Remote Sensing information to inform climate related activities. In 2015, SERVIR-Mekong conducted a geospatial needs assessment for the Lower Mekong countries which included individual country consultations. The team found that many countries were dependent on land cover and land use maps for land resource planning, quantifying ecosystem services, including resilience to climate change, biodiversity conservation, and other critical social issues. Many of the Lower Mekong countries have developed national scale land cover maps derived in part from remote sensing products and geospatial technologies. However, updates are infrequent and classification systems do not always meet the needs of key user groups. In addition, data products stop at political boundaries and are often not accessible making the data unusable across country boundaries and with resource management partners. Many of these countries rely on global land cover products to fill the gaps of their national efforts, compromising consistency between data and policies. These gaps in national efforts can be filled by a flexible regional land cover monitoring system that is co-developed by regional partners with the specific intention of meeting national transboundary needs, for example including consistent forest definitions in transboundary watersheds. Based on these facts, key regional stakeholders identified a need for a land cover monitoring system that will produce frequent, high quality land cover maps using a consistent regional classification scheme that is compatible with national country needs. SERVIR-Mekong is currently developing a solution that leverages recent developments in remote sensing science and technology, such as Google Earth Engine (GEE), and working together with production partners to develop a system that will use a common set of input data sources to generate high

Hospital utilization by health maintenance organizations. Separating apples from oranges.

PubMed

Mott, P D

1986-05-01

The hospitalization rate of HMOs is reported to be 444 bed days per 1,000 enrollees per year. It is often forgotten that there is also out-of-plan utilization. A review of previous studies and a survey of reporting practices by three HMOs illustrate many problems with HMO utilization data. HMO rates, like those of other insurers, reflect only the hospital admissions that the plans know about and pay for, not the total hospital experience of their enrollees. While only a thorough tracking of subscriber utilization of all insurers and institutions will provide estimates of the magnitude of unreported admissions and their impact on utilization rates, this report enumerates the ways in which patients may receive inpatient care without the HMO having a record of the admissions and/or having to pay for them. It was found that admissions can be unreported when another insurer or institution pays (e.g., Medicare, No Fault, Workmen's Compensation, duplicate coverage, school health and liability insurance or VA, military, municipal, and state hospitals); when the HMO does not cover benefits (e.g., cosmetic and oral surgery, experimental procedures, long-term psychiatric, chronic, or rehabilitation stays); and when HMO coverage is denied for procedural reasons (e.g., catastrophic stays covered by reinsurance, newborns, voluntary "leakage," or improper following of HMO procedures). True HMO rates are unknown but are estimated by some authors to be 7-37% higher than the reported figure, depending on which types of unreported use are estimated. There is a need for future analyses to quantify true hospitalization rates of enrollees of HMOs and other insurers.

Land cover mapping of North and Central America—Global Land Cover 2000

USGS Publications Warehouse

Latifovic, Rasim; Zhu, Zhi-Liang

2004-01-01

The Land Cover Map of North and Central America for the year 2000 (GLC 2000-NCA), prepared by NRCan/CCRS and USGS/EROS Data Centre (EDC) as a regional component of the Global Land Cover 2000 project, is the subject of this paper. A new mapping approach for transforming satellite observations acquired by the SPOT4/VGTETATION (VGT) sensor into land cover information is outlined. The procedure includes: (1) conversion of daily data into 10-day composite; (2) post-seasonal correction and refinement of apparent surface reflectance in 10-day composite images; and (3) extraction of land cover information from the composite images. The pre-processing and mosaicking techniques developed and used in this study proved to be very effective in removing cloud contamination, BRDF effects, and noise in Short Wave Infra-Red (SWIR). The GLC 2000-NCA land cover map is provided as a regional product with 28 land cover classes based on modified Federal Geographic Data Committee/Vegetation Classification Standard (FGDC NVCS) classification system, and as part of a global product with 22 land cover classes based on Land Cover Classification System (LCCS) of the Food and Agriculture Organisation. The map was compared on both areal and per-pixel bases over North and Central America to the International Geosphere–Biosphere Programme (IGBP) global land cover classification, the University of Maryland global land cover classification (UMd) and the Moderate Resolution Imaging Spectroradiometer (MODIS) Global land cover classification produced by Boston University (BU). There was good agreement (79%) on the spatial distribution and areal extent of forest between GLC 2000-NCA and the other maps, however, GLC 2000-NCA provides additional information on the spatial distribution of forest types. The GLC 2000-NCA map was produced at the continental level incorporating specific needs of the region.

IMPLEMENTATION OF HEALTH TECHNOLOGY ASSESSMENT WORK IN A HOSPITAL IN KAZAKHSTAN.

PubMed

Kosherbayeva, Lyazzat; Hailey, David; Kurakbaev, Kural; Tsoy, Aleksey; Zhuzzhanov, Ormanbek; Donbay, Abilay; Kumar, Ainur; Nadyrov, Kamalzhan

2016-01-01

The aim of this study was to implement health technology assessment (HA) in the First General City Hospital in Astana, Kazakhstan. We organized trainings to familiarize hospital staff with the purpose and details of HTA. An HTA committee was established, with representation from hospital physicians and managers, and criteria for prioritization of health technologies determined. Clinical departments of the hospital were asked to prepare applications for new technologies for their services. The HTA committee reviewed five applications and selected a technology from one of these, on single incision laparoscopic surgery (SILS), for assessment. A short HTA report on SILS was prepared, covering its safety, clinical effectiveness, and cost effectiveness. The report was used to support a request to the Department of Health for additional funding to implement this technology within the hospital. This funding was approved and SILS was established in several hospital departments. This successful initial experience with HTA has paved the way for its routine use by the hospital for informing decisions on the procurement and use of new health technologies.

From Hospital to School: How a Transition Liaison Can Help.

ERIC Educational Resources Information Center

Stuart, Judy L.; Goodsitt, Jodi L.

1996-01-01

The role of the transition liaison professional, who is knowledgeable in medical terminology, hospital procedures, and educational/community services for helping children with chronic illnesses, is explained. Discussion covers effects of recent laws, the need for a formal discharge program and planning model, and the many functions of the…

Pastoral care in hospitals: a literature review.

PubMed

Proserpio, Tullio; Piccinelli, Claudia; Clerici, Carlo Alfredo

2011-01-01

This literature review investigates the potential contribution of the pastoral care provided in hospitals by hospital chaplains, as part of an integrated view of patient care, particularly in institutions dealing with severe disease. A search was conducted in the Medline database covering the last 10 years. Ninety-eight articles were considered concerning the modern hospital chaplains' relationships and the principal procedures and practices associated with their roles, i.e., their relations with the scientific world, with other religious figures in the community, with other faiths and religious confessions, with other public health professionals and operators, with colleagues in professional associations and training activities, and with the hospital organization as a whole, as well as their patient assessment activities and the spiritual-religious support they provide, also for the patients' families. Improvements are needed on several fronts to professionalize the pastoral care provided in hospitals and modernize the figure of the hospital chaplain. These improvements include better relations between modern chaplains and the hospital organization and scientific world; more focus on a scientific approach to their activities and on evaluating the efficacy of pastoral care activities; greater clarity in the definition of the goals, methods and procedures; the design of protocols and a stance on important ethical issues; respect for the various faiths, different cultures and both religious and nonreligious or secularized customs; greater involvement in the multidisciplinary patient care teams, of which the hospital chaplains are an integral part; stronger integration with public health operators and cooperation with the psychosocial professions; specific training on pastoral care and professional certification of chaplains; and the development of shared ethical codes for the profession.

Multidecadal Changes in Near-Global Cloud Cover and Estimated Cloud Cover Radiative Forcing

NASA Technical Reports Server (NTRS)

Norris, Joel

2005-01-01

The first paper was Multidecadal changes in near-global cloud cover and estimated cloud cover radiative forcing, by J. R. Norris (2005, J. Geophys. Res. - Atmos., 110, D08206, doi: lO.l029/2004JD005600). This study examined variability in zonal mean surface-observed upper-level (combined midlevel and high-level) and low-level cloud cover over land during 1971-1 996 and over ocean during 1952-1997. These data were averaged from individual synoptic reports in the Extended Edited Cloud Report Archive (EECRA). Although substantial interdecadal variability is present in the time series, long-term decreases in upper-level cloud cover occur over land and ocean at low and middle latitudes in both hemispheres. Near-global upper-level cloud cover declined by 1.5%-sky-cover over land between 1971 and 1996 and by 1.3%-sky-cover over ocean between 1952 and 1997. Consistency between EECRA upper-level cloud cover anomalies and those from the International Satellite Cloud Climatology Project (ISCCP) during 1984-1 997 suggests the surface-observed trends are real. The reduction in surface-observed upper-level cloud cover between the 1980s and 1990s is also consistent with the decadal increase in all-sky outgoing longwave radiation reported by the Earth Radiation Budget Satellite (EMS). Discrepancies occur between time series of EECRA and ISCCP low-level cloud cover due to identified and probable artifacts in satellite and surface cloud data. Radiative effects of surface-observed cloud cover anomalies, called "cloud cover radiative forcing (CCRF) anomalies," are estimated based on a linear relationship to climatological cloud radiative forcing per unit cloud cover. Zonal mean estimated longwave CCRF has decreased over most of the globe. Estimated shortwave CCRF has become slightly stronger over northern midlatitude oceans and slightly weaker over northern midlatitude land areas. A long-term decline in the magnitude of estimated shortwave CCRF occurs over low-latitude land and ocean

Project CHOICE: #62. A Career Unit for Grades 5 and 6. Hospitals. (Health Occupations Career Cluster).

ERIC Educational Resources Information Center

Kern County Superintendent of Schools, Bakersfield, CA.

This teaching unit, Hospitals, is one in a series of curriculum guides developed by Project CHOICE (Children Have Options in Career Education) to provide the classroom teacher with a source of career-related activities linking 5th and 6th grade elementary classroom experiences with the world of work. These eight lessons on hospitals cover the…

Investigating motivating factors for sound hospital waste management.

PubMed

Ali, Mustafa; Wang, Wenping; Chaudhry, Nawaz

2016-08-01

Sustainable management of hospital waste requires an active involvement of all key players. This study aims to test the hypothesis that three motivating factors, namely, Reputation, Liability, and Expense, influence hospital waste management. The survey for this study was conducted in two phases, with the pilot study used for exploratory factor analysis and the subsequent main survey used for cross-validation using confirmatory factor analysis. The hypotheses were validated through one-sample t tests. Correlations were established between the three motivating factors and organizational characteristics of hospital type, location, category, and size. The hypotheses were validated, and it was found that the factors of Liability and Expense varied considerably with respect to location and size of a hospital. The factor of Reputation, however, did not exhibit significant variation. In conclusion, concerns about the reputation of a facility and an apprehension of liability act as incentives for sound hospital waste management, whereas concerns about financial costs and perceived overburden on staff act as disincentives. This paper identifies the non economic motivating factors that can be used to encourage behavioral changes regarding waste management at hospitals in resource constrained environments. This study discovered that organizational characteristics such as hospital size and location cause the responses to vary among the subjects. Hence a policy maker must take into account the institutional setting before introducing a change geared towards better waste management outcomes across hospitals. This study covers a topic that has hitherto been neglected in resource constrained countries. Thus it can be used as one of the first steps to highlight and tackle the issue.

Cover Your Cough

MedlinePlus

... KB] Spanish [153 KB] Cover Your Cough, Flyer & Poster for Health Care Settings Flyer : English Portuguese [268 ... KB] Chinese [246 KB] Cover Your Cough, Flyer & Poster for Community and Public Settings Flyer : English Portuguese [ ...

The Second Lebanon War Experience at Western Galilee Hospital.

PubMed

Lino, Bartholomew; Eisenman, Arie; Schuster, Richard; Giloni, Carlos; Bharoum, Masad; Daniel, Moshe; Dallas, Cham

2016-02-01

The summer of 2006 in northern Israel served as the battleground for the second war against Hezbollah based along Israel's border with southern Lebanon. Western Galilee Hospital (WGH), which is located only 6 miles from the Lebanese border, served as a major medical center in the vicinity of the fighting. The hospital was directly impacted by Hezbollah with a Katyusha rocket, which struck the ophthalmology department on the 4th floor. WGH was able to utilize a 450-bed underground facility that maintained full hospital functionality throughout the conflict. In a major feat of rapid evacuation, the entire hospital population was relocated under the cover of darkness to these bunkers in just over 1 hour, thus emptying the building prior to the missile impact. Over half of the patients presenting during the conflict did not incur physical injury but qualified as acute stress disorder patients. The particulars of this evacuation remain unique owing to the extraordinary circumstances, but many of the principles employed in this maneuver may serve as a template for other hospitals requiring emergency evacuation. Hospital functionality drastically changed to accommodate the operational reality of war, and many of these tactics warrant closer investigation for possible implementation in other conflict zones.

What Medicare Covers

MedlinePlus

... your Medicare coverage — Original Medicare or a Medicare Advantage Plan (Part C). What Part A covers Medicare ... health plans cover Medicare health plans include Medicare Advantage, Medical Savings Account (MSA), Medicare Cost plans, PACE, ...

Dimer covering and percolation frustration.

PubMed

Haji-Akbari, Amir; Haji-Akbari, Nasim; Ziff, Robert M

2015-09-01

Covering a graph or a lattice with nonoverlapping dimers is a problem that has received considerable interest in areas, such as discrete mathematics, statistical physics, chemistry, and materials science. Yet, the problem of percolation on dimer-covered lattices has received little attention. In particular, percolation on lattices that are fully covered by nonoverlapping dimers has not evidently been considered. Here, we propose a procedure for generating random dimer coverings of a given lattice. We then compute the bond percolation threshold on random and ordered coverings of the square and the triangular lattices on the remaining bonds connecting the dimers. We obtain p_{c}=0.367713(2) and p_{c}=0.235340(1) for random coverings of the square and the triangular lattices, respectively. We observe that the percolation frustration induced as a result of dimer covering is larger in the low-coordination-number square lattice. There is also no relationship between the existence of long-range order in a covering of the square lattice and its percolation threshold. In particular, an ordered covering of the square lattice, denoted by shifted covering in this paper, has an unusually low percolation threshold and is topologically identical to the triangular lattice. This is in contrast to the other ordered dimer coverings considered in this paper, which have higher percolation thresholds than the random covering. In the case of the triangular lattice, the percolation thresholds of the ordered and random coverings are very close, suggesting the lack of sensitivity of the percolation threshold to microscopic details of the covering in highly coordinated networks.

Mean species cover: a harmonized indicator of shrub cover for forest inventories

Treesearch

Iciar Alberdi; Sonia Condés; Ronald E. Mcroberts; Susanne Winter

2018-01-01

Because shrub cover is related to many forest ecosystem functions, it is one of the most relevant variables for describing these communities. Nevertheless, a harmonized indicator of shrub cover for large-scale reporting is lacking. The aims of the study were threefold: to define a shrub indicator that can be used by European countries for harmonized shrub cover...

Institutional Conservation Program Evaluation Project: Results of hospital survey pretest

DOE Office of Scientific and Technical Information (OSTI.GOV)

Collins, N.E.; Hatfield, B.K.; Kier, P.H.

As part of a study of energy conservation efforts in schools and hospitals and an evaluation of the Institutional Conservation Program sponsored by the US Department of Energy (DOE), teams from Argonne National Laboratory, Lawrence Berkeley Laboratory, and DOE visited 15 hospitals to pretest a survey instrument (in the form of a 10-page questionnaire and a list of definitions) that will be sent to 1800 hospitals to solicit information on their energy consumption, energy conservation activities, and decision-making processes. The pretest had several purposes, including identification of problems in the survey instrument's format and in the wording of instructions andmore » questions. This report covers all aspects of the pretest. Characteristics of the hospitals and of the interviewees are discussed. Pretest procedures are described and responses to some of the survey questions are provided. Narrative summaries of selected interviews, containing informative anecdotes, are included in an appendix, as are technology transfer ideas and the final version of the survey instrument.« less

42 CFR 413.118 - Payment for facility services related to covered ASC surgical procedures performed in hospitals...

Code of Federal Regulations, 2010 CFR

2010-10-01

... establishes the method for determining Medicare payments for services related to covered ambulatory surgical... deductibles and coinsurance; or (2) The blended payment amount as described in paragraph (d) of this section...) Blended payment amount. (1) For cost reporting periods beginning on or after October 1, 1987 but before...

Public hospital care: equal for all or equal for some? Evidence from the Philippines.

PubMed

James, Chris D; Peabody, John; Hanson, Kara; Solon, Orville

2015-03-01

In low- and middle-income countries, government budgets are rarely sufficient to cover a public hospital's operating costs. Shortfalls are typically financed through a combination of health insurance contributions and user charges. The mixed nature of this financing arrangement potentially creates financial incentives to treat patients with equal health need unequally. Using data from the Philippines, the authors analyzed whether doctors respond to such incentives. After controlling for a patient's condition, they found that patients using insurance, paying more for hospital accommodation, and being treated in externally monitored hospitals were likely to receive more care. This highlights the worrying possibility that public hospital patients with equal health needs are not always equally treated. © 2011 APJPH.

How a new 'public plan' could affect hospitals' finances and private insurance premiums.

PubMed

Dobson, Allen; DaVanzo, Joan E; El-Gamil, Audrey M; Berger, Gregory

2009-01-01

Two key health reform bills in the House of Representatives and Senate include the option of a "public plan" as an additional source of health coverage. At least initially, the plan would primarily be structured to cover many of the uninsured and those who now have individual coverage. Because it is possible, and perhaps even likely, that this new public payer would pay less than private payers for the same services, such a plan could negatively affect hospital margins. Hospitals may attempt to recoup losses by shifting costs to private payers. We outline the financial pressures that hospitals and private payers could experience under various assumptions. High uninsured enrollment in a public plan would bolster hospital margins; however, this effect is reversed if the privately insured enter a public plan in large proportions, potentially stressing the hospital industry and increasing private insurance premiums.

Energy management installation at North Middlesex Hospital.

PubMed

Hart, V A

1986-05-01

The author is the Energy Conservation Officer for the Haringey Health Authority. The North Middlesex Hospital is an acute unit with approximately 700 beds. Currently, twenty-one outstations control the maternity/radio therapy tower complex plus the outpatients' department. Plans have been approved to extend the system and Phase 2 will cover pathology, administration, medical and surgical blocks together with x-ray and casualty blocks. Transmitton Ltd, as in Phase 1, will supply the hardware and contract management.

Cover crops for Alabama

USDA-ARS?s Scientific Manuscript database

Cover crops are grown to benefit the following crop as well as to improve the soil, but they are normally not intended for harvest. Selecting the right cover crops for farming operations can improve yields, soil and water conservation and quality, and economic productivity. Properly managed cover ...

10 CFR 455.142 - Grant awards for schools, hospitals, and coordinating agencies.

Code of Federal Regulations, 2010 CFR

2010-01-01

... measures, including renewable resource measures, for buildings covered by an application approved in... 10 Energy 3 2010-01-01 2010-01-01 false Grant awards for schools, hospitals, and coordinating agencies. 455.142 Section 455.142 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION GRANT PROGRAMS FOR...

Land-cover change detection

USGS Publications Warehouse

Chen, Xuexia; Giri, Chandra; Vogelmann, James

2012-01-01

Land cover is the biophysical material on the surface of the earth. Land-cover types include grass, shrubs, trees, barren, water, and man-made features. Land cover changes continuously.  The rate of change can be either dramatic and abrupt, such as the changes caused by logging, hurricanes and fire, or subtle and gradual, such as regeneration of forests and damage caused by insects (Verbesselt et al., 2001).  Previous studies have shown that land cover has changed dramatically during the past sevearal centuries and that these changes have severely affected our ecosystems (Foody, 2010; Lambin et al., 2001). Lambin and Strahlers (1994b) summarized five types of cause for land-cover changes: (1) long-term natural changes in climate conditions, (2) geomorphological and ecological processes, (3) human-induced alterations of vegetation cover and landscapes, (4) interannual climate variability, and (5) human-induced greenhouse effect.  Tools and techniques are needed to detect, describe, and predict these changes to facilitate sustainable management of natural resources.

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

Establishment of research-oriented hospital: an important way for translational medicine development in China.

PubMed

Li, Meina; Zhang, Lulu

2015-01-01

Globally, one of the major trends is the development of translational medicine. The traditional hospital structure could not meet the demands of translational medicine development any longer and to explore a novel hospital structure is imperative. Following the times, China proposed and implemented a development strategy for a first-class modern research-oriented hospital. To establish a research-oriented hospital has become an important strategy to guide the scientific development of high-quality medical institutions and to advance translational medicine development. To facilitate translational medicine by developing research-oriented hospital, the Chinese Research Hospital Association (CRHA) has been established, which provides service of medicine, talents cultivation, scientific research and clinical teaching and covers areas of theoretical research, academic exchange, translational medicine, talents training and practice guiding. On the whole, research-oriented hospital facilitated translational medicine by developing interdisciplinary platform, training core competencies in clinical and translational research, providing financial support of translational research, and hosting journals on translational medicine, etc.

Choice of reserve capacity by hospitals: a problem for prospective payment.

PubMed

Widmer, Philippe K; Trottmann, Maria; Zweifel, Peter

2018-06-01

This contribution analyzes the impact of prospective payment on hospital decisions with regard to reserve capacity, using Swiss hospital data covering the years 2004-2009. This data set is unique because it permits distinguishing of institutional characteristics (e.g., ownership status) from the mode of payment as determinants of hospital efficiency, due to the fact that some Swiss cantons introduced prospective payment early while others waited for federal legislation to be enacted in 2012. Since a hospital's choice of reserve capacity depends also on the risk preferences of management while affecting the cost function, heterogeneity is predicted even in the presence of identical technology and factor prices. For estimating hospitals' marginal costs, we employ the flexible representation of risk preferences by Pope and Chavas [Am J Agric Econ 76, 196-204 (1994)]. Production uncertainty is measured as the difference between actual admissions and admissions predicted by an autoregressive moving average model. Its effect on hospital cost is analyzed using a multilevel stochastic cost frontier model with random coefficients reflecting unobserved differences in technology. Public hospitals are found to opt for a higher probability of meeting unexpected demand, as predicted. Their operating cost is 1.1% higher than for private hospitals and even 1.9% higher than for teaching hospitals, creating an incentive to turn away patients or to keep them waiting for treatment.

[Yesterdays and happenings at hospitals of Tehuacán, Puebla, México].

PubMed

Fajardo-Ortiz, Guillermo

2004-01-01

The history of the hospital of Tehuacán, the second city importance in Puebla State, began in 1744, when the Hospital de San Juan de Dios (Hospital of St. John) was founded; in 1820, it was converted into the Municipal of Civil Hospital. The medical establishement continues to provide services to the poor to this day annual also covers health public workers of services for the municipality. The Hospital de la Cruz Roja Mexicana (The Mexican Red Cross Hospital) was created in 1934 provide medical services for accident victims: The hospital services of the Mexican Institute of Social Security (IMSS) began in 1953; an earthquake destroyed the building in 1973, and a new hospital was inaugurated in 1979; at present, it readers services to 98,000 persons. The Sanatorio del Sagrado Corazón (Sacred Heart Sanatorium) is a private religious institution founded at the beginning of the second half the 20th century. In 1996, the Hospital General (General Hospital) began to provide services, takes care of the poor of the geographical region, and is financed with federal funds. The Instituto de Seguridad y Servicios Sociales para Trabajadores del Estado (Institute of Securtiy and Social Services for the Workers of the State, ISSSTE) has a small hospital with 10 beds, it was founded in 1995.

Maternal request CS--role of hospital teaching status and for-profit ownership.

PubMed

Xirasagar, Sudha; Lin, Herng-Ching

2007-05-01

To examine whether hospitals' for-profit (FP) ownership and non-teaching status are associated with greater likelihood of maternal request cesarean (CS) relative to public and not-for-profit (NFP) and teaching status, respectively. Retrospective, cross-sectional, population-based study of Taiwan's National Health Insurance claims data, covering all 739,531 vaginal delivery-eligible singleton deliveries during 1997-2000, using multiple logistic regression analyses. Adjusted for maternal age and geographic location, FP district hospitals (almost all non-teaching), followed by ob/gyn clinics were significantly more likely to perform request CS (OR=3.5-2.3) than public and NFP teaching hospitals. Among non-teaching and teaching hospitals, FPs were more likely to perform request CS than public and NFP hospitals (OR=2.3 and 2.5, respectively). Our findings are consistent with greater propensity of physicians in FP institutions to accommodate patient requests involving revenue-maximizing procedures such as request CS. This effect is moderated by teaching hospitals' preference for complicated cases, consistent with their teaching mission and hi-tech infrastructure.

Identifying specific beliefs to target to improve restaurant employees' intentions for performing three important food safety behaviors.

PubMed

Pilling, Valerie K; Brannon, Laura A; Shanklin, Carol W; Howells, Amber D; Roberts, Kevin R

2008-06-01

Current national food safety training programs appear ineffective at improving food safety practices in foodservice operations, given the substantial number of Americans affected by foodborne illnesses after eating in restaurants each year. The Theory of Planned Behavior (TpB) was used to identify important beliefs that may be targeted to improve foodservice employees' intentions for three food safety behaviors that have the most substantial affect on public health: hand washing, using thermometers, and proper handling of food contact surfaces. In a cross-sectional design, foodservice employees (n=190) across three midwestern states completed a survey assessing TpB components and knowledge for the three food safety behaviors. Multiple regression analyses were performed on the TpB components for each behavior. Independent-samples t tests identified TpB beliefs that discriminated between participants who absolutely intend to perform the behaviors and those with lower intention. Employees' attitudes were the one consistent predictor of intentions for performing all three behaviors. However, a unique combination of important predictors existed for each separate behavior. Interventions for improving employees' behavioral intentions for food safety should focus on TpB components that predict intentions for each behavior and should bring all employees' beliefs in line with those of the employees who already intend to perform the food safety behaviors. Registered dietitians; dietetic technicians, registered; and foodservice managers can use these results to enhance training sessions and motivational programs to improve employees' food safety behaviors. Results also assist these professionals in recognizing their responsibility for enforcing and providing adequate resources for proper food safety behaviors.

Thematic accuracy of the National Land Cover Database (NLCD) 2001 land cover for Alaska

USGS Publications Warehouse

Selkowitz, D.J.; Stehman, S.V.

2011-01-01

The National Land Cover Database (NLCD) 2001 Alaska land cover classification is the first 30-m resolution land cover product available covering the entire state of Alaska. The accuracy assessment of the NLCD 2001 Alaska land cover classification employed a geographically stratified three-stage sampling design to select the reference sample of pixels. Reference land cover class labels were determined via fixed wing aircraft, as the high resolution imagery used for determining the reference land cover classification in the conterminous U.S. was not available for most of Alaska. Overall thematic accuracy for the Alaska NLCD was 76.2% (s.e. 2.8%) at Level II (12 classes evaluated) and 83.9% (s.e. 2.1%) at Level I (6 classes evaluated) when agreement was defined as a match between the map class and either the primary or alternate reference class label. When agreement was defined as a match between the map class and primary reference label only, overall accuracy was 59.4% at Level II and 69.3% at Level I. The majority of classification errors occurred at Level I of the classification hierarchy (i.e., misclassifications were generally to a different Level I class, not to a Level II class within the same Level I class). Classification accuracy was higher for more abundant land cover classes and for pixels located in the interior of homogeneous land cover patches. ?? 2011.

An educational conference in a general hospital.

PubMed

Caldwell, Gordon

2011-12-01

Western Sussex Hospitals National Health Service (NHS) Trust comprises the District General Hospitals of Worthing and Chichester. Both hospitals have successful postgraduate medical education centres, providing training for junior doctors and continuing professional development for senior doctors. Until now, there have been limited multi-professional teaching and learning activities available. The two hospitals have recently merged. The education executive felt that workplace learning had become undervalued since the implementation of Modernising Medical Careers in the UK. The executive wanted to provide a multi-professional conference on Workplace Learning, both to support the merger and to promote the value of workplace and multi-professional learning. The conference topic covering the 'how' of workplace learning was innovative. Many educational conferences concentrate on the organisation and evaluation of classroom learning, rather than on how learning can be facilitated in the workplace during ordinary working practice. It was also innovative to ensure that the presenters were representative of the multi-professional workforce. The presentations were limited to 8 minutes each to promote high-impact short presentations. The talks were recorded for publishing on the trust's intranet and the internet. A committed team in a district general hospital can provide a high-quality educational conference with wide appeal. Local health care professionals can produce short high-impact presentations. The use of modern information technology and audio-visual systems can make the presentations available to both local and worldwide audiences. © Blackwell Publishing Ltd 2011.

Effective Application of a Quality System in the Donation Process at Hospital Level.

PubMed

Trujnara, M; Czerwiński, J; Osadzińska, J

2016-06-01

This article describes the application of a quality system at the hospital level at the Multidisciplinary Hospital in Warsaw-Międzylesie in Poland. A quality system of hospital procedures (in accordance with the ISO system 9001:2008) regarding the donation process, from the identification of a possible donor to the retrieval of organs, was applied there in 2014. Seven independent documents about hospital procedures, were designed to cover the entire process of donation. The number of donors identified increased after the application of the quality system. The reason for this increase is, above all, the cooperation of the well-trained team of specialists who have been engaged in the process of donation for many years, but formal procedures certainly organize the process and make it easier. Copyright © 2016. Published by Elsevier Inc.

Hatch Cover Slides Through Hatch

NASA Technical Reports Server (NTRS)

Alton, Charles; Okane, James H.

1989-01-01

Hatch cover for pressurized vessel provides tight seal but opened quickly from either side. In opening or closing, cover sweeps out relatively little volume within vessel, so it does not hinder movement of people or objects from vessel to outside or placement of people or objects near hatch. Cover uses internal pressure to create seal when closed. Design of cover eliminates leakage paths, and cover immune to hazards of sudden decompression or jamming when bolts and latches fail.

Mortality outcomes in hospitals with public, private not-for-profit and private for-profit ownership in Chile 2001-2010.

PubMed

Cid Pedraza, Camilo; Herrera, Cristian A; Prieto Toledo, Lorena; Oyarzún, Felipe

2015-03-01

Public, private not-for-profit (PNFP) and private for-profit (PFP) hospitals may have different behaviour and performance in different indicators such as health outcomes, cost-efficiency and quality. Chile has a mixed healthcare system both in financing and service delivery. The public National Health Fund (Fondo Nacional de Salud) covers 76% of the population-poorer and with higher health risks-whereas private health insurers cover 16% of the population-richer and with lower health risks. The aim of the study was to analyse the in-patient mortality outcomes by hospital ownership in Chile. We use hospital discharge data in Chile for the period 2001-10 with a total of 16,205,314 discharges in 20 public, 6 PNFP and 15 PFP hospitals. We analyse in-patient mortality considering all diagnoses and a subsample considering only myocardial infarction and stroke diagnoses. Using a probit regression, we estimate how hospital ownership explains in-patient mortality controlling for other confounding variables like health and socioeconomic status, and hospital characteristics. The discharge condition was reported as death in 3.5% of the public hospitals' discharges, 1.3% in PNFP and 0.7% in PFP. PNFP and PFP hospitals show a lower risk of in-hospital mortality for all diagnoses, myocardial infarction and stroke in comparison with public hospitals. The question about which type of hospital ownership performs better in Chile remains open. Policy decisions regarding health service provision requires more evidence explaining differences by ownership. Better controls for health risk and hospital characteristics are suggested to address these differences in hospital performance. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2015; all rights reserved.

Retail food reform: How to effectively bridge what we say and what we do in our hospital settings.

PubMed

Dojeiji, Laurie; Taylor, Andra; Boland, Cholly; Brennan, Carolyn; Penney, Randy

2017-03-01

Hospital leaders in Eastern Ontario, Canada, have acknowledged the critical role of food to health and the need for progressive change that goes beyond personal responsibility paradigms. The Healthy Foods in Champlain Hospitals program aims to create supportive, healthy nutrition environments in hospital retail food settings. Twenty independent hospital corporations have collectively initiated a plan to transition cafeteria, vending, franchise, and volunteer operations towards healthier offerings. Hospitals are actively implementing a set of progressively phased, evidence-based nutrition criteria, which cover food and beverage categories, preparation methods, product placement, and provision of nutrition information. Implementation strategies and successes, as well as challenges and limitations, are discussed.

Towards improving hospital performance in Uganda and Zambia: reflections and opportunities for autonomy.

PubMed

Hanson, Kara; Atuyambe, Lynn; Kamwanga, Jolly; McPake, Barbara; Mungule, Oswald; Ssengooba, Freddie

2002-07-01

Hospitals have been relatively neglected although their high resource consumption implies that gains from improving the services they deliver may be substantial. Nevertheless, the challenges posed by hospital reforms are great. Hospital autonomy usually consists of both decentralisation, and a greater measure of exposure to market forces. In Uganda and Zambia, more traditional 'decentralisation' of authority to district level authorities includes district hospitals; and some measure of 'autonomy' (known as 'self-accounting status' in Uganda) has been applied to some or all second and third level referral hospitals. The hospital policies pursued in both countries present opportunities to tackle their hospital sectors. In Zambia, purchasing of services means that new incentives and policy mechanisms can come into play. Little advantage has been taken of these opportunities to date. In Uganda, there is no financial link between districts and higher levels of the system, but decentralisation of control over personnel is more advanced. These two components--the alignment of incentives (to promote access and quality for those intended to be covered by the public budget) and the effective decentralisation of control over key resources--seem to us the key tools to address the stubborn problems of hospitals.

Addressing geographic access barriers to emergency care services: a national ecologic study of hospitals in Brazil.

PubMed

Rocha, Thiago Augusto Hernandes; da Silva, Núbia Cristina; Amaral, Pedro Vasconcelos; Barbosa, Allan Claudius Queiroz; Rocha, João Victor Muniz; Alvares, Viviane; de Almeida, Dante Grapiuna; Thumé, Elaine; Thomaz, Erika Bárbara Abreu Fonseca; de Sousa Queiroz, Rejane Christine; de Souza, Marta Rovery; Lein, Adriana; Lopes, Daniel Paulino; Staton, Catherine A; Vissoci, João Ricardo Nickenig; Facchini, Luiz Augusto

2017-08-22

Unequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges. The present work can be classified as a cross-sectional ecological study. To carry out the present study, data of all 5843 Brazilian hospitals were categorized among high complexity centers and small hospitals. The geographical access barriers were identified through the use of two-step floating catchment area method. Once concluded the previous step an evaluation using the Getis-Ord-Gi method was performed to identify spatial clusters of municipalities with limited access to high complexity centers but well covered by well-equipped small hospitals. The analysis of accessibility index of high complexity centers highlighted large portions of the country with nearly zero hospital beds by inhabitant. In contrast, it was possible observe a group of 1595 municipalities with high accessibility to small hospitals, simultaneously with a low coverage of high complexity centers. Among the 1595 municipalities with good accessibility to small hospitals, 74% (1183) were covered by small hospitals with at least 60% of minimum emergency service requirements. The spatial clusters analysis aggregated 589 municipalities with high values related to minimum emergency service requirements. Small hospitals in these 589 cities could promote the equity in access to emergency services benefiting more than eight million people. There is a spatial disequilibrium within the country with prominent gaps in the health care network for emergency services. Taking this challenge into consideration, small hospitals could be a possible solution and foster equity in access

Silostop Bunker Covers

USDA-ARS?s Scientific Manuscript database

The quality of the seal provided by the plastic cover is a key issue for minimizing losses in bunker and pile silos. Most bunker covers are 6 to 8 mil polyethylene sheets held in place by tires or tire sidewalls. Frequently there are problems with spoilage at the shoulders (i.e., against the walls),...

The effect of coverings, including plastic bags and wraps, on mortality and morbidity in preterm and full-term neonates.

PubMed

Oatley, H K; Blencowe, H; Lawn, J E

2016-05-01

Neonatal hypothermia is an important risk factor for mortality and morbidity, and is common even in temperate climates. We conducted a systematic review to determine whether plastic coverings, used immediately following delivery, were effective in reducing the incidence of mortality, hypothermia and morbidity. A total of 26 studies (2271 preterm and 1003 term neonates) were included. Meta-analyses were conducted as appropriate. Plastic wraps were associated with a reduction in hypothermia in preterm (⩽29 weeks; risk ratio (RR)=0.57; 95% confidence interval (CI) 0.46 to 0.71) and term neonates (RR=0.76; 95% CI 0.60 to 0.96). No significant reduction in neonatal mortality or morbidity was found; however, the studies were underpowered for these outcomes. For neonates, especially preterm, plastic wraps combined with other environmental heat sources are effective in reducing hypothermia during stabilization and transfer within hospital. Further research is needed to quantify the effects on mortality or morbidity, and investigate the use of plastic coverings outside hospital settings or without additional heat sources.

The effect of coverings, including plastic bags and wraps, on mortality and morbidity in preterm and full-term neonates

PubMed Central

Oatley, H K; Blencowe, H; Lawn, J E

2016-01-01

Neonatal hypothermia is an important risk factor for mortality and morbidity, and is common even in temperate climates. We conducted a systematic review to determine whether plastic coverings, used immediately following delivery, were effective in reducing the incidence of mortality, hypothermia and morbidity. A total of 26 studies (2271 preterm and 1003 term neonates) were included. Meta-analyses were conducted as appropriate. Plastic wraps were associated with a reduction in hypothermia in preterm (⩽29 weeks; risk ratio (RR)=0.57; 95% confidence interval (CI) 0.46 to 0.71) and term neonates (RR=0.76; 95% CI 0.60 to 0.96). No significant reduction in neonatal mortality or morbidity was found; however, the studies were underpowered for these outcomes. For neonates, especially preterm, plastic wraps combined with other environmental heat sources are effective in reducing hypothermia during stabilization and transfer within hospital. Further research is needed to quantify the effects on mortality or morbidity, and investigate the use of plastic coverings outside hospital settings or without additional heat sources. PMID:27109095

Evaluation of the validity and reliability of A-scan ultrasound biometry with a single use disposable cover.

PubMed

Cass, K; Thompson, C M; Tromans, C; Wood, I C J

2002-03-01

The UK Medical Devices Agency has suggested that ophthalmic practitioners should, where practicable and not compromising clinical outcome, restrict corneal contact devices to single patient use to minimise a remote theoretical risk of transmission of new variant Creutzfeldt-Jakob disease (vCJD). This study reports on a modified technique of ultrasound A-scan biometry that complies with the MDA recommendations. The right eyes of 37 consecutive hospital patients had a series of biometry readings taken with a Humphrey 820 A-scan instrument with a plane wave transducer use d conventionally and with the addition of a disposable latex cover. Intrasessional repeatability of axial length measurements was similar for conventional readings--mean difference 0.027 mm, 95% confidence intervals (CI) +/- 0.44 mm and those taken with a disposable cover (0.028 mm, CI +/- 0.38). Intersessional repeatability was equivalent with (0.002 mm, CI +.- 0.51) and without a cover (0.03 mm, CI +/- 0.51). Readings with a cover were not significantly different from those without (paired t test; p >0.05), but tended to be greater (mean difference 0.085 mm, CI +/- 0.60). These findings suggest that corneal contact biometry with a disposable cover is a viable and theoretically safer alternative to the conventional technique.

Monthly fractional green vegetation cover associated with land cover classes of the conterminous USA

USGS Publications Warehouse

Gallo, Kevin P.; Tarpley, Dan; Mitchell, Ken; Csiszar, Ivan; Owen, Timothy W.; Reed, Bradley C.

2001-01-01

The land cover classes developed under the coordination of the International Geosphere-Biosphere Programme Data and Information System (IGBP-DIS) have been analyzed for a study area that includes the Conterminous United States and portions of Mexico and Canada. The 1-km resolution data have been analyzed to produce a gridded data set that includes within each 20-km grid cell: 1) the three most dominant land cover classes, 2) the fractional area associated with each of the three dominant classes, and 3) the fractional area covered by water. Additionally, the monthly fraction of green vegetation cover (fgreen) associated with each of the three dominant land cover classes per grid cell was derived from a 5-year climatology of 1-km resolution NOAA-AVHRR data. The variables derived in this study provide a potential improvement over the use of monthly fgreen linked to a single land cover class per model grid cell.

A Simulated Hospital Pharmacy Module Using an Electronic Medical Record in a Pharmaceutical Care Skills Laboratory Course

PubMed Central

DiVall, Margarita V.; Guerra, Christina; Brown, Todd

2013-01-01

Objectives. To implement and evaluate the effects of a simulated hospital pharmacy module using an electronic medical record on student confidence and abilities to perform hospital pharmacist duties. Design. A module was developed that simulated typical hospital pharmacist tasks. Learning activities were modified based upon student feedback and instructor assessment. Assessments. Ninety-seven percent of respondents reported full-time hospital internship experience and 72% had electronic medical record experience prior to completing the module. Mean scores on confidence with performing typical hospital pharmacist tasks significantly increased from the pre-module survey to the post-module survey from 1.5-2.9 (low comfort/confidence) to 2.0-3.4 (moderate comfort/confidence). Course assessments confirmed student achievement of covered competencies. Conclusions. A simulated hospital pharmacy module improved pharmacy students’ hospital practice skills and their perceived comfort and confidence in completing the typical duties of a hospital pharmacist. PMID:23610480

Effectiveness of government strategies for financial protection against costs of hospitalization Care in India.

PubMed

Ranjan, Alok; Dixit, Priyanka; Mukhopadhyay, Indranil; Thiagarajan, Sundararaman

2018-04-16

In the past decade, India has seen the introduction of many 'publicly funded health insurance' schemes (PFHIs) that claim to cover approximately 300 million people and are essentially forms of purchasing care from both public and private providers to reduce out-of-pocket expenditure (OOPE) for hospitalization. Data from a recent government-organized nationwide household survey, The National Sample Survey 71st Round, were used to analyse the effectiveness and equity of tax-funded public health services and PFHIs as distinct but overlapping approaches to financial protection for hospitalization across different socio-economic categories. Cross-tabulation analysis, multivariate logistic regression and propensity score matching were the main analytical methods used. Government hospitals provide access to 45.6% of all hospitalization needs. Although poorer quintiles use public hospitals more often, even in the poorest quintile, as many as 37.2% are utilizing private hospitals. The average OOPE that a household experiences for hospitalization in public hospitals is approximately only one-fifth of the OOPE for hospitalization in the private sector. PFHI schemes cover 12.8% of the population, and coverage is higher in upper quintiles and in urban areas. Hospitalization rates increase with PFHI coverage, and this occurs with both public and private providers. Propensity score matching shows that PFHI contributes to a marginal reduction (1%) in 'catastrophic health expenditure incidence at the 25% threshold' (CHE-25) for the bottom three quintiles. The reported coverage of PFHIs was greater in the upper income quintiles. Utilization of public services was greater in the poorer income quintiles and more marginalized social groups. Periodic surveys are essential to guide policy choices regarding the appropriate mix of strategies for financial protection in pluralistic systems. There is a need for caution regarding any shift in the role of governments from providing services to

Failure to rescue in safety-net hospitals: availability of hospital resources and differences in performance.

PubMed

Wakeam, Elliot; Hevelone, Nathanael D; Maine, Rebecca; Swain, Jabaris; Lipsitz, Stuart A; Finlayson, Samuel R G; Ashley, Stanley W; Weissman, Joel S

2014-03-01

Failure to rescue (FTR), the mortality rate among surgical patients with complications, is an emerging quality indicator. Hospitals with a high safety-net burden, defined as the proportion of patients covered by Medicaid or uninsured, provide a disproportionate share of medical care to vulnerable populations. Given the financial strains on hospitals with a high safety-net burden, availability of clinical resources may have a role in outcome disparities. To assess the association between safety-net burden and FTR and to evaluate the effect of clinical resources on this relationship. A retrospective cohort of 46,519 patients who underwent high-risk inpatient surgery between January 1, 2007, and December 31, 2010, was assembled using the Nationwide Inpatient Sample. Hospitals were divided into the following 3 safety-net categories: high-burden hospitals (HBHs), moderate-burden hospitals (MBHs), and low-burden hospitals (LBHs). Bivariate and multivariate analyses controlling for patient, procedural, and hospital characteristics, as well as clinical resources, were used to evaluate the relationship between safety-net burden and FTR. FTR. Patients in HBHs were younger (mean age, 65.2 vs 68.2 years; P = .001), more likely to be of black race (11.3% vs 4.2%, P < .001), and less likely to undergo an elective procedure (39.3% vs 48.6%, P = .002) compared with patients in LBHs. The HBHs were more likely to be large, major teaching facilities and to have high levels of technology (8.6% vs 4.0%, P = .02), sophisticated internal medicine (7.7% vs 4.3%, P = .10), and high ratios of respiratory therapists to beds (39.7% vs 21.1%, P < .001). However, HBHs had lower proportions of registered nurses (27.9% vs 38.8%, P = .02) and were less likely to have a positron emission tomographic scanner (15.4% vs 22.0%, P = .03) and a fully implemented electronic medical record (12.6% vs 17.8%, P = .03). Multivariate analyses showed that HBHs (adjusted odds ratio, 1.35; 95% CI

Effects of outsourced nursing on quality outcomes in long-term acute-care hospitals.

PubMed

Alvarez, M Raymond; Kerr, Bernard J; Burtner, Joan; Ledlow, Gerald; Fulton, Larry V

2011-03-01

Use of outsourced nurses is often a stop-gap measure for unplanned vacancies in smaller healthcare facilities such as long-term acute-care hospitals (LTACHs). However, the relationship of utilization levels (low, medium, or high percentages) of nonemployees covering staff schedules often is perceived to have negative relationships with quality outcomes. To assess this issue, the authors discuss the outcomes of their national study of LTACH hospitals that indicated no relationship existed between variations in percentage of staffing by contracted nurses and selected outcomes in this post-acute-care setting.

Medicaid claims history of Florida long-term care facility residents hospitalized for pressure ulcers.

PubMed

Baker, J

1996-01-01

The purpose of this study was to identify patterns of admission, discharge, and readmission between hospital and long-term care facility among a group of Florida long-term care facility residents with pressure ulcers whose care was paid for by Medicaid. A patient-specific, longitudinal claims history database was constructed from data provided by the Florida Department of Health and Rehabilitative Services. This database was used to determine and analyze hospital admissions for pressure ulcer care among Medicaid recipients cared for in a long-term care facility. Analysis of the data determined that more than half of the Medicaid-covered long-term care facility residents who formed the target study group (54.57%) had multiple hospital admissions associated with pressure ulcers. Pressure ulcer hospital admissions amounted to a program cost of $9.9 million.

Missed Opportunities for Improving Nutrition Through Institutional Food: The Case for Food Worker Training

PubMed Central

Deutsch, Jonathan; Patinella, Stefania; Freudenberg, Nicholas

2013-01-01

The institutional food sector—including food served in schools, child care settings, hospitals, and senior centers—is a largely untapped resource for public health that may help to arrest increasing rates of obesity and diet-related health problems. To make this case, we estimated the reach of a diverse institutional food sector in 1 large municipality, New York City, in 2012, and explored the potential for improving institutional food by building the skills and nutritional knowledge of foodservice workers through training. Drawing on the research literature and preliminary data collected in New York City, we discuss the dynamics of nutritional decision-making in these settings. Finally, we identify opportunities and challenges associated with training the institutional food workforce to enhance nutrition and health. PMID:23865653

Injectable-antineoplastic-drug practices in Michigan hospitals.

PubMed

Cohen, I A; Newland, S J; Kirking, D M

1987-05-01

Practices related to parenteral (injectable) antineoplastic drugs (PADs) in Michigan hospitals were surveyed. All hospitals in Michigan were surveyed to assess compliance with American Society of Hospital Pharmacists (ASHP) and Occupational Safety and Health Administration (OSHA) recommendations related to PADs. Other PAD-related practice issues not covered within those guidelines were also studied. Surveys were mailed to the pharmacy directors of the state's 192 acute-care hospitals. Included were questions concerning policies and procedures for ordering, storing, preparing, handling, labeling, transporting, administering, and disposing of PADs. Questions concerning staff education, spill cleanup, and personnel issues were also included. A total of 169 questionnaires were returned, yielding a response rate of 88%. Of those respondents, 132 indicated that they prepare PAD doses for inpatients. Adherence rates were high for several of the PAD-preparation recommendations, including handwashing (97%) and gloving (98.5%). Rates for gowning (71.2%), labeling of PAD doses as biohazards (chemical hazards) (73.5%), and use of Class II biological-safety cabinets (71.2%) were less favorable. Practice areas with relatively poor adherence rates included use of plastic-backed absorbent pads under PAD preparation areas (53.8%), storing PADs separately from other drugs (48.5%), informing prospective employees of potential risks of handling PADs (36.4%), availability of spill kits (36.4%), and attaching and priming i.v. tubing before adding PADs to i.v. containers (5.4%). Many pharmacy departments in Michigan hospitals can substantially improve their adherence to ASHP and OSHA recommendations related to PADs.

[Reasons for the construction of Bispebjerg Hospital--a hospital with light, air and freedom of nature].

PubMed

Permin, Henrik; Wagner, Peter

2009-01-01

landscape architect Edvard Glaesel (1858-1915) were entrusted with the task to develop the design of the hospital. Bispebjerg Hospital was built in the years 1907-13 on a piece of land of 21 hectares on a slope facing southeast at Bispebjerg Bakke at the lower end bordering on Lersøen, a lake which eventually was filled and drained. The 6 red 2-story brick pavilions are located around an axis along Bispebjerg hill with southeast facing bedrooms over viewing the lush patient gardens. These sick rooms all had large double windows at the southeast providing excellent daylight. On the walls are washable frescoes with motifs from nature. Pavilion buildings are flanked by two avenues with linden trees on both sides and connected by crossroads between the buildings. Underground tunnels link the buildings. On both sides, the two lower pavilions on the same side of the central avenue staircase are linked together by a long covered bridge leading from the first floor of the first building to the ground flour in the next building because of the terrain slope. This bridge connects the two pavilions with a building with operating theatres so that patients can be transferred indoors between operation theatre and sick room. Surrounding the sick pavilions administrative building, rheumatic outpatient department, laundry, kitchen and engine house are placed. Between the buildings, avenues and crossroads gardens designed with benches, beautiful flowerbeds and bouquets were established to the leisure of the patients. The hospital offers a wealth ot fine architectural designs and presents itself as a kind of garden village within the city.

Assessing and comparing information security in swiss hospitals.

PubMed

Landolt, Sarah; Hirschel, Jürg; Schlienger, Thomas; Businger, Walter; Zbinden, Alex M

2012-11-07

Availability of information in hospitals is an important prerequisite for good service. Significant resources have been invested to improve the availability of information, but it is also vital that the security of this information can be guaranteed. The goal of this study was to assess information security in hospitals through a questionnaire based on the International Organization for Standardization (ISO) and the International Electrotechnical Commission (IEC) standard ISO/IEC 27002, evaluating Information technology - Security techniques - Code of practice for information-security management, with a special focus on the effect of the hospitals' size and type. The survey, set up as a cross-sectional study, was conducted in January 2011. The chief information officers (CIOs) of 112 hospitals in German-speaking Switzerland were invited to participate. The online questionnaire was designed to be fast and easy to complete to maximize participation. To group the analyzed controls of the ISO/IEC standard 27002 in a meaningful way, a factor analysis was performed. A linear score from 0 (not implemented) to 3 (fully implemented) was introduced. The scores of the hospitals were then analyzed for significant differences in any of the factors with respect to size and type of hospital. The participating hospitals were offered a benchmark report about their status. The 51 participating hospitals had an average score of 51.1% (range 30.6% - 81.9%) out of a possible 100% where all items in the questionnaire were fully implemented. Room for improvement could be identified, especially for the factors covering "process and quality management" (average score 1.3 ± 0.8 out of a maximum of 3) and "organization and risk management" (average score 1.3 ± 0.7 out of a maximum of 3). Private hospitals scored significantly higher than university hospitals in the implementation of "security zones" and "backup" (P = .008). Half (50.00%, 8588/17,177) of all assessed hospital beds

Trends of adverse drug reactions related-hospitalizations in Spain (2001-2006)

PubMed Central

2010-01-01

Background Adverse drug reactions (ADR) are a substantial cause of hospital admissions. We conducted a nationwide study to estimate the burden of hospital admissions for ADRs in Spain during a six-year period (2001-2006) along with the associated total health cost. Methods Data were obtained from the national surveillance system for hospital data (Minimum Basic Data Set) maintained by the Ministry of Health and Consumer Affairs, and covering more than 95% of Spanish hospitals. From these admissions we selected all hospitalization that were code as drug-related (ICD-9-CM codes E), but intended forms of overdoses, errors in administration and therapeutics failure were excluded. The average number of hospitalizations per year, annual incidence of hospital admissions, average length of stay in the hospital, and case-fatality rate, were calculated. Results During the 2001-2006 periods, the total number of hospitalized patients with ADR diagnosis was 350,835 subjects, 1.69% of all acute hospital admissions in Spain. The estimated incidence of admissions due to ADR decreased during the period 2001-2006 (p < 0.05). More than five percent of patients (n = 19,734) died during an ADR-related hospitalization. The drugs most commonly associated with ADR-related hospitalization were antineoplastic and immunosuppressive drugs (n = 75,760), adrenal cortical steroids (n = 47,539), anticoagulants (n = 26,546) and antibiotics (n = 22,144). The costs generated by patients in our study increased by 19.05% between 2001 and 2006. Conclusions Approximately 1.69% of all acute hospital admissions were associated with ADRs. The rates were much higher for elderly patients. The total cost of ADR-related hospitalization to the Spanish health system is high and has increased between 2001 and 2006. ADRs are an important cause of admission, resulting in considerable use of national health system beds and a significant number of deaths. PMID:20942906

Multidisciplinary in-hospital teams improve patient outcomes: A review.

PubMed

Epstein, Nancy E

2014-01-01

The use of multidisciplinary in-hospital teams limits adverse events (AE), improves outcomes, and adds to patient and employee satisfaction. Acting like "well-oiled machines," multidisciplinary in-hospital teams include "staff" from different levels of the treatment pyramid (e.g. staff including nurses' aids, surgical technicians, nurses, anesthesiologists, attending physicians, and others). Their enhanced teamwork counters the "silo effect" by enhancing communication between the different levels of healthcare workers and thus reduces AE (e.g. morbidity/mortality) while improving patient and healthcare worker satisfaction. Multiple articles across diverse disciplines incorporate a variety of concepts of "teamwork" for staff covering emergency rooms (ERs), hospital wards, intensive care units (ICUs), and most critically, operating rooms (ORs). Cohesive teamwork improved communication between different levels of healthcare workers, and limited adverse events, improved outcomes, decreased the length of stay (LOS), and yielded greater patient "staff" satisfaction. Within hospitals, delivering the best medical/surgical care is a "team sport." The goals include: Maximizing patient safety (e.g. limiting AE) and satisfaction, decreasing the LOS, and increasing the quality of outcomes. Added benefits include optimizing healthcare workers' performance, reducing hospital costs/complications, and increasing job satisfaction. This review should remind hospital administrators of the critical need to keep multidisciplinary teams together, so that they can continue to operate their "well-oiled machines" enhancing the quality/safety of patient care, while enabling "staff" to optimize their performance and enhance their job satisfaction.

Hospital activity and hospital profits.

PubMed

Hegji, Charles E

2007-01-01

The paper uses data from a cross section of southeastern hospitals to examine which activities are profitable for hospitals. The analysis suggests that hospitals may operate at less than profit-maximizing levels of output. In addition, contrary to popular belief emergency rooms are shown to be profit generating centers for hospitals.

Clinical audit of COPD patients requiring hospital admissions in Spain: AUDIPOC study.

PubMed

Pozo-Rodríguez, Francisco; López-Campos, Jose Luis; Alvarez-Martínez, Carlos J; Castro-Acosta, Ady; Agüero, Ramón; Hueto, Javier; Hernández-Hernández, Jesús; Barrón, Manuel; Abraira, Victor; Forte, Anabel; Sanchez Nieto, Juan Miguel; Lopez-Gabaldón, Encarnación; Cosío, Borja G; Agustí, Alvar

2012-01-01

AUDIPOC is a nationwide clinical audit that describes the characteristics, interventions and outcomes of patients admitted to Spanish hospitals because of an exacerbation of chronic obstructive pulmonary disease (ECOPD), assessing the compliance of these parameters with current international guidelines. The present study describes hospital resources, hospital factors related to case recruitment variability, patients' characteristics, and adherence to guidelines. An organisational database was completed by all participant hospitals recording resources and organisation. Over an 8-week period 11,564 consecutive ECOPD admissions to 129 Spanish hospitals covering 70% of the Spanish population were prospectively identified. At hospital discharge, 5,178 patients (45% of eligible) were finally included, and thus constituted the audited population. Audited patients were reassessed 90 days after admission for survival and readmission rates. A wide variability was observed in relation to most variables, hospital adherence to guidelines, and readmissions and death. Median inpatient mortality was 5% (across-hospital range 0-35%). Among discharged patients, 37% required readmission (0-62%) and 6.5% died (0-35%). The overall mortality rate was 11.6% (0-50%). Hospital size and complexity and aspects related to hospital COPD awareness were significantly associated with case recruitment. Clinical management most often complied with diagnosis and treatment recommendations but rarely (<50%) addressed guidance on healthy life-styles. The AUDIPOC study highlights the large across-hospital variability in resources and organization of hospitals, patient characteristics, process of care, and outcomes. The study also identifies resources and organizational characteristics associated with the admission of COPD cases, as well as aspects of daily clinical care amenable to improvement.

Improving the School Food Environment

PubMed Central

CULLEN, KAREN W.; HARTSTEIN, JILL; REYNOLDS, KIM D.; VU, MAIHAN; RESNICOW, KEN; GREENE, NATASHA; WHITE, MAMIE A.

2009-01-01

Our objective for this study was to examine the feasibility of instituting environmental changes during a 6-week pilot in school foodservice programs, with long-term goals of improving dietary quality and preventing obesity and type 2 diabetes in youth. Participants included students and staff from six middle schools in three states. Formative assessment with students and school staff was conducted in the spring of 2003 to inform the development of school foodservice policy changes. Thirteen potential policy goals were delineated. These formed the basis for the environmental change pilot intervention implemented during the winter/spring of 2004. Questionnaires were used to assess the extent to which the 13 foodservice goals were achieved. Success was defined as achieving 75% of goals not met at baseline. Daily data were collected on goal achievement using the schools’ daily food production and sales records. Qualitative data were also collected after the pilot study to obtain feedback from students and staff. Formative research with staff and students identified potential environmental changes. Most schools made substantial changes in the National School Lunch Program meal and snack bar/a la carte offerings. Vending goals were least likely to be achieved. Only one school did not meet the 75% goal achievement objective. Based on the objective data as well as qualitative feedback from student focus groups and interviews with students and school staff, healthful school foodservice changes in the cafeteria and snack bar can be implemented and were acceptable to the staff and students. Implementing longer-term and more ambitious changes and assessing cost issues and the potential enduring impact of these changes on student dietary change and disease risk reduction merits investigation. PMID:17324667

Completion of the National Land Cover Database (NLCD) 1992-2001 Land Cover Change Retrofit Product

EPA Science Inventory

The Multi-Resolution Land Characteristics Consortium has supported the development of two national digital land cover products: the National Land Cover Dataset (NLCD) 1992 and National Land Cover Database (NLCD) 2001. Substantial differences in imagery, legends, and methods betwe...

Climate Impacts of Cover Crops

NASA Astrophysics Data System (ADS)

Lombardozzi, D.; Wieder, W. R.; Bonan, G. B.; Morris, C. K.; Grandy, S.

2016-12-01

Cover crops are planted in agricultural rotation with the intention of protecting soil rather than harvest. Cover crops have numerous environmental benefits that include preventing soil erosion, increasing soil fertility, and providing weed and pest control- among others. In addition to localized environmental benefits, cover crops can have important regional or global biogeochemical impacts by increasing soil organic carbon, changing emissions of greenhouse trace gases like nitrous oxide and methane, and reducing hydrologic nitrogen losses. Cover crops may additionally affect climate by changing biogeophysical processes, like albedo and latent heat flux, though these potential changes have not yet been evaluated. Here we use the coupled Community Atmosphere Model (CAM5) - Community Land Model (CLM4.5) to test how planting cover crops in the United States may change biogeophysical fluxes and climate. We present seasonal changes in albedo, heat fluxes, evaporative partitioning, radiation, and the resulting changes in temperature. Preliminary analyses show that during seasons when cover crops are planted, latent heat flux increases and albedo decreases, changing the evaporative fraction and surface temperatures. Understanding both the biogeophysical changes caused by planting cover crops in this study and the biogeochemical changes found in other studies will give a clearer picture of the overall impacts of cover crops on climate and atmospheric chemistry, informing how this land use strategy will impact climate in the future.

Unannounced versus announced hospital surveys: a nationwide cluster-randomized controlled trial.

PubMed

Ehlers, Lars Holger; Simonsen, Katherina Beltoft; Jensen, Morten Berg; Rasmussen, Gitte Sand; Olesen, Anne Vingaard

2017-06-01

To evaluate the effectiveness of unannounced versus announced surveys in detecting non-compliance with accreditation standards in public hospitals. A nationwide cluster-randomized controlled trial. All public hospitals in Denmark were invited. Twenty-three hospitals (77%) (3 university hospitals, 5 psychiatric hospitals and 15 general hospitals) agreed to participate. Twelve hospitals were randomized to receive unannounced surveys (intervention group) and eleven hospitals to receive announced surveys (control group). We hypothesized that the hospitals receiving the unannounced surveys would reveal a higher degree of non-compliance with accreditation standards than the hospitals receiving announced surveys. Nine surveyors trained and employed by the Danish Institute for Quality and Accreditation in Healthcare (IKAS) were randomized into teams and conducted all surveys. The outcome was the surveyors' assessment of the hospitals' level of compliance with 113 performance indicators-an abbreviated set of the Danish Healthcare Quality Programme (DDKM) version 2, covering organizational standards, patient pathway standards and patient safety standards. Compliance with performance indicators was analyzed using binomial regression analysis with bootstrapped robust standard errors. In all, 16 202 measurements were acceptable for data analysis. The risk of observing non-compliance with performance indicators for the intervention group compared with the control group was statistically insignificant (risk difference (RD) = -0.6 percentage points [-2.51-1.31], P = 0.54). A converged analysis of the six patient safety critical standards, requiring 100% compliance to gain accreditation status revealed no statistically significant difference (RD = -0.78 percentage points [-4.01-2.44], P = 0.99). Unannounced hospital surveys were not more effective than announced surveys in detecting quality problems in Danish hospitals. ClinicalTrials.gov NCT02348567, https://clinicaltrials.gov/ct2

Cover crops and N credits

USDA-ARS?s Scientific Manuscript database

Cover crops often provide many short- and long-term benefits to cropping systems. Legume cover crops can significantly reduce the N fertilizer requirement of non-legume cash crops that follow. The objectives of this presentation were to: I) educate stakeholders about the potential benefits of cover ...

Forest service contributions to the national land cover database (NLCD): Tree Canopy Cover Production

Treesearch

Bonnie Ruefenacht; Robert Benton; Vicky Johnson; Tanushree Biswas; Craig Baker; Mark Finco; Kevin Megown; John Coulston; Ken Winterberger; Mark Riley

2015-01-01

A tree canopy cover (TCC) layer is one of three elements in the National Land Cover Database (NLCD) 2011 suite of nationwide geospatial data layers. In 2010, the USDA Forest Service (USFS) committed to creating the TCC layer as a member of the Multi-Resolution Land Cover (MRLC) consortium. A general methodology for creating the TCC layer was reported at the 2012 FIA...

Completion of the National Land Cover Database (NLCD) 1992–2001 Land Cover Change Retrofit product

USGS Publications Warehouse

Fry, J.A.; Coan, Michael; Homer, Collin G.; Meyer, Debra K.; Wickham, J.D.

2009-01-01

The Multi-Resolution Land Characteristics Consortium has supported the development of two national digital land cover products: the National Land Cover Dataset (NLCD) 1992 and National Land Cover Database (NLCD) 2001. Substantial differences in imagery, legends, and methods between these two land cover products must be overcome in order to support direct comparison. The NLCD 1992-2001 Land Cover Change Retrofit product was developed to provide more accurate and useful land cover change data than would be possible by direct comparison of NLCD 1992 and NLCD 2001. For the change analysis method to be both national in scale and timely, implementation required production across many Landsat Thematic Mapper (TM) and Enhanced Thematic Mapper Plus (ETM+) path/rows simultaneously. To meet these requirements, a hybrid change analysis process was developed to incorporate both post-classification comparison and specialized ratio differencing change analysis techniques. At a resolution of 30 meters, the completed NLCD 1992-2001 Land Cover Change Retrofit product contains unchanged pixels from the NLCD 2001 land cover dataset that have been cross-walked to a modified Anderson Level I class code, and changed pixels labeled with a 'from-to' class code. Analysis of the results for the conterminous United States indicated that about 3 percent of the land cover dataset changed between 1992 and 2001.

77 FR 48733 - Transitional Program for Covered Business Method Patents-Definitions of Covered Business Method...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-14

... Office 37 CFR Part 42 Transitional Program for Covered Business Method Patents--Definitions of Covered Business Method Patent and Technological Invention; Final Rule #0;#0;Federal Register / Vol. 77 , No. 157... Business Method Patents-- Definitions of Covered Business Method Patent and Technological Invention AGENCY...

Endoscopic treatment of benign biliary strictures using covered self-expandable metal stents (CSEMS).

PubMed

Irani, Shayan; Baron, Todd H; Akbar, Ali; Lin, Otto S; Gluck, Michael; Gan, Ian; Ross, Andrew S; Petersen, Bret T; Topazian, Mark; Kozarek, Richard A

2014-01-01

Traditional endoscopic management of benign biliary strictures (BBS) consists of placement of one or more plastic stents. Emerging data support the use of covered self-expandable metal stents (CSEMS). We sought to assess outcome of endoscopic temporary placement of CSEMS in patients with BBS. This was a retrospective study of CSEMS placement for BBS between May 2005 and July 2012 from two tertiary care centers. A total of 145 patients (81 males, median age 59 years) with BBS were identified; 73 of which were classified as extrinsic and were caused by chronic pancreatitis, and 70 were intrinsic. Main outcome measures were resolution of stricture and adverse events (AEs) due to self-expandable metal stents (SEMS)-related therapy. Fully covered and partially covered 8-10 mm diameter SEMS were placed and subsequently removed in 121/125 (97 %) attempts in BBS (failure to remove four partially covered stents). Stricture resolution occurred in 83/125 (66 %) patients after a median stent duration of 26 weeks (median follow-up 90 weeks). Resolution of extrinsic strictures was significantly lower compared to intrinsic strictures (31/65, 48 % vs. 52/60, 87 %, p = 0.004) despite longer median stent duration (30 vs. 20 weeks). Thirty-seven AEs occurred in 25 patients (17 %), with 12 developing multiple AEs including cholangitis (n = 17), pancreatitis (n = 5), proximal stent migration (n = 3), cholecystitis (n = 2), pain requiring SEMS removal and/or hospitalization (n = 3), inability to remove (n = 4), and new stricture formation (n = 3). Benign biliary strictures can be effectively treated with CSEMS. Successful resolution of biliary strictures due to extrinsic disease is seen significantly less often than those due to intrinsic disease. Removal is successful in all patients with fully covered SEMS.

Evaluation of the validity and reliability of A-scan ultrasound biometry with a single use disposable cover

PubMed Central

Cass, K; Thompson, C M; Tromans, C; Wood, I C J

2002-01-01

Background: The UK Medical Devices Agency has suggested that ophthalmic practitioners should, where practicable and not compromising clinical outcome, restrict corneal contact devices to single patient use to minimise a remote theoretical risk of transmission of new variant Creutzfeldt-Jakob disease (vCJD). This study reports on a modified technique of ultrasound A-scan biometry that complies with the MDA recommendations. Methods: The right eyes of 37 consecutive hospital patients had a series of biometry readings taken with a Humphrey 820 A-scan instrument with a plane wave transducer use d conventionally and with the addition of a disposable latex cover. Results: Intrasessional repeatability of axial length measurements was similar for conventional readings—mean difference 0.027 mm, 95% confidence intervals (CI) ± 0.44 mm and those taken with a disposable cover (0.028 mm, CI ± 0.38). Intersessional repeatability was equivalent with (0.002 mm, CI ± 0.51) and without a cover (0.03 mm, CI ± 0.51). Readings with a cover were not significantly different from those without (paired t test; p >0.05), but tended to be greater (mean difference 0.085 mm, CI ± 0.60). Conclusions: These findings suggest that corneal contact biometry with a disposable cover is a viable and theoretically safer alternative to the conventional technique. PMID:11864896

ENGINEERING BULLETIN: LANDFILL COVERS

EPA Science Inventory

Landfill covers are used at Superfund sites to minimize surface water infiltration and control gas migration. In many cases covers are used in conjunction with other waste treatment technologies, such as slurry walls, ground water pump-and-treat systems, and gas collection. This ...

Automatic design of magazine covers

NASA Astrophysics Data System (ADS)

Jahanian, Ali; Liu, Jerry; Tretter, Daniel R.; Lin, Qian; Damera-Venkata, Niranjan; O'Brien-Strain, Eamonn; Lee, Seungyon; Fan, Jian; Allebach, Jan P.

2012-03-01

In this paper, we propose a system for automatic design of magazine covers that quantifies a number of concepts from art and aesthetics. Our solution to automatic design of this type of media has been shaped by input from professional designers, magazine art directors and editorial boards, and journalists. Consequently, a number of principles in design and rules in designing magazine covers are delineated. Several techniques are derived and employed in order to quantify and implement these principles and rules in the format of a software framework. At this stage, our framework divides the task of design into three main modules: layout of magazine cover elements, choice of color for masthead and cover lines, and typography of cover lines. Feedback from professional designers on our designs suggests that our results are congruent with their intuition.

Medicare program; hospital outpatient prospective payment system and CY 2007 payment rates; CY 2007 update to the ambulatory surgical center covered procedures list; Medicare administrative contractors; and reporting hospital quality data for FY 2008 inpatient prospective payment system annual payment update program--HCAHPS survey, SCIP, and mortality. Final rule with comment period and final rule.

PubMed

2006-11-24

This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system, and to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 and the Deficit Reduction Act (DRA) of 2005. In this final rule with comment period, we describe changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2007. In addition, this final rule with comment period implements future CY 2009 required reporting on quality measures for hospital outpatient services paid under the prospective payment system. This final rule with comment period revises the current list of procedures that are covered when furnished in a Medicare-approved ambulatory surgical center (ASC), which are applicable to services furnished on or after January 1, 2007. This final rule with comment period revises the emergency medical screening requirements for critical access hospitals (CAHs). This final rule with comment period supports implementation of a restructuring of the contracting entities responsibilities and functions that support the adjudication of Medicare fee-for-service (FFS) claims. This restructuring is directed by section 1874A of the Act, as added by section 911 of the MMA. The prior separate Medicare intermediary and Medicare carrier contracting authorities under Title XVIII of the Act have been replaced with the Medicare Administrative Contractor (MAC) authority. This final rule continues to implement the requirements of the DRA that require that we expand the "starter set" of 10 quality measures that we used in FY 2005 and FY 2006 for the hospital inpatient prospective payment system (IPPS) Reporting Hospital Quality Data

Undertaking capacity assessments for people with dementia in general hospitals.

PubMed

Murray, Aileen

2016-08-01

Ensuring that older patients are discharged from hospital in a safe and appropriate manner is a fundamental aspect of nursing care. However, it is clear from the literature and clinical practice that determining people's capacity and whether they are able to decide where they live on discharge is a significant challenge. There is variation in practice despite the legal framework provided by the Mental Capacity Act (MCA) 2005, covering England and Wales, which raises questions about adherence to the legislation. Using a case study, this article explores aspects of the MCA and clinical practice that affect older patients' outcomes on discharge from general hospital settings. It demonstrates how effective multidisciplinary working, using the legal frameworks available, can ensure that an individual's independence and well-being are maintained.

Financial protection mechanisms for inpatients at selected Philippine hospitals.

PubMed

Caballes, Alvin B; Söllner, Walter; Nañagas, Juan

2012-11-01

The study was undertaken to determine, from the patient's perspective, the comparative effectiveness of locally established financial protection mechanisms particularly for indigent and severely-ill hospitalized patients. Data was obtained from a survey conducted in 2010 in Philippine provinces which were part of the Health Systems Development Project and involved 449 patients from selected private and public hospitals. Direct medical expenses incurred during the confinement period, whether already paid for prior to or only billed upon discharge, were initially considered. Expenses were found to be generally larger for the more severely ill and lower for the poor. Hospital-provided discounts and social health insurance (PhilHealth) reimbursements were the financial protection mechanisms evaluated in this study. In average terms, only up to 46% of inpatient expenses were potentially covered by the combined financial support. Depending on the hospital type, 28-42% of submitted PhilHealth claims were invalidated. Multiple linear regression analysis was utilized to determine the relationship of the same set of patients' demographic characteristics, socioeconomic status, severity of illness, and hospital assignments with selected expense categories and financial protection measures. Pre-discharge expenditures were significantly higher in public hospitals. The very ill also faced significantly larger expenses, including those for final hospital charges. Hospital-derived discounts provided significantly more support for indigent as well as very sick patients. The amounts for verified PhilHealth claims were significantly greater for the moderately-ill and, incongruously, the financially better-off patients. Sponsored Program members, supposed indigents enjoying fully-subsidized PhilHealth enrollment, qualified for higher mean reimbursements. However, there was a weak correlation between such patients and those identified as poor by the hospital social service staff. Thus

National land-cover pattern data

Treesearch

Kurt H. Riitters; James D. Wickham; James E. Vogelmann; K. Bruce Jones

2000-01-01

Land cover and its spatial patterns are key ingredients in ecological studies that consider large regions and the impacts of human activities. Because humanity is a principal driver of land-cover change over large regions (Turner et al. 1990), land-cover data provide direct measures of human activity, and both direct and indirect measures of ecological conditions...

Gainesville's urban forest canopy cover

Treesearch

Francisco Escobedo; Jennifer A. Seitz; Wayne Zipperer

2009-01-01

Ecosystem benefits from trees are linked directly to the amount of healthy urban forest canopy cover. Urban forest cover is dynamic and changes over time due to factors such as urban development, windstorms, tree removals, and growth. The amount of a city's canopy cover depends on its land use, climate, and people's preferences. This fact sheet examines how...

MODIS Snow-Cover Products

NASA Technical Reports Server (NTRS)

Hall, Dorothy K.; Riggs, George A.; Salomonson, Vinvent V.; DiGirolamo, Nicolo; Bayr, Klaus J.; Houser, Paul (Technical Monitor)

2001-01-01

On December 18, 1999, the Terra satellite was launched with a complement of five instruments including the Moderate Resolution Imaging Spectroradiometer (MODIS). Many geophysical products are derived from MODIS data including global snow-cover products. These products have been available through the National Snow and Ice Data Center (NSIDC) Distributed Active Archive Center (DAAC) since September 13, 2000. MODIS snow-cover products represent potential improvement to the currently available operation products mainly because the MODIS products are global and 500-m resolution, and have the capability to separate most snow and clouds. Also the snow-mapping algorithms are automated which means that a consistent data set is generated for long-term climates studies that require snow-cover information. Extensive quality assurance (QA) information is stored with the product. The snow product suite starts with a 500-m resolution swath snow-cover map which is gridded to the Integerized Sinusoidal Grid to produce daily and eight-day composite tile products. The sequence then proceeds to a climate-modeling grid product at 5-km spatial resolution, with both daily and eight-day composite products. A case study from March 6, 2000, involving MODIS data and field and aircraft measurements, is presented. Near-term enhancements include daily snow albedo and fractional snow cover.

Clinical Audit of COPD Patients Requiring Hospital Admissions in Spain: AUDIPOC Study

PubMed Central

Pozo-Rodríguez, Francisco; López-Campos, Jose Luis; Álvarez-Martínez, Carlos J.; Castro-Acosta, Ady; Agüero, Ramón; Hueto, Javier; Hernández-Hernández, Jesús; Barrón, Manuel; Abraira, Victor; Forte, Anabel; Sanchez Nieto, Juan Miguel; Lopez-Gabaldón, Encarnación; Cosío, Borja G.; Agustí, Alvar

2012-01-01

Backgrounds AUDIPOC is a nationwide clinical audit that describes the characteristics, interventions and outcomes of patients admitted to Spanish hospitals because of an exacerbation of chronic obstructive pulmonary disease (ECOPD), assessing the compliance of these parameters with current international guidelines. The present study describes hospital resources, hospital factors related to case recruitment variability, patients’ characteristics, and adherence to guidelines. Methodology/Principal Findings An organisational database was completed by all participant hospitals recording resources and organisation. Over an 8-week period 11,564 consecutive ECOPD admissions to 129 Spanish hospitals covering 70% of the Spanish population were prospectively identified. At hospital discharge, 5,178 patients (45% of eligible) were finally included, and thus constituted the audited population. Audited patients were reassessed 90 days after admission for survival and readmission rates. A wide variability was observed in relation to most variables, hospital adherence to guidelines, and readmissions and death. Median inpatient mortality was 5% (across-hospital range 0–35%). Among discharged patients, 37% required readmission (0–62%) and 6.5% died (0–35%). The overall mortality rate was 11.6% (0–50%). Hospital size and complexity and aspects related to hospital COPD awareness were significantly associated with case recruitment. Clinical management most often complied with diagnosis and treatment recommendations but rarely (<50%) addressed guidance on healthy life-styles. Conclusions/Significance The AUDIPOC study highlights the large across-hospital variability in resources and organization of hospitals, patient characteristics, process of care, and outcomes. The study also identifies resources and organizational characteristics associated with the admission of COPD cases, as well as aspects of daily clinical care amenable to improvement. PMID:22911875

Clinical information systems: cornerstone for an efficient hospital management.

PubMed

Lovis, Christian

2011-01-01

The university hospitals of Geneva are the largest consortium of public hospitals in Switzerland. This organization is born in 1995, after a political decision to merge the seven public and teaching hospitals of the Canton of Geneva. From an information technologies perspective, it took several years to reach a true unified vision of the complete organization. The clinical information system is deployed in all sites covering in- and outpatient cares. It is seen as the cornerstone of information management and flow in the organization, for direct patient care and decision support, but also for the management to drive, improve and leverage the activities, for better efficiency, quality and safety of care, but also to drive processes. As the system has become more important for the organization, it has required progressive changes in its governance. The high importance of interoperability and use of formal representation has become a major challenge in order to be able to reuse clinical information for real-time care and management activities, and for secondary usage such as billing, resource management, strategic planning and clinical research. This paper proposes a short overview of the tools allowing to leverage the management for physicians, nurses, human resources and hospital governance.

Teaching hospital performance: towards a community of shared values?

PubMed

Mauro, Marianna; Cardamone, Emma; Cavallaro, Giusy; Minvielle, Etienne; Rania, Francesco; Sicotte, Claude; Trotta, Annarita

2014-01-01

This paper explores the performance dimensions of Italian teaching hospitals (THs) by considering the multiple constituent model approach, using measures that are subjective and based on individual ideals and preferences. Our research replicates a study of a French TH and deepens it by adjusting it to the context of an Italian TH. The purposes of this research were as follows: to identify emerging views on the performance of teaching hospitals and to analyze how these views vary among hospital stakeholders. We conducted an in-depth case study of a TH using a quantitative survey method. The survey uses a questionnaire based on Parsons' social system action theory, which embraces the major models of organizational performance and covers three groups of internal stakeholders: physicians, caregivers and administrative staff. The questionnaires were distributed between April and September 2011. The results confirm that hospital performance is multifaceted and includes the dimensions of efficiency, effectiveness and quality of care, as well as organizational and human features. There is a high degree of consensus among all observed stakeholder groups about these values, and a shared view of performance is emerging. Our research provides useful information for defining management priorities to improve the performance of THs. Copyright © 2013 Elsevier Ltd. All rights reserved.

[Music as a resource in care for hospitalized children: a possible intervention?].

PubMed

Ferreira, Caroline Cristina Moreira; Remedi, Patrícia Pereira; de Lima, Regina Aparecida Garcia

2006-01-01

This bibliographic study involved the Medline and LILACS databases as well as non-systematized searches and covered the period from 1994 to 2004. We aimed to analyze the bibliographic production on pediatric nursing and music, in order to identify current knowledge in this area. Our analysis revealed 3 units of meaning: the setting, interventions and repercussions. The results disclose the benefits music can offer to hospitalized children, their family members and health teams. We observed that music can be used in hospitals as a low-cost, nonpharmacological and noninvasive intervention, promoting development processes with a view to the health of children, families and workers.

Using machine learning to examine medication adherence thresholds and risk of hospitalization.

PubMed

Lo-Ciganic, Wei-Hsuan; Donohue, Julie M; Thorpe, Joshua M; Perera, Subashan; Thorpe, Carolyn T; Marcum, Zachary A; Gellad, Walid F

2015-08-01

Quality improvement efforts are frequently tied to patients achieving ≥80% medication adherence. However, there is little empirical evidence that this threshold optimally predicts important health outcomes. To apply machine learning to examine how adherence to oral hypoglycemic medications is associated with avoidance of hospitalizations, and to identify adherence thresholds for optimal discrimination of hospitalization risk. A retrospective cohort study of 33,130 non-dual-eligible Medicaid enrollees with type 2 diabetes. We randomly selected 90% of the cohort (training sample) to develop the prediction algorithm and used the remaining (testing sample) for validation. We applied random survival forests to identify predictors for hospitalization and fit survival trees to empirically derive adherence thresholds that best discriminate hospitalization risk, using the proportion of days covered (PDC). Time to first all-cause and diabetes-related hospitalization. The training and testing samples had similar characteristics (mean age, 48 y; 67% female; mean PDC=0.65). We identified 8 important predictors of all-cause hospitalizations (rank in order): prior hospitalizations/emergency department visit, number of prescriptions, diabetes complications, insulin use, PDC, number of prescribers, Elixhauser index, and eligibility category. The adherence thresholds most discriminating for risk of all-cause hospitalization varied from 46% to 94% according to patient health and medication complexity. PDC was not predictive of hospitalizations in the healthiest or most complex patient subgroups. Adherence thresholds most discriminating of hospitalization risk were not uniformly 80%. Machine-learning approaches may be valuable to identify appropriate patient-specific adherence thresholds for measuring quality of care and targeting nonadherent patients for intervention.

Paget disease of bone among hospitalized patients in Poland.

PubMed

Kanecki, Krzysztof; Nitsch-Osuch, Aneta; Goryński, Paweł; Bogdan, Magdalena; Tarka, Patryk; Tyszko, Piotr Zbigniew

2018-03-14

Paget's disease (PDB) is a focal disorder of bone remodeling that occurs commonly in older people with decreasing prevalence reported in European countries. This disease is most often asymptomatic, but it can cause a variety of medical complications resulting in considerable morbidity and reduced quality of life. There is little information regarding the epidemiology of PDB in Poland. To the best of the authors' knowledge, this is the first large epidemiological analysis of this disease in Poland. The aim of this study was to analyze factors that may be related to the PDB epidemiology among hospitalized patients in Poland. The analysis was conducted on the basis of population-based administrative data, taken from a Polish hospital morbidity study carried out by the National Institute of Public Health between January 2008 - December 2014. Analyzed data covered 662 hospitalization records. The final study sample comprised 94 (41.8%) male and 131 (58.2%) female patients with first-time hospitalizations for PDB, with a significant predominance of females (P<0.02), and the predominance of patients living in urban (73%) than in rural areas (27%), P<0.001. The average age of the sample was 56.8 years (CI: 54.3-59.3; SD 18.8; range 1-93 years). The number of PDB cases hospitalized in Poland significantly decreased during the analyzed period of time. PDB is a rare disease with decreasing trends observed among hospitalized patients in Poland. The study results may suggest the existence of environmental risk factors for the development of PDB.

Mapping land cover through time with the Rapid Land Cover Mapper—Documentation and user manual

USGS Publications Warehouse

Cotillon, Suzanne E.; Mathis, Melissa L.

2017-02-15

The Rapid Land Cover Mapper is an Esri ArcGIS® Desktop add-in, which was created as an alternative to automated or semiautomated mapping methods. Based on a manual photo interpretation technique, the tool facilitates mapping over large areas and through time, and produces time-series raster maps and associated statistics that characterize the changing landscapes. The Rapid Land Cover Mapper add-in can be used with any imagery source to map various themes (for instance, land cover, soils, or forest) at any chosen mapping resolution. The user manual contains all essential information for the user to make full use of the Rapid Land Cover Mapper add-in. This manual includes a description of the add-in functions and capabilities, and step-by-step procedures for using the add-in. The Rapid Land Cover Mapper add-in was successfully used by the U.S. Geological Survey West Africa Land Use Dynamics team to accurately map land use and land cover in 17 West African countries through time (1975, 2000, and 2013).

Household costs of hospitalized dengue illness in semi-rural Thailand

PubMed Central

Ratanawong, Pitcha; Sewe, Maquines Odhiambo; Wilder-Smith, Annelies; Kittayapong, Pattamaporn

2017-01-01

Background Dengue-related illness is a leading cause of hospitalization and death in Thailand and other Southeast Asian countries, imposing a major economic burden on households, health systems, and governments. This study aims to assess the economic impact of hospitalized dengue cases on households in Chachoengsao province in eastern Thailand. Methods We conducted a prospective cost-of-illness study of hospitalized pediatric and adult dengue patients at three public hospitals. We examined all hospitalized dengue cases regardless of disease severity. Patients or their legal guardians were interviewed using a standard questionnaire to determine household-level medical and non-medical expenditures and income losses during the illness episode. Results Between March and September 2015, we recruited a total of 224 hospitalized patients (<5 years, 4%; 5–14 years, 20%, 15–24 years, 36%, 25–34 years, 15%; 35–44 years, 10%; 45+ years, 12%), who were clinically diagnosed with dengue. The total cost of a hospitalized dengue case was higher for adult patients than pediatric patients, and was US$153.6 and US$166.3 for pediatric DF and DHF patients, respectively, and US$171.2 and US$226.1 for adult DF and DHF patients, respectively. The financial burden on households increased with the severity of dengue illness. Conclusions Although 74% of the households reported that the patient received free medical care, hospitalized dengue illness cost approximately 19–23% of the monthly household income. These results indicated that dengue imposed a substantial financial burden on households in Thailand where a great majority of the population was covered by the Universal Coverage Scheme for health care. PMID:28937986

Factors affecting mortality and resource use for hospitalized patients with cirrhosis

PubMed Central

Charatcharoenwitthaya, Phunchai; Soonthornworasiri, Ngamphol; Karaketklang, Khemajira; Poovorawan, Kittiyod; Pan-ngum, Wirichada; Chotiyaputta, Watcharasak; Tanwandee, Tawesak; Phaosawasdi, Kamthorn

2017-01-01

Abstract Hospitalizations for advanced liver disease are costly and associated with significant mortality. This population-based study aimed to evaluate factors associated with in-hospital mortality and resource use for the management of hospitalized patients with cirrhosis. Mortality records and resource utilization for 52,027 patients hospitalized with cirrhosis and/or complications of portal hypertension (ascites, hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, or hepatorenal syndrome) were extracted from a nationally representative sample of Thai inpatients covered by Universal Coverage Scheme during 2009 to 2013. The rate of dying in the hospital increased steadily by 12% from 9.6% in 2009 to 10.8% in 2013 (P < .001). Complications of portal hypertension were independently associated with increased in-hospital mortality except for ascites. The highest independent risk for hospital death was seen with hepatorenal syndrome (odds ratio [OR], 5.04; 95% confidence interval [CI], 4.38–5.79). Mortality rate remained high in patients with infection, particularly septicemia (OR, 4.26; 95% CI, 4.0–4.54) and pneumonia (OR, 2.44; 95% CI, 2.18–2.73). Receiving upper endoscopy (OR, 0.29; 95% CI, 0.27–0.32) and paracentesis (OR, 0.93; 95% CI, 0.87–1.00) were associated with improved patient survival. The inflation-adjusted national annual costs (P = .06) and total hospital days (P = .07) for cirrhosis showed a trend toward increasing during the 5-year period. Renal dysfunction, infection, and sequelae of portal hypertension except for ascites were independently associated with increased resource utilization. Renal dysfunction, infection, and portal hypertension-related complications are the main factors affecting in-hospital mortality and resource utilization for hospitalized patients with cirrhosis. The early intervention for modifiable factors is an important step toward improving hospital outcomes. PMID:28796076

46 CFR 171.117 - Dead covers.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 7 2011-10-01 2011-10-01 false Dead covers. 171.117 Section 171.117 Shipping COAST... Dead covers. (a) Except as provided in paragraph (b) of this section, each port light with the sill located below the margin line must have a hinged, inside dead cover. (b) The dead cover on a port light...

46 CFR 171.117 - Dead covers.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 7 2014-10-01 2014-10-01 false Dead covers. 171.117 Section 171.117 Shipping COAST... Dead covers. (a) Except as provided in paragraph (b) of this section, each port light with the sill located below the margin line must have a hinged, inside dead cover. (b) The dead cover on a port light...

46 CFR 171.117 - Dead covers.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 7 2013-10-01 2013-10-01 false Dead covers. 171.117 Section 171.117 Shipping COAST... Dead covers. (a) Except as provided in paragraph (b) of this section, each port light with the sill located below the margin line must have a hinged, inside dead cover. (b) The dead cover on a port light...

46 CFR 171.117 - Dead covers.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 7 2012-10-01 2012-10-01 false Dead covers. 171.117 Section 171.117 Shipping COAST... Dead covers. (a) Except as provided in paragraph (b) of this section, each port light with the sill located below the margin line must have a hinged, inside dead cover. (b) The dead cover on a port light...

46 CFR 171.117 - Dead covers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Dead covers. 171.117 Section 171.117 Shipping COAST... Dead covers. (a) Except as provided in paragraph (b) of this section, each port light with the sill located below the margin line must have a hinged, inside dead cover. (b) The dead cover on a port light...

MODIS Snow-Cover Products

NASA Technical Reports Server (NTRS)

Hall, Dorothy K.; Riggs, George A.; Salomonson, Vincent V.; DiGirolamo, Nicole E.; Bayr, Klaus J.; Houser, Paul R. (Technical Monitor)

2002-01-01

On December 18, 1999, the Terra satellite was launched with a complement of five instruments including the Moderate Resolution Imaging Spectroradiometer (MODIS). Many geophysical products are derived from MODIS data including global snow-cover products. MODIS snow and ice products have been available through the National Snow and Ice Data Center (NSIDC) Distributed Active Archive Center (DAAC) since September 13, 2000. MODIS snow-cover products represent potential improvement to or enhancement of the currently-available operational products mainly because the MODIS products are global and 500-m resolution, and have the capability to separate most snow and clouds. Also the snow-mapping algorithms are automated which means that a consistent data set may be generated for long-term climate studies that require snow-cover information. Extensive quality assurance (QA) information is stored with the products. The MODIS snow product suite begins with a 500-m resolution, 2330-km swath snow-cover map which is then gridded to an integerized sinusoidal grid to produce daily and 8-day composite tile products. The sequence proceeds to a climate-modeling grid (CMG) product at about 5.6-km spatial resolution, with both daily and 8-day composite products. Each pixel of the CMG contains fraction of snow cover from 40 - 100%. Measured errors of commission in the CMG are low, for example, on the continent of Australia in the spring, they vary from 0.02 - 0.10%. Near-term enhancements include daily snow albedo and fractional snow cover. A case study from March 6, 2000, involving MODIS data and field and aircraft measurements, is presented to show some early validation work.

Optimal shortening of uniform covering arrays

PubMed Central

Rangel-Valdez, Nelson; Avila-George, Himer; Carrizalez-Turrubiates, Oscar

2017-01-01

Software test suites based on the concept of interaction testing are very useful for testing software components in an economical way. Test suites of this kind may be created using mathematical objects called covering arrays. A covering array, denoted by CA(N; t, k, v), is an N × k array over Zv={0,…,v-1} with the property that every N × t sub-array covers all t-tuples of Zvt at least once. Covering arrays can be used to test systems in which failures occur as a result of interactions among components or subsystems. They are often used in areas such as hardware Trojan detection, software testing, and network design. Because system testing is expensive, it is critical to reduce the amount of testing required. This paper addresses the Optimal Shortening of Covering ARrays (OSCAR) problem, an optimization problem whose objective is to construct, from an existing covering array matrix of uniform level, an array with dimensions of (N − δ) × (k − Δ) such that the number of missing t-tuples is minimized. Two applications of the OSCAR problem are (a) to produce smaller covering arrays from larger ones and (b) to obtain quasi-covering arrays (covering arrays in which the number of missing t-tuples is small) to be used as input to a meta-heuristic algorithm that produces covering arrays. In addition, it is proven that the OSCAR problem is NP-complete, and twelve different algorithms are proposed to solve it. An experiment was performed on 62 problem instances, and the results demonstrate the effectiveness of solving the OSCAR problem to facilitate the construction of new covering arrays. PMID:29267343

7 CFR 65.135 - Covered commodity.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., PEANUTS, AND GINSENG General Provisions Definitions § 65.135 Covered commodity. (a) Covered commodity... nuts; (6) Pecans; and (7) Ginseng. (b) Covered commodities are excluded from this part if the commodity...

7 CFR 65.135 - Covered commodity.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., PEANUTS, AND GINSENG General Provisions Definitions § 65.135 Covered commodity. (a) Covered commodity... nuts; (6) Pecans; and (7) Ginseng. (b) Covered commodities are excluded from this part if the commodity...

7 CFR 65.135 - Covered commodity.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., PEANUTS, AND GINSENG General Provisions Definitions § 65.135 Covered commodity. (a) Covered commodity... nuts; (6) Pecans; and (7) Ginseng. (b) Covered commodities are excluded from this part if the commodity...

7 CFR 65.135 - Covered commodity.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., PEANUTS, AND GINSENG General Provisions Definitions § 65.135 Covered commodity. (a) Covered commodity... nuts; (6) Pecans; and (7) Ginseng. (b) Covered commodities are excluded from this part if the commodity...

Involuntary smoking in the restaurant workplace. A review of employee exposure and health effects.

PubMed

Siegel, M

1993-07-28

To determine the relative exposure to environmental tobacco smoke for bar and restaurant employees compared with office employees and with nonsmokers exposed in the home (part 1) and to determine whether this exposure is contributing to an elevated lung cancer risk in these employees (part 2). MEDLINE and bibliographies from identified publications. In part 1, published studies of indoor air quality were included if they reported a mean concentration of carbon monoxide, nicotine, or particulate matter from measurements taken in one or more bars, restaurants, offices, or residences with at least one smoker. In part 2, published epidemiologic studies that reported a risk estimate for lung cancer incidence or mortality in food-service workers were included if they controlled, directly or indirectly, for active smoking. In part 1, a weighted average of the mean concentration of carbon monoxide, nicotine, and respirable suspended particulates reported in studies was calculated for bars, restaurants, offices, and residences. In part 2, the relative lung cancer risk for food-service workers compared with that for the general population was examined in the six identified studies. Levels of environmental tobacco smoke in restaurants were approximately 1.6 to 2.0 times higher than in office workplaces of other businesses and 1.5 times higher than in residences with at least one smoker. Levels in bars were 3.9 to 6.1 times higher than in offices and 4.4 to 4.5 times higher than in residences. The epidemiologic evidence suggested that there may be a 50% increase in lung cancer risk among food-service workers that is in part attributable to tobacco smoke exposure in the workplace. Environmental tobacco smoke is a significant occupational health hazard for food-service workers. To protect these workers, smoking in bars and restaurants should be prohibited.

[Snow cover pollution monitoring in Ufa].

PubMed

Daukaev, R A; Suleĭmanov, R A

2008-01-01

The paper presents the results of examining the snow cover polluted with heavy metals in the large industrial town of Ufa. The level of man-caused burden on the snow cover of the conventional parts of the town was estimated and compared upon exposure to a wide range of snow cover pollutants. The priority snow cover pollutants were identified among the test heavy metals.

Pin-Retraction Mechanism On Quick-Release Cover

NASA Technical Reports Server (NTRS)

Macmartin, Malcolm

1994-01-01

Quick-release cover includes pin-retraction mechanism releasing cover quickly from lower of two sets of pin connections holding cover. Cover released at top by pulling lever as described in "Lever-Arm Pin Puller" (NPO-18788). Removal of cover begins when technician or robot pulls upper-pin-release lever. Cover swings downward until tabs on lower pins are pulled through slots in their receptacles. Lower pins are then free.

Wheelspace windage cover plate for turbine

DOEpatents

Lathrop, Norman Douglas

2002-01-01

Windage cover plates are secured between the wheels and spacer of a turbine rotor to prevent hot flow path gas ingestion into the wheelspace cavities. Each cover plate includes a linear, axially extending body curved circumferentially with a radially outwardly directed wall at one axial end. The wall defines a axially opening recess for receiving a dovetail lug. The cover plate includes an axially extending tongue received in a circumferential groove of the spacer. The cover plate is secured with the tongue in the groove and dovetail lug in the recess. Lap joints between circumferentially adjacent cover plates are provided.

Assessing and Comparing Information Security in Swiss Hospitals

PubMed Central

Hirschel, Jürg; Schlienger, Thomas; Businger, Walter; Zbinden, Alex M

2012-01-01

Background Availability of information in hospitals is an important prerequisite for good service. Significant resources have been invested to improve the availability of information, but it is also vital that the security of this information can be guaranteed. Objective The goal of this study was to assess information security in hospitals through a questionnaire based on the International Organization for Standardization (ISO) and the International Electrotechnical Commission (IEC) standard ISO/IEC 27002, evaluating Information technology – Security techniques – Code of practice for information-security management, with a special focus on the effect of the hospitals’ size and type. Methods The survey, set up as a cross-sectional study, was conducted in January 2011. The chief information officers (CIOs) of 112 hospitals in German-speaking Switzerland were invited to participate. The online questionnaire was designed to be fast and easy to complete to maximize participation. To group the analyzed controls of the ISO/IEC standard 27002 in a meaningful way, a factor analysis was performed. A linear score from 0 (not implemented) to 3 (fully implemented) was introduced. The scores of the hospitals were then analyzed for significant differences in any of the factors with respect to size and type of hospital. The participating hospitals were offered a benchmark report about their status. Results The 51 participating hospitals had an average score of 51.1% (range 30.6% - 81.9%) out of a possible 100% where all items in the questionnaire were fully implemented. Room for improvement could be identified, especially for the factors covering “process and quality management” (average score 1.3 ± 0.8 out of a maximum of 3) and “organization and risk management” (average score 1.3 ± 0.7 out of a maximum of 3). Private hospitals scored significantly higher than university hospitals in the implementation of “security zones” and “backup” (P = .008

Impact on public hospitals if private health insurance rates in Victoria declined.

PubMed

Hanning, Brian W T

2004-12-13

The additional cost of treating acute care type Victorian private patients as public patients in Victorian public hospitals based on the current public sector payment model and rates was calculated, as was the loss of health fund income to public hospitals. If all private cases became public the net recurrent cost would be $1.05 billion assuming all patients were still treated. If private health insurance (PHI) uptake had declined to 23.3% as was projected without Lifetime Health Cover and the 30% rebate, the additional operating cost and income loss would be $385 million. This compares to the Victorian cost of the 30% rebate for acute hospital cases of $383 million. This takes no account of capital costs and possible public sector access problems. The analysis suggests that 31 extra operating theatres would be needed in the public sector (had the transfer of surgical patients from the public sector to the private sector not occurred). This analysis suggests that without the PHI rebate the current stresses on Victorian public hospitals would be increased, not decreased.

Sources of Intrusions in Children’s Dietary Recalls from a Validation Study of Order Prompts

PubMed Central

Baxter, Suzanne Domel; Hardin, James W.; Royer, Julie A.; Smith, Albert F.; Guinn, Caroline H.

2008-01-01

Validation-study data and foodservice production records were analyzed to test hypotheses concerning sources of intrusions (reports of uneaten items) in the school-meal parts of children’s dietary recalls. Each child was observed eating school meals on two days, and interviewed the morning after each observation day; one interview used forward-order (morning-to-evening) and one used reverse-order (evening-to-morning) prompts. Lunch intrusions were likelier to have been available in the foodservice environment at lunch as day before the interview came closer, and on days before than after the interview. Temporal dating errors are contributing sources of intrusions in the school-lunch parts of children’s recalls. PMID:18987088

Primary total hip replacement versus hip resurfacing - hospital considerations.

PubMed

Ward, William G; Carter, Christina J; Barone, Marisa; Jinnah, Riyaz

2011-01-01

Multiple factors regarding surgical procedures and patient selection affect hospital staffing needs as well as hospital revenues. In order to better understand the potential impact on hospitals that hip arthroplasty device selection (standard total hip arthroplasty vs. resurfacing) creates, a review of all primary hip arthroplasties performed at one institution was designed to identify factors that impacted hospital staffing needs and revenue generation. All primary hip arthroplasties undertaken over three fiscal years (2008 to 2010) were reviewed, utilizing only hospital business office data and medical records data that had been previously extracted prior for billing purposes. Analysis confirmed differing demographics for two hip arthroplasty populations, with the resurfacing patients (compared to the conventional total hip arthroplasty population) consisting of younger patients (mean age, 50 vs. 61 years), who were more often male (75% vs. 45%), were more likely to have osteoarthritis as their primary diagnosis (83 vs. 67%) and were more often covered by managed care or commercial insurance (83 vs. 34%). They also had shorter hospital stays (mean length of stay, 2.3 vs. 4.1 days) and consequently provided a more favorable financial revenue stream to the hospital on a per patient basis. Several trends appeared during the study periods. There was a steady increase in all procedures in all groups except for the resurfacings, which decreased 26% in males and 53% in females between 2009 and 2010. Differences were observed in the demographics of patients presenting for resurfacing, compared to those presenting for conventional total hip arthroplasty. In addition to the revenue stream considerations, institutions undertaking a resurfacing program must commit the resources and planning in order to rehabilitate these patients more expeditiously than is usually required with conventional hip arthroplasty patients.

Vegetative covers for waste containment.

PubMed

Rock, Steven A

2003-01-01

Disposal of municipal and hazardous waste in the United States is primarily accomplished by containment in lined and capped landfills. Evapotranspiration cover systems offer an alternative to conventional landfill cap systems. These covers work on completely different principles than traditional covers do, and that difference may slow understanding and acceptance by site owners, regulators, and stakeholders. This chapter provides an introduction to this alternative technique and explains some of the common concerns regarding its implementation.

Forest Cover Estimation in Ireland Using Radar Remote Sensing: A Comparative Analysis of Forest Cover Assessment Methodologies.

PubMed

Devaney, John; Barrett, Brian; Barrett, Frank; Redmond, John; O Halloran, John

2015-01-01

Quantification of spatial and temporal changes in forest cover is an essential component of forest monitoring programs. Due to its cloud free capability, Synthetic Aperture Radar (SAR) is an ideal source of information on forest dynamics in countries with near-constant cloud-cover. However, few studies have investigated the use of SAR for forest cover estimation in landscapes with highly sparse and fragmented forest cover. In this study, the potential use of L-band SAR for forest cover estimation in two regions (Longford and Sligo) in Ireland is investigated and compared to forest cover estimates derived from three national (Forestry2010, Prime2, National Forest Inventory), one pan-European (Forest Map 2006) and one global forest cover (Global Forest Change) product. Two machine-learning approaches (Random Forests and Extremely Randomised Trees) are evaluated. Both Random Forests and Extremely Randomised Trees classification accuracies were high (98.1-98.5%), with differences between the two classifiers being minimal (<0.5%). Increasing levels of post classification filtering led to a decrease in estimated forest area and an increase in overall accuracy of SAR-derived forest cover maps. All forest cover products were evaluated using an independent validation dataset. For the Longford region, the highest overall accuracy was recorded with the Forestry2010 dataset (97.42%) whereas in Sligo, highest overall accuracy was obtained for the Prime2 dataset (97.43%), although accuracies of SAR-derived forest maps were comparable. Our findings indicate that spaceborne radar could aid inventories in regions with low levels of forest cover in fragmented landscapes. The reduced accuracies observed for the global and pan-continental forest cover maps in comparison to national and SAR-derived forest maps indicate that caution should be exercised when applying these datasets for national reporting.

Forest Cover Estimation in Ireland Using Radar Remote Sensing: A Comparative Analysis of Forest Cover Assessment Methodologies

PubMed Central

Devaney, John; Barrett, Brian; Barrett, Frank; Redmond, John; O`Halloran, John

2015-01-01

Quantification of spatial and temporal changes in forest cover is an essential component of forest monitoring programs. Due to its cloud free capability, Synthetic Aperture Radar (SAR) is an ideal source of information on forest dynamics in countries with near-constant cloud-cover. However, few studies have investigated the use of SAR for forest cover estimation in landscapes with highly sparse and fragmented forest cover. In this study, the potential use of L-band SAR for forest cover estimation in two regions (Longford and Sligo) in Ireland is investigated and compared to forest cover estimates derived from three national (Forestry2010, Prime2, National Forest Inventory), one pan-European (Forest Map 2006) and one global forest cover (Global Forest Change) product. Two machine-learning approaches (Random Forests and Extremely Randomised Trees) are evaluated. Both Random Forests and Extremely Randomised Trees classification accuracies were high (98.1–98.5%), with differences between the two classifiers being minimal (<0.5%). Increasing levels of post classification filtering led to a decrease in estimated forest area and an increase in overall accuracy of SAR-derived forest cover maps. All forest cover products were evaluated using an independent validation dataset. For the Longford region, the highest overall accuracy was recorded with the Forestry2010 dataset (97.42%) whereas in Sligo, highest overall accuracy was obtained for the Prime2 dataset (97.43%), although accuracies of SAR-derived forest maps were comparable. Our findings indicate that spaceborne radar could aid inventories in regions with low levels of forest cover in fragmented landscapes. The reduced accuracies observed for the global and pan-continental forest cover maps in comparison to national and SAR-derived forest maps indicate that caution should be exercised when applying these datasets for national reporting. PMID:26262681

10 CFR 950.14 - Standby Support Contract: Covered events, exclusions, covered delay and covered cost provisions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... environmental laws or regulations such as those related to pollution abatement or human health and the... a covered event(s) is determined to be the cause of delay in attainment of full power operation...

10 CFR 950.14 - Standby Support Contract: Covered events, exclusions, covered delay and covered cost provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... environmental laws or regulations such as those related to pollution abatement or human health and the... a covered event(s) is determined to be the cause of delay in attainment of full power operation...

10 CFR 950.14 - Standby Support Contract: Covered events, exclusions, covered delay and covered cost provisions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... environmental laws or regulations such as those related to pollution abatement or human health and the... a covered event(s) is determined to be the cause of delay in attainment of full power operation...

10 CFR 950.14 - Standby Support Contract: Covered events, exclusions, covered delay and covered cost provisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... environmental laws or regulations such as those related to pollution abatement or human health and the... a covered event(s) is determined to be the cause of delay in attainment of full power operation...

COVER (cover of vaccination evaluated rapidly): description of the England and Wales scheme.

PubMed

Begg, N T; Gill, O N; White, J M

1989-03-01

The COVER scheme, a method for the rapid evaluation of vaccine coverage in England and Wales, is described. The primary aim of the scheme is to improve cover by providing health district vaccination programme coordinators with relevant timely information. Quarterly data were obtained from, analysed and promptly fed back to, 126 health districts on cohorts of children who had recently attained the target ages for receiving the selected sentinel vaccines; 18 months for third diphtheria and third pertussis and 2 years for measles. Although the data suggested that vaccination cover is improving, national performance still falls well short of 90%, the 1990 target set by the World Health Organisation for countries in Europe.

Patients' expectations of information provided at cancer hospitals in Japan.

PubMed

Hamajima, N; Tajima, K; Morishita, M; Hyodo, C; Sakakibara, N; Kawai, C; Moritaka, S

1996-10-01

In order to survey patients' views on disease and treatment information that should be provided at hospitals, an anonymous self-administered questionnaire was distributed to patients at Aichi Cancer Center Hospital in 1995. All eligible first-visit outpatients (97 persons), randomly selected revisit outpatients (99 persons; about one in ten refused), and all except six eligible inpatients in good condition at discharge (97 persons) responded. Out of 293 patients (115 males, 174 females and 4 unspecified), 74% answered that they wanted to be informed of their diagnosis irrespective of circumstances, 20% answered that they would want to be informed only in certain circumstances, and 2% did not want to be informed at all. There were no significant differences in response among the three sources of patients. Inpatients wanted more (81%) to be explained about recommended therapy than either first-visit outpatients (67%) or revisit outpatients (67%). The majority considered that about a 30-minute explanation was needed using pamphlet-like written materials or video. When asked what information was needed when choosing a cancer hospital, 71% specified information on the specialty of the hospital, 57% the content of the care provided, 23% the name and specialty of the doctors, 20% the waiting period before scheduled admission, 13% the average admission period, 11% the number of patients with the same disease, 10% the waiting time at the outpatient clinic, 6% the meal menu, and 4% the number of private wards. Forty-three percent wanted an information service covering all hospitals in the region through an information center. The results revealed that patients at this cancer hospital required information on their disease, treatment, and hospital specialty.

Covered Bridge Security Manual

Treesearch

Brett Phares; Terry Wipf; Ryan Sievers; Travis Hosteng

2013-01-01

The design, construction, and use of covered timber bridges is all but a lost art in these days of pre-stressed concrete, high-performance steel, and the significant growth both in the volume and size of vehicles. Furthermore, many of the existing covered timber bridges are preserved only because of their status on the National Registry of Historic Places or the...

Astrobiology of Antarctic ice Covered Lakes

NASA Astrophysics Data System (ADS)

Doran, P. T.; Fritsen, C. H.

2005-12-01

Antarctica contains a number of permanently ice-covered lakes which have often been used as analogs of purported lakes on Mars in the past. Antarctic subglacial lakes, such as Lake Vostok, have also been viewed as excellent analogs for an ice covered ocean on the Jovian moon Europa, and to a lesser extend on Mars. Lakes in the McMurdo Dry Valleys of East Antarctica have ice covers that range from 3 to 20 meters thick. Water salinities range from fresh to hypersaline. The thinner ice-covered lakes have a well-documented ecology that relies on the limited available nutrients and the small amount of light energy that penetrates the ice covers. The thickest ice-covered lake (Lake Vida in Victoria Valley) has a brine beneath 20 m of ice that is 7 times sea water and maintains a temperature below -10 degrees Celsius. This lake is vastly different from the thinner ice-covered lakes in that there is no communication with the atmosphere. The permanent ice cover is so thick, that summer melt waters can not access the sub-ice brine and so the ice grows from the top up, as well as from the bottom down. Brine trapped beneath the ice is believed to be ancient, stranded thousands of years ago when the ice grew thick enough to isolate it from the surface. We view Lake Vida as an excellent analog for the last aquatic ecosystem to have existed on Mars under a planetary cooling. If, as evidence is now increasingly supporting, standing bodies of water existed on Mars in the past, their fate under a cooling would be to go through a stage of permanent ice cover establishment, followed by a thickening of that ice cover until the final stage just prior to a cold extinction would be a Lake Vida-like lake. If dust storms or mass movements covered these ancient lakes, remnants may well be in existence in the subsurface today. A NASA Astrobiology Science and Technology for Exploring Planets (ASTEP) project will drill the Lake Vida ice cover and access the brine and sediments beneath in

Sensitivity of selected landscape pattern metrics to land-cover misclassification and differences in land-cover composition

Treesearch

James D. Wickham; Robert V. O' Neill; Kurt H. Riitters; Timothy G. Wade; K. Bruce Jones

1997-01-01

Calculation of landscape metrics from land-cover data is becoming increasingly common. Some studies have shown that these measurements are sensitive to differences in land-cover composition, but none are known to have tested also their a sensitivity to land-cover misclassification. An error simulation model was written to test the sensitivity of selected land-scape...

A total pleural covering of absorbable cellulose mesh prevents pneumothorax recurrence in patients with Birt-Hogg-Dubé syndrome.

PubMed

Mizobuchi, Teruaki; Kurihara, Masatoshi; Ebana, Hiroki; Yamanaka, Sumitaka; Kataoka, Hideyuki; Okamoto, Shouichi; Kobayashi, Etsuko; Kumasaka, Toshio; Seyama, Kuniaki

2018-05-15

Birt-Hogg-Dubé syndrome (BHDS) is a recently recognized inherited multiple cystic lung disease causing recurrent pneumothoraces. Similarly to the lesions in patients with lymphangioleiomyomatosis (LAM), the pulmonary cysts are innumerable and widely dispersed and cannot all be removed. We recently described a total pleural covering (TPC) that covers the entire visceral pleura with oxidized regenerated cellulose (ORC) mesh. TPC successfully prevented the recurrence of pneumothorax in LAM patients. The purpose of this study was to evaluate the effect of an ORC pleural covering on pneumothorax recurrence in BHDS patients. This retrospective study enrolled a total of 81 pneumothorax patients with the diagnosis of BHDS who underwent 90 covering surgeries from January 2010 to August 2017 at Tamagawa Hospital. During the first half of the study period, a lower pleural covering (LPC) which covered the affected area with ORC mesh was mainly used to treat 38 pneumothoraces. During the second half of the study period, TPC was primarily performed for 52 pneumothoraces. All the thoracoscopic surgeries were successfully performed without serious complications (≥ Clavien-Dindo grade III). The median follow-up periods after LPC/TPC were 66/34 months, respectively. Pneumothorax recurrence rates after LPC at 2.5/5/7.5 years postoperatively were 5.4/12/42%, respectively; none of the patients who had underwent TPC developed postoperative pneumothorax recurrence (P = 0.032). TPC might be an effective option for surgical treatment of intractable pneumothorax in patients with BHDS.

THE ALTERNATIVE COVERS ASSESSMENT PROGRAM (ACAP)

EPA Science Inventory

Alternative covers attempt to achieve equivalent performance to conventional impermeable covers through an action that has been described as 'sponge and pump'. In this type of cover system, the soil and plants absorb moisture from precipitation, store it in the plant and soil str...

Magnet hospital recognition in hospital systems over time.

PubMed

Lasater, Karen B; Richards, Michael R; Dandapani, Nikila B; Burns, Lawton R; McHugh, Matthew D

2017-06-13

Magnet hospitals are recognized for nursing excellence and high-value patient outcomes, yet little is known about which and when hospitals pursue Magnet recognition. Concurrently, hospital systems are becoming a more prominent feature of the U.S. health care landscape. The aim of the study was to examine Magnet adoption among hospital systems over time. Using American Hospital Association surveys (1998-2012), we characterized the proportion of Magnet hospitals belonging to systems. We used hospital level fixed-effects regressions to capture changes in a given system hospital's Magnet status over time in relation to a variety of conditions, including prior Magnet adoption by system affiliates and nonaffiliates in local and geographically distant markets and whether these relationships varied by degree of system centralization. The proportion of Magnet hospitals belonging to a system is increasing. Prior Magnet adoption by a hospital within the local market was associated with an increased likelihood of a given system hospital becoming Magnet, but the effect was larger if there was prior adoption by affiliates (7.4% higher likelihood) versus nonaffiliates (2.7% higher likelihood). Prior adoption by affiliates and nonaffiliates in geographically distant markets had a lesser effect. Hospitals belonging to centralized systems were more reactive to Magnet adoption of nonaffiliate hospitals as compared with those in decentralized systems. Hospital systems take an organizational perspective toward Magnet adoption, whereby more system affiliates achieve Magnet recognition over time. The findings are relevant to health care and nursing administrators and policymakers interested in the diffusion of an empirically supported organizational innovation associated with quality outcomes, particularly in a time of increasing hospital consolidation and system expansion. We identify factors associated with Magnet adoption across system hospitals and demonstrate the importance of

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.

Decentralization in Indonesia: lessons from cost recovery rate of district hospitals.

PubMed

Maharani, Asri; Femina, Devi; Tampubolon, Gindo

2015-07-01

In 1991, Indonesia began a process of decentralization in the health sector which had implications for the country's public hospitals. The public hospitals were given greater authority to manage their own personnel, finance and procurement, with which they were allowed to operate commercial sections in addition to offering public services. These public services are subsidized by the government, although patients still pay certain proportion of fees. The main objectives of health sector decentralization are to increase the ability of public hospitals to cover their costs and to reduce government subsidies. This study investigates the consequences of decentralization on cost recovery rate of public hospitals at district level. We examine five service units (inpatient, outpatient, operating room, laboratory and radiology) in three public hospitals. We find that after 20 years of decentralization, district hospitals still depend on government subsidies, demonstrated by the fact that the cost recovery rate of most service units is less than one. The commercial sections fail to play their role as revenue generator as they are still subsidized by the government. We also find that the bulk of costs are made up of staff salaries and incentives in all units except radiology. As this study constitutes exploratory research, further investigation is needed to find out the reasons behind these results. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Job satisfaction among hospital nurses revisited: a systematic review.

PubMed

Lu, Hong; Barriball, K Louise; Zhang, Xian; While, Alison E

2012-08-01

The current nursing shortage and high turnover is of great concern in many countries because of its impact upon the efficiency and effectiveness of any healthcare delivery system. Recruitment and retention of nurses are persistent problems associated with job satisfaction. To update review paper published in 2005. This paper analyses 100 papers relating to job satisfaction among hospital nurses derived from systematic searches of seven databases covering English and Chinese language publications 1966-2011 (updating the original paper with 46 additional studies published 2004-2011). Despite varying levels of job satisfaction across studies, sources and effects of job satisfaction were similar. Hospital nurse job satisfaction is closely related to working conditions and the organizational environment, job stress, role conflict and ambiguity, role perception and role content, organizational and professional commitment. More research is required to understand the relative importance of the many identified factors relating to job satisfaction of hospital nurses. It is argued that the absence of a robust causal model reflecting moderators or moderator is undermining the development of interventions to improve nurse retention. Copyright © 2011 Elsevier Ltd. All rights reserved.

Land cover trends dataset, 1973-2000

USGS Publications Warehouse

Soulard, Christopher E.; Acevedo, William; Auch, Roger F.; Sohl, Terry L.; Drummond, Mark A.; Sleeter, Benjamin M.; Sorenson, Daniel G.; Kambly, Steven; Wilson, Tamara S.; Taylor, Janis L.; Sayler, Kristi L.; Stier, Michael P.; Barnes, Christopher A.; Methven, Steven C.; Loveland, Thomas R.; Headley, Rachel; Brooks, Mark S.

2014-01-01

The U.S. Geological Survey Land Cover Trends Project is releasing a 1973–2000 time-series land-use/land-cover dataset for the conterminous United States. The dataset contains 5 dates of land-use/land-cover data for 2,688 sample blocks randomly selected within 84 ecological regions. The nominal dates of the land-use/land-cover maps are 1973, 1980, 1986, 1992, and 2000. The land-use/land-cover maps were classified manually from Landsat Multispectral Scanner, Thematic Mapper, and Enhanced Thematic Mapper Plus imagery using a modified Anderson Level I classification scheme. The resulting land-use/land-cover data has a 60-meter resolution and the projection is set to Albers Equal-Area Conic, North American Datum of 1983. The files are labeled using a standard file naming convention that contains the number of the ecoregion, sample block, and Landsat year. The downloadable files are organized by ecoregion, and are available in the ERDAS IMAGINETM (.img) raster file format.

Economic factors affecting head and neck reconstructive microsurgery: the surgeons' and hospital's perspective.

PubMed

Deleyiannis, Frederic W-B; Porter, Andrew C

2007-07-01

The purpose of this study was to determine the relative financial value of providing the service of free-tissue transfer for head and neck reconstruction from the surgeons' and hospital's perspective. Medical and hospital accounting records of 58 consecutive patients undergoing head and neck resections and simultaneous free-flap reconstruction were reviewed. Software from the Center for Medicare and Medicaid Services was used to calculate anticipated Medicare payments to the surgeon based on current procedural terminology codes and to the hospital based on diagnosis-related group codes. The mean actual payment to the surgeon for a free flap was $2300.60. This payment was 91.6 percent ($2300 out of $2510) of the calculated payment if all payments had been reimbursed by Medicare. Total charges and total payment to the hospital for the 58 patients were $19,148,852 and $2,765,552, respectively. After covering direct costs, total hospital revenue (i.e., margin) was $1,056,886. The mostly commonly assigned diagnosis-related group code was 482 (n = 35). According to the fee schedule for that code, if Medicare had been the insurance plan for these 35 patients, the mean payment to the hospital would have been $45,840. The actual mean hospital payment was $44,133. This actual hospital payment represents 96 percent of the calculated Medicare hospital payment ($44,133 of $45,840). Free-flap reconstruction of the head and neck generates substantial revenue for the hospital. For their mutual benefit, hospitals should join with physicians in contract negotiations of physician reimbursement with insurance companies. Bolstered reimbursement figures would better attract and retain skilled surgeons dedicated to microvascular reconstruction.

Continental estimates of forest cover and forest cover changes in the dry ecosystems of Africa between 1990 and 2000

PubMed Central

Bodart, Catherine; Brink, Andreas B; Donnay, François; Lupi, Andrea; Mayaux, Philippe; Achard, Frédéric

2013-01-01

Aim This study provides regional estimates of forest cover in dry African ecoregions and the changes in forest cover that occurred there between 1990 and 2000, using a systematic sample of medium-resolution satellite imagery which was processed consistently across the continent. Location The study area corresponds to the dry forests and woodlands of Africa between the humid forests and the semi-arid regions. This area covers the Sudanian and Zambezian ecoregions. Methods A systematic sample of 1600 Landsat satellite imagery subsets, each 20 km × 20 km in size, were analysed for two reference years: 1990 and 2000. At each sample site and for both years, dense tree cover, open tree cover, other wooded land and other vegetation cover were identified from the analysis of satellite imagery, which comprised multidate segmentation and automatic classification steps followed by visual control by national forestry experts. Results Land cover and land-cover changes were estimated at continental and ecoregion scales and compared with existing pan-continental, regional and local studies. The overall accuracy of our land-cover maps was estimated at 87%. Between 1990 and 2000, 3.3 million hectares (Mha) of dense tree cover, 5.8 Mha of open tree cover and 8.9 Mha of other wooded land were lost, with a further 3.9 Mha degraded from dense to open tree cover. These results are substantially lower than the 34 Mha of forest loss reported in the FAO's 2010 Global Forest Resources Assessment for the same period and area. Main conclusions Our method generates the first consistent and robust estimates of forest cover and change in dry Africa with known statistical precision at continental and ecoregion scales. These results reduce the uncertainty regarding vegetation cover and its dynamics in these previously poorly studied ecosystems and provide crucial information for both science and environmental policies. PMID:23935237

49 CFR 193.2167 - Covered systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 3 2013-10-01 2013-10-01 false Covered systems. 193.2167 Section 193.2167...: FEDERAL SAFETY STANDARDS Design Impoundment Design and Capacity § 193.2167 Covered systems. A covered impounding system is prohibited except for concrete wall designed tanks where the concrete wall is an outer...

49 CFR 193.2167 - Covered systems.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 3 2011-10-01 2011-10-01 false Covered systems. 193.2167 Section 193.2167...: FEDERAL SAFETY STANDARDS Design Impoundment Design and Capacity § 193.2167 Covered systems. A covered impounding system is prohibited except for concrete wall designed tanks where the concrete wall is an outer...

49 CFR 193.2167 - Covered systems.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 3 2012-10-01 2012-10-01 false Covered systems. 193.2167 Section 193.2167...: FEDERAL SAFETY STANDARDS Design Impoundment Design and Capacity § 193.2167 Covered systems. A covered impounding system is prohibited except for concrete wall designed tanks where the concrete wall is an outer...

A globally complete map of supraglacial debris cover and a new toolkit for debris cover research

NASA Astrophysics Data System (ADS)

Herreid, Sam; Pellicciotti, Francesca

2017-04-01

A growing canon of literature is focused on resolving the processes and implications of debris cover on glaciers. However, this work is often confined to a handful of glaciers that were likely selected based on criteria optimizing their suitability to test a specific hypothesis or logistical ease. The role of debris cover in a glacier system is likely to not go overlooked in forthcoming research, yet the magnitude of this role at a global scale has not yet been fully described. Here, we present a map of debris cover for all glacierized regions on Earth including the Greenland Ice Sheet using 30 m Landsat data. This dataset will begin to open a wider context to the high quality, localized findings from the debris-covered glacier research community and help inform large-scale modeling efforts. A global map of debris cover also facilitates analysis attempting to isolate first order geomorphological and climate controls of supraglacial debris production. Furthering the objective of expanding the inclusion of debris cover in forthcoming research, we also present an under development suite of open-source, Python based tools. Requiring minimal and often freely available input data, we have automated the mapping of: i) debris cover, ii) ice cliffs, iii) debris cover evolution over the Landsat era and iv) glacier flow instabilities from altered debris structures. At the present time, debris extent is the only globally complete quantity but with the expanding repository of high quality global datasets and further tool development minimizing manual tasks and computational cost, we foresee all of these tools being applied globally in the near future.

[Decrease in hospitalizations due to polyvalent medical day hospital].

PubMed

Escobar, M A; García-Egido, A A; Carmona, R; Lucas, A; Márquez, C; Gómez, F

2012-02-01

The day hospital is an alternative to hospitalization. This alternative improves accessibility and comfort of the patients, and avoids hospitalizations. Nevertheless, the efficacy of the polyvalent medical day hospital in avoiding hospitalizations has not been evaluated. To analyze hospital stays avoided by the polyvalent medical day hospital of a university hospital of the Andalusian Health Service. An observational prospective study of the patients studied and/or treated in the polyvalent medical day hospital of the Hospital Universitario Puerto Real over a one year period. A total of 9640 patients were attended to, with 1413 procedures and 4921 i.v. treatments. There were 3182 visits to the priority consultation of the polyvalent medical day hospital. The most frequent consultation complaints were constitutional symptoms (15.9%) and anemia (14.5%). After the first visit, 21.5% of the patients were discharged and fewer than 3% were hospitalized. Hospitalization was avoided in 16.8% of the patients, there being a 6.0% decrease in the need for hospital beds (5.0% reduction in the internal medicine unit). Inadequate hospitalizations and 30-day readmissions decreased 93.3% and 4.2%, respectively. The most frequent diagnosis was neoplasm (26.0%), and most of the beds freed up were generated by patients diagnosed of neoplasm (26.7%). With this type of polyvalent medical day hospital, we have observed improved efficiency of health care, freeing up hospital beds by reducing hospitalizations, inadequate hospitalizations and re-admissions in the medical units involved. Copyright © 2011 Elsevier España, S.L. All rights reserved.

78 FR 28121 - Lamb Promotion, Research, and Information Order; Amendment to the Order To Raise the Assessment Rate

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-14

... advertising, retail promotions, public relations campaigns and media outreach, foodservice programs, consumer.... Comments On June 12, 2012, the Department published in the Federal Register (77 FR 34868) for public...

29 CFR 1918.31 - Hatch coverings.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 7 2011-07-01 2011-07-01 false Hatch coverings. 1918.31 Section 1918.31 Labor Regulations...) SAFETY AND HEALTH REGULATIONS FOR LONGSHORING Working Surfaces § 1918.31 Hatch coverings. (a) No cargo... partially opened intermediate deck unless either the hatch at that deck is sufficiently covered or an...

29 CFR 1918.31 - Hatch coverings.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 7 2010-07-01 2010-07-01 false Hatch coverings. 1918.31 Section 1918.31 Labor Regulations...) SAFETY AND HEALTH REGULATIONS FOR LONGSHORING Working Surfaces § 1918.31 Hatch coverings. (a) No cargo... partially opened intermediate deck unless either the hatch at that deck is sufficiently covered or an...

29 CFR 1918.31 - Hatch coverings.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 7 2013-07-01 2013-07-01 false Hatch coverings. 1918.31 Section 1918.31 Labor Regulations...) SAFETY AND HEALTH REGULATIONS FOR LONGSHORING Working Surfaces § 1918.31 Hatch coverings. (a) No cargo... partially opened intermediate deck unless either the hatch at that deck is sufficiently covered or an...

29 CFR 1918.31 - Hatch coverings.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 7 2014-07-01 2014-07-01 false Hatch coverings. 1918.31 Section 1918.31 Labor Regulations...) SAFETY AND HEALTH REGULATIONS FOR LONGSHORING Working Surfaces § 1918.31 Hatch coverings. (a) No cargo... partially opened intermediate deck unless either the hatch at that deck is sufficiently covered or an...

29 CFR 1918.31 - Hatch coverings.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 7 2012-07-01 2012-07-01 false Hatch coverings. 1918.31 Section 1918.31 Labor Regulations...) SAFETY AND HEALTH REGULATIONS FOR LONGSHORING Working Surfaces § 1918.31 Hatch coverings. (a) No cargo... partially opened intermediate deck unless either the hatch at that deck is sufficiently covered or an...

Managing cover crops: an economic perspective

USDA-ARS?s Scientific Manuscript database

Common reasons given by producers as to why they do not adopt cover crops are related to economics: time, labor, and cost required for planting and managing cover crops. While many of the agronomic benefits of cover crops directly relate to economics, there are costs associated with adopting the pra...

VEGETATIVE COVERS FOR WASTE CONTAINMENT

EPA Science Inventory

Disposal of municipal ahd hazardous waste in the United States is primarily accomplished by containment in lined and capped landfills. Evapotranspiration cover systems offer an alternative to conventional landfill cap systems. These covers work on completely different principles ...

Snow cover in the Siberian forest-steppe

NASA Technical Reports Server (NTRS)

Zykov, I. V.

1985-01-01

A study is made of the snow cover on an experimental agricultural station in Mariinsk in the winter of 1945 to 1946. Conditions of snow cover formation, and types and indicators of snow cover are discussed. Snow cover structure and conditions and nature of thawing are described.

10 CFR 950.22 - Covered event determination.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Covered event determination. 950.22 Section 950.22 Energy... Covered event determination. (a) Completeness review. Upon notification of a covered event from the... with paragraph (c) of this section. (b) Covered Event Determination. The Claims Administrator shall...

10 CFR 950.22 - Covered event determination.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Covered event determination. 950.22 Section 950.22 Energy... Covered event determination. (a) Completeness review. Upon notification of a covered event from the... with paragraph (c) of this section. (b) Covered Event Determination. The Claims Administrator shall...

10 CFR 950.22 - Covered event determination.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Covered event determination. 950.22 Section 950.22 Energy... Covered event determination. (a) Completeness review. Upon notification of a covered event from the... with paragraph (c) of this section. (b) Covered Event Determination. The Claims Administrator shall...

10 CFR 950.22 - Covered event determination.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Covered event determination. 950.22 Section 950.22 Energy... Covered event determination. (a) Completeness review. Upon notification of a covered event from the... with paragraph (c) of this section. (b) Covered Event Determination. The Claims Administrator shall...

10 CFR 950.22 - Covered event determination.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Covered event determination. 950.22 Section 950.22 Energy... Covered event determination. (a) Completeness review. Upon notification of a covered event from the... with paragraph (c) of this section. (b) Covered Event Determination. The Claims Administrator shall...

An information hidden model holding cover distributions

NASA Astrophysics Data System (ADS)

Fu, Min; Cai, Chao; Dai, Zuxu

2018-03-01

The goal of steganography is to embed secret data into a cover so no one apart from the sender and intended recipients can find the secret data. Usually, the way the cover changing was decided by a hidden function. There were no existing model could be used to find an optimal function which can greatly reduce the distortion the cover suffered. This paper considers the cover carrying secret message as a random Markov chain, taking the advantages of a deterministic relation between initial distributions and transferring matrix of the Markov chain, and takes the transferring matrix as a constriction to decrease statistical distortion the cover suffered in the process of information hiding. Furthermore, a hidden function is designed and the transferring matrix is also presented to be a matrix from the original cover to the stego cover. Experiment results show that the new model preserves a consistent statistical characterizations of original and stego cover.

Land Cover Characterization Program

USGS Publications Warehouse

,

1997-01-01

(2) identify sources, develop procedures, and organize partners to deliver data and information to meet user requirements. The LCCP builds on the heritage and success of previous USGS land use and land cover programs and projects. It will be compatible with current concepts of government operations, the changing needs of the land use and land cover data users, and the technological tools with which the data are applied.

WATER COOLED RETORT COVER

DOEpatents

Ash, W.J.; Pozzi, J.F.

1962-05-01

A retort cover is designed for use in the production of magnesium metal by the condensation of vaporized metal on a collecting surface. The cover includes a condensing surface, insulating means adjacent to the condensing surface, ind a water-cooled means for the insulating means. The irrangement of insulation and the cooling means permits the magnesium to be condensed at a high temperature and in massive nonpyrophoric form. (AEC)

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.

The key to health services in Turkey: new perspectives on leadership and hospital management.

PubMed

Sahin, Alper A

2014-01-01

Health services are one of the most important criteria for making a country function. Turkey has mobilized all of its resources to provide high-quality, easily accessible and patient-friendly services for its population. To achieve this aim, the Turkish health care system has been undergoing a significant transformation through its Health Transformation Programme begun in 2005. The reforms focus on the introduction of a general health insurance system, changing hospital health services, improvements in hospital management and transformational leadership skills. Firstly, all state-run hospitals in the country were merged under the same umbrella, giving millions of people covered by the national security agency access to all of these hospitals. Secondly, all drugs and medical equipment used by patients were made free of charge. Thanks to these developments, hospitals were modernized, and this modernization process in the health sector is still continuing swiftly. On the other hand, for Turkish hospitals to survive, they need to modernize further and become closer to European models, and produce new leaders with new paradigms. In this new and changing health system, hospital leaders and executive officers should be visionaries and strategists advising when to change direction. Following this doctrine, most Turkish hospitals are now run by two top executives: the hospital manager and the chief executive officer who is in charge of business functions. These executives should clearly be the leaders of high-quality, health care organizations.

On numerically pluricanonical cyclic coverings

NASA Astrophysics Data System (ADS)

Kulikov, V. S.; Kharlamov, V. M.

2014-10-01

We investigate some properties of cyclic coverings f\\colon Y\\to X (where X is a complex surface of general type) branched along smooth curves B\\subset X that are numerically equivalent to a multiple of the canonical class of X. Our main results concern coverings of surfaces of general type with p_g=0 and Miyaoka-Yau surfaces. In particular, such coverings provide new examples of multi-component moduli spaces of surfaces with given Chern numbers and new examples of surfaces that are not deformation equivalent to their complex conjugates.

Exclusive contracts in the hospital setting: a two-edged sword: part 2: pros and cons, avoidance strategies, and negotiating tips.

PubMed

Portman, Robert M

2007-06-01

Hospitals routinely enter into contracts with radiology groups for the right to be the exclusive providers of radiologic services at the facilities in exchange for the groups' agreeing to provide and manage all aspects of those services within the hospitals. These exclusive contracts generally result in radiology departments and associated equipment being closed off to physicians who are not part of the contracting groups. Although exclusive contracts offer obvious benefits to the physicians who receive them and obvious disadvantages for those who are excluded, they also present pitfalls for physicians in the chosen group. Part 1 of this article discussed the legal issues raised by exclusive contracts. Part 2 weighs the practical advantages and disadvantages of exclusive contracts for physicians covered and not covered by such contracts and strategies for avoiding them, as well as provisions that can be included in medical staff bylaws to protect physicians from the automatic termination of privileges when a hospital enters into or terminates an exclusive contract. The remainder of the article provides tips on specific provisions of exclusive contracts that should be included or avoided.

Association Between the 2014 Medicaid Expansion and US Hospital Finances.

PubMed

Blavin, Fredric

2016-10-11

The Affordable Care Act expanded Medicaid eligibility for millions of low-income adults. The choice for states to expand Medicaid could affect the financial health of hospitals by decreasing the proportion of patient volume and unreimbursed expenses attributable to uninsured patients while increasing revenue from newly covered patients. To estimate the association between the Medicaid expansion in 2014 and hospital finances by assessing differences between hospitals in states that expanded Medicaid and in those states that did not expand Medicaid. Observational study with analysis of data for nonfederal general medical or surgical hospitals in fiscal years 2011 through 2014, using data from the American Hospital Association Annual Survey and the Health Care Cost Report Information System from the US Centers for Medicare & Medicaid Services. Multivariable difference-in-difference regression analyses were used to compare states with Medicaid expansion with states without Medicaid expansion. Hospitals in states that expanded Medicaid eligibility before January 2014 were excluded. Medicaid expansion in 2014, accounting for variation in fiscal year start dates. Hospital-reported information on uncompensated care, uncompensated care as a percentage of total hospital expenses, Medicaid revenue, Medicaid as a percentage of total revenue, operating margins, and excess margins. The sample included between 1200 and 1400 hospitals per fiscal year in 19 states with Medicaid expansion and between 2200 and 2400 hospitals per fiscal year in 25 states without Medicaid expansion (with sample size varying depending on the outcome measured). Expansion of Medicaid was associated with a decline of $2.8 million (95% CI, -$4.1 to -$1.6 million; P < .001) in mean annual uncompensated care costs per hospital. Hospitals in states with Medicaid expansion experienced a $3.2 million increase (95% CI, $0.9 to $5.6 million; P = .008) in mean annual Medicaid revenue per hospital, relative

A comparative analysis of the Global Land Cover 2000 and MODIS land cover data sets

USGS Publications Warehouse

Giri, C.; Zhu, Z.; Reed, B.

2005-01-01

Accurate and up-to-date global land cover data sets are necessary for various global change research studies including climate change, biodiversity conservation, ecosystem assessment, and environmental modeling. In recent years, substantial advancement has been achieved in generating such data products. Yet, we are far from producing geospatially consistent high-quality data at an operational level. We compared the recently available Global Land Cover 2000 (GLC-2000) and MODerate resolution Imaging Spectrometer (MODIS) global land cover data to evaluate the similarities and differences in methodologies and results, and to identify areas of spatial agreement and disagreement. These two global land cover data sets were prepared using different data sources, classification systems, and methodologies, but using the same spatial resolution (i.e., 1 km) satellite data. Our analysis shows a general agreement at the class aggregate level except for savannas/shrublands, and wetlands. The disagreement, however, increases when comparing detailed land cover classes. Similarly, percent agreement between the two data sets was found to be highly variable among biomes. The identified areas of spatial agreement and disagreement will be useful for both data producers and users. Data producers may use the areas of spatial agreement for training area selection and pay special attention to areas of disagreement for further improvement in future land cover characterization and mapping. Users can conveniently use the findings in the areas of agreement, whereas users might need to verify the informaiton in the areas of disagreement with the help of secondary information. Learning from past experience and building on the existing infrastructure (e.g., regional networks), further research is necessary to (1) reduce ambiguity in land cover definitions, (2) increase availability of improved spatial, spectral, radiometric, and geometric resolution satellite data, and (3) develop advanced

Specialty hospital market proliferation: Strategic implications for general hospitals.

PubMed

Al-Amin, Mona; Zinn, Jacqueline; Rosko, Michael D; Aaronson, William

2010-01-01

Since the early 1990s, specialty hospitals have been continuously increasing in number. A moratorium was passed in 2003 that prohibited physicians' referrals of Medicare patients to newly established specialty hospitals if the physician has ownership stakes in the hospital. Although this moratorium expired in effect in 2007, many are still demanding that the government pass new policies to discourage the proliferation of specialty hospitals. This study aimed at examining the regulatory and environmental forces that influence specialty hospitals founding rate. Specifically, we use the resource partitioning theory to investigate the relationship between general hospitals closure rates and the market entry of specialty hospitals. This study will help managers of general hospitals in their strategic thinking and planning. We rely on secondary data resources, which include the American Hospital Association, Area Resource file, census, and Center for Medicare and Medicaid Services data, to perform a longitudinal analysis of the founding rate of specialty hospital in the 48 states. Specifically, we use the negative binomial generalized estimating equation approach available through Stata 9.0 to study the effect of general hospitals closure rate and environmental variables on the proliferation of specialty hospitals. Specialty hospitals founding rate seems to be significantly related to general hospitals closure rates. Moreover, results indicate that economic, supply, regulatory, and financial conditions determine the founding rate of specialty hospitals in different states. The results from this study indicate that the closure of general hospitals creates market conditions that encourage the market entry of specialized health care delivery forms such as specialty hospitals. Managers of surviving general hospitals have to view the closure of other general hospitals not just as an opportunity to increase market share but also as a threat of competition from new forms of

49 CFR 826.3 - Proceedings covered.

Code of Federal Regulations, 2014 CFR

2014-10-01

....” For the Board, the type of proceeding covered includes (but may not be limited to) aviation enforcement cases appealed to the Board under sections 501, 609, 611 and 901 of the Federal Aviation Act (49 U... believes the proceeding is covered by the Act; whether the procedure is covered will then be an issue for...

49 CFR 826.3 - Proceedings covered.

Code of Federal Regulations, 2013 CFR

2013-10-01

....” For the Board, the type of proceeding covered includes (but may not be limited to) aviation enforcement cases appealed to the Board under sections 501, 609, 611 and 901 of the Federal Aviation Act (49 U... believes the proceeding is covered by the Act; whether the procedure is covered will then be an issue for...

Developed land cover of Puerto Rico

Treesearch

William A. Gould; Sebastian Martinuzzi; Olga M. Ramos Gonzalez

2008-01-01

This map shows the distribution of developed land cover in Puerto Rico (Martinuzzi et al. 2007). Developed land cover refers to urban, built-up and non-vegetated areas that result from human activity. These typically include built structures, concrete, asphalt, and other infrastructure. The developed land cover was estimated using Landsat 7 ETM+ satellite images pan...

21 CFR 880.6185 - Cast cover.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cast cover. 880.6185 Section 880.6185 Food and....6185 Cast cover. (a) Identification. A cast cover is a device intended for medical purposes that is made of waterproof material and placed over a cast to protect it from getting wet during a shower or a...

Measuring and analyzing urban tree cover

Treesearch

David J. Nowak; Rowan A. Rowntree; E. Gregory McPherson; Susan M. Sisinni; Esther R. Kirkmann; Jack C. Stevens

1996-01-01

Measurement of city tree cover can aid in urban vegetation planning, management, and research by revealing characteristics of vegetation across a city. Urban tree cover in the United States ranges from 0.4% in Lancaster, California, to 55% in Baton Rouge, Louisiana. Two important factors that affect the amount of urban tree cover are the natural environment and land...

Quantization of noncompact coverings and its physical applications

NASA Astrophysics Data System (ADS)

Ivankov, Petr

2018-02-01

A rigorous algebraic definition of noncommutative coverings is developed. In the case of commutative algebras this definition is equivalent to the classical definition of topological coverings of locally compact spaces. The theory has following nontrivial applications: • Coverings of continuous trace algebras, • Coverings of noncommutative tori, • Coverings of the quantum SU(2) group, • Coverings of foliations, • Coverings of isospectral deformations of Spin - manifolds. The theory supplies the rigorous definition of noncommutative Wilson lines.

21 CFR 882.5250 - Burr hole cover.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Burr hole cover. 882.5250 Section 882.5250 Food... DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5250 Burr hole cover. (a) Identification. A burr hole cover is a plastic or metal device used to cover or plug holes drilled into the skull...

21 CFR 882.5250 - Burr hole cover.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Burr hole cover. 882.5250 Section 882.5250 Food... DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5250 Burr hole cover. (a) Identification. A burr hole cover is a plastic or metal device used to cover or plug holes drilled into the skull...

21 CFR 882.5250 - Burr hole cover.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Burr hole cover. 882.5250 Section 882.5250 Food... DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5250 Burr hole cover. (a) Identification. A burr hole cover is a plastic or metal device used to cover or plug holes drilled into the skull...

Estimated reductions in hospitalizations and deaths from childhood diarrhea following implementation of rotavirus vaccination in Africa.

PubMed

Shah, Minesh P; Tate, Jacqueline E; Mwenda, Jason M; Steele, A Duncan; Parashar, Umesh D

2017-10-01

Rotavirus is the leading cause of hospitalizations and deaths from diarrhea. 33 African countries had introduced rotavirus vaccines by 2016. We estimate reductions in rotavirus hospitalizations and deaths for countries using rotavirus vaccination in national immunization programs and the potential of vaccine introduction across the continent. Areas covered: Regional rotavirus burden data were reviewed to calculate hospitalization rates, and applied to under-5 population to estimate baseline hospitalizations. Rotavirus mortality was based on 2013 WHO estimates. Regional pre-licensure vaccine efficacy and post-introduction vaccine effectiveness studies were used to estimate summary effectiveness, and vaccine coverage was applied to calculate prevented hospitalizations and deaths. Uncertainties around input parameters were propagated using boot-strapping simulations. In 29 African countries that introduced rotavirus vaccination prior to end 2014, 134,714 (IQR 112,321-154,654) hospitalizations and 20,986 (IQR 18,924-22,822) deaths were prevented in 2016. If all African countries had introduced rotavirus vaccines at benchmark immunization coverage, 273,619 (47%) (IQR 227,260-318,102) hospitalizations and 47,741 (39%) (IQR 42,822-52,462) deaths would have been prevented. Expert commentary: Rotavirus vaccination has substantially reduced hospitalizations and deaths in Africa; further reductions are anticipated as additional countries implement vaccination. These estimates bolster wider introduction and continued support of rotavirus vaccination programs.

Midwest Cover Crops Field Guide

USDA-ARS?s Scientific Manuscript database

Producers who want to prevent soil erosion, improve nutrient cycling, sustain their soils, and protect/maintain the environment have been returning to a very old practice: planting cover crops. Cover crops are effective tools for reducing soil erosion and increasing nutrient recycling on farmlands, ...

Assessing uncertainties in land cover projections.

PubMed

Alexander, Peter; Prestele, Reinhard; Verburg, Peter H; Arneth, Almut; Baranzelli, Claudia; Batista E Silva, Filipe; Brown, Calum; Butler, Adam; Calvin, Katherine; Dendoncker, Nicolas; Doelman, Jonathan C; Dunford, Robert; Engström, Kerstin; Eitelberg, David; Fujimori, Shinichiro; Harrison, Paula A; Hasegawa, Tomoko; Havlik, Petr; Holzhauer, Sascha; Humpenöder, Florian; Jacobs-Crisioni, Chris; Jain, Atul K; Krisztin, Tamás; Kyle, Page; Lavalle, Carlo; Lenton, Tim; Liu, Jiayi; Meiyappan, Prasanth; Popp, Alexander; Powell, Tom; Sands, Ronald D; Schaldach, Rüdiger; Stehfest, Elke; Steinbuks, Jevgenijs; Tabeau, Andrzej; van Meijl, Hans; Wise, Marshall A; Rounsevell, Mark D A

2017-02-01

Understanding uncertainties in land cover projections is critical to investigating land-based climate mitigation policies, assessing the potential of climate adaptation strategies and quantifying the impacts of land cover change on the climate system. Here, we identify and quantify uncertainties in global and European land cover projections over a diverse range of model types and scenarios, extending the analysis beyond the agro-economic models included in previous comparisons. The results from 75 simulations over 18 models are analysed and show a large range in land cover area projections, with the highest variability occurring in future cropland areas. We demonstrate systematic differences in land cover areas associated with the characteristics of the modelling approach, which is at least as great as the differences attributed to the scenario variations. The results lead us to conclude that a higher degree of uncertainty exists in land use projections than currently included in climate or earth system projections. To account for land use uncertainty, it is recommended to use a diverse set of models and approaches when assessing the potential impacts of land cover change on future climate. Additionally, further work is needed to better understand the assumptions driving land use model results and reveal the causes of uncertainty in more depth, to help reduce model uncertainty and improve the projections of land cover. © 2016 John Wiley & Sons Ltd.

Development and implementation of a human accuracy program in patient foodservice.

PubMed

Eden, S H; Wood, S M; Ptak, K M

1987-04-01

For many years, industry has utilized the concept of human error rates to monitor and minimize human errors in the production process. A consistent quality-controlled product increases consumer satisfaction and repeat purchase of product. Administrative dietitians have applied the concepts of using human error rates (the number of errors divided by the number of opportunities for error) at four hospitals, with a total bed capacity of 788, within a tertiary-care medical center. Human error rate was used to monitor and evaluate trayline employee performance and to evaluate layout and tasks of trayline stations, in addition to evaluating employees in patient service areas. Long-term employees initially opposed the error rate system with some hostility and resentment, while newer employees accepted the system. All employees now believe that the constant feedback given by supervisors enhances their self-esteem and productivity. Employee error rates are monitored daily and are used to counsel employees when necessary; they are also utilized during annual performance evaluation. Average daily error rates for a facility staffed by new employees decreased from 7% to an acceptable 3%. In a facility staffed by long-term employees, the error rate increased, reflecting improper error documentation. Patient satisfaction surveys reveal satisfaction, for tray accuracy increased from 88% to 92% in the facility staffed by long-term employees and has remained above the 90% standard in the facility staffed by new employees.

Modeling of Passive Forces of Machine Tool Covers

NASA Astrophysics Data System (ADS)

Kolar, Petr; Hudec, Jan; Sulitka, Matej

The passive forces acting against the drive force are phenomena that influence dynamical properties and precision of linear axes equipped with feed drives. Covers are one of important sources of passive forces in machine tools. The paper describes virtual evaluation of cover passive forces using the cover complex model. The model is able to compute interaction between flexible cover segments and sealing wiper. The result is deformation of cover segments and wipers which is used together with measured friction coefficient for computation of cover total passive force. This resulting passive force is dependent on cover position. Comparison of computational results and measurement on the real cover is presented in the paper.

Hospital Readmission Risk: Isolating Hospital from Patient Effects

PubMed Central

Krumholz, Harlan M.; Wang, Kun; Lin, Zhenqiu; Dharmarajan, Kumar; Horwitz, Leora I.; Ross, Joseph S.; Drye, Elizabeth E.; Bernheim, Susannah M.; Normand, Sharon-Lise T.

2017-01-01

Background To isolate hospital effects on hospitals’ risk-standardized readmission rates, we examined readmission outcomes among patients with multiple admissions for a similar diagnosis at >1 hospital within a given year. Methods We divided the Centers for Medicare & Medicaid Services hospital-wide readmission measure cohort from July 2014–June 2015 into 2 random samples. We used the first sample to calculate each hospital’s risk-standardized readmission rate and classified hospitals into performance quartiles. In the second sample, we identified patients with 2 admissions for similar diagnoses at different hospitals that occurred more than a month and less than a year apart, and compared observed readmission rates for those admitted to hospitals in different performance quartiles. Results In the sample used to characterize hospital performance, the median risk-standardized readmission rate was 15.5% (IQR 15.3%–15.8%). The other sample included 37,508 patients with 2 admissions for similar diagnoses at 4,272 different hospitals. The observed readmission rate was consistently higher when patients were admitted to hospitals in the worse performing quartile, but the only statistically significant difference was observed when the same patients were admitted to hospitals in the best and worst performing quartiles, in which the absolute readmission rate difference was 1.95 percentage points (95% CI, 0.39%–3.50%). Conclusions When the same patients were admitted with similar diagnoses to hospitals in the best performing quartile compared with the worst performing quartile for hospital readmission performance, there is a significant difference in rates of readmission within 30 days. The findings suggest that hospital quality contributes in part to readmission rates independent of patient factors. PMID:28902587

Risk of hospitalization and death following prostate biopsy in Scotland.

PubMed

Brewster, D H; Fischbacher, C M; Nolan, J; Nowell, S; Redpath, D; Nabi, G

2017-01-01

To investigate the risk of hospitalization and death following prostate biopsy. Retrospective cohort study. Our study population comprised 10,285 patients with a record of first ever prostate biopsy between 2009 and 2013 on computerized acute hospital discharge or outpatient records covering Scotland. Using the general population as a comparison group, expected numbers of admissions/deaths were derived by applying age-, sex-, deprivation category-, and calendar year-specific rates of hospital admissions/deaths to the study population. Indirectly standardized hospital admission ratios (SHRs) and mortality ratios (SMRs) were calculated by dividing the observed numbers of admissions/deaths by expected numbers. Compared with background rates, patients were more likely to be admitted to hospital within 30 days (SHR 2.7; 95% confidence interval 2.4, 2.9) and 120 days (SHR 4.0; 3.8, 4.1) of biopsy. Patients with prior co-morbidity had higher SHRs. The risk of death within 30 days of biopsy was not increased significantly (SMR 1.6; 0.9, 2.7), but within 120 days, the risk of death was significantly higher than expected (SMR 1.9; 1.5, 2.4). The risk of death increased with age and tended to be higher among patients with prior co-morbidity. Overall risks of hospitalization and of death up to 120 days were increased both in men diagnosed and those not diagnosed with prostate cancer. Higher rates of adverse events in older patients and patients with prior co-morbidity emphasizes the need for careful patient selection for prostate biopsy and justifies ongoing efforts to minimize the risk of complications. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Regulatory guidance on soil cover systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kane, J.D.

1991-12-31

The US Nuclear Regulatory Commission (NRC) in September 1991, completed revisions to 14 sections of the Standard Review Plan (SRP) for the Review of a License Application for a Low-Level Radioactive Waste Disposal Facility. The major purposes of the SRP are to ensure the quality and uniformity of the NRC staff`s safety reviews, and to present a well-defined base from which to evaluate the acceptability of information and data provided in the Safety Analysis Report (SAR) portion of the license application. SRP 3.2, entitled, Design Considerations for Normal and Abnormal/Accident Conditions, was one of the sections that was revised bymore » the NRC staff. This revision was completed to provide additional regulatory guidance on the important considerations that need to be addressed for the proper design and construction of soil cover systems that are to be placed over the LLW. The cover system over the waste is acknowledged to be one of the most important engineered barriers for the long-term stable performance of the disposal facility. The guidance in revised SRP 3.2 summarizes the previous efforts and recommendations of the US Army Corps of Engineers (COE), and a peer review panel on the placement of soil cover systems. NRC published these efforts in NUREG/CR-5432. The discussions in this paper highlight selected recommendations on soil cover issues that the NRC staff considers important for ensuring the safe, long-term performance of the soil cover systems. The development phases to be discussed include: (1) cover design; (2) cover material selection; (3) laboratory and field testing; (4) field placement control and acceptance; and (5) penetrations through the constructed covers.« less

Hospital Standardized Mortality Ratios: Sensitivity Analyses on the Impact of Coding

PubMed Central

Bottle, Alex; Jarman, Brian; Aylin, Paul

2011-01-01

Introduction Hospital standardized mortality ratios (HSMRs) are derived from administrative databases and cover 80 percent of in-hospital deaths with adjustment for available case mix variables. They have been criticized for being sensitive to issues such as clinical coding but on the basis of limited quantitative evidence. Methods In a set of sensitivity analyses, we compared regular HSMRs with HSMRs resulting from a variety of changes, such as a patient-based measure, not adjusting for comorbidity, not adjusting for palliative care, excluding unplanned zero-day stays ending in live discharge, and using more or fewer diagnoses. Results Overall, regular and variant HSMRs were highly correlated (ρ > 0.8), but differences of up to 10 points were common. Two hospitals were particularly affected when palliative care was excluded from the risk models. Excluding unplanned stays ending in same-day live discharge had the least impact despite their high frequency. The largest impacts were seen when capturing postdischarge deaths and using just five high-mortality diagnosis groups. Conclusions HSMRs in most hospitals changed by only small amounts from the various adjustment methods tried here, though small-to-medium changes were not uncommon. However, the position relative to funnel plot control limits could move in a significant minority even with modest changes in the HSMR. PMID:21790587

Utilizing Multiple Datasets for Snow Cover Mapping

NASA Technical Reports Server (NTRS)

Tait, Andrew B.; Hall, Dorothy K.; Foster, James L.; Armstrong, Richard L.

1999-01-01

Snow-cover maps generated from surface data are based on direct measurements, however they are prone to interpolation errors where climate stations are sparsely distributed. Snow cover is clearly discernable using satellite-attained optical data because of the high albedo of snow, yet the surface is often obscured by cloud cover. Passive microwave (PM) data is unaffected by clouds, however, the snow-cover signature is significantly affected by melting snow and the microwaves may be transparent to thin snow (less than 3cm). Both optical and microwave sensors have problems discerning snow beneath forest canopies. This paper describes a method that combines ground and satellite data to produce a Multiple-Dataset Snow-Cover Product (MDSCP). Comparisons with current snow-cover products show that the MDSCP draws together the advantages of each of its component products while minimizing their potential errors. Improved estimates of the snow-covered area are derived through the addition of two snow-cover classes ("thin or patchy" and "high elevation" snow cover) and from the analysis of the climate station data within each class. The compatibility of this method for use with Moderate Resolution Imaging Spectroradiometer (MODIS) data, which will be available in 2000, is also discussed. With the assimilation of these data, the resolution of the MDSCP would be improved both spatially and temporally and the analysis would become completely automated.

The application of hospitality elements in hospitals.

PubMed

Wu, Ziqi; Robson, Stephani; Hollis, Brooke

2013-01-01

In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives. Increasingly, research evidence suggests the value of enhancing the physical environment to foster healing and drive consumer decisions and perceptions of service quality. Although interest is increasing in the broader applicability of numerous hospitality concepts to the healthcare field, the focus of this article is design innovations, and the services that such innovations support, from the hospitality industry. To identify physical hotel design elements and associated operational features that have been used in the healthcare arena, a series of interviews with hospital and hotel design experts were conducted. Current examples and suggestions for future hospitality elements were also sought from the experts, academic journals, and news articles. Hospitality elements applied in existing hospitals that are addressed in this article include hotel-like rooms and decor; actual hotels incorporated into medical centers; hotel-quality food, room service, and dining facilities for families; welcoming lobbies and common spaces; hospitality-oriented customer service training; enhanced service offerings, including concierges; spas or therapy centers; hotel-style signage and way-finding tools; and entertainment features. Selected elements that have potential for future incorporation include executive lounges and/or communal lobbies with complimentary wireless Internet and refreshments, centralized controls for patients, and flexible furniture. Although the findings from this study underscore the need for more hospitality-like environments in hospitals, the investment decisions made by healthcare executives must be balanced with cost-effectiveness and the assurance that clinical excellence remains the top priority.

Hospital decentralisation in Romania: stakeholders' perspectives in the newsprint media.

PubMed

Popa, Adela Elena

2014-01-01

In the summer of 2010, Romania undertook a process of hospital decentralisation as part of the reform in the healthcare sector. The national newsprint media covered the process thoroughly. This paper is a study of how key stakeholders' views, attitudes, beliefs and attitudes towards decentralisation are represented in print media. 106 articles, published between June and September 2010, retrieved from the online databases of six leading national dailies were analysed. A mixed methodology was used in the data analysis stage. The qualitative data exploration identified five voices belonging to stakeholders involved directly or indirectly in the process: the representatives of central government, the local authorities (district and local councils, municipal mayors), health professionals (managers and physicians in hospitals), the media (journalists, analysts) and finally voices from civil society, professional associations and advocacy groups. These were the main actors negotiating the subjective meanings of the decentralisation process. An imbalance between these key actors were observed in the frequency, content and tone of the messages delivered in media during the four months. Central government and the local authorities were the most active voices, but the respective discourses differed significantly. An analysis of the accounts identified three main themes: the financial problem (hospitals liabilities and future spending), human resource in hospitals (the impact of decentralisation upon it) and the political character of the decentralisation. Copyright © 2013 John Wiley & Sons, Ltd.

The Regional Land Cover Monitoring System: Building regional capacity through innovative land cover mapping approaches

NASA Astrophysics Data System (ADS)

Saah, D.; Tenneson, K.; Hanh, Q. N.; Aekakkararungroj, A.; Aung, K. S.; Goldstein, J.; Cutter, P. G.; Maus, P.; Markert, K. N.; Anderson, E.; Ellenburg, W. L.; Ate, P.; Flores Cordova, A. I.; Vadrevu, K.; Potapov, P.; Phongsapan, K.; Chishtie, F.; Clinton, N.; Ganz, D.

2017-12-01

Earth observation and Geographic Information System (GIS) tools, products, and services are vital to support the environmental decision making by governmental institutions, non-governmental agencies, and the general public. At the heart of environmental decision making is the monitoring land cover and land use change (LCLUC) for land resource planning and for ecosystem services, including biodiversity conservation and resilience to climate change. A major challenge for monitoring LCLUC in developing regions, such as Southeast Asia, is inconsistent data products at inconsistent intervals that have different typologies across the region and are typically made in without stakeholder engagement or input. Here we present the Regional Land Cover Monitoring System (RLCMS), a novel land cover mapping effort for Southeast Asia, implemented by SERVIR-Mekong, a joint NASA-USAID initiative that brings Earth observations to improve environmental decision making in developing countries. The RLCMS focuses on mapping biophysical variables (e.g. canopy cover, tree height, or percent surface water) at an annual interval and in turn using those biophysical variables to develop land cover maps based on stakeholder definitions of land cover classes. This allows for flexible and consistent land cover classifications that can meet the needs of different institutions across the region. Another component of the RLCMS production is the stake-holder engagement through co-development. Institutions that directly benefit from this system have helped drive the development for regional needs leading to services for their specific uses. Examples of services for regional stakeholders include using the RLCMS to develop maps using the IPCC classification scheme for GHG emission reporting and developing custom annual maps as an input to hydrologic modeling/flood forecasting systems. In addition to the implementation of this system and the service stemming from the RLCMS in Southeast Asia, it is

Shuttle landing facility cloud cover study: Climatological analysis and two tenths cloud cover rule evaluation

NASA Technical Reports Server (NTRS)

Atchison, Michael K.; Schumann, Robin; Taylor, Greg; Warburton, John; Wheeler, Mark; Yersavich, Ann

1993-01-01

The two-tenths cloud cover rule in effect for all End Of Mission (EOM) STS landings at the Kennedy Space Center (KSC) states: 'for scattered cloud layers below 10,000 feet, cloud cover must be observed to be less than or equal to 0.2 at the de-orbit burn go/no-go decision time (approximately 90 minutes before landing time)'. This rule was designed to protect against a ceiling (below 10,000 feet) developing unexpectedly within the next 90 minutes (i.e., after the de-orbit burn decision and before landing). The Applied Meteorological Unit (AMU) developed and analyzed a database of cloud cover amounts and weather conditions at the Shuttle Landing Facility for a five-year (1986-1990) period. The data indicate the best time to land the shuttle at KSC is during the summer while the worst time is during the winter. The analysis also shows the highest frequency of landing opportunities occurs for the 0100-0600 UTC and 1300-1600 UTC time periods. The worst time of the day to land a shuttle is near sunrise and during the afternoon. An evaluation of the two-tenths cloud cover rule for most data categorizations has shown that there is a significant difference in the proportions of weather violations one and two hours subsequent to initial conditions of 0.2 and 0.3 cloud cover. However, for May, Oct., 700 mb northerly wind category, 1500 UTC category, and 1600 UTC category there is some evidence that the 0.2 cloud cover rule may be overly conservative. This possibility requires further investigation. As a result of these analyses, the AMU developed nomograms to help the Spaceflight Meteorological Group (SMG) and the Cape Canaveral Forecast Facility (CCFF) forecast cloud cover for EOM and Return to Launch Site (RTLS) at KSC. Future work will include updating the two tenths database, further analysis of the data for several categorizations, and developing a proof of concept artificial neural network to provide forecast guidance of weather constraint violations for shuttle

Hospital Morbidity Database for Epidemiological Studies on Churg-Strauss Syndrome.

PubMed

Kanecki, Krzysztof; Nitsch-Osuch, Aneta; Gorynski, Paweł; Tarka, Patryk; Tyszko, Piotr

2017-01-01

Churg-Strauss syndrome or more accurately eosinophilic granulomatosis with polyangiitis (EGPA) is a small-vessel necrotizing vasculitis with a characteristic late-onset allergic rhinitis and asthma. The use of hospital morbidity database is an important element of the epidemiological analysis of this rare disease. The present study was undertaken to assess the incidence of EGPA and factors related to its epidemiology in Poland; the first analysis of the kind in Poland, enabling a comparison in the European context. This is a retrospective, population-based study using hospital discharge records with EGPA diagnosis, collected for a National Institute of Public Health survey covering the period from 2008 to 2013. The group consisted of 344 patients (206 females and 138 males) with the first-time hospitalization for EGPA. The major findings are that the annual incidence of EGPA in Poland was 1.5 per million (95% confidence intervals: 1.2-1.8), with the point prevalence of 8.8 per million at the end of 2013. A greater incidence of EGPA was observed in the regions with urban predominance. We conclude that discharge records may be a useful element of epidemiological studies on EGPA.

[Innovative ET cover system and its hydrologic evaluation].

PubMed

Liu, Chuan-shun; Cai, Jun-xiong; Wang, Jing-zhai; Rong, Yu

2010-07-01

The evapotranspiration (ET) cover system,as an alternative cover system of landfill, has been used in many remediation projects since 2003. It is an inexpensive, practical,and easily maintained biological system, but is mainly favorable in arid and semiarid sites due to limited water-holding capacity of the single loam layer and limited transpiration of grass. To improve the effectiveness of percolation control, an innovative scheme of ET was suggested in this paper: (1) a clay liner was added under the single loam layer to increase the water-holding capacity; (2) combined vegetation consisting of shrub and grass was used to replace the grass cover. Hydrologic evaluation of conventional cover,ET cover and the innovative ET cover under the same condition was performed using the computer program HELP, which showed the performance of the innovative ET cover is obviously superior to that of ET cover and conventional cover.

10 CFR 950.14 - Standby Support Contract: Covered events, exclusions, covered delay and covered cost provisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... include a provision setting forth the type of events that are covered events under the contract. The type...) Litigation in State, Federal, local, or tribal courts, including appeals of Commission decisions related to..., including but not limited to the following types of events: (i) The sponsor's failure to comply with...

Analysis of Hospital Readmission Patterns in Medicare Fee-for-Service and Medicare Advantage Beneficiaries.

PubMed

Oh, Joobong June Park

The study was conducted to examine the hospital readmission patterns of two groups of Medicare beneficiaries-those covered by traditional Medicare (Medicare fee-for-service [FFS]) and those enrolled in a Medicare risk plan (Medicare Advantage [MA])-and to determine the characteristics that significantly increase the likelihood of multiple hospital readmissions. The study setting is the Hospital of the University of Pennsylvania (HUP) located in Philadelphia, PA. A retrospective descriptive study design was used to analyze the electronic data from the HUP information technology system for Medicare beneficiaries, 65 years and older, who had an index hospital admission at the HUP during 2012 (January 1, 2012, through December 31, 2012), and were subsequently readmitted one or more times to the HUP during the observation period. FFS and MA beneficiaries were hospitalized an average of 1.5 (±1.0) times; 69% were rehospitalized once and 30% were rehospitalized two or more times. Characteristics that increased the likelihood of multiple hospital readmissions included being discharged on a weekend, admitted through the emergency department with a diagnosis of injury and poisoning, being diagnosed with a new problem of the circulatory system, having an exacerbation of a circulatory system illness, and having an infection related to a previous admission. Characteristics that decreased the likelihood of multiple hospital readmissions included being discharged to a skilled nursing facility and being discharged home with home health services. Identification of the risk factors and characteristics that increase the likelihood of multiple hospital readmissions will permit early interventions in discharge planning, as evidenced by decreasing the rate of hospital readmissions and the length of hospital stays, increasing in time to hospital readmission, and preventing the first readmission and a subsequent return to the hospital.

Potential for Monitoring Snow Cover in Boreal Forests by Combining MODIS Snow Cover and AMSR-E SWE Maps

NASA Technical Reports Server (NTRS)

Riggs, George A.; Hall, Dorothy K.; Foster, James L.

2009-01-01

Monitoring of snow cover extent and snow water equivalent (SWE) in boreal forests is important for determining the amount of potential runoff and beginning date of snowmelt. The great expanse of the boreal forest necessitates the use of satellite measurements to monitor snow cover. Snow cover in the boreal forest can be mapped with either the Moderate Resolution Imaging Spectroradiometer (MODIS) or the Advanced Microwave Scanning Radiometer for EOS (AMSR-E) microwave instrument. The extent of snow cover is estimated from the MODIS data and SWE is estimated from the AMSR-E. Environmental limitations affect both sensors in different ways to limit their ability to detect snow in some situations. Forest density, snow wetness, and snow depth are factors that limit the effectiveness of both sensors for snow detection. Cloud cover is a significant hindrance to monitoring snow cover extent Using MODIS but is not a hindrance to the use of the AMSR-E. These limitations could be mitigated by combining MODIS and AMSR-E data to allow for improved interpretation of snow cover extent and SWE on a daily basis and provide temporal continuity of snow mapping across the boreal forest regions in Canada. The purpose of this study is to investigate if temporal monitoring of snow cover using a combination of MODIS and AMSR-E data could yield a better interpretation of changing snow cover conditions. The MODIS snow mapping algorithm is based on snow detection using the Normalized Difference Snow Index (NDSI) and the Normalized Difference Vegetation Index (NDVI) to enhance snow detection in dense vegetation. (Other spectral threshold tests are also used to map snow using MODIS.) Snow cover under a forest canopy may have an effect on the NDVI thus we use the NDVI in snow detection. A MODIS snow fraction product is also generated but not used in this study. In this study the NDSI and NDVI components of the snow mapping algorithm were calculated and analyzed to determine how they changed

In-Hospital Disease Burden of Sarcoidosis in Switzerland from 2002 to 2012.

PubMed

Pohle, Susanne; Baty, Florent; Brutsche, Martin

2016-01-01

Sarcoidosis is a multisystem disease with an unpredictable and sometimes fatal course while the underlying pathomechanism is still unclear. Reasons of the increasing hospitalization rate and mortality in the United States remain in dispute but incriminated are a number of distinct comorbidities and risk factors as well as the application of more aggressive therapeutic agents. Studies reflecting the recent development in central Europe are lacking. Our aim was to investigate the recent mortality and hospitalization rates as well as the underlying comorbidities of hospitalized sarcoidosis patients in Switzerland. In this longitudinal, nested case-control study, a nation-wide database provided by the Swiss Federal Office for Statistics enclosing every hospital entry covering the years 2002-2012 (n = 15,627,573) was analyzed. There were 8,385 cases with a diagnosis of sarcoidosis representing 0.054% (8,385 / 15,627,573) of all hospitalizations in Switzerland. These cases were compared with age- and sex-matched controls without the diagnosis of sarcoidosis. Hospitalization and mortality rates in Switzerland remained stable over the observed time period. Comorbidity analysis revealed that sarcoidosis patients had significantly higher medication-related comorbidities compared to matched controls, probably due to systemic corticosteroids and immunosuppressive therapy. Sarcoidosis patients were also more frequently re-hospitalized (median annual hospitalization rate 0.28 [IQR 0.15-0.65] vs. 0.19 [IQR 0.13-0.36] per year; p < 0.001), had a longer hospital stay (6 [IQR 2-13] vs. 4 [IQR 1-8] days; p < 0.001), had more comorbidities (4 [IQR 2-7] vs. 2 [IQR 1-5]; p < 0.001), and had a significantly higher in-hospital mortality (2.6% [95% CI 2.3%-2.9%] vs. 1.8% [95% CI 1.5%-2.1%] (p < 0.001). A worse outcome was observed among sarcoidosis patients having co-occurrence of associated respiratory diseases. Moreover, age was an important risk factor for re-hospitalization.

The Impact of Hospital Size on CMS Hospital Profiling.

PubMed

Sosunov, Eugene A; Egorova, Natalia N; Lin, Hung-Mo; McCardle, Ken; Sharma, Vansh; Gelijns, Annetine C; Moskowitz, Alan J

2016-04-01

The Centers for Medicare & Medicaid Services (CMS) profile hospitals using a set of 30-day risk-standardized mortality and readmission rates as a basis for public reporting. These measures are affected by hospital patient volume, raising concerns about uniformity of standards applied to providers with different volumes. To quantitatively determine whether CMS uniformly profile hospitals that have equal performance levels but different volumes. Retrospective analysis of patient-level and hospital-level data using hierarchical logistic regression models with hospital random effects. Simulation of samples including a subset of hospitals with different volumes but equal poor performance (hospital effects=+3 SD in random-effect logistic model). A total of 1,085,568 Medicare fee-for-service patients undergoing 1,494,993 heart failure admissions in 4930 hospitals between July 1, 2005 and June 30, 2008. CMS methodology was used to determine the rank and proportion (by volume) of hospitals reported to perform "Worse than US National Rate." Percent of hospitals performing "Worse than US National Rate" was ∼40 times higher in the largest (fifth quintile by volume) compared with the smallest hospitals (first quintile). A similar gradient was seen in a cohort of 100 hospitals with simulated equal poor performance (0%, 0%, 5%, 20%, and 85% in quintiles 1 to 5) effectively leaving 78% of poor performers undetected. Our results illustrate the disparity of impact that the current CMS method of hospital profiling has on hospitals with higher volumes, translating into lower thresholds for detection and reporting of poor performance.

Corrugated cover plate for flat plate collector

DOEpatents

Hollands, K. G. Terry; Sibbitt, Bruce

1978-01-01

A flat plate radiant energy collector is providing having a transparent cover. The cover has a V-corrugated shape which reduces the amount of energy reflected by the cover away from the flat plate absorber of the collector.

Total expenditures per patient in hospital-owned and physician-owned physician organizations in California.

PubMed

Robinson, James C; Miller, Kelly

Hospitals are rapidly acquiring medical groups and physician practices. This consolidation may foster cooperation and thereby reduce expenditures, but also may lead to higher expenditures through greater use of hospital-based ambulatory services and through greater hospital pricing leverage against health insurers. To determine whether total expenditures per patient were higher in physician organizations (integrated medical groups and independent practice associations) owned by local hospitals or multihospital systems compared with groups owned by participating physicians. Data were obtained on total expenditures for the care provided to 4.5 million patients treated by integrated medical groups and independent practice associations in California between 2009 and 2012. The patients were covered by commercial health maintenance organization (HMO) insurance and the data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid. Total expenditures per patient annually, measured in terms of what insurers paid to the physician organizations for professional services, to hospitals for inpatient and outpatient procedures, to clinical laboratories for diagnostic tests, and to pharmaceutical manufacturers for drugs and biologics. Annual expenditures per patient were compared after adjusting for patient illness burden, geographic input costs, and organizational characteristics. Of the 158 organizations, 118 physician organizations (75%) were physician-owned and provided care for 3,065,551 patients, 19 organizations (12%) were owned by local hospitals and provided care for 728,608 patients, and 21 organizations (13%) were owned by multihospital systems and provided care for 693,254 patients. In 2012, physician-owned physician organizations had mean expenditures of $3066 per patient (95% CI, $2892 to $3240), hospital-owned physician organizations had mean expenditures of $4312 per patient (95% CI, $3768 to $4857), and

ESTIMATING IMPERVIOUS COVER FROM REGIONALLY AVAILABLE DATA

EPA Science Inventory

The objective of this study is to compare and evaluate the reliability of different approaches for estimating impervious cover including three empirical formulations for estimating impervious cover from population density data, estimation from categorized land cover data, and to ...

Border Lakes land-cover classification

Treesearch

Marvin Bauer; Brian Loeffelholz; Doug Shinneman

2009-01-01

This document contains metadata and description of land-cover classification of approximately 5.1 million acres of land bordering Minnesota, U.S.A. and Ontario, Canada. The classification focused on the separation and identification of specific forest-cover types. Some separation of the nonforest classes also was performed. The classification was derived from multi-...

Run for cover! What's covering your greenhouse and how is it affecting seedling growth?

Treesearch

Jeremy R. Pinto; Kas Dumroese; John D. Marshall

2006-01-01

Analysis of seedling growth characteristics between two greenhouse cover types, old fiberglass and new polycarbonate, shows significant differences in height and sturdiness coefficients in ponderosa pine (Pinus ponderosa) seedlings. Three rates of nitrogen (N) application (20, 40, and 60 mg) indicate that seedling growth will increase under both cover types, but may...

Quality and equity of care in U.S. hospitals.

PubMed

Trivedi, Amal N; Nsa, Wato; Hausmann, Leslie R M; Lee, Jonathan S; Ma, Allen; Bratzler, Dale W; Mor, Maria K; Baus, Kristie; Larbi, Fiona; Fine, Michael J

2014-12-11

Nearly every U.S. hospital publicly reports its performance on quality measures for patients who are hospitalized for acute myocardial infarction, heart failure, or pneumonia. Because performance rates are not reported according to race or ethnic group, it is unclear whether improvements in equity of care have accompanied aggregate improvements in health care quality over time. We assessed performance rates for quality measures covering three conditions (six measures for acute myocardial infarction, four for heart failure, and seven for pneumonia). These rates, adjusted for patient- and hospital-level covariates, were compared among non-Hispanic white, non-Hispanic black, and Hispanic patients who received care between 2005 and 2010 in acute care hospitals throughout the United States. Adjusted performance rates for the 17 quality measures improved by 3.4 to 57.6 percentage points between 2005 and 2010 for white, black, and Hispanic adults (P<0.001 for all comparisons). In 2005, as compared with adjusted performance rates for white patients, adjusted performance rates were more than 5 percentage points lower for black patients on 3 measures (range of differences, 12.3 to 14.2) and for Hispanic patients on 6 measures (5.6 to 14.5). Gaps decreased significantly on all 9 of these measures between 2005 and 2010, with adjusted changes for differences between white patients and black patients ranging from -8.5 to -11.8 percentage points and from -6.2 to -15.1 percentage points for differences between white patients and Hispanic patients. Decreasing differences according to race or ethnic group were attributable to more equitable care for white patients and minority patients treated in the same hospital, as well as to greater performance improvements among hospitals that disproportionately serve minority patients. Improved performance on quality measures for white, black, and Hispanic adults hospitalized for acute myocardial infarction, heart failure, or pneumonia was

Satellite Snow-Cover Mapping: A Brief Review

NASA Technical Reports Server (NTRS)

Hall, Dorothy K.

1995-01-01

Satellite snow mapping has been accomplished since 1966, initially using data from the reflective part of the electromagnetic spectrum, and now also employing data from the microwave part of the spectrum. Visible and near-infrared sensors can provide excellent spatial resolution from space enabling detailed snow mapping. When digital elevation models are also used, snow mapping can provide realistic measurements of snow extent even in mountainous areas. Passive-microwave satellite data permit global snow cover to be mapped on a near-daily basis and estimates of snow depth to be made, but with relatively poor spatial resolution (approximately 25 km). Dense forest cover limits both techniques and optical remote sensing is limited further by cloudcover conditions. Satellite remote sensing of snow cover with imaging radars is still in the early stages of research, but shows promise at least for mapping wet or melting snow using C-band (5.3 GHz) synthetic aperture radar (SAR) data. Observing System (EOS) Moderate Resolution Imaging Spectroradiometer (MODIS) data beginning with the launch of the first EOS platform in 1998. Digital maps will be produced that will provide daily, and maximum weekly global snow, sea ice and lake ice cover at 1-km spatial resolution. Statistics will be generated on the extent and persistence of snow or ice cover in each pixel for each weekly map, cloudcover permitting. It will also be possible to generate snow- and ice-cover maps using MODIS data at 250- and 500-m resolution, and to study and map snow and ice characteristics such as albedo. been under development. Passive-microwave data offer the potential for determining not only snow cover, but snow water equivalent, depth and wetness under all sky conditions. A number of algorithms have been developed to utilize passive-microwave brightness temperatures to provide information on snow cover and water equivalent. The variability of vegetative Algorithms are being developed to map global snow

39 CFR 233.3 - Mail covers.

Code of Federal Regulations, 2011 CFR

2011-07-01

... transcription, photograph, photocopy or any other facsimile of the image of the outside cover, envelope, wrapper... Postal Inspection Service to transmit mail cover reports directly to the requesting authority. (j) Review...

39 CFR 233.3 - Mail covers.

Code of Federal Regulations, 2010 CFR

2010-07-01

... transcription, photograph, photocopy or any other facsimile of the image of the outside cover, envelope, wrapper... Postal Inspection Service to transmit mail cover reports directly to the requesting authority. (j) Review...

39 CFR 233.3 - Mail covers.

Code of Federal Regulations, 2013 CFR

2013-07-01

... transcription, photograph, photocopy or any other facsimile of the image of the outside cover, envelope, wrapper... Postal Inspection Service to transmit mail cover reports directly to the requesting authority. (j) Review...

39 CFR 233.3 - Mail covers.

Code of Federal Regulations, 2012 CFR

2012-07-01

... transcription, photograph, photocopy or any other facsimile of the image of the outside cover, envelope, wrapper... Postal Inspection Service to transmit mail cover reports directly to the requesting authority. (j) Review...

39 CFR 233.3 - Mail covers.

Code of Federal Regulations, 2014 CFR

2014-07-01

... transcription, photograph, photocopy or any other facsimile of the image of the outside cover, envelope, wrapper... Postal Inspection Service to transmit mail cover reports directly to the requesting authority. (j) Review...

Role of the Hospital Library Within the Hospital System *†

PubMed Central

Lorenzi, Nancy M.

1969-01-01

The results of a survey of hospital administrators, attending staff and house staff physicians, librarians, library committee chairmen, and nursing staff in five Northeastern Ohio hospitals concerning the status of the hospital library within the total hospital system are related. Results indicate that hospital libraries operate in the “fringe” area of the hospital system. A concentric-circle figure indicates the present position of the majority of hospital libraries surveyed. The future relationship of the library within the hospital system has also been represented by a concentric-circle figure. PMID:5778727

Development of key indicators of hospital resilience: a modified Delphi study.

PubMed

Zhong, Shuang; Clark, Michele; Hou, Xiang-Yu; Zang, Yuli; FitzGerald, Gerard

2015-04-01

Hospital resilience is an emerging concept, which can be defined as 'a hospital's ability to resist, absorb, and respond to the shock of disasters while maintaining its critical health care functions, and then recover to its original state or adapt to a new one'. Our aim was to develop a comprehensive framework of key indicators of hospital resilience. A panel of 33 Chinese experts was invited to participate in a three-round, modified Delphi study to develop a set of potential measures previously derived from a literature review. In the first round, these potential measures were modified to cover the comprehensive domains of hospital resilience. The importance of proposed measures was scored by experts on a five-point Likert scale. Subsequently, the experts reconsidered their voting in light of the previous aggregated results. Agreement on measures was defined as at least 70% of the responders agreeing or strongly agreeing to the inclusion of a measure. A large proportion of preliminary measures (89.5%) were identified as having good potential for assessing hospital resilience. These measures were categorized into eight domains, 17 subdomains, and 43 indicators. The highest rated indicators (mean score) were: equipment for on-site rescue (4.7), plan initiation (4.6), equipment for referral of patients with complex care needs (4.5), the plan execution (4.4), medication management strategies (4.4), emergency medical treatment conditions (4.4), disaster committee (4.4), stock types and quantities for essential medications (4.4), surge capacity of emergency beds (4.4), and mass-casualty triage protocols (4.4). This framework identifies a comprehensive set of indicators of hospital resilience. It can be used for hospital assessment, as well as informing priority practices to address future disasters better. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Field Water Balance of Landfill Final Covers

EPA Science Inventory

Landfill covers are critical to waste containment, yet field performance of specific cover designs has not been well documented and seldom been compared in side-by-side testing. A study was conducted to assess the ability of landfill final covers to control percolation into unde...

Covered bridge manual

DOT National Transportation Integrated Search

2005-04-01

This manual provides guidance to those involved with all aspects of the work, from initial inspection and evaluation, through the engineering of rehabilitation, to construction issues. Broadly speaking, this manual covers general terminology and hist...

50 CFR 600.1101 - Inshore fee system for repayment of the loan to harvesters of Pollock from the directed fishing...

Code of Federal Regulations, 2010 CFR

2010-10-01

... is a general food-service wholesaler or supplier, a restaurant, a retailer, a consumer, some other... recoveries shall be applied to reduce the unpaid balance of the loan. (g) Prohibitions and penalties. (1) The...

[Prevention of accidental needle sticks before the Directive 2010/32/EU in a sample of Italian hospitals].

PubMed

Di Bari, Virginia; De Carli, Gabriella; Puro, Vincenzo

2015-05-04

Needlesticks and cuts are the most common occupational injuries in healthcare workers (HCWs). Directive 2010/32/EU defines principles and preventive interventions. To assess, in hospitals participating in the Italian Study on Occupational Risk of HIV (SIROH) project, which are very active in prevention, the degree of application of the measures provided for by the Directive, prior to its incorporation into Italian law. An open questionnaire covering the 9 focal points of the Directive, as a guide for a presentation at the SIROH meeting in 2013. Of 100 SIROH hospitals, 97% and 96% respectively provide specific information and education initiatives (54% and 73% of which expressly for new employees). All centres reinforce the ban on recapping, and 30 monitor its application by inspecting sharps containers; all hospitals place containers on mobile trolleys and 78 provide operating procedures for their replacement; all introduced at least one needlestick-prevention device (NPD; 4 on average, range 1-11), most frequently intravenous catheters (91%) and winged needles (87%), but 39% only in selected units; 14 centres implemented initiatives to eliminate unnecessary needles. Regarding hepatitis B, all centres screen and vaccinate HCWs but only 78% monitor their response: 89% of HCWs were immunized. Post-exposure management protocols, although based on the same rationale, differ significantly causing considerable differences in  costs. Most of the preventive interventions covered by the Directive were implemented in SIROH hospitals. It is necessary to invest in NPD availability and dissemination, elimination of unnecessary needles, and streamline post-exposure protocols. The situation in the remaining Italian facilities should be investigated.

Supplementing cross-cover communication with the patient acuity rating.

PubMed

Phillips, Andrew W; Yuen, Trevor C; Retzer, Elizabeth; Woodruff, James; Arora, Vineet; Edelson, Dana P

2013-03-01

Patient hand-offs at physician shift changes have limited ability to convey the primary team's longitudinal insight. The Patient Acuity Rating (PAR) is a previously validated, 7-point scale that quantifies physician judgment of patient stability, where a higher score indicates a greater risk of clinical deterioration. Its impact on cross-covering physician understanding of patients is not known. To determine PAR contribution to sign-outs. Cross-sectional survey. Intern physicians at a university teaching hospital. Subjects were surveyed using randomly chosen, de-identified patient sign-outs, previously assigned PAR scores by their primary teams. For each sign-out, subjects assigned a PAR score, then responded to hypothetical cross-cover scenarios before and after being informed of the primary team's PAR. Changes in intern assessment of the scenario before and after being informed of the primary team's PAR were measured. In addition, responses between novice and experienced interns were compared. Between May and July 2008, 23 of 39 (59 %) experienced interns and 25 of 42 (60 %) novice interns responded to 480 patient scenarios from ten distinct sign-outs. The mean PAR score assigned by subjects was 4.2 ± 1.6 vs. 3.8 ± 1.8 by the primary teams (p < 0.001). After viewing the primary team's PAR score, interns changed their level of concern in 47.9 % of cases, their assessment of the importance of immediate bedside evaluation in 48.7 % of cases, and confidence in their assessment in 43.2 % of cases. For all three assessments, novice interns changed their responses more frequently than experienced interns (p = 0.03, 0.009, and <0.001, respectively). Overall interns reported the PAR score to be theoretically helpful in 70.8 % of the cases, but this was more pronounced in novice interns (81.2 % vs 59.6 %, p < 0.001). The PAR adds valuable information to sign-outs that could impact cross-cover decision-making and potentially benefit patients

A Citizen's Guide to Evapotranspiration Covers

EPA Pesticide Factsheets

This guide explains Evapotranspiration Covers which are Evapotranspiration (ET) covers are a type of cap placed over contaminated material, such as soil, landfill waste, or mining tailings, to prevent water from reaching it.

[Clinical risk management in german hospitals - does size really matter?].

PubMed

Bohnet-Joschko, S; Jandeck, L M; Zippel, C; Andersen, M; Krummenauer, F

2011-06-01

In the last years, German hospitals have implemented different measures to increase patient safety. Special importance has been attached to near miss reporting systems (critical incident reporting system, CIRS) as instruments for risk identification in health care, instruments that promise high potential for organisational learning. To gain insight into the current status of critical incident reporting systems and other instruments for clinical risk management, a survey among 341 hospitals was carried out in 2009. Questions covered a process of six steps: from risk strategy to methods for risk identification, to risk analysis and risk assessment, to risk controlling and risk monitoring. Structured telephone interviews were conducted with 341 German hospitals, featuring in their statutory quality reports certain predefined key terms that indicated the concluded or planned implementation of clinical risk management. The main objective of those interviews was to check the relation between status/organisation of self-reported risk management and both operator (private, public, NPO) and size of hospital. The implementation of near miss reporting systems (CIRS) in German hospitals has been constantly rising since 2004: in 2009, 54 % of the interviewed hospitals reported an implemented CIRS; of these, 72 % reported the system to be hospital-wide. An association between CIRS and private, public or NPO-operator could not be detected (Fisher p = 1.000); however, the degree of CIRS implementation was significantly increasing with the size of the hospital, i.e., the number of beds (Fisher p = 0.008): only 38 % of the hospitals with less than 100 beds reported CIRS implementation against 52 % of those between 100 to 500 beds, and 67 % of those with more than 500 beds. While 62 % of the hospitals interviewed reported the maintenance of a risk management committee, only 14 % reported the implementation of risk analysing techniques. As to clinical risk

Updating the 2001 National Land Cover Database land cover classification to 2006 by using Landsat imagery change detection methods

USGS Publications Warehouse

Xian, George; Homer, Collin G.; Fry, Joyce

2009-01-01

The recent release of the U.S. Geological Survey (USGS) National Land Cover Database (NLCD) 2001, which represents the nation's land cover status based on a nominal date of 2001, is widely used as a baseline for national land cover conditions. To enable the updating of this land cover information in a consistent and continuous manner, a prototype method was developed to update land cover by an individual Landsat path and row. This method updates NLCD 2001 to a nominal date of 2006 by using both Landsat imagery and data from NLCD 2001 as the baseline. Pairs of Landsat scenes in the same season in 2001 and 2006 were acquired according to satellite paths and rows and normalized to allow calculation of change vectors between the two dates. Conservative thresholds based on Anderson Level I land cover classes were used to segregate the change vectors and determine areas of change and no-change. Once change areas had been identified, land cover classifications at the full NLCD resolution for 2006 areas of change were completed by sampling from NLCD 2001 in unchanged areas. Methods were developed and tested across five Landsat path/row study sites that contain several metropolitan areas including Seattle, Washington; San Diego, California; Sioux Falls, South Dakota; Jackson, Mississippi; and Manchester, New Hampshire. Results from the five study areas show that the vast majority of land cover change was captured and updated with overall land cover classification accuracies of 78.32%, 87.5%, 88.57%, 78.36%, and 83.33% for these areas. The method optimizes mapping efficiency and has the potential to provide users a flexible method to generate updated land cover at national and regional scales by using NLCD 2001 as the baseline.

Effects of particulate matter exposure on multiple sclerosis hospital admission in Lombardy region, Italy

PubMed Central

Laura, Angelici; Mirko, Piola; Tommaso, Cavalleri; Giorgia, Randi; Francesca, Cortini; Roberto, Bergamaschi; Andrea, Baccarelli A; Alberto, Bertazzi Pier; Cecilia, Pesatori Angela; Valentina, Bollati

2016-01-01

Background Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of the central nervous system, characterized by recurrent relapses of inflammation that cause mild to severe disability. Exposure to airborne particulate matter (PM) has been associated with acute increases in systemic inflammatory responses and neuroinflammation. In the present study, we hypothesize that exposure to PM < 10 µm in diameter (PM10) might increase the occurrence of MS-related hospitalizations. Methods We obtained daily concentrations of PM10 from 53 monitoring sites covering the study area and we identified 8287 MS-related hospitalization through hospital admission-discharge records of the Lombardy region, Italy, between 2001 and 2009. We used a Poisson regression analysis to investigate the association between exposure to PM10 and risk of hospitalization. Results A higher RR of hospital admission for MS relapse was associated with exposure to PM10 at different time intervals. The maximum effect of PM10 on MS hospitalization was found for exposure between days 0 and 7: Hospital admission for MS increased 42% (95%CI 1.39–1.45) on the days preceded by one week with PM10 levels in the highest quartile. The p-value for trend across quartiles was < 0.001. Conclusions These data support the hypothesis that air pollution may have a role in determining MS occurrence and relapses. Our findings could open new avenues for determining the pathogenic mechanisms of MS and potentially be applied to other autoimmune diseases. PMID:26624240

Changing patterns of psychiatric inpatient care for children and adolescents in general hospitals, 1988-1995.

PubMed

Pottick, K J; McAlpine, D D; Andelman, R B

2000-08-01

The authors examine patterns in utilization of psychiatric inpatient services by children and adolescents in general hospitals during 1988-1995. National Hospital Discharge Survey data were used to describe utilization patterns for children and adolescents with primary psychiatric diagnoses in general hospitals from 1988 to 1995. During the study period, there was a 36% increase in hospital discharges and a 44% decline in mean length of stay, resulting in a 23% decline in the number of bed-days, from more than 3 million to about 2.5 million. The number of nonpsychotic major depressive disorders increased significantly. Discharges from public hospitals have declined, and those from proprietary hospitals have risen. Concurrently, the role of private insurance declined and the role of Medicaid increased. During the period of study, the mean and median length of stay declined most for children and adolescents who were hospitalized in private facilities and those covered by private insurance. Across the United States, the mean length of stay declined significantly; this decline was almost 60% in the West. Discharges also declined in the West, in contrast to the Midwest and the South, where they significantly increased. Increased numbers of discharges and decreased length of stay may reflect evolving market forces and characteristics of hospitals. Further penetration by managed care into the public insurance system or modifications in existing Medicaid policy could have a profound impact on the availability of inpatient resources.

Absence of snow cover reduces understory plant cover and alters plant community composition in boreal forests.

PubMed

Kreyling, Juergen; Haei, Mahsa; Laudon, Hjalmar

2012-02-01

Snow regimes affect biogeochemistry of boreal ecosystems and are altered by climate change. The effects on plant communities, however, are largely unexplored despite their influence on relevant processes. Here, the impact of snow cover on understory community composition and below-ground production in a boreal Picea abies forest was investigated using a long-term (8-year) snow cover manipulation experiment consisting of the treatments: snow removal, increased insulation (styrofoam pellets), and control. The snow removal treatment caused longer (118 vs. 57 days) and deeper soil frost (mean minimum temperature -5.5 vs. -2.2°C) at 10 cm soil depth in comparison to control. Understory species composition was strongly altered by the snow cover manipulations; vegetation cover declined by more than 50% in the snow removal treatment. In particular, the dominant dwarf shrub Vaccinium myrtillus (-82%) and the most abundant mosses Pleurozium schreberi (-74%) and Dicranum scoparium (-60%) declined strongly. The C:N ratio in V. myrtillus leaves and plant available N in the soil indicated no altered nitrogen nutrition. Fine-root biomass in summer, however, was negatively affected by the reduced snow cover (-50%). Observed effects are attributed to direct frost damage of roots and/ or shoots. Besides the obvious relevance of winter processes on plant ecology and distribution, we propose that shifts in the vegetation caused by frost damage may be an important driver of the reported alterations in biogeochemistry in response to altered snow cover. Understory plant performance clearly needs to be considered in the biogeochemistry of boreal systems in the face of climate change.

Steering Patients to Safer Hospitals? The Effect of a Tiered Hospital Network on Hospital Admissions

PubMed Central

Scanlon, Dennis P; Lindrooth, Richard C; Christianson, Jon B

2008-01-01

Objective To determine if a tiered hospital benefit and safety incentive shifted the distribution of admissions toward safer hospitals. Data Sources/Study Setting A large manufacturing company instituted the hospital safety incentive (HSI) for union employees. The HSI gave union patients a financial incentive to choose hospitals that met the Leapfrog Group's three patient safety “leaps.” The analysis merges data from four sources: claims and enrollment data from the company, the American Hospital Association, the AHRQ HCUP-SID, and a state Office of the Insurance Commissioner. Study Design Changes in hospital admissions’ patterns for union and nonunion employees using a difference-in-difference design. We estimate the probability of choosing a specific hospital from a set of available alternatives using conditional logistic regression. Principal Findings Patients affiliated with the engineers’ union and admitted for a medical diagnosis were 2.92 times more likely to select a hospital designated as safer in the postperiod than in the preperiod, while salaried nonunion (SNU) patients (not subject to the financial incentive) were 0.64 times as likely to choose a compliant hospital in the post- versus preperiod. The difference-in-difference estimate, which is based on the predictions of the conditional logit model, is 0.20. However, the machinists’ union was also exposed to the incentive and they were no more likely to choose a safer hospital than the SNU patients. The incentive did not have an effect on patients admitted for a surgical diagnosis, regardless of union status. All patients were averse to travel time, but those union patients selecting an incentive hospital were less averse to travel time. Conclusions Patient price incentives and quality/safety information may influence hospital selection decisions, particularly for medical admissions, though the optimal incentive level for financial return to the plan sponsor is not clear. PMID:18761676

Communication eases pains of acquisition. Suburban hospital becomes part of Mercy Healthcare Sacramento.

PubMed

1995-03-01

In 1991 American River Hospital, a facility in the suburbs of Sacramento, CA, was bought by Mercy Healthcare Sacramento. At the time, MHS owned three hospitals and a number of outpatient delivery sites. The acquisition fit MHS's strategic plan, which was to develop an integrated delivery system covering the metropolitan area. After completing the purchase, MHS began consolidating the operations of the new Mercy American River Hospital with those of nearby Mercy San Juan Hospital. Consolidation was eased by the fact that the two facilities shared a primary service area, with many physicians serving on the staffs of both hospitals. Though they had been competitors, the hospitals had collaborated on a number of activities. And they shared a common vision of managed care. An employee climate survey conducted in 1993 showed that some American River employees had, before the acquisition, feared being "inappropriately influenced by the Catholic Church." Others saw American River and Mercy San Juan as differing in their patient care and worried that the two styles might not be compatible. Still other American River employees were afraid they would lose their jobs. But the survey revealed that American River employees had seen no major cultural barriers to the acquisition. They had perceived MHS as a values-driven organization whose focus was the healing ministry. During the consolidation, a joint MHS-American River communications team held meetings and published newsletters to help employees understand the process. American River employees participated in a formal blessing of the transfer of their hospital's ownership to MHS.

On twelve types of covering-based rough sets.

PubMed

Safari, Samira; Hooshmandasl, Mohammad Reza

2016-01-01

Covering approximation spaces are a generalization of equivalence-based rough set theories. In this paper, we will consider twelve types of covering based approximation operators by combining four types of covering lower approximation operators and three types of covering upper approximation operators. Then, we will study the properties of these new pairs and show they have most of the common properties among existing covering approximation pairs. Finally, the relation between these new pairs is studied.

46 CFR 111.30-11 - Deck coverings.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 4 2013-10-01 2013-10-01 false Deck coverings. 111.30-11 Section 111.30-11 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Switchboards § 111.30-11 Deck coverings. Non-conducting deck coverings, such as non-conducting...

46 CFR 111.30-11 - Deck coverings.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Deck coverings. 111.30-11 Section 111.30-11 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Switchboards § 111.30-11 Deck coverings. Non-conducting deck coverings, such as non-conducting...

46 CFR 111.30-11 - Deck coverings.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 4 2014-10-01 2014-10-01 false Deck coverings. 111.30-11 Section 111.30-11 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Switchboards § 111.30-11 Deck coverings. Non-conducting deck coverings, such as non-conducting...

46 CFR 111.30-11 - Deck coverings.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Deck coverings. 111.30-11 Section 111.30-11 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Switchboards § 111.30-11 Deck coverings. Non-conducting deck coverings, such as non-conducting...

46 CFR 111.30-11 - Deck coverings.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 4 2012-10-01 2012-10-01 false Deck coverings. 111.30-11 Section 111.30-11 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Switchboards § 111.30-11 Deck coverings. Non-conducting deck coverings, such as non-conducting...

Correlates of post-hospital physical function at 1 year in skilled nursing facility residents.

PubMed

Lee, Jia; Rantz, Marilyn

2008-05-01

This paper is a report of a study to examine the relationship between health-related admission factors and post-hospital physical function at 3, 6, 9 and 12 months in older adult nursing facility residents. Physical functional decline is a significant health problem for older adults and has far-reaching effects. In particular, the immediate post-hospital period is a high-risk time, because shortened hospital stays make it likely that older patients are discharged in a state of incomplete recovery. Data spanning from July 2002 to June 2005 were extracted from a comprehensive assessment tool, the Minimum Data Set, for 38,591 beneficiaries of a federal health insurance programme covering older adults in the Midwestern region of the United States of America. We investigated relationships between admission factors and post-hospital physical function at 3, 6, 9 and 12 months. The admission factors were health-related variables assessed at the time of skilled nursing facility admission from an acute care hospital. The most important admission factors related to post-hospital physical function at 3, 6, 9 and 12 months were baseline physical function, urinary incontinence and pressure ulcer. Cognitive impairment at admission demonstrated a stronger relationship with poor physical function as resident length of stay increased. Nurses in skilled nursing facilities should screen post-hospital older adults for risk of physical functional decline at admission using identified admission factors. For continuous nursing care, older adults need to be assessed at least once a month during the first 3 months after hospital discharge.

Indicators: Lakeshore Habitat/Riparian Vegetative Cover

EPA Pesticide Factsheets

Riparian and lakeshore vegetative cover consist of the vegetation corridor alongside streams, rivers, and lakes. Vegetative cover refers to overhanging or submerged tree limbs, shrubs, and other plants growing along the shore of the waterbody.

MODIS Vegetative Cover Conversion and Vegetation Continuous Fields

NASA Astrophysics Data System (ADS)

Carroll, Mark; Townshend, John; Hansen, Matthew; DiMiceli, Charlene; Sohlberg, Robert; Wurster, Karl

Land cover change occurs at various spatial and temporal scales. For example, large-scale mechanical removal of forests for agro-industrial activities contrasts with the small-scale clearing of subsistence farmers. Such dynamics vary in spatial extent and rate of land conversion. Such changes are attributable to both natural and anthropogenic factors. For example, lightning- or human-ignited fires burn millions of acres of land surface each year. Further, land cover conversion requires ­contrasting with the land cover modification. In the first instance, the dynamic represents extensive categorical change between two land cover types. Land cover modification mechanisms such as selective logging and woody encroachment depict changes within a given land cover type rather than a conversion from one land cover type to another. This chapter describes the production of two standard MODIS land products used to document changes in global land cover. The Vegetative Cover Conversion (VCC) product is designed primarily to serve as a global alarm for areas where land cover change occurs rapidly (Zhan et al. 2000). The Vegetation Continuous Fields (VCF) product is designed to continuously ­represent ground cover as a proportion of basic vegetation traits. Terra's launch in December 1999 afforded a new opportunity to observe the entire Earth every 1.2 days at 250-m spatial resolution. The MODIS instrument's appropriate spatial and ­temporal resolutions provide the opportunity to substantially improve the characterization of the land surface and changes occurring thereupon (Townshend et al. 1991).

Transfusion of red blood cells: no impact on length of hospital stay in moderately anaemic parturients.

PubMed

Palo, R; Ahonen, J; Salo, H; Salmenperä, M; Krusius, T; Mäki, T

2007-05-01

In a search for information to improve decision making on red blood cell (RBC) transfusion, we examined the impact of RBC transfusion on the length of hospital stay for delivery in moderately anaemic women (haemoglobin, 7-10 g/dl). This was a retrospective, observational study covering 2 years (2002 and 2003), and included major blood-transfusing hospitals from four university and five central hospital districts managing 67.5% of Finnish in-hospital deliveries. The impact of the transfusion of 1-2 RBC units vs. no transfusion on the length of hospital stay was evaluated for three different haemoglobin levels: 7-7.9, 8-8.9 and 9-10 g/dl. Of the 1954 moderately anaemic mothers in hospital for delivery, 13.3% were transfused with RBC. The mean length of hospital stay was 5.2 days vs. the average Finnish hospital delivery stay of 3.5 days. No differences in stay were found between patients with comparable anaemia transfused with 1-2 RBC units or none (at the three haemoglobin levels: P= 0.50, P= 0.07 and P= 0.54, respectively). The final haemoglobin value was higher (P < 0.001) in transfused patients. The duration of admission for delivery in moderately anaemic parturients was longer than the average length of hospital stay in Finnish parturients. However, 1-2 RBC units had no impact on the length of stay, suggesting that unnecessary RBCs are transfused after delivery. Thus, transfusion practices in obstetrics are not always optimal.

Moderating role of interior amenities on hospital medical directors' patient-related work stresses.

PubMed

Lin, Blossom Yen-Ju; Lin, Yung-Kai; Juan, Chi Wen; Lee, Suhsing; Lin, Cheng-Chieh

2013-01-01

Considering hospital medical directors' work stress, this study aims to examine how interior amenities might moderate the effect of work stress on their health. Previous studies have revealed that hospital medical directors-senior physicians in the management positions with high-demand jobs in clinical practices and management-had a lower self-rated health. This was a cross-sectional survey study and 737 hospital medical directors in Taiwan were included. A developed and structured questionnaire covered the dimensions of patient-related work stress (i.e., physician-patient relationship stress and patient condition stress), hospital interior amenities (i.e., indoor plants, aquarium, music, art and exhibitions, and private or personalized spaces that are common or surround the workplace of healthcare professionals), and self-rated health status and health complaints. Hierarchical regressions were performed. Hospital medical directors' physician-patient relationship stresses were found to have more negative effects on their self-reported health status and complaints than do their patient condition stresses; however, only indoor plants were found to have moderating effects on their short-term health complaints (p < 0.05). On the other hand, the hospital medical directors' patient condition stresses were negatively related to their short-term health complaints; however, music, art and exhibitions, and private or personalized spaces in the workplaces had moderating effects (p < 0.05). Considering the unavoidable patient-related work stresses imposed on hospital medical directors, some proposed interior amenities can produce buffering effects on work stress to some extent. Future studies could focus on finding alternatives to relieve hospital medical directors' physician-patient relationship work stresses. Evidence-based design, physicians, privacy and security, satisfaction, work environmentPreferred Citation: Lin, B. Y.-J., Lin, Y.-K., Juan, C.W., Lee, S., Lin, C

49 CFR 1560.111 - Covered airport operators.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 9 2014-10-01 2014-10-01 false Covered airport operators. 1560.111 Section 1560... Transmission of Secure Flight Passenger Data for Watch List Matching § 1560.111 Covered airport operators. (a) Applicability. This section applies to a covered airport operator that has a program approved by TSA through...

49 CFR 1560.111 - Covered airport operators.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 9 2011-10-01 2011-10-01 false Covered airport operators. 1560.111 Section 1560... Transmission of Secure Flight Passenger Data for Watch List Matching § 1560.111 Covered airport operators. (a) Applicability. This section applies to a covered airport operator that has a program approved by TSA through...

49 CFR 1560.111 - Covered airport operators.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 9 2013-10-01 2013-10-01 false Covered airport operators. 1560.111 Section 1560... Transmission of Secure Flight Passenger Data for Watch List Matching § 1560.111 Covered airport operators. (a) Applicability. This section applies to a covered airport operator that has a program approved by TSA through...

49 CFR 1560.111 - Covered airport operators.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 9 2010-10-01 2010-10-01 false Covered airport operators. 1560.111 Section 1560... Transmission of Secure Flight Passenger Data for Watch List Matching § 1560.111 Covered airport operators. (a) Applicability. This section applies to a covered airport operator that has a program approved by TSA through...

49 CFR 1560.111 - Covered airport operators.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 9 2012-10-01 2012-10-01 false Covered airport operators. 1560.111 Section 1560... Transmission of Secure Flight Passenger Data for Watch List Matching § 1560.111 Covered airport operators. (a) Applicability. This section applies to a covered airport operator that has a program approved by TSA through...

The role of matched controls in building an evidence base for hospital-avoidance schemes: a retrospective evaluation.

PubMed

Steventon, Adam; Bardsley, Martin; Billings, John; Georghiou, Theo; Lewis, Geraint Hywel

2012-08-01

To test whether two hospital-avoidance interventions altered rates of hospital use: "intermediate care" and "integrated care teams." Linked administrative data for England covering the period 2004 to 2009. This study was commissioned after the interventions had been in place for several years. We developed a method based on retrospective analysis of person-level data comparing health care use of participants with that of prognostically matched controls. Individuals were linked to administrative datasets through a trusted intermediary and a unique patient identifier. Participants who received the intermediate care intervention showed higher rates of unscheduled hospital admission than matched controls, whereas recipients of the integrated care team intervention showed no difference. Both intervention groups showed higher rates of mortality than did their matched controls. These are potentially powerful techniques for assessing impacts on hospital activity. Neither intervention reduced admission rates. Although our analysis of hospital utilization controlled for a wide range of observable characteristics, the difference in mortality rates suggests that some residual confounding is likely. Evaluation is constrained when performed retrospectively, and careful interpretation is needed. © Health Research and Educational Trust.

Spatio-temporal change in forest cover and carbon storage considering actual and potential forest cover in South Korea.

PubMed

Nam, Kijun; Lee, Woo-Kyun; Kim, Moonil; Kwak, Doo-Ahn; Byun, Woo-Hyuk; Yu, Hangnan; Kwak, Hanbin; Kwon, Taesung; Sung, Joohan; Chung, Dong-Jun; Lee, Seung-Ho

2015-07-01

This study analyzes change in carbon storage by applying forest growth models and final cutting age to actual and potential forest cover for six major tree species in South Korea. Using National Forest Inventory data, the growth models were developed to estimate mean diameter at breast height, tree height, and number of trees for Pinus densiflora, Pinus koraiensis, Pinus rigida, Larix kaempferi, Castanea crenata and Quercus spp. stands. We assumed that actual forest cover in a forest type map will change into potential forest covers according to the Hydrological and Thermal Analogy Groups model. When actual forest cover reaches the final cutting age, forest volume and carbon storage are estimated by changed forest cover and its growth model. Forest volume between 2010 and 2110 would increase from 126.73 to 157.33 m(3) hm(-2). Our results also show that forest cover, volume, and carbon storage could abruptly change by 2060. This is attributed to the fact that most forests are presumed to reach final cutting age. To avoid such dramatic change, a regeneration and yield control scheme should be prepared and implemented in a way that ensures balance in forest practice and yield.

Reusable pipe flange covers

DOEpatents

Holden, James Elliott; Perez, Julieta

2001-01-01

A molded, flexible pipe flange cover for temporarily covering a pipe flange and a pipe opening includes a substantially round center portion having a peripheral skirt portion depending from the center portion, the center portion adapted to engage a front side of the pipe flange and to seal the pipe opening. The peripheral skirt portion is formed to include a plurality of circumferentially spaced tabs, wherein free ends of the flexible tabs are formed with respective through passages adapted to receive a drawstring for pulling the tabs together on a back side of the pipe flange.

45 CFR 162.923 - Requirements for covered entities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Requirements for covered entities. 162.923 Section... Requirements for covered entities. (a) General rule. Except as otherwise provided in this part, if a covered entity conducts, with another covered entity that is required to comply with a transaction standard...

45 CFR 162.923 - Requirements for covered entities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Requirements for covered entities. 162.923 Section... Requirements for covered entities. (a) General rule. Except as otherwise provided in this part, if a covered entity conducts, with another covered entity that is required to comply with a transaction standard...

10 CFR 950.31 - Covered event dispute resolution.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Covered event dispute resolution. 950.31 Section 950.31... § 950.31 Covered event dispute resolution. (a) If a sponsor disagrees with the Covered Event...) days of receipt of the Covered Event Determination, deliver to the Claims Administrator written notice...

10 CFR 950.31 - Covered event dispute resolution.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Covered event dispute resolution. 950.31 Section 950.31... § 950.31 Covered event dispute resolution. (a) If a sponsor disagrees with the Covered Event...) days of receipt of the Covered Event Determination, deliver to the Claims Administrator written notice...

10 CFR 950.31 - Covered event dispute resolution.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Covered event dispute resolution. 950.31 Section 950.31... § 950.31 Covered event dispute resolution. (a) If a sponsor disagrees with the Covered Event...) days of receipt of the Covered Event Determination, deliver to the Claims Administrator written notice...

10 CFR 950.31 - Covered event dispute resolution.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Covered event dispute resolution. 950.31 Section 950.31... § 950.31 Covered event dispute resolution. (a) If a sponsor disagrees with the Covered Event...) days of receipt of the Covered Event Determination, deliver to the Claims Administrator written notice...

10 CFR 950.31 - Covered event dispute resolution.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Covered event dispute resolution. 950.31 Section 950.31... § 950.31 Covered event dispute resolution. (a) If a sponsor disagrees with the Covered Event...) days of receipt of the Covered Event Determination, deliver to the Claims Administrator written notice...

Seasonal land-cover regions of the United States

USGS Publications Warehouse

Loveland, Thomas R.; Merchant, James W.; Brown, Jesslyn F.; Ohlen, Donald O.; Reed, Bradley C.; Olson, Paul; Hutchinson, John

1995-01-01

Global-change investigations have been hindered by deficiencies in the availability and quality of land-cover data. The U.S. Geological Survey and the University of Nebraska-Lincoln have collaborated on the development of a new approach to land-cover characterization that attempts to address requirements of the global-change research community and others interested in regional patterns of land cover. An experimental 1 -kilometer-resolution database of land-cover characteristics for the coterminous U.S. has been prepared to test and evaluate the approach. Using multidate Advanced Very High Resolution Radiometer (AVHRR) satellite data complemented by elevation, climate, ecoregions, and other digital spatial datasets, the authors define 152, seasonal land-cover regions. The regionalization is based on a taxonomy of areas with respect to data on land cover, seasonality or phenology, and relative levels of primary production. The resulting database consists of descriptions of the vegetation, land cover, and seasonal, spectral, and site characteristics for each region. These data are used in the construction of an illustrative 1:7,500,000-scaIe map of the seasonal land-cover regions as well as of smaller-scale maps portraying general land cover and seasonality. The seasonal land-cover characteristics database can also be tailored to provide a broad range of other landscape parameters useful in national and global-scale environmental modeling and assessment.

How different are hospitals' responses to a financial reform? The impact on efficiency of activity-based financing.

PubMed

Biørn, Erik; Hagen, Terje P; Iversen, Tor; Magnussen, Jon

2010-03-01

For policy-makers the heterogeneity of hospital response to reforms is of crucial concern. Even though a reform may entail a positive effect on average efficiency, policy-makers will consider the reform as less attractive if the variation in hospital efficiency increases. The reason is that increased variance of efficiency across hospitals is likely to increase the impact of geography on access to hospital services. This paper examines the heterogeneity with respect to the impact of a financial reform-Activity Based Financing (ABF)-on hospital efficiency in Norway. From a theoretical model we find an ambiguous effect of hospital heterogeneity on the effect of ABF on efficiency. The data set is from a contiguous 10-year panel of 47 hospitals covering both pre-ABF years and years after its imposition. Substantial heterogeneity in the responses, as measured by both estimated and predicted coefficients, is found. We did not find any significant correlation between pre-ABF measures of efficiency and the effect of ABF on efficiency. We did however find a strongly significant correlation between the effect of ABF and post-ABF efficiency. Thus, the analysis confirms the impression that, whereas pre-ABF efficiency did not play any role in how hospitals responded to ABF, those responding generally ended up as better-performing hospitals. Hence, for the type of reform studied in this article we find that policy-makers do not need to worry about the impact of location on patients' access to hospital services.

Hospital variation in survival trends for in-hospital cardiac arrest.

PubMed

Girotra, Saket; Cram, Peter; Spertus, John A; Nallamothu, Brahmajee K; Li, Yan; Jones, Philip G; Chan, Paul S

2014-06-10

During the past decade, survival after in-hospital cardiac arrest has improved markedly. It remains unknown whether the improvement in survival has occurred uniformly at all hospitals or was driven by large improvements at only a few hospitals. We identified 93 342 adults with an in-hospital cardiac arrest at 231 hospitals in the Get With The Guidelines(®)-Resuscitation registry during 2000-2010. Using hierarchical regression models, we evaluated hospital-level trends in survival to discharge. Mean age was 66 years, 59% were men, and 21% were black. Between 2000 and 2010, there was a significant decrease in age, prevalence of heart failure and myocardial infarction, and cardiac arrests due to shockable rhythms (P<0.001 for all) and an increase in prevalence of sepsis, respiratory insufficiency, renal insufficiency, intensive care unit location, and mechanical ventilation before arrest (P<0.001 for all). After adjustment for temporal trends in baseline characteristics, hospital rates of in-hospital cardiac arrest survival improved by 7% per year (odds ratio [OR] 1.07, 95% CI 1.06 to 1.08, P<0.001). Improvement in survival varied markedly and ranged from 3% in the bottom hospital quartile to 11% in the top hospital quartile. Compared with minor teaching hospitals (OR 1.04, 95% CI 1.02 to 1.06), hospital rate of survival improvement was greater at major teaching (OR 1.08, 95% CI 1.06 to 1.10) and nonteaching hospitals (OR 1.07, 95% CI 1.05 to 1.09, P value for interaction=0.03). Although in-hospital cardiac arrest survival has improved during the past decade, the magnitude of improvement varied across hospitals. Future studies are needed to identify hospital processes that have led to the largest improvement in survival. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Towards realistic Holocene land cover scenarios: integration of archaeological, palynological and geomorphological records and comparison to global land cover scenarios.

NASA Astrophysics Data System (ADS)

De Brue, Hanne; Verstraeten, Gert; Broothaerts, Nils; Notebaert, Bastiaan

2016-04-01

Accurate and spatially explicit landscape reconstructions for distinct time periods in human history are essential for the quantification of the effect of anthropogenic land cover changes on, e.g., global biogeochemical cycles, ecology, and geomorphic processes, and to improve our understanding of interaction between humans and the environment in general. A long-term perspective covering Mid and Late Holocene land use changes is recommended in this context, as it provides a baseline to evaluate human impact in more recent periods. Previous efforts to assess the evolution and intensity of agricultural land cover in past centuries or millennia have predominantly focused on palynological records. An increasing number of quantitative techniques has been developed during the last two decades to transfer palynological data to land cover estimates. However, these techniques have to deal with equifinality issues and, furthermore, do not sufficiently allow to reconstruct spatial patterns of past land cover. On the other hand, several continental and global databases of historical anthropogenic land cover changes based on estimates of global population and the required agricultural land per capita have been developed in the past decennium. However, at such long temporal and spatial scales, reconstruction of past anthropogenic land cover intensities and spatial patterns necessarily involves many uncertainties and assumptions as well. Here, we present a novel approach that combines archaeological, palynological and geomorphological data for the Dijle catchment in the central Belgium Loess Belt in order to arrive at more realistic Holocene land cover histories. Multiple land cover scenarios (> 60.000) are constructed using probabilistic rules and used as input into a sediment delivery model (WaTEM/SEDEM). Model outcomes are confronted with a detailed geomorphic dataset on Holocene sediment fluxes and with REVEALS based estimates of vegetation cover using palynological data from

46 CFR 127.440 - Operability of window coverings.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Operability of window coverings. 127.440 Section 127.440... ARRANGEMENTS Construction of Windows, Visibility, and Operability of Coverings § 127.440 Operability of window coverings. Any covering or protection placed over a window or porthole that could be used as a means of...

Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals.

PubMed

Dimitrov, Nikolay; Koenig, William; Bosson, Nichole; Song, Sarah; Saver, Jeffrey L; Mack, William J; Sanossian, Nerses

2015-09-01

Comprehensive stroke systems of care include routing to the nearest designated stroke center hospital, bypassing non-designated hospitals. Routing protocols are implemented at the state or county level and vary in qualification criteria and determination of destination hospital. We surveyed all counties in the state of California for presence and characteristics of their prehospital stroke routing protocols. Each county's local emergency medical services agency (LEMSA) was queried for the presence of a stroke routing protocol. We reviewed these protocols for method of stroke identification and criteria for patient transport to a stroke center. Thirty-three LEMSAs serve 58 counties in California with populations ranging from 1,175 to nearly 10 million. Fifteen LEMSAs (45%) had stroke routing protocols, covering 23 counties (40%) and 68% of the state population. Counties with protocols had higher population density (1,500 vs. 140 persons per square mile). In the six counties without designated stroke centers, patients meeting criteria were transported out of county. Stroke identification in the field was achieved using the Cincinnati Prehospital Stroke Screen in 72%, Los Angeles Prehospital Stroke Screen in 7% and a county-specific protocol in 22%. California EMS prehospital acute stroke routing protocols cover 68% of the state population and vary in characteristics including activation by symptom onset time and destination facility features, reflecting matching of system design to local geographic resources.

The National Land Cover Database

USGS Publications Warehouse

Homer, Collin G.; Fry, Joyce A.; Barnes, Christopher A.

2012-01-01

The National Land Cover Database (NLCD) serves as the definitive Landsat-based, 30-meter resolution, land cover database for the Nation. NLCD provides spatial reference and descriptive data for characteristics of the land surface such as thematic class (for example, urban, agriculture, and forest), percent impervious surface, and percent tree canopy cover. NLCD supports a wide variety of Federal, State, local, and nongovernmental applications that seek to assess ecosystem status and health, understand the spatial patterns of biodiversity, predict effects of climate change, and develop land management policy. NLCD products are created by the Multi-Resolution Land Characteristics (MRLC) Consortium, a partnership of Federal agencies led by the U.S. Geological Survey. All NLCD data products are available for download at no charge to the public from the MRLC Web site: http://www.mrlc.gov.

Land cover changes in central Sonora Mexico

Treesearch

Diego Valdez-Zamudio; Alejandro Castellanos-Villegas; Stuart Marsh

2000-01-01

Remote sensing techniques have been demonstrated to be very effective tools to help detect, analyze, and evaluate land cover changes in natural areas of the world. Changes in land cover can generally be attributed to either natural or anthropogenic forces. Multitemporal satellite imagery and airborne videography were used to detect, analyze, and evaluate land cover...

Identifying Patterns in Implementation of Hospital Pressure Ulcer Prevention Programs: A Multisite Qualitative Study.

PubMed

Soban, Lynn M; Finley, Erin P; Miltner, Rebecca S

2016-01-01

To describe the presence or absence of key components of hospital pressure ulcer (PU) prevention programs in 6 acute care hospitals. Multisite comparative case study. Using purposeful selection based on PU rates (high vs low) and hospital size, 6 hospitals within the Veterans Health Administration health care system were invited to participate. Key informant interviews (n = 48) were conducted in each of the 6 participating hospitals among individuals playing key roles in PU prevention: senior nursing leadership (n = 9), nurse manager (n = 7), wound care specialist (n = 6), frontline RNs (n = 26). Qualitative data were collected during face-to-face, semistructured interviews. Interview protocols were tailored to each interviewee's role with a core set of common questions covering 3 major content areas: (1) practice environment (eg, policies and wound care specialists), (2) current prevention practices (eg, conduct of PU risk assessment and skin inspection), and (3) barriers to PU prevention. We conducted structured coding of 5 key components of PU prevention programs and cross-case analysis to identify patterns in operationalization and implementation of program components across hospitals based on facility size and PU rates (low vs high). All hospitals had implemented all PU prevention program components. Component operationalization varied considerably across hospitals. Wound care specialists were integral to the operationalization of the 4 other program components examined; however, staffing levels and work assignments of wound care specialists varied widely. Patterns emerged among hospitals with low and high PU rates with respect to wound care specialist staffing, data monitoring, and staff education. We found hospital-level variations in PU prevention programs. Wound care specialist staffing may represent a potential point of leverage in achieving other PU program components, particularly performance monitoring and staff education.

Use, trends, and impacts of nurse overtime in New York hospitals, 1995--2000

NASA Astrophysics Data System (ADS)

Berney, Barbara L.

Over the last several years, nurses and their advocates have expressed concern about heavy use of overtime (OT) in hospitals and claimed that it undermines the quality of nursing care. Some hospital managers view OT as an important staffing and scheduling tool. This study examines trends in the use of nurse overtime and its effects on several nurse-sensitive patient outcomes. Previous studies have demonstrated a relationship between several patient outcomes and nurse staffing levels, but little is known about the impact of nurse overtime on patient outcomes. Using staffing and discharge data covering 1995 to 2000 from 160 acute general hospitals in New York State, this study examines hospital characteristics that are associated with the use of OT. These characteristics include size, location, RN unionization, hospital ownership and teaching status. The study examines trends in the use of OT. Finally, it uses multivariate regression to analyze the relationship between OT and the rates of six nurse-sensitive patient outcomes and mortality. Significant differences were observed in the use of OT by hospital ownership and by union status. Government hospitals used less OT than non-government hospitals. Non-union hospitals used slightly less OT than hospitals with unionized nurses. As total RN hours and straight (non-OT) hours per acute inpatient day increased, OT decreased. OT use as a percent of total inpatient RN hours increased significantly over the study period from 3.9% to 5.5%. Trends varied by hospital characteristic. This dissertation finds little evidence for an association between nurse OT and patient outcomes. One reason may be that the administrative data used track OT use and adverse events for whole years. Since OT use is episodic, data that examine the occurrence of adverse events during periods of heavy nurse overtime may be more sensitive to the impact of OT. That hospitals vary dramatically in their OT use and that some categories of hospitals (e

[Terrorists' target World Cup 2006: disaster medicine on the sidelines?! Aspects of hospital disaster planning].

PubMed

Weidringer, J W; Ansorg, J; Ulrich, B C; Polonius, M-J; Domres, B D

2004-09-01

Focussing on possible mass casualty situations during events such as the soccer world championship in 2006, the Professional Board of Surgeons in Germany and the German Society for Surgery canvassed surgeons-in-chief in the last quarter of 2003 concerning disaster plans for hospitals. The rate of returned questionnaires amounted to 26% covering the following areas of interest: plans-ready to use, known by the employees as well as by the rescue coordination center, performance of exercises, and concepts on decontamination and detoxification. Based on past numbers of casualties during soccer disasters, an excursus into details also includes a description of an approach to reduce the danger of bottleneck effects at doors. A preliminary concept based on the upcoming system for funding hospitals in Germany and including new partnerships is outlined, succeeded by some hopefully helpful hints for a web-based hospital disaster plan.

The relationship of hospital ownership and service composition to hospital charges

PubMed Central

Eskoz, Robin; Peddecord, K. Michael

1985-01-01

The relationship of hospital ownership and service composition to hospital charges was examined for 456 general acute hospitals in California. Ancillary services had higher profit margins, both gross and net profits, than daily hospital services. Ancillary services accounted for 55.3 percent of total patient revenue. Charges per day were 23 percent higher for ancillary services than for daily hospital services. Net profits for daily and ancillary services were lowest at county hospitals. Proprietary hospitals had the highest net profits for total ancillary services and the highest mean charges. Not-for-profit hospitals had the highest profit margins for daily hospital services. Neither direct nor total costs for ancillary services were significantly different among ownership groups, although direct costs for daily hospital services were significantly higher at proprietary hospitals. PMID:10311161

AsMA journal covers, a history.

PubMed

Day, Pamela C

2014-01-01

The cover of our journal has changed quite often over the years. As we look forward to changing the name and design of the journal, it seems appropriate to reflect on the previous journal titles and covers. A brief history follows.

Assessment of Aerobic Exercise Adverse Effects during COPD Exacerbation Hospitalization

PubMed Central

Mesquita, Carolina Bonfanti; Caram, Laura M. O.; Dourado, Victor Zuniga; de Godoy, Irma; Tanni, Suzana Erico

2017-01-01

Introduction. Aerobic exercise performed after hospital discharge for exacerbated COPD patients is already recommended to improve respiratory and skeletal muscle strength, increase tolerance to activity, and reduce the sensation of dyspnea. Previous studies have shown that anaerobic activity can clinically benefit patients hospitalized with exacerbated COPD. However, there is little information on the feasibility and safety of aerobic physical activity performed by patients with exacerbated COPD during hospitalization. Objective. To evaluate the effects of aerobic exercise on vital signs in hospitalized patients with exacerbated COPD. Patients and Methods. Eleven COPD patients (63% female, FEV1: 34.2 ± 13.9% and age: 65 ± 11 years) agreed to participate. Aerobic exercise was initiated 72 hours after admission on a treadmill; speed was obtained from the distance covered in a 6-minute walk test (6MWT). Vital signs were assessed before and after exercise. Results. During the activity systolic blood pressure increased from 125.2 ± 13.6 to 135.8 ± 15.0 mmHg (p = 0.004) and respiratory rate from 20.9 ± 4.4 to 24.2 ± 4.5 rpm (p = 0.008) and pulse oximetry (SpO2) decreased from 93.8 ± 2.3 to 88.5 ± 5.7% (p < 0.001). Aerobic activity was considered intense, heart rate ranged from 99.2 ± 11.5 to 119.1 ± 11.1 bpm at the end of exercise (p = 0.092), and patients reached on average 76% of maximum heart rate. Conclusion. Aerobic exercise conducted after 72 hours of hospitalization in patients with exacerbated COPD appears to be safe. PMID:28265180

Medical Record Clerk Training Program, Course of Study; Student Manual: For Medical Record Personnel in Small Rural Hospitals in Colorado.

ERIC Educational Resources Information Center

Community Health Service (DHEW/PHS), Arlington, VA. Div. of Health Resources.

The manual provides major topics, objectives, activities and, procedures, references and materials, and assignments for the training program. The topics covered are hospital organization and community role, organization and management of a medical records department, international classification of diseases and operations, medical terminology,…

Modeling percent tree canopy cover: a pilot study

Treesearch

John W. Coulston; Gretchen G. Moisen; Barry T. Wilson; Mark V. Finco; Warren B. Cohen; C. Kenneth Brewer

2012-01-01

Tree canopy cover is a fundamental component of the landscape, and the amount of cover influences fire behavior, air pollution mitigation, and carbon storage. As such, efforts to empirically model percent tree canopy cover across the United States are a critical area of research. The 2001 national-scale canopy cover modeling and mapping effort was completed in 2006,...

Cloud cover models derived from satellite radiation measurements

NASA Technical Reports Server (NTRS)

Bean, S. J.; Somerville, P. N.

1979-01-01

Using daily measurement of day and night infrared and incoming and absorbed solar radiation obtained from a TIROS satellite over a period of approximately 45 months, and integrated over 2.5 degree latitude-longitude grids, the proportion of cloud cover over each grid each day was derived for the entire period. For each of four three-month periods, estimates a and b of the two parameters of the best-fit beta distribution were obtained for each grid location. The (a,b) plane was divided into a number of regions. All the geographical locations whose (a,b) estimates were in the same region in the (a,b) plane were said to have the same cloud cover type for that season. For each season, the world was thus divided into separate cloud cover types. Using estimates of mean cloud cover for each season, the world was again divided into separate cloud cover types. The process was repeated for standard deviations. Thus for each season, three separate cloud cover models were obtained using the criteria of shape of frequency distribution, mean cloud cover, and variability of cloud cover. The cloud cover statistics were derived from once-a-day, near-local-noon satellite radiation measurements.

Hospital output forecasts and the cost of empty hospital beds.

PubMed Central

Pauly, M V; Wilson, P

1986-01-01

This article investigates the cost incurred when hospitals have different levels of beds to treat a given number of patients. The cost of hospital care is affected by both the forecasted level of admissions and the actual number of admissions. When the relationship between forecasted and actual admissions is held constant, it is found that an empty hospital bed at a typical hospital in Michigan has a relatively low cost, about 13 percent or less of the cost of an occupied bed. However, empty beds in large hospitals do add significantly to cost. If hospital beds are closed, whether by closing beds at hospitals which remain in business or by closing entire hospitals, cost savings are estimated to be small. PMID:3759473

Hospital Variation in Survival Trends for In‐hospital Cardiac Arrest

PubMed Central

Girotra, Saket; Cram, Peter; Spertus, John A.; Nallamothu, Brahmajee K.; Li, Yan; Jones, Philip G.; Chan, Paul S.

2014-01-01

Background During the past decade, survival after in‐hospital cardiac arrest has improved markedly. It remains unknown whether the improvement in survival has occurred uniformly at all hospitals or was driven by large improvements at only a few hospitals. Methods and Results We identified 93 342 adults with an in‐hospital cardiac arrest at 231 hospitals in the Get With The Guidelines®‐Resuscitation registry during 2000–2010. Using hierarchical regression models, we evaluated hospital‐level trends in survival to discharge. Mean age was 66 years, 59% were men, and 21% were black. Between 2000 and 2010, there was a significant decrease in age, prevalence of heart failure and myocardial infarction, and cardiac arrests due to shockable rhythms (P<0.001 for all) and an increase in prevalence of sepsis, respiratory insufficiency, renal insufficiency, intensive care unit location, and mechanical ventilation before arrest (P<0.001 for all). After adjustment for temporal trends in baseline characteristics, hospital rates of in‐hospital cardiac arrest survival improved by 7% per year (odds ratio [OR] 1.07, 95% CI 1.06 to 1.08, P<0.001). Improvement in survival varied markedly and ranged from 3% in the bottom hospital quartile to 11% in the top hospital quartile. Compared with minor teaching hospitals (OR 1.04, 95% CI 1.02 to 1.06), hospital rate of survival improvement was greater at major teaching (OR 1.08, 95% CI 1.06 to 1.10) and nonteaching hospitals (OR 1.07, 95% CI 1.05 to 1.09, P value for interaction=0.03). Conclusion Although in‐hospital cardiac arrest survival has improved during the past decade, the magnitude of improvement varied across hospitals. Future studies are needed to identify hospital processes that have led to the largest improvement in survival. PMID:24922627

Intercomparison of Satellite-Derived Snow-Cover Maps

NASA Technical Reports Server (NTRS)

Hall, Dorothy K.; Tait, Andrew B.; Foster, James L.; Chang, Alfred T. C.; Allen, Milan

1999-01-01

In anticipation of the launch of the Earth Observing System (EOS) Terra, and the PM-1 spacecraft in 1999 and 2000, respectively, efforts are ongoing to determine errors of satellite-derived snow-cover maps. EOS Moderate Resolution Imaging Spectroradiometer (MODIS) and Advanced Microwave Scanning Radiometer-E (AMSR-E) snow-cover products will be produced. For this study we compare snow maps covering the same study area acquired from different sensors using different snow- mapping algorithms. Four locations are studied: 1) southern Saskatchewan; 2) a part of New England (New Hampshire, Vermont and Massachusetts) and eastern New York; 3) central Idaho and western Montana; and 4) parts of North and South Dakota. Snow maps were produced using a prototype MODIS snow-mapping algorithm used on Landsat Thematic Mapper (TM) scenes of each study area at 30-m and when the TM data were degraded to 1 -km resolution. National Operational Hydrologic Remote Sensing Center (NOHRSC) 1 -km resolution snow maps were also used, as were snow maps derived from 1/2 deg. x 1/2 deg. resolution Special Sensor Microwave Imager (SSM/1) data. A land-cover map derived from the International Geosphere-Biosphere Program (IGBP) land-cover map of North America was also registered to the scenes. The TM, NOHRSC and SSM/I snow maps, and land-cover maps were compared digitally. In most cases, TM-derived maps show less snow cover than the NOHRSC and SSM/I maps because areas of incomplete snow cover in forests (e.g., tree canopies, branches and trunks) are seen in the TM data, but not in the coarser-resolution maps. The snow maps generally agree with respect to the spatial variability of the snow cover. The 30-m resolution TM data provide the most accurate snow maps, and are thus used as the baseline for comparison with the other maps. Comparisons show that the percent change in amount of snow cover relative to the 3 0-m resolution TM maps is lowest using the TM I -km resolution maps, ranging from 0 to 40

49 CFR 633.11 - Covered projects.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF TRANSPORTATION PROJECT MANAGEMENT OVERSIGHT Project Management Oversight Services § 633.11 Covered projects. The Administrator may contract for project management oversight services when the... 49 Transportation 7 2010-10-01 2010-10-01 false Covered projects. 633.11 Section 633.11...

49 CFR 633.11 - Covered projects.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF TRANSPORTATION PROJECT MANAGEMENT OVERSIGHT Project Management Oversight Services § 633.11 Covered projects. The Administrator may contract for project management oversight services when the... 49 Transportation 7 2012-10-01 2012-10-01 false Covered projects. 633.11 Section 633.11...

49 CFR 633.11 - Covered projects.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF TRANSPORTATION PROJECT MANAGEMENT OVERSIGHT Project Management Oversight Services § 633.11 Covered projects. The Administrator may contract for project management oversight services when the... 49 Transportation 7 2013-10-01 2013-10-01 false Covered projects. 633.11 Section 633.11...

49 CFR 633.11 - Covered projects.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF TRANSPORTATION PROJECT MANAGEMENT OVERSIGHT Project Management Oversight Services § 633.11 Covered projects. The Administrator may contract for project management oversight services when the... 49 Transportation 7 2014-10-01 2014-10-01 false Covered projects. 633.11 Section 633.11...

49 CFR 633.11 - Covered projects.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF TRANSPORTATION PROJECT MANAGEMENT OVERSIGHT Project Management Oversight Services § 633.11 Covered projects. The Administrator may contract for project management oversight services when the... 49 Transportation 7 2011-10-01 2011-10-01 false Covered projects. 633.11 Section 633.11...

49 CFR 1016.103 - Proceedings covered.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 8 2010-10-01 2010-10-01 false Proceedings covered. 1016.103 Section 1016.103 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT... BY PARTIES TO BOARD ADJUDICATORY PROCEEDINGS General Provisions § 1016.103 Proceedings covered. (a...

49 CFR 1016.103 - Proceedings covered.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 8 2011-10-01 2011-10-01 false Proceedings covered. 1016.103 Section 1016.103 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT... BY PARTIES TO BOARD ADJUDICATORY PROCEEDINGS General Provisions § 1016.103 Proceedings covered. (a...

Fish assemblage responses to forest cover

Treesearch

Chris L. Burcher; Matthew E. McTammany; E. Fred Benfield; Gene S. Helfman

2008-01-01

We investigated whether fish assemblage structure in southern Appalachian streams differed with historical and contemporary forest cover. We compared fish assemblages in 2nd?4th order streams draining watersheds that had increased forest cover between 1950 and 1993 (i.e., reforesting watersheds).

The costs of acute readmissions to a different hospital - Does the effect vary across provider types?

PubMed

Møller Dahl, Christian; Planck Kongstad, Line

2017-06-01

Treatment costs are found to vary substantially and systematically within DRGs. Several factors have been shown to contribute to the variation in costs within DRGs. We argue that readmissions might also explain part of the observed variation in costs. A substantial number of all readmissions occur to a different hospital. The change in hospital indicates that a progression of the illness has occurred since the initial hospitalisation. As a result, different-hospital readmissions might be more costly compared to same-hospital admissions. The aim of this paper is twofold. Firstly, to analyse differences in costs between different-hospital readmissions and same-hospital readmissions within the same DRG. Secondly, to investigate whether the effect of different-hospital readmission on costs vary depending of provider type (general versus teaching hospital). We use a rich Danish patient-level administrative data set covering inpatient stays in the period 2008-2010. We exploit the fact that some patients are readmitted within the same DRG and that some of these readmissions occur at different hospitals in a propensity score difference-in-difference design. The estimates are based on a restricted sample of n = 328 patients. Our results show that the costs of different-hospital readmissions are significantly higher relative to the costs of same-hospital readmission (approx. €777). Furthermore, the cost difference is found to be almost twice the size for patients readmitted to a teaching hospital (approx. €1016) (P < 0.10) compared to patients readmitted to a different general hospital (approx. €511) (P < 0.10). The results suggest that hospitals in general face a potential risk by treating different-hospital readmissions, and that the financial consequences are highest among teaching hospitals. If teaching hospitals are not compensated for the additional costs of treating different-hospital readmission patients, they might be unfairly funded under a DRG

Assessing the impact of privatizing public hospitals in three American states: implications for universal health coverage.

PubMed

Villa, Stefano; Kane, Nancy

2013-01-01

Many countries with universal health systems have relied primarily on publicly-owned hospitals to provide acute care services to covered populations; however, many policymakers have experimented with expansion of the private sector for what they hope will yield more cost-effective care. The study provides new insight into the effects of hospital privatization in three American states (California, Florida, and Massachusetts) in the period 1994 to 2003, focusing on three aspects: 1) profitability; 2) productivity and efficiency; and 3) benefits to the community (particularly, scope of services offered, price level, and impact on charity care). For each variable analyzed, we compared the 3-year mean values pre- and postconversion. Pre- and postconversion changes in hospitals' performance were then compared with a nonequivalent comparison group of American public hospitals. The results of our study indicate that following privatization, hospitals increased operating margins, reduced their length of stay, and enjoyed higher occupancy, but at some possible cost to access to care for their communities in terms of higher price markups and loss of beneficial but unprofitable services. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Health-care providers' perspectives on health-insurance access, waiving procedures, and hospital detention practices in Kenya.

PubMed

Mostert, Saskia; Njuguna, Festus; van der Burgt, Renske H M; Musimbi, Joyce; Langat, Sandra; Skiles, Jodi; Seijffert, Anneloes; Sitaresmi, Mei N; Vik, Terry A; van de Ven, Peter M; Kaspers, Gertjan J L

2018-05-09

Patients at Kenyan public hospitals are detained if their families cannot pay their medical bills. Access to health insurance and waiving procedures to prevent detention may be limited. This study explores the perspectives of health-care providers (HCP) on health-insurance access, waiving procedures, and hospital detention practices. A self-administered structured questionnaire was completed by 104 HCP (response rate 78%) involved in childhood cancer care. The perspectives of respondents were as follows: all children with cancer should have health insurance according to 96% of HCP. After parents apply for health insurance, it takes too long before treatment costs are covered (67% agree). Patients with childhood cancer without health insurance have a higher chance of abandoning treatment (82% agree). Hospitals should waive bills of all children with cancer when parents have payment difficulties (69% agree). Waiving procedures take too long (75%). Parents are scared by waiving procedures and may decide never to return to the hospital again (68%). Poor families delay visiting the hospital because they fear hospital detention and first seek alternative treatment (92%). When poor families finally come to the hospital, the disease is in advanced stage already (94%). Parents sometimes have to abandon their detained child at the hospital if they cannot pay hospital bills (68%). Detention of children at the hospital if parents cannot pay their medical bills is not approved by 84% of HCP. HCP acknowledge that access to health insurance needs improvement and that waiving procedures contribute to treatment abandonment. By far, most HCP disapprove of hospital detention practices. These factors warrant urgent attention and adjustment. © 2018 Wiley Periodicals, Inc.

Timely precipitation drives cover crop outcomes

USDA-ARS?s Scientific Manuscript database

Cover crops can expand ecosystem services, though sound management recommendations for their use within semi-arid cropping systems is currently constrained by a lack of information. This study was conducted to determine agroecosystem responses to late-summer seeded cover crops under no-till managem...

Questions and Answers Regarding the 2009 New Source Performance Standards (NSPS) Emissions Guidelines, and State Plan Process for Hospital, Medical, and Infectious Waste Incinerators (HMIWI)

EPA Pesticide Factsheets

This July 2011 document contains questions and answers on the Hospital/Medical/Infectious Waste Incinerators (HMIWI) regulations. The questions cover topics such as state plan requirements, compliance, applicability, operator training, and more.

Vegetative soil covers for hazardous waste landfills

NASA Astrophysics Data System (ADS)

Peace, Jerry L.

Shallow land burial has been the preferred method for disposing of municipal and hazardous wastes in the United States because it is the simplest, cheapest, and most cost-effective method of disposal. Arid and semiarid regions of the western United States have received considerable attention over the past two decades in reference to hazardous, radioactive, and mixed waste disposal. Disposal is based upon the premise that low mean annual precipitation, high evapotranspiration, and low or negligible recharge, favor waste isolation from the environment for long periods of time. The objective of this study is to demonstrate that containment of municipal and hazardous wastes in arid and semiarid environments can be accomplished effectively without traditional, synthetic materials and complex, multi-layer systems. This research demonstrates that closure covers utilizing natural soils and native vegetation i.e., vegetative soil covers, will meet the technical equivalency criteria prescribed by the U.S. Environmental Protection Agency for hazardous waste landfills. Vegetative soil cover design combines layers of natural soil, native plant species, and climatic conditions to form a sustainable, functioning ecosystem that maintains the natural water balance. In this study, percolation through a natural analogue and an engineered cover is simulated using the one-dimensional, numerical code UNSAT-H. UNSAT-H is a Richards' equation-based model that simulates soil water infiltration, unsaturated flow, redistribution, evaporation, plant transpiration, and deep percolation. This study incorporates conservative, site-specific soil hydraulic and vegetation parameters. Historical meteorological data from 1919 to 1996 are used to simulate percolation through the natural analogue and an engineered cover, with and without vegetation. This study indicates that a 1 m (3 ft) cover is the minimum design thickness necessary to meet the U.S. Environmental Protection Agency

Selection of medicines in Chilean public hospitals: an exploratory study.

PubMed

Collao, Juan F; Smith, Felicity; Barber, Nick

2013-01-07

There is a growing interest in high income countries to control expenditure on medicines by improving the rationale for their selection. However, in middle income countries with differing priorities and needs, little attention has been paid to this issue. In this paper we explore the policies and processes for the selection and use of medicines in a group of hospitals in Chile, a middle income country which has recently joined the OECD. A combination of qualitative and quantitative methods was used. A national survey questionnaire was distributed to investigate the role and operation of PTCs (Pharmacy and Therapeutics Committees). Interviews were conducted with key actors in the selection of medicines in large urban public hospitals. The national survey had an overall response rate of 42% (83 out of 196), whilst 7 out of 14 hospitals participated in the qualitative study. High complexity hospitals are large urban hospitals; all of which claim to have a working PTC. The pharmacy offices are mainly involved in dispensing medicines with little involvement in clinical duties.The interviews conducted suggest that the formulary of all the hospitals visited is no more than a stock list. PTCs are unable to influence the prescribing practices of doctors. Members do not feel prepared to challenge the opinions of specialists requesting a certain drug, and decisions are based primarily on costs. The inclusion of medicines in the clinical practice of hospitals is as a result of doctors bypassing the PTC and requesting the purchase of exceptional items, some of which are included in the formulary if they are widely used. There is an urgent need to develop medicine policies in hospitals in Chile. The procedures used to purchase medicines need to be revised. Central guidance for PTCs could help ensure a more rational use of medicines. PTCs need to be empowered to design formularies which cover all the clinical needs of doctors, training members in the analysis of scientific

Selection of medicines in Chilean public hospitals: an exploratory study

PubMed Central

2013-01-01

Background There is a growing interest in high income countries to control expenditure on medicines by improving the rationale for their selection. However, in middle income countries with differing priorities and needs, little attention has been paid to this issue. In this paper we explore the policies and processes for the selection and use of medicines in a group of hospitals in Chile, a middle income country which has recently joined the OECD. Methods A combination of qualitative and quantitative methods was used. A national survey questionnaire was distributed to investigate the role and operation of PTCs (Pharmacy and Therapeutics Committees). Interviews were conducted with key actors in the selection of medicines in large urban public hospitals. Results The national survey had an overall response rate of 42% (83 out of 196), whilst 7 out of 14 hospitals participated in the qualitative study. High complexity hospitals are large urban hospitals; all of which claim to have a working PTC. The pharmacy offices are mainly involved in dispensing medicines with little involvement in clinical duties. The interviews conducted suggest that the formulary of all the hospitals visited is no more than a stock list. PTCs are unable to influence the prescribing practices of doctors. Members do not feel prepared to challenge the opinions of specialists requesting a certain drug, and decisions are based primarily on costs. The inclusion of medicines in the clinical practice of hospitals is as a result of doctors bypassing the PTC and requesting the purchase of exceptional items, some of which are included in the formulary if they are widely used. Conclusions There is an urgent need to develop medicine policies in hospitals in Chile. The procedures used to purchase medicines need to be revised. Central guidance for PTCs could help ensure a more rational use of medicines. PTCs need to be empowered to design formularies which cover all the clinical needs of doctors, training

Health Care Consumption among Elderly Patients in California: A Comprehensive 10-Year Evaluation of Trends in Hospitalization Rates and Charges

ERIC Educational Resources Information Center

Koziol, James A.; Zuraw, Bruce L.; Christiansen, Sandra C.

2002-01-01

Purpose: This report examines health care rates, charges, and patterns of consumption from a comprehensive California hospitalization data set covering 1986-1995. An improved understanding of current trends in health care consumption would facilitate the development of future resource allocation models. Design and Methods: We obtained discharge…

A cloud cover model based on satellite data

NASA Technical Reports Server (NTRS)

Somerville, P. N.; Bean, S. J.

1980-01-01

A model for worldwide cloud cover using a satellite data set containing infrared radiation measurements is proposed. The satellite data set containing day IR, night IR and incoming and absorbed solar radiation measurements on a 2.5 degree latitude-longitude grid covering a 45 month period was converted to estimates of cloud cover. The global area was then classified into homogeneous cloud cover regions for each of the four seasons. It is noted that the developed maps can be of use to the practicing climatologist who can obtain a considerable amount of cloud cover information without recourse to large volumes of data.

7 CFR 353.4 - Products covered.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 5 2012-01-01 2012-01-01 false Products covered. 353.4 Section 353.4 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE EXPORT CERTIFICATION § 353.4 Products covered. Plants and plant products when...

7 CFR 353.4 - Products covered.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 5 2010-01-01 2010-01-01 false Products covered. 353.4 Section 353.4 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE EXPORT CERTIFICATION § 353.4 Products covered. Plants and plant products when...

The WAMI Rural Hospital Project. Part 3: Building health care leadership in rural communities.

PubMed

Elder, W G; Amundson, B A

1991-01-01

The WAMI Rural Hospital Project (RHP) intervention combined aspects of community development, strategic planning and organizational development to address the leadership issues in six Northwest rural hospitals. Hospitals and physicians, other community health care providers and local townspeople were involved in this intervention, which was accomplished in three phases. In the first phase, extensive information about organizational effectiveness was collected at each site. Phase two consisted of 30 hours of education for the physician, board, and hospital administrator community representatives covering management, hospital board governance, and scope of service planning. In the third phase, each community worked with a facilitator to complete a strategic plan and to resolve conflicts addressed in the management analyses. The results of the evaluation demonstrated that the greatest change noted among RHP hospitals was improvement in the effectiveness of their governing boards. All boards adopted some or all of the project's model governance plan and had successfully completed considerable portions of their strategic plans by 1989. Teamwork among the management triad (hospital, board, and medical staff) was also substantially improved. Other improvements included the development of marketing plans for the three hospitals that did not initially have them and more effective use of outside consultants. The project had less impact on improving the functioning of the medical chief of staff, although this was not a primary target of the intervention. There was also relatively less community interest in joining regional health care associations. The authors conclude that an intervention program tailored to address specific community needs and clearly identified leadership deficiencies can have a positive effect on rural health care systems.

Hospital Characteristics Associated With Postdischarge Hospital Readmission, Observation, and Emergency Department Utilization.

PubMed

Horwitz, Leora I; Wang, Yongfei; Altaf, Faseeha K; Wang, Changqin; Lin, Zhenqiu; Liu, Shuling; Grady, Jacqueline; Bernheim, Susannah M; Desai, Nihar R; Venkatesh, Arjun K; Herrin, Jeph

2018-04-01

Whether types of hospitals with high readmission rates also have high overall postdischarge acute care utilization (including emergency department and observation care) is unknown. Cross-sectional analysis. Nonfederal United States acute care hospitals. Using methodology established by the Centers for Medicare & Medicaid Services, we calculated each hospital's "excess days in acute care" for fee-for-service (FFS) Medicare beneficiaries aged over 65 years discharged after hospitalization for acute myocardial infarction, heart failure (HF), or pneumonia, representing the mean difference between predicted and expected total days of acute care utilization in the 30 days following hospital discharge, per 100 discharges. We assessed the multivariable association of 8 hospital characteristics with excess days in acute care and the proportion of hospitals with each characteristic that were statistical outliers (95% credible interval estimate does not include 0). We included 2184 hospitals for acute myocardial infarction [228 (10.4%) better than expected, 549 (25.1%) worse than expected], 3720 hospitals for HF [484 (13.0%) better and 840 (22.6%) worse], and 4195 hospitals for pneumonia [673 (16.0%) better, 1005 (24.0%) worse]. Results for all conditions were similar. Worse than expected outliers for pneumonia included: 18.8% of safety net hospitals versus 26.1% of nonsafety net hospitals; 16.7% of public hospitals versus 33.1% of for-profit hospitals; 19.5% of nonteaching hospitals versus 52.2% of major teaching hospitals; 7.9% of rural hospitals versus 42.1% of large urban hospitals; 5.9% of hospitals with 24-<50 beds versus 58% of hospitals with >500 beds; and 29.0% of hospitals with nurse-to-bed ratios >1.0-1.5 versus 21.7% of hospitals with ratios >2.0. Including emergency department and observation stays in measures of postdischarge utilization produces similar results as measuring only readmissions in that major teaching, urban and for-profit hospitals still perform

The single-hospital county: is its hospital at risk?

PubMed Central

Chang, C F; Tuckman, H P

1991-01-01

This article focuses on a hospital group that has not received adequate attention in the literature: the sole provider of short-term, acute hospital care located in a county. In Tennessee, SPHs (single provider hospitals) are fewer in number but are present in more counties than multiprovider hospitals (MPHs). They are smaller in size, less labor and capital intensive, more likely to be a government hospital, and more likely to be in a rural area with low income and limited health care resources. SPHs operate with lower costs, charge patients less, and have lower revenue write-offs than MPHs. As a result, their cash flow is sufficient to fund their depreciation and they consistently earn modest returns. Between 1982 and 1988, a total of 16 hospitals failed in Tennessee but only 3 were SPHs. While SPHs have not been profitable enough to make them ideal candidates for takeover by major hospital systems, they are not a population that is unduly at risk. PMID:1905685

Hospital autonomy: the experience of Kenyatta National Hospital.

PubMed

Collins, D; Njeru, G; Meme, J; Newbrander, W

1999-01-01

An increasing number of countries are exploring the introduction or expansion of autonomous hospitals as one of the numerous health reforms they are introducing to their health system. Hospital autonomy is one of the forms of decentralization that is focused on a specific institution rather than on a political unit. It has gained much interest because it is an attempt to amalgamate the best elements of the public and private sectors in how a hospital is governed, managed and financed. This paper reviews the key elements of the concept of hospital autonomy, the reasons for its expanded use in many countries and a specific example of making a major teaching hospital autonomous in Kenya. A review of the successful experience of Kenyatta National Hospital and its process of introducing autonomy, with regard to governance, operations and management, and finances, lead to several conclusions on replicability. The legal framework is a critical element for successfully structuring the autonomous hospital. Additionally, success is highly dependent on the extent to which there is adequate funding during the process of attaining autonomy due to the length of the transition period needed. Autonomy must be granted within the context of the national health system and national health objectives and be consistent with those aims and their underlying societal values. Finally, as with decentralization, success is dependent upon the preparation done with the systems and management necessary for the proper governance and operation of autonomous hospitals.

Relationship between organizational factors and performance among pay-for-performance hospitals.

PubMed

Vina, Ernest R; Rhew, David C; Weingarten, Scott R; Weingarten, Jason B; Chang, John T

2009-07-01

The Centers for Medicare & Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration (HQID) project aims to improve clinical performance through a pay-for-performance program. We conducted this study to identify the key organizational factors associated with higher performance. An investigator-blinded, structured telephone survey of eligible hospitals' (N = 92) quality improvement (QI) leaders was conducted among HQID hospitals in the top 2 or bottom 2 deciles submitting performance measure data from October 2004 to September 2005. The survey covered topics such as QI interventions, data feedback, physician leadership, support for QI efforts, and organizational culture. More top performing hospitals used clinical pathways for the treatment of AMI (49% vs. 15%, p < 0.01), HF (44% vs. 18%, p < 0.01), PN (38% vs. 13%, p < 0.01) and THR/TKR (56% vs. 23%, p < 0.01); organized into multidisciplinary teams to manage patients with AMI (93% vs. 77%, p < 0.05) and HF (93% vs. 69%, p < 0.01); used order sets for the treatment of THR/TKR (91% vs. 64%, p < 0.01); and implemented computerized physician order entry in the hospital (24.4% vs. 7.9%, p < 0.05). Finally, more top performers reported having adequate human resources for QI projects (p < 0.01); support of the nursing staff to increase adherence to quality indicators (p < 0.01); and an organizational culture that supported coordination of care (p < 0.01), pace of change (p < 0.01), willingness to try new projects (p < 0.01), and a focus on identifying system errors rather than blaming individuals (p < 0.05). Organizational structure, support, and culture are associated with high performance among hospitals participating in a pay-for-performance demonstration project. Multiple organizational factors remain important in optimizing clinical care.

Climatological determinants of woody cover in Africa.

PubMed

Good, Stephen P; Caylor, Kelly K

2011-03-22

Determining the factors that influence the distribution of woody vegetation cover and resolving the sensitivity of woody vegetation cover to shifts in environmental forcing are critical steps necessary to predict continental-scale responses of dryland ecosystems to climate change. We use a 6-year satellite data record of fractional woody vegetation cover and an 11-year daily precipitation record to investigate the climatological controls on woody vegetation cover across the African continent. We find that-as opposed to a relationship with only mean annual rainfall-the upper limit of fractional woody vegetation cover is strongly influenced by both the quantity and intensity of rainfall events. Using a set of statistics derived from the seasonal distribution of rainfall, we show that areas with similar seasonal rainfall totals have higher fractional woody cover if the local rainfall climatology consists of frequent, less intense precipitation events. Based on these observations, we develop a generalized response surface between rainfall climatology and maximum woody vegetation cover across the African continent. The normalized local gradient of this response surface is used as an estimator of ecosystem vegetation sensitivity to climatological variation. A comparison between predicted climate sensitivity patterns and observed shifts in both rainfall and vegetation during 2009 reveals both the importance of rainfall climatology in governing how ecosystems respond to interannual fluctuations in climate and the utility of our framework as a means to forecast continental-scale patterns of vegetation shifts in response to future climate change.

Replacing fallow by cover crops: economic sustainability

NASA Astrophysics Data System (ADS)

Gabriel, José Luis; Garrido, Alberto; Quemada, Miguel

2013-04-01

Replacing fallow by cover crops in intensive fertilized systems has been demonstrated as an efficient tool for reducing nitrate leaching. However, despite the evident environmental services provided and the range of agronomic benefits documented in the literature, farmers' adoption of this new technology is still limited because they are either unwilling or unable, although adoption reluctance is frequently rooted in low economic profitability, low water se efficiency or poor knowledge. Economic analyses permit a comparison between the profit that farmers obtain from agricultural products and the cost of adopting specific agricultural techniques. The goal of this study was to evaluate the economic impact of replacing the usual winter fallow with cover crops (barley (Hordeum vulgare L., cv. Vanessa), vetch (Vicia villosa L., cv. Vereda) and rapeseed (Brassica napus L., cv. Licapo)) in irrigated maize systems and variable Mediterranean weather conditions using stochastic Monte-Carlo simulations of key farms' financial performance indicators. The three scenarios studied for each cover crop were: i) just leaving the cover crop residue in the ground, ii) leaving the cover crop residue but reduce following maize fertilization according to the N available from the previous cover crop and iii) selling the cover crop residue for animal feeding. All the scenarios were compared with respect to a typical maize-fallow rotation. With observed data from six different years and in various field trials, looking for different weather conditions, probability distribution functions of maize yield, cover crop biomass production and N fertilizer saving was fitted. Based in statistical sources maize grain price, different forage prices and the cost of fertilizer were fitted to probability distribution functions too. As result, introducing a cover crop involved extra costs with respect to fallow as the initial investment, because new seed, herbicide or extra field operations. Additional

Completion of the 2011 National Land Cover Database for the Conterminous United States – Representing a Decade of Land Cover Change Information

EPA Science Inventory

The National Land Cover Database (NLCD) provides nationwide data on land cover and land cover change at the native 30-m spatial resolution of the Landsat Thematic Mapper (TM). The database is designed to provide five-year cyclical updating of United States land cover and associat...

Available Equipment in School Foodservice.

ERIC Educational Resources Information Center

Meyer, Mary Kay

This report provides data on the National Food Service Management Institute's multi-year research project that identified type, style, age, and condition of available food service equipment in K-12 schools nationwide. The study found that smaller schools, serving less than 400 lunches per day, had kitchens equipped with ranges, small…

14 CFR 14.02 - Proceedings covered.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Proceedings covered. 14.02 Section 14.02 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES RULES IMPLEMENTING THE EQUAL ACCESS TO JUSTICE ACT OF 1980 General Provisions § 14.02 Proceedings covered. (a) The...