Epidemiological Trends of Cutaneous Leishmaniasis in Al-Madinah Al-Munawarah Province, Western Region of Saudi Arabia.

PubMed

Elmekki, Miskelyemen Abdelatti; Elhassan, Mogahid M; Ozbak, Hani A; Qattan, Ilham T; Saleh, Satti M; Alharbi, Ali H

2017-01-01

To investigate the epidemiological trends of cutaneous leishmaniasis (CL) in Al-Madinah Al-Munawarah, western region of KSA. Four hundred and sixty-seven parasitologically confirmed CL cases attending Al-Meeqat Hospital, Al-Madinah, during 2012-2015, were included in this study. Both Saudi and non-Saudi nationals were infected, with the highest infection rate being among Saudis (68.7%). Males were more affected than females as 86.9% of the total CL cases were males. Moreover, CL was prevalent in all age groups with higher frequency among young adults and adolescents (23.1% and 22.7%, respectively). Interestingly, almost all the patients in the adolescent and child age groups were Saudis (96.2% and 93.5%, respectively). Considering geographical distribution, the highest percentage of the cases (40.5%) were from the northern parts of Al-Madinah province while the eastern parts reported the least infection rate (7.3%). Few cases (2.5%) were supposed to encounter the infection abroad. Additionally, the frequency of infection was found to follow a seasonal distribution. Regarding treatment, pentostam, ketoconazole, or cryotherapy were the treatment options usually used. CL is prevalent in Al-Madinah Al-Munawarah area and new foci are being introduced. Thus, detailed studies with large surveillances regarding vector and reservoir hosts in and around the area are needed.

Epidemiological Trends of Cutaneous Leishmaniasis in Al-Madinah Al-Munawarah Province, Western Region of Saudi Arabia

PubMed Central

Elmekki, Miskelyemen Abdelatti; Elhassan, Mogahid M; Ozbak, Hani A; Qattan, Ilham T; Saleh, Satti M; Alharbi, Ali H

2017-01-01

Objective: To investigate the epidemiological trends of cutaneous leishmaniasis (CL) in Al-Madinah Al-Munawarah, western region of KSA. Materials and Methods: Four hundred and sixty-seven parasitologically confirmed CL cases attending Al-Meeqat Hospital, Al-Madinah, during 2012–2015, were included in this study. Results: Both Saudi and non-Saudi nationals were infected, with the highest infection rate being among Saudis (68.7%). Males were more affected than females as 86.9% of the total CL cases were males. Moreover, CL was prevalent in all age groups with higher frequency among young adults and adolescents (23.1% and 22.7%, respectively). Interestingly, almost all the patients in the adolescent and child age groups were Saudis (96.2% and 93.5%, respectively). Considering geographical distribution, the highest percentage of the cases (40.5%) were from the northern parts of Al-Madinah province while the eastern parts reported the least infection rate (7.3%). Few cases (2.5%) were supposed to encounter the infection abroad. Additionally, the frequency of infection was found to follow a seasonal distribution. Regarding treatment, pentostam, ketoconazole, or cryotherapy were the treatment options usually used. Conclusion: CL is prevalent in Al-Madinah Al-Munawarah area and new foci are being introduced. Thus, detailed studies with large surveillances regarding vector and reservoir hosts in and around the area are needed. PMID:29302149

The comparison of printed resources bacterial contamination in libraries of Al-Zahra Hospital and Sciences Faculty of Isfahan University and the determination of their antibiotic sensitivity pattern.

PubMed

Rafiei, Hosein; Chadeganipour, Mostafa; Ojaghi, Rezvan; Maracy, Mohammad Reza; Nouri, Rasool

2017-01-01

During the library loan process, the printed resources can be a carrier of pathogenic bacteria. In this study, it was tried to compare the Bacterial Contamination Rates and their antibiotic sensitivity pattern in printed resources of a hospital and a non-hospital library. This is a cross-sectional study. Returning books from the Al-Zahra hospital library and library of Sciences faculty of Isfahan University provides the research community. The sample size, 96 cases, was calculated using quota sampling. For sampling sterile swab dipped in trypticase soy broth medium and transfer trypticase soy broth medium were used. To identify different type of isolated bacteria from Gram-staining test and biochemical tests such as; TSI, IMViC and etc., were used. 76 (79.2%) and 20 (20.8%) of cultured samples were negative and positive, the respectively. Of 20 positive samples, 11 samples (55%) belong to the family Enterobacteriaceae that after detecting by Differential teste identified all 11 samples of Enterobacter that all of them were sensitive to Gentamicin and Ofloxacin. Also the most resistance to Nitrofurantoin and Amikacin was observed. 9 cases remained (45%) were coagulase-negative Staphylococcus that all of them were sensitive to the Trimethoprim-sulfamethoxazole and Cephalexin antibiotics also the most resistance to Cefixime was observed. Considering that the Enterobacter sp and coagulase-negative Staphylococcus were separated from the books, the books as well as other hospital and medical equipment can transmit the infection to librarians, library users, patients and hospital staff, and also it can produce serious infections in patients with immune deficiency.

The comparison of printed resources bacterial contamination in libraries of Al-Zahra Hospital and Sciences Faculty of Isfahan University and the determination of their antibiotic sensitivity pattern

PubMed Central

Rafiei, Hosein; Chadeganipour, Mostafa; Ojaghi, Rezvan; Maracy, Mohammad Reza; Nouri, Rasool

2017-01-01

Introduction: During the library loan process, the printed resources can be a carrier of pathogenic bacteria. In this study, it was tried to compare the Bacterial Contamination Rates and their antibiotic sensitivity pattern in printed resources of a hospital and a non-hospital library. Methods: This is a cross-sectional study. Returning books from the Al-Zahra hospital library and library of Sciences faculty of Isfahan University provides the research community. The sample size, 96 cases, was calculated using quota sampling. For sampling sterile swab dipped in trypticase soy broth medium and transfer trypticase soy broth medium were used. To identify different type of isolated bacteria from Gram-staining test and biochemical tests such as; TSI, IMViC and etc., were used. Results: 76 (79.2%) and 20 (20.8%) of cultured samples were negative and positive, the respectively. Of 20 positive samples, 11 samples (55%) belong to the family Enterobacteriaceae that after detecting by Differential teste identified all 11 samples of Enterobacter that all of them were sensitive to Gentamicin and Ofloxacin. Also the most resistance to Nitrofurantoin and Amikacin was observed. 9 cases remained (45%) were coagulase-negative Staphylococcus that all of them were sensitive to the Trimethoprim-sulfamethoxazole and Cephalexin antibiotics also the most resistance to Cefixime was observed. Conclusion: Considering that the Enterobacter sp and coagulase-negative Staphylococcus were separated from the books, the books as well as other hospital and medical equipment can transmit the infection to librarians, library users, patients and hospital staff, and also it can produce serious infections in patients with immune deficiency. PMID:28546984

Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines.

PubMed

Osborne, Andrew; Taylor, Louise; Reuber, Markus; Grünewald, Richard A; Parkinson, Martin; Dickson, Jon M

2015-01-01

Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies. Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration. The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Advanced vs. Basic Life Support in the Treatment of Out-of-Hospital Cardiopulmonary Arrest in the Resuscitation Outcomes Consortium.

PubMed

Kurz, Michael Christopher; Schmicker, Robert H; Leroux, Brian; Nichol, Graham; Aufderheide, Tom P; Cheskes, Sheldon; Grunau, Brian; Jasti, Jamie; Kudenchuk, Peter; Vilke, Gary M; Buick, Jason; Wittwer, Lynn; Sahni, Ritu; Straight, Ronald; Wang, Henry E

2018-04-30

Prior observational studies suggest no additional benefit from advanced life support (ALS) when compared with providing basic life support (BLS) for patients with out-of-hospital cardiac arrest (OHCA). We compared the association of ALS care with OHCA outcomes using prospective clinical data from the Resuscitation Outcomes Consortium (ROC). Included were consecutive adults OHCA treated by participating emergency medical services (EMS) agencies between June 1, 2011, and June 30, 2015. We defined BLS as receipt of cardiopulmonary resuscitation (CPR) and/or automated defibrillation and ALS as receipt of an advanced airway, manual defibrillation, or intravenous drug therapy. We compared outcomes among patients receiving: 1) BLS-only; 2) BLS + late ALS; 3) BLS + early ALS; and 4) ALS-first care. Using multivariable logistic regression, we evaluated the associations between level of care and return of spontaneous circulation (ROSC), survival to hospital discharge, and survival with good functional status, adjusting for age, sex, witnessed arrest, bystander CPR, shockable initial rhythm, public location, EMS response time, CPR quality, and ROC site. Among 35,065 patients with OHCA, characteristics were median age 68 years (IQR 56-80), male 63.9%, witnessed arrest 43.8%, bystander CPR 50.6%, and shockable initial rhythm 24.2%. Care delivered was: 4.0% BLS-only, 31.5% BLS + late ALS, 17.2% BLS + early ALS, and 47.3% ALS-first. ALS care with or without initial BLS care was independently associated with increased adjusted ROSC and survival to hospital discharge unless delivered greater than 6 min after BLS arrival (BLS + late ALS). Regardless of when it was delivered, ALS care was not associated with significantly greater functional outcome. ALS care was associated with survival to hospital discharge when provided initially or within six minutes of BLS arrival. ALS care, with or without initial BLS care, was associated with increased ROSC, however it was

Antibiotic Prescribing Patterns in Outpatient Emergency Clinics at Queen Rania Al Abdullah II Children's Hospital, Jordan, 2013.

PubMed

Al-Niemat, Sahar I; Aljbouri, Tareq M; Goussous, Lana S; Efaishat, Rania A; Salah, Rehab K

2014-07-01

To investigate antibiotics prescribing patterns in the outpatient pediatric emergency clinic at Queen Rania Al Abdullah II Children's Hospital at Royal Medical Services in Amman, Jordan. The data was collected from the emergency pharmacy over the period of a -five consecutive months. The methodology recommended by the World Health Organization for investigating drug use in a health facility was followed. The study measures the percentage of encounter with a prescribed antibiotic and the percentage share of each antibiotic category. The distribution of diagnostic categories that accounted for all antibiotics being prescribed and the distribution of each antibiotic being prescribed for upper respiratory tract infections (URTIs) were also measured. Antibiotic prescribing was frequent during pediatric visits to the outpatient pediatric emergency clinic resulting in a high percentage of encounters (85%) when compared to appropriate. Emergency physicians continue to frequently prescribe broad spectrum antibiotics which accounted for approximately (60%) of the total prescribed antibiotics and (83%) of prescribed antibiotics for upper respiratory tract infections and macrolides (primarily azithromycin) were the leading class among them. Our results showed high consumption of antibiotics by emergency department pediatricians which highlight the importance for interventions to promote rational and judicious prescribing. An insight into factors influencing antibiotics prescribing patterns by military prescribers is required.

Missan Surgical Hospital Under the Economic Support Fund Al Amarah, Iraq

DTIC Science & Technology

2009-07-16

budget shortages resulting from the reduction in crude oil prices will continue to impact the GOI’s ability to adequately equip, operate, and maintain...staff to operate and maintain the hospital. However, the reduction in oil prices resulted in budget shortages, which delayed the Iraqi funding...operating budget.” The recent fluctuation in oil prices has resulted in budget uncertainty for the GOI, including the funding of projects for the

Infection after open heart surgery in Golestan teaching hospital of Ahvaz, Iran.

PubMed

Nashibi, Roohangiz; Mohammadi, Mohammad Javad; Alavi, Seyed Mohammad; Yousefi, Farid; Salmanzadeh, Shokrolah; Ahmadi, Fatemeh; Varnaseri, Mehran; Ramazani, Asghar; Moogahi, Sasan

2018-02-01

The present study surveyed demographic and infection data which were obtained after open heart surgery (OHS) through patient's admission in Golestan teaching hospital, Ahvaz metropolitan city of Iran, taking into account the confirmed location of the infection, microorganism and antibiotic susceptibility. The occurrence of infection among patients during 48 to 72 h after surgery and hospital admission is the definition of Nosocomial infections (NIs) (Salmanzadeh et al., 2015) [1]. All of them after OHS were chosen for this study. In this paper, type of catheter, fever, type of microorganism, antibiotic susceptibility, location of the infection and outcome (live or death) were studied (Juhl et al., 2017; Salsano et al., 2017) [2], [3]. After the completion of the observations and recording patients' medical records, the coded data were fed into EXCELL. Data analysis was performed using SPSS 16.

ALS syndrome in patients with HIV-1 infection.

PubMed

Verma, Ashok; Berger, Joseph R

2006-01-15

A viral etiology of amyotrophic lateral sclerosis (ALS) has been proposed because of the selective vulnerability of motor neurons to certain viruses. During the last 20 years, at least 19 cases of ALS or ALS-like disease have been reported in HIV-1 (HIV) seropositive individuals. To describe two cases of clinically definite ALS in patients with HIV infection and to review the previously reported cases of HIV-associated ALS syndrome. A multidisciplinary ALS center and Neuro-AIDS clinic at a tertiary care university hospital. We investigated and prospectively monitored two patients who had developed clinically definite ALS by El Escorial criteria several years after acquiring the HIV infection. The previously reported cases of ALS or ALS-like disease in patients with HIV infection were reviewed for comparison and contrast with the characteristics of sporadic ALS. The clinical course of ALS in our two HIV seropositive individuals mirrored that of classical sporadic ALS. A review of previously described 19 patients with ALS syndrome revealed clinically definite ALS in 4 cases and clinically probable or possible ALS in 15. ALS commenced at different stages of the HIV disease; in 7 patients, HIV infection was discovered contemporaneously with diagnosis of ALS. CD4+ T cell count ranged from 2 to 560 cells/mm3. Three (1 definite ALS) of the fatal cases were studied at autopsy and all exhibited pathology outside the motor neuron pool. Unlike our patients, 7 of 8 patients with HIV-associated ALS syndrome receiving HAART demonstrated at least partial recovery of their motor deficit. ALS-like syndrome can occur in association with HIV infection; however, the causal relationship remains uncertain. Patients with ALS syndrome related to HIV infection are generally younger in age and often demonstrate pathology outside the motor neuron system. Patients with HIV-associated ALS syndrome may improve following antiretroviral therapy. An aggressive HAART regimen to reduce viral load

Prospective study of cost of care at multidisciplinary ALS centers adhering to American Academy of Neurology (AAN) ALS practice parameters.

PubMed

Boylan, Kevin; Levine, Todd; Lomen-Hoerth, Catherine; Lyon, Mary; Maginnis, Kimberly; Callas, Peter; Gaspari, Celeste; Tandan, Rup

2015-01-01

Multidisciplinary care in ALS is associated with longer survival, improved quality of life, and reduced hospital admissions, but there are no published data on institutional costs associated with multidisciplinary ALS care at U.S. centers. We prospectively examined institutional costs, adherence to AAN Practice Parameters and patient satisfaction in multidisciplinary ALS clinics at 18 U.S. ALS centers. Centers reported patient volumes; direct costs for staff salary/benefits, supplies and equipment; and institutional non-salary and overhead costs over a three-month period. In 1117 patients seen during this period, mean age was 61.5 years (range 25-91 years), 56% were male, and mean ALSFRS-R score was 29. Mean total salary/benefit cost per clinic day for all providers was $2964 (range $1692-$5236 across centers). Mean salary/benefit cost per patient per clinic was $507 (range $258-$806 across centers). Differences among centers in reporting non-salary costs prevented meaningful analysis. Practice parameter adherence and patient satisfaction were high. This prospective collaborative study demonstrates the direct financial burden of evidence-based multidisciplinary ALS care in the U.S.; more refined non-salary and overhead cost data are needed to evaluate the full cost impact of care. These data may be useful in supporting evidence-based models of patient centered care for ALS.

Review of thromboembolic prophylaxis in patients attending Cork University Hospital.

PubMed

Byrne, Stephen; Weaver, Daniel Timothy

2013-06-01

Although preventable, venous thromboembolism remains a common cause of hospital acquired morbidity and mortality. Guidelines, such as the one produced by the American College of Chest Physicians (ACCP), are aimed at reducing hospital associated venous thromboemboli. Unfortunately the majority of studies have revealed inadequate adherence to these guidelines. The objective of this study was to evaluate the use of venous thromboembolism prophylaxis at Cork University Hospital. Cork University Hospital, Wilton, Cork, Ireland. Data from the patient's chart, drug kardex and laboratory results were recorded during April 2010. A Caprini score, a venous thromboembolism risk factor assessment tool, was subsequently calculated for each patient based on data collected. Appropriate prophylaxis was determined after examining data collected, Caprini score and prophylactic regime according to the ACCP 8th edition guidelines. Primary outcome was to analyse adherence to VTE prophylaxis guidelines. A total of 394 patients met the inclusion criteria and were reviewed, of which, 60% (n = 236) were medical and 37% (n = 146) were surgical patients. In total 63% of patients received some form of venous thromboembolism prophylaxis. Furthermore, 54% of medical and 76% of surgical patients received prophylaxis. However only 37% of the patients studied received appropriate thromboprophylaxis according to the ACCP 8th edition guidelines (Geerts et al. in chest 133(6 Suppl):381S-453S, 2008). Additionally 51% of surgical and 27% of medical patients received appropriate prophylaxis. Data collected from Cork University Hospital revealed poor adherence to international venous thromboembolism prophylaxis guidelines. As stated in the ACCP 8th edition guidelines, every hospital should develop a formal strategy for venous thromboembolism prevention (Geerts et al. in chest 133(6 Suppl):381S-453S, 2008). In order to improve adherence to guidelines, Cork University Hospital should develop, implement and

Recentralization within decentralization: County hospital autonomy under devolution in Kenya

PubMed Central

Manyara, Anthony M.; Molyneux, Sassy; Tsofa, Benjamin

2017-01-01

Background In 2013, Kenya transitioned into a devolved system of government with a central government and 47 semi-autonomous county governments. In this paper, we report early experiences of devolution in the Kenyan health sector, with a focus on public county hospitals. Specifically, we examine changes in hospital autonomy as a result of devolution, and how these have affected hospital functioning. Methods We used a qualitative case study approach to examine the level of autonomy that hospitals had over key management functions and how this had affected hospital functioning in three county hospitals in coastal Kenya. We collected data by in-depth interviews of county health managers and hospital managers in the case study hospitals (n = 21). We adopted the framework proposed by Chawla et al (1995) to examine the autonomy that hospitals had over five management domains (strategic management, finance, procurement, human resource, and administration), and how these influenced hospital functioning. Findings Devolution had resulted in a substantial reduction in the autonomy of county hospitals over the five key functions examined. This resulted in weakened hospital management and leadership, reduced community participation in hospital affairs, compromised quality of services, reduced motivation among hospital staff, non-alignment of county and hospital priorities, staff insubordination, and compromised quality of care. Conclusion Increasing the autonomy of county hospitals in Kenya will improve their functioning. County governments should develop legislation that give hospitals greater control over resources and key management functions. PMID:28771558

Navy nurse anesthetists at Fleet Hospital Five: the Desert Shield/Storm experience.

PubMed

Hrezo, Richard J

2003-06-01

In 1990, the United States Navy deployed its first operational fleet hospital: "Fleet Hospital Five" in support of Operation Desert Shield/Storm. Within 2 weeks of notification, the 900 medical providers assigned to this medical facility, which was capable of providing major trauma surgery and critical care, were on their way to Al Jabayl, Saudi Arabia. This article discusses the unique characteristics of this facility and introduces the crucial role that nurse anesthetists play. The article also introduces several innovative ideas that were developed and tested to expand the capabilities of the hospital.

Do Pediatric Teams Affect Outcomes of Injured Children Requiring Inter-hospital Transport?

PubMed

Calhoun, Amanda; Keller, Martin; Shi, Junxin; Brancato, Celeste; Donovan, Kathy; Kraus, Diana; Leonard, Julie C

2017-01-01

Studies show that pediatric trauma centers produce better outcomes and reduced mortality for injured children. Yet, most children do not have timely access to a pediatric trauma center and require stabilization locally with subsequent transfer. Investigators have demonstrated that pediatric transport teams (PTT) improve outcomes for critically ill children; however, these studies did not differentiate outcomes for injured children. It may be that moderate to severely injured children actually fare worse with PTT due to slower transport times inherent to their remote locations and thus delays in important interventions. The purpose of this study was to determine if outcomes for injured children are affected by use of PTT for inter-hospital transfer. We conducted a retrospective chart review of 1,177 children transferred to a pediatric trauma center for injury care between March 1st, 2012 and December 31st, 2013. We compared children who were transported by PTT (ground/air) to those transported by ground advanced life support (ALS) and air critical care (ACC). We described patient characteristics and transport times. For PTT vs. ALS and ACC, we compared hospital length of stay (LOS), transport interventions and adverse events. 1,177 injured children were transferred by the following modes: 68% ALS, 13% ACC, 11% Ground PTT, and 9% Air PTT. Children transported by PTT were younger and had higher ISS and lower GCS scores. PTT had a longer total transport time, departure preparation time, and patient bedside time. After controlling for age, ISS, GCS, transport mode, distance, and time, we found no significant difference in LOS between PTT vs. ALS and ACC. A subgroup analysis of children with higher ISS scores demonstrated a 65% longer LOS for children transported by ACC vs. PTT. There were no differences between transport teams with regard to acidosis, hypocarbia or hypercarbia, or maintenance of tubes and lines. Children transported by PTT were younger and sicker (vs

Portland Retail Druggists Association vs Abbott Laboratories et al, part 1.

PubMed

Greenberg, R B

1976-06-01

The findings of the U.S. Supreme Court, in its March 24, 1976, decision in the case of Portland Retail Druggists vs Abbott Laboratories et al, are presented. The case deals with price differentials offered to nonprofit hospitals by pharmaceutical manufacturers. Historical background leading to the case, and early rulings of a federal district court and a court of appeals, are discussed. The Supreme Court decision appears to reflect favorably on current hospital policies and procedures for drug purchasing and ambulatory care. Issues that require further clarification will be discussed in Part 2.

Evolution of a youth work service in hospital.

PubMed

Hilton, Donna; Jepson, Shelley

2012-07-01

Youth workers are based predominantly in the community and use a range of informal educational activities to help young people between the ages of 11 and 25 cultivate their personal and social development. The supraregional paediatric nephrology unit at Nottingham City Hospital successfully evaluated the role of a youth worker, funded by a national renal charity, and secured long-term funding for the post in 2000 (Hilton et al 2004, Watson 2004). This article describes the evolution of the youth service over a decade, following the amalgamation of two children's units into one site and the creation of a unified youth service for the Nottingham Children's Hospital in 2008.

Neonatal screening for sickle cell disease, glucose-6-phosphate dehydrogenase deficiency and a-thalassemia in Qatif and Al Hasa.

PubMed

Nasserullah, Z; Al Jame, A; Abu Srair, H; Al Qatari, G; Al Naim, S; Al Aqib, A; Mokhtar, M

1998-01-01

Screening programs to determine the frequency of sickle cell, glucose-6-phosphate dehydrogenase deficiency and alpha-thalassemia gene are available in Saudi Arabia, although not used frequently. Greater use of these programs will decrease the morbidity and mortality of Saudi children affected by these disorders. Neonatal hemoglobin electrophoresis and glucose-6-dehydrogenase fluorescent spot tests were performed on newborn babies delivered between December 1992 and December 1993 at the Qatif Central Hospital and at the King Fahad Hospital in Al Hasa. Cord blood samples were collected from babies born in these two hospitals. Babies born in other hospitals had blood collected in their first visit to Qatif primary care centers at the time of vaccination. All specimens were sent to Dammam Central Laboratory. The diagnosis of sickle cell and alpha-thalassemia was based on cellulose acetate electrophoresis and confirmed by agar gel electrophoresis, and glucose-6-phosphate dehydrogenase was confirmed by fluorescent spot test. A total of 12,220 infants, including 11,313 Saudis (92.6%), were screened over a 12-month period. The common phenotypes detected in these infants included AF, AF Bartâs, SFA, SFA Bartâs, FS and FS Bartâs. In the Saudi infants, homozygous sickle cell disease was detected in 2.35% and 1.08% in Qatif and Al Hasa, respectively. The frequencies of sickle cell gene were 0.1545% and 0.1109% in Qatif and Al Hasa. alphathalassemia gene based on an elevated level of Hb Bartâs were 28% and 16.3% in Qatif and Al Hasa. The screening for G6PD deficiency revealed a high prevalence of 30.6% and 14.7% in Qatif and Al Hasa. In the non-Saudi infants, the frequencies were low. The outcome of this study indicates that the Saudi populations in Qatif and Al Hasa are at risk for hemoglobinopathies and G6PD. Neonatal screening programs are essential and cost effective and should be maintained as a routine practice.

A profile of out-of-hospital cardiac arrests in Northern Emirates, United Arab Emirates.

PubMed

Batt, Alan M; Al-Hajeri, Ahmed S; Cummins, Fergal H

2016-11-01

To report the characteristics of out-of-hospital cardiac arrest patients and their outcomes in the emirates of Sharjah, Ras-al-Khaimah, Umm Al-Quwain, Fujairah, and Ajman in the United Arab Emirates (collectively known as the Northern Emirates). Methods: This is a prospective descriptive cohort study of out-of-hospital cardiac arrest incidents transported by the national ambulance crews between February 2014 and March 2015 in the Northern Emirates. Results: A total of 384 patients were enrolled in this study. Male victims of out-of-hospital cardiac arrest represented 76% of the participants. The mean age of the study population was 50.9 years. An over-all prehospital return of spontaneous circulation rate of 3.1% was documented, as well as a 30% rate of bystander cardiopulmonary resuscitation being performed. Public access defibrillators were applied in 0.5% of cases. Data is presented according to Utstein reporting criteria. Conclusion: Baseline data for out-of-hospital cardiac arrest was established for the first time in the Northern Emirates of the United Arab Emirates. A low survival rate for out-of-hospital cardiac arrest, low rates of bystander cardiopulmonary resuscitation, and low public access defibrillator use were discovered. Although low by comparison to established western systems results are similar to other systems in the region. Determining the baseline data presented in this study is essential in recommending and implementing strategies to reduce mortality from out-of-hospital cardiac arrest.

A profile of out-of-hospital cardiac arrests in Northern Emirates, United Arab Emirates

PubMed Central

Batt, Alan M.; Al-Hajeri, Ahmed S.; Cummins, Fergal H.

2016-01-01

Objectives: To report the characteristics of out-of-hospital cardiac arrest patients and their outcomes in the emirates of Sharjah, Ras-al-Khaimah, Umm Al-Quwain, Fujairah, and Ajman in the United Arab Emirates (collectively known as the Northern Emirates). Methods: This is a prospective descriptive cohort study of out-of-hospital cardiac arrest incidents transported by the national ambulance crews between February 2014 and March 2015 in the Northern Emirates. Results: A total of 384 patients were enrolled in this study. Male victims of out-of-hospital cardiac arrest represented 76% of the participants. The mean age of the study population was 50.9 years. An over-all prehospital return of spontaneous circulation rate of 3.1% was documented, as well as a 30% rate of bystander cardiopulmonary resuscitation being performed. Public access defibrillators were applied in 0.5% of cases. Data is presented according to Utstein reporting criteria. Conclusion: Baseline data for out-of-hospital cardiac arrest was established for the first time in the Northern Emirates of the United Arab Emirates. A low survival rate for out-of-hospital cardiac arrest, low rates of bystander cardiopulmonary resuscitation, and low public access defibrillator use were discovered. Although low by comparison to established western systems results are similar to other systems in the region. Determining the baseline data presented in this study is essential in recommending and implementing strategies to reduce mortality from out-of-hospital cardiac arrest. PMID:27761558

Cerebral saturation in cardiac arrest patients measured with near-infrared technology during pre-hospital advanced life support. Results from Copernicus I cohort study.

PubMed

Genbrugge, Cornelia; De Deyne, Cathy; Eertmans, Ward; Anseeuw, Kurt; Voet, Dirk; Mertens, Ilse; Sabbe, Marc; Stroobants, Jan; Bruckers, Liesbeth; Mesotten, Dieter; Jans, Frank; Boer, Willem; Dens, Jo

2018-03-23

To date, monitoring options during pre-hospital advanced life support (ALS) are limited. Regional cerebral saturation (rSO 2 ) may provide more information concerning the brain during ALS. We hypothesized that an increase in rSO 2 during ALS in out-of hospital cardiac arrest (OHCA) patients is associated with return of spontaneous circulation (ROSC). A prospective, non-randomized multicenter study was conducted in the pre-hospital setting of six hospitals in Belgium. Cerebral saturation was measured during pre-hospital ALS by a medical emergency team in OHCA patients. Cerebral saturation was continuously measured until ALS efforts were terminated or until the patient with sustained ROSC (>20 min) arrived at the emergency department. To take the longitudinal nature of the data into account, a linear mixed model was used. The correlation between the repeated measures of a patient was handled by means of ​a random intercept and a random slope. Our primary analysis tested the association of rSO 2 with ROSC. Of the 329 patients 110 (33%) achieved ROSC. First measured rSO 2 was 30% ± 18 in the ROSC group and 24% ± 15 in the no-ROSC group (p = .004; mean ± SD). Higher mean rSO 2 values were observed in the ROSC group compared to the no-ROSC group (41% ± 13 versus 33% ± 13 respectively; p < 0.001). The median increase in rSO 2, measured from start until two minutes before ROSC, was higher in the ROSC group (ROSC group 17% (IQR 6-29)) than in the no-ROSC group (8% (IQR 2-13); p < 0.001). An increase in rSO 2 above 15% was associated with ROSC (OR 4.5; 95%CI 2.747-7.415; p < 0.001). Regional cerebral saturation measurements can be used during pre-hospital ALS as an additional marker to predict ROSC. An increase of at least 15% in rSO 2 during ALS is associated with a higher probability of ROSC. Copyright © 2018 Elsevier B.V. All rights reserved.

Effect of hospital nutrition support on growth velocity and nutritional status of low birth weight infants.

PubMed

Azzeh, Firas S; Alazzeh, Awfa Y; Dabbour, Ibrahim R; Jazar, Abdelelah S; Obeidat, Ahmed A

2014-10-01

Infants with low birth weights are provided with hospital nutrition support to enhance their survivability and body weights. However, different hospitals have different nutrition support formulas. Therefore, the effectiveness of these nutrition support formulas should be investigated. To assess the effect of hospital nutrition support on growth velocity and nutritional status of low birth weight infants at Al-Noor hospital, Saudi Arabia. A cross-sectional study was conducted between October, 2010 and December, 2012. Three hundred newborns were recruited from Al-Noor Hospital in Makkah city, Saudi Arabia. Infants were selected according to their birth weights and were divided equally into three groups; (i) Low Birth Weight (LBW) infants (1501- 2500 g birth weight), (ii) Very Low Birth Weight (VLBW) infants (1001-1500 g birth weight) and (iii) Extremely Low Birth Weight (ELBW) infants (< 1000 g birth weight). Data were collected at birth and at discharged. Infants' weights were recorded and growth velocity was calculated. Some biochemical tests and mineral levels were measured. Body mass index values of VLBW and ELBW groups were lower (p < 0.05) than LBW group. The growth velocity of infants in all groups ranged between 8.7 to 10.2 g/kg/d with no differences (p > 0.05) were observed among groups. Serum calcium, phosphorus and potassium levels at discharge were higher (p < 0.05) than that at birth for ELBW and VLBW groups; while sodium level decreased in ELBW group to be within normal ranges. Albumin level was improved (p < 0.05) in ELBW group. Health care management for low birth weight infants in Al-Noor Hospital was not sufficient to achieve normal growth rate for low birth weight infants, while biochemical indicators were remarkably improved in all groups. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Syrian revolution: a field hospital under attack.

PubMed

Hasanin, Ahmed; Mukhtar, Ahmed; Mokhtar, Ali; Radwan, Ahmed

2013-01-01

Syrian revolution that began on March 15, 2011 represents not only a political crisis but also a humanitarian one where many relief attempts for saving civil injured were tried. A secret field hospital organized by the medical Arab union was set in Al-Bab town in the district of Aleppo. Egyptian volunteer physicians were the operating team who reached Syria through the Turkish border. Medical supplies were delivered from Turkey and medical equipment were taken from the government hospital which was not running at that time. Many Syrian volunteers helped in running this field hospital most of them were non-medical personnel who were trained to help in some medical purposes. Total number of cases referred to the hospital was 75. Surgical intervention was needed for 28 patients. Most common procedures needed were vascular procedures (32 percent), orthopedic procedures (32 percent), and abdominal exploration (25 percent). Median injury severity score (ISS) for admitted patients were 21 with interquartile range (14-21). Two patients died intraoperatively due to massive bleeding. Setting up a field hospital in such an area with unsafe conditions needs good communication with medical and relief organizations in the site of crisis, selection of a location as near as possible to the Turkish border, developing a convenient triaging plan, and training nonmedical volunteers to do simple tasks.

Out-of-Hospital Fluid in Severe Sepsis: Effect on Early Resuscitation in the Emergency Department

PubMed Central

Seymour, Christopher W.; Cooke, Colin R.; Mikkelsen, Mark E.; Hylton, Julie; Rea, Tom D.; Goss, Christopher H.; Gaieski, David F.; Band, Roger A.

2014-01-01

Background Early identification and treatment of patients with severe sepsis improves outcome, yet the role of out-of-hospital intravenous (IV) fluid is unknown. Objective To determine if the delivery of out-of-hospital fluid in patients with severe sepsis is associated with reduced time to achievement of goal-oriented resuscitation in the emergency department (ED). Methods We performed a secondary data analysis of a retrospective cohort study in a metropolitan, tertiary care, university-based medical center supported by a two-tiered system of out-of-hospital emergency medical services (EMS) providers. We studied the association between delivery of out-of-hospital fluid by advanced life support (ALS) providers and the achievement of resuscitation endpoints (central venous pressure [CVP] ≥8 mmHg, mean arterial pressure [MAP] ≥65 mmHg, and central venous oxygen saturation [ScvO2] ≥70%) within six hours after triage during early goal-directed therapy (EGDT) in the ED. Results Twenty five (48%) of 52 patients transported by ALS with severe sepsis received out-of-hospital fluid. Data for age, gender, source of sepsis, and presence of comorbidities were similar between patients who did and did not receive out-of-hospital fluid. Patients receiving out-of-hospital fluid had lower out-of-hospital mean (± standard deviation) systolic blood pressure (95 ± 40 mmHg vs. 117 ± 29 mmHg; p = 0.03) and higher median (interquartile range) Sequential Organ Failure Assessment (SOFA) scores in the ED (7 [5–8] vs. 4 [4–6]; p = 0.01) than patients not receiving out-of-hospital fluid. Despite greater severity of illness, patients receiving out-of-hospital fluid approached but did not attain a statistically significant increase in the likelihood of achieving MAP ≥65 mmHg within six hours after ED triage (70% vs. 44%, p = 0.09). On average, patients receiving out-of-hospital fluid received twice the fluid volume within one hour after ED triage (1.1 L [1.0–2.0 L] vs. 0.6 L [0

[Medico-economic evaluation of therapeutic strategies at hospital: A systematic review of French studies].

PubMed

Baudouin, A; Armoiry, X; Dussart, C

2017-05-01

Therapeutic innovation contributes to the increase of health care expenditures in France. Medico-economic evaluation has still a minor role in the decision-making for the registration of drugs and medical devices in hospitals. This study aimed to systematically review published works on medico-economic studies conducted within French hospitals. A literature review was carried out to search for medico-economic studies conducted by hospital teams on therapeutic or diagnostic strategies employed within French hospitals and published from 2010 to 2014. Quality assessment of selected studies was performed according to Drummond et al.'s checklist, which is also used within French guidelines. Of the 44 analyzed articles, methods for identification and measure of costs and results complied with guidelines in 95 % of cases. For results interpretation, compliance was 91 %. Costs discounting (29 %) and the use of sensitivity analysis to account for results uncertainty (70 %) were the parameters with the lowest compliance to guidelines. A good training of health professionals in using economic and statistic tools, and the transferability of results of medico-economic studies are essential and should be optimized to enable a broader use of medico-economic evaluation within the scope of decision-making in French hospitals. Copyright © 2016 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

The effect of changes in hospital reimbursement on nurse staffing decisions at safety net and nonsafety net hospitals.

PubMed

Lindrooth, Richard C; Bazzoli, Gloria J; Needleman, Jack; Hasnain-Wynia, Romana

2006-06-01

The financial savings from the Balanced Budget Act (BBA) are attractive to policy makers, but such savings come at a cost. We measure changes in nurse staffing at hospitals related to potential declines in reimbursement through the BBA. Following Hadley, Zuckerman, and Feder (1989), we define a fiscal pressure index (FPI) to measure the differential effect of the BBA. We estimate the effect of the FPI on the number of full-time equivalent registered nurses (RN) and licensed practical nurses (LPN) per adjusted patient day using American Hospital Association (AHA) data of a panel of hospitals from 1996 to 2001. The AHA data are combined with the Area Resource Files and health maintenance organizations penetration data. We control for hospital heterogeneity using fixed effects. All urban short-term general hospitals that responded to the staffing and uncompensated care questions in the AHA survey between 1996 and 2001. We define safety net hospitals as those with a high ratio of uncompensated costs to total hospital expenses (see, e.g., Zuckerman et al. 2001). We find that the nonsafety net hospitals that were most susceptible to the provisions of the BBA experienced a decline in RN staffing ratios about twice the rate of the nonsafety net hospitals that were least susceptible to the BBA. We are unable to detect an effect of the BBA on staffing at safety net hospitals. RN and LPN staffing levels per adjusted patient day declined, on average, between 1996 and 2001. Within the context of the general decline, we find that RN staffing per adjusted patient day declined even more at nonsafety net hospitals that were most susceptible to lower reimbursement related to the BBA. Thus, there was a small but statistically significant incremental effect of potential BBA losses on RN staffing at hospitals that were expected to be affected most. This incremental decline represented about a 6 percent increase in nurse workload that in isolation might not affect quality. Nevertheless

Co-circulation of Dengue and Chikungunya Viruses, Al Hudaydah, Yemen, 2012

PubMed Central

El-Sawaf, Gamal; Faggioni, Giovanni; Vescio, Fenicia; Al Ameri, Ranya; De Santis, Riccardo; Helaly, Ghada; Pomponi, Alice; Metwally, Dalia; Fantini, Massimo; Qadi, Hussein; Ciccozzi, Massimo; Lista, Florigio

2014-01-01

We investigated 400 cases of dengue-like illness in persons hospitalized during an outbreak in Al Hudaydah, Yemen, in 2012. Overall, 116 dengue and 49 chikungunya cases were diagnosed. Dengue virus type 2 was the predominant serotype. The co-circulation of these viruses indicates that mosquitoborne infections represent a public health threat in Yemen. PMID:25061762

Amyotrophic lateral sclerosis (ALS), a novel rare cause of elevated plasma troponin T levels.

PubMed

Von Lueder, Thomas G; Melsom, Morten Nissen; Atar, Dan; Agewall, Stefan

2011-01-01

In this article, we report on a patient with chronic and modestly elevated plasma troponin T (TnT) levels and frequent hospitalizations following the first admission until his death one year later. The patient was initially admitted for dyspnea and discharged from hospital with a diagnosis of non-ST elevation acute myocardial infarction (AMI). Coronary angiography and echocardiography were normal, but the patient received the (false) diagnosis of AMI at two further admissions, based purely on elevated TnT. Shortly thereafter, severe respiratory failure with restrictive-type spirometry pattern became the predominant clinical symptom, with constantly elevated TnT levels at frequent re-admissions. Due to inconsistent follow-up by primarily junior and non-specialist staff at a number of different wards, pulmonary function tests and previous smoking history were mis-interpreted as typical of chronic obstructive pulmonary disease (COPD). The patient received standard COPD treatment without any improvement. After a year of gradually worsening respiratory failure and repeated hospitalizations, thorough assessment by a pulmonologist and neurologist established the final diagnosis of amyotrophic lateral sclerosis (ALS). The patient died shortly thereafter. While progressive respiratory failure is well-known to determine morbidity and mortality in patients with ALS, chronically elevated TnT levels in the absence of coronary artery disease have, to our best knowledge, not been described so far. We suggest that chronic myocardial hypoxia due to ALS-related hypoxic respiratory failure was the most likely underlying etiology for the elevated TnT levels seen here but other mechanism such as immune-mediated myocardial injury cannot be excluded.

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.

The relative effectiveness of managed care penetration and the healthcare safety net in reducing avoidable hospitalizations.

PubMed

Pracht, Etienne E; Orban, Barbara L; Comins, Meg M; Large, John T; Asin-Oostburg, Virginia

2011-01-01

Avoidable hospitalizations represent a key indicator for access to, and the quality of, primary care. Therefore, understanding their behavior is essential in terms of management of healthcare resources and costs. This analysis examines the affect of 2 healthcare strategies on the rate of avoidable hospitalization, managed care and the healthcare safety net. The avoidable hospitalizations definition developed by Weissman et al. (1992) was used to identify relevant inpatient episodes. A 2-stage simultaneous equations multivariate regression model with instrumental variables was used to estimate the relative influence of HMO penetration and the composition of local hospital markets on the rate of avoidable hospitalizations. Control variables in the model include healthcare supply and demand, demographic, socioeconomic, and health status characteristics. Increased market presence of public hospitals significantly reduced avoidable hospitalizations. HMO penetration did not influence the rate of avoidable hospitalizations. The results suggest that public investments in healthcare facilities and infrastructure are more effective in reducing avoidable hospitalizations. © 2011 National Association for Healthcare Quality.

Anxiety and hospitalization in adolescence: relations to attachment style and parental support.

PubMed

Vulliez-Coady, Lauriane; Vidal, Chrystelle; Vivot, Aurore; Monnin, Julie; Nezelof, Sylvie; Bifulco, Antonia

2013-09-01

This exploratory study examined attachment style and state/trait anxiety in adolescents - 30 recently hospitalized psychiatric patients, and 49 school controls. All were aged 13-18, with the majority (67%) female. The attachment style interview (ASI, Bifulco et al. 2002) was administered, together with the Recent Life Events questionnaire (Brugha & Cragg 1990) and the STAI anxiety questionnaire (Spielberger et al. 1983). Results showed the hospitalised group to have significantly more negative interactions with parents and poorer support than the comparison group. They had significantly more insecure attachment style (96% s 37%). Among the hospitalized adolescents, both the Anxious and the Avoidant attachment style group had higher anxiety scores on the STAI-trait scores than on the STAI-state scores assessed during the first days of hospitalisation. This suggests adolescents, even those with Avoidant attachment feel less anxious after admission. Implications for assessing attachment style in adolescent patients to aid with care planning is discussed.

Percepcion de los profesores universitarios acerca del concepto cultura cientifica y de sus implicaciones en el nuevo bachillerato del Recinto de Rio Piedras de la Universidad de Puerto Rico

NASA Astrophysics Data System (ADS)

Ramos Pastrana, Nilsa

El Senado Academico del Recinto de Rio Piedras de la Universidad de Puerto Rico aprobo en el ano academico 2005-2006 la Certificacion 46, que contiene los lineamientos de un nuevo bachillerato. Este nuevo bachillerato introdujo cambios significativos en el curriculo tradicional. Entre ellos se encuentra la reduccion del componente de educacion general y el de Ciencias Biologicas en particular. La reduccion de creditos en el componente de Ciencias Biologicas ha obligado a reevaluar el concepto de cultura cientifica que desarrollan esos cursos. El proposito del estudio consistio en auscultar las percepciones de los profesores de las Facultades de Administracion de Empresas, Humanidades, Ciencias Sociales, Ciencias Naturales, Educacion y Estudios Generales del Recinto de Rio Piedras de la Universidad de Puerto Rico en torno al concepto de cultura cientifica, los contenidos disciplinares del curso de Ciencias Biologicas y la reduccion de creditos en el nuevo bachillerato. Las preguntas que guiaron la investigacion fueron: ¿cuales son las percepciones que tienen los profesores de las Facultades de Administracion de Empresas, Ciencias Sociales, Estudios Generales, Ciencias Naturales, Humanidades y Educacion, en torno al concepto de cultura cientifica y los contenidos disciplinares del curso de Ciencias Biologicas? ¿cuales son las percepciones que tienen los profesores de Ciencias Biologicas en torno al concepto cultura cientifica y los contenidos disciplinares del curso de Ciencias Biologicas? ¿existen diferencias significativas por facultad, genero, experiencia, rango y nombramiento en las percepciones que tienen los profesores del Recinto de Rio Piedras de la Universidad de Puerto Rico sobre los elementos que caracterizan la cultura cientifica y los contenidos biologicos que deben tener los egresados del Recinto? ¿que implicaciones curriculares tienen estos testimonios en el desarrollo del concepto de cultura cientifica en el nuevo bachillerato? Para realizar la

Synthesizing (ZrAl3 + AlN)/Mg-Al composites by a 'matrix exchange' method

NASA Astrophysics Data System (ADS)

Gao, Tong; Li, Zengqiang; Hu, Kaiqi; Han, Mengxia; Liu, Xiangfa

2018-06-01

A method named 'matrix exchange' to synthesize ZrAl3 and AlN reinforced Mg-Al composite was developed in this paper. By inserting Al-10ZrN master alloy into Mg matrix and reheating the cooled ingot to 550 °C, Al and Mg atoms diffuse to the opposite side. As a result, liquid melt occurs once the interface areas reach to proper compositions. Then dissolved Al atoms react with ZrN, leading to the in-situ formation of ZrAl3 and AlN particles, while the Al matrix is finally replaced by Mg. This study provides a new insight for preparing Mg composites.

[Strategics of medical centers and regional hospitals in response to new labour insurance fee schedule].

PubMed

Wang, S C; Sheen, P C; Ko, Y C

1993-02-01

The purpose of this paper is to evaluate the medical centers and regional hospitals, strategic response to the implementation of new labour insurance fee schedule. This survey selects fifty-one medical centers and regional hospitals, with the response rate of 92.73%. This questionnaire was developed and evaluated by the authors and mailed to the questionnaire response by hospital's director or relative department director. We have selected Shortell et al. (1985) theory as the framework for evaluating and explaining hospital response to regulation environment (ex: change in the reimbursement system) at institutional-level response (ex: hospital association activity aimed at influencing regulation), managerial-level response (ex: increased physician participation in hospital-wide decision making; starting or expanding a planning department) and technical-level response (ex: shared clinical services such as lab., X-ray, pharmacy). The result found that hospitals with the characteristics as non-public ownership, medical centers, bigger size, and more administrative staff are more inclined to adopt institutional-level response. And a technical-level response occurs to hospital when market competibility becomes more intense which leads to higher reimbursement resource dependency.

Development of a method for classification of hospitals based on results of the diagnosis-related groups and the principle of case-mix index.

PubMed

Shelf, Louay

2016-08-18

This research used DRGs and CMI to adjust medical waste production through the calculation of DRGs and CMI scores. These scores were used to assess the performances of teaching hospitals in Damascus. The linear correlations between these scores and the annual amount of waste and DRGs values were studied. The differences between the daily waste generations before and after the adjustment process were determined. Accordingly, the highest values of DRGs and CMI Scores were for the pediatric and Al Assad hospitals respectively. Among the teaching hospitals in Damascus, Al Assad has achieved the highest performance. Based on the results, the accuracy and homogeneity of medical waste generation rates were improved, which in turn leads to continuous improvement in the management of medical wastes.

[Assessment levels of the user's satisfaction in a private hospital].

PubMed

da Cruz, Wilma Batista Souza; Melleiro, Marta Maria

2010-03-01

The objective of this study was to analyze the satisfaction of the users of a private hospital in terms of a number of attributes of the services in units. This exploratory, descriptive study used a quantitative approach and was developed in a private hospital in the city of São Paulo. The casuistry consisted of 71 users and data collection was performed during the period from March to August 2007, using a derivative of the scale model of the Service Quality (SERVQUAL) of the evaluative model of Parasuraman et al. The level of overall satisfaction ranged around 95%. The assurance (96%) and reliability (96%) were considered the most important dimensions of quality, followed by empathy (95%), responsiveness (93%) and tangibility (88%). Medical and nursing staffs introduced high levels of satisfaction. 91% has intention to recommend the hospital. This research provided the knowledge of the attributes most important in terms of satisfaction and contributed to confirming or reshaping assistance and management processes.

Desarrollo de una Interfaz de Control para un Observatorio Astronómico Robotizado con fines educativos en la Facultad de Ciencias Exactas; Físicas y Naturales de la UNSJ

NASA Astrophysics Data System (ADS)

Pogrebinsky, L.; Francile, C.

We report the development and the construction of an Interface to Control a robotized Astronomical Observatory (ICOA), which allows to control the operation of an observatory based on a Meade LX200 telescope. The interface operates together with a computer to control and supervise all the local variables of the observatory, and can take the control of it in risky situations. It serves as a link among the control computer and all the necessary devices for the astronomical observation such as the telescope, the dome, the weather station, the CCD camera, the calibration devices and the security devices. The computer receives orders from an operator who can be or not at the site of observation. The goal of this robotized observatory is the operation in a secure, autonomous and unattended way, with the purpose of to be used remotely by the students of the "Facultad de Ciencias Exactas, Físicas y Naturales" of the UNSJ. FULL TEXT IN SPANISH

Technical Support Document: Development of the Advanced Energy Design Guide for Large Hospitals - 50% Energy Savings

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

Bonnema, E.; Leach, M.; Pless, S.

2013-06-01

This Technical Support Document describes the process and methodology for the development of the Advanced Energy Design Guide for Large Hospitals: Achieving 50% Energy Savings Toward a Net Zero Energy Building (AEDG-LH) ASHRAE et al. (2011b). The AEDG-LH is intended to provide recommendations for achieving 50% whole-building energy savings in large hospitals over levels achieved by following Standard 90.1-2004. The AEDG-LH was created for a 'standard' mid- to large-size hospital, typically at least 100,000 ft2, but the strategies apply to all sizes and classifications of new construction hospital buildings. Its primary focus is new construction, but recommendations may be applicablemore » to facilities undergoing total renovation, and in part to many other hospital renovation, addition, remodeling, and modernization projects (including changes to one or more systems in existing buildings).« less

Magnetism of Al-substituted magnetite reduced from Al-hematite

NASA Astrophysics Data System (ADS)

Jiang, Zhaoxia; Liu, Qingsong; Zhao, Xiang; Roberts, Andrew P.; Heslop, David; Barrón, Vidal; Torrent, José

2016-06-01

Aluminum-substituted magnetite (Al-magnetite) reduced from Al-substituted hematite or goethite (Al-hematite or Al-goethite) is an environmentally important constituent of magnetically enhanced soils. In order to characterize the magnetic properties of Al-magnetite, two series of Al-magnetite samples were synthesized through reduction of Al-hematite by a mixed gas (80% CO2 and 20% CO) at 395°C for 72 h in a quartz tube furnace. Al-magnetite samples inherited the morphology of their parent Al-hematite samples, but only those transformed from Al-hematite synthesized at low temperature possessed surficial micropores, which originated from the release of structural water during heating. Surface micropores could thus serve as a practical fingerprint of fire or other high-temperature mineralogical alteration processes in natural environments, e.g., shear friction in seismic zones. In addition, Al substitution greatly affects the magnetic properties of Al-magnetite. For example, coercivity (Bc) increases with increasing Al content and then decreases slightly, while the saturation magnetization (Ms), Curie temperature (Tc), and Verwey transition temperature (Tv) all decrease with increasing Al content due to crystal defect formation and dilution of magnetic ions caused by Al incorporation. Moreover, different trends in the correlation between Tc and Bc can be used to discriminate titanomagnetite from Al-magnetite, which is likely to be important in environmental and paleomagnetic studies, particularly in soil.

Electron irradiation response on Ge and Al-doped SiO 2 optical fibres

NASA Astrophysics Data System (ADS)

Yaakob, N. H.; Wagiran, H.; Hossain, I.; Ramli, A. T.; Bradley, D. A.; Hashim, S.; Ali, H.

2011-05-01

This paper describes the thermoluminescence response, sensitivity, stability and reproducibility of SiO 2 optical fibres with various electron energies and doses. The TL materials that comprise Al- and Ge-doped silica fibres were used in this experiment. The TL results are compared with those of the commercially available TLD-100. The doped SiO 2 optical fibres and TLD-100 are placed in a solid phantom and irradiated with 6, 9 and 12 MeV electron beams at doses ranging from 0.2 to 4.0 Gy using the LINAC at Hospital Sultan Ismail, Johor Bahru, Malaysia. It was found that the commercially available Al- and Ge-doped optical fibres have a linear dose-TL signal relationship. The intensity of TL response of Ge-doped fibre is markedly greater than that of the Al-doped fibre.

Familial ALS

PubMed Central

Boylan, Kevin

2015-01-01

Synopsis Genes linked to ALS susceptibility are being identified at an increasing rate owing to advances in molecular genetic technology. Genetic mechanisms in ALS pathogenesis appear to exert major effects in ~10% of patients, but genetic factors at some level may be important components of disease risk in most ALS patients. Identification of gene variants associated with ALS has informed concepts of the pathogenesis of ALS, aided the identification of therapeutic targets, facilitated research to develop new ALS biomarkers, and supported the establishment of clinical diagnostic tests for ALS-linked genes. Translation of this knowledge to ALS therapy development is ongoing. PMID:26515623

Ab initio modeling of zincblende AlN layer in Al-AlN-TiN multilayers

DOE PAGES

Yadav, S. K.; Wang, J.; Liu, X. -Y.

2016-06-13

An unusual growth mechanism of metastable zincblende AlN thin film by diffusion of nitrogen atoms into Al lattice is established. Using first-principles density functional theory, we studied the possibility of thermodynamic stability of AlN as a zincblende phase due to epitaxial strains and interface effect, which fails to explain the formation of zincblende AlN. We then compared the formation energetics of rocksalt and zincblende AlN in fcc Al through direct diffusion of nitrogen atoms to Al octahedral and tetrahedral interstitials. Furthermore, the formation of a zincblende AlN thin film is determined to be a kinetically driven process, not a thermodynamicallymore » driven process.« less

Interfacial characterization of Al-Al thermocompression bonds

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

Malik, N., E-mail: nishantmalik1987@gmail.com; SINTEF ICT, Department of Microsystems and Nanotechnology, P.O. Box 124 Blindern, N-0314 Oslo; Carvalho, P. A.

2016-05-28

Interfaces formed by Al-Al thermocompression bonding were studied by the transmission electron microscopy. Si wafer pairs having patterned bonding frames were bonded using Al films deposited on Si or SiO{sub 2} as intermediate bonding media. A bond force of 36 or 60 kN at bonding temperatures ranging from 400–550 °C was applied for a duration of 60 min. Differences in the bonded interfaces of 200 μm wide sealing frames were investigated. It was observed that the interface had voids for bonding with 36 kN at 400 °C for Al deposited both on Si and on SiO{sub 2}. However, the dicing yield was 33% for Al onmore » Si and 98% for Al on SiO{sub 2}, attesting for the higher quality of the latter bonds. Both a bond force of 60 kN applied at 400 °C and a bond force of 36 kN applied at 550 °C resulted in completely bonded frames with dicing yields of, respectively, 100% and 96%. A high density of long dislocations in the Al grains was observed for the 60 kN case, while the higher temperature resulted in grain boundary rotation away from the original Al-Al interface towards more stable configurations. Possible bonding mechanisms and reasons for the large difference in bonding quality of the Al films deposited on Si or SiO{sub 2} are discussed.« less

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

[Job satisfaction of hospital doctors. Results of a study of a national sample of hospital doctors in Germany].

PubMed

Rosta, J; Gerber, A

2008-01-01

This paper presents the findings on the level of job satisfaction among hospital physicians in Germany and puts the results into relation to demographic variables and employment status. Data were collected as part of the survey "Work Life, Lifestyle and Health among Hospital Doctors in Germany 2006" using anonymous self-reporting questionnaires. Job satisfaction was scored using the scale according to Warr et al. It consists of 10 items with a seven-point Likert scale (1=dissatisfaction; 7=satisfaction), so the sum score ranks between 10 and 70. The following variables were correlated to job satisfaction: demographic variables (gender, age), and employment status (specialty, geographical localisation of hospital, hospital type, level of seniority, working time pattern). The response rate was 58% (n=1917). Doctors reported an average job satisfaction of 44.3. Comparing different specialties, physicians in radiology had the highest (47.6) and in surgery (43.0) the lowest level of job satisfaction. Below-average job satisfaction could also be found in urology (43.5) and internal medicine (43.7). The regression analysis showed that the younger age group (B=-1.45; p=0.031) and those with a status as junior physician (B=-4.97; p=0.0001) were significantly dissatisfied. Out of the ten items assessed "working hours" (3.25), "payment" (3.59), "physical working conditions" (3.96) and "recognition for good work" (4.08) attained the lowest ratings. Hospital doctors in Germany are moderately satisfied with their jobs - less satisfied than their colleagues in England, New Zealand and Norway. Improvement of job satisfaction and working conditions should be achieved via effective regulation of working hours and improvement of recognition for medical work regarding monetary and non-monetary factors such as payment and positive feedback for good work.

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.

The influence of insurance status on waiting times in German acute care hospitals: an empirical analysis of new data

PubMed Central

2009-01-01

Background There is an ongoing debate in Germany about the assumption that patients with private health insurance (PHI) benefit from better access to medical care, including shorter waiting times (Lüngen et al. 2008), compared to patients with statutory health insurance (SHI). Problem Existing analyses of the determinants for waiting times in Germany are a) based on patient self-reports and b) do not cover the inpatient sector. This paper aims to fill both gaps by (i) generating new primary data and (ii) analyzing waiting times in German hospitals. Methods We requested individual appointments from 485 hospitals within an experimental study design, allowing us to analyze the impact of PHI versus SHI on waiting times (Asplin et al. 2005). Results In German acute care hospitals patients with PHI have significantly shorter waiting times than patients with SHI. Conclusion Discrimination in waiting times by insurance status does occur in the German acute hospital sector. Since there is very little transparency in treatment quality in Germany, we do not know whether discrimination in waiting times leads to discrimination in the quality of treatment. This is an important issue for future research. PMID:20025744

Thermal Modeling of Al-Al and Al-Steel Friction Stir Spot Welding

NASA Astrophysics Data System (ADS)

Jedrasiak, P.; Shercliff, H. R.; Reilly, A.; McShane, G. J.; Chen, Y. C.; Wang, L.; Robson, J.; Prangnell, P.

2016-09-01

This paper presents a finite element thermal model for similar and dissimilar alloy friction stir spot welding (FSSW). The model is calibrated and validated using instrumented lap joints in Al-Al and Al-Fe automotive sheet alloys. The model successfully predicts the thermal histories for a range of process conditions. The resulting temperature histories are used to predict the growth of intermetallic phases at the interface in Al-Fe welds. Temperature predictions were used to study the evolution of hardness of a precipitation-hardened aluminum alloy during post-weld aging after FSSW.

[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.

Proton irradiation studies on Al and Al5083 alloy

NASA Astrophysics Data System (ADS)

Bhattacharyya, P.; Gayathri, N.; Bhattacharya, M.; Gupta, A. Dutta; Sarkar, Apu; Dhar, S.; Mitra, M. K.; Mukherjee, P.

2017-10-01

The change in the microstructural parameters and microhardness values in 6.5 MeV proton irradiated pure Al and Al5083 alloy samples have been evaluated using different model based techniques of X-ray diffraction Line Profile Analysis (XRD) and microindendation techniques. The detailed line profile analysis of the XRD data showed that the domain size increases and saturates with irradiation dose both in the case of Al and Al5083 alloy. The corresponding microstrain values did not show any change with irradiation dose in the case of the pure Al but showed an increase at higher irradiation doses in the case of Al5083 alloy. The microindendation results showed that unirradiated Al5083 alloy has higher hardness value compared to that of unirradiated pure Al. The hardness increased marginally with irradiation dose in the case of Al5083, whereas for pure Al, there was no significant change with dose.

Promoting safer blood transfusion practice in hospital.

PubMed

Parris, E; Grant-Casey, J

Results from a national comparative audit of bedside transfusion practice show that patients in the UK are at risk of misidentification and poor monitoring when undergoing a blood transfusion. A commonly identified reason for poor compliance with guidelines from the British Committee for Standards in Haematology (BCSH et al 1999) is a lack of awareness of good transfusion practice (National Blood Service (NBS) 2005). This article discusses the implications of the audit findings for the administration of blood at the bedside and examines initiatives to support hospital staff in their efforts to improve blood transfusion safety.

Combustion synthesis of AlB2-Al2O3 composite powders with AlB2 nanowire structures

NASA Astrophysics Data System (ADS)

Yang, Pan; Xiao, Guoqing; Ding, Donghai; Ren, Yun; Yang, Shoulei; Lv, Lihua; Hou, Xing

2018-05-01

Using of Al and B2O3 powders as starting materials, and Mg-Al alloy as additives, AlB2-Al2O3 composite powders with AlB2 nanowire structures were successfully fabricated via combustion synthesis method in Ar atmosphere at a pressure of 1.5 MPa. The effect of different amount of Mg-Al alloy on the phase compositions and morphology of the combustion products was investigated. The results revealed that AlB2 and Al2O3 increased, whereas Al decreased with the content of Mg-Al alloy increasing. The impurities MgAl2O4 and AlB12 would exist in the sample with adding of 18 wt% Mg-Al alloy. Interestingly, FESEM/TEM/EDS results showed that AlB2 nanowires were observed in the products when the content of Mg-Al alloy is 6 wt% and 12 wt%. The more AlB2 nanowires can be found as the content of Mg-Al alloy increased. And the yield of AlB2 nanowires with the diameter of about 200 nanometers (nm) and the length up to several tens of micrometers (μm) in the combustion product is highest when the content of Mg-Al alloy is 12 wt%. The vapor, such as Mg-Al (g), B2O2 (g), AlO (g) and Al2O (g), produced during the process of combustion synthesis, reacted with each other to yield AlB2 nanowires by vapor-solid (VS) mechanism and the corresponding model was also proposed.

Interfacial Phenomena in Al/Al, Al/Cu, and Cu/Cu Joints Soldered Using an Al-Zn Alloy with Ag or Cu Additions

NASA Astrophysics Data System (ADS)

Pstruś, Janusz; Gancarz, Tomasz

2014-05-01

The studies of soldered joints were carried out in systems: Al/solder/Al, Al/solder/Cu, Cu/solder/Cu, where the solder was (Al-Zn)EUT, (Al-Zn)EUT with 0.5, 1.0, and 1.5 at.% of Ag and (Al-Zn)EUT with 0.5, 1.0, and 1.5 at.% of Cu addition. Brazing was performed at 500 °C for 3 min. The EDS analysis indicated that the composition of the layers starting from the Cu pad was CuZn, Cu5Zn8, and CuZn4, respectively. Wetting tests were performed at 500 °C for 3, 8, 15, and 30 min, respectively. Thickness of the layers and their kinetics of growth were measured based on the SEM micrographs. The formation of interlayers was not observed from the side of Al pads. On the contrary, dissolution of the Al substrate and migration of Al-rich particles into the bulk of the solder were observed.

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

Orientation relationship of eutectoid FeAl and FeAl2.

PubMed

Scherf, A; Kauffmann, A; Kauffmann-Weiss, S; Scherer, T; Li, X; Stein, F; Heilmaier, M

2016-04-01

Fe-Al alloys in the aluminium range of 55-65 at.% exhibit a lamellar microstructure of B2-ordered FeAl and triclinic FeAl 2 , which is caused by a eutectoid decomposition of the high-temperature Fe 5 Al 8 phase, the so-called ∊ phase. The orientation relationship of FeAl and FeAl 2 has previously been studied by Bastin et al. [ J. Cryst. Growth (1978 ▸), 43 , 745] and Hirata et al. [ Philos. Mag. Lett. (2008 ▸), 88 , 491]. Since both results are based on different crystallographic data regarding FeAl 2 , the data are re-evaluated with respect to a recent re-determination of the FeAl 2 phase provided by Chumak et al. [ Acta Cryst. (2010 ▸), C 66 , i87]. It is found that both orientation relationships match subsequent to a rotation operation of 180° about a 〈112〉 crystallographic axis of FeAl or by applying the inversion symmetry of the FeAl 2 crystal structure as suggested by the Chumak data set. Experimental evidence for the validity of the previously determined orientation relationships was found in as-cast fully lamellar material (random texture) as well as directionally solidified material (∼〈110〉 FeAl || solidification direction) by means of orientation imaging microscopy and global texture measurements. In addition, a preferential interface between FeAl and FeAl 2 was identified by means of trace analyses using cross sectioning with a focused ion beam. On the basis of these habit planes the orientation relationship between the two phases can be described by ([Formula: see text]01) FeAl || (114)[Formula: see text] and [111] FeAl || [1[Formula: see text]0][Formula: see text]. There is no evidence for twinning within FeAl lamellae or alternating orientations of FeAl lamellae. Based on the determined orientation and interface data, an atomistic model of the structure relationship of Fe 5 Al 8 , FeAl and FeAl 2 in the vicinity of the eutectoid decomposition is derived. This model is analysed with respect to the strain which has to be

Performance evaluation of Al-Zahra academic medical center based on Iran balanced scorecard model

PubMed Central

Raeisi, Ahmad Reza; Yarmohammadian, Mohammad Hossein; Bakhsh, Roghayeh Mohammadi; Gangi, Hamid

2012-01-01

Background: Growth and development in any country's national health system, without an efficient evaluation system, lacks the basic concepts and tools necessary for fulfilling the system's goals. The balanced scorecard (BSC) is a technique widely used to measure the performance of an organization. The basic core of the BSC is guided by the organization's vision and strategies, which are the bases for the formation of four perspectives of BSC. The goal of this research is the performance evaluation of Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences, based on Iran BSC model. Materials and Methods: This is a combination (quantitative–qualitative) research which was done at Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences in 2011. The research populations were hospital managers at different levels. Sampling method was purposive sampling in which the key informed personnel participated in determining the performance indicators of hospital as the BSC team members in focused discussion groups. After determining the conceptual elements in focused discussion groups, the performance objectives (targets) and indicators of hospital were determined and sorted in perspectives by the group discussion participants. Following that, the performance indicators were calculated by the experts according to the predetermined objectives; then, the score of each indicator and the mean score of each perspective were calculated. Results: Research findings included development of the organizational mission, vision, values, objectives, and strategies. The strategies agreed upon by the participants in the focus discussion group included five strategies, which were customer satisfaction, continuous quality improvement, development of human resources, supporting innovation, expansion of services and improving the productivity. Research participants also agreed upon four perspectives for the Al-Zahra hospital BSC. In the patients and community

Performance evaluation of Al-Zahra academic medical center based on Iran balanced scorecard model.

PubMed

Raeisi, Ahmad Reza; Yarmohammadian, Mohammad Hossein; Bakhsh, Roghayeh Mohammadi; Gangi, Hamid

2012-01-01

Growth and development in any country's national health system, without an efficient evaluation system, lacks the basic concepts and tools necessary for fulfilling the system's goals. The balanced scorecard (BSC) is a technique widely used to measure the performance of an organization. The basic core of the BSC is guided by the organization's vision and strategies, which are the bases for the formation of four perspectives of BSC. The goal of this research is the performance evaluation of Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences, based on Iran BSC model. This is a combination (quantitative-qualitative) research which was done at Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences in 2011. The research populations were hospital managers at different levels. Sampling method was purposive sampling in which the key informed personnel participated in determining the performance indicators of hospital as the BSC team members in focused discussion groups. After determining the conceptual elements in focused discussion groups, the performance objectives (targets) and indicators of hospital were determined and sorted in perspectives by the group discussion participants. Following that, the performance indicators were calculated by the experts according to the predetermined objectives; then, the score of each indicator and the mean score of each perspective were calculated. Research findings included development of the organizational mission, vision, values, objectives, and strategies. The strategies agreed upon by the participants in the focus discussion group included five strategies, which were customer satisfaction, continuous quality improvement, development of human resources, supporting innovation, expansion of services and improving the productivity. Research participants also agreed upon four perspectives for the Al-Zahra hospital BSC. In the patients and community perspective (customer), two objectives and

Bifurcation analysis and global dynamics of a mathematical model of antibiotic resistance in hospitals.

PubMed

Cen, Xiuli; Feng, Zhilan; Zheng, Yiqiang; Zhao, Yulin

2017-12-01

Antibiotic-resistant bacteria have posed a grave threat to public health by causing a number of nosocomial infections in hospitals. Mathematical models have been used to study transmission dynamics of antibiotic-resistant bacteria within a hospital and the measures to control antibiotic resistance in nosocomial pathogens. Studies presented in Lipstich et al. (Proc Natl Acad Sci 97(4):1938-1943, 2000) and Lipstich and Bergstrom (Infection control in the ICU environment. Kluwer, Boston, 2002) have provided valuable insights in understanding the transmission of antibiotic-resistant bacteria in a hospital. However, their results are limited to numerical simulations of a few different scenarios without analytical analyses of the models in broader parameter regions that are biologically feasible. Bifurcation analysis and identification of the global stability conditions can be very helpful for assessing interventions that are aimed at limiting nosocomial infections and stemming the spread of antibiotic-resistant bacteria. In this paper we study the global dynamics of the mathematical model of antibiotic resistance in hospitals considered in Lipstich et al. (2000) and Lipstich and Bergstrom (2002). The invasion reproduction number [Formula: see text] of antibiotic-resistant bacteria is derived, and the relationship between [Formula: see text] and two control reproduction numbers of sensitive bacteria and resistant bacteria ([Formula: see text] and [Formula: see text]) is established. More importantly, we prove that a backward bifurcation may occur at [Formula: see text] when the model includes superinfection, which is not mentioned in Lipstich and Bergstrom (2002). More specifically, there exists a new threshold [Formula: see text], such that if [Formula: see text], then the system can have two positive interior equilibria, which leads to an interesting bistable phenomenon. This may have critical implications for controlling the antibiotic-resistance in a hospital.

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

Ohmic contacts to Al-rich AlGaN heterostructures

DOE PAGES

Douglas, E. A.; Reza, S.; Sanchez, C.; ...

2017-06-06

Due to the ultra-wide bandgap of Al-rich AlGaN, up to 5.8 eV for the structures in this study, obtaining low resistance ohmic contacts is inherently difficult to achieve. A comparative study of three different fabrication schemes is presented for obtaining ohmic contacts to an Al-rich AlGaN channel. Schottky-like behavior was observed for several different planar metallization stacks (and anneal temperatures), in addition to a dry-etch recess metallization contact scheme on Al 0.85Ga 0.15N/Al 0.66Ga 0.34N. However, a dry etch recess followed by n +-GaN regrowth fabrication process is reported as a means to obtain lower contact resistivity ohmic contacts onmore » a Al 0.85Ga 0.15N/Al 0.66Ga 0.34N heterostructure. In conclusion, specific contact resistivity of 5×10 -3 Ω cm 2 was achieved after annealing Ti/Al/Ni/Au metallization.« less

Growth and stress-induced transformation of zinc blende AlN layers in Al-AlN-TiN multilayers

DOE PAGES

Li, Nan; Yadav, Satyesh K.; Wang, Jian; ...

2015-12-18

We report that AlN nanolayers in sputter deposited {111}Al/AlN/TiN multilayers exhibit the metastable zinc-blende-structure (z-AlN). Based on density function theory calculations, the growth of the z-AlN is ascribed to the kinetically and energetically favored nitridation of the deposited aluminium layer. In situ nanoindentation of the as-deposited {111}Al/AlN/TiN multilayers in a high-resolution transmission electron microscope revealed the z-AlN to wurzite AlN phase transformation through collective glide of Shockley partial dislocations on every two {111} planes of the z-AlN.

A cross sectional study of maternal 'near-miss' cases in major public hospitals in Egypt, Lebanon, Palestine and Syria.

PubMed

Bashour, Hyam; Saad-Haddad, Ghada; DeJong, Jocelyn; Ramadan, Mohammed Cherine; Hassan, Sahar; Breebaart, Miral; Wick, Laura; Hassanein, Nevine; Kharouf, Mayada

2015-11-13

The maternal near-miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health. We report findings from the formative stage of a World Health Organization (WHO) funded implementation research study that was undertaken to collect primary data at the facility level on the prevalence, characteristics, and management of maternal near-miss cases in four major public referral hospitals - one each in Egypt, Lebanon, Palestine and Syria. We conducted a cross sectional study of maternal near-miss cases in the four contexts beginning in 2011, where we collected data on severe maternal morbidity in the four study hospitals, using the WHO form (Individual Form HRP A65661). In each hospital, a research team including trained hospital healthcare providers carried out the data collection. A total of 9,063 live birth deliveries were reported during the data collection period across the four settings, with a total of 77 cases of severe maternal outcomes (71 maternal near-miss cases and 6 maternal deaths). Higher indices for the maternal mortality index were found in both Al Galaa hospital, in Egypt (8.6%) and Dar Al Tawleed hospital in Syria (14.3%), being large referral hospitals, compared to Ramallah hospital in Palestine and Rafik Hariri University hospital in Lebanon. Compared to the WHO's Multicountry Survey using the same data collection tool, our study's mortality indices are higher than the index of 5.6% among countries with a moderate maternal mortality ratio in the WHO Survey. Overall, haemorrhage-related complications were the most frequent conditions among maternal near-miss cases across the four study hospitals. In all hospitals, coagulation dysfunctions (76.1%) were the most prevalent dysfunction among maternal near-miss cases, followed by cardiovascular dysfunctions. The coverage of key evidence-based interventions among women experiencing a near-miss was either universal or very high in the study hospitals

Requirements for Successful Adoption of a Glucose Measurement System Into a Hospital POC Program.

PubMed

Füzéry, Anna K; Cembrowski, George S

2016-07-01

Widespread and successful implementation of any glucose measurement system in a hospital point-of-care (POC) program requires a number of features in addition to accurate and reliable analytical performance. Such features include, but are not limited to, a system's glucose-hematocrit dependence, durability, information technology capabilities, and battery capacity and battery life. While the study of Ottiger et al in this issue supports the analytical accuracy and reliability of Bayer's CONTOUR XT® blood glucose monitoring system, the suitability of other features of this system for a hospital POC program remains to be established. © 2016 Diabetes Technology Society.

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.

Comparing the Thermodynamic Behaviour of Al(1)+ZrO2(s) to Al(1)+Al2O3(s)

NASA Technical Reports Server (NTRS)

Copland, Evan

2004-01-01

In an effort to better determine the thermodynamic properties of Al(g) and Al2O(g). the vapor in equilibrium with Al(l)+ZrO2(s) was compared to the vapor in equilibrium with Al(l)+Al2O3(s) over temperature range 1197-to-1509K. The comparison was made directly by Knudsen effusion-cell mass spectrometry with an instrument configured for a multiple effusion-cell vapor source (multi-cell KEMS). Second law enthalpies of vaporization of Al(g) and Al2O(g) together with activity measurements show that Al(l)+ZrO2(s) is thermodynamically equivalent to Al(l)+Al2O3(s), indicating Al(l) remained pure and Al2O3(s) was present in the ZrO2-cell. Subsequent observation of the Al(l)/ZrO2 and vapor/ZrO2 interfaces revealed a thin Al2O3-layer had formed, separating the ZrO2-cell from Al(l) and Al(g)+Al2O(g), effectively transforming it into an Al2O3 effusion-cell. This behavior agrees with recent observations made for Beta-NiAl(Pt) alloys measured in ZrO2 effusion-cell.

Proposed BioRepository platform solution for the ALS research community.

PubMed

Sherman, Alex; Bowser, Robert; Grasso, Daniela; Power, Breen; Milligan, Carol; Jaffa, Matthew; Cudkowicz, Merit

2011-01-01

ALS is a rare disorder whose cause and pathogenesis is largely unknown ( 1 ). There is a recognized need to develop biomarkers for ALS to better understand the disease, expedite diagnosis and to facilitate therapy development. Collaboration is essential to obtain a sufficient number of samples to allow statistically meaningful studies. The availability of high quality biological specimens for research purposes requires the development of standardized methods for collection, long-term storage, retrieval and distribution of specimens. The value of biological samples to scientists and clinicians correlates with the completeness and relevance of phenotypical and clinical information associated with the samples ( 2 , 3 ). While developing a secure Web-based system to manage an inventory of multi-site BioRepositories, algorithms were implemented to facilitate ad hoc parametric searches across heterogeneous data sources that contain data from clinical trials and research studies. A flexible schema for a barcode label was introduced to allow association of samples to these data. The ALSBank™ BioRepository platform solution for managing biological samples and associated data is currently deployed by the Northeast ALS Consortium (NEALS). The NEALS Consortium and the Massachusetts General Hospital (MGH) Neurology Clinical Trials Unit (NCTU) support a network of multiple BioBanks, thus allowing researchers to take advantage of a larger specimen collection than they might have at an individual institution. Standard operating procedures are utilized at all collection sites to promote common practices for biological sample integrity, quality control and associated clinical data. Utilizing this platform, we have created one of the largest virtual collections of ALS-related specimens available to investigators studying ALS.

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.

Nanoporous Al sandwich foils using size effect of Al layer thickness during Cu/Al/Cu laminate rolling

NASA Astrophysics Data System (ADS)

Yu, Hailiang; Lu, Cheng; Tieu, A. Kiet; Li, Huijun; Godbole, Ajit; Kong, Charlie

2018-06-01

The roll bonding technique is one of the most widely used methods to produce metal laminate sheets. Such sheets offer interesting research opportunities for both scientists and engineers. In this paper, we report on an experimental investigation of the 'thickness effect' during laminate rolling for the first time. Using a four-high multifunction rolling mill, Cu/Al/Cu laminate sheets were fabricated with a range of thicknesses (16, 40, 70 and 130 μm) of the Al layer. The thickness of the Cu sheets was a constant 300 μm. After rolling, TEM images show good bonding quality between the Cu and Al layers. However, there are many nanoscale pores in the Al layer. The fraction of nanoscale pores in the Al layer increases with a reduction in the Al layer thickness. The finite element method was used to simulate the Cu/Al/Cu rolling process. The simulation results reveal the effect of the Al layer thickness on the deformation characteristics of the Cu/Al/Cu laminate. Finally, we propose that the size effect of the Al layer thickness during Cu/Al/Cu laminate rolling may offer a method to fabricate 'nanoporous' Al sandwich laminate foils. Such foils can be used in electromagnetic shielding of electrical devices and noisy shielding of building.

Ti{sub 2}AlN thin films synthesized by annealing of (Ti+Al)/AlN multilayers

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

Cabioch, Thierry, E-mail: Thierry.cabioch@univ-poitiers.fr; Alkazaz, Malaz; Beaufort, Marie-France

2016-08-15

Highlights: • Epitaxial thin films of the MAX phase Ti{sub 2}AlN are obtained by thermal annealing. • A new metastable (Ti,Al,N) solid solution with the structure of α-T is evidenced. • The formation of the MAX phase occurs at low temperature (600 °C). - Abstract: Single-phase Ti{sub 2}AlN thin films were obtained by annealing in vacuum of (Ti + Al)/AlN multilayers deposited at room temperature by magnetron sputtering onto single-crystalline (0001) 4H-SiC and (0001) Al{sub 2}O{sub 3} substrates. In-situ X-ray diffraction experiments combined with ex-situ cross-sectional transmission electron microscopy observations reveal that interdiffusion processes occur in the multilayer at amore » temperature of ∼400 °C leading to the formation of a (Ti, Al, N) solid solution, having the hexagonal structure of α-Ti, whereas the formation of Ti{sub 2}AlN occurs at 550–600 °C. Highly oriented (0002) Ti{sub 2}AlN thin films can be obtained after an annealing at 750 °C.« less

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

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

ALS Association

MedlinePlus

... toward a world without ALS! Walk to Defeat ALS® Walk to Defeat ALS® draws people of all ... We need your help. I Will Advocate National ALS Registry The National ALS Registry is a congressionally ...

[Epidemiological, clinical, cytologic and immunophenotypic aspects of acute leukemia in children: the experience at the hematology laboratory of IBN SINA University Hospital Center].

PubMed

Doumbia, Mariam; Uwingabiye, Jean; Bissan, Aboubacar; Rachid, Razine; Benkirane, Souad; Masrar, Azlarab

2016-01-01

The aim of this study was to describe epidemiological, cytologic and immunophenotypic aspects of acute leukemias (AL) in children diagnosed at IBN SINA University Hospital Center and to determine the concordance between cytology and immunophenotyping results. This is a cross-sectional study conducted in the hematology laboratory of IBN SINA University Hospital Center between June 2012 and May 2014. Among the 104 cases with diagnosed AL, 52% were boys with a sex-ratio H/F= 1.32, the average age was 5.7 years. The distribution of different types of AL was: lymphoid AL (LAL) (74%), myeloid (AML) (20.2%), biphenotypic AL (BAL) (65.8%). Among the LALs, 78% were classified as B LAL and 22% as T LAL. Clinical signs were mainly presented with tumor syndrome (73.1%), fever (61%) and hemorrhagic syndrome (50%). The most common blood count abnormalities were: thrombopenia (89.4%), anemia (86.5%), hyperleukocytosis (79.8%). The rate of peripheral and bone marrow blasts was statistically higher for LAL than for AML and BAL (p <0.001). The rate of relapse and mortality was 21.2% and 16. 3% respectively. Concordance rate between the results of cytology and of immunophenotyping was 92.7% for LAL and 82.6% for AML. Diagnosis of AL is always based primarily on cytology. Immunophenotyping allowed us to make a better distinction between acute leukemias. The management of paediatric AL is a major health problem which requires specialized care centers.

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.

Piezo-tunnel effect in Al/Al2O3/Al junctions elaborated by atomic layer deposition

NASA Astrophysics Data System (ADS)

Rafael, R.; Puyoo, E.; Malhaire, C.

2017-11-01

In this work, the electrical transport in Al/Al2O3/Al junctions under mechanical stress is investigated in the perspective to use them as strain sensors. The metal/insulator/metal junctions are elaborated with a low temperature process (≤200 °C) fully compatible with CMOS back-end-of-line. The conduction mechanism in the structure is found to be Fowler-Nordheim tunneling, and efforts are made to extract the relevant physical parameters. Gauge factors up to -32.5 were found in the fabricated devices under tensile stress. Finally, theoretical mechanical considerations give strong evidence that strain sensitivity in Al/Al2O3/Al structures originates not only from geometrical deformations but also from the variation of interface barrier height and/or effective electronic mass in the tunneling oxide layer.

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

Influence of AlN(0001) Surface Reconstructions on the Wettability of an Al/AlN System: A First-Principle Study.

PubMed

Cao, Junhua; Liu, Yang; Ning, Xiao-Shan

2018-05-11

A successful application of a hot dip coating process that coats aluminum (Al) on aluminum nitride (AlN) ceramics, revealed that Al had a perfect wettability to the ceramics under specific circumstances, which was different from previous reports. In order to elucidate the mechanism that controlled the supernormal wetting phenomenon during the dip coating, a first-principle calculation of an Al(111)/AlN(0001) interface, based on the density functional theory (DFT), was employed. The wettability of the Al melt on the AlN(0001) surface, as well as the effect that the surface reconstruction of AlN and the oxygen adsorption had on Al for the adhesion and the wettability of the Al/AlN system, were studied. The results revealed that a LCM (laterally contracted monolayer) reconstruction could improve the adhesion and wettability of the system. Oxygen adsorption on the free surface of Al decreased the contact angle, because the adsorption reduced of the surface tension of Al. A prefect wetting was obtained only after some of the oxygen atoms adsorbed on the free surface of Al. The supernormal wetting phenomenon came from the surface reconstruction of the AlN and the adsorption of oxygen atoms on the Al melt surface.

Japanese version of the ALS-FTD-Questionnaire (ALS-FTD-Q-J).

PubMed

Watanabe, Yasuhiro; Beeldman, Emma; Raaphorst, Joost; Izumi, Yuishin; Yoshino, Hiide; Masuda, Michihito; Atsuta, Naoki; Ito, Satoru; Adachi, Tadashi; Adachi, Yoshiki; Yokota, Osamu; Oda, Masaya; Hanashima, Ritsuko; Ogino, Mieko; Ichikawa, Hiroo; Hasegawa, Kazuko; Kimura, Hideki; Shimizu, Toshio; Aiba, Ikuko; Yabe, Hayato; Kanba, Makoto; Kusumi, Kimiyoshi; Aoki, Tetsuya; Hiroe, Yu; Watanabe, Hirohisa; Nishiyama, Kazutoshi; Nomoto, Masahiro; Sobue, Gen; Nakashima, Kenji

2016-08-15

Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) share common clinical, genetic and neuropathological features. Some ALS patients have behavioral/personality changes, which could result in significant obstacles in the care provided by family members and caregivers. An easy screening tool would contribute greatly to the evaluation of these symptoms. We translated the ALS-FTD-Questionnaire, developed in the Netherlands, into Japanese (ALS-FTD-Q-J) and examined the clinimetric properties (internal consistency, construct and clinical validity). Patients with ALS and/or behavioral variant FTD (bvFTD) were evaluated alongside healthy controls in this multicenter study. All ALS patients, regardless of bvFTD status, were further evaluated by the frontal behavioral inventory (FBI) and for frontal/executive function, cognition, anxiety/depression, and motor functions. Data from 146 subjects were analyzed: ALS (92), ALS-bvFTD (6), bvFTD (16), and healthy controls (32). The internal consistency of the ALS-FTD-Q-J was good (Cronbach α=0.92). The ALS-FTD-Q-J showed construct validity as it exhibited a high correlation with the FBI (r=0.79). However, correlations were moderate with anxiety/depression and low with cognitive scales, in contrast to the original report, i.e. a moderate correlation with cognition and a low correlation with anxiety/depression. The ALS-FTD-Q-J discriminated ALS patients from (ALS-)bvFTD patients and controls. Thus, the ALS-FTD-Q-J is useful for evaluating Japanese ALS/FTD patients. Copyright © 2016 Elsevier B.V. All rights reserved.

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

3-Dimensional Microstructure of Al-Al3Ti Alloy Severely Deformed by ECAP

NASA Astrophysics Data System (ADS)

Sato, Hisashi; Hishikawa, Takahisa; Makino, Yuuki; Kunimine, Takahiro; Watanabe, Yoshimi

Microstructure of Al-Al3Ti alloy deformed by Equal-Channel-Angular Pressing (ECAP) is 3-dimensionally investigated. Especially, distribution of Al3Ti particles is focused in this study. The Al-Al3Ti alloy has coarse Al3Ti platelet particles in α-Al matrix. When the Al-Al3Ti alloy is deformed by ECAP under route A, fine Al3Ti platelet particles are observed. These Al3Ti platelet particles are aligned along to deformation axis, and its plane normal is perpendicular to the deformation axis. On the other hand, Al-Al3Ti alloy ECAPed under route Bc forms several groups consisted of fine Al3Ti platelet particles. Moreover, longitudinal size of the Al3Ti particle groups is close to that of initial Al3Ti particles with 4-pass ECAP specimen. These distribution behaviors of the Al3Ti particle can be explained by plastic flow of α-Al matrix. Finally, it is concluded that distribution of Al3Ti particle in Al-Al3Ti alloy by ECAP is controlled by plastic deformation of α-Al matrix.

Abu al-Layth al-Libi

DTIC Science & Technology

2015-02-01

in the region and apparently “showed brilliance in this regard through his perfect memorization , clever understanding, persistence, and patience...Taliban’s officials quietly left the capital without informing 73 Vernie Liebl, “Al-Qaida on the US Invasion of Afghanistan in Their Own Words ,” Small Wars... memorization . A talented and charismatic orator, he also used to deliver eulogies and `Id sermons. As to `Abdallah Sa`id al-Libi, his profile is similar

Defect structures in ordered intermetallics; grain boundaries and surfaces in FeAl, NiAl, CoAl and TiAl

NASA Astrophysics Data System (ADS)

Mutasa, Batsirai Manyara

Ordered intermetallics based on transition metal aluminides have been proposed as structural materials for advanced aerospace applications. The development of these materials, which have the advantages of low density and high operating temperatures, have been focused on the aluminides of titanium, nickel and iron. Though these materials exhibit attractive properties at elevated temperatures, their utilization is limited due to their propensity for low temperature fracture and susceptibility to decreased ductility due to environmental effects. A major embrittlement mechanism at ambient temperatures in these aluminides has been by the loss of cohesive strength at the interfaces (intergranular failure). This study focuses on this mechanism of failure, by undertaking a systematic study of the energies and structures of specific grain boundaries in some of these compounds. The relaxed atomistic grain boundary structures in B2 aluminides, FeAl, NiAl and CoAl and L10 gamma-TiAl were investigated using molecular statics and embedded atom potentials in order to explore general trends for a series of B2 compounds as well as TiAl. The potentials used correctly predict the proper mechanism of compositional disorder of these compounds. Using these potentials, point defects, free surface energies and various grain boundary structures of similar energies in three B2 compounds, FeAl, NiAl and CoAl were studied. These B2 alloys exhibited increasing anti-phase boundary energies respectively. The misorientations chosen for detailed study correspond to the Sigma5(310) and Sigma5(210) boundaries. These boundaries were investigated with consideration given to possible variations in the local chemical composition. The effects of both boundary stoichiometry and bulk stoichiometry on grain boundary energetics were also considered. Defect energies were calculated for boundaries contained in both stoichiometric and off-stoichiometric bulk. The surface energies for these aluminides were also

A Rechargeable Al/S Battery with an Ionic-Liquid Electrolyte.

PubMed

Gao, Tao; Li, Xiaogang; Wang, Xiwen; Hu, Junkai; Han, Fudong; Fan, Xiulin; Suo, Liumin; Pearse, Alex J; Lee, Sang Bok; Rubloff, Gary W; Gaskell, Karen J; Noked, Malachi; Wang, Chunsheng

2016-08-16

Aluminum metal is a promising anode material for next generation rechargeable batteries owing to its abundance, potentially dendrite-free deposition, and high capacity. The rechargeable aluminum/sulfur (Al/S) battery is of great interest owing to its high energy density (1340 Wh kg(-1) ) and low cost. However, Al/S chemistry suffers poor reversibility owing to the difficulty of oxidizing AlSx . Herein, we demonstrate the first reversible Al/S battery in ionic-liquid electrolyte with an activated carbon cloth/sulfur composite cathode. Electrochemical, spectroscopic, and microscopic results suggest that sulfur undergoes a solid-state conversion reaction in the electrolyte. Kinetics analysis identifies that the slow solid-state sulfur conversion reaction causes large voltage hysteresis and limits the energy efficiency of the system. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Seroprevalence of Cytomegalovirus among pregnant women and hospitalized children in Palestine.

PubMed

Neirukh, Tahani; Qaisi, Ayda; Saleh, Niveen; Rmaileh, Areej Abu; Zahriyeh, Eman Abu; Qurei, Lina; Dajani, Firas; Nusseibeh, Taghreed; Khamash, Hatem; Baraghithi, Sabri; Azzeh, Maysa

2013-11-09

Human Cytomegalovirus (HCMV) is the most common cause of congenital infections. The maternal immune status plays a major role in the likelihood of congenital infection. The aim of this study is to shed light on the seroprevalence of HCMV in pregnant women, hospitalized children and newborns including cases of congenital infections in Palestine. We analyzed HCMV IgG and IgM test results that had been ordered for pregnant women, hospitalized children and newborns in the years 2006-2012 at Al-Makassed Islamic Charitable Hospital (MICH) in East Jerusalem. Furthermore, we reviewed the medical charts of newborns and HCMV IgM-positive children. HCMV IgG was positive in 96.6% of pregnant women, in 88% of hospitalized children and in 98.4% of hospitalized newborns. HCMV IgM was positive in 11.5% of pregnant women, in 11.7% of hospitalized children and in 2% of hospitalized newborns respectively. The HCMV avidity assay revealed that 95% of IgM-positive pregnant women had high avidity (>60%) indicating that most Palestinian women were undergoing a recurrent HCMV infection. Real time PCR on limited number of cases indicated that 62.5% of infants, mostly born to IgM-positive mothers and 83.3% of HCMV IgM-positive children had detectable HCMV DNA in their urine. Out of the 249 newborns tested during this study period, four (1.6%) were subjected to Gancyclovir treatment because of symptomatic congenital HCMV infection. This is the first report to provide an insight into HCMV seroprevalence in Palestine. Despite the high rate of seropositivity, the importance of HCMV testing during pregnancy should not be underestimated. A comprehensive study with a long term follow-up examination of offspring born to HCMV IgM-positive mothers would be required to provide estimates of an accurate percentage of symptomatic congenital HCMV infection in Palestine.

Growth of Ni-Al alloys on Ni(1 1 1), from Al deposits of various thicknesses: (II) Formation of NiAl over a Ni 3Al interfacial layer

NASA Astrophysics Data System (ADS)

Le Pévédic, S.; Schmaus, D.; Cohen, C.

2007-01-01

This paper describes the second part of a study devoted to the growth of thin Ni-Al alloys after deposition of Al on Ni(1 1 1). In the previous paper [S. Le Pévédic, D. Schmaus, C. Cohen, Surf. Sci. 600 (2006) 565] we have described the results obtained for ultra-thin Al deposits, leading, after annealing at 750 K, to an epitaxial layer of Ni 3Al(1 1 1). In the present paper we show that this regime is only observed for Al deposits smaller than 8 × 10 15 Al/cm 2 and we describe the results obtained for Al deposits exceeding this critical thickness, up to 200 × 10 15 Al/cm 2. Al deposition was performed at low temperature (around 130 K) and the alloying process was followed in situ during subsequent annealing, by Auger electron spectroscopy, low energy electron diffraction and ion beam analysis-channeling measurements, in an ultra-high vacuum chamber connected to a Van de Graaff accelerator. We evidence the formation, after annealing at 750 K, of a crystallographically and chemically well-ordered NiAl(1 1 0) layer (whose thickness depends on the deposited Al amount), over a Ni 3Al "interfacial" layer (whose thickness—about 18 (1 1 1) planes—is independent of the deposited Al amount). The NiAl overlayer is composed of three variants, at 120° from each other in the surface plane, in relation with the respective symmetries of NiAl(1 1 0) and Ni 3Al(1 1 1). The NiAl layer is relaxed (the lattice parameters of cc-B2 NiAl and fcc-L1 2 Ni 3Al differ markedly), and we have determined its epitaxial relationship. In the case of the thickest alloyed layer formed the results concerning the structure of the NiAl layer have been confirmed and refined by ex situ X-ray diffraction and information on its grain size has been obtained by ex situ Atomic Force Microscopy. The kinetics of the alloying process is complex. It corresponds to an heterogeneous growth leading, above the thin Ni 3Al interfacial layer, to a mixture of Al and NiAl over the whole Al film, up to the

Multidisciplinary ALS care improves quality of life in patients with ALS.

PubMed

Van den Berg, J P; Kalmijn, S; Lindeman, E; Veldink, J H; de Visser, M; Van der Graaff, M M; Wokke, J H J; Van den Berg, L H

2005-10-25

To examine the effect of multidisciplinary ALS care on the quality-of-life (QoL) in patients with ALS and their caregivers. In a cross-sectional study, 208 patients with ALS and their caregivers were interviewed. QoL was assessed using the 36-item Short Form Health Survey (SF-36) and two visual analogue scales (VAS). Criteria for multidisciplinary ALS care were: an ALS team headed by a consultant in rehabilitation medicine and consisting of at least a physical therapist, occupational therapist, speech pathologist, dietician and a social worker; use of the Dutch ALS consensus guidelines for ALS care; and at least six incident ALS patients per year. Clinical characteristics and functional loss of the 133 patients receiving multidisciplinary ALS care and the 75 patients receiving general ALS care were similar. The percentage of patients with adequate aids and appliances was higher in those with multidisciplinary ALS care (93.1 vs 81.3%, p = 0.008), whereas the number of visits to professional caregivers was similar in both groups. Patients in the multidisciplinary ALS care group had a better mental QoL on the SF-36 Mental Summary Score than those in the general care group (p = 0.01). The difference in QoL was most pronounced in the domains of Social Functioning and Mental Health, and was independent of the presence of aids and appliances. No significant differences were found in the SF-36 Physical Summary Score, VAS, or in QoL of caregivers of patients with ALS. High standard of care improves mental quality-of-life in patients with ALS.

Development of Novel Data Processing Schemes and Global Seismic Event Database and Special Studies to Support the Explosions Monitoring Research Program

DTIC Science & Technology

2012-06-28

Centrales a Través de Residuos y Atenuación de Ondas Sísmicas,” Tesis de Grado, UMSA, Facultad de Ciencias Puras y Naturales, Departamento de ...velocity model we plan to develop in the future will be more revealing about near-source anisotropy. In addition, any picking errors are...shows the spectrum for an earthquake located at a distance of 216 km from the LPAZ MINE PROVINCIA Reference Viloco Loayza A 70 Km al SE de la

Childhood extravasation injuries: improved outcome following the introduction of hospital-wide guidelines.

PubMed

Ghanem, Ali M; Mansour, Abdulrab; Exton, Rebecca; Powell, Jonathan; Mashhadi, Syed; Bulstrode, Neil; Smith, Gillian

2015-04-01

Extravasation is an iatrogenic injury that may produce soft tissue necrosis requiring surgical reconstruction (Rose et al., 2008) and (Goon et al., 2006). Previous review of extravasation injuries within our hospital showed that early referral to plastic surgeons and washout of high-risk cases lead to favourable outcome in 86% of patients (Gault, 1993). Hospital-wide guidelines were introduced in 2005. This paper closes the audit loop by evaluating extravasation injuries outcome following the introduction of these guidelines. All patients referred to the plastic surgery department for extravasation injuries between October 2008 and October 2009 were reviewed. A favourable outcome was defined as resolution without tissue loss requiring surgical reconstruction. Patients were excluded if they sustained the extravasation in other institution. A total of 82 extravasation injuries in 78 patients were reviewed during the audit period. Mean age was 3.2 years (Median 0.2 years, Minimum 0 day, and maximum 16.7 years). The injuries were more frequent on the left half of the body (52%) and involving the upper limbs (59%). Mean time to referral was 8 h, with 60% of patients referred within 6 h of the injury, 30% in 6-12 h, and 10% referred after more than 12 h 26% of the injuries required washout treatment - the rest was treated conservatively. Tissue necrosis occurred in 3 cases (4%) but required no surgical intervention due to the small area affected. Our audit showed an improved outcome of extravasation injury following introduction of hospital-wide guidelines of early referral to specialist team and washout of high-risk cases. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

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.

AlGaN-based ultraviolet light-emitting diodes on sputter-deposited AlN templates with epitaxial AlN/AlGaN superlattices

NASA Astrophysics Data System (ADS)

Zhao, Lu; Zhang, Shuo; Zhang, Yun; Yan, Jianchang; Zhang, Lian; Ai, Yujie; Guo, Yanan; Ni, Ruxue; Wang, Junxi; Li, Jinmin

2018-01-01

We demonstrate AlGaN-based ultraviolet light-emitting diodes (UV-LEDs) grown by metalorganic chemical vapor deposition (MOCVD) on sputter-deposited AlN templates upon sapphire substrates. An AlN/AlGaN superlattices structure is inserted as a dislocation filter between the LED structure and the AlN template. The full width at half maximum values for (0002) and (10 1 bar 2) X-ray rocking curves of the n-type Al0.56Ga0.44N layer are 513 and 1205 arcsec, respectively, with the surface roughness of 0.52 nm. The electron concentration and mobility measured by Hall measurement are 9.3 × 1017cm-3 and 54 cm2/V·s at room temperature, respectively. The light output power of a 282-nm LED reaches 0.28 mW at 20 mA with an external quantum efficiency of 0.32%. And the values of leakage current and forward voltage of the LEDs are ∼3 nA at -10 V and 6.9 V at 20 mA, respectively, showing good electrical performance. It is expected that the cost of the UV-LED can be reduced by using sputter-deposited AlN template.

Determining the level and cost of sickness presenteeism among hospital staff in Turkey.

PubMed

Aysun, Kandemir; Bayram, Şahin

2017-12-01

This study aimed to determine the associations between sickness presenteeism and socio-demographic factors, perceived health status and health complaints among hospital staff and to calculate the cost burdens and productivity losses attributed to presenteeism. A cross-sectional study was conducted using 951 hospital staff, including physicians, nurses, midwives, other health personnel and administrative staff working in two hospitals located in Kırıkkale province in Turkey. The health and work performance questionnaire developed by Kessler et al. was revised to measure sickness presenteeism. After performing Student's t test and a one-way analysis of variance, presenteeism was mostly observed in women, nurse-midwives, young employees, university health staff and health workers with low health status. Average productivity loss and cost of lost productivity per staff member were calculated as 19.92 h/TRY 315.57 for 2 weeks and 478.08 h/TRY 7573.68 for 1 year. The problem of sickness presenteeism is mostly observed in women and nurses. It causes both financial burdens and productivity losses for hospitals. These survey results are thus expected to provide critically important information on presenteeism for decision-makers and healthcare managers.

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.

Cyclic oxidation resistance of a reaction milled NiAl-AlN composite

NASA Technical Reports Server (NTRS)

Lowell, Carl E.; Barrett, Charles A.; Whittenberger, J. D.

1990-01-01

Based upon recent mechanical property tests a NiAl-AlN composite produced by cryomilling has very attractive high temperature strength. This paper focuses on the oxidation resistance of the NiAl-AlN composite at 1473 and 1573 K as compared to that of Ni-47Al-0.15Zr, one of the most oxidation resistant intermetallics. The results of cyclic oxidation tests show that the NiAl-AlN composite has excellent properties although not quite as good as those of Ni-47Al-0.15Zr. The onset of failure of the NiAl-AlN was unique in that it was not accompanied by a change in scale composition from alumina to less protective oxides. Failure in the composite appears to be related to the entrapment of AlN particles within the alumina scale.

ALS-Plus Syndrome: Non-Pyramidal Features in a Large ALS Cohort

PubMed Central

McCluskey, Leo; Vandriel, Shannon; Elman, Lauren; Van Deerlin, Vivianna M.; Powers, John; Boller, Ashley; Wood, Elisabeth McCarty; Woo, John; McMillan, Corey T.; Rascovsky, Katya; Grossman, Murray

2014-01-01

Objective Autopsy studies show widespread pathology in amyotrophic lateral sclerosis (ALS), but clinical surveys of multisystem disease in ALS are rare. We investigated ALS-Plus syndrome, an understudied group of patients with clinical features extending beyond pyramidal and neuromuscular systems with or without cognitive/behavioral deficits. Methods In a large, consecutively-ascertained cohort of 550 patients with ALS, we documented atypical clinical manifestations. Genetic screening for C9orf72 hexanucleotide expansions was performed in 343 patients, and SOD1, TARDBP, and VCP were tested in the subgroup of patients with a family history of ALS. Gray matter and white matter imaging was available in a subgroup of 30 patients. Results Seventy-five (13.6%) patients were identified with ALS-Plus syndrome. We found disorders of ocular motility, cerebellar, extrapyramidal and autonomic functioning. Relative to those without ALS-Plus, cognitive impairment (8.0% vs 2.9%, p=0.029), bulbar-onset (49.3% vs 23.2%, p<0.001), and pathogenic mutations (20.0% vs 8.4%, p=0.015) were more than twice as common in ALS-Plus. Survival was significantly shorter in ALS-Plus (29.66 months vs 42.50 months, p=0.02), regardless of bulbar-onset or mutation status. Imaging revealed significantly greater cerebellar and cerebral disease in ALS-Plus compared to those without ALS-Plus. Conclusions ALS-Plus syndrome is not uncommon, and the presence of these atypical features is consistent with neuropathological observations that ALS is a multisystem disorder. ALS-Plus syndrome is associated with increased risk for poor survival and the presence of a pathogenic mutation. PMID:25086858

Patients' perceptions of interactions with hospital staff are associated with hospital readmissions: a national survey of 4535 hospitals.

PubMed

Yang, Lianping; Liu, Chaojie; Huang, Cunrui; Mukamel, Dana B

2018-01-29

Reducing 30-day hospital readmissions has become a focus of the current national payment policies. Medicare requires that hospitals collect and report patients' experience with their care as a condition of payment. However, the extent to which patients' experience with hospital care is related to hospital readmission is unknown. We established multivariate regression models in which 30-day risk-adjusted readmission rates were the dependent variables and patients' perceptions of the responsiveness of the hospital staff and communication (as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores) were the independent variables of interest. We selected six different clinical conditions for analyses, including acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure, hip/knee surgery, pneumonia, and stroke. Data included all acute care hospitals reporting in Hospital Compare in 2014. The number of hospitals with reported readmissions ranged from 2234 hospitals for AMI to 3758 hospitals for pneumonia. The average 30-day readmission rates ranged from 5.19% for knee/hip surgery to 22.7% for COPD. Patient experience of hospital-staff responsiveness as "top-box" ranged from 64% to 67% across the six clinical conditions, communication with nurses ranged from 77% to 79% and communication with doctors ranged from 80% to 81% (higher numbers are better). Our finding suggests that hospitals with better staff responsiveness were significantly more likely to have lower 30-day readmissions for all conditions. The effect size depended on the baseline readmission rates, with the largest effect on hospitals in the upper 75th quartile. A ten-percentage-point increase in staff responsiveness led to a 0.03-0.18 percentage point decrease in readmission rates. We found that neither communication with physicians nor communication with nurses was significantly associated with hospital readmissions. Our findings

Hospital successes and failures indicate change in hospital marketing.

PubMed

Krampf, R F; Miller, D W

1993-01-01

Marketing has become an essential management function for hospitals during the past decade. A number of changes have occurred in hospital marketing as they have progressed through the marketing adoption process. A survey of Hospital CEOs reporting hospital successes and failures in the area of marketing have recently placed emphasis on sales and advertising based upon marketing research programs thus indicating entrance into the "Integrated Tactical Marketing" phase. This study also indicates that a few hospitals have entered the "Strategic Marketing Orientation" phase while future plans reported by the CEOs provide evidence that this trend is likely to continue.

Managing hospitals in turbulent times: do organizational changes improve hospital survival?

PubMed Central

Lee, S Y; Alexander, J A

1999-01-01

OBJECTIVE: To examine (1) the degree to which organizational changes affected hospital survival; (2) whether core and peripheral organizational changes affected hospital survival differently; and (3) how simultaneous organizational changes affected hospital survival. DATA SOURCES: AHA Hospital Surveys, the Area Resource File, and the AHA Hospital Guides, Part B: Multihospital Systems. STUDY DESIGN: The study employed a longitudinal panel design. We followed changes in all community hospitals in the continental United States from 1981 through 1994. The dependent variable, hospital closure, was examined as a function of multiple changes in a hospital's core and peripheral structures as well as the hospital's organizational and environmental characteristics. Cox regression models were used to test the expectations that core changes increased closure risk while peripheral changes decreased such risk, and that simultaneous core and peripheral changes would lead to higher risk of closure. PRINCIPAL FINDINGS: Results indicated more peripheral than core changes in community hospitals. Overall, findings contradicted our expectations. Change in specialty, a core change, was beneficial for hospitals, because it reduced closure risk. The two most frequent peripheral changes, downsizing and leadership change, were positively associated with closure. Simultaneous organizational changes displayed a similar pattern: multiple core changes reduced closure risk, while multiple peripheral changes increased the risk. These patterns held regardless of the level of uncertainty in hospital environments. CONCLUSIONS: Organizational changes are not all beneficial for hospitals, suggesting that hospital leaders should be both cautious and selective in their efforts to turn their hospitals around. PMID:10536977

Developing IT Infrastructure for Rural Hospitals: A Case Study of Benefits and Challenges of Hospital-to-Hospital Partnerships.

PubMed

Reddy, Madhu C; Purao, Sandeep; Kelly, Mary

2008-01-01

This article presents a study identifying benefits and challenges of a novel hospital-to-hospital information technology (IT) outsourcing partnership (HHP). The partnership is an innovative response to the problem that many smaller, rural hospitals face: to modernize their IT infrastructure in spite of a severe shortage of resources. The investigators studied three rural hospitals that outsourced their IT infrastructure, through an HHP, to a larger, more technologically advanced hospital in the region. The study design was based on purposive sampling and interviews of senior managers from the four hospitals. The results highlight the HHP's benefits and challenges from both the rural hospitals' and vendor hospital's perspectives. The HHP was considered a success: a key outcome was that it has improved the rural hospitals' IT infrastructure at an affordable cost. The investigators discuss key elements for creating a successful HHP and offer preliminary answers to the question of what it takes for an HHP to be successful.

Developing IT Infrastructure for Rural Hospitals: A Case Study of Benefits and Challenges of Hospital-to-Hospital Partnerships

PubMed Central

Reddy, Madhu C.; Purao, Sandeep; Kelly, Mary

2008-01-01

This article presents a study identifying benefits and challenges of a novel hospital-to-hospital information technology (IT) outsourcing partnership (HHP). The partnership is an innovative response to the problem that many smaller, rural hospitals face: to modernize their IT infrastructure in spite of a severe shortage of resources. The investigators studied three rural hospitals that outsourced their IT infrastructure, through an HHP, to a larger, more technologically advanced hospital in the region. The study design was based on purposive sampling and interviews of senior managers from the four hospitals. The results highlight the HHP's benefits and challenges from both the rural hospitals' and vendor hospital's perspectives. The HHP was considered a success: a key outcome was that it has improved the rural hospitals' IT infrastructure at an affordable cost. The investigators discuss key elements for creating a successful HHP and offer preliminary answers to the question of what it takes for an HHP to be successful. PMID:18436901

Valence subband coupling effect on polarization of spontaneous emissions from Al-rich AlGaN/AlN quantum wells.

PubMed

Lu, Huimin; Yu, Tongjun; Yuan, Gangcheng; Jia, Chuanyu; Chen, Genxiang; Zhang, Guoyi

2012-12-03

The optical polarization properties of Al-rich AlGaN/AlN quantum wells (QWs) were investigated using the theoretical model based on the k·p method. Numerical results show that there is valence subband coupling which can influence the peak emission wavelength and emission intensity for TE and TM polarization components from Al-rich AlGaN/AlN QWs. Especially the valence subband coupling could be strong enough when CH1 is close to HH1 and LH1 subbands to modulate the critical Al content switching dominant emissions from TE to TM polarization. It is believed that the valence subband coupling may give important influence on polarization properties of spontaneous emissions and should be considered in designing high efficiency AlGaN-based ultraviolet (UV) LEDs.

Modulating optical polarization properties of Al-rich AlGaN/AlN quantum well by controlling wavefunction overlap

NASA Astrophysics Data System (ADS)

Chen, X. J.; Yu, T. J.; Lu, H. M.; Yuan, G. C.; Shen, B.; Zhang, G. Y.

2013-10-01

Using modified k.p perturbation method, the optical polarization properties of Al-rich AlGaN/AlN quantum wells (QWs) are studied. It is found that change of wavefunction overlaps between conduction band and valance subbands of heavy hole, light hole, and crystal-field split off hole is different. Such difference leads to the overturn of polarization degree and modulates optical polarization properties as well width and strain vary. This prompts that changing wavefunction overlaps of electron and hole can lead to a way to modulate optical polarization properties of Al-rich AlGaN/AlN QWs, on no condition that valence band order changes.

Effect of AlB2 on the P-threshold in Al-Si alloy

NASA Astrophysics Data System (ADS)

Wu, Yuying; Liu, Xiangfa

2018-06-01

The nucleation of primary Si in Al-Si alloys has been investigated in this work. It was found that there was a threshold concentration of P, below which AlP can not heterogeneous nucleate primary Si in Al-12 wt%Si alloy. AlB2 can not nucleate primary Si directly, but the presence of AlB2 may assist the nucleation of AlP leading to the nucleation of primary Si particles. In addition, with addition of AlB2, the nucleation efficiency of AlP can be improved in Al-18 wt%Si alloy. The orientation relationship between AlB2 and AlP has been calculated, and the adsorption model for AlB2 and AlP was proposed in this work.

Measuring hospital input price increases: The rebased hospital market basket

PubMed Central

Freeland, Mark S.; Chulis, George S.; Brown, Aaron P.; Skellan, David; Maple, Brenda T.; Singer, Naphtale; Lemieux, Jeffrey; Arnett, Ross H.

1991-01-01

The input prices indexes used in part to set payment rates for Medicare inpatient hospital services in both prospective payment system (PPS) and PPS-excluded hospitals were rebased from 1982 to 1987 beginning with payments for fiscal year 1991. In this article, the issues and evidence used to determine the composition of the revised hospital input price indexes are discussed. One issue is the need for a separate market basket for PPS-excluded hospitals. Also, the payment implications of using hospital-industry versus economywide measures of wage rates as price proxies for the growth in hospital wage rates are addressed. PMID:10113610

High temperature deformation of NiAl and CoAl

NASA Technical Reports Server (NTRS)

Nix, W. D.

1982-01-01

The high temperature mechanical properties of the aluminides are reviewed with respect to their potential as high temperature structural materials. It is shown that NiAl and CoAl are substantially stronger than the pure metals Ni and Co at high temperatures and approach the strength of some superalloys, particularly when those superalloys are tested in "weak" directions. The factors that limit and control the high temperature strengths of NiAl and CoAl are examined to provide a basis for the development of intermetallic alloys of this type.

Neoliberalist influences on nursing hospital work process and organization.

PubMed

Souza, Norma Valéria Dantas de Oliveira; Gonçalves, Francisco Gleidson de Azevedo; Pires, Ariane da Silva; David, Helena Maria Scherlowski Leal

2017-01-01

To describe and analyze the influence of the neoliberal economic and political model on the nursing hospital work process and organization. Qualitative descriptive research, having as its scenery a university hospital. The subjects were 34 nursing workers. The data collection took place from March to July 2013, through semi-structured interview. The data treatment technique used was content analysis, which brought up the following category: working conditions precariousness and its consequences to the hospital work process and organization in the neoliberal context. The consequences of neoliberalism on hospital work process and organization were highlighted, being observed physical structure, human resources and material inadequacies that harms the assistance quality. In addition to wage decrease that cause the need of second jobs and work overload. There is a significant influence of the neoliberal model on hospital work, resulting on working conditions precariousness. Descrever e analisar a influência do modelo econômico e político neoliberal na organização e no processo de trabalho hospitalar de enfermagem. Pesquisa qualitativa e descritiva, tendo como cenário um hospital universitário. Os participantes foram 34 trabalhadores de enfermagem. A coleta ocorreu de março a julho de 2013, por meio de entrevista semiestruturada. A técnica de tratamento dos dados foi a análise de conteúdo, que fez emergir a seguinte categoria: precarização das condições laborais e suas repercussões para organização e processo de trabalho hospitalar no contexto neoliberal. Evidenciaram-se repercussões do neoliberalismo na organização e no processo de trabalho hospitalar, verificando-se inadequações na estrutura física, nos recursos humanos e materiais, que afetavam a qualidade da assistência. Além de perdas salariais que levam à necessidade de outros empregos e sobrecarga de trabalho. Há forte influência do modelo neoliberal no trabalho hospitalar, resultando

Hospital at home versus in-patient hospital care.

PubMed

Shepperd, S; Iliffe, S

2005-07-20

Hospital at home is defined as a service that provides active treatment by health care professionals, in the patient's home, of a condition that otherwise would require acute hospital in-patient care, always for a limited period. To assess the effects of hospital at home compared with in-patient hospital care. We searched the Cochrane Effective Practice and Organisation of Care Group (EPOC) specialised register (November 2004), MEDLINE (1966 to 1996), EMBASE (1980 to 1995), Social Science Citation Index (1992 to 1995), Cinahl (1982 to 1996), EconLit (1969 to 1996), PsycLit (1987 to 1996), Sigle (1980 to 1995) and the Medical Care supplement on economic literature (1970 to 1990). Randomised trials of hospital at home care compared with acute hospital in-patient care. The participants were patients aged 18 years and over. Two reviewers independently extracted data and assessed study quality. Twenty two trials are included in this update of the review. Among trials evaluating early discharge hospital at home schemes we found an odds ratio (OR) for mortality of 1.79 95% CI 0.85 to 3.76 for elderly medical patients (age 65 years and over) (n = 3 trials); OR 0.58; 95% CI 0.29 to 1.17 for patients with chronic obstructive pulmonary disease (COPD) (n = 5 trials); and OR 0.78; 95%CI 0.52 to 1.19 for patients recovering from a stroke (n = 4 trials). Two trials evaluating the early discharge of patients recovering from surgery reported an OR 0.43 (95% CI 0.02 to 10.89) for patients recovering from a hip replacement and an OR 1.01 (95% CI 0.37 to 2.81) for patients with a mix of conditions at three months follow-up. For readmission to hospital we found an OR 1.76; 95% CI 0.78 to 3.99 at 3 months follow-up for elderly medical patients (n = 2 trials); OR 0.81; 95% CI 0.55 to 1.19 for patients with COPD (n = 5 trials); and OR 0.96; 95% CI 0.63 to 1.45 for patients recovering from a stroke (n = 3 trials). No significant heterogeneity was observed. One trial recruiting patients

Atomistic Modeling of RuAl and (RuNi) Al Alloys

NASA Technical Reports Server (NTRS)

Gargano, Pablo; Mosca, Hugo; Bozzolo, Guillermo; Noebe, Ronald D.; Gray, Hugh R. (Technical Monitor)

2002-01-01

Atomistic modeling of RuAl and RuAlNi alloys, using the BFS (Bozzolo-Ferrante-Smith) method for alloys is performed. The lattice parameter and energy of formation of B2 RuAl as a function of stoichiometry and the lattice parameter of (Ru(sub 50-x)Ni(sub x)Al(sub 50)) alloys as a function of Ni concentration are computed. BFS based Monte Carlo simulations indicate that compositions close to Ru25Ni25Al50 are single phase with no obvious evidence of a miscibility gap and separation of the individual B2 phases.

A low body temperature on arrival at hospital following out-of-hospital-cardiac-arrest is associated with increased mortality in the TTM-study.

PubMed

Hovdenes, Jan; Røysland, Kjetil; Nielsen, Niklas; Kjaergaard, Jesper; Wanscher, Michael; Hassager, Christian; Wetterslev, Jørn; Cronberg, Tobias; Erlinge, David; Friberg, Hans; Gasche, Yvan; Horn, Janneke; Kuiper, Michael; Pellis, Tommaso; Stammet, Pascal; Wise, Matthew P; Åneman, Anders; Bugge, Jan Frederik

2016-10-01

To investigate the association of temperature on arrival to hospital after out-of-hospital-cardiac arrest (OHCA) with the primary outcome of mortality, in the targeted temperature management (TTM) trial. The TTM trial randomized 939 patients to TTM at 33 or 36°C for 24h. Patients were categorized according to their recorded body temperature on arrival and also categorized to groups of patients being actively cooled or passively rewarmed. OHCA patients having a temperature ≤34.0°C on arrival at hospital had a significantly higher mortality compared to the OHCA patients with a higher temperature on arrival. A low body temperature on arrival was associated with a longer time to return of spontaneous circulation (ROSC) and duration of transport time to hospital. Patients who were actively cooled or passively rewarmed during the first 4h had similar mortality. In a multivariate logistic regression model mortality was significantly related to time from OHCA to ROSC, time from OHCA to advanced life support (ALS), age, sex and first registered rhythm. None of the temperature related variables (included the TTM-groups) were significantly related to mortality. OHCA patients with a temperature ≤34.0°C on arrival have a higher mortality than patients with a temperature ≥34.1°C on arrival. A low temperature on arrival is associated with a long time to ROSC. Temperature changes and TTM-groups were not associated with mortality in a regression model. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Agreement between coding schemas used to identify bleeding-related hospitalizations in claims analyses of nonvalvular atrial fibrillation patients.

PubMed

Coleman, Craig I; Vaitsiakhovich, Tatsiana; Nguyen, Elaine; Weeda, Erin R; Sood, Nitesh A; Bunz, Thomas J; Schaefer, Bernhard; Meinecke, Anna-Katharina; Eriksson, Daniel

2018-01-01

Schemas to identify bleeding-related hospitalizations in claims data differ in billing codes used and coding positions allowed. We assessed agreement across bleeding-related hospitalization coding schemas for claims analyses of nonvalvular atrial fibrillation (NVAF) patients on oral anticoagulation (OAC). We hypothesized that prior coding schemas used to identify bleeding-related hospitalizations in claim database studies would provide varying levels of agreement in incidence rates. Within MarketScan data, we identified adults, newly started on OAC for NVAF from January 2012 to June 2015. Billing code schemas developed by Cunningham et al., the US Food and Drug Administration (FDA) Mini-Sentinel program, and Yao et al. were used to identify bleeding-related hospitalizations as a surrogate for major bleeding. Bleeds were subcategorized as intracranial hemorrhage (ICH), gastrointestinal (GI), or other. Schema agreement was assessed by comparing incidence, rates of events/100 person-years (PYs), and Cohen's kappa statistic. We identified 151 738 new-users of OAC with NVAF (CHA2DS2-VASc score = 3, [interquartile range = 2-4] and median HAS-BLED score = 3 [interquartile range = 2-3]). The Cunningham, FDA Mini-Sentinel, and Yao schemas identified any bleeding-related hospitalizations in 1.87% (95% confidence interval [CI]: 1.81-1.94), 2.65% (95% CI: 2.57-2.74), and 4.66% (95% CI: 4.55-4.76) of patients (corresponding rates = 3.45, 4.90, and 8.65 events/100 PYs). Kappa agreement across schemas was weak-to-moderate (κ = 0.47-0.66) for any bleeding hospitalization. Near-perfect agreement (κ = 0.99) was observed with the FDA Mini-Sentinel and Yao schemas for ICH-related hospitalizations, but agreement was weak when comparing Cunningham to FDA Mini-Sentinel or Yao (κ = 0.52-0.53). FDA Mini-Sentinel and Yao agreement was moderate (κ = 0.62) for GI bleeding, but agreement was weak when comparing Cunningham to FDA Mini-Sentinel or Yao (κ�

Hospitals look to hospitality service firms to meet TQM goals.

PubMed

Hard, R

1992-05-20

Hospitals that hire contract service firms to manage one or all aspects of their hospitality service departments increasingly expect those firms to help meet total quality management goals as well as offer the more traditional cost reduction, quality improvement and specialized expertise, finds the 1992 Hospital Contract Services Survey conducted by Hospitals.

Al6H18: A baby crystal of γ-AlH3

NASA Astrophysics Data System (ADS)

Kiran, B.; Kandalam, Anil K.; Xu, Jing; Ding, Y. H.; Sierka, M.; Bowen, K. H.; Schnöckel, H.

2012-10-01

Using global-minima search methods based on the density functional theory calculations of (AlH3)n (n = 1-8) clusters, we show that the growth pattern of alanes for n ≥ 4 is dominated by structures containing hexa-coordinated Al atoms. This is in contrast to the earlier studies where either linear or ring structures of AlH3 were predicted to be the preferred structures in which the Al atoms can have a maximum of five-fold coordination. Our calculations also reveal that the Al6H18 cluster, with its hexa-coordination of the Al atoms, resembles the unit-cell of γ-AlH3, thus Al6H18 is designated as the "baby crystal." The fragmentation energies of the (AlH3)n (n = 2-8) along with the dimerization energies for even n clusters indicate an enhanced stability of the Al6H18 cluster. Both covalent (hybridization) and ionic (charge) contribution to the bonding are the driving factors in stabilizing the isomers containing hexa-coordinated Al atoms.

Hospitals Known for Nursing Excellence Associated with Better Hospital Experience for Patients.

PubMed

Stimpfel, Amy Witkoski; Sloane, Douglas M; McHugh, Matthew D; Aiken, Linda H

2016-06-01

To examine the relationship between Magnet recognition, an indicator of nursing excellence, and patients' experience with their hospitalization reported in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This secondary analysis includes cross-sectional data from the 2010 HCAHPS survey, the American Hospital Association, and the American Nurses Credentialing Center. We conducted a retrospective observational study. Using common hospital identifiers, we created a matched set of 212 Magnet hospitals and 212 non-Magnet hospitals. Patients in Magnet hospitals gave their hospitals higher overall ratings, were more likely to recommend their hospital, and reported more positive care experiences with nurse communication. Magnet recognition is associated with better patient care experiences, which may positively enhance reimbursement for hospitals. © Health Research and Educational Trust.

Do HMO penetration and hospital competition impact quality of hospital care?

PubMed

Rivers, P A; Fottler, M D

2004-11-01

This study examines the impact of HMO penetration and competition on hospital markets. A modified structure-conduct-performance paradigm was applied to the health care industry in order to investigate the impact of HMO penetration and competition on risk-adjusted hospital mortality rates (i.e. quality of hospital care). Secondary data for 1957 acute care hospitals in the USA from the 1991 American Hospital Association's Annual Survey of Hospitals were used. The outcome variables were risk-adjusted mortality rates in 1991. Predictor variables were market characteristics (i.e. managed care penetration and hospital competition). Control variables were environmental, patient, and institutional characteristics. Associations between predictor and outcome variables were investigated using statistical regression techniques. Hospital competition had a negative relationship with risk-adjusted mortality rates (a negative indicator of quality of care). HMO penetration, hospital competition, and an interaction effect of HMO penetration and competition were not found to have significant effects on risk-adjusted mortality rates. These findings suggest that when faced with intense competition, hospitals may respond in ways associated with reducing their mortality rates.

[Re-organization of internal medicine wing in hospitals: a last-ditch effort or the beginning of reform?].

PubMed

Sharabi, Yehonatan

2014-01-01

Over the last decade numerous publications have dealt with ongoing changes in the traditional practice of internal medicine. In general, in-hospital medicine has evolved into ambulatory or specialized care. In this volume of Harefuah, Yinon et al. discuss trends at Shaare-Zedek Medical Center, focusing on the challenge of attracting residents to general internal medicine. Their model addresses local problems, but they have laid the groundwork for a more radical change. They present an evolutionary process that would transform hospital practice to become both more patient-centered and integrative, with an interdisciplinary team that translates the strengths of in-hospital (in- and out-patient care) vs. ambulatory or over-specialized care. Such reform should also include changes in clinical medical education, coupled with research and academic activities that can only take place in hospitals. The health care system is waiting for the next academic medical center that will take the lead in accepting this challenge and spearhead much needed reform.

Hospital and Community Characteristics Associated With Pediatric Direct Admission to Hospital.

PubMed

Leyenaar, JoAnna K; Shieh, Meng-Shiou; Lagu, Tara; Pekow, Penelope S; Lindenauer, Peter K

2017-10-27

One quarter of pediatric hospitalizations begin as direct admissions, defined as hospitalization without receiving care in the hospital's emergency department (ED). Direct admission rates are highly variable across hospitals, yet previous studies have not examined reasons for this variation. We aimed to determine the relationships between hospital and community factors and pediatric direct admission rates, and to evaluate the degree to which these characteristics explain variation in risk-adjusted direct admission rates. We conducted a cross-sectional study of the Healthcare Cost and Utilization Project's Kids Inpatient Database, American Hospital Association Database, and Area Health Resource File, including children <18 years of age who were admitted for a medical hospitalization in states contributing data to all data sets. Using hierarchical generalized linear modeling, we generated risk-adjusted direct admission rates and used generalized linear models to assess the association of hospital and community characteristics with these risk-adjusted rates. We included 211,458 children discharged from 933 hospitals and 26 states; 20.2% were admitted directly. One-fifth of the variance in risk-adjusted direct admission rates was attributed to observed hospital and community factors. The greatest proportion of this explained variance was related to ED volume (37%), volume of pediatric hospitalizations (27%), and size of the pediatrician workforce (12%). Direct admission rates were associated with several hospital and community characteristics, but the majority of variation in hospitals' direct admission rates was not explained by these factors. These findings suggest opportunities for diverse hospital types to develop the infrastructure and communication systems necessary to support pediatric direct admissions. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Hospital prices and market structure in the hospital and insurance industries.

PubMed

Moriya, Asako S; Vogt, William B; Gaynor, Martin

2010-10-01

There has been substantial consolidation among health insurers and hospitals, recently, raising questions about the effects of this consolidation on the exercise of market power. We analyze the relationship between insurer and hospital market concentration and the prices of hospital services. We use a national US dataset containing transaction prices for health care services for over 11 million privately insured Americans. Using three years of panel data, we estimate how insurer and hospital market concentration are related to hospital prices, while controlling for unobserved market effects. We find that increases in insurance market concentration are significantly associated with decreases in hospital prices, whereas increases in hospital concentration are non-significantly associated with increases in prices. A hypothetical merger between two of five equally sized insurers is estimated to decrease hospital prices by 6.7%.

Frequency and antimicrobial susceptibility of gram-negative bacteria isolated from 2 hospitals in Makkah, Saudi Arabia.

PubMed

Asghar, Atif H; Faidah, Hani S

2009-08-01

To estimate the prevalence and antibiotic susceptibility of the gram-negative bacteria isolated from 2 hospitals in Makkah. This study was undertaken in 2 main tertiary care hospitals namely; Al-Noor Specialist Hospital, and Hera Hospital in Makkah, Kingdom of Saudi Arabia from October 2005 to March 2006. A total of 1137 gram-negative bacteria were identified in non-duplicate clinical specimens obtained from 965 patients of various body sites infections. Demographic data, identity of microorganisms, and antimicrobial susceptibilities were obtained from medical and laboratory records. The most prevalent gram-negative bacteria were Escherichia coli (31.6%), and Pseudomonas aeruginosa (31.2%), followed by Acinetobacter baumannii (10.8%), Klebsiella pneumoniae (8.3%), Klebsiella sp. (6.2%), Haemophilus influenzae (3.7%), Proteus sp. (3.3%), and Enterobacter sp. (1.9%). Results demonstrated that gram-negative bacteria have a high rate of resistance to commonly used antibiotics. Furthermore, multi-drug resistance was also common in this study. Our data showed a high rate of resistance among gram-negative pathogens in comparison with other countries in the world. The implementation of monitoring programs is an important part of the prevention strategy against the development of antibiotic resistance in hospitals.

[Hospitalization period and nutritional status in hospitalized patients].

PubMed

Merhi, V A Leandro; de Oliveira, Ma R Marques; Caran, A L; Tristão, T Menuzzo Graupner; Ambo, R Miante; Tanner, M A; Vergna, C Marton

2007-01-01

With the objective of studying the nutritional status and its relationship with hospitalization period, a cross-sectional study was done with patients from a private hospital representing a population with a better socioeconomic condition. The anthropometric data of 267 patients, 46% males and 54% females ranging from 20 to 80 years of age, were assessed on the second day of hospitalization. Hospitalization period associated with nutritional status. The data were analyzed by the software Excel and Sigma Stat, using Fisher's exact test and the chi-square test. The studied population presented a body mass index of 25.9 +/- 5.3 and most patients lost weight during hospitalization. The longest hospitalization periods were found among patients with lung diseases (13 days), some being pre-obese (40%) with a small prevalence of undernutrition (4%). The percentage distribution of nutritional status among the groups according to diagnosis was different (P < 0.01) when assessed by the Fisher's exact test and the percentage distribution in weight variation between men and women was different (P < 0.02) when assessed by the chi-square test. When the population was segmented according to age, the percentage distribution of the nutritional status between > 60 and < or = 60 did not present a difference when assessed by the chi-square test. The results of this study show that the nutritional status in some diseases deserves special attention given the greater risk found in these situations, contributing to a longer hospitalization period.

Factors Influencing Fourth-Year Pharmacy Students' Decisions to Pursue a Hospital Pharmacy Residency.

PubMed

Dupuis, Sébastien; Martel, Alexis; Arfa, Taha; Valma, Joannah; Williamson, David R; Perreault, Marc M

2016-01-01

The Canadian Society of Hospital Pharmacists promotes the recruitment of residency-trained pharmacists for work in hospitals and related health care settings. However, Quebec hospitals are still hiring non-residency trained pharmacists, in part because of a severe shortage of hospital pharmacists. To date, no studies have examined the factors influencing the career choices of fourth-year pharmacy students in Canada. To identify motivating factors and barriers influencing students' decision to pursue a hospital pharmacy residency. All 186 fourth-year students in the Faculty of Pharmacy, Université de Montréal, were invited by e-mail to participate in a validated and institutionally approved survey that was available online between March and May 2014. Of the 138 respondents who returned a completed survey (74% response rate), 36 (26%) planned to apply for a hospital pharmacy residency. Those planning to apply for a residency were older (p = 0.037) and had more hospital work experience (36% versus 3%, p < 0.001) than those not planning to apply. The most important motivators for pursuing a residency were potential gains in knowledge (reported by 88% of respondents, whether or not they were planning to pursue a residency), experience (80%), and self-confidence (62%). The most frequently reported barriers were recognition that a hospital pharmacy residency is a highly demanding program (65%), having work available upon graduation from the undergraduate program (43%), and financial obligations (34%). Hospital experiential rotations influenced, either positively or negatively, 23 (72%) of the 32 students who changed their decision to pursue or not pursue residency training over the course of their studies. The potential gain in knowledge and experience acquired through residency, the fact that it is considered a highly demanding program, and having work available upon graduation from undergraduate studies were the most influential factors in fourth-year pharmacy

Factors Influencing Fourth-Year Pharmacy Students’ Decisions to Pursue a Hospital Pharmacy Residency

PubMed Central

Dupuis, Sébastien; Martel, Alexis; Arfa, Taha; Valma, Joannah; Williamson, David R; Perreault, Marc M

2016-01-01

Background: The Canadian Society of Hospital Pharmacists promotes the recruitment of residency-trained pharmacists for work in hospitals and related health care settings. However, Quebec hospitals are still hiring non–residency trained pharmacists, in part because of a severe shortage of hospital pharmacists. To date, no studies have examined the factors influencing the career choices of fourth-year pharmacy students in Canada. Objectives: To identify motivating factors and barriers influencing students’ decision to pursue a hospital pharmacy residency. Methods: All 186 fourth-year students in the Faculty of Pharmacy, Université de Montréal, were invited by e-mail to participate in a validated and institutionally approved survey that was available online between March and May 2014. Results: Of the 138 respondents who returned a completed survey (74% response rate), 36 (26%) planned to apply for a hospital pharmacy residency. Those planning to apply for a residency were older (p = 0.037) and had more hospital work experience (36% versus 3%, p < 0.001) than those not planning to apply. The most important motivators for pursuing a residency were potential gains in knowledge (reported by 88% of respondents, whether or not they were planning to pursue a residency), experience (80%), and self-confidence (62%). The most frequently reported barriers were recognition that a hospital pharmacy residency is a highly demanding program (65%), having work available upon graduation from the undergraduate program (43%), and financial obligations (34%). Hospital experiential rotations influenced, either positively or negatively, 23 (72%) of the 32 students who changed their decision to pursue or not pursue residency training over the course of their studies. Conclusions: The potential gain in knowledge and experience acquired through residency, the fact that it is considered a highly demanding program, and having work available upon graduation from undergraduate studies were

Approaches to Process Performance Modeling: A Summary from the SEI Series of Workshops on CMMI High Maturity Measurement and Analysis

DTIC Science & Technology

2010-01-01

Soporte de Modelos Sistémicos: Aplicación al Sector de Desarrollo de Software de Argentina,” Tesis de PhD, Universidad Tecnológica Nacional-Facultad...with New Results 31  2.3  Other Simulation Approaches 37  Conceptual Planning , Execution, and Operation of Combat Fire Support Effectiveness: A...Figure 29:  Functional Structure of Multiple Regression Model 80  Figure 30:  TSP Quality Plan One 85  Figure 31:  TSP Quality Plan Two 85  Figure

Hospital variation in time to defibrillation after in-hospital cardiac arrest.

PubMed

Chan, Paul S; Nichol, Graham; Krumholz, Harlan M; Spertus, John A; Nallamothu, Brahmajee K

2009-07-27

Delays to defibrillation are associated with worse survival after in-hospital cardiac arrest, but the degree to which hospitals vary in defibrillation response times and hospital predictors of delays remain unknown. Using hierarchical models, we evaluated hospital variation in rates of delayed defibrillation (>2 minutes) and its impact on survival among 7479 adult inpatients with cardiac arrests at 200 hospitals within the National Registry of Cardiopulmonary Resuscitation. Adjusted rates of delayed defibrillation varied substantially among hospitals (range, 2.4%-50.9%), with hospital-level effects accounting for a significant amount of the total variation in defibrillation delays after adjusting for patient factors. We found a 46% greater odds of patients with identical covariates getting delayed defibrillation at one randomly selected hospital compared with another. Among traditional hospital factors evaluated, however, only bed volume (reference category: <200 beds; 200-499 beds: odds ratio [OR], 0.62 [95% confidence interval {CI}, 0.48-0.80]; >or=500 beds: OR, 0.74 [95% CI, 0.53-1.04]) and arrest location (reference category: intensive care unit; telemetry unit: OR, 1.92 [95% CI, 1.65-2.22]; nonmonitored unit: OR, 1.90 [95% CI, 1.61-2.24]) were associated with differences in rates of delayed defibrillation. Wide variation also existed in adjusted hospital rates of survival to discharge (range, 5.3%-49.6%), with higher survival among hospitals in the top-performing quartile for defibrillation time (compared with the bottom quartile: OR for top quartile, 1.41 [95% CI, 1.11-1.77]). Rates of delayed defibrillation vary widely among hospitals but are largely unexplained by traditional hospital factors. Given its association with improved survival, future research is needed to better understand best practices in the delivery of defibrillation at top-performing hospitals.

The Impact of Hospital Pay-for-Performance on Hospital and Medicare Costs

PubMed Central

Kruse, Gregory B; Polsky, Daniel; Stuart, Elizabeth A; Werner, Rachel M

2012-01-01

Objective To evaluate the effects of Medicare's hospital pay-for-performance demonstration project on hospital revenues, costs, and margins and on Medicare costs. Data Sources/Study Setting All health care utilization for Medicare beneficiaries hospitalized for acute myocardial infarction (AMI; ICD-9-CM code 410.x1) in fiscal years 2002–2005 from Medicare claims, containing 420,211 admissions with AMI. Study Design We test for changes in hospital costs and revenues and Medicare payments among 260 hospitals participating in the Medicare hospital pay-for-performance demonstration project and a group of 780 propensity-score-matched comparison hospitals. Effects were estimated using a difference-in-difference model with hospital fixed effects, testing for changes in costs among pay-for-performance hospitals above and beyond changes in comparison hospitals. Principal Findings We found no significant effect of pay-for-performance on hospital financials (revenues, costs, and margins) or Medicare payments (index hospitalization and 1 year after admission) for AMI patients. Conclusions Pay-for-performance in the CMS hospital demonstration project had minimal impact on hospital financials and Medicare payments to providers. As P4P extends to all hospitals under the Affordable Care Act, these results provide some estimates of the impact of P4P and emphasize our need for a better understanding of the financial implications of P4P on providers and payers if we want to create sustainable and effective programs to improve health care value. PMID:23088391

The impact of hospital pay-for-performance on hospital and Medicare costs.

PubMed

Kruse, Gregory B; Polsky, Daniel; Stuart, Elizabeth A; Werner, Rachel M

2012-12-01

To evaluate the effects of Medicare's hospital pay-for-performance demonstration project on hospital revenues, costs, and margins and on Medicare costs. All health care utilization for Medicare beneficiaries hospitalized for acute myocardial infarction (AMI; ICD-9-CM code 410.x1) in fiscal years 2002-2005 from Medicare claims, containing 420,211 admissions with AMI. We test for changes in hospital costs and revenues and Medicare payments among 260 hospitals participating in the Medicare hospital pay-for-performance demonstration project and a group of 780 propensity-score-matched comparison hospitals. Effects were estimated using a difference-in-difference model with hospital fixed effects, testing for changes in costs among pay-for-performance hospitals above and beyond changes in comparison hospitals. We found no significant effect of pay-for-performance on hospital financials (revenues, costs, and margins) or Medicare payments (index hospitalization and 1 year after admission) for AMI patients. Pay-for-performance in the CMS hospital demonstration project had minimal impact on hospital financials and Medicare payments to providers. As P4P extends to all hospitals under the Affordable Care Act, these results provide some estimates of the impact of P4P and emphasize our need for a better understanding of the financial implications of P4P on providers and payers if we want to create sustainable and effective programs to improve health care value. © Health Research and Educational Trust.

27Al MQMAS of the δ-Al 13-Keggin

DOE PAGES

Pilgrim, C. D.; Callahan, J. R.; Colla, C. A.; ...

2017-01-20

Here, one-dimensional 27Al, 23Na Magic-Angle-Spinning (MAS) NMR and 27Al Multiple-Quantum Magic-Angle-Spinning NMR (MQMAS) measurements are reported for the δ-isomer of the Al 13 Keggin structure at high spinning speed and 14.1 T field. Values for the CQ and η parameters are on the same scale as those seen in other isomers of the Al 13 structure. Density functional theory (DFT) calculations are performed for comparison to the experimental fits using the B3PW91/6-31+G* and PBE0/6-31+G* levels of theory, with the Polarizable Continuum Model (PCM).

Hospital diversification strategy.

PubMed

Eastaugh, Steven R

2014-01-01

To determine the impact of health system restructuring on the levels of hospital diversification and operating ratio this article analyzed 94 teaching hospitals and 94 community hospitals during the period 2008-2013. The 47 teaching hospitals are matched with 47 other teaching hospitals experiencing the same financial market position in 2008, but with different levels of preference for risk and diversification in their strategic plan. Covariates in the analysis included levels of hospital competition and the degree of local government planning (for example, highly regulated in New York, in contrast to Texas). Moreover, 47 nonteaching community hospitals are matched with 47 other community hospitals in 2008, having varying manager preferences for service-line diversification and risk. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as jointly dependent. Institutional diversification is found to yield better financial position, and the better operating profits provide the firm the wherewithal to diversify. Some services are in a growth phase, like bariatric weight-loss surgery and sleep disorder clinics. Hospital managers' preferences for risk/return potential were considered. An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification, and divestiture, occasionally leading to closure or merger.

Pressure induced coordination change of Al in silicate melts from Al K edge XANES of high pressure NaAlSi2O6-NaAlSi3O8 glasses

NASA Astrophysics Data System (ADS)

Li, Dien; Secco, R. A.; Bancroft, G. M.; Fleet, M. E.

Aluminum K-edge XANES spectra of high pressure and high temperature (4.4 GPa and 1575°C) glasses along the NaAlSi2O6 (Jd)-NaAlSi3O8 (Ab) join are reported using synchrotron radiation, and shown to provide direct experimental evidence for the pressure-induced coordination change of Al. Five- and six-fold coordinated Al (5Al and 6Al), characterized by Al K-edge positions at 1567.8 and 1568.7 eV, respectively, first appear in glass of composition Jd60Ab40 and increase in proportion progressively with increasing Jd content. The end-member jadeite glass contains about 6% of each of 5Al and 6Al. The present direct measurements confirm literature suggestions for the important role of Al in controlling viscosity and diffusion in mantle melts.

Assessing behavioural changes in ALS: cross-validation of ALS-specific measures.

PubMed

Pinto-Grau, Marta; Costello, Emmet; O'Connor, Sarah; Elamin, Marwa; Burke, Tom; Heverin, Mark; Pender, Niall; Hardiman, Orla

2017-07-01

The Beaumont Behavioural Inventory (BBI) is a behavioural proxy report for the assessment of behavioural changes in ALS. This tool has been validated against the FrSBe, a non-ALS-specific behavioural assessment, and further comparison of the BBI against a disease-specific tool was considered. This study cross-validates the BBI against the ALS-FTD-Q. Sixty ALS patients, 8% also meeting criteria for FTD, were recruited. All patients were evaluated using the BBI and the ALS-FTD-Q, completed by a carer. Correlational analysis was performed to assess construct validity. Precision, sensitivity, specificity, and overall accuracy of the BBI when compared to the ALS-FTD-Q, were obtained. The mean score of the whole sample on the BBI was 11.45 ± 13.06. ALS-FTD patients scored significantly higher than non-demented ALS patients (31.6 ± 14.64, 9.62 ± 11.38; p < 0.0001). A significant large positive correlation between the BBI and the ALS-FTD-Q was observed (r = 0.807, p < 0.0001), and no significant correlations between the BBI and other clinical/demographic characteristics indicate good convergent and discriminant validity, respectively. 72% of overall concordance was observed. Precision, sensitivity, and specificity for the classification of severely impaired patients were adequate. However, lower concordance in the classification of mild behavioural changes was observed, with higher sensitivity using the BBI, most likely secondary to BBI items which endorsed behavioural aspects not measured by the ALS-FTD-Q. Good construct validity has been further confirmed when the BBI is compared to an ALS-specific tool. Furthermore, the BBI is a more comprehensive behavioural assessment for ALS, as it measures the whole behavioural spectrum in this condition.

Doping and compensation in Al-rich AlGaN grown on single crystal AlN and sapphire by MOCVD

NASA Astrophysics Data System (ADS)

Bryan, Isaac; Bryan, Zachary; Washiyama, Shun; Reddy, Pramod; Gaddy, Benjamin; Sarkar, Biplab; Breckenridge, M. Hayden; Guo, Qiang; Bobea, Milena; Tweedie, James; Mita, Seiji; Irving, Douglas; Collazo, Ramon; Sitar, Zlatko

2018-02-01

In order to understand the influence of dislocations on doping and compensation in Al-rich AlGaN, thin films were grown by metal organic chemical vapor deposition (MOCVD) on different templates on sapphire and low dislocation density single crystalline AlN. AlGaN grown on AlN exhibited the highest conductivity, carrier concentration, and mobility for any doping concentration due to low threading dislocation related compensation and reduced self-compensation. The onset of self-compensation, i.e., the "knee behavior" in conductivity, was found to depend only on the chemical potential of silicon, strongly indicating the cation vacancy complex with Si as the source of self-compensation. However, the magnitude of self-compensation was found to increase with an increase in dislocation density, and consequently, AlGaN grown on AlN substrates demonstrated higher conductivity over the entire doping range.

The Existence of a Designer Al=Al Double Bond in the LiAl2 H4- Cluster Formed by Electronic Transmutation.

PubMed

Lundell, Katie A; Zhang, Xinxing; Boldyrev, Alexander I; Bowen, Kit H

2017-12-22

The Al=Al double bond is elusive in chemistry. Herein we report the results obtained via combined photoelectron spectroscopy and ab initio studies of the LiAl 2 H 4 - cluster that confirm the formation of a conventional Al=Al double bond. Comprehensive searches for the most stable structures of the LiAl 2 H 4 - cluster have shown that the global minimum isomer I possesses a geometric structure which resembles that of Si 2 H 4 , demonstrating a successful example of the transmutation of Al atoms into Si atoms by electron donation. Theoretical simulations of the photoelectron spectrum discovered the coexistence of two isomers in the ion beam, including the one with the Al=Al double bond. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Hospital Web site 'tops' in Louisiana. Hospital PR, marketing group cites East Jefferson General Hospital.

PubMed

Rees, Tom

2002-01-01

East Jefferson General Hospital in Metairie, La., launched a new Web site in October 2001. Its user-friendly home page offers links to hospital services, medical staff, and employer information. Its jobline is a powerful tool for recruitment. The site was awarded the 2002 Pelican Award for Best Consumer Web site by the Louisiana Society for Hospital Public Relations & Marketing.

Hospital fundamentals.

PubMed

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

2014-07-01

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

Lou Gehrig's Disease (ALS)

MedlinePlus

... for Educators Search English Español Lou Gehrig's Disease (ALS) KidsHealth / For Kids / Lou Gehrig's Disease (ALS) What's ... with ALS in the 1930s. What Happens in ALS? ALS damages motor neurons in the brain and ...

Characterization of N-polar AlN in GaN/AlN/(Al,Ga)N heterostructures grown by metal-organic chemical vapor deposition

NASA Astrophysics Data System (ADS)

Li, Haoran; Mazumder, Baishakhi; Bonef, Bastien; Keller, Stacia; Wienecke, Steven; Speck, James S.; Denbaars, Steven P.; Mishra, Umesh K.

2017-11-01

In GaN/(Al,Ga)N high-electron-mobility transistors (HEMT), AlN interlayer between GaN channel and AlGaN barrier suppresses alloy scattering and significantly improves the electron mobility of the two-dimensional electron gas. While high concentrations of gallium were previously observed in Al-polar AlN interlayers grown by metal-organic chemical vapor deposition, the N-polar AlN (Al x Ga1-x N) films examined by atom probe tomography in this study exhibited aluminum compositions (x) equal to or higher than 95% over a wide range of growth conditions. The also investigated AlN interlayer in a N-polar GaN/AlN/AlGaN/ S.I. GaN HEMT structure possessed a similarly high x content.

Pure AlN layers in metal-polar AlGaN/AlN/GaN and AlN/GaN heterostructures grown by low-temperature ammonia-based molecular beam epitaxy

NASA Astrophysics Data System (ADS)

Kaun, Stephen W.; Mazumder, Baishakhi; Fireman, Micha N.; Kyle, Erin C. H.; Mishra, Umesh K.; Speck, James S.

2015-05-01

When grown at a high temperature (820 °C) by ammonia-based molecular beam epitaxy (NH3-MBE), the AlN layers of metal-polar AlGaN/AlN/GaN heterostructures had a high GaN mole fraction (∼0.15), as identified by atom probe tomography in a previous study (Mazumder et al 2013 Appl. Phys. Lett. 102 111603). In the study presented here, growth at low temperature (<740 °C) by NH3-MBE yielded metal-polar AlN layers that were essentially pure at the alloy level. The improved purity of the AlN layers grown at low temperature was correlated to a dramatic increase in the sheet density of the two-dimensional electron gas (2DEG) at the AlN/GaN heterointerface. Through application of an In surfactant, metal-polar AlN(3.5 nm)/GaN and AlGaN/AlN(2.5 nm)/GaN heterostructures grown at low temperature yielded low 2DEG sheet resistances of 177 and 285 Ω/□, respectively.

Interdiffusion in U 3Si-Al, U 3Si 2-Al, and USi-Al dispersion fuels during irradiation

NASA Astrophysics Data System (ADS)

Kim, Yeon Soo; Hofman, Gerard L.

2011-03-01

Uranium-silicide compound fuel dispersion in an Al matrix is used in research and test reactors worldwide. Interaction layer (IL) growth between fuel particles and the matrix is one of performance issues. The interaction layer growth data for U 3Si, U 3Si 2 and USi dispersions in Al were obtained from both out-of-pile and in-pile tests. The IL is dominantly U(AlSi) 3 from out-of-pile tests, but its (Al + Si)/U ratio from in-pile tests is higher than the out-of-pile data, because of amorphous behavior of the ILs. IL growth correlations were developed for U 3Si-Al and U 3Si 2-Al. The IL growth rates were dependent on the U/Si ratio of the fuel compounds. During irradiation, however, the IL growth rates did not decrease with the decreasing U/Si ratio by fission. It is reasoned that transition metal fission products in the IL compensate the loss of U atoms by providing chemical potential for Al diffusion and volume expansion by solid swelling and gas bubble swelling. The addition of Mo in U 3Si 2 reduces the IL growth rate, which is similar to that of UMo alloy dispersion in a silicon-added Al matrix.

Thirty-day readmission rates following hospitalization for pediatric sickle cell crisis at freestanding children's hospitals: risk factors and hospital variation.

PubMed

Sobota, Amy; Graham, Dionne A; Neufeld, Ellis J; Heeney, Matthew M

2012-01-01

Readmission within 30 days after hospitalization for sickle cell crisis was developed by The National Association of Children's Hospitals (NACHRI) to improve hospital quality, however, there have been few studies validating this. We performed a retrospective examination of 12,104 hospitalizations for sickle crisis from July 1, 2006 and December 31, 2008 at 33 freestanding children's hospitals in the Pediatric Health Information System (PHIS) database. Hospitalizations met NACHRI criteria; inpatient admission, APR DRG code 662, age < 18, discharge home, and length of stay within 2 SD of the mean. We describe 30-day readmission rates, identify factors associated with readmission accounting for patient-level clustering and compare unadjusted versus adjusted variation in readmission rates. We identified 4,762 patients with 12,104 qualifying hospitalizations (1-30 per patient). Two thousand seventy-four (17%) hospitalizations resulted in a readmission within 30 days. Significant factors associated with readmission were age (OR 1.06/year, P < 0.0001), inpatient use of steroids (OR 1.48, P = 0.01) admission for pain without other sickle complications (OR 1.52, P < 0.0001) and simple transfusion (OR 0.58, P = 0.0002). There was significant variation in readmission rates between hospitals, even after accounting for clustering by patient and hospital case mix. In a sample of free-standing children's hospitals, 17% of hospitalizations for sickle cell crisis result in readmission within 30 days. Older patients, those treated with steroids and those admitted for pain are more likely to be readmitted; simple transfusion is protective. Even after adjusting for case mix substantial hospital variation remains, but specific hospital to hospital comparisons differ depending on the exact methods used. Copyright © 2011 Wiley Periodicals, Inc.

Hospital turnaround strategies.

PubMed

Langabeer, James

2008-01-01

Despite reports of higher profitability in recent years, hospitals are failing at a faster rate than ever before. Although many hospitals leave decisions regarding revenues and costs to chief financial officers and their staff, this is a recipe for disaster. From research conducted over the last 4 years on hospital bankruptcies and turnarounds, the author found that a common series of actions will help organizations evade collapse. The author explored these turnaround strategies through research and analysis of a variety of hospitals and health systems that had a high probability of immediate financial crisis or collapse. His continued observation and analysis of these hospitals in subsequent years showed that most hospitals never emerge from their bleak financial conditions. However, a few hospital administrations have successfully turned around their organizations.

Hospital Report Cards for Hospital-Acquired Pressure Ulcers: How good are the grades?

PubMed Central

Meddings, Jennifer A.; Reichert, Heidi; Hofer, Tim; McMahon, Laurence F.

2013-01-01

BACKGROUND Value-based purchasing programs will use administrative data to compare hospitals by rates of hospital-acquired pressure ulcers (HAPUs) for public reporting and financial penalties. Validation of administrative data for these purposes, however, is lacking. OBJECTIVE To assess the validity of the administrative data used to generate HAPU rates to compare hospitals for public reporting and financial penalty, by comparing hospital performance as assessed by HAPU rates generated from administrative and surveillance data. DESIGN Retrospective analysis of 2 million all-payer administrative records for 448 California hospitals and quarterly hospital-wide surveillance data for 213 hospitals from the California Nursing Outcomes and Prevalence Study (as publicly reported on CalHospitalCompare). SETTING 196 acute-care hospitals with >=6 months of available administrative and surveillance data PATIENTS Non-obstetric adults discharged in 2009. MEASUREMENTS Hospital-specific HAPU rates were computed as the percentage of discharged adults (from administrative data) or examined adults (from surveillance data) with >=1 HAPU stage II and above (HAPU2+). Categorization of hospital performance using administrative data was compared to the grade assigned using the surveillance data. RESULTS By administrative data, the mean (CI) hospital-specific HAPU2+ rate was 0.15% (0.13, 0.17); by surveillance data, the mean (CI) hospital-specific HAPU2+ rate was 2.0% (1.8, 2.2). Of the 49 hospitals with HAPU2+ rates from administrative data in the highest (worst) quartile, the surveillance dataset assigned these hospitals performance grades of “Superior” for 3 hospitals, “Above Average” for 14 hospitals, “Average” for 15 hospitals, and “Below Average” for 17 hospitals. LIMITATIONS Data are from 1 state, 1 year. CONCLUSIONS Hospital performance scores generated from HAPU2+ rates varied considerably from administrative data and surveillance data, suggesting administrative

Medicare's Hospital Readmissions Reduction Program in Surgery May Disproportionately Affect Minority-serving Hospitals.

PubMed

Shih, Terry; Ryan, Andrew M; Gonzalez, Andrew A; Dimick, Justin B

2015-06-01

To project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals. The Hospital Readmissions Reduction Program will potentially expand penalties for higher-than-predicted readmission rates to cardiac procedures in the near future. The impact of these penalties on minority-serving hospitals is unknown. We examined national Medicare beneficiaries undergoing coronary artery bypass grafting in 2008 to 2010 (N = 255,250 patients, 1186 hospitals). Using hierarchical logistic regression, we calculated hospital observed-to-expected readmission ratios. Hospital penalties were projected according to the Hospital Readmissions Reduction Program formula using only coronary artery bypass grafting readmissions with a 3% maximum penalty of total Medicare revenue. Hospitals were classified into quintiles according to proportion of black patients treated. Minority-serving hospitals were defined as hospitals in the top quintile whereas non-minority-serving hospitals were those in the bottom quintile. Projected readmission penalties were compared across quintiles. Forty-seven percent of hospitals (559 of 1186) were projected to be assessed a penalty. Twenty-eight percent of hospitals (330 of 1186) would be penalized less than 1% of total Medicare revenue whereas 5% of hospitals (55 of 1186) would receive the maximum 3% penalty. Minority-serving hospitals were almost twice as likely to be penalized than non-minority-serving hospitals (61% vs 32%) and were projected almost triple the reductions in reimbursement ($112 million vs $41 million). Minority-serving hospitals would disproportionately bear the burden of readmission penalties if expanded to include cardiac surgery. Given these hospitals' narrow profit margins, readmission penalties may have a profound impact on these hospitals' ability to care for disadvantaged patients.

Hospital economics of primary total knee arthroplasty at a teaching hospital.

PubMed

Healy, William L; Rana, Adam J; Iorio, Richard

2011-01-01

The hospital cost of total knee arthroplasty (TKA) in the United States is a major growing expense for the Centers for Medicare & Medicaid Services (CMS). Many hospitals are unable to deliver TKA with profitable or breakeven economics under the current Diagnosis-Related Group (DRG) hospital reimbursement system. The purposes of the current study were to (1) determine revenue, expenses, and profitability (loss) for TKA for all patients and for different payors; (2) define changes in utilization and unit costs associated with this operation; and (3) describe TKA cost control strategies to provide insight for hospitals to improve their economic results for TKA. From 1991 to 2009, Lahey Clinic converted a $2172 loss per case on primary TKA in 1991 to a $2986 profit per case in 2008. The improved economics was associated with decreasing revenue in inflation-adjusted dollars and implementation of hospital cost control programs that reduced hospital expenses for TKA. Reduction of hospital length of stay and reduction of knee implant costs were the major drivers of hospital expense reduction. During the last 25 years, our economic experience with TKA is concerning. Hospital revenues have lagged behind inflation, hospital expenses have been reduced, and our institution is earning a profit. However, the margin for TKA is decreasing and Managed Medicare patients do not generate a profit. The erosion of hospital revenue for TKA will become a critical issue if it leads to economic losses for hospitals or reduced access to TKA. Level III, Economic and Decision Analyses. See Guidelines for Authors for a complete description of levels of evidence.

ALS - resources

MedlinePlus

Resources - ALS ... The following organizations are good resources for information on amyotrophic lateral sclerosis : Muscular Dystrophy Association -- www.mda.org/disease/amyotrophic-lateral-sclerosis National Amyotrophic Lateral Sclerosis (ALS) ...

Study of the Al m 26 ( d , p ) Al 27 Reaction and the Influence of the Al 26 0 + Isomer on the Destruction of Al 26 in the Galaxy

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

Almaraz-Calderon, S.; Rehm, K. E.; Gerken, N.

The existence of 26Al (t 1/2 = 7.17 × 10 5 yr) in the interstellar medium provides a direct confirmation of ongoing nucleosynthesis in the Galaxy. The presence of a low-lying 0 + isomer ( 26Al m), however, severely complicates the astrophysical calculations. Here we present for the first time a study of the 26Al m (d, p) 27 Al reaction using an isomeric 26Al beam. The selectivity of this reaction allowed the study of ℓ = 0 transfers to T = 1/2, and T = 3/2 states in 27Al . Mirror symmetry arguments were then used to constrain themore » 26Al m (p,γ) 27Si reaction rate and provide an experimentally determined upper limit of the rate for the destruction of isomeric 26Al via radiative proton capture reactions, which is expected to dominate the destruction path of 26Al m in asymptotic giant branch stars, classical novae, and core collapse supernovae.« less

Study of the Al m 26 ( d , p ) Al 27 Reaction and the Influence of the Al 26 0 + Isomer on the Destruction of Al 26 in the Galaxy

DOE PAGES

Almaraz-Calderon, S.; Rehm, K. E.; Gerken, N.; ...

2017-08-17

The existence of 26Al (t 1/2 = 7.17 × 10 5 yr) in the interstellar medium provides a direct confirmation of ongoing nucleosynthesis in the Galaxy. The presence of a low-lying 0 + isomer ( 26Al m), however, severely complicates the astrophysical calculations. Here we present for the first time a study of the 26Al m (d, p) 27 Al reaction using an isomeric 26Al beam. The selectivity of this reaction allowed the study of ℓ = 0 transfers to T = 1/2, and T = 3/2 states in 27Al . Mirror symmetry arguments were then used to constrain themore » 26Al m (p,γ) 27Si reaction rate and provide an experimentally determined upper limit of the rate for the destruction of isomeric 26Al via radiative proton capture reactions, which is expected to dominate the destruction path of 26Al m in asymptotic giant branch stars, classical novae, and core collapse supernovae.« less

Study of the ^{26}Al^{m}(d,p)^{27}Al Reaction and the Influence of the ^{26}Al 0^{+} Isomer on the Destruction of ^{26}Al in the Galaxy.

PubMed

Almaraz-Calderon, S; Rehm, K E; Gerken, N; Avila, M L; Kay, B P; Talwar, R; Ayangeakaa, A D; Bottoni, S; Chen, A A; Deibel, C M; Dickerson, C; Hanselman, K; Hoffman, C R; Jiang, C L; Kuvin, S A; Nusair, O; Pardo, R C; Santiago-Gonzalez, D; Sethi, J; Ugalde, C

2017-08-18

The existence of ^{26}Al (t_{1/2}=7.17×10^{5}  yr) in the interstellar medium provides a direct confirmation of ongoing nucleosynthesis in the Galaxy. The presence of a low-lying 0^{+} isomer (^{26}Al^{m}), however, severely complicates the astrophysical calculations. We present for the first time a study of the ^{26}Al^{m}(d,p)^{27}Al reaction using an isomeric ^{26}Al beam. The selectivity of this reaction allowed the study of ℓ=0 transfers to T=1/2, and T=3/2 states in ^{27}Al. Mirror symmetry arguments were then used to constrain the ^{26}Al^{m}(p,γ)^{27}Si reaction rate and provide an experimentally determined upper limit of the rate for the destruction of isomeric ^{26}Al via radiative proton capture reactions, which is expected to dominate the destruction path of ^{26}Al^{m} in asymptotic giant branch stars, classical novae, and core collapse supernovae.

Reduced electron back-injection in Al2O3/AlOx/Al2O3/graphene charge-trap memory devices

NASA Astrophysics Data System (ADS)

Lee, Sejoon; Song, Emil B.; Min Kim, Sung; Lee, Youngmin; Seo, David H.; Seo, Sunae; Wang, Kang L.

2012-12-01

A graphene charge-trap memory is devised using a single-layer graphene channel with an Al2O3/AlOx/Al2O3 oxide stack, where the ion-bombarded AlOx layer is intentionally added to create an abundance of charge-trap sites. The low dielectric constant of AlOx compared to Al2O3 reduces the potential drop in the control oxide Al2O3 and suppresses the electron back-injection from the gate to the charge-storage layer, allowing the memory window of the device to be further extended. This shows that the usage of a lower dielectric constant in the charge-storage layer compared to that of the control oxide layer improves the memory performance for graphene charge-trap memories.

Hospital Variation in Time to Epinephrine for Nonshockable In-Hospital Cardiac Arrest.

PubMed

Khera, Rohan; Chan, Paul S; Donnino, Michael; Girotra, Saket

2016-12-20

For patients with in-hospital cardiac arrests attributable to nonshockable rhythms, delays in epinephrine administration beyond 5 minutes is associated with worse survival. However, the extent of hospital variation in delayed epinephrine administration and its effect on hospital-level outcomes is unknown. Within Get With The Guidelines-Resuscitation, we identified 103 932 adult patients (≥18 years) at 548 hospitals with an in-hospital cardiac arrest attributable to a nonshockable rhythm who received at least 1 dose of epinephrine between 2000 and 2014. We constructed 2-level hierarchical regression models to quantify hospital variation in rates of delayed epinephrine administration (>5 minutes) and its association with hospital rates of survival to discharge and survival with functional recovery. Overall, 13 213 (12.7%) patients had delays to epinephrine, and this rate varied markedly across hospitals (range, 0%-53.8%). The odds of delay in epinephrine administration were 58% higher at 1 randomly selected hospital in comparison with a similar patient at another randomly selected hospital (median odds ratio, 1.58; 95% confidence interval, 1.51-1.64). The median risk-standardized survival rate was 12.0% (range, 5.4%-31.9%), and the risk-standardized survival with functional recovery was 7.4% (range, 0.9%-30.8%). There was an inverse correlation between a hospital's rate of delayed epinephrine administration and its risk-standardized rate of survival to discharge (ρ=-0.22, P<0.0001) and survival with functional recovery (ρ=-0.14, P=0.001). In comparison with a median survival rate of 12.9% (interquartile range, 11.1%-15.4%) at hospitals in the lowest quartile of epinephrine delay, risk-standardized survival was 16% lower at hospitals in the quartile with the highest rate of epinephrine delays (10.8%; interquartile range, 9.7%-12.7%). Delays in epinephrine administration following in-hospital cardiac arrest are common and variy across hospitals. Hospitals with

The Hospitalized Child.

ERIC Educational Resources Information Center

Marchionne, Anne T.

Ways hospitals can promote the psychological and social well being of young patients are explored in this paper. First, the importance of familiarizing the child with the hospital is emphasized. Second, emotions hospitalized children may feel and the possible causes of those emotions are listed. Third, methods hospital personnel can use to help…

77 FR 73732 - In the Matter of Amendment of the Designation of al-Qa'ida in Iraq, aka Jam'at al Tawhid wa'al...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-11

...'ida in Iraq, aka Jam'at al Tawhid wa'al-Jihad, aka The Monotheism and Jihad Group, aka The al-Zarqawi Network, aka al-Tawhid, aka Tanzim Qa`idat al-Jihad fi Bilad al-Rafidayn, aka The Organization of al-Jihad... Rivers, aka al-Qaida of Jihad Organization in the Land of the Two Rivers, aka al- Qaida Group of Jihad in...

Phenotypic and genotypic studies of ALS cases in ALS-SMA families.

PubMed

Corcia, Philippe; Vourc'h, Patrick; Blasco, Helene; Couratier, Philippe; Dangoumau, Audrey; Bellance, Remi; Desnuelle, Claude; Viader, Fausto; Pautot, Vivien; Millecamps, Stephanie; Bakkouche, Salah; Salachas, FranÇois; Andres, Christian R; Meininger, Vincent; Camu, William

2018-08-01

Amyotrophic lateral sclerosis (ALS) and spinal muscular atrophy (SMA) are the most frequent motor neuron disorders in adulthood and infancy, respectively. There is a growing literature supporting common pathophysiological patterns between those disorders. One important clinical issue for that is the co-occurrence of both diseases within a family. To collect families in which ALS and SMA patients co-exist and describe the phenotype and the genotype of ALS patients. Nine families with co-occurrence of SMA and ALS have been gathered over the last 15 years. Epidemiological, phenotype and genetic status were collected. Out of the nine families, six corresponded to the criteria of familial ALS (FALS). Clinical data were available for 11 patients out of the 15 ALS cases. Mean age of onset was 58.5 years, site of onset was lower limbs in nine cases (81.8%), median duration was 22 months. Four ALS patients carried a mutation: three mutations in SOD1 gene (G147N in two cases and one with E121G) and one repeat expansion in the C9ORF72 gene. Three patients had abnormal SMN1 copy numbers. While the high proportion of familial history of ALS cases in these ALS-SMA pedigrees could have suggested that these familial clusters of the two most frequent MND rely on a genetic background, we failed to exclude that this occurred by chance.

Distribution and size of lava shields on the Al Haruj al Aswad and the Al Haruj al Abyad Volcanic Systems, Central Libya

NASA Astrophysics Data System (ADS)

Elshaafi, Abdelsalam; Gudmundsson, Agust

2017-05-01

The Al Haruj Volcanic Province (AHVP) consists of two distinct volcanic systems. In the north is the system of Al Haruj al Aswad, covering an area of 34,200 km2, while in the south the system of Al Haruj al Abyad, covering an area of 7,850 km2. The systems have produced some 432 monogenetic volcanoes, primarily scoria (cinder) cones, lava shields, and maars. The density distribution of the volcanoes in each system, plotted as eruption points or sites, has a roughly elliptical surface expression, suggesting similar plan-view geometry of the magma sources, here suggested as deep-seated reservoirs. More specifically, the Al Haruj al Aswad magma reservoir has major and minor axes of 210 km and 119 km, respectively, and an area of 19,176 km2, the corresponding figures for the Haruj al Abyad reservoir being 108 km and 74 km, for the axes, and 6209 km2 for the area. We measured 55 lava shields on the AHVP. They are mostly restricted to the northern and southern parts of AHVP and date from late Miocene to (at least) the end of Pleistocene, while some may have been active into Holocene. In fact, although primarily monogenetic, some of the lava shields show evidence of (possibly Holocene) fissure eruptions in the summit parts. The early lava shields tend to be located at the edges of volcanic systems and with greater volumes than later (more central) shields. The average lava shield basal diameter is 4.5 km and height 63 m. There is strong linear correlation between lava shield volume and basal area, the coefficient of determination (R2) being about 0.75. When 22 Holocene Icelandic lava shields are added to the dataset, for comparison, the correlation between volume and basal area becomes R2 = 0.95. Numerical models suggest that the local stress fields favoured rupture and dyke injection at the margins of the source reservoirs during late Miocene - early Pliocene, in agreement with the distribution of the early, large-volume shields.

Hospital library foreign language labs: the experiences of two hospital libraries.

PubMed

Whelan, Julia S; Schneider, Elizabeth; Woodworth, Karl; Markwell, Linda Garr

2006-01-01

Increasingly, hospital-based physicians, residents, and medical students are welcoming into their care foreign-born patients, who do not speak English. Most hospitals today have an Interpretive Services Department, but many of the physicians, residents, and medical students want to become more proficient in the most frequently spoken foreign languages in their respective locales. To help recruit and retain a diverse workforce, some hospitals sponsor English programs for staff. The Treadwell Library at Massachusetts General Hospital in Boston, Massachusetts, and the Grady Branch Library at Grady Memorial Hospital in Atlanta, Georgia, have developed a special collection and hospital library-based language laboratories in order to meet this need.

Physician-Owned Surgical Hospitals Outperform Other Hospitals in Medicare Value-Based Purchasing Program.

PubMed

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

2016-10-01

The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals and creates financial incentives for quality improvement and fosters increased transparency. Limited information is available comparing hospital performance across health care business models. The 2015 Hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Of 3,089 hospitals with total performance scores, categories of representative health care business models included 104 physician-owned surgical hospitals, 111 University HealthSystem Consortium, 14 US News & World Report Honor Roll hospitals, 33 Kaiser Permanente, and 124 Pioneer accountable care organization affiliated hospitals. Estimated mean total performance scores for physician-owned surgical hospitals (64.4; 95% CI, 61.83-66.38) and Kaiser Permanente (60.79; 95% CI, 56.56-65.03) were significantly higher compared with all remaining hospitals, and University HealthSystem Consortium members (36.8; 95% CI, 34.51-39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included physician-owned surgical hospitals (mean 2.32; p < 0.0001), US News & World Report honorees (mean 2.24; p = 0.0140), and University HealthSystem Consortium members (mean 1.99; p < 0.0001), and Kaiser Permanente hospitals had lower case mix value (mean 1.54; p < 0.0001). Re-estimation of total performance scores did not change the original results after adjustment for differences in hospital case mix index. The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals can guide value improvement and policy-making decisions for all Medicare Value

Hospital marketing revisited.

PubMed

Costello, M M

1987-05-01

With more hospitals embracing the marketing function in their organizational management over the past decade, hospital marketing can no longer be considered a fad. However, a review of hospital marketing efforts as reported in the professional literature indicates that hospitals must pay greater attention to the marketing mix elements of service, price and distribution channels as their programs mature.

[Medico-economic assessment of the Pontoise Hospital stroke unit].

PubMed

Yekhlef, F; Decup, D; Niclot, P; Servan, J; Descombes, S; Richecoeur, J; Ollivier, A

2010-11-01

Annually, approximately 120,000 people in France have a stroke. Various controlled studies have pointed out the benefits of treatment in a stroke unit (SU). The objective of this study was to evaluate, from a medical point of view, the economic impact of the Pontoise Hospital SU. Based on the national cost study (NCS [étude nationale des coûts: ENC]) we analyzed data of five diagnosis related groups (DRG) which have a principle diagnosis in relation with stroke. This work was limited to strokes and transient ischemic events in adults and excluded sub-arachnoid hemorrhage. Medical and economic parameters were collected over the period from January to October 2006 and compared with those of the same period in 2005, that is to say before the opening of the SU. Three hundred and twenty-three hospital stays occurred between January 1st and October 31st, 2006 and 216 during the same time period before the opening of the SU, an increase of approximately 50% of all stroke-related admissions in our hospital. The number of stays carried out in the neurology unit increased by 29%. There was no significant difference between the two periods regarding age (median 69 versus 70 years) and sex- ratio. Average length of stay (ALS) was the same (9 days). There were no significant differences concerning the death rate (5.6% versus 6.2%) and that of discharge to home (44.6% versus 44.4%). The cost by stay in 2006 was 3534 euros [median; min 664-max 57,542] versus 3541 euros in 2005 [681-35,149] (p=0.57). Analysis by DRG highlighted an increase in the cost for serious strokes, cerebral infarctions and hemorrhages. For transitory ischemic events, the cost and the ALS decreased. After the opening of the SU, there was an increase in the activity without an increase in the total cost. This could be related in part to the limited means allocated to the stroke unit at its opening (in particular medical staff). The NCS can be used to evaluate the activity of a stroke unit. This work could

Trends in hospital librarianship and hospital library services: 1989 to 2006.

PubMed

Thibodeau, Patricia L; Funk, Carla J

2009-10-01

The research studied the status of hospital librarians and library services to better inform the Medical Library Association's advocacy activities. The Vital Pathways Survey Subcommittee of the Task Force on Vital Pathways for Hospital Librarians distributed a web-based survey to hospital librarians and academic health sciences library directors. The survey results were compared to data collected in a 1989 survey of hospital libraries by the American Hospital Association in order to identify any trends in hospital libraries, roles of librarians, and library services. A web-based hospital library report form based on the survey questions was also developed to more quickly identify changes in the status of hospital libraries on an ongoing basis. The greatest change in library services between 1989 and 2005/06 was in the area of access to information, with 40% more of the respondents providing access to commercial online services, 100% more providing access to Internet resources, and 28% more providing training in database searching and use of information resources. Twenty-nine percent (n = 587) of the 2005/06 respondents reported a decrease in staff over the last 5 years. Survey data support reported trends of consolidation of hospitals and hospital libraries and additions of new services. These services have likely required librarians to acquire new skills. It is hoped that future surveys will be undertaken to continue to study these trends.

The politics of local hospital reform: a case study of hospital reorganization following the 2002 Norwegian hospital reform.

PubMed

Tjerbo, Trond

2009-11-20

The Norwegian hospital reform of 2002 was an attempt to make restructuring of hospitals easier by removing politicians from the decision-making processes. To facilitate changes seen as necessary but politically difficult, the central state took over ownership of the hospitals and stripped the county politicians of what had been their main responsibility for decades. This meant that decisions regarding hospital structure and organization were now being taken by professional administrators and not by politically elected representatives. The question raised here is whether this has had any effect on the speed of restructuring of the hospital sector. The empirical part is a case study of the restructuring process in Innlandet Hospital Trust (IHT), which was one of the largest enterprise established after the hospital reform and where the vision for restructuring was clearly set. Different sources of qualitative data are used in the analysis. These include interviews with key actors, observational data and document studies. The analysis demonstrates how the new professional leaders at first acted in accordance with the intentions of the hospital reform, but soon chose to avoid the more ambitious plans for restructuring the hospital structure and in fact reintroduced local politics into the decision-making process. The analysis further illustrates how local networks and engagement of political representatives from all levels of government complicated the decision-making process surrounding local structural reforms. Local political representatives teamed up with other actors and created powerful networks. At the same time, national politicians had incentives to involve themselves in the processes as supporters of the status quo. Because of the incentives that faced political actors and the controversial nature of major hospital reforms, the removal of local politicians and the centralization of ownership did not necessarily facilitate reforms in the hospital structure

The politics of local hospital reform: a case study of hospital reorganization following the 2002 Norwegian hospital reform

PubMed Central

2009-01-01

Background The Norwegian hospital reform of 2002 was an attempt to make restructuring of hospitals easier by removing politicians from the decision-making processes. To facilitate changes seen as necessary but politically difficult, the central state took over ownership of the hospitals and stripped the county politicians of what had been their main responsibility for decades. This meant that decisions regarding hospital structure and organization were now being taken by professional administrators and not by politically elected representatives. The question raised here is whether this has had any effect on the speed of restructuring of the hospital sector. Method The empirical part is a case study of the restructuring process in Innlandet Hospital Trust (IHT), which was one of the largest enterprise established after the hospital reform and where the vision for restructuring was clearly set. Different sources of qualitative data are used in the analysis. These include interviews with key actors, observational data and document studies. Results The analysis demonstrates how the new professional leaders at first acted in accordance with the intentions of the hospital reform, but soon chose to avoid the more ambitious plans for restructuring the hospital structure and in fact reintroduced local politics into the decision-making process. The analysis further illustrates how local networks and engagement of political representatives from all levels of government complicated the decision-making process surrounding local structural reforms. Local political representatives teamed up with other actors and created powerful networks. At the same time, national politicians had incentives to involve themselves in the processes as supporters of the status quo. Conclusion Because of the incentives that faced political actors and the controversial nature of major hospital reforms, the removal of local politicians and the centralization of ownership did not necessarily facilitate

Hospital Rating Systems and Implications For Patient Travel to Better-rated Hospitals.

PubMed

Subramanian, Arun; Adler, Joel T; Shah, Nilay D; Hyder, Joseph A

2017-03-01

Publicly reported hospital ratings aim to encourage transparency, spur quality improvement, and empower patient choice. Travel burdens may limit patient choice, particularly for older adults (aged 65 years and more) who receive most medical care. For 3 major hospital ratings systems, we estimated travel burden as the additional 1-way travel distance to receive care at a better-rated hospital.Distances were estimated from publicly available data from the US Census, US News Top Hospitals, Society of Thoracic Surgeons composite rating for coronary artery bypass grafting (STS-CABG), and Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Services (HCAHPS).Hospitals were rated for HCAHPS (n = 4656), STS-CABG (n = 470), and US News Top Hospitals (n = 15). Older adults were commonly located within 25 miles of their closest HCAHPS hospital (89.6%), but less commonly for STS-CABG (62.9%). To receive care at a better-rated hospital, travel distances commonly exceeded 25 miles: HCAHPS (39.2%), STS-CABG (62.7%), and US News Top Hospital (85.2%). Additional 1-way travel distances exceeded 25 miles commonly: HCAHPS (23.7%), STS-CABG (36.7%), US News Top Hospitals (81.8%).Significant travel burden is common for older adults seeking "better" care and is an important limitation of current hospital ratings for empowering patient choice.

Formation of gamma'-Ni3Al via the Peritectoid Reaction: gamma plus beta (+Al2O3) equals gamma'(+Al2O3)

NASA Technical Reports Server (NTRS)

Copland, Evan

2008-01-01

The activities of Al and Ni were measured using multi-cell Knudsen effusion-cell mass spectrometry (multi-cell KEMS), over the composition range 8 - 32 at.%Al and temperature range T = 1400 - 1750 K in the Ni-Al-O system. These measurements establish that equilibrium solidification of gamma'-Ni3Al-containing alloys occurs by the eutectic reaction, L (+ Al2O3) = gamma + beta (+ Al2O3), at 1640 plus or minus 1 K and a liquid composition of 24.8 plus or minus 0.2 at.%Al (at an unknown oxygen content). The {gamma + beta + Al2O3} phase field is stable over the temperature range 1633 - 1640 K, and gamma'-Ni3Al forms via the peritectiod, gamma + beta (+ Al2O3) = gamma'(+ Al2O3), at 1633 plus or minus 1 K. This behavior is inconsistent with the current Ni-Al phase diagram and a new diagram is proposed. This new Ni-Al phase diagram explains a number of unusual steady state solidification structures reported previously and provides a much simpler reaction scheme in the vicinity of the gamma'-Ni3Al phase field.

The Status of Hospital Information Systems in Iranian Hospitals

PubMed Central

Jahanbakhsh, Maryam; Sharifi, Mohammed; Ayat, Masar

2014-01-01

Background: The area of e-Health is broad and has an excellent growth potential. An increasing number of experts believe that e-Health will fuel the next breakthroughs in health system improvements throughout the world, but there is frequent evidence of unsustainable use of e-Health systems in medical centres, particularly hospitals, for different reasons in different countries. Iran is also a developing country which is presently adopting this promising technology for its traditional healthcare delivery but there is not much information about the use of e-Health systems in its hospitals, and the weakness and opportunities of utilization of such Hospital Information Systems (HIS). Methods: For this research, a number of Hospitals from Isfahan, Iran, are selected using convenient sampling. E-health research professionals went there to observe their HIS and collect required data as a qualitative survey. The design of interview questions was based on the researchers’ experiences and knowledge in this area along with elementary interviews with experts on HIS utilization in hospitals. Results: Efficient administration of e-health implementation improves the quality of healthcare, reduces costs and medical errors, makes healthcare resources available to rural areas, etc. However, there are numerous issues affecting the successful utilization of e-health in Hospitals, such as a lack of a perfect HIS implementation plan and well-defined strategy, inadequate IT-security for the protection of e-health-related data, improper training and educational issues, legal challenges, privacy concerns, improper documentation of lessons learned, resistance to the application of new technologies, and finally a lack of recovery plan and disaster management. These results along with some informative stories are extracted from interview sessions to uncover associated challenges of HIS utilization in Iranian hospitals. Conclusion: The utilization of e-health in Iranian hospitals

Hospitable Classrooms: Biblical Hospitality and Inclusive Education

ERIC Educational Resources Information Center

Anderson, David W.

2011-01-01

This paper contributes to a Christian hermeneutic of special education by suggesting the biblical concept of hospitality as a necessary characteristic of classroom and school environments in which students with disabilities and other marginalized students can be effectively incorporated into the body of the classroom. Christian hospitality, seen…

Directional Solidification and Mechanical Properties of NiAl-NiAlTa Alloys

NASA Technical Reports Server (NTRS)

Johnson, D. R.; Chen, X. F.; Oliver, B. F.; Noebe, R. D.; Whittenberger, J. D.

1995-01-01

Directional solidification of eutectic alloys is a promising technique for producing in-situ composite materials exhibiting a balance of properties. Consequently, the microstructure, creep strength and fracture toughness of directionally solidified NiAl-NiAlTa alloys were investigated. Directional solidification was performed by containerless processing techniques to minimize alloy contamination. The eutectic composition was found to be NiAl-15.5 at% Ta and well-aligned microstructures were produced at this composition. A near-eutectic alloy of NiAl-14.5Ta was also investigated. Directional solidification of the near-eutectic composition resulted in microstructures consisting of NiAl dendrites surrounded by aligned eutectic regions. The off-eutectic alloy exhibited promising compressive creep strengths compared to other NiAl-based intermetallics, while preliminary testing indicated that the eutectic alloy was competitive with Ni-base single crystal superalloys. The room temperature toughness of these two-phase alloys was similar to that of polycrystalline NiAl even with the presence of the brittle Laves phase NiAlTa.

The impact of HMO and hospital competition on hospital costs.

PubMed

Younis, Mustafa Z; Rivers, Patrick A; Fottler, Myron D

2005-01-01

This study examines the impact of HMO penetration and competition on health system performance, as measured by hospital cost per adjusted admissions. The study population consisted of acute-care hospitals in the United States. The findings of this study suggest that there is no relationship between HMO competition and hospital cost per adjusted admission. Governmental efforts to stimulate competition in the hospital market, if focused on promoting HMOs, are not likely to produce cost-containing results quickly.

Development and Implementation of a Comprehensive Risk Management Program at the USAF Academy Hospital.

DTIC Science & Technology

1980-04-01

much less con - cerned about malpractice problems. As a result of the program, they began to view the risk management program as their own and to recog...that con - tributes to better patient care. 131 Implementing Risk Management According to Donovan and Bader, an action plan for the systems approach might...Al87 344 DEVELOPMENT AND IMPLEMENTATION OF A COMPREHENSIVE RISK 1 MANAGEMENT PROGRAM AT THE USAF ACADEMY HOSPITAL(U) ARMY HEALTH CARE STUDIES AND

[Surgical technique for the treatment of the serious acute necrotic pancreatitis in the National Hospital Edgardo Rebagliati Martins].

PubMed

Barreda Cevasco, Luis Alberto; Targarona Modena, Javier; Rodriguez Alegría, César

2002-01-01

A surgical technique for the treatment of severe acute pancreatitis with necrosis is presented as an alternative in the surgical treatment of this pathology; 60 patients underwent a surgery by the author et al. between October 1997 and January 2002, at the National Hospital Edgardo Rebagliati Martins, Lima, Peru. The mortality rate was 25%.

Theory and X-ray Absorption Spectroscopy for Aluminum Coordination Complexes – Al K-Edge Studies of Charge and Bonding in (BDI)Al, (BDI)AlR2, and (BDI)AlX2 Complexes.

PubMed

Altman, Alison B; Pemmaraju, C D; Camp, Clément; Arnold, John; Minasian, Stefan G; Prendergast, David; Shuh, David K; Tyliszczak, Tolek

2015-08-19

Polarized aluminum K-edge X-ray absorption near edge structure (XANES) spectroscopy and first-principles calculations were used to probe electronic structure in a series of (BDI)Al, (BDI)AlX2, and (BDI)AlR2 coordination compounds (X = F, Cl, I; R = H, Me; BDI = 2,6-diisopropylphenyl-β-diketiminate). Spectral interpretations were guided by examination of the calculated transition energies and polarization-dependent oscillator strengths, which agreed well with the XANES spectroscopy measurements. Pre-edge features were assigned to transitions associated with the Al 3p orbitals involved in metal-ligand bonding. Qualitative trends in Al 1s core energy and valence orbital occupation were established through a systematic comparison of excited states derived from Al 3p orbitals with similar symmetries in a molecular orbital framework. These trends suggested that the higher transition energies observed for (BDI)AlX2 systems with more electronegative X(1-) ligands could be ascribed to a decrease in electron density around the aluminum atom, which causes an increase in the attractive potential of the Al nucleus and concomitant increase in the binding energy of the Al 1s core orbitals. For (BDI)Al and (BDI)AlH2 the experimental Al K-edge XANES spectra and spectra calculated using the eXcited electron and Core-Hole (XCH) approach had nearly identical energies for transitions to final state orbitals of similar composition and symmetry. These results implied that the charge distributions about the aluminum atoms in (BDI)Al and (BDI)AlH2 are similar relative to the (BDI)AlX2 and (BDI)AlMe2 compounds, despite having different formal oxidation states of +1 and +3, respectively. However, (BDI)Al was unique in that it exhibited a low-energy feature that was attributed to transitions into a low-lying p-orbital of b1 symmetry that is localized on Al and orthogonal to the (BDI)Al plane. The presence of this low-energy unoccupied molecular orbital on electron-rich (BDI)Al distinguishes

Development of Al2O3 fiber-reinforced Al2O3-based ceramics.

PubMed

Tanimoto, Yasuhiro; Nemoto, Kimiya

2004-09-01

The purpose of this study was to use a tape casting technique to develop an Al2O3 fiber-reinforced Al2O3-based ceramic material (Al2O3-fiber/Al2O3 composite) into a new type of dental ceramic. The Al2O3-based ceramic used a matrix consisting of 60 wt% Al2O3 powder and 40 wt% SiO2-B2O3 powder. The prepreg sheets of Al2O3-fiber/Al2O3 composite (in which uniaxially aligned Al2O3 fibers were infiltrated with the Al2O3-based matrix) were fabricated continuously using tape casting technique with a doctor blade system. Multilayer preforms of Al2O3-fiber/Al2O3 composite sheets were then sintered at a maximum temperature of 1000 degrees C under an atmospheric pressure in a furnace. The results showed that the shrinkage and bending properties of Al2O3-fiber/Al2O3 composite exceeded those of unreinforced Al2O3--hence demonstrating the positive effects of fiber reinforcement. In conclusion, the tape casting technique has been utilized to successfully develop a new type of dental ceramic material.

Trends in hospital librarianship and hospital library services: 1989 to 2006

PubMed Central

Thibodeau, Patricia L.; Funk, Carla J.

2009-01-01

Objective: The research studied the status of hospital librarians and library services to better inform the Medical Library Association's advocacy activities. Methods: The Vital Pathways Survey Subcommittee of the Task Force on Vital Pathways for Hospital Librarians distributed a web-based survey to hospital librarians and academic health sciences library directors. The survey results were compared to data collected in a 1989 survey of hospital libraries by the American Hospital Association in order to identify any trends in hospital libraries, roles of librarians, and library services. A web-based hospital library report form based on the survey questions was also developed to more quickly identify changes in the status of hospital libraries on an ongoing basis. Results: The greatest change in library services between 1989 and 2005/06 was in the area of access to information, with 40% more of the respondents providing access to commercial online services, 100% more providing access to Internet resources, and 28% more providing training in database searching and use of information resources. Twenty-nine percent (n = 587) of the 2005/06 respondents reported a decrease in staff over the last 5 years. Conclusions: Survey data support reported trends of consolidation of hospitals and hospital libraries and additions of new services. These services have likely required librarians to acquire new skills. It is hoped that future surveys will be undertaken to continue to study these trends. PMID:19851491

The Effect of Simulated Welding Conditions on Austenite Decomposition Kinetics.

DTIC Science & Technology

1981-07-01

Departamento de Metalurgia, . Facultad de Ciencias Quimicas , Universidad Complutense, Madrid, Spain 1981 .. 2 1982 A Approved for Public Release...Development London England London England CONTRACT NUMBER DAJA 37-80-C-0298 Departamento de Metalurgia, Facultad de Ciencias Quimicas , Universidad...Complu -nse, Madrid, Spain 19h1 Approved for Public Release, Distribution unlimited E~flA: Departameflto de Metalurgia. Facultad de Ciencias Quimicas

Driving hospital transformation with SLMTA in a regional hospital in Cameroon

PubMed Central

Asong, Terence; Ngale, Elive; Mangwa, Beatrice; Ndasi, Juliana; Mouladje, Maurice; Lekunze, Remmie; Mbome, Victor; Njukeng, Patrick; Shang, Judith

2014-01-01

Background Inspired by the transformation of the Regional Hospital Buea laboratory through implementation of the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme, hospital management adapted the SLMTA toolkit to drive hospital-wide quality improvement. Objective This paper describes changes in the hospital following the quality improvement activities in hygiene and sanitation, the outpatient waiting area and the surgical and maternity wards. Methods In March 2011, hospital management established a quality improvement task force and created a hospital-wide quality improvement roadmap, following the SLMTA model. The roadmap comprised improvement projects, accountability plans, patient feedback forms and log books to track quality indicators including patient wait time, satisfaction level, infection rates, birth outcomes and hospital revenue. Results There was steady improvement in service delivery during the 11 months after the introduction of the quality improvement initiatives: patient wait time at the reception was reduced from three hours to less than 30 minutes and patient satisfaction increased from 15% to 60%. Treatment protocols were developed and documented for various units, infrastructure and workflow processes were improved and there was increased staff awareness of the importance of providing quality services. Maternal infection rates dropped from 3% to 0.5% and stillbirths from 5% to < 1%. The number of patients increased as a result of improved services, leading to a 25% increase in hospital revenue. Conclusion The SLMTA programme was adapted successfully to meet the needs of the entire hospital. Such a programme has the potential to impact positively on hospital quality systems; consideration should be made for development of a formal SLMTA-like programme for hospital quality improvement. PMID:29043192

NiAl-base composite containing high volume fraction of AlN for advanced engines

NASA Technical Reports Server (NTRS)

Hebsur, Mohan (Inventor); Whittenbeger, John D. (Inventor); Lowell, Carl F. (Inventor)

1994-01-01

A particulate reinforced NiAl-AlN composite alloy has a NiAl matrix and greater than about 13 volume percent fine particles of AlN within the matrix. The particles preferably have a diameter from about 15 nanometers to about 50 nanometers. The particulate reinforced NiAl-AlN composite alloy may be prepared by cryomilling prealloyed NiAl in liquid nitrogen using grinding media having a diameter of from about 2 to 6 mm at an impeller speed of from about 450 RPM to about 800 RPM. The cryomilling may be done for a duration of from about 4 hours to about 20 hours to obtain a cryomilled powder. The cryomilled powder may be consolidated to form the particulate reinforced NiAl-AlN composite alloy. The particulate reinforced alloy can further include a toughening alloy. The toughening alloy may include NiCrAlY, FeCrAlY, and FeAl.

Effects of competition on hospital quality: an examination using hospital administrative data.

PubMed

Palangkaraya, Alfons; Yong, Jongsay

2013-06-01

This paper investigates the effects of competition on hospital quality using hospital administration data from the State of Victoria, Australia. Hospital quality is measured by 30-day mortality rates and 30-day unplanned readmission rates. Competition is measured by Herfindahl-Hirschman index and the numbers of competing public and private hospitals. The paper finds that hospitals facing higher competition have lower unplanned admission rates. However, competition is related negatively to hospital quality when measured by mortality, albeit the effects are weak and barely statistically significant. The paper also finds that the positive effect of competition on quality as measured by unplanned readmission differs greatly depending on whether the hospital is publicly or privately owned.

Molecular dynamics study of Al and Ni 3Al sputtering by Al clusters bombardment

NASA Astrophysics Data System (ADS)

Zhurkin, Eugeni E.; Kolesnikov, Anton S.

2002-06-01

The sputtering of Al and Ni 3Al (1 0 0) surfaces induced by impact of Al ions and Al N clusters ( N=2,4,6,9,13,55) with energies of 100 and 500 eV/atom is studied at atomic scale by means of classical molecular dynamics (MD). The MD code we used implements many-body tight binding potential splined to ZBL at short distances. Special attention has been paid to model dense cascades: we used quite big computation cells with lateral periodic and damped boundary conditions. In addition, long simulation times (10-25 ps) and representative statistics (up to 1000 runs per each case) were considered. The total sputtering yields, energy and time spectrums of sputtered particles, as well as preferential sputtering of compound target were analyzed, both in the linear and non-linear regimes. The significant "cluster enhancement" of sputtering yield was found for cluster sizes N⩾13. In parallel, we estimated collision cascade features depending on cluster size in order to interpret the nature of observed non-linear effects.

Thirty-Day Readmission Rates Following Hospitalization for Pediatric Sickle Cell Crisis at Freestanding Children’s Hospitals: Risk Factors and Hospital Variation

PubMed Central

Sobota, Amy; Graham, Dionne A.; Neufeld, Ellis J.; Heeney, Matthew M.

2015-01-01

Background Readmission within 30 days after hospitalization for sickle cell crisis was developed by The National Association of Children’s Hospitals (NACHRI) to improve hospital quality, however, there have been few studies validating this. Procedure We performed a retrospective examination of 12,104 hospitalizations for sickle crisis from July 1, 2006 and December 31, 2008 at 33 freestanding children’s hospitals in the Pediatric Health Information System (PHIS) database. Hospitalizations met NACHRI criteria; inpatient admission, APR DRG code 662, age < 18, discharge home, and length of stay within 2 SD of the mean. We describe 30-day readmission rates, identify factors associated with readmission accounting for patient-level clustering and compare unadjusted versus adjusted variation in readmission rates. Results We identified 4,762 patients with 12,104 qualifying hospitalizations (1–30 per patient). Two thousand seventy-four (17%) hospitalizations resulted in a readmission within 30 days. Significant factors associated with readmission were age (OR 1.06/year, P < 0.0001), inpatient use of steroids (OR 1.48, P = 0.01) admission for pain without other sickle complications (OR 1.52, P < 0.0001) and simple transfusion (OR 0.58, P = 0.0002). There was significant variation in readmission rates between hospitals, even after accounting for clustering by patient and hospital case mix. Conclusions In a sample of free-standing children’s hospitals, 17% of hospitalizations for sickle cell crisis result in readmission within 30 days. Older patients, those treated with steroids and those admitted for pain are more likely to be readmitted; simple transfusion is protective. Even after adjusting for case mix substantial hospital variation remains, but specific hospital to hospital comparisons differ depending on the exact methods used. PMID:21674766

Nb/Al-AlOx/Nb Edge Junctions for Distributed Mixers

NASA Astrophysics Data System (ADS)

Amos, R. S.; Lichtenberger, A. W.; Tong, C. E.; Blundell, R.; Pan, S.-K.; Kerr, A. R.

We have fabricated high quality Nb/Al-oxide/Al/Nb edge junctions using a Nb/SiO/sub 2/ bi-layer film as the base electrode, suitable for use as traveling wave mixers. An edge is cut in the bi-layer with an ion gun at a 45 degree angle using a photoresist mask. The wafer is then cleaned in-situ with a physical ion gun clean followed by the deposition of a thin Al (a1) film, which is then thermally oxidized, an optional second Al (a2) layer, and a Nb counter electrode. It was found that devices with an a2 layer resulted in superior electrical characteristics, though proximity effects increased strongly with a2 thickness. The counter electrode is defined with an SF/sub 6/+N/sub 2/ reactive ion etch, using the Al barrier layer as an etch stop. The Al barrier layer is then either removed with an Al wet etch to isolate the individual devices, or the devices are separated with an anodization process. Various ion gun cleaning conditions have been examined; in addition, both wet and plasma etch bi-layer edge surface pre-treatments were investigated. It was found that edge junctions with large widths (i.e., those more suitable for traveling wave mixers) typically benefited more from such treatments. Initial receiver results at 260 GHz have yielded a DSB noise temperature of 60 K.

Photoelectrical, photophysical and photocatalytic properties of Al based MOFs: MIL-53(Al) and MIL-53-NH{sub 2}(Al)

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

An, Yang; Li, Huiliang; Liu, Yuanyuan, E-mail: yyliu@sdu.edu.cn

Two Al based MOFs (MIL-53(Al) and MIL-53-NH{sub 2} (Al)) were synthesized, and their photoelectrical, photophysical and photocatalytic properties towards oxygen evolution from water were investigated. Different from the ligand to metal charge transfer process previously reported, we proposes a new photocatalytic mechanism based on electron tunneling according to the results of theoretical calculation, steady state and time resolved fluorescence spectra. The organic linkers absorb photons, giving rise to electrons and holes. Then, the photogenerated electrons tunnel through the AlO{sub 6}-octahedra, which not only inhibit the recombination of photogenerated charge carriers, but also is a key factor to the photocatalytic activitymore » of Al based MOFs. - Graphical abstract: The photoelectrical, photophysical and photocatalytic properties towards oxygen evolution from water of two Al based MOFs were investigated. A new photocatalytic mechanism was proposed based on electron tunneling according to the results of both theoretical calculation and steady state, time resolved fluorescence spectra. The electron tunneling process not only inhibit the recombination of photogenerated charge carriers, but also is a key factor to the photocatalytic activity of Al based MOFs.« less

Determinants of Hospital Pharmacists' Job Satisfaction in Romanian Hospitals.

PubMed

Iorga, Magdalena; Dondaș, Corina; Soponaru, Camelia; Antofie, Ioan

2017-12-11

Aim : The purpose of this study is to identify the level of job satisfaction among hospital pharmacists in Romania in relation to environmental, socio-demographic, and individual factors. Material and Methods : Seventy-eight hospital pharmacists were included in the research. The Job Satisfaction Scale was used to measure the level of satisfaction with their current jobs, and the TAS-20 was used to evaluate emotional experience and awareness. Additionally, 12 items were formulated in order to identify the reasons for dissatisfaction with jobs, such as budget, number of working hours, legislation, relationships with colleagues, hospital departments, or stakeholders. Data were analyzed using IBM SPSS Statistics version 23. Results : The analyses of the data revealed a low level of satisfaction regarding the pay-promotion subscale, a high level of satisfaction with the management-interpersonal relationship dimension, and a high level of satisfaction regarding the organization-communication subscale. Seventy-four percent of subjects are dissatisfied about the annual budget, and 86.3% are not at all satisfied with present legislation. Conclusions : These results are important for hospital pharmacists and hospital management in order to focus on health policies, management, and environmental issues, with the purpose of increasing the level of satisfaction among hospital pharmacists.

Determinants of Hospital Pharmacists’ Job Satisfaction in Romanian Hospitals

PubMed Central

Iorga, Magdalena; Dondaș, Corina; Soponaru, Camelia; Antofie, Ioan

2017-01-01

Aim: The purpose of this study is to identify the level of job satisfaction among hospital pharmacists in Romania in relation to environmental, socio-demographic, and individual factors. Material and Methods: Seventy-eight hospital pharmacists were included in the research. The Job Satisfaction Scale was used to measure the level of satisfaction with their current jobs, and the TAS-20 was used to evaluate emotional experience and awareness. Additionally, 12 items were formulated in order to identify the reasons for dissatisfaction with jobs, such as budget, number of working hours, legislation, relationships with colleagues, hospital departments, or stakeholders. Data were analyzed using IBM SPSS Statistics version 23. Results: The analyses of the data revealed a low level of satisfaction regarding the pay–promotion subscale, a high level of satisfaction with the management–interpersonal relationship dimension, and a high level of satisfaction regarding the organization–communication subscale. Seventy-four percent of subjects are dissatisfied about the annual budget, and 86.3% are not at all satisfied with present legislation. Conclusions: These results are important for hospital pharmacists and hospital management in order to focus on health policies, management, and environmental issues, with the purpose of increasing the level of satisfaction among hospital pharmacists. PMID:29232878

Mother-baby friendly hospital.

PubMed

Aragon-choudhury, P

1996-01-01

In Manila, the Philippines, the Dr. Jose Fabella Memorial Hospital has been a maternity hospital for 75 years. It averages 90 deliveries a day. Its fees are P200-P500 for a normal delivery and P800-P2000 for a cesarean section. Patients pay what they can and pay the balance when they can. The hospital provides a safe motherhood package that encompasses teaching responsible parenthood, prenatal care, labor, delivery, postpartum care, breast feeding, family planning, and child survival. In 1986, the hospital introduced innovative policies and procedures that promote, protect, and support breast feeding. It has a rooming-in policy that has saved the hospital P6.5 million so far. In the prenatal stage, hospital staff inform pregnant women that colostrum protects the newborn against infections, that suckling stimulates milk production, and that there is no basis to the claim of having insufficient breast milk. Sales representatives of milk substitutes are banned from the hospital. Staff confiscate milk bottles or formula. A lactation management team demonstrates breast feeding procedures. Mothers also receive support on the correct way of breast feeding from hospital staff, volunteers from the Catholic Women's League, consumer groups, and women lawyers. The hospital's policy is no breast milk, no discharge. This encourages mothers to motivate each other to express milk immediately after birth. The hospital has received numerous awards for its breast feeding promotion efforts. UNICEF has designated Fabella Hospital as a model of the Baby-Friendly Hospital Initiative. The hospital serves as the National Lactation Management Education Training Center. People from other developing countries have received training in lactation management here. The First Lady of the Philippines, the First Lady of the US, and the Queen of Spain have all visited the hospital. The hospital has also integrated its existing services into a women's health care center.

The effect of hospital control strategies on physician satisfaction and physician-hospital conflict.

PubMed Central

Burns, L R; Andersen, R M; Shortell, S M

1990-01-01

This article examines several strategies that hospitals use to control their medical staffs. Such strategies include placing physicians on salary, developing exclusive hospital affiliations with physicians, and involving physicians in decision-making bodies. Using regression techniques, we investigate which hospitals are more likely to utilize these strategies and whether such strategies are effective in promoting physician-hospital integration. Contrary to our expectations, corporate hospital structures (e.g., for-profit hospitals, membership in multihospital systems) generally do not employ these strategies more often and oftentimes employ them less. There is also little evidence that control strategies are effective levers for increasing physician satisfaction or decreasing physician-hospital conflict. We suggest that control strategies are useful for purposes other than promoting physician-hospital integration. Finally, hospital ownership appears to exert the biggest effect on physician satisfaction and conflict. PMID:2380074

[Long-term psychiatric hospitalizations].

PubMed

Plancke, L; Amariei, A

2017-02-01

Long-term hospitalizations in psychiatry raise the question of desocialisation of the patients and the inherent costs. Individual indicators were extracted from a medical administrative database containing full-time psychiatric hospitalizations for the period 2011-2013 of people over 16 years old living in the French region of Nord-Pas-de-Calais. We calculated the proportion of people who had experienced a hospitalization with a duration of 292 days or more during the study period. A bivariate analysis was conducted, then ecological data (level of health-care offer, the deprivation index and the size of the municipalities of residence) were included into a multilevel regression model in order to identify the factors significantly related to variability of long-term hospitalization rates. Among hospitalized individuals in psychiatry, 2.6% had had at least one hospitalization of 292 days or more during the observation period; the number of days in long-term hospitalization represented 22.5% of the total of days of full-time hospitalization in psychiatry. The bivariate analysis revealed that seniority in the psychiatric system was strongly correlated with long hospitalization rates. In the multivariate analysis, the individual indicators the most related to an increased risk of long-term hospitalization were: total lack of autonomy (OR=9.0; 95% CI: 6.7-12.2; P<001); diagnoses of psychological development disorders (OR=9.7; CI95%: 4.5-20.6; P<.001); mental retardation (OR=4.5; CI95%: 2.5-8.2; P<.001): schizophrenia (OR=3.0; CI95%: 1.7-5.2; P<.001); compulsory hospitalization (OR=1.7; CI95%: 1.4-2.1; P<.001); having experienced therapeutic isolation (OR=1.8; CI95%: 1.5-2.1; P<.001). Variations of long-term hospitalization rates depending on the type of establishment were very high, but the density of hospital beds or intensity of ambulatory activity services were not significantly linked to long-term hospitalization. The inhabitants of small urban units had

Oxidation of Al2O3 continuous fiber-reinforced/NiAl composites

NASA Technical Reports Server (NTRS)

Doychak, J.; Nesbitt, J. A.; Noebe, R. D.; Bowman, R. R.

1992-01-01

The 1200 C and 1300 C isothermal and cyclic oxidation behavior of Al2O3 continuous fiber-reinforced/NiAl composites were studied. Oxidation resulted in formation of Al2O3 external scales in a similar manner as scales formed on monolithic NiAl. The isothermal oxidation of an Al2O3/NiAl composite resulted in oxidation of the matrix along the fiber/matrix interface near the fiber ends. This oxide acted as a wedge between the fiber and the matrix, and, under cyclic oxidation conditions, led to further oxidation along the fiber lengths and eventual cracking of the composite. The oxidation behavior of composites in which the Al2O3 fibers were sputter coated with nickel prior to processing was much more severe. This was attributed to open channels around the fibers which formed during processing, most likely as a result of the diffusion of the nickel coating into the matrix.

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

PubMed Central

Lakbala, Parvin

2016-01-01

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

Structure of oxides prepared by decomposition of layered double Mg–Al and Ni–Al hydroxides

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

Cherepanova, Svetlana V.; Novosibirsk State University, Novosibirsk; Leont’eva, Natalya N., E-mail: n_n_leonteva@list.ru

2015-05-15

Abstracts: Thermal decomposition of Mg–Al and Ni–Al layered double hydroxides LDH at temperatures lower than 800 °C leads to the formation of oxides with different structures. Mg–Al oxide has a very defective structure and consists of octahedral layers as in periclase MgO and mixed octahedral–tetrahedral layers as in spinel MgAl{sub 2}O{sub 4}. Mixed Ni–Al oxide has a sandwich-like structure, consisting of a core with Al-doped NiO-like structure and some surface layers with spinel NiAl{sub 2}O{sub 4} structure epitaxial connected with the core. Suggested models were verified by simulation of X-ray diffraction patterns using DIFFaX code, as well as HRTEM, IR-,more » UV-spectroscopies, and XPS. - Graphical abstract: In the Mg–Al layered double hydroxide Al{sup 3+} ions migrate into interlayers during decomposition. The Mg–Al oxide represents sequence of octahedral and octahedral–tetrahedral spinel layers with vacancies. The Ni–Al oxide has a sandwich-like structure with NiO-like core and surface spinel layers as a result of migration of Al{sup 3+} ions on the surface. The models explain the presence and absence of “memory effect” for the Mg–Al and Ni–Al oxides, respectively. - Highlights: • We study products of Mg(Ni)–Al LDH decomposition by calcination at 500(400)–800 °C. • In Mg–Al/Ni–Al LDH Al ions migrate into interlayers/on the surface during decomposition. • Mg–Al oxide represents sequence of periclase- and spinel-like layers with vacancies. • Ni–Al oxide has a sandwich-like structure with NiO-like core and surface spinel layers. • The models explain the presence/absence of “memory effect” for Mg–Al/Ni–Al oxides.« less

Norovirus - hospital

MedlinePlus

Gastroenteritis - norovirus; Colitis - norovirus; Hospital acquired infection - norovirus ... small health problem for you can be a big health problem for someone in the hospital who is already sick. Even when there is ...

Candiduria in hospitalized patients in teaching hospitals of Ahvaz.

PubMed

Zarei-Mahmoudabadi, A; Zarrin, M; Ghanatir, F; Vazirianzadeh, B

2012-12-01

Nosocomial infections are usually acquired during hospitalization. Fungal infection of the urinary tract is increasing due to predisposing factors such as; antibacterial agents, indwelling urinary catheters, diabetes mellitus, long hospitalization, immunosuppressive agents, use of IV catheters, radiation therapy, malignancy. The aim of our study was to determine the prevalence of candiduria and urinary tract infection in patients admitted in Golestan and Emam Khomeini hospitals of Ahvaz, Iran. During 14 months, a total of 744 urine samples were collected and transferred to medical mycology laboratory immediately. Ten µl of uncentrifuged sample was cultured on CHROM agar Candida plates and incubated at 37°C for 24-48h aerobically. Candida species were identified based on colony morphology on CHROM agar Candida, germ tube production and micro-morphology on corn meal agar including 1% Tween 80. In the present study, 744 hospitalized patients were sampled (49.5%, female; 50.5%, male). The prevalence of candiduria in subjects was 16.5% that included 65.1% female and 34.9% male. The most common isolates were C. albicans (53.3%), followed by C. glabrata (24.4%), C. tropicalis (3.7%), C. krusei (2.2%), and Geotrichum spp. (0.7%) Urine cultures yielded more than 10,000 yeast colonies in 34.1% of cases, and the major predisposing factor associated with candiduria was antibiotic therapy (69.1%). Candiduria is relatively common in hospitalized patients in educational hospitals of Ahvaz. In addition, there is a strong correlation between the incidence of candiduria in hospitalized patients and broad-spectrum antibiotics therapy.

Hospital libraries in perspective.

PubMed Central

Holst, R

1991-01-01

The proliferation of hospital libraries since World War II has created a generation of librarians who take for granted the existence of libraries in hospitals. A literature review for the first half of the twentieth century presents a picture of uncertainty and struggle for identity for the hospital library. Then as now, hospital libraries reflect the institutions within which they operate. A brief history of the development of the American hospital provides a context for describing the various roles that the hospital library has played within its parent institution during the twentieth century. Some personal reflections on working in a hospital library are also presented. PMID:1998812

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

PubMed Central

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

2016-01-01

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

Mobile Technology in Hospital Schools: What Are Hospital Teachers' Professional Learning Needs?

ERIC Educational Resources Information Center

McCarthy, Aidan; Maor, Dorit; McConney, Andrew

2017-01-01

The aim of this study was to identify hospital teachers' professional learning needs to enable effective use of mobile technology in hospital schools. Hospitalized students cannot attend their regular schools and as a result their educational progress and development can suffer. In an attempt to address this, hospital schools provide learning…

Molecular structure of Mg-Al, Mn-Al and Zn-Al halotrichites-type double sulfates--an infrared spectroscopic study.

PubMed

Palmer, Sara J; Frost, Ray L

2011-05-01

Near infrared (NIR), X-ray diffraction (XRD) and infrared (IR) spectroscopy have been applied to halotrichites of the formula MgAl(2)(SO(4))(4)·22H(2)O, MnAl(2)(SO(4))(4)·22H(2)O and ZnAl(2)(SO(4))(4)·22H(2)O. Comparison of the halotrichites in different spectral regions has shown that the incorporation of a divalent transition metal into the halotrichite structure causes a shift in OH stretching band positions to lower wavenumbers. Therefore, an increase of the hydrogen bond strength of the bonded water is observed for divalent cations with a larger molecular mass. XRD has confirmed the formation of halotrichite for all three samples and characteristic peaks of halotrichite have been identified for each halotrichite-type compound. It has been observed that Mg-Al and Mn-Al halotrichite are very similar in structure, while Zn-Al showed several differences particularly in the NIR spectra. This work has shown that compounds with halotrichite structures can be synthesised and characterised by infrared and NIR spectroscopy. Copyright © 2011 Elsevier B.V. All rights reserved.

Marginal Hospital Cost of Surgery-related Hospital-acquired Pressure Ulcers.

PubMed

Spector, William D; Limcangco, Rhona; Owens, Pamela L; Steiner, Claudia A

2016-09-01

Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs). To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics. Data are from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011 and 2012. PU information was obtained using retrospective structured record review from trained MPMS data abstractors. Costs are derived using HCUP hospital-specific cost-to-charge ratios. Marginal cost estimates were made using Extended Estimating Equations. We estimated the marginal cost at the 25th, 50th, and 75th percentiles of the cost distribution using Simultaneous Quantile Regression. We find that 3.5% of major surgical patients developed HAPUs and that the HAPUs added ∼$8200 to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital characteristics. This is an ∼44% addition to the cost of a major surgical stay but less than half of the unadjusted cost difference. In addition, we find that for high-cost stays (75th percentile) HAPUs added ∼$12,100, whereas for low-cost stays (25th percentile) HAPUs added ∼$3900. This paper suggests that HAPUs add ∼44% to the cost of major surgical hospital stays, but the amount varies depending on the total cost of the visit.

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

PubMed Central

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

2011-01-01

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

Organizational culture and its relationship with hospital performance in public hospitals in China.

PubMed

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

2011-12-01

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

Mechanisms of elevated-temperature deformation in the B2 aluminides NiAl and CoAl

NASA Technical Reports Server (NTRS)

Yaney, D. L.; Nix, W. D.

1988-01-01

A strain rate change technique, developed previously for distinguishing between pure-metal and alloy-type creep behavior, was used to study the elevated-temperature deformation behavior of the intermetallic compounds NiAl and CoAl. Tests on NiAl were conducted at temperatures between 1100 and 1300 K while tests on CoAl were performed at temperatures ranging from 1200 to 1400 K. NiAl exhibits pure-metal type behavior over the entire temperature range studied. CoAl, however, undergoes a transition from pure-metal to alloy-type deformation behavior as the temperature is decreased from 1400 to 1200 K. Slip appears to be inherently more difficult in CoAl than in NiAl, with lattice friction effects limiting the mobility of dislocations at a much higher tmeperature in CoAl than in NiAl. The superior strength of CoAl at elevated temperatures may, therefore, be related to a greater lattice friction strengthening effect in CoAl than in NiAl.

Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies.

PubMed

Sanghavi, Prachi; Jena, Anupam B; Newhouse, Joseph P; Zaslavsky, Alan M

2015-11-03

Most Medicare patients seeking emergency medical transport are treated by ambulance providers trained in advanced life support (ALS). Evidence supporting the superiority of ALS over basic life support (BLS) is limited, but some studies suggest ALS may harm patients. To compare outcomes after ALS and BLS in out-of-hospital medical emergencies. Observational study with adjustment for propensity score weights and instrumental variable analyses based on county-level variations in ALS use. Traditional Medicare. 20% random sample of Medicare beneficiaries from nonrural counties between 2006 and 2011 with major trauma, stroke, acute myocardial infarction (AMI), or respiratory failure. Neurologic functioning and survival to 30 days, 90 days, 1 year, and 2 years. Except in cases of AMI, patients showed superior unadjusted outcomes with BLS despite being older and having more comorbidities. In propensity score analyses, survival to 90 days among patients with trauma, stroke, and respiratory failure was higher with BLS than ALS (6.1 percentage points [95% CI, 5.4 to 6.8 percentage points] for trauma; 7.0 percentage points [CI, 6.2 to 7.7 percentage points] for stroke; and 3.7 percentage points [CI, 2.5 to 4.8 percentage points] for respiratory failure). Patients with AMI did not exhibit differences in survival at 30 days but had better survival at 90 days with ALS (1.0 percentage point [CI, 0.1 to 1.9 percentage points]). Neurologic functioning favored BLS for all diagnoses. Results from instrumental variable analyses were broadly consistent with propensity score analyses for trauma and stroke, showed no survival differences between BLS and ALS for respiratory failure, and showed better survival at all time points with BLS than ALS for patients with AMI. Only Medicare beneficiaries from nonrural counties were studied. Advanced life support is associated with substantially higher mortality for several acute medical emergencies than BLS. National Science Foundation, Agency for

From cottage to community hospitals: Watlington Cottage Hospital and its regional context, 1874-2000.

PubMed

Hall, John

2012-01-01

The appearance in England from the 1850s of 'cottage hospitals' in considerable numbers constituted a new and distinctive form of hospital provision. The historiography of hospital care has emphasised the role of the large teaching hospitals, to the neglect of the smaller and general practitioner hospitals. This article inverts that attention, by examining their history and shift in function to 'community hospitals'within their regional setting in the period up to 2000. As the planning of hospitals on a regional basis began from the 1920s, the impact of NHS organisational and planning mechanisms on smaller hospitals is explored through case studies at two levels. The strategy for community hospitals of the Oxford NHS Region--one of the first Regions to formulate such a strategy--and the impact of that strategy on one hospital, Watlington Cottage Hospital, is critically examined through its existence from 1874 to 2000.

The effects of health information technology adoption and hospital-physician integration on hospital efficiency.

PubMed

Cho, Na-Eun; Chang, Jongwha; Atems, Bebonchu

2014-11-01

To determine the impact of health information technology (HIT) adoption and hospital-physician integration on hospital efficiency. Using 2010 data from the American Hospital Association's (AHA) annual survey, the AHA IT survey, supplemented by the CMS Case Mix Index, and the US Census Bureau's small area income and poverty estimates, we examined how the adoption of HIT and employment of physicians affected hospital efficiency and whether they were substitutes or complements. The sample included 2173 hospitals. We employed a 2-stage approach. In the first stage, data envelopment analysis was used to estimate technical efficiency of hospitals. In the second stage, we used instrumental variable approaches, notably 2-stage least squares and the generalized method of moments, to examine the effects of IT adoption and integration on hospital efficiency. We found that HIT adoption and hospital-physician integration, when considered separately, each have statistically significant positive impacts on hospital efficiency. Also, we found that hospitals that adopted HIT with employed physicians will achieve less efficiency compared with hospitals that adopted HIT without employed physicians. Although HIT adoption and hospital-physician integration both seem to be key parts of improving hospital efficiency when one or the other is utilized individually, they can hurt hospital efficiency when utilized together.

CVD Fiber Coatings for Al2O3/NiAl Composites

NASA Technical Reports Server (NTRS)

Boss, Daniel E.

1995-01-01

While sapphire-fiber-reinforced nickel aluminide (Al2O3/NiAl) composites are an attractive candidate for high-temperature structures, the significant difference in the coefficient of thermal expansion between the NiAl matrix and the sapphire fiber creates substantial residual stresses in the composite. This study seeks to produce two fiber-coating systems with the potential to reduce the residual stresses in the sapphire/NiAl composite system. Chemical vapor deposition (CVD) was used to produce both the compensating and compliant-fiber coatings for use in sapphire/NiAl composites. A special reactor was designed and built to produce the FGM and to handle the toxic nickel precursors. This process was successfully used to produce 500-foot lengths of fiber with coating thicknesses of approximately 3 microns, 5 microns, and 10 microns.

Hospitals' Internal Accountability

PubMed Central

Kraetschmer, Nancy; Jass, Janak; Woodman, Cheryl; Koo, Irene; Kromm, Seija K.; Deber, Raisa B.

2014-01-01

This study aimed to enhance understanding of the dimensions of accountability captured and not captured in acute care hospitals in Ontario, Canada. Based on an Ontario-wide survey and follow-up interviews with three acute care hospitals in the Greater Toronto Area, we found that the two dominant dimensions of hospital accountability being reported are financial and quality performance. These two dimensions drove both internal and external reporting. Hospitals' internal reports typically included performance measures that were required or mandated in external reports. Although respondents saw reporting as a valuable mechanism for hospitals and the health system to monitor and track progress against desired outcomes, multiple challenges with current reporting requirements were communicated, including the following: 58% of survey respondents indicated that performance-reporting resources were insufficient; manual data capture and performance reporting were prevalent, with the majority of hospitals lacking sophisticated tools or technology to effectively capture, analyze and report performance data; hospitals tended to focus on those processes and outcomes with high measurability; and 53% of respondents indicated that valuable cross-system accountability, performance measures or both were not captured by current reporting requirements. PMID:25305387

Strengthening hospital nursing.

PubMed

Buerhaus, Peter I; Needleman, Jack; Mattke, Soeren; Stewart, Maureen

2002-01-01

Hospitals, nurses, the media, Congress, and the private sector are increasingly concerned about shortages of registered nurses (RNs) and the impact on safety and quality of patient care. Findings from a growing number of studies provide evidence of a relationship between hospital nurse staffing and adverse outcomes experienced by medical and surgical patients. These findings have policy implications for strengthening the nursing profession, monitoring the quality of hospital care associated with nursing, and improving the relationship between hospitals and the nursing profession.

Facility evaluation of resigned hospital physicians:managerial implications for hospital physician manpower.

PubMed

Cheng, Kao-Chi; Lee, Tsung-Lin; Lin, Yen-Ju; Liu, Chiu-Shong; Lin, Cheng-Chieh; Lai, Shih-Wei

2016-12-01

Turnover of physicians might be responsible for reducing patients' trust and affecting hospital performance. This study aimed to understand physicians' psychological status regarding their hospital work environment and the resources of independent practitioners. This was a cross-sectional study with 774 physicians who had resigned from hospitals and were now practicing privately in clinics in Taichung City as its study population. A mail survey with a multidimensional questionnaire was sent to each subject. This study revealed that older physicians were less satisfied regarding the work environment in their respective former hospitals. Male physicians were found to be more satisfied with the tangible resources of their hospitals. Internal medicine physicians were found to be less satisfied overall with the intangible resources. Gynecologists and pediatricians were found to be more satisfied with their hospital environments. The physicians who worked long hours per week reported that they were less satisfied with their job content. The physicians who had opportunities to learn advanced skills and enhance their knowledge were more satisfied with their hospital environment, tangible resources, and intangible resources. In addition, physicians in private hospitals were found to be more satisfied with their job content, but they were less satisfied with work motivation and retention and intangible resources. In addition, physicians who worked in hospitals located in Taichung city reported that they were less satisfied with their tangible resources than the physicians working in hospitals outside of the city. This study focused on the satisfaction of physicians who had already left their respective hospitals instead of current retained physicians. From this study, it is our recommendation that hospital managers should pay closer attention to the real needs and expectations of the physicians they employ, and managers should consider adjusting their managerial perspectives

Substantial shifts in ranking of California hospitals by hospital-associated methicillin-resistant Staphylococcus aureus infection following adjustment for hospital characteristics and case mix.

PubMed

Tehrani, David M; Phelan, Michael J; Cao, Chenghua; Billimek, John; Datta, Rupak; Nguyen, Hoanglong; Kwark, Homin; Huang, Susan S

2014-10-01

States have established public reporting of hospital-associated (HA) infections-including those of methicillin-resistant Staphylococcus aureus (MRSA)-but do not account for hospital case mix or postdischarge events. Identify facility-level characteristics associated with HA-MRSA infection admissions and create adjusted hospital rankings. A retrospective cohort study of 2009-2010 California acute care hospitals. We defined HA-MRSA admissions as involving MRSA pneumonia or septicemia events arising during hospitalization or within 30 days after discharge. We used mandatory hospitalization and US Census data sets to generate hospital population characteristics by summarizing across admissions. Facility-level factors associated with hospitals' proportions of HA-MRSA infection admissions were identified using generalized linear models. Using state methodology, hospitals were categorized into 3 tiers of HA-MRSA infection prevention performance, using raw and adjusted values. Among 323 hospitals, a median of 16 HA-MRSA infections (range, 0-102) per 10,000 admissions was found. Hospitals serving a greater proportion of patients who had serious comorbidities, were from low-education zip codes, and were discharged to locations other than home were associated with higher HA-MRSA infection risk. Total concordance between all raw and adjusted hospital rankings was 0.45 (95% confidence interval, 0.40-0.51). Among 53 community hospitals in the poor-performance category, more than 20% moved into the average-performance category after adjustment. Similarly, among 71 hospitals in the superior-performance category, half moved into the average-performance category after adjustment. When adjusting for nonmodifiable facility characteristics and case mix, hospital rankings based on HA-MRSA infections substantially changed. Quality indicators for hospitals require adequate adjustment for patient population characteristics for valid interhospital performance comparisons.

Epidemiology and Outcomes of Hospitalized Burn Patients in Gaza Strip: A Descriptive Study.

PubMed

Elsous, Aymen; Ouda, Mahmoud; Mohsen, Samah; Al-Shaikh, Mohammed; Mokayad, Siham; Abo-Shaban, Nafiz; Hamad, Abed Al-Rahman

2016-01-01

Burns are serious health problems and leading causes of mortality and morbidity in the Eastern Mediterranean Region. This study aimed to overview the epidemiological profile and to present outcomes among hospitalized burn patients in AL Alamy burn center in Gaza. This was a cross-sectional retrospective study of medical records of hospitalized patients from July 2013 to June 2014. Descriptive analysis for studied variables was applied and P ≤ 0.05 considered statistically significant. One humdred eighty nime admissions, 60.8% were males and 63% were under 10 years old. Burn patients in the age range between 19-40 years represented 25.9%. Most common burn injuries were accidental (86.2%), located at home (88.9%), caused by scald (66.1%) and by fire flame (23.8%). On admission, the majority of cases presented with second degree burn (45.5%) or mixed burn (38.6%). The mean TBSA was 11.86 (SD ± 10.78) ranging from 1% to 75% whereas, the mean hospital length of stay was 11.45 (SD ± 12.60) ranging from 1 to 115 days. Total in hospital mortality rate was 2.1% and length of stay was significantly associated with TBSA (P < 0.001). Young children below 10 years seem to be at a higher risk for burn injuries. A significant improvement in burn patients care is observed and practiced and in hospital mortality rate is better compared to neighbouring countries. Preventive programs focusing on safety measures, especially for mothers working in the home, should be implemented urgently to save our children.

The Relationship Between Hospital Value-Based Purchasing Program Scores and Hospital Bond Ratings.

PubMed

Rangnekar, Anooja; Johnson, Tricia; Garman, Andrew; O'Neil, Patricia

2015-01-01

Tax-exempt hospitals and health systems often borrow long-term debt to fund capital investments. Lenders use bond ratings as a standard metric to assess whether to lend funds to a hospital. Credit rating agencies have historically relied on financial performance measures and a hospital's ability to service debt obligations to determine bond ratings. With the growth in pay-for-performance-based reimbursement models, rating agencies are expanding their hospital bond rating criteria to include hospital utilization and value-based purchasing (VBP) measures. In this study, we evaluated the relationship between the Hospital VBP domains--Clinical Process of Care, Patient Experience of Care, Outcome, and Medicare Spending per Beneficiary (MSPB)--and hospital bond ratings. Given the historical focus on financial performance, we hypothesized that hospital bond ratings are not associated with any of the Hospital VBP domains. This was a retrospective, cross-sectional study of all hospitals that were rated by Moody's for fiscal year 2012 and participated in the Centers for Medicare & Medicaid Services' VBP program as of January 2014 (N = 285). Of the 285 hospitals in the study, 15% had been assigned a bond rating of Aa, and 46% had been assigned an A rating. Using a binary logistic regression model, we found an association between MSPB only and bond ratings, after controlling for other VBP and financial performance scores; however, MSPB did not improve the overall predictive accuracy of the model. Inclusion of VBP scores in the methodology used to determine hospital bond ratings is likely to affect hospital bond ratings in the near term.

Hospital board effectiveness: relationships between board training and hospital financial viability.

PubMed

Molinari, C; Morlock, L; Alexander, J; Lyles, C A

1992-01-01

This study examined whether hospital governing boards that invest in board education and training are more informed and effective decision-making bodies. Measures of hospital financial viability (i.e., selected financial ratios and outcomes) are used as indicators of hospital board effectiveness. Board participation in educational programs was significantly associated with improved profitability, liquidity, and occupancy levels, suggesting that investment in the education of directors is likely to enhance hospital viability and thus increase board effectiveness.

Study on Mg/Al Weld Seam Based on Zn–Mg–Al Ternary Alloy

PubMed Central

Liu, Liming; Liu, Fei; Zhu, Meili

2014-01-01

Based on the idea of alloying welding seams, a series of Zn–xAl filler metals was calculated and designed for joining Mg/Al dissimilar metals by gas tungsten arc (GTA) welding. An infrared thermography system was used to measure the temperature of the welding pool during the welding process to investigate the solidification process. It was found that the mechanical properties of the welded joints were improved with the increasing of the Al content in the Zn–xAl filler metals, and when Zn–30Al was used as the filler metal, the ultimate tensile strength could reach a maximum of 120 MPa. The reason for the average tensile strength of the joint increasing was that the weak zone of the joint using Zn–30Al filler metal was generated primarily by α-Al instead of MgZn2. When Zn–40Al was used as the filler metal, a new transition zone, about 20 μm-wide, appeared in the edge of the fusion zone near the Mg base metal. Due to the transition zones consisting of MgZn2- and Al-based solid solution, the mechanical property of the joints was deteriorated. PMID:28788508

Chemical failure modes of AlQ3-based OLEDs: AlQ3 hydrolysis.

PubMed

Knox, John E; Halls, Mathew D; Hratchian, Hrant P; Schlegel, H Bernhard

2006-03-28

Tris(8-hydroxyquinoline)aluminum(III), AlQ3, is used in organic light-emitting diodes (OLEDs) as an electron-transport material and emitting layer. The reaction of AlQ3 with trace H2O has been implicated as a major failure pathway for AlQ3-based OLEDs. Hybrid density functional calculations have been carried out to characterize the hydrolysis of AlQ3. The thermochemical and atomistic details for this important reaction are reported for both the neutral and oxidized AlQ3/AlQ3+ systems. In support of experimental conclusions, the neutral hydrolysis reaction pathway is found to be a thermally activated process, having a classical barrier height of 24.2 kcal mol(-1). First-principles infrared and electronic absorption spectra are compared to further characterize AlQ3 and the hydrolysis pathway product, AlQ2OH. The activation energy for the cationic AlQ3 hydrolysis pathway is found to be 8.5 kcal mol(-1) lower than for the neutral reaction, which is significant since it suggests a role for charge imbalance in promoting chemical failure modes in OLED devices.

Hospital days, hospitalization costs, and inpatient mortality among patients with mucormycosis: a retrospective analysis of US hospital discharge data

PubMed Central

2014-01-01

Background Mucormycosis is a rare and potentially fatal fungal infection occurring primarily in severely immunosuppressed patients. Because it is so rare, reports in the literature are mainly limited to case reports or small case series. The aim of this study was to evaluate inpatient mortality, length of stay (LOS), and costs among a matched sample of high-risk patients with and without mucormycosis in a large nationally representative database. Methods We conducted a retrospective analysis using the 2003–2010 Healthcare Cost and Utilization Project – Nationwide Inpatient Sample (HCUP-NIS). The NIS is a nationally representative 20% sample of hospitalizations from acute care United States (US) hospitals, with survey weights available to compute national estimates. We classified hospitalizations into four mutually exclusive risk categories for mucormycosis: A- severely immunocompromised, B- critically ill, C- mildly/moderately immunocompromised, D- major surgery or pneumonia. Mucormycosis hospitalizations (“cases”) were identified by ICD-9-CM code 117.7. Non-mucormycosis hospitalizations (“non-cases”) were propensity-score matched to cases 3:1. We examined demographics, clinical characteristics, and hospital outcomes (mortality, LOS, costs). Weighted results were reported. Results From 319,366,817 total hospitalizations, 5,346 cases were matched to 15,999 non-cases. Cases and non-cases did not differ significantly in age (49.6 vs. 49.7 years), female sex (40.5% vs. 41.0%), White race (53.3% vs. 55.9%) or high-risk group (A-49.1% vs. 49.0%, B-20.0% vs. 21.8%, C-25.5% vs. 23.8%, D-5.5% vs. 5.4%). Cases experienced significantly higher mortality (22.1% vs. 4.4%, P < 0.001), with mean LOS and total costs more than 3-fold higher (24.5 vs. 8.0 days and $90,272 vs. $25,746; both P < 0.001). Conclusions In a national hospital database, hospitalizations with mucormycosis had significantly higher inpatient mortality, LOS, and hospital costs than matched

Optical, structural, and nuclear scientific studies of AlGaN with high Al composition

NASA Astrophysics Data System (ADS)

Lin, Tse Yang; Chung, Yee Ling; Li, Lin; Yao, Shude; Lee, Y. C.; Feng, Zhe Chuan; Ferguson, Ian T.; Lu, Weijie

2010-08-01

AlGaN epilayers with higher Al-compositions were grown by Metalorganic Chemical Vapor Deposition (MOCVD) on (0001) sapphire. Trimethylgallium (TMGa), trimethylaluminium (TMAl) and NH3 were used as the source precursors for Ga, Al, and N, respectively. A 25 nm AlN nucleation layer was first grown at low-temperature of 590 °C at 300 Torr. Followed, AlxGa1-xN layers were grown at 1080 °C on low-temperature AlN nucleation layers. The heterostructures were characterized by a series of techniques, including x-ray diffraction (XRD), Rutherford backscattering (RBS), photoluminescence (PL), scanning electron microscopy (SEM) and Raman scattering. Precise Al compositions were determined through XRD, RBS, and SEM combined measurements. Room Temperature Raman Scattering spectra shows three major bands from AlGaN alloys, which are AlN-like, A1 longitudinal optical (LO) phonon modes, and E2 transverse optical (TO) band, respectively, plus several peak comes from the substrate. Raman spectral line shape analysis lead to an optical determination of the electrical property free carrier concentration of AlGaN. The optical properties of AlGaN with high Al composition were presented here.

Hospital Variation in Time to Epinephrine for Non-Shockable In-Hospital Cardiac Arrest

PubMed Central

Khera, Rohan; Chan, Paul S.; Donnino, Michael; Girotra, Saket

2016-01-01

Background For patients with in-hospital cardiac arrests due to non-shockable rhythms, delays in epinephrine administration beyond 5 minutes is associated with worse survival. However, the extent of hospital variation in delayed epinephrine administration and its impact on hospital-level outcomes is unknown. Methods Within Get with the Guidelines-Resuscitation, we identified 103,932 adult patients (≥18 years) at 548 hospitals with an in-hospital cardiac arrest due to a non-shockable rhythm who received at least 1 dose of epinephrine between 2000 to 2014. We constructed two-level hierarchical regression models to quantify hospital variation in rates of delayed epinephrine administration (>5 minutes) and its association with hospital rates of survival to discharge and survival with functional recovery. Results Overall, 13,213 (12.7%) patients had delays to epinephrine, and this rate varied markedly across hospitals (range: 0% to 53.8%). The odds of delay in epinephrine administration were 58% higher at one randomly selected hospital compared to a similar patient at another randomly selected hospitals (median odds ratio [OR] 1.58; 95% C.I. 1.51 – 1.64). Median risk-standardized survival rate was 12.0% (range: 5.4% to 31.9%) and risk-standardized survival with functional recovery was 7.4% (range: 0.9% to 30.8%). There was an inverse correlation between a hospital’s rate of delayed epinephrine administration and its risk-standardized rate of survival to discharge (ρ= −0.22, P<0.0001) and survival with functional recovery (ρ= −0.14, P=0.001). Compared to a median survival rate of 12.9% (interquartile range 11.1% to 15.4%) at hospitals in the lowest quartile of epinephrine delay, risk-standardized survival was 16% lower at hospitals in the quartile with the highest rate of epinephrine delays (10.8%, interquartile range: 9.7% to 12.7%). Conclusions Delays in epinephrine administration following in-hospital cardiac arrest are common and varies across hospitals

Epitaxial growth of Al9Ir2 intermetallic compound on Al(100): Mechanism and interface structure

NASA Astrophysics Data System (ADS)

Kadok, J.; Pussi, K.; Šturm, S.; Ambrožič, B.; Gaudry, É.; de Weerd, M.-C.; Fournée, V.; Ledieu, J.

2018-04-01

The adsorption of Ir adatoms on Al(100) has been investigated under various exposures and temperature conditions. The experimental and theoretical results reveal a diffusion of Ir adatoms within the Al(100) surface selvedge already at 300 K. Above 593 K, two domains of a (√{5 }×√{5 }) R 26 .6∘ phase are identified by low energy electron diffraction (LEED) and scanning tunneling microscopy measurements. This phase corresponds to the initial growth of an Al9Ir2 compound at the Al(100) surface. The Al9Ir2 intermetallic domains are terminated by bulklike pure Al layers. The structural stability of Al9Ir2 (001) grown on Al(100) has been analyzed by density functional theory based calculations. Dynamical LEED analysis is consistent with an Ir adsorption leading to the growth of an Al9Ir2 intermetallic compound. We propose that the epitaxial relationship Al9Ir2(001 ) ∥Al (100) and Al9Ir2[100 ] ∥Al [031 ]/[013 ] originates from a matching of Al atomic arrangements present both on Al(100) and on pure Al(001) layers present in the Al9Ir2 compound. Finally, the interface between Al9Ir2 precipitates and the Al matrix has been characterized by transmission electron microscopy measurements. The cross-sectional observations are consistent with the formation of Al9Ir2 (001) compounds. These measurements indicate an important Ir diffusion within Al(100) near the surface region. The coherent interface between Al9Ir2 and the Al matrix is sharp.

Positioning hospitals: a model for regional hospitals.

PubMed

Reddy, A C; Campbell, D P

1993-01-01

In an age of marketing warfare in the health care industry, hospitals need creative strategies to compete successfully. Lately, positioning concepts have been added to the health care marketer's arsenal of strategies. To blend theory with practice, the authors review basic positioning theory and present a framework for developing positioning strategies. They also evaluate the marketing strategies of a regional hospital to provide a case example.

Formation of gamma(sup prime)-Ni3Al via the Peritectoid Reaction: gamma + beta (+ Al2O3)=gamma(sup prime)(+ Al2O3)

NASA Technical Reports Server (NTRS)

Copeland, Evan

2008-01-01

The activities of Al and Ni were measured using multi-cell Knudsen effusion-cell mass spectrometry (multi-cell KEMS), over the composition range 8-32 at.%Al and temperature range T=1400-1750 K in the Ni-Al-O system. These measurements establish that equilibrium solidification of gamma(sup prime)-Ni3Al-containing alloys occurs by the eutectic reaction, L (+ Al2O3)=gamma + Beta(+ Al2O3), at 1640 +/- 1 K and a liquid composition of 24.8 +/- 0.2 at.%al (at an unknown oxygen content). The {gamma + Beta (+Al2O3} phase field is stable over the temperature range 1633-1640 K, and gamma(sup prime)-Ni3Al forms via the peritectoid, gamma + Beta (+ Al2O3)=gamma(sup prime) (+ Al2O3), at 1633 +/- 1 K. This behavior is consistent with the current Ni-Al phase diagram and a new diagram is proposed. This new Ni-Al phase diagram explains a number of unusual steady-state solidification structures reported previously and provides a much simpler reaction scheme in the vicinity of the gamma(sup prime)-Ni2Al phase field.

Hospital enterprise Architecture Framework (Study of Iranian University Hospital Organization).

PubMed

Haghighathoseini, Atefehsadat; Bobarshad, Hossein; Saghafi, Fatehmeh; Rezaei, Mohammad Sadegh; Bagherzadeh, Nader

2018-06-01

Nowadays developing smart and fast services for patients and transforming hospitals to modern hospitals is considered a necessity. Living in the world inundated with information systems, designing services based on information technology entails a suitable architecture framework. This paper aims to present a localized enterprise architecture framework for the Iranian university hospital. Using two dimensions of implementation and having appropriate characteristics, the best 17 enterprises frameworks were chosen. As part of this effort, five criteria were selected according to experts' inputs. According to these criteria, five frameworks which had the highest rank were chosen. Then 44 general characteristics were extracted from the existing 17 frameworks after careful studying. Then a questionnaire was written accordingly to distinguish the necessity of those characteristics using expert's opinions and Delphi method. The result showed eight important criteria. In the next step, using AHP method, TOGAF was chosen regarding having appropriate characteristics and the ability to be implemented among reference formats. In the next step, enterprise architecture framework was designed by TOGAF in a conceptual model and its layers. For determining architecture framework parts, a questionnaire with 145 questions was written based on literature review and expert's opinions. The results showed during localization of TOGAF for Iran, 111 of 145 parts were chosen and certified to be used in the hospital. The results showed that TOGAF could be suitable for use in the hospital. So, a localized Hospital Enterprise Architecture Modelling is developed by customizing TOGAF for an Iranian hospital at eight levels and 11 parts. This new model could be used to be performed in other Iranian hospitals. Copyright © 2018 Elsevier B.V. All rights reserved.

Chemical trend of superconducting transition temperature in hole-doped delafossite of CuAlO2, AgAlO2 and AuAlO2

NASA Astrophysics Data System (ADS)

Nakanishi, Akitaka; Katayama-Yoshida, Hiroshi

2012-12-01

We have performed the first-principles calculations about the superconducting transition temperature Tc of hole-doped delafossite CuAlO2, AgAlO2 and AuAlO2. Calculated Tc are about 50 K (CuAlO2), 40 K (AgAlO2) and 3 K(AuAlO2) at maximum in the optimum hole-doping concentration. The low Tc of AuAlO2 is attributed to the weak electron-phonon interaction caused by the low covalency and heavy atomic mass.

For-Profit Hospital Status and Rehospitalizations to Different Hospitals: An Analysis of Medicare Data

PubMed Central

Kind, Amy JH; Bartels, Christie; Mell, Matthew W; Mullahy, John; Smith, Maureen

2010-01-01

BACKGROUND About one-quarter of rehospitalized Medicare patients are admitted to hospitals different from their original. The extent to which this practice is related to for-profit hospital status, and impacts payments and mortality, is unknown. OBJECTIVE To describe and examine predictors of and payments for rehospitalization to a different hospital within 30 days among Medicare beneficiaries in for-profit and in not-for-profit/public hospitals. DESIGN Retrospective cohort study. SETTING Medicare fee-for-service hospitals throughout the United States. PARTICIPANTS Random 5% national sample of Medicare beneficiaries with acute-care rehospitalizations within 30-days of discharge, 2005–2006 (N=74,564). MEASUREMENTS 30-day rehospitalizations to different hospitals; total payments/mortality over subsequent 30-days. Multivariate logistic and quantile regression models included index hospital for-profit status, discharge counts, geographic region, rural-urban commuting area, and teaching status; and patient sociodemographics, disabled status, comorbidities, and a measure of risk-adjustment. RESULTS 22% (16,622) of the sample was rehospitalized to a different hospital. Factors associated with increased risk for rehospitalization to a different hospital included being hospitalized within a for-profit, major medical school-affiliated, or low volume index hospital, and having a Medicare-defined disability. When compared to those rehospitalized to the same hospital, patients rehospitalized to different hospitals had significantly higher adjusted 30-day total payments (median additional $1,308/patient, p-value<0.001), but no significant differences in 30-day mortality, regardless of index hospital for-profit status. LIMITATIONS The analysis lacked detailed clinical data, and did not assess specific provider practice motivations or the role of patient choice. CONCLUSIONS Rehospitalizations to different hospitals are common among Medicare beneficiaries, more likely among those

[Development of a clinical pathway for the attention of patients with amyotrophic lateral sclerosis in a regional network. ALS Assistance Network-Comunidad de Madrid].

PubMed

Rodríguez de Rivera, F J; Grande, M; García-Caballero, J; Muñoz-Blanco, J; Mora, J; Esteban, J; Guerrero, A; Matias-Guiu, J; de Andrés-Colsa, R; Buey, C; Díez-Tejedor, E

2007-01-01

Amyotrophic lateral sclerosis (ALS) requires complex multidisciplinary attention. Clinical pathways are assistance plans for certain diseases with a predictable course. These plans are established in isolated centers, not in multicenter regions. The aim is to develop a clinical pathway capable of organizing and homogenizing assistance given in ALS Assistance Network-Comunidad de Madrid which is made up of five hospitals, from the beginning until the end of the disease. In successive meetings, neurologists of these hospitals and members of the Madrid Health Service evaluated published therapeutic guidelines and other documents used in ALS assistance. A clinical pathway was developed adapting this information to social-health care conditions in the Comunidad de Madrid following the FOCUS-PDCA model. A clinical pathway was created consisting of a scientist-technical framework which arranges the attention in relationship to the diagnosis and treatment, according to the degree of disease progression and a chronogram. This is accompanied by several patient information documents on the disease and the tests that are required, and a patient assistance evaluation form. The standards are established to reach and to promote 354 constant improvement in patient care. Clinical pathway for the ALS assistance in a regional network organizes the attention and cares that the patients must receive from the beginning to the end of the disease. This arrangement and homogenization of the attention improves the quality of patient care, diminishes variability and rationalizes the use of the health care resources.

[Hospital governance and the structure of German hospital supervisory boards].

PubMed

Kuntz, L; Pulm, J; Wittland, M

2014-06-01

When thinking about corporate governance frequently the supervisory board comes to mind. The aim of this study is to investigate the relationship between the participation of single professions in the supervisory board and hospital financial performance. Based on governance codes, relevant professions that should be part of the supervisory board are identified. With the help of a multiple regression, the relationship between the fractions of these professions in the supervisory board and the return on assets in the year 2009 is examined. The sample consists of 182 hospitals. The study shows that participation of physicians in the supervisory board is related to a higher return on assets. Furthermore, the association between the fractions of nurses and politicians and hospitals financial performance is ­negative. The composition of the supervisory board has a significant effect on hospital performance; it is an important issue for hospital owners. The present study identifies only one positive relationship between the involvement of physicians and financial performance. Other professions could be relevant in achieving other objectives. Further studies are necessary to analyse the effects on other dimensions of hospital performance, e. g., on quality. © Georg Thieme Verlag KG Stuttgart · New York.

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

PubMed

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

2015-09-02

To compare physician owned hospitals (POHs) with non-POHs on metrics around patient populations, quality of care, costs, and payments. Observational study. Acute care hospitals in 95 hospital referral regions in the United States, 2010. 2186 US acute care hospitals (219 POHs and 1967 non-POHs). Proportions of patients using Medicaid and those from ethnic and racial minority groups; hospital performance on patient experience metrics, care processes, risk adjusted 30 day mortality, and readmission rates; costs of care; care payments; and Medicare market share. The 219 POHs were more often small (<100 beds), for profit, and in urban areas. 120 of these POHs were general (non-specialty) hospitals. Compared with patients from non-POHs, those from POHs were younger (77.4 v 78.4 years, P<0.001), less likely to be admitted through an emergency department (23.2% v. 29.0%, P<0.001), equally likely to be black (5.1% v 5.5%, P=0.85) or to use Medicaid (14.9% v 15.4%, P=0.75), and had similar numbers of chronic diseases and predicted mortality scores. POHs and non-POHs performed similarly on patient experience scores, processes of care, risk adjusted 30 day mortality, 30 day readmission rates, costs, and payments for acute myocardial infarction, congestive heart failure, and pneumonia. Although POHs may treat slightly healthier patients, they do not seem to systematically select more profitable or less disadvantaged patients or to provide lower value care. © Blumenthal et al 2015.

Draft Genome Sequences of Six Multidrug-Resistant Clinical Strains of Acinetobacter baumannii, Isolated at Two Major Hospitals in Kuwait.

PubMed

Nasser, Kother; Mustafa, Abu Salim; Khan, Mohd Wasif; Purohit, Prashant; Al-Obaid, Inaam; Dhar, Rita; Al-Fouzan, Wadha

2018-04-19

Acinetobacter baumannii is an important opportunistic pathogen in global health care settings. Its dissemination and multidrug resistance pose an issue with treatment and outbreak control. Here, we present draft genome assemblies of six multidrug-resistant clinical strains of A. baumannii isolated from patients admitted to one of two major hospitals in Kuwait. Copyright © 2018 Nasser et al.

Total quality in acute care hospitals: guidelines for hospital managers.

PubMed

Holthof, B

1991-08-01

Quality improvement can not focus exclusively on peer review and the scientific evaluation of medical care processes. These essential elements have to be complemented with a focus on individual patient needs and preferences. Only then will hospitals create the competitive advantage needed to survive in an increasingly market-driven hospital industry. Hospital managers can identify these patients' needs by 'living the patient experience' and should then set the hospital's quality objectives according to its target patients and their needs. Excellent quality program design, however, is not sufficient. Successful implementation of a quality improvement program further requires fundamental changes in pivotal jobholders' behavior and mindset and in the supporting organizational design elements.

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

Code of Federal Regulations, 2010 CFR

2010-10-01

... other than psychiatric hospitals. 424.13 Section 424.13 Public Health CENTERS FOR MEDICARE & MEDICAID... other than psychiatric hospitals. (a) Content of certification and recertification. Medicare Part A pays for inpatient hospital services of hospitals other than psychiatric hospitals only if a physician...

Is Hospital Teaching Status a Key Factor in Hospital Charge for Children with Hip Fractures?

PubMed Central

Gao, Yubo; Pugely, Andrew; Karam, Matthew; Phisitkul, Phinit; Mendoza, Sergio; Johnston, Richard C.

2013-01-01

OBJECTIVE Proximal femur fractures cause significant pain and economic cost among pediatric patients. The purposes of this study were (a) to evaluate the distribution by hospital type (teaching hospital vs non-teaching hospital) of U.S. pediatric patients aged 1-20 years who were hospitalized with a closed hip fracture and (b) to discern the mean hospital charge and hospital length of stay after employing propensity score to reduce selec-tion bias. METHODS The 2006 Healthcare Cost and Uti-lization Project (HCUP) Kids’ Inpatient Database (KID) was queried for children aged up to 20 years that had principle diagnosis of hip fracture injury. Hip fractures were defined by International Classifi-cation of Diseases, 9th Revision, Clinical Modifica-tion codes 820.0, 820.2 and 820.8 under Section “Injury and Poisoning (800-999)” with principle internal fixation procedure codes 78.55, 79.15 and 79.35. Patient demographics and hospital status were presented and analyzed. Differences in mean hospital charge and hospital length of stay by hospital teaching status were assessed via two propensity score based methods. RESULTS In total, 1,827 patients were nation-ally included for analysis: 1,392 (76.2%) were treated at a teaching hospital and 435 (23.8%) were treated at a non-teaching hospital. The average age of the patients was 12.88 years old in teaching hospitals vs 14.33 years old in nonteaching hospitals. The propensity score based ad-justment method showed mean hospital charge was $34,779 in teaching hospitals and $32,891 in the non-teaching hospitals, but these differences were not significant (p=0.2940). Likewise, mean length of hospital stay was 4.1 days in teaching hospitals and 3.89 days in non-teaching hospitals, but these differences were also not significant (p=0.4220). Conclusions Hospital teaching status did not affect length of stay or total hospital costs in children treated surgically for proximal femur fractures. Future research should be directed at

Elevation of Plasmin-α2-plasmin Inhibitor Complex Predicts the Diagnosis of Systemic AL Amyloidosis in Patients with Monoclonal Protein.

PubMed

Ishiguro, Kazuya; Hayashi, Toshiaki; Yokoyama, Yoshihiro; Aoki, Yuka; Onodera, Kei; Ikeda, Hiroshi; Ishida, Tadao; Nakase, Hiroshi

2018-03-15

Objective The complication of systemic immunoglobulin light chain (AL) amyloidosis in patients with monoclonal immunoglobulin affects the prognosis, but amyloid deposition in tissues is sometimes difficult to detect due to bleeding tendencies and preferential distributions. However, fibrinolysis is known to be exacerbated in patients with systemic AL amyloidosis specifically. We therefore explored new biomarkers for predicting a diagnosis of systemic AL amyloidosis focusing on coagulation and fibrinolysis markers. Methods We reviewed the clinical features and treatment outcomes of patients with serum monoclonal protein, including primary systemic AL amyloidosis and multiple myeloma (MM), treated at our hospital between January 2008 and December 2014. Results Among several biomarkers, only the serum level of plasmin-α2-plasmin inhibitor complex (PIC) in patients with systemic AL amyloidosis (n=26) at the diagnosis was significantly higher than in patients with MM without AL amyloidosis (n=26) (mean±standard deviation, 3.69±2.82 μg/mL vs. 1.23±0.97 μg/mL, p<0.01). The cut-off for predicting a diagnosis of systemic AL amyloidosis in patients with serum monoclonal protein was 1.72 μg/mL with 84.6% sensitivity and 80.8% specificity. Hepatic involvement resulted in a significantly higher PIC level than no involvement in patients with systemic AL amyloidosis. The serum PIC level was also associated with the hematological response of systemic AL amyloidosis. Conclusion PIC is a useful biomarker for the diagnosis and management of patients with systemic AL amyloidosis.

Atomistic simulation of Al-graphene thin film growth on polycrystalline Al substrate

NASA Astrophysics Data System (ADS)

Zhang, Lan; Zhu, Yongchao; Li, Na; Rong, Yan; Xia, Huimin; Ma, Huizhong

2018-03-01

The growth of Al-Graphene composite coatings on polycrystalline Al substrate was investigated by using classical molecular dynamics (MD) simulations. Unlike the diffusion behaviors on single crystal surface, most of adatoms were easily bound by the steps on polycrystalline Al surface, owing to the local accelerated energy. Both Ehrlich-Schwoebel (ES) barriers and the steering effect backed up the volmer-weber growth mode, which was consistent with the dynamic growth process observed in the deposit. The morphology of composite coatings was significantly affected by graphene flakes. Enrichment of graphene flakes gave rise to an increase of the local thickness, and graphene flakes only existed in Al grain boundaries. The size of Al grains in the composite coating visibly decreased when compared with that in the pure Al coating. This grain refinement and the mechanical property can be reinforced by the increase of graphene flakes.

Hospital board effectiveness: relationships between governing board composition and hospital financial viability.

PubMed Central

Molinari, C; Morlock, L; Alexander, J; Lyles, C A

1993-01-01

OBJECTIVE. Two theories--agency and managerialism--are compared with respect to their usefulness in explaining the role of insiders on the hospital board: whether their participation enhances or impairs board financial decision making. DATA SOURCES/STUDY SETTING. The study used 1985 hospital financial and governing board data for a representative sample of acute care California hospitals. STUDY DESIGN. Relationships were examined cross-sectionally between the presence or absence of insiders on the board and measures of hospital financial viability while controlling for the organizational factors of system affiliation, ownership, size, region, and corporate restructuring. PRINCIPAL FINDINGS. Multiple regression analysis found significant relationships between insider (CEO, medical staff) participation and hospital viability. CONCLUSIONS. These results support the managerial theory of governance by suggesting that the CEO and medical staff provide informational advantages to the hospital governing board. However, the cross-sectional design points to the need for future longitudinal studies in order to sequence these relationships between insider participation and improved hospital viability. PMID:8344824

Insulator-semiconductor interface fixed charges in AlGaN/GaN metal-insulator-semiconductor devices with Al2O3 or AlTiO gate dielectrics

NASA Astrophysics Data System (ADS)

Le, Son Phuong; Nguyen, Duong Dai; Suzuki, Toshi-kazu

2018-01-01

We have investigated insulator-semiconductor interface fixed charges in AlGaN/GaN metal-insulator-semiconductor (MIS) devices with Al2O3 or AlTiO (an alloy of Al2O3 and TiO2) gate dielectrics obtained by atomic layer deposition on AlGaN. Analyzing insulator-thickness dependences of threshold voltages for the MIS devices, we evaluated positive interface fixed charges, whose density at the AlTiO/AlGaN interface is significantly lower than that at the Al2O3/AlGaN interface. This and a higher dielectric constant of AlTiO lead to rather shallower threshold voltages for the AlTiO gate dielectric than for Al2O3. The lower interface fixed charge density also leads to the fact that the two-dimensional electron concentration is a decreasing function of the insulator thickness for AlTiO, whereas being an increasing function for Al2O3. Moreover, we discuss the relationship between the interface fixed charges and interface states. From the conductance method, it is shown that the interface state densities are very similar at the Al2O3/AlGaN and AlTiO/AlGaN interfaces. Therefore, we consider that the lower AlTiO/AlGaN interface fixed charge density is not owing to electrons trapped at deep interface states compensating the positive fixed charges and can be attributed to a lower density of oxygen-related interface donors.

26Al- 26Mg and 207Pb- 206Pb systematics of Allende CAIs: Canonical solar initial 26Al/ 27Al ratio reinstated

NASA Astrophysics Data System (ADS)

Jacobsen, Benjamin; Yin, Qing-zhu; Moynier, Frederic; Amelin, Yuri; Krot, Alexander N.; Nagashima, Kazuhide; Hutcheon, Ian D.; Palme, Herbert

2008-07-01

The precise knowledge of the initial 26Al/ 27Al ratio [( 26Al/ 27Al) 0] is crucial if we are to use the very first solid objects formed in our Solar System, calcium-aluminum-rich inclusions (CAIs) as the "time zero" age-anchor and guide future work with other short-lived radio-chronometers in the early Solar System, as well as determining the inventory of heat budgets from radioactivities for early planetary differentiation. New high-precision multi-collector inductively-coupled plasma mass spectrometry (MC-ICP-MS) measurements of 27Al/ 24Mg ratios and Mg-isotopic compositions of nine whole-rock CAIs (six mineralogically characterized fragments and three micro-drilled inclusions) from the CV carbonaceous chondrite, Allende yield a well-defined 26Al- 26Mg fossil isochron with an ( 26Al/ 27Al) 0 of (5.23 ± 0.13) × 10 - 5 . Internal mineral isochrons obtained for three of these CAIs ( A44A, AJEF, and A43) are consistent with the whole-rock CAI isochron. The mineral isochron of AJEF with ( 26Al/ 27Al) 0 = (4.96 ± 0.25) × 10 - 5 , anchored to our precisely determined absolute 207Pb- 206Pb age of 4567.60 ± 0.36 Ma for the same mineral separates, reinstate the "canonical" ( 26Al/ 27Al) 0 of 5 × 10 - 5 for the early Solar System. The uncertainty in ( 26Al/ 27Al) 0 corresponds to a maximum time span of ± 20 Ka (thousand years), suggesting that the Allende CAI formation events were culminated within this time span. Although all Allende CAIs studied experienced multistage formation history, including melting and evaporation in the solar nebula and post-crystallization alteration likely on the asteroidal parent body, the 26Al- 26Mg and U-Pb-isotopic systematics of the mineral separates and bulk CAIs behaved largely as closed-system since their formation. Our data do not support the "supra-canonical" 26Al/ 27Al ratio of individual minerals or their mixtures in CV CAIs, suggesting that the supra-canonical 26Al/ 27Al ratio in the CV CAIs may have resulted from post

Effects of Al(III) and Nano-Al13 Species on Malate Dehydrogenase Activity

PubMed Central

Yang, Xiaodi; Cai, Ling; Peng, Yu; Li, Huihui; Chen, Rong Fu; Shen, Ren Fang

2011-01-01

The effects of different aluminum species on malate dehydrogenase (MDH) activity were investigated by monitoring amperometric i-t curves for the oxidation of NADH at low overpotential using a functionalized multi-wall nanotube (MWNT) modified glass carbon electrode (GCE). The results showed that Al(III) and Al13 can activate the enzymatic activity of MDH, and the activation reaches maximum levels as the Al(III) and Al13 concentration increase. Our study also found that the effects of Al(III) and Al13 on the activity of MDH depended on the pH value and aluminum speciation. Electrochemical and circular dichroism spectra methods were applied to study the effects of nano-sized aluminum compounds on biomolecules. PMID:22163924

Effects of Al(III) and nano-Al13 species on malate dehydrogenase activity.

PubMed

Yang, Xiaodi; Cai, Ling; Peng, Yu; Li, Huihui; Chen, Rong Fu; Shen, Ren Fang

2011-01-01

The effects of different aluminum species on malate dehydrogenase (MDH) activity were investigated by monitoring amperometric i-t curves for the oxidation of NADH at low overpotential using a functionalized multi-wall nanotube (MWNT) modified glass carbon electrode (GCE). The results showed that Al(III) and Al(13) can activate the enzymatic activity of MDH, and the activation reaches maximum levels as the Al(III) and Al(13) concentration increase. Our study also found that the effects of Al(III) and Al(13) on the activity of MDH depended on the pH value and aluminum speciation. Electrochemical and circular dichroism spectra methods were applied to study the effects of nano-sized aluminum compounds on biomolecules.

Medical Student Education in State Psychiatric Hospitals: A Survey of US State Hospitals.

PubMed

Nurenberg, Jeffry R; Schleifer, Steven J; Kennedy, Cheryl; Walker, Mary O; Mayerhoff, David

2016-04-01

State hospitals may be underutilized in medical education. US state psychiatric hospitals were surveyed on current and potential psychiatry medical student education. A 10-item questionnaire, with multiple response formats, was sent to identified hospitals in late 2012. Ninety-seven of 221 hospitals contacted responded. Fifty-three (55%) reported current medical student education programs, including 27 clinical clerkship rotations. Education and training in other disciplines was prevalent in hospitals both with and without medical students. The large majority of responders expressed enthusiasm about medical education. The most frequent reported barrier to new programs was geographic distance from the school. Limited resources were limiting factors for hospitals with and without current programs. Only a minority of US state hospitals may be involved in medical student education. While barriers such as geographic distance may be difficult to overcome, responses suggest opportunities for expanding medical education in the state psychiatric hospitals.

Fracture toughness of Ti-Al3Ti-Al-Al3Ti laminate composites under static and cyclic loading conditions

NASA Astrophysics Data System (ADS)

Patselov, A. M.; Gladkovskii, S. V.; Lavrikov, R. D.; Kamantsev, I. S.

2015-10-01

The static and cyclic fracture toughnesses of a Ti-Al3Ti-Al-Al3Ti laminate composite material containing at most 15 vol % intermetallic compound are studied. Composite specimens are prepared by terminating reaction sintering of titanium and aluminum foils under pressure. The fracture of the titanium layers is quasi-cleavage during cyclic crack growth and is ductile during subsequent static loading.

Measuring Rural Hospital Quality

ERIC Educational Resources Information Center

Moscovice, Ira; Wholey, Douglas R.; Klingner, Jill; Knott, Astrid

2004-01-01

Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities. This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive…

42 CFR 486.322 - Condition: Relationships with hospitals, critical access hospitals, and tissue banks.

Code of Federal Regulations, 2013 CFR

2013-10-01

... access hospitals, and tissue banks. 486.322 Section 486.322 Public Health CENTERS FOR MEDICARE & MEDICAID... Measures § 486.322 Condition: Relationships with hospitals, critical access hospitals, and tissue banks. (a... hospital and critical access hospital staff. (c) Standard: Cooperation with tissue banks. (1) The OPO must...

42 CFR 486.322 - Condition: Relationships with hospitals, critical access hospitals, and tissue banks.

Code of Federal Regulations, 2014 CFR

2014-10-01

... access hospitals, and tissue banks. 486.322 Section 486.322 Public Health CENTERS FOR MEDICARE & MEDICAID... Measures § 486.322 Condition: Relationships with hospitals, critical access hospitals, and tissue banks. (a... hospital and critical access hospital staff. (c) Standard: Cooperation with tissue banks. (1) The OPO must...

42 CFR 486.322 - Condition: Relationships with hospitals, critical access hospitals, and tissue banks.

Code of Federal Regulations, 2010 CFR

2010-10-01

... access hospitals, and tissue banks. 486.322 Section 486.322 Public Health CENTERS FOR MEDICARE & MEDICAID... Measures § 486.322 Condition: Relationships with hospitals, critical access hospitals, and tissue banks. (a... hospital and critical access hospital staff. (c) Standard: Cooperation with tissue banks. (1) The OPO must...

42 CFR 486.322 - Condition: Relationships with hospitals, critical access hospitals, and tissue banks.

Code of Federal Regulations, 2012 CFR

2012-10-01

... access hospitals, and tissue banks. 486.322 Section 486.322 Public Health CENTERS FOR MEDICARE & MEDICAID... Measures § 486.322 Condition: Relationships with hospitals, critical access hospitals, and tissue banks. (a... hospital and critical access hospital staff. (c) Standard: Cooperation with tissue banks. (1) The OPO must...

42 CFR 486.322 - Condition: Relationships with hospitals, critical access hospitals, and tissue banks.

Code of Federal Regulations, 2011 CFR

2011-10-01

... access hospitals, and tissue banks. 486.322 Section 486.322 Public Health CENTERS FOR MEDICARE & MEDICAID... Measures § 486.322 Condition: Relationships with hospitals, critical access hospitals, and tissue banks. (a... hospital and critical access hospital staff. (c) Standard: Cooperation with tissue banks. (1) The OPO must...

Severe Maternal Morbidity and Hospital Cost among Hospitalized Deliveries in the United States.

PubMed

Chen, Han-Yang; Chauhan, Suneet P; Blackwell, Sean C

2018-05-03

 The objective of this study was to estimate the contemporary national rate of severe maternal morbidity (SMM) and its associated hospital cost during delivery hospitalization.  We conducted a retrospective study identifying all delivery hospitalizations in the United States between 2011 and 2012. We used data from the National (Nationwide) Inpatient sample of the Healthcare Cost and Utilization Project. The delivery hospitalizations with SMM were identified by having at least one of the 25 previously established list of diagnosis and procedure codes. Aggregate and mean hospital costs were estimated. A generalized linear regression model was used to examine the association between SMM and hospital costs.  Of 7,438,946 delivery hospitalizations identified, the rate of SMM was 154 per 10,000 delivery hospitalizations. Without any SMM, the mean hospital cost was $4,300 and with any SMM, the mean hospital cost was $11,000. After adjustment, comparing to those without any SMM, the mean cost of delivery hospitalizations with any SMM was 2.1 (95% confidence interval: 2.1-2.2) times higher, and this ratio increases from 1.7-fold in those with only one SMM to 10.3-fold in those with five or more concurrent SMM.  The hospital cost with any SMM was 2.1 times higher than those without any SMM. Our findings highlight the need to identify interventions and guide research efforts to mitigate the rate of SMM and its economic burden. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hospital Choice of Rural Medicare Beneficiaries: Patient, Hospital Attributes, and the Patient–Physician Relationship

PubMed Central

Tai, Wan-Tzu Connie; Porell, Frank W; Adams, E Kathleen

2004-01-01

Objective To examine how patient and hospital attributes and the patient–physician relationship influence hospital choice of rural Medicare beneficiaries. Data Sources Medicare Current Beneficiary Survey (MCBS), Health Care Financing Administration (HCFA) Provider of Services (POS) file, American Hospital Association (AHA) Annual Survey, and Medicare Hospital Service Area (HSA) files for 1994 and 1995. Study Design The study sample consisted of 1,702 hospitalizations of rural Medicare beneficiaries. McFadden's conditional logit model was used to analyze hospital choices of rural Medicare beneficiaries. The model included independent variables to control for patients' and hospitals' attributes and the distance to hospital alternatives. Principal Findings The empirical results show strong preferences of aged patients for closer hospitals and those of greater scale and service capacity. Patients with complex acute medical conditions and those with more resources were more likely to bypass their closest rural hospitals. Beneficiaries were more likely to bypass their closest rural hospital if they had no regular physician, had a shorter patient–physician tie, were dissatisfied with the availability of health care, and had a longer travel time to their physician's office. Conclusions The significant influences of patients' socioeconomic, health, and functional status, their satisfaction with and access to primary care, and their strong preferences for certain hospital attributes should inform federal program initiatives about the likely impacts of policy changes on hospital bypassing behavior. PMID:15533193

Hospital-Confirmed Acute Myocardial Infarction: Prehospital Identification Using the Medical Priority Dispatch System.

PubMed

Clawson, Jeff J; Gardett, Isabel; Scott, Greg; Fivaz, Conrad; Barron, Tracey; Broadbent, Meghan; Olola, Christopher

2018-02-01

Introduction Early recognition of an acute myocardial infarction (AMI) can increase the patient's likelihood of survival. As the first point of contact for patients accessing medical care through emergency services, emergency medical dispatchers (EMDs) represent the earliest potential identification point for AMIs. The objective of the study was to determine how AMI cases were coded and prioritized at the dispatch point, and also to describe the distribution of these cases by patient age and gender. Hypothesis/Problem No studies currently exist that describe the EMD's ability to correctly triage AMIs into Advanced Life Support (ALS) response tiers. The retrospective descriptive study utilized data from three sources: emergency medical dispatch, Emergency Medical Services (EMS), and emergency departments (EDs)/hospitals. The primary outcome measure was the distributions of AMI cases, as categorized by Chief Complaint Protocol, dispatch priority code and level, and patient age and gender. The EMS and ED/hospital data came from the Utah Department of Health (UDoH), Salt Lake City, Utah. Dispatch data came from two emergency communication centers covering the entirety of Salt Lake City and Salt Lake County, Utah. Overall, 89.9% of all the AMIs (n=606) were coded in one of the three highest dispatch priority levels, all of which call for ALS response (called CHARLIE, DELTA, and ECHO in the studied system). The percentage of AMIs significantly increased for patients aged 35 years and older, and varied significantly by gender, dispatch level, and chief complaint. A total of 85.7% of all deaths occurred among patients aged 55 years and older, and 88.9% of the deaths were handled in the ALS-recommended priority levels. Acute myocardial infarctions may present as a variety of clinical symptoms, and the study findings demonstrated that more than one-half were identified as having chief complaints of Chest Pain or Breathing Problems at the dispatch point, followed by Sick

Variations in hospitalization rates among nursing home residents: the role of discretionary hospitalizations.

PubMed

Carter, Mary W

2003-08-01

To examine variations in hospitalization rates among nursing home residents associated with discretionary hospitalization practices. Quarterly Medicaid case-mix reimbursement data from the state of Massachusetts served as the core data source for this study, which was linked with data from the Medicare Provider Analysis and Review file (MEDPAR) to specify hospitalization status, nursing facility attribute data from the state of Massachusetts to specify facility-level organizational and structural attributes, and data from the Area Resource File (ARF) to specify area market-level attributes. Data spans three years (1991-1993) to produce a longitudinal analytical file containing 72,319 person-quarter-level observations. Two-step, multivariate logistic regression models were estimated for highly discretionary hospitalizations versus those containing less discretion, and low discretionary hospitalizations versus those containing greater amounts of physician discretion. Findings indicate that facility case-mix levels and area hospital bed supply levels contribute to variations in hospitalization rates among nursing home residents. Highly discretionary hospitalizations appear to be most sensitive to patient diagnoses best described as chronic, ambulatory care sensitive conditions. Findings suggest that defining hospitalizations simply in terms of whether an event occurs versus otherwise may obscure valuable information regarding the contribution of various risk factors to highly discretionary versus low discretionary hospitalization rates.

Mobility in hospital work: towards a pervasive computing hospital environment.

PubMed

Morán, Elisa B; Tentori, Monica; González, Víctor M; Favela, Jesus; Martínez-Garcia, Ana I

2007-01-01

Handheld computers are increasingly being used by hospital workers. With the integration of wireless networks into hospital information systems, handheld computers can provide the basis for a pervasive computing hospital environment; to develop this designers need empirical information to understand how hospital workers interact with information while moving around. To characterise the medical phenomena we report the results of a workplace study conducted in a hospital. We found that individuals spend about half of their time at their base location, where most of their interactions occur. On average, our informants spent 23% of their time performing information management tasks, followed by coordination (17.08%), clinical case assessment (15.35%) and direct patient care (12.6%). We discuss how our results offer insights for the design of pervasive computing technology, and directions for further research and development in this field such as transferring information between heterogeneous devices and integration of the physical and digital domains.

Co-existence of a few and sub micron inhomogeneities in Al-rich AlGaN/AlN quantum wells

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

Iwata, Yoshiya; Oto, Takao; Banal, Ryan G.

2015-03-21

Inhomogeneity in Al-rich AlGaN/AlN quantum wells is directly observed using our custom-built confocal microscopy photoluminescence (μ-PL) apparatus with a reflective system. The μ-PL system can reach the AlN bandgap in the deep ultra-violet spectral range with a spatial resolution of 1.8 μm. In addition, cathodoluminescence (CL) measurements with a higher spatial resolution of about 100 nm are performed. A comparison of the μ-PL and CL measurements reveals that inhomogeneities, which have different spatial distributions of a few- and sub-micron scales that are superimposed, play key roles in determining the optical properties.

Competition among Turkish hospitals and its effect on hospital efficiency and service quality.

PubMed

Torun, Nazan; Celik, Yusuf; Younis, Mustafa Z

2013-01-01

The level of competition among hospitals in Turkey was analyzed for the years 1990 through 2006 using the Herfindahl-Hirschman Index (HHI). Multiple and simple regression analyses were run to observe the development of competition among hospitals over this period of time, to examine likely determinants of competition, and to calculate the effects of competition on efficiency and quality in individual hospitals. This study found that the level of competition among hospitals in Turkey has increased throughout the years. Also, competition has had a positive effect on the efficiency of hospitals; however, it did not have a significant positive effect on their quality. Moreover, there are important differences in the level of competition among hospitals that vary according to the geographical region, the type of ownership, and the type of hospital. This study is one of the first to evaluate the effects of health policies on competition as well as the effects of increasing competition on hospital quality and efficiency in Turkey.

Hospital power structure and the democratization of hospital administration in Quebec.

PubMed

Eakin, J M

1984-01-01

In 1973, the Canadian Province of Quebec 'democratized' its hospital boards of directors by replacing the previous 'elite' boards by boards representative of the hospitals' major interest groups. This study looks at the impact of these participatory boards on the distribution of power within hospitals, particularly their effect on the hospital administrators' position of control in relation to their boards of directors and medical staff. Findings include a deterioration in the administrators' sense of organizational control, a weakening of the boards' authority over physicians, and a concentration of decision-making outside of the boardroom.

Hospital benchmarking: are U.S. eye hospitals ready?

PubMed

de Korne, Dirk F; van Wijngaarden, Jeroen D H; Sol, Kees J C A; Betz, Robert; Thomas, Richard C; Schein, Oliver D; Klazinga, Niek S

2012-01-01

Benchmarking is increasingly considered a useful management instrument to improve quality in health care, but little is known about its applicability in hospital settings. The aims of this study were to assess the applicability of a benchmarking project in U.S. eye hospitals and compare the results with an international initiative. We evaluated multiple cases by applying an evaluation frame abstracted from the literature to five U.S. eye hospitals that used a set of 10 indicators for efficiency benchmarking. Qualitative analysis entailed 46 semistructured face-to-face interviews with stakeholders, document analyses, and questionnaires. The case studies only partially met the conditions of the evaluation frame. Although learning and quality improvement were stated as overall purposes, the benchmarking initiative was at first focused on efficiency only. No ophthalmic outcomes were included, and clinicians were skeptical about their reporting relevance and disclosure. However, in contrast with earlier findings in international eye hospitals, all U.S. hospitals worked with internal indicators that were integrated in their performance management systems and supported benchmarking. Benchmarking can support performance management in individual hospitals. Having a certain number of comparable institutes provide similar services in a noncompetitive milieu seems to lay fertile ground for benchmarking. International benchmarking is useful only when these conditions are not met nationally. Although the literature focuses on static conditions for effective benchmarking, our case studies show that it is a highly iterative and learning process. The journey of benchmarking seems to be more important than the destination. Improving patient value (health outcomes per unit of cost) requires, however, an integrative perspective where clinicians and administrators closely cooperate on both quality and efficiency issues. If these worlds do not share such a relationship, the added

Sole Community Hospitals: Are They Different? A Statistical Analysis of the Hospitals and Their Treatment under TEFRA and PPS. Hospital Studies Program. Hospital Cost and Utilization Project. Research Note 5.

ERIC Educational Resources Information Center

Farley, Dean E.

A study examined the treatment of sole community hospitals under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) and the Prospective Payment System (PPS) for Medicare as compared to the treatment of hospitals not designated as sole community hospitals under these same two policy guidelines. (A sole community hospital is defined as a…

Age Differences in Hospital Mortality for Acute Myocardial Infarction: Implications for Hospital Profiling.

PubMed

Dharmarajan, Kumar; McNamara, Robert L; Wang, Yongfei; Masoudi, Frederick A; Ross, Joseph S; Spatz, Erica E; Desai, Nihar R; de Lemos, James A; Fonarow, Gregg C; Heidenreich, Paul A; Bhatt, Deepak L; Bernheim, Susannah M; Slattery, Lara E; Khan, Yosef M; Curtis, Jeptha P

2017-10-17

Publicly reported hospital risk-standardized mortality rates (RSMRs) for acute myocardial infarction (AMI) are calculated for Medicare beneficiaries. Outcomes for older patients with AMI may not reflect general outcomes. To examine the relationship between hospital 30-day RSMRs for older patients (aged ≥65 years) and those for younger patients (aged 18 to 64 years) and all patients (aged ≥18 years) with AMI. Retrospective cohort study. 986 hospitals in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry-Get With the Guidelines. Adults hospitalized for AMI from 1 October 2010 to 30 September 2014. Hospital 30-day RSMRs were calculated for older, younger, and all patients using an electronic health record measure of AMI mortality endorsed by the National Quality Forum. Hospitals were ranked by their 30-day RSMRs for these 3 age groups, and agreement in rankings was plotted. The correlation in hospital AMI achievement scores for each age group was also calculated using the Hospital Value-Based Purchasing (HVBP) Program method computed with the electronic health record measure. 267 763 and 276 031 AMI hospitalizations among older and younger patients, respectively, were identified. Median hospital 30-day RSMRs were 9.4%, 3.0%, and 6.2% for older, younger, and all patients, respectively. Most top- and bottom-performing hospitals for older patients were neither top nor bottom performers for younger patients. In contrast, most top and bottom performers for older patients were also top and bottom performers for all patients. Similarly, HVBP achievement scores for older patients correlated weakly with those for younger patients (R = 0.30) and strongly with those for all patients (R = 0.92). Minority of U.S. hospitals. Hospital mortality rankings for older patients with AMI inconsistently reflect rankings for younger patients. Incorporation of younger patients into assessment of hospital outcomes would permit further examination of the

In-Hospital Ischemic Stroke

PubMed Central

2015-01-01

Between 2.2% and 17% of all strokes have symptom onset during hospitalization in a patient originally admitted for another diagnosis or procedure. These in-hospital strokes represent a unique population with different risk factors, more mimics, and substantially worsened outcomes compared to community-onset strokes. The fact that these strokes manifest during the acute care hospitalization, in patients with higher rates of thrombolytic contraindications, creates distinct challenges for treatment. However, the best evidence suggests benefit to treating appropriately selected in-hospital ischemic strokes with thrombolysis. Evidence points toward a “quality gap” for in-hospital stroke with longer in-hospital delays to evaluation and treatment, lower rates of evaluation for etiology, and decreased adherence to consensus quality process measures of care. This quality gap for in-hospital stroke represents a focused opportunity for quality improvement. PMID:26288675

Using the Hospital Nutrition Environment Scan to Evaluate Health Initiative in Hospital Cafeterias.

PubMed

Derrick, Jennifer Willahan; Bellini, Sarah Gunnell; Spelman, Julie

2015-11-01

Health-promoting environments advance health and prevent chronic disease. Hospitals have been charged to promote health and wellness to patients, communities, and 5.3 million adults employed in United States health care environments. In this cross-sectional observational study, the Hospital Nutrition Environment Scan (HNES) was used to measure the nutrition environment of hospital cafeterias and evaluate the influence of the LiVe Well Plate health initiative. Twenty-one hospitals in the Intermountain West region were surveyed between October 2013 and May 2014. Six hospitals participated in the LiVe Well Plate health initiative and were compared with 15 hospitals not participating. The LiVe Well Plate health initiative identified and promoted a healthy meal defined as <600 kcal, <700 mg sodium, and <30% fat. Signage with nutrition information and health initiative branding were also posted at point of purchase. Hospital cafeterias were scored on four subcategories: facilitators and barriers, grab-and-go items, menu offerings, and selection options at point of purchase. Overall, hospitals scored 35.3±13.7 (range=7 to 63) points of 86 total possible points. Cafeterias in health initiative hospitals had significantly higher mean nutrition composite scores compared with non-health initiative hospitals (49.2 vs 29.7; P<0.001). Promoting healthy entrées with nutrition information and branding has a positive influence on the nutrition environment of hospital cafeterias. Additional research is needed to quantify and strategize ways to improve nutrition environments within hospital cafeterias and assess the influence on healthy lifestyle behaviors. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Aluminium (Al) speciation in serum and urine after subcutaneous venom immunotherapy with Al as adjuvant.

PubMed

Michalke, Bernhard; Kramer, Matthias F; Brehler, Randolf

2018-02-21

Aluminium is associated with disorders and is the commonly used vaccine adjuvant. Understanding the mechanisms of how Al is transported, metabolized or of its toxicity depends on the knowledge of Al-interactions with bioligands, i.e. Al-species. Al-speciation in serum is difficult because of low concentration and the risk of exogenous Al contamination. Furthermore, Al-measurements may be hampered according to various interferences. This study aims for developing quality controlled protocols for reliable Al- and Al-species determination and for investigating probable differences in Al (-speciation) after Al-containing subcutaneous immunotherapy (SIT). Sample donors were recruited either for the control group ("class-0", they never had been treated with SIT containing an Al-depot extract) or for the SIT-group ("class-1", they previously had been treated with SIT for insect venom allergy with an Al-depot extract). Blood was drawn for medical reasons and serum prepared. Additionally, some sample donors collected 24-h-urine. They had been informed (and they consented) about the scientific use of their samples. The study was approved by the ethic committee of the "Medical Association Westphalia-Lippe" and of the University of Münster, evaluating the study positively (No. 2013-667-f-S). We applied quality controlled sample preparation and interference-free Al detection by ICP sectorfield-mass spectrometry. Al-species were analysed using size-exclusion-chromatography-ICP-qMS. Al-concentrations or speciation in urine samples showed no differences between class-0 and class-1. Al-citrate was the main uric Al-species. In serum elevated Al-concentrations were found for both classes, with class-1 samples being significantly higher than class-0 (p = 0.041), but class-0 samples being approximately 10-fold too high compared to reference values from non-exposed persons. We identified gel-monovettes as contamination source. In contamination-free samples from HNO 3 -prewashed gel

[Crisis unit at the general hospital: Determinants of further hospitalization].

PubMed

Norotte, C; Omnès, C; Crozier, C; Verlyck, C; Romanos, M

2017-10-01

The availability of short-stay beds for brief admission (less than 72hours) of crisis patients presenting to the emergency room is a model that has gained a growing interest because it allows time for developing alternatives to psychiatric hospitalization and favors a maintained functioning in the community. Still, the determinants influencing the disposition decision at discharge after crisis intervention remain largely unexplored. The primary objective of this study was to determine the factors predicting aftercare dispositions at crisis unit discharge: transfer for further hospitalization or return to the community. Secondary objectives included the description of clinical and socio-demographic characteristics of patients admitted to the crisis unit upon presentation to the emergency room. All patients (n=255) admitted to the short-stay unit of the emergency department of Rambouillet General Hospital during a one-year period were included in the study. Patient characteristics were collected in a retrospective manner from medical records: patterns of referral, acute stressors, presenting symptoms, initial patient demand, Diagnostic and Statistical Manual, 5th edition (DSM-5) disorders, psychiatric history, and socio-demographic characteristics were inferred. Logistic regression analysis was used to determine the factors associated with hospitalization decision upon crisis intervention at discharge. Following crisis intervention at the short-stay unit, 100 patients (39.2%) required further hospitalization and were transferred. Statistically significant factors associated with a higher probability of hospitalization (P<0.05) included the patient's initial wish to be hospitalized (OR=4.28), the presence of a comorbid disorder (OR=3.43), a referral by family or friends (OR=2.89), a history of psychiatric hospitalization (OR=2.71) and suicidal ideation on arrival in the emergency room (OR=2.26). Conversely, significant factors associated with a lower probability of

Synthesis of core-shell AlOOH hollow nanospheres by reacting Al nanoparticles with water

NASA Astrophysics Data System (ADS)

Lozhkomoev, A. S.; Glazkova, E. A.; Bakina, O. V.; Lerner, M. I.; Gotman, I.; Gutmanas, E. Y.; Kazantsev, S. O.; Psakhie, S. G.

2016-05-01

A novel route for the synthesis of boehmite nanospheres with a hollow core and the shell composed of highly crumpled AlOOH nanosheets by oxidizing Al nanopowder in pure water under mild processing conditions is described. The stepwise events of Al transformation into boehmite are followed by monitoring the pH in the reaction medium. A mechanism of formation of hollow AlOOH nanospheres with a well-defined shape and crystallinity is proposed which includes the hydration of the Al oxide passivation layer, local corrosion of metallic Al accompanied by hydrogen evolution, the rupture of the protective layer, the dissolution of Al from the particle interior and the deposition of AlOOH nanosheets on the outer surface. In contrast to previously reported methods of boehmite nanoparticle synthesis, the proposed method is simple, and environmentally friendly and allows the generation of hydrogen gas as a by-product. Due to their high surface area and high, slit-shaped nanoporosity, the synthesized AlOOH nanostructures hold promise for the development of more effective catalysts, adsorbents, vaccines and drug carriers.

Millimeter distance effects of surface plasmon polaritons in electroformed Al-Al2O3-Ag diodes

NASA Astrophysics Data System (ADS)

Hickmott, T. W.

2017-02-01

Electroforming of metal-insulator-metal diodes is a soft dielectric breakdown that changes the high resistance of as-prepared diodes to a low resistance state. Electroforming of Al-Al2O3-metal diodes with anodic Al2O3 results in voltage-controlled negative resistance in the current-voltage (I-V) characteristics, electroluminescence (EL), and electron emission into vacuum (EM). EL is due to electrons injected at the Al-Al2O3 interface combining with radiative defects in Al2O3. Surface plasmon polaritons (SPPs) are electromagnetic waves that can be excited by photons or electrons. SPPs are confined to a metal-dielectric interface, cause large electric fields in the metal and dielectric, and have ranges of micrometers. The temperature dependence of I-V curves, EL, and EM of a group of electroformed Al-Al2O3-Ag diodes with Al2O3 thicknesses between 12 nm and 20 nm, group A, was measured between 200 K and 300 K. After a sequence of temperature measurements, the Al-Al2O3-Ag diodes, the Al-Al2O3 regions between diodes, and portions of the Ag on the glass region that provides contacts to the diodes are darkened. The range of darkening is >7 mm in a diode with 12 nm of Al2O3 and 2.0-3.5 mm in diodes with Al2O3 thicknesses between 14 nm and 20 nm. Darkening is attributed to the occurrence of SPPs generated by EL photons at the Ag-Al2O3 and Al-Al2O3 interfaces. The results are compared to a second group of Al-Al2O3-Ag diodes with identical Al2O3 thicknesses, group B, that were prepared in the same way as the diodes of group A except for a difference in the deposition of Al films for the two groups. Al-Al2O3-Ag diodes of group B exhibit enhanced EL, which is attributed to spontaneous emission of recombination centers in Al2O3 being enhanced by large electromagnetic fields that are due to SPPs that are generated by EL photons.

Electronic transport through Al/InN nanowire/Al junctions

DOE PAGES

Lu, Tzu -Ming; Wang, George T.; Pan, Wei; ...

2016-02-10

We report non-linear electronic transport measurement of Al/Si-doped n-type InN nanowire/Al junctions performed at T = 0.3 K, below the superconducting transition temperature of the Al electrodes. The proximity effect is observed in these devices through a strong dip in resistance at zero bias. In addition to the resistance dip at zero bias, several resistance peaks can be identified at bias voltages above the superconducting gap of the electrodes, while no resistance dip is observed at the superconducting gap. The resistance peaks disappear as the Al electrodes turn normal beyond the critical magnetic field except one which remains visible atmore » fields several times higher than critical magnetic field. An unexpected non-monotonic magnetic field dependence of the peak position is observed. As a result, we discuss the physical origin of these observations and propose that the resistance peaks could be the McMillan-Rowell oscillations arising from different closed paths localized near different regions of the junctions.« less

[Smoking prevalence in hospital workers: meta-analysis in 45 Catalan hospitals].

PubMed

Martínez, Cristina; Martínez-Sánchez, Jose M; Antón, Laura; Riccobene, Anna; Fu, Marcela; Quirós, Nuria; Saltó, Esteve; Fernández, Esteve

2016-01-01

To estimate the prevalence of smoking in workers from hospitals within the Catalan Network for Smoke-free hospitals from 2009 to 2012 according to workers' sociodemographic characteristics and the type of hospital. A meta-analysis was performed of prevalence surveys from representative samples of workers from 45 hospitals. The combined prevalence for all hospitals was calculated using a regression model with a random effects model weighted by sample size. The overall prevalence of smoking was 28.1% (95%CI: 26.1 to 30.0%) with a maximum and minimum of 40.3% and 19.1%, respectively. The health professionals with the lowest prevalence of smoking were physicians (16.4%; 95%CI: 12.9 to 19.9) and nurses (25.4%; 95%CI 21.6 to 29.2). The prevalence of smoking in hospital health workers was lower than in the general population of working age. Physicians were the group with the lowest smoking prevalence. Smoking cessation should be promoted among other professional groups. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

[Screening for malnutrition among hospitalized patients in a Colombian University Hospital].

PubMed

Cruz, Viviana; Bernal, Laura; Buitrago, Giancarlo; Ruiz, Álvaro J

2017-04-01

On admission, 30 to 50% of hospitalized patients have some degree of malnutrition, which is associated with longer length of stay, higher rates of complications, mortality and greater costs. To determine the frequency of screening for risk of malnutrition in medical records and assess the usefulness of the Malnutrition Screening Tool (MST). In a cross-sectional study, we searched for malnutrition screening in medical records, and we applied the MST tool to hospitalized patients at the Internal Medicine Wards of San Ignacio University Hospital. Of 295 patients included, none had been screened for malnutrition since hospital admission. Sixty one percent were at nutritional risk, with a higher prevalence among patients with HIV (85.7%), cancer (77.5%) and pneumonia. A positive MST result was associated with a 3.2 days increase in length of hospital stay (p = 0.024). The prevalence of malnutrition risk in hospitalized patients is high, but its screening is inadequate and it is underdiagnosed. The MST tool is simple, fast, low-cost, and has a good diagnostic performance.

Hospital pharmacy workforce in Brazil.

PubMed

Santos, Thiago R; Penm, Jonathan; Baldoni, André O; Ayres, Lorena Rocha; Moles, Rebekah; Sanches, Cristina

2018-01-04

This study aims to describe the distribution of the hospital pharmacy workforce in Brazil. Data were acquired, during 2016, through the Brazilian National Database of Healthcare Facilities (CNES). The following variables were extracted: hospital name, registry number, telephone, e-mail, state, type of institution, subtype, management nature, ownership, presence of research/teaching activities, complexity level, number of hospital beds, presence of pharmacists, number of pharmacists, pharmacist specialization. All statistical analyses were performed by IBM SPSS v.19. The number of hospitals with a complete registry in the national database was 4790. The majority were general hospitals (77.9%), managed by municipalities (66.1%), under public administration (44.0%), had no research/teaching activities (90.5%), classified as medium complexity (71.6%), and had no pharmacist in their team (50.6%). Furthermore, almost 60.0% of hospitals did not comply with the minimum recommendations of having a pharmacist per 50 hospital beds. The Southeast region had the highest prevalence of pharmacists, with 64.4% of hospitals having a pharmaceutical professional. This may have occurred as this region had the highest population to hospital ratio. Non-profit hospitals were more likely to have pharmacists compared to those under public administration and private hospitals. This study mapped the hospital pharmacy workforce in Brazil, showing a higher prevalence of hospital pharmacists in the Southeast region, and in non-profit specialized hospitals.

Sustainability and scalability of the hospital elder life program at a community hospital.

PubMed

Rubin, Fred H; Neal, Kelly; Fenlon, Kerry; Hassan, Shuja; Inouye, Sharon K

2011-02-01

The Hospital Elder Life Program (HELP), an effective intervention to prevent delirium in older hospitalized adults, has been successfully replicated in a community teaching hospital as a quality improvement project. This article reports on successfully sustaining the program over 7 years and expanding its scale from one to six inpatient units at the same hospital. The program currently serves more than 7,000 older patients annually and is accepted as the standard of care throughout the hospital. Innovations that enhanced scalability and widespread implementation included ensuring dedicated staffing for the program, local adaptations to streamline protocols, continuous recruitment of volunteers, and more-efficient data collection. Outcomes include a lower rate of incident delirium; shorter length of stay (LOS); greater satisfaction of patients, families, and nursing staff; and significantly lower costs for the hospital. The financial return of the program, estimated at more than $7.3 million per year during 2008, comprises cost savings from delirium prevention and revenue generated from freeing up hospital beds (shorter LOS of HELP patients with and without delirium). Delirium poses a major challenge for hospital quality of care, patient safety, Medicare no-pay conditions, and costs of hospital care for older persons. Faced with rising numbers of elderly patients, hospitals can use HELP to improve the quality and cost-effectiveness of care. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

Rechargeable Al/Cl2 battery with molten AlCl4/-/ electrolyte.

NASA Technical Reports Server (NTRS)

Holleck, G. L.; Giner, J.; Burrows, B.

1972-01-01

A molten salt system based on Al- and Cl2 carbon electrodes, with an AlCl3 alkali chloride eutectic as electrolyte, offers promise as a rechargeable, high energy density battery which can operate at a relatively low temperature. Electrode kinetic studies showed that the electrode reactions at the Al anode were rapid and that the observed passivation phenomena were due to the formation at the electrode surface of a solid salt layer resulting from concentration changes on anodic or cathodic current flow. It was established that carbon electrodes were intrinsically active for chlorine reduction in AlCl3-alkali chloride melts. By means of a rotating vitreous carbon disk electrode, the kinetic parameters were determined.

Two-Phase Eutectic Growth in Al-Cu and Al-Cu-Ag

NASA Astrophysics Data System (ADS)

Senninger, Oriane; Peters, Matthew; Voorhees, Peter W.

2018-02-01

The microstructure developed by two-phase lamellar eutectics (α ) -(θ {-Al}2{Cu}) in Al-Cu and Al-Cu-Ag alloys is analyzed. A model of two-phase eutectic growth in multicomponent alloys is used to determine the scaling law of the eutectic microstructure using the alloy thermophysical properties. The application of the model to these alloys shows that the addition of Ag to Al-Cu alloys does not significantly change the length scale of the microstructure, which is in agreement with previous experimental studies. This is explained by the combined phenomena of the decrease in interface energies with the addition of Ag and the superheating of the (α ) phase interface induced by the Ag composition profile.

Noninvasive and invasive ventilation and enteral nutrition for ALS in Italy.

PubMed

Fini, Nicola; Georgoulopoulou, Eleni; Vinceti, Marco; Monelli, Marco; Pinelli, Giovanni; Vacondio, Paolo; Giovannini, Michele; Dallari, Rossano; Marudi, Andrea; Mandrioli, Jessica

2014-10-01

We performed a population-based study to assess amyotrophic lateral sclerosis (ALS) survival after noninvasive ventilation (NIV), invasive ventilation (IV), and enteral nutrition (EN). We included patients diagnosed from 2000 to 2009 in Modena, where a prospective registry and a Motor Neuron Diseases Centre have been active since 2000. Of the 193 incident cases, 47.7% received NIV, 24.3% received tracheostomy, and 49.2% received EN. A total of 10.4% of the patients refused NIV, 31.6% refused IV, and 8.7% refused EN. The median survival times after NIV, IV, and EN were 15, 19, and 9 months, respectively. Of the tracheostomized patients, 79.7% were discharged from the hospital; 73.0% were discharged to home. The median survival times for tracheostomized patients who were cared for at home and in nursing homes were 43 and 2 months, respectively. The multivariate analysis demonstrated that the place of discharge was the only independent prognostic factor after IV (P<0.01). Service organizations may promote adherence to NIV, IV, EN, and influence postprocedure survival. These data may be useful in defining health plans regarding advanced ALS care and in patient counseling. © 2014 Wiley Periodicals, Inc.

Hot Corrosion Behavior of Stainless Steel with Al-Si/Al-Si-Cr Coating

NASA Astrophysics Data System (ADS)

Fu, Guangyan; Wu, Yongzhao; Liu, Qun; Li, Rongguang; Su, Yong

2017-03-01

The 1Cr18Ni9Ti stainless steel with Al-Si/Al-Si-Cr coatings is prepared by slurry process and vacuum diffusion, and the hot corrosion behavior of the stainless steel with/without the coatings is studied under the condition of Na2SO4 film at 950 °C in air. Results show that the corrosion kinetics of stainless steel, the stainless steel with Al-Si coating and the stainless steel with Al-Si-Cr coating follow parabolic laws in several segments. After 24 h corrosion, the sequence of the mass gain for the three alloys is the stainless steel with Al-Si-Cr coating < the stainless steel with Al-Si coating < the stainless steel without any coating. The corrosion products of the three alloys are layered. Thereinto, the corrosion products of stainless steel without coating are divided into two layers, where the outside layer contains a composite of Fe2O3 and FeO, and the inner layer is Cr2O3. The corrosion products of the stainless steel with Al-Si coating are also divided into two layers, of which the outside layer mainly consists of Cr2O3, and the inner layer is mainly SiO2. The corrosion film of the stainless steel with Al-Si-Cr coating is thin and dense, which combines well with substrate. Thereinto, the outside layer is mainly Cr2O3, and the inside layer is Al2O3. In the matrix of all of the three alloys, there exist small amount of sulfides. Continuous and protective films of Cr2O3, SiO2 and Al2O3 form on the surface of the stainless steel with Al-Si and Al-Si-Cr coatings, which prevent further oxidation or sulfide corrosion of matrix metals, and this is the main reason for the much smaller mass gain of the two alloys than that of the stainless steel without any coatings in the 24 h hot corrosion process.

The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital.

PubMed

Forster, Alan J; Taljaard, Monica; Oake, Natalie; Wilson, Kumanan; Roth, Virginia; van Walraven, Carl

2012-01-10

The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital is not yet fully understood. We determined the independent impact of hospital-acquired infection with C. difficile on length of stay in hospital. We conducted a retrospective observational cohort study of admissions to hospital between July 1, 2002, and Mar. 31, 2009, at a single academic hospital. We measured the association between infection with hospital-acquired C. difficile and time to discharge from hospital using Kaplan-Meier methods and a Cox multivariable proportional hazards regression model. We controlled for baseline risk of death and accounted for C. difficile as a time-varying effect. Hospital-acquired infection with C. difficile was identified in 1393 of 136,877 admissions to hospital (overall risk 1.02%, 95% confidence interval [CI] 0.97%-1.06%). The crude median length of stay in hospital was greater for patients with hospital-acquired C. difficile (34 d) than for those without C. difficile (8 d). Survival analysis showed that hospital-acquired infection with C. difficile increased the median length of stay in hospital by six days. In adjusted analyses, hospital-acquired C. difficile was significantly associated with time to discharge, modified by baseline risk of death and time to acquisition of C. difficile. The hazard ratio for discharge by day 7 among patients with hospital-acquired C. difficile was 0.55 (95% CI 0.39-0.70) for patients in the lowest decile of baseline risk of death and 0.45 (95% CI 0.32-0.58) for those in the highest decile; for discharge by day 28, the corresponding hazard ratios were 0.74 (95% CI 0.60-0.87) and 0.61 (95% CI 0.53-0.68). Hospital-acquired infection with C. difficile significantly prolonged length of stay in hospital independent of baseline risk of death.

Microstructural and Phase Composition Differences Across the Interfaces in Al/Ti/Al Explosively Welded Clads

NASA Astrophysics Data System (ADS)

Fronczek, Dagmara Malgorzata; Chulist, Robert; Litynska-Dobrzynska, Lidia; Lopez, Gabriel Alejandro; Wierzbicka-Miernik, Anna; Schell, Norbert; Szulc, Zygmunt; Wojewoda-Budka, Joanna

2017-09-01

The microstructure and phase composition of Al/Ti/Al interfaces with respect to their localization were investigated. An aluminum-flyer plate exhibited finer grains located close to the upper interface than those present within the aluminum-base plate. The same tendency, but with a higher number of twins, was observed for titanium. Good quality bonding with a wavy shape and four intermetallic phases, namely, TiAl3, TiAl, TiAl2, and Ti3Al, was only obtained at the interface closer to the explosive material. The other interface was planar with three intermetallic compounds, excluding the metastable TiAl2 phase. As a result of a 100-hour annealing at 903 K (630 °C), an Al/TiAl3/Ti/TiAl3/Al sandwich was manufactured, formed with single crystalline Al layers. A substantial difference between the intermetallic layer thicknesses was measured, with 235.3 and 167.4 µm obtained for the layers corresponding to the upper and lower interfaces, respectively. An examination by transmission electron microscopy of a thin foil taken from the interface area after a 1-hour annealing at 825 K (552 °C) showed a mixture of randomly located TiAl3 grains within the aluminum. Finally, the hardness results were correlated with the microstructural changes across the samples.

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.

Determinants of the direct cost of heart failure hospitalization in a public tertiary hospital.

PubMed

Parissis, John; Athanasakis, Kostas; Farmakis, Dimitrios; Boubouchairopoulou, Nadia; Mareti, Christina; Bistola, Vasiliki; Ikonomidis, Ignatios; Kyriopoulos, John; Filippatos, Gerasimos; Lekakis, John

2015-02-01

Heart failure (HF) is the first reason for hospital admission in the elderly and represents a major financial burden, the greatest part of which results from hospitalization costs. We sought to analyze current HF hospitalization-related expenditure and identify predictors of cost in a public tertiary hospital in Europe. We performed a retrospective chart review of 197 consecutive patients, aged 56±16years, 80% male, with left ventricular ejection fraction (LVEF) of 30±10%, hospitalized for HF in a major university hospital in Athens, Greece. The survey involved the number of hospitalization days, laboratory investigations and medical therapies. Patients who were hospitalized in CCU/ICU or underwent interventional procedures or device implantations were excluded from analysis. Costs were estimated based on the Greek healthcare system perspective in 2013. Patients were hospitalized for a median of 7 days with a total direct cost of €3198±3260/patient. The largest part of the expenses (79%) was attributed to hospitalization (ward), while laboratory investigations and medical treatment accounted for 17% and 4%, respectively. In multivariate analysis, pre-admission New York Heart Association NYHA class (p=0.001), serum creatinine (p=0.003) and NT-proBNP (p=0.004) were significant independent predictors of hospitalization cost. Direct cost of HF hospitalization is high particularly in patients with more severe symptoms, profound neurohormonal activation and renal dysfunction. Strategies to lower hospitalization rates are warranted in the current setting of financial constraints faced by many European countries. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Response of rice to Al stress and identification of quantitative trait Loci for Al tolerance.

PubMed

Ma, Jian Feng; Shen, Renfang; Zhao, Zhuqing; Wissuwa, Matthias; Takeuchi, Yoshinobu; Ebitani, Takeshi; Yano, Masahiro

2002-06-01

Rice (Oryza sativa L.) shows the highest tolerance to Al toxicity among small-grain cereal crops, however, the mechanisms and genetics responsible for its high Al tolerance are not yet well understood. We investigated the response of rice to Al stress using the japonica variety Koshihikari in comparison to the indica variety Kasalath. Koshihikari showed higher tolerance at various Al concentrations than Kasalath. The Al content in root apexes was less in Koshihikari than in Kasalath, suggesting that exclusion mechanisms rather than internal detoxification are acting in Koshihikari. Al-induced secretion of citrate was observed in both Koshihikari and Kasalath, however, it is unlikely to be the mechanism for Al tolerance because there was no significant difference in the amount of citrate secreted between Koshihikari and Kasalath. Quantitative trait loci (QTLs) for Al tolerance were mapped in a population of 183 backcross inbred lines (BILs) derived from a cross of Koshihikari and Kasalath. Three putative QTLs controlling Al tolerance were detected on chromosomes 1, 2 and 6. Kasalath QTL alleles on chromosome 1 and 2 reduced Al tolerance but increased tolerance on chromosome 6. The three QTLs explained about 27% of the phenotypic variation in Al tolerance. The existence of QTLs for Al tolerance was confirmed in substitution lines for corresponding chromosomal segments.

Current status of nutritional support for hospitalized children: a nationwide hospital-based survey in South Korea.

PubMed

Kim, Seung; Lee, Eun Hye; Yang, Hye Ran

2018-06-01

The prevalence of malnutrition among hospitalized children ranges between 12% and 24%. Although the consequences of hospital malnutrition are enormous, it is often unrecognized and untreated. The aim of this study was to identify the current status of in-hospital nutrition support for children in South Korea by carrying out a nationwide hospital-based survey. Out of 345 general and tertiary hospitals in South Korea, a total of 53 institutes with pediatric gastroenterologists and more than 10 pediatric inpatients were selected. A questionnaire was developed by the nutrition committee of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition. The questionnaires were sent to pediatric gastroenterologists in each hospital. Survey was performed by e-mails. Forty hospitals (75.5%) responded to the survey; 23 of them were tertiary hospitals, and 17 of them were general hospitals. Only 21 hospitals (52.5%) had all the required nutritional support personnel (including pediatrician, nutritionist, pharmacist, and nurse) assigned to pediatric patients. Routine nutritional screening was performed in 22 (55.0%) hospitals on admission, which was lower than that in adult patients (65.8%). Nutritional screening tools varied among hospitals; 33 of 40 (82.5%) hospitals used their own screening tools. The most frequently used nutritional assessment parameters were weight, height, hemoglobin, and serum albumin levels. In our nationwide hospital-based survey, the most frequently reported main barriers of nutritional support in hospitals were lack of manpower and excessive workload, followed by insufficient knowledge and experience. Although this nationwide hospital-based survey targeted general and tertiary hospitals with pediatric gastroenterologists, manpower and medical resources for nutritional support were still insufficient for hospitalized children, and nutritional screening was not routinely performed in many hospitals. More attention to hospital malnutrition

What happens in hospitals does not stay in hospitals: antibiotic-resistant bacteria in hospital wastewater systems.

PubMed

Hocquet, D; Muller, A; Bertrand, X

2016-08-01

Hospitals are hotspots for antimicrobial-resistant bacteria (ARB) and play a major role in both their emergence and spread. Large numbers of these ARB will be ejected from hospitals via wastewater systems. In this review, we present quantitative and qualitative data of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, vancomycin-resistant enterococci and Pseudomonas aeruginosa in hospital wastewaters compared to community wastewaters. We also discuss the fate of these ARB in wastewater treatment plants and in the downstream environment. Published studies have shown that hospital effluents contain ARB, the burden of these bacteria being dependent on their local prevalence. The large amounts of antimicrobials rejected in wastewater exert a continuous selective pressure. Only a few countries recommend the primary treatment of hospital effluents before their discharge into the main wastewater flow for treatment in municipal wastewater treatment plants. Despite the lack of conclusive data, some studies suggest that treatment could favour the ARB, notably ESBL-producing E. coli. Moreover, treatment plants are described as hotspots for the transfer of antibiotic resistance genes between bacterial species. Consequently, large amounts of ARB are released in the environment, but it is unclear whether this release contributes to the global epidemiology of these pathogens. It is reasonable, nevertheless, to postulate that it plays a role in the worldwide progression of antibiotic resistance. Antimicrobial resistance should now be seen as an 'environmental pollutant', and new wastewater treatment processes must be assessed for their capability in eliminating ARB, especially from hospital effluents. Copyright © 2016. Published by Elsevier Ltd.

Herpes Zoster Associated Hospital Admissions in Italy: Review of the Hospital Discharge Forms

PubMed Central

Gabutti, Giovanni; Serenelli, Carlotta; Cavallaro, Alessandra; Ragni, Pietro

2009-01-01

In Italy a specific surveillance system for zoster does not exist, and thus updated and complete epidemiological data are lacking. The objective of this study was to retrospectively review the national hospital discharge forms database for the period 1999–2005 using the code ICD9-CM053. In the period 1999–2005, 35,328 hospital admissions have been registered with annual means of 4,503 hospitalizations and 543 day-hospital admissions. The great part of hospitalizations (61.9%) involved subjects older than 65 years; the mean duration of stay was 8 days. These data, even if restricted to hospitalizations registered at national level, confirm the epidemiological impact of shingles and of its complications. PMID:19826547

Financial impact of surgical site infections on hospitals: the hospital management perspective.

PubMed

Shepard, John; Ward, William; Milstone, Aaron; Carlson, Taylor; Frederick, John; Hadhazy, Eric; Perl, Trish

2013-10-01

Surgical site infections (SSIs) may increase health care costs, but few studies have conducted an analysis from the perspective of hospital administrators. To determine the change in hospital profit due to SSIs. Retrospective study of data from January 1, 2007, to December 31, 2010. The study was performed at 4 of The Johns Hopkins Health System acute care hospitals in Maryland: Johns Hopkins Bayview (560 beds); Howard County General Hospital (238 beds); The Johns Hopkins Hospital (946 beds); and Suburban Hospital (229 beds). Eligible patients for the study included those patients admitted to the 4 hospitals between January 1, 2007, and December 31, 2010, with complete data and the correct International Classification of Diseases, Ninth Revision code, as determined by the infection preventionist. Infection preventionists performed complete medical record review using National Healthcare Safety Network definitions to identify SSIs. Patients were stratified using the All Patient Refined Diagnosis Related Groups to estimate the change in hospital profit due to SSIs. Surgical site infections. The outcomes of the study were the difference in daily total charges, length of stay (LOS), 30-day readmission rate, and profit for patients with an SSI when compared with patients without an SSI. The hypothesis, formulated prior to data collection, that patients with an SSI have higher daily total costs, a longer LOS, and higher 30-day readmission rates than patients without an SSI, was tested using a nonpaired Mann-Whitney U test, an analysis of covariance, and a Pearson χ2 test. Hospital charges were used as a proxy for hospital cost. RESULTS The daily total charges, mean LOS, and 30-day readmission rate for patients with an SSI compared with patients without an SSI were $7493 vs $7924 (P = .99); 10.56 days vs 5.64 days (P < .001); and 51.94 vs 8.19 readmissions per 100 procedures (P < .001). The change in profit due SSIs was $2 268 589. The data suggest that

An epidemiological study of cutaneous leishmaniasis in Al-jabal Al-gharbi, Libya.

PubMed

Abdellatif, Manal Z M; El-Mabrouk, Khamis; Ewis, Ashraf A

2013-02-01

Cutaneous leishmaniasis (CL) is an endemic parasitic infection in the Mediterranean region, including Libya and its Al-jabal Al-gharbi province. We aimed at studying the occupational relevance as well as other epidemiological aspects of CL. We investigated 140 CL cases who attended at Gharyan outpatient polyclinic during a period of 6 months in 2009. CL infection was clinically diagnosed and confirmed by demonstration of Leishmania parasites on smears from lesions. Our findings showed that males were more affected than females (P=0.04), and people above 10-years were more affected than younger ones (P=0.0001). A significant percent of CL cases belonged to Al-Kawasem subprovince (P=0.0001). Farm-related activities were the most frequent occupations among CL cases (P=0.04). In addition to farm workers, housewives and students are at risk groups since they are engaged at farm activities. Moreover, those who have occupations that require staying outdoors for a part of night, e.g., policemen, are also at risk. Compared to children, adult CL patients had multiple lesions (P=0.001) that were more prevalent in their upper and lower extremities than the face (P=0.0001). We conclude that CL is a major health problem in Al-jabal Al-gharbi province of Libya. The presence of rodents and sandflies makes it a suitable environment for Leishmania to spread in an endemic epidemiological pattern. Being engaged in farming activities or outdoor occupations increases the risk of infection. Various clinical patterns of CL suggest the presence of more than 1 species of Leishmania at Al-jabal Al-gharbi province. We propose that the 2 species responsible for CL in this area are L. major and L. tropica. Further investigations to identify the leishmanial species responsible for CL at Al-jabal Al-gharbi together with adoption of preventive and control programs are needed.

An Epidemiological Study of Cutaneous Leishmaniasis in Al-Jabal Al-Gharbi, Libya

PubMed Central

Abdellatif, Manal Z. M.; El-Mabrouk, Khamis

2013-01-01

Cutaneous leishmaniasis (CL) is an endemic parasitic infection in the Mediterranean region, including Libya and its Al-jabal Al-gharbi province. We aimed at studying the occupational relevance as well as other epidemiological aspects of CL. We investigated 140 CL cases who attended at Gharyan outpatient polyclinic during a period of 6 months in 2009. CL infection was clinically diagnosed and confirmed by demonstration of Leishmania parasites on smears from lesions. Our findings showed that males were more affected than females (P=0.04), and people above 10-years were more affected than younger ones (P=0.0001). A significant percent of CL cases belonged to Al-Kawasem subprovince (P=0.0001). Farm-related activities were the most frequent occupations among CL cases (P=0.04). In addition to farm workers, housewives and students are at risk groups since they are engaged at farm activities. Moreover, those who have occupations that require staying outdoors for a part of night, e.g., policemen, are also at risk. Compared to children, adult CL patients had multiple lesions (P=0.001) that were more prevalent in their upper and lower extremities than the face (P=0.0001). We conclude that CL is a major health problem in Al-jabal Al-gharbi province of Libya. The presence of rodents and sandflies makes it a suitable environment for Leishmania to spread in an endemic epidemiological pattern. Being engaged in farming activities or outdoor occupations increases the risk of infection. Various clinical patterns of CL suggest the presence of more than 1 species of Leishmania at Al-jabal Al-gharbi province. We propose that the 2 species responsible for CL in this area are L. major and L. tropica. Further investigations to identify the leishmanial species responsible for CL at Al-jabal Al-gharbi together with adoption of preventive and control programs are needed. PMID:23467624

The Impact of Setting the Standards of Health Promoting Hospitals on Hospital Indicators in Iran

PubMed Central

Amiri, Mohammad; Khosravi, Ahmad; Riyahi, Leila

2016-01-01

Hospitals play a critical role in the health promotion of the society. This study aimed to determine the impact of establishing standards of health promoting hospitals on hospital indicators in Shahroud. This applied study was a quasi-experimental one which was conducted in 2013. Standards of health promoting hospitals were established as an intervention procedure in the Fatemiyeh hospital. Parameters of health promoting hospitals were compared in intervention and control hospitals before and after of intervention (6 months). The data were analyzed using chi-square and t-test. With the establishment of standards for health promotion hospitals, standard scores in intervention and control hospitals were found to be 72.26 ± 4.1 and 16.26 ± 7.5, respectively. T-test showed a significant difference between the mean scores of the hospitals under study (P = 0.001).The chi-square test also showed a significant relationship between patient satisfaction before and after the intervention so that patients’ satisfaction was higher after the intervention (P = 0.001). Commenting on the short-term or long-term positive impacts of establishing standards of health promoting hospitals on all hospital indicators is a bit difficult but preliminary results show the positive impact of the implementation of standards in case hospitals which has led to the improvement of many indicators in the hospital. PMID:27959930

The hospital incident command system: modified model for hospitals in iran.

PubMed

Djalali, Ahmadreza; Hosseinijenab, Vahid; Peyravi, Mahmoudreza; Nekoei-Moghadam, Mahmood; Hosseini, Bashir; Schoenthal, Lisa; Koenig, Kristi L

2015-03-27

Effectiveness of hospital management of disasters requires a well-defined and rehearsed system. The Hospital Incident Command System (HICS), as a standardized method for command and control, was established in Iranian hospitals, but it has performed fairly during disaster exercises. This paper describes the process for, and modifications to HICS undertaken to optimize disaster management in hospitals in Iran. In 2013, a group of 11 subject matter experts participated in an expert consensus modified Delphi to develop modifications to the 2006 version of HICS. The following changes were recommended by the expert panel and subsequently implemented: 1) A Quality Control Officer was added to the Command group; 2) Security was defined as a new section; 3) Infrastructure and Business Continuity Branches were moved from the Operations Section to the Logistics and the Administration Sections, respectively; and 4) the Planning Section was merged within the Finance/Administration Section. An expert consensus group developed a modified HICS that is more feasible to implement given the managerial organization of hospitals in Iran. This new model may enhance hospital performance in managing disasters. Additional studies are needed to test the feasibility and efficacy of the modified HICS in Iran, both during simulations and actual disasters. This process may be a useful model for other countries desiring to improve disaster incident management systems for their hospitals.

Draft Genome Sequences of 12 Clinical and Environmental Methicillin-Resistant Staphylococcus pseudintermedius Strains Isolated from a Veterinary Teaching Hospital in Washington State.

PubMed

Shah, Devendra H; Jones, Lisa P; Paul, Narayan; Davis, Margaret A

2018-04-12

Methicillin-resistant Staphylococcus pseudintermedius (MRSP) is a globally emergent multidrug-resistant pathogen of dogs associated with nosocomial transmission in dogs and with potential zoonotic impacts. Here, we report the draft whole-genome sequences of 12 hospital-associated MRSP strains and their resistance genotypes and phenotypes. Copyright © 2018 Shah et al.

Formation of epitaxial Al 2O 3/NiAl(1 1 0) films: aluminium deposition

NASA Astrophysics Data System (ADS)

Lykhach, Y.; Moroz, V.; Yoshitake, M.

2005-02-01

Structure of epitaxial Al 2O 3 layers formed on NiAl(1 1 0) substrates has been studied by means of reflection high-energy electron diffraction (RHEED). The elucidated structure was compared to the model suggested for 0.5 nm-thick Al 2O 3 layers [K. Müller, H. Lindner, D.M. Zehner, G. Ownby, Verh. Dtsch. Phys. Ges. 25 (1990) 1130; R.M. Jaeger, H. Kuhlenbeck, H.J. Freund, Surf. Sci. 259 (1991) 235]. The stepwise growth of Al 2O 3 film, involving deposition and subsequent oxidation of aluminium onto epitaxial 0.5 nm-thick Al 2O 3 layers, has been investigated. Aluminium was deposited at room temperature, whereas its oxidation took place during annealing at 1070 K. The Al 2O 3 thickness was monitored by means of Auger electron spectroscopy (AES). It was found that Al 2O 3 layer follows the structure of 0.5 nm thick Al 2O 3 film, although a tilting of Al 2O 3(1 1 1) surface plane with respect to NiAl(1 1 0) surface appeared after Al deposition.

Do hospitals cross-subsidize?

PubMed Central

David, Guy; Lindrooth, Richard C.; Helmchen, Lorens A.; Burns, Lawton R.

2017-01-01

Despite its salience as a regulatory tool to ensure the delivery of unprofitable medical services, cross-subsidization of services within hospital systems has been notoriously difficult to detect and quantify. We use repeated shocks to a profitable service in the market for hospital-based medical care to test for cross-subsidization of unprofitable services. Using patient-level data from general short-term hospitals in Arizona and Colorado before and after entry by cardiac specialty hospitals, we study how incumbent hospitals adjusted their provision of three uncontested services that are widely considered to be unprofitable. We estimate that the hospitals most exposed to entry reduced their provision of psychiatric, substance-abuse, and trauma care services at a rate of about one uncontested-service admission for every four cardiac admissions they stood to lose. Although entry by single-specialty hospitals may adversely affect the provision of unprofitable uncontested services, these findings warrant further evaluation of service-line cross-subsidization as a means to finance them. PMID:25062300

Amyotrophic lateral sclerosis (ALS)

MedlinePlus

Lou Gehrig disease; ALS; Upper and lower motor neuron disease; Motor neuron disease ... One out of 10 cases of ALS is due to a genetic defect. The cause is unknown in most other cases. In ALS, motor nerve cells (neurons) waste away ...

All About ALS

MedlinePlus

... by storm with videos of people pouring ice water on themselves for the Ice Bucket Challenge. The worldwide phenomenon raised awareness—and millions of research dollars—for a fatal disease called ALS. ALS ...

Hospital Dermatology, Introduction.

PubMed

Fox, Lindy P

2017-03-01

Inpatient dermatology is emerging as a distinct dermatology subspecialty where dermatologists specialize in caring for patients hospitalized with skin disease. While the main focus of inpatient dermatology is the delivery of top-quality and timely dermatologic care to patients in the hospital setting, the practice of hospital-based dermatology has many additional components that are critical to its success. ©2017 Frontline Medical Communications.

Relative performance of for-profit psychiatric hospitals in investor-owned systems and nonprofit psychiatric hospitals.

PubMed

McCue, M J; Clement, J P

1993-01-01

The authors analyzed the differences in operational and financial performance between 42 matched pairs of for-profit psychiatric hospitals belonging to multifacility organizations and nonprofit psychiatric hospitals for the fiscal years ending in 1986 through 1990. The pairs of short-term hospitals were matched according to location, standard metropolitan statistical area, or wage index. Analyses were based on data on these hospitals from the Health Care Financing Administration. The groups of variables studied included the hospitals' operational performance and productivity, profitability and payer mix, revenue and expenses, and capital structure. Differences in the mean values of the variables for the for-profit hospitals and the nonprofit hospitals were analyzed by pairwise t tests. The for-profit organization hospitals had significantly higher net revenue, lower salary expenses, and higher profits than the nonprofit hospitals. Patients in the for-profit hospitals had longer stays, and these hospitals had fewer full-time employees per adjusted inpatient day and per adjusted discharge. The higher prices and operating margins of the for-profit hospitals belonging to investor-owned systems reflect the profit-maximizing goal of these facilities. The ability of for-profit organization hospitals to achieve economies of scale in expenses, however, was not evident except in the case of salary expenses.

A multicenter qualitative study on preventing hospital-acquired urinary tract infection in US hospitals.

PubMed

Saint, Sanjay; Kowalski, Christine P; Forman, Jane; Damschroder, Laura; Hofer, Timothy P; Kaufman, Samuel R; Creswell, John W; Krein, Sarah L

2008-04-01

Although urinary tract infection (UTI) is the most common hospital-acquired infection, there is little information about why hospitals use or do not use a range of available preventive practices. We thus conducted a multicenter study to understand better how US hospitals approach the prevention of hospital-acquired UTI. This research is part of a larger study employing both quantitative and qualitative methods. The qualitative phase consisted of 38 semistructured phone interviews with key personnel at 14 purposefully sampled US hospitals and 39 in-person interviews at 5 of those 14 hospitals, to identify recurrent and unifying themes that characterize how hospitals have addressed hospital-acquired UTI. Four recurrent themes emerged from our study data. First, although preventing hospital-acquired UTI was a low priority for most hospitals, there was substantial recognition of the value of early removal of a urinary catheter for patients. Second, those hospitals that made UTI prevention a high priority also focused on noninfectious complications and had committed advocates, or "champions," who facilitated prevention activities. Third, hospital-specific pilot studies were important in deciding whether or not to use devices such as antimicrobial-impregnated catheters. Finally, external forces, such as public reporting, influenced UTI surveillance and infection prevention activities. Clinicians and policy makers can use our findings to develop initiatives that, for example, use a champion to promote the removal of unnecessary urinary catheters or exploit external forces, such public reporting, to enhance patient safety.

Hospitality as an Environmental Metaphor.

ERIC Educational Resources Information Center

Horwood, Bert

1991-01-01

Compares stewardship and hospitality as they relate to the biosphere. Traces the origin of the word "hospitality," discusses cultural traditions of hospitality, and applies the concept of hospitality to the natural world. Considers forms of symbiosis in nature: commensals, mutualism, and parasitism. Hospitality promotes respect,…

The Medicare Hospital Readmissions Reduction Program: potential unintended consequences for hospitals serving vulnerable populations.

PubMed

Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

2014-06-01

To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. © Health Research and Educational Trust.

The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations

PubMed Central

Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

2014-01-01

Objective To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Data Sources/Study Setting Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Study Design Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Principal Findings Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Conclusions Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. PMID:24417309

Oxidation behavior of Al/Cr coating on Ti2AlNb alloy at 900 °C

NASA Astrophysics Data System (ADS)

Yang, Zhengang; Liang, Wenping; Miao, Qiang; Chen, Bowen; Ding, Zheng; Roy, Nipon

2018-04-01

In this paper, the Al/Cr coating was fabricated on the surface of Ti2AlNb alloy via rf magnetron sputtering and double glow treatment to enhance oxidation resistance. The protective coating with an outer layer of Al and inner layer of Cr has great bonding strength due to the in-diffusion of Cr and the inter-diffusion between Al and Cr to form Al-Cr alloyed layer which has great hardness. Acoustic emission curve which was detected via WS-2005 scratch tester indicates the bonding strength between Al/Cr coating and substrate is great. Morphology of Ti2AlNb alloy with Al/Cr coating after scratch test shows that the scratch is smooth without disbanding, and the depth and breadth of scratch are changed uniformly. The mass change was reduced after oxidation test due to the Al/Cr protective coating. Isothermal oxidation test at 900 °C was researched. Results indicate that Al/Cr coating provided oxidation resistance of Ti2AlNb alloy with prolonged air exposure at 900 °C. Al2O3 was detected by XRD patterns and SEM images, and was formed on the surface of Ti2AlNb alloy to protect substrate during oxidation test. A certain content of Cr is beneficial for the formation of Al2O3. Besides, Cr2O3 was produced under Al2O3 by outward diffusion of Cr to protect substrate sequentially, no cracks were discovered on Al/Cr protective coating. The process of Ti outward diffusion into surface was suppressive due to integration of Cr-Ti and Al-Ti intermetallics. A steady, adherent and continuous coated layer of Al/Cr on Ti2AlNb alloy increases oxidation resistance.

Elastocaloric effect in CuAlZn and CuAlMn shape memory alloys under compression

PubMed Central

Qian, Suxin; Wang, Yi; Pillsbury, Thomas E.; Hada, Yoshiharu; Yamaguchi, Yuki; Fujimoto, Kenjiro; Hwang, Yunho; Radermacher, Reinhard; Cui, Jun; Yuki, Yoji; Toyotake, Koutaro; Takeuchi, Ichiro

2016-01-01

This paper reports the elastocaloric effect of two Cu-based shape memory alloys: Cu68Al16Zn16 (CuAlZn) and Cu73Al15Mn12 (CuAlMn), under compression at ambient temperature. The compression tests were conducted at two different rates to approach isothermal and adiabatic conditions. Upon unloading at a strain rate of 0.1 s−1 (adiabatic condition) from 4% strain, the highest adiabatic temperature changes (ΔTad) of 4.0 K for CuAlZn and 3.9 K for CuAlMn were obtained. The maximum stress and hysteresis at each strain were compared. The stress at the maximum recoverable strain of 4.0% for CuAlMn was 120 MPa, which is 70% smaller than that of CuAlZn. A smaller hysteresis for the CuAlMn alloy was also obtained, about 70% less compared with the CuAlZn alloy. The latent heat, determined by differential scanning calorimetry, was 4.3 J g−1 for the CuAlZn alloy and 5.0 J g−1 for the CuAlMn alloy. Potential coefficients of performance (COPmat) for these two alloys were calculated based on their physical properties of measured latent heat and hysteresis, and a COPmat of approximately 13.3 for CuAlMn was obtained. This article is part of the themed issue ‘Taking the temperature of phase transitions in cool materials’. PMID:27402936

Structural and compositional evolution of Al{sub 3}(Zr,Y) precipitates in Al-Zr-Y alloy

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

Gao, Haiyan, E-mail: gaohaiyan@sjtu.edu.cn

Structural and compositional evolution of Al{sub 3}(Zr,Y) precipitates in aged Al-Zr-Y alloy was investigated through atom probe tomography (APT) and transmission electron microscope (TEM) analysis and first principles calculations. The results show that short-bar-shaped D0{sub 19}-Al{sub 3}Y with some Zr atoms dissolved in precipitated at the very beginning of decomposition and worked as heterogeneous nuclei for L1{sub 2}-Al{sub 3}Zr with spherical morphology after being aged at 400 °C for 2 h. Quasi-static coarsening happened as the aging treatment lasted from 2 h to 200 h. However, distribution of Zr and Y atoms in Al{sub 3}(Zr,Y) is nearly uniform and Al{submore » 3}(Zr,Y) do not have the typical “Al{sub 3}RE core-Al{sub 3}Zr shell” structure which observed in other RE containing Al-Zr-RE alloys with L1{sub 2}-Al{sub 3}RE as nuclei. First principles calculations revealed that binding energy between Y and Zr is strong during the growth of Al{sub 3}(Zr,Y), which led to the co-precipitation of Y and Zr atoms and attribute to the evolution of Al{sub 3}(Zr,Y). - Highlights: •Al{sub 3}Y precipitated firstly and then became nuclei for Al{sub 3}Zr during aging of Al-Zr-Y. •Al{sub 3}(Zr,Y) precipitates do not have the typical “Al{sub 3}Y core-Al{sub 3}Zr shell” structure. •Strong binding between Y and Zr led to the co-precipitation of Y and Zr atoms.« less

Sociodemographic and Clinical Characteristics of Psychiatric Inpatients Hospitalized Involuntarily and Voluntarily in a Mental Health Hospital

PubMed Central

GÜLTEKİN, Bülent Kadri; ÇELİK, Seda; TİHAN, Aysu; BEŞKARDEŞ, Ali Fuat; SEZER, Umut

2013-01-01

Introduction In this study, we aimed to investigate and compare the sociodemographic and clinical characteristics of psychiatric inpatients hospitalized involuntarily and voluntarily. To our knowledge, there is no study analyzing involuntary psychiatric hospitalization in our country. Method In this retrospective study, we included a total of 504 patients who were involuntarily or voluntarily hospitalized in Bolu Izzet Baysal Mental Health Hospital between 1st of May and 31st October 2010. The data were obtained from the hospital records. Result In the 6-month period, 13.1% of 504 inpatients were hospitalized involuntarily. The number of male patients who were involuntarily hospitalized was higher than the number of female patients. Most of the patients in the involuntary hospitalized group were graduates of primary school, were not married and were not working at the time of hospitalization. Schizophrenia was the most common diagnosis in the involuntarily hospitalized psychiatric patients and these patients needed longer stay in the hospital. The next hospitalization of the involuntarily hospitalized patients was mostly involuntary. Conclusion Most of the involuntarily hospitalized psychiatric inpatients were male, were not working and had the diagnosis of schizophrenia. These general psychiatric risk factors were more important in involuntary hospitalization compared to voluntary hospitalization. We concluded that the high prevalence of involuntary hospitalizations deserved further studies. PMID:28360546

Revisiting Deng et al.'s Multiparty Quantum Secret Sharing Protocol

NASA Astrophysics Data System (ADS)

Hwang, Tzonelih; Hwang, Cheng-Chieh; Yang, Chun-Wei; Li, Chuan-Ming

2011-09-01

The multiparty quantum secret sharing protocol [Deng et al. in Chin. Phys. Lett. 23: 1084-1087, 2006] is revisited in this study. It is found that the performance of Deng et al.'s protocol can be much improved by using the techniques of block-transmission and decoy single photons. As a result, the qubit efficiency is improved 2.4 times and only one classical communication, a public discussion, and two quantum communications between each agent and the secret holder are needed rather than n classical communications, n public discussions, and 3n/2 quantum communications required in the original scheme.

[Hospitalization due to skin diseases at Hôtel-Dieu de France Hospital (Beirut), 1998-2007].

PubMed

Maatouk, Ismaël; Moutran, Roy; Tomb, Roland

2012-01-01

This study aims to determine retrospectively the nature and frequency of dermatological diseases leading to hospitalization at Hôtel-Dieu de France Hospital (HDF) in Beirut, between 1998 and 2007 and to compare them with literature data. For the patients who were hospitalized in dermatology at HDF, we studied: demographics, diagnosis of hospitalization, length of stay, service, mode of financial support, in-hospital evolution, diagnostic tests and treatment. The data were processed by SPSS program. Alopecia areata, psoriatic erythroderma, acute urticaria and vasculitic purpura are the top four diagnoses (85% of hospitalizations). The third of the patients was admitted to same day care. The financial support of the hospitalization is based primarily on public insurance (57.6%). Corticosteroids are the most widely used treatment for patients in dermatology hospital with a frequency of 59.8%. The number of hospitalizations peaked at 44 in 2002 and since then has been declining (11 hospitalizations in 2007). Pathologies encountered in hospital are different from those encountered during consultation. Management of skin diseases on an outpatient basis is often insufficient. In the literature, no profile of skin diseases leading to hospitalization is similar to our study.

Healthcare technologies, quality improvement programs and hospital organizational culture in Canadian hospitals

PubMed Central

2013-01-01

Background Healthcare technology and quality improvement programs have been identified as a means to influence healthcare costs and healthcare quality in Canada. This study seeks to identify whether the ability to implement healthcare technology by a hospital was related to usage of quality improvement programs within the hospital and whether the culture within a hospital plays a role in the adoption of quality improvement programs. Methods A cross-sectional study of Canadian hospitals was conducted in 2010. The sample consisted of hospital administrators that were selected by provincial review boards. The questionnaire consisted of 3 sections: 20 healthcare technology items, 16 quality improvement program items and 63 culture items. Results Rasch model analysis revealed that a hierarchy existed among the healthcare technologies based upon the difficulty of implementation. The results also showed a significant relationship existed between the ability to implement healthcare technologies and the number of quality improvement programs adopted. In addition, culture within a hospital served a mediating role in quality improvement programs adoption. Conclusions Healthcare technologies each have different levels of difficulty. As a consequence, hospitals need to understand their current level of capability before selecting a particular technology in order to assess the level of resources needed. Further the usage of quality improvement programs is related to the ability to implement technology and the culture within a hospital. PMID:24119419

Potential for Hospital Based Corneal Retreival in Hassan District Hospital

PubMed Central

Melsakkare, Suresh Ramappa; Manipur, Sahana R.; Acharya, Pavana; Ramamurthy, Lakshmi Bomalapura

2015-01-01

Context In developing countries, corneal diseases are the second leading cause of blindness. This corneal blindness can be treated through corneal transplantation. Though the present infrastructure is strong enough to increase keratoplasty numbers at a required rate, India has largest corneal blind population in the world. So a constant supply of high quality donor corneal tissue is the key factor for reduction of prevalence of corneal blindness. Considering the magnitude of corneal blindness and shortage of donor cornea, there is a huge gap in the demand and supply. Aim To study the potential for hospital based retrieval of donor corneal tissue in Hassan district hospital after analysing the indicated and contraindicated causes of deaths, so that hospital corneal retrieval program in Hassan district hospital can be planned. Materials and Methods The cross-sectional, retrospective and record-based study included all hospital deaths with age group more than two years occurred during one year period (January 2014 to December 2014). Data regarding demographic profile, cause of death, treatment given and presence of any systemic diseases were collected. The causes of deaths which are contraindicated for the retrieval of corneas were analysed and noted. The contraindications were based on the NPCB guidelines for standard of eye banking in India 2009. Results Out of 855 deaths, number of deaths in males (565) was greater than females (290). Numbers of deaths were highest between 41-60 years age group (343). Deaths due to HIV, septicaemia, meningitis, encephalitis, disseminated malignancies were contraindicated for corneal retrieval. Corneas could be retrieved from 736 deaths out of 855. Potential for corneal retrieval in a period of one year in Hassan District hospital was 86%. Conclusion Hospital corneal retrieval program has got a great potential to bridge the gap between the need for the cornea and actually collected corneas which will contribute enormously in

[The Brazilian Hospital Information System and the acute myocardial infarction hospital care].

PubMed

Escosteguy, Claudia Caminha; Portela, Margareth Crisóstomo; Medronho, Roberto de Andrade; de Vasconcellos, Maurício Teixeira Leite

2002-08-01

To analyze the applicability of the Brazilian Unified Health System's national hospital database to evaluate the quality of acute myocardial infarction hospital care. It was evaluated 1,936 hospital admission forms having acute myocardial infarction (AMI) as primary diagnosis in the municipal district of Rio de Janeiro, Brazil, in 1997. Data was collected from the national hospital database. A stratified random sampling of 391 medical records was also evaluated. AMI diagnosis agreement followed the literature criteria. Variable accuracy analysis was performed using kappa index agreement. The quality of AMI diagnosis registered in hospital admission forms was satisfactory according to the gold standard of the literature. In general, the accuracy of the variables demographics (sex, age group), process (medical procedures and interventions), and outcome (hospital death) was satisfactory. The accuracy of demographics and outcome variables was higher than the one of process variables. Under registration of secondary diagnosis was high in the forms and it was the main limiting factor. Given the study findings and the widespread availability of the national hospital database, it is pertinent its use as an instrument in the evaluation of the quality of AMI medical care.

Fabrication of Al/Mg/Al Composites via Accumulative Roll Bonding and Their Mechanical Properties

PubMed Central

Nie, Jinfeng; Liu, Mingxing; Wang, Fang; Zhao, Yonghao; Li, Yusheng; Cao, Yang; Zhu, Yuntian

2016-01-01

Al(1060)/Mg(AZ31)/Al(1060) multilayered composite was successfully produced using an accumulative roll bonding (ARB) process for up to four cycles at an elevated temperature (400 °C). The microstructure evolution of the composites and the bonding characteristics at the interfaces between Al and Mg layers with increasing ARB cycles were characterized through optical microscopy, field emission scanning electron microscopy (FESEM) and transmission electron microscopy (TEM). It was found that the grains of Al and Mg layers were significantly refined and Al3Mg2 and Al12 Mg17 intermetallic compound layers formed at the Al/Mg bonding interfaces. The strength increased gradually and the ultimate tensile strength (UTS) reached a maximum value of about 240 MPa at the third pass. Furthermore, the strengthening mechanism of the composite was analyzed based on the fracture morphologies. PMID:28774072

The Relationship between Self-esteem and Quality of Life of Patients with Idiopathic Thrombocytopenic Purpura at Isfahan's Sayed Al-Shohada Hospital, Iran, in 2013.

PubMed

Hemati, Zeinab; Kiani, Davood

2016-04-01

Idiopathic thrombocytopenic purpura (ITP) is a chronic disease which is accompanied with hopelessness and loss of the sense of well-being due to its symptoms and treatment. It also affects patients' sense of social and spiritual well-being. This disorder decreases patients' self-esteem and their quality of life by changing their mental image and self-confidence. This study was performed to find the relationship between self-esteem and quality of life of patients with ITP. This was a descriptive-analytical study on 64 patients with ITP who referred to Isfahan's Sayed Al-Shohada Hospital, Iran. In this study, patients with ITP were selected randomly using a random number chart. The data collection tools consisted of the World Health Organization Quality of Life (WHOQOL)-BREF and Coopersmith Self-esteem Inventory (CSEI). Data were analyzed using SPSS and chi-square and Mann-Whitney tests and the Pearson and Spearman's rank correlation coefficients. In total, 64 patients completed the questionnaires. RESULTS showed that 32% of subjects were over 36 years of age and 59% were women. In addition, 29.7% of ITP patients had low self-esteem and quality of life. Chi-square test showed a significant relationship between self-esteem and quality of life of patients with ITP. The results of the present study showed that considerable attention must be paid to self-esteem, as one of the most important factors influencing the promotion of quality of life. Therefore, it is suggested that patient's self-esteem be improved by the implementation of educational and psychological programs in order to decrease the consequences of poor quality of life.

Suppression of gate leakage current in in-situ grown AlN/InAlN/AlN/GaN heterostructures based on the control of internal polarization fields

NASA Astrophysics Data System (ADS)

Kotani, Junji; Yamada, Atsushi; Ishiguro, Tetsuro; Yamaguchi, Hideshi; Nakamura, Norikazu

2017-03-01

This paper investigates the gate leakage characteristics of in-situ AlN capped InAlN/AlN/GaN heterostructures grown by metal-organic vapor phase epitaxy. It was revealed that the leakage characteristics of AlN capped InAlN/AlN/GaN heterostructures are strongly dependent on the growth temperature of the AlN cap. For an AlN capped structure with an AlN growth temperature of 740 °C, the leakage current even increased although there exists a large bandgap material on InAlN/AlN/GaN heterostructures. On the other hand, a large reduction of the gate leakage current by 4-5 orders of magnitudes was achieved with a very low AlN growth temperature of 430 °C. X-ray diffraction analysis of the AlN cap grown at 740 °C indicated that the AlN layer is tensile-strained. In contrast to this result, the amorphous structure was confirmed for the AlN cap grown at 430 °C by transmission electron microscopy. Furthermore, theoretical analysis based on one-dimensional band simulation was carried out, and the large increase in two-dimensional electron gas (2DEG) observed in Hall measurements was well reproduced by taking into account the spontaneous and piezo-electric polarization in the AlN layer grown at 740 °C. For the AlN capped structure grown at 430 °C, it is believed that the reduced polarization field in the AlN cap suppressed the penetration of 2DEG into the InAlN barrier layer, resulting in a small impact on 2DEG mobility and density. We believe that an in-situ grown AlN cap with a very low growth temperature of 430 °C is a promising candidate for high-frequency/high-power GaN-based devices with low gate leakage current.

Has competition increased hospital technical efficiency?

PubMed

Lee, Keon-Hyung; Park, Jungwon; Lim, Seunghoo; Park, Sang-Chul

2015-01-01

Hospital competition and managed care have affected the hospital industry in various ways including technical efficiency. Hospital efficiency has become an important topic, and it is important to properly measure hospital efficiency in order to evaluate the impact of policies on the hospital industry. The primary independent variable is hospital competition. By using the 2001-2004 inpatient discharge data from Florida, we calculate the degree of hospital competition in Florida for 4 years. Hospital efficiency scores are developed using the Data Envelopment Analysis and by using the selected input and output variables from the American Hospital Association's Annual Survey of Hospitals for those acute care general hospitals in Florida. By using the hospital efficiency score as a dependent variable, we analyze the effects of hospital competition on hospital efficiency from 2001 to 2004 and find that when a hospital was located in a less competitive market in 2003, its technical efficiency score was lower than those in a more competitive market.

Depolarization currents in Al 2O 3 and MgAl 2O 4 oxides

NASA Astrophysics Data System (ADS)

Carvalhaes, R. P. M.; Rocha, M. S.; de Souza, S. S.; Blak, A. R.

2004-06-01

In the present work, dipole defects in γ-irradiated and thermally treated samples of Al 2O 3 and MgAl 2O 4 oxides are investigated, applying the thermally stimulated depolarisation currents technique (TSDC). The TSDC spectra of MgAl 2O 4 doped with Fe 2+, Fe 3+, Co 2+, Cr 3+ and Mn 2+ show four bands at 130 K, 160 K, 250 K and 320 K, and the spectra of Al 2O 3 doped with Mg 2+, Cr 3+ and Fe 3+ show bands between 230 K and 260 K. It has been observed that the bands at 130 K, 160 K and 250 K in MgAl 2O 4 spinel and that the 230 K and 240 K bands in Al 2O 3 are related to dipole defects. The other bands are possibly related to different types of charge storage mechanisms (space-charge and interfacial polarisation) or deal with distributions in activation energies and/or in relaxation times. A thermal decrease of the TSDC bands for heat treatments above 1000 K has been observed. In MgAl 2O 4 spinel, the 250 K band could be recovered after γ-irradiation and the two dipole peaks in Al 2O 3 were partially recovered. Thermal treatments affect the dipole aggregation processes in both oxides. Optical absorption (AO) results indicate that the presence of bands of water molecules in the infrared region obstructs the appearance of the TSDC bands in both Al 2O 3 and MgAl 2O 4. The 250 K peak in MgAl 2O 4 was correlated to V-type centres and the 250 K peak in Al 2O 3 to a substitutional Mg 2+ ion near a trapped hole localised on an adjacent oxygen ion.

The growth of high-Al-content InAlGaN quaternary alloys by RF-MBE

NASA Astrophysics Data System (ADS)

Wang, B. Z.; Wang, X. L.; Wang, X. Y.; Guo, L. C.; Wang, X. H.; Xiao, H. L.; Liu, H. X.

2007-02-01

High-Al-content InxAlyGa1-x-yN (x = 1-10%, y = 34-45%) quaternary alloys were grown on sapphire by radio-frequency plasma-excited molecular beam epitaxy. Rutherford back-scattering spectrometry, high resolution x-ray diffraction and cathodoluminescence were used to characterize the InAlGaN alloys. The experimental results show that InAlGaN with an appropriate Al/In ratio (near 4.7, which is a lattice-match to the GaN under-layer) has better crystal and optical quality than the InAlGaN alloys whose Al/In ratios are far from 4.7. Some cracks and V-defects occur in high-Al/In-ratio InAlGaN alloys. In the CL image, the cracks and V-defect regions are the emission-enhanced regions.

Preparation, deformation, and failure of functional Al-Sn and Al-Sn-Pb nanocrystalline alloys

NASA Astrophysics Data System (ADS)

Noskova, N. I.; Vil'Danova, N. F.; Filippov, Yu. I.; Churbaev, R. V.; Pereturina, I. A.; Korshunov, L. G.; Korznikov, A. V.

2006-12-01

Changes in the structure, hardness, mechanical properties, and friction coefficient of Al-30% Sn, Al-15% Sn-25% Pb, and Al-5% Sn-35% Pb (wt %) alloys subjected to severe plastic deformation by equal-channel angular pressing (with a force of 40 tonne) and by shear at a pressure of 5 GPa have been studied. The transition into the nanocrystalline state was shown to occur at different degrees of plastic deformation. The hardness exhibits nonmonotonic variations, namely, first it increases and subsequently decreases. The friction coefficient of the Al-30% Sn, Al-15% Sn-25% Pb, and Al-5% Sn-35% Pb alloys quenched from the melt was found to be 0.33; the friction coefficients of these alloys in the submicrocrystalline state (after equal-channel angular pressing) equal 0.24, 0.32, and 0.35, respectively. The effect of disintegration into nano-sized powders was found to occur in the Al-15% Sn-25% Pb, and Al-5% Sn-35% Pb alloys after severe plastic deformation to ɛ = 6.4 and subsequent short-time holding.

Incidence of influenza‐associated mortality and hospitalizations in Argentina during 2002–2009

PubMed Central

Azziz‐Baumgartner, Eduardo; Cabrera, Ana María; Cheng, Po‐Yung; Garcia, Enio; Kusznierz, Gabriela; Calli, Rogelio; Baez, Clarisa; Buyayisqui, María Pía; Poyard, Eleonora; Pérez, Emanuel; Basurto‐Davila, Ricardo; Palekar, Rakhee; Oliva, Otavio; Alencar, Airlane Pereira; de Souza, Regilo; dos Santos, Thais; Shay, David K.; Widdowson, Marc‐Alain; Breese, Joseph; Echenique, Horacio

2013-01-01

Please cite this paper as: Azziz‐Baumgartner et al. (2012) Incidence of influenza‐associated mortality and hospitalizations in Argentina during 2002–2009. Influenza and Other Respiratory Viruses DOI: 10.1111/irv.12022. Background  We estimated rates of influenza‐associated deaths and hospitalizations in Argentina, a country that recommends annual influenza vaccination for persons at high risk of complications from influenza illness. Methods  We identified hospitalized persons and deaths in persons diagnosed with pneumonia and influenza (P&I, ICD‐10 codes J10‐J18) and respiratory and circulatory illness (R&C, codes I00‐I99 and J00‐J99). We defined the influenza season as the months when the proportion of samples that tested positive for influenza exceeded the annual median. We used hospitalizations and deaths during the influenza off‐season to estimate, using linear regression, the number of excess deaths that occurred during the influenza season. To explore whether excess mortality varied by sex and whether people were age <65 or ≥65 years, we used Poisson regression of the influenza‐associated rates. Results  During 2002–2009, 2411 P&I and 8527 R&C mean excess deaths occurred annually from May to October. If all of these excess deaths were associated with influenza, the influenza‐associated mortality rate was 6/100 000 person‐years (95% CI 4–8/100 000 person‐years for P&I and 21/100 000 person‐years (95% CI 12–31/100 000 person‐years) for R&C. During 2005–2008, we identified an average of 7868 P&I excess hospitalizations and 22 994 R&C hospitalizations per year, resulting in an influenza‐associated hospitalization rate of 2/10 000 person‐years (95% CI 1–3/10 000 person‐years) for P&I and 6/10 000 person‐years (95% CI 3–8/10 000 person‐years) for R&C. Conclusion  Our findings suggest that annual rates of influenza‐associated hospitalizations and death in Argentina were substantial

Hospitalization costs and complications in hospitalized patients with type 2 diabetes mellitus in Beijing, China.

PubMed

Bao, Xiaoyuan; Yang, Chao; Fang, Kai; Shi, Moye; Yu, Guopei; Hu, Yonghua

2017-04-01

The aim of the present study was to investigate hospitalization costs, diabetes complications, and their relationships using a large dataset in Beijing, China. Data for 2006-10 from the 38 top-ranked (Grade 3 A) hospitals in Beijing, obtained from electronic Hospitalization Summary Reports (HSRs), were analyzed for hospitalization costs and diabetic complications. Patient demographics, types of costs, and length of hospital stay (LOS) were also evaluated. During the period evaluated, 62 523 patients with diabetes were hospitalized, of which 41 875 (67.0 %) had diabetes-associated complications. The median cost of hospitalization for diabetic patients was 7996.11 RMB. Prescribed drugs and laboratory tests were two major contributors to hospitalization costs, accounting for 36.2 % and 22.4 %, respectively. Hospitalization costs were significantly associated with LOS, number of complications, age, year of admission, admission status, sex, and medical insurance (P < 0.001). Both hospitalization costs and LOS increased substantially with an increase in the number of complications (P < 0.001). The highest hospitalization costs were seen in those diabetic patients with foot complications. Diabetic complications have a significant effect on increases in hospitalization costs and LOS in patients with type 2 diabetes mellitus. © 2016 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

Do more hospital beds lead to higher hospitalization rates? a spatial examination of Roemer's Law.

PubMed

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

2013-01-01

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

Medicare Payment Penalties and Safety Net Hospital Profitability: Minimal Impact on These Vulnerable Hospitals.

PubMed

Bazzoli, Gloria J; Thompson, Michael P; Waters, Teresa M

2018-02-08

To examine relationships between penalties assessed by Medicare's Hospital Readmission Reduction Program and Value-Based Purchasing Program and hospital financial condition. Centers for Medicare and Medicaid Services, American Hospital Association, and Area Health Resource File data for 4,824 hospital-year observations. Bivariate and multivariate analysis of pooled cross-sectional data. Safety net hospitals have significantly higher HRRP/VBP penalties, but, unlike nonsafety net hospitals, increases in their penalty rate did not significantly affect their total margins. Safety net hospitals appear to rely on nonpatient care revenues to offset higher penalties for the years studied. While reassuring, these funding streams are volatile and may not be able to compensate for cumulative losses over time. © Health Research and Educational Trust.

Support for hospital-based HIV testing and counseling: a national survey of hospital marketing executives.

PubMed

Boscarino, J A; Steiber, S R

1995-01-01

Today, hospitals are involved extensively in social marketing and promotional activities. Recently, investigators from the Centers for Disease Control and Prevention (CDC) estimated that routine testing of hospital patients for human immunodeficiency virus (HIV) could identify more than 100,000 patients with previously unrecognized HIV infections. Several issues are assessed in this paper. These include hospital support for voluntary HIV testing and AIDS education and the impact that treating AIDS patients has on the hospital's image. Also tested is the hypothesis that certain hospitals, such as for-profit institutions and those outside the AIDS epicenters, would be less supportive of hospital-based AIDS intervention strategies. To assess these issues, a national random sample of 193 executives in charge of hospital marketing and public relations were surveyed between December 1992 and January 1993. The survey was part of an ongoing annual survey of hospitals and included questions about AIDS, health education, marketing, patient satisfaction, and hospital planning. Altogether, 12.4 percent of executives indicated their hospital had a reputation for treating AIDS patients. Among hospitals without an AIDS reputation, 34.1 percent believed developing one would be harmful to the hospital's image, in contrast to none in hospitals that had such a reputation (chi 2 = 11.676, df = 1, P = .0006). Although 16.6 percent did not know if large-scale HIV testing should be implemented, a near majority (47.7 percent) expressed some support. In addition, 15 percent reported that HIV-positive physicians on the hospital's medical staff should not be allowed to practice medicine, but 32.1 percent indicated that they should. Also, 33.1 percent thought the hospital should be more involved in AIDS education. Finally, certain hospital characteristics,such as location and for-profit status, were not associated with support for hospital-based AIDS interventions. Contrary to what was

Temperature dependence of the dielectric response of anodized Al-Al2O3-metal capacitors

NASA Astrophysics Data System (ADS)

Hickmott, T. W.

2003-03-01

The temperature dependence of capacitance, CM, and conductance, GM, of Al-Al2O3-metal capacitors with Cu, Ag, and Au electrodes has been measured between 100 and 340 K at seven frequencies between 10 kHz and 1 MHz. Al2O3 films between 15 and 64 nm thick were formed by anodizing evaporated Al films in borate-glycol or borate-H2O electrolyte. The interface capacitance at the Al2O3-metal interface, CI, which is in series with the capacitance CD due to the Al2O3 dielectric, is determined from plots of 1/CM versus insulator thickness. CI is not fixed for a given metal-insulator interface but depends on the vacuum system used to deposit the metal electrode. CI is nearly temperature independent. When CI is taken into account the dielectric constant of Al2O3 determined from capacitance measurements is ˜8.3 at 295 K. The dielectric constant does not depend on anodizing electrolyte, insulator thickness, metal electrode, deposition conditions for the metal electrode or measurement frequency. By contrast, GM of Al-Al2O3-metal capacitors depends on both the deposition conditions of the metal and on the metal. For Al-Al2O3-Cu capacitors, GM is larger for capacitors with large values of 1/CI that result when Cu is evaporated in an oil-pumped vacuum system. For Al-Al2O3-Ag capacitors, GM does not depend on the Ag deposition conditions.

Indoor air quality levels in a University Hospital in the Eastern Province of Saudi Arabia

PubMed Central

El-Sharkawy, Mahmoud F.; Noweir, Mohamed E. H.

2014-01-01

Aim of the Study: The complex hospital environment requires special attention to ensure a healthy indoor air quality (IAQ) to protect patients and healthcare workers against hospital-acquired infections and occupational diseases. Poor hospital IAQ may cause outbreaks of building-related illness such as headaches, fatigue, eye, and skin irritations, and other symptoms. The general objective for this study was to assess IAQ inside a large University hospital at Al-Khobar City in the Eastern Province of Saudi Arabia. Materials and Methods: Different locations representing areas where most activities and tasks are performed were selected as sampling points for air pollutants in the selected hospital. In addition, several factors were studied to determine those that were most likely to affect the IAQ levels. The temperature and relative percent humidity of different air pollutants were measured simultaneously at each location. Results: The outdoor levels of all air pollutant levels, except volatile organic compounds (VOCs), were higher than the indoor levels which meant that the IAQ inside healthcare facilities (HCFs) were greatly affected by outdoor sources, particularly traffic. The highest levels of total suspended particulates (TSPs) and those less than 10 microns (PM10) inside the selected hospital were found at locations that are characterized with m4ore human activity. Conclusions: Levels of particulate matter (both PM10 and TSP) were higher than the Air Quality Guidelines (AQGs). The highest concentrations of the fungal species recorded were Cladosporium and Penicillium. Education of occupants of HCF on IAQ is critical. They must be informed about the sources and effects of contaminants and the proper operation of the ventilation system. PMID:24696632

75 FR 68799 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-09

... 0938-AP86 Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services.... SUMMARY: This notice announces the inpatient hospital deductible and the hospital and extended care... extended care services in a skilled nursing facility in a benefit period. DATES: Effective Date: This...

[Malnutrition screening in hospitalized children: influence of the hospital unit on its management].

PubMed

Marteletti, O; Caldari, D; Guimber, D; Mention, K; Michaud, L; Gottrand, F

2005-08-01

The aims of this study were to assess the prevalence of malnutrition in a pediatric population hospitalized in a French regional hospital and to evaluate the influence of type of hospital unit (pediatric or not) in the screening and the management of malnutrition. This one-day cross-sectional survey was performed in three different seasons during 2003. Every child aged 2 months to 16 years old, hospitalized for more than 48 hours was included. Weight for height, Z-score and Body Mass Index Z-score were used for nutritional assessment. Type of hospitalisation unit, date of admission, associated diagnosis, screening and treatment of malnutrition were also taken into account. Two hundred and eighty hospitalized children were undernourished (11%) and thirty-one children were obese (11%) with no difference in prevalence of malnutrition between pediatric and non-pediatric units. At the time of the study, malnutrition was recognized in one third of the children, at a similar rate whatever the type of hospitalized unit. The children hospitalized in pediatrics wards benefited more frequently from nutritional intervention, i.e. dietician care (43 vs. 16% P < 0.01). Prevalence of malnutrition in hospitalized children is low and the same in pediatric or non-pediatric units. Screening of malnutrition remains unsatisfactory in hospital. However, malnutrition is more frequently treated in pediatric unit compared with non-pediatric unit.

From Snow to Hill to ALS: An epidemiological odyssey in search of ALS causation.

PubMed

Armon, Carmel

2018-05-21

Establishing mechanisms of disease causation in neurodegenerative diseases has long seemed to be beyond the pale of traditional epidemiological tools. Establishing a plausible mechanism for initiation of amyotrophic lateral sclerosis (ALS) has appeared a particularly elusive goal. This review shows that a likely mechanism for ALS initiation may be inferred by applying classical methods of epidemiological inference. Advances in characterizing the biology of ALS suggest that most cases of ALS are cortically-generated, part of the ALS-FTD spectrum, with focal onset and spread by contiguity within the motor super-network. Evidence-based methods identified the most credible exogenous risk factor - smoking. AB Hill's nine viewpoints to inferring causation from association were invoked. The most likely mechanism consistent with smoking being a risk factor for ALS was inferred: cumulative DNA damage, akin to cumulative somatic mutations in carcinogenesis. Focal onset supports the concept that these changes, occurring in a single cell, may trigger the cascade leading to clinical ALS. The plausibility of this mechanism was affirmed by its coherence/consistency with other observations in sporadic, familial and western Pacific ALS. Application of traditional epidemiological reasoning suggests that cumulative DNA damage may contribute to disease onset in ALS. Copyright © 2018 Elsevier B.V. All rights reserved.

Polarization and Fowler-Nordheim tunneling in anodized Al-Al2O3-Au diodes

NASA Astrophysics Data System (ADS)

Hickmott, T. W.

2000-06-01

Polarization in anodic Al2O3 films is measured by using quasi-dc current-voltage (I-V) curves of Al-Al2O3-Au diodes. A reproducible polarization state is established by applying a negative voltage to the Au electrode of a rectifying Al-Al2O3-Au diode. The difference between subsequent I-V curves with Au positive is a measure of polarization in the sample. The magnitude of polarization charge in Al2O3 depends on the anodizing electrolyte. Al2O3 films formed in H2O-based electrolytes have approximately ten times the polarization charge of Al2O3 films formed in ethylene glycol-based electrolyte. Anodizing conditions that produce greater polarizing charge in anodic Al2O3 result in voltage-time curves during anodization under galvanostatic conditions that are nonlinear. Anodic films with greater polarizing charge also have a greater apparent interface capacitance which is independent of Al2O3 thickness. I-V curves of Al-Al2O3-Au diodes for increasing voltage are dominated by polarization. I-V curves for decreasing voltage are reproducible and parallel but depend on the maximum current and voltage reached during the measurement. There is no single current corresponding to a given voltage. I-V curves for decreasing voltage are analyzed assuming that the conduction mechanism is Fowler-Nordheim (FN) tunneling. There is a qualitative difference between the FN tunneling parameters for Al2O3 films formed in H2O-based electrolytes and those formed in ethylene glycol-based electrolyte. For the former the value of the exponential term in the FN analysis increases as the value of maximum voltage and current in an I-V characteristic increases, while the value of the pre-exponential term is nearly constant. For the latter, the exponential term is nearly constant as maximum voltage and current increase, but the pre-exponential term decreases by about 5 decades. Thus polarization charge incorporated during formation of anodized Al2O3 strongly affects the formation of the insulating

Hospital mergers and market overlap.

PubMed Central

Brooks, G R; Jones, V G

1997-01-01

OBJECTIVE: To address two questions: What are the characteristics of hospitals that affect the likelihood of their being involved in a merger? What characteristics of particular pairs of hospitals affect the likelihood of the pair engaging in a merger? DATA SOURCES/STUDY SETTING: Hospitals in the 12 county region surrounding the San Francisco Bay during the period 1983 to 1992 were the focus of the study. Data were drawn from secondary sources, including the Lexis/Nexis database, the American Hospital Association, and the Office of Statewide Health Planning and Development of the State of California. STUDY DESIGN: Seventeen hospital mergers during the study period were identified. A random sample of pairs of hospitals that did not merge was drawn to establish a statistically efficient control set. Models constructed from hypotheses regarding hospital and market characteristics believed to be related to merger likelihood were tested using logistic regression analysis. DATA COLLECTION: See Data Sources/Study Setting. PRINCIPAL FINDINGS: The analysis shows that the likelihood of a merger between a particular pair of hospitals is positively related to the degree of market overlap that exists between them. Furthermore, market overlap and performance difference interact in their effect on merger likelihood. In an analysis of individual hospitals, conditions of rivalry, hospital market share, and hospital size were not found to influence the likelihood that a hospital will engage in a merger. CONCLUSIONS: Mergers between hospitals are not driven directly by considerations of market power or efficiency as much as by the existence of specific merger opportunities in the hospitals' local markets. Market overlap is a condition that enables a merger to occur, but other factors, such as the relative performance levels of the hospitals in question and their ownership and teaching status, also play a role in influencing the likelihood that a merger will in fact take place. PMID

CuAlO2 and CuAl2O4 thin films obtained by stacking Cu and Al films using physical vapor deposition

NASA Astrophysics Data System (ADS)

Castillo-Hernández, G.; Mayén-Hernández, S.; Castaño-Tostado, E.; DeMoure-Flores, F.; Campos-González, E.; Martínez-Alonso, C.; Santos-Cruz, J.

2018-06-01

CuAlO2 and CuAl2O4 thin films were synthesized by the deposition of the precursor metals using the physical vapor deposition technique and subsequent annealing. Annealing was carried out for 4-6 h in open and nitrogen atmospheres respectively at temperatures of 900-1000 °C with control of heating and cooling ramps. The band gap measurements ranged from 3.3 to 4.5 eV. Electrical properties were measured using the van der Pauw technique. The preferred orientations of CuAlO2 and CuAl2O4 were found to be along the (1 1 2) and (3 1 1) planes, respectively. The phase percentages were quantified using a Rietveld refinement simulation and the energy dispersive X-ray spectroscopy indicated that the composition is very close to the stoichiometry of CuAlO2 samples and with excess of aluminum and deficiency of copper for CuAl2O4 respectively. High resolution transmission electron microscopy identified the principal planes in CuAlO2 and in CuAl2O4. Higher purities were achieved in nitrogen atmosphere with the control of the cooling ramps.

Phenotypic and Molecular Characterization of Multidrug Resistant Klebsiella pneumoniae Isolated from Different Clinical Sources in Al-Najaf Province-Iraq.

PubMed

Aljanaby, Ahmed Abduljabbar Jaloob; Alhasnawi, Haneen Mohammed Reda Jaber

2017-01-01

Burns infections and urinary tract infections are the most important prevalent diseases in Asian countries, such as Iraq. Klebsiella pneumoniae is one of the most important bacteria cause this type of infections especially in hospitals. Therefore, the aim of this study was to investigate the prevalence of multi-drug resistance K. pneumoniae and extended-spectrum beta-lactamases producing K. pneumoniae isolates from inpatients with urinary tract infection and burns infections in Al-Kufa hospital in Al-Najaf province, Iraq. A total of 285 clinical samples were collected from in-patients infected with urinary tract infection (141 urine samples) and burns infections (144 burns swabs). Fourteen different antibiotics were used by disc diffusion method and 13 antimicrobials resistance genes were used by PCR technique. A total of 43 K. pneumoniae strains were isolated. The highest resistance rate was observed for amoxicillin 25 μg and amoxicillin+clavulanic acid 20+10 μg (97.67%) while the lowest resistance rate was observed for imipenem 10 μg (9.30%). The most common resistance associated-genes were blaSHV (86.04%) and at lower prevalence were IMP (9.30%). Klebsiella pneumoniae strains isolated from burns infections were more virulent than those isolated from urinary tract infections.

Three-Dimensional FIB/EBSD Characterization of Irradiated HfAl3-Al Composite

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

Hua, Zilong; Guillen, Donna Post; Harris, William

2016-09-01

A thermal neutron absorbing material, comprised of 28.4 vol% HfAl3 in an Al matrix, was developed to serve as a conductively cooled thermal neutron filter to enable fast flux materials and fuels testing in a pressurized water reactor. In order to observe the microstructural change of the HfAl3-Al composite due to neutron irradiation, an EBSD-FIB characterization approach is developed and presented in this paper. Using the focused ion beam (FIB), the sample was fabricated to 25µm × 25µm × 20 µm and mounted on the grid. A series of operations were carried out repetitively on the sample top surface tomore » prepare it for scanning electron microscopy (SEM). First, a ~100-nm layer was removed by high voltage FIB milling. Then, several cleaning passes were performed on the newly exposed surface using low voltage FIB milling to improve the SEM image quality. Last, the surface was scanned by Electron Backscattering Diffraction (EBSD) to obtain the two-dimensional image. After 50 to 100 two-dimensional images were collected, the images were stacked to reconstruct a three-dimensional model using DREAM.3D software. Two such reconstructed three-dimensional models were obtained from samples of the original and post-irradiation HfAl3-Al composite respectively, from which the most significant microstructural change caused by neutron irradiation apparently is the size reduction of both HfAl3 and Al grains. The possible reason is the thermal expansion and related thermal strain from the thermal neutron absorption. This technique can be applied to three-dimensional microstructure characterization of irradiated materials.« less

76 FR 67567 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-01

... Extended Care Services Coinsurance Amounts for CY 2012; Part A Premiums for CY 2012 for the Uninsured Aged... Program; Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for CY... announces the inpatient hospital deductible and the hospital and extended care services coinsurance amounts...

Assessing the efficiency of hospital pharmacy services in Thai public district hospitals.

PubMed

Rattanachotphanit, Thananan; Limwattananon, Chulaporn; Limwattananon, Supon; Johns, Jeff R; Schommer, Jon C; Brown, Lawrence M

2008-07-01

The purpose of this study was to assess the efficiency of hospital pharmacy services and to determine the environmental factors affecting pharmacy service efficiency. The technical efficiency of a hospital pharmacy was assessed to evaluate the hospital's ability to use pharmacy manpower in order to produce the maximum output of the pharmacy service. Data Envelopment Analysis (DEA) was used as an efficiency measurement. The two labor inputs were pharmacists and support personnel and the ten outputs were from four pharmacy activities: drug dispensing, drug purchasing and inventory control, patient-oriented activities, and health consumer protection services. This was used to estimate technical efficiency. A Tobit regression model was used to determine the effect of the hospital size, location, input mix of pharmacy staff, working experience of pharmacists at the study hospitals, and use of technology on the pharmacy service efficiency. Data for pharmacy service input and output quantities were obtained from 155 respondents. Nineteen percent were found to have full efficiency with a technical efficiency score of 1.00. Thirty-six percent had a technical efficiency score of 0.80 or above and 27% had a low technical efficiency score (< 0.60). The average TE score increased in respect to the hospital size (0.60, 0.71, 0.75, and 0.83 in 10, 30, 60, and 90-120 bed hospitals, respectively). Hospital size and geographic location were significantly associated with pharmacy service efficiency.

Hospital managers' attitude and commitment toward electronic medical records system in Isfahan hospitals 2014.

PubMed

Jahanbakhsh, Maryam; Karimi, Saeed; Hassanzadeh, Akbar; Beigi, Maliheh

2017-01-01

Electronic medical record system (EMRS) is a valuable system for safe access to the patient's data and increases health care quality. Manpower is one of the requirements for EMRS, among which manager is the most important person in any hospital. Taking into account manager's positive attitude and good commitments, EMRS will be implemented successfully. As such, we decided to assess manager's attitude and commitment toward EMRS in Isfahan hospitals in the year of 2014. This article aimed to determine the hospital managers' attitude and commitment toward the implementation of EMRS. The present article is an applied analytic study. Research society consisted of the managers of all the hospitals in Isfahan that include hospitals affiliated to Isfahan University of Medical Sciences, private, and social security hospitals. This study was done in 2014. Data collection tools included a questionnaire for which reliability and validity were determined. Data were analyzed by means of SPSS 20. Average score for the managers' attitude toward EMRS in the city of Isfahan was 77.5 out of 100 and their average score for commitment was 74.7. Manager's attitude in social security hospitals was more positive than the private and governmental ones (83.3%). In addition, the amount of commitment by the managers in social security hospitals was higher than the same in private and governmental hospitals (86.6%). At present, managers' attitude and commitment in Isfahan hospitals toward EMRS are very high and social security hospitals show more readiness in this respect.

The Genyornis Egg: Response to Miller et al.'s commentary on Grellet-Tinner et al., 2016

NASA Astrophysics Data System (ADS)

Grellet-Tinner, Gerald; Spooner, Nigel A.; Handley, Warren D.; Worthy, Trevor H.

2017-04-01

Williams (1981) and Williams and Rich (1991) attributed Australian Quaternary fossil eggshell that differed from that of emu Dromaius novaehollandiae to the extinct bird Genyornis newtoni without any osteological or embryonic support. Such association by proximity or abundance mirrors the case of the mistaken association of oviraptor eggs to Protoceratops in the 1920's by Andrews (Grellet-Tinner and Makovicky, 2006). No other candidate species was considered, and this attribution has been unchallenged and followed by everyone thereafter. Much research has been done on this Australian eggshell, with one result being that the extinction of the parent of this eggshell is the most well documented for a taxon in Australia (e.g., Miller et al., 1999, 2005). Grellet-Tinner et al. (2016) raised several problems with the identity of the eggshell Williams (1981) attributed to Genyornis newtoni and suggested that extinct megapodes of the genus Progura were the more likely layer of this eggshell type, therein referred to as ;putative Genyornis oological material; (PGOM). Miller et al. (2017) challenged our hypothesis stating that ;Based on the dimensions of the reconstructed Spooner Egg,Grellet-Tinner et al. (2016)argue that PGOM is too small for a bird with the body mass estimated for Genyornis (168-275 kg) … …[and] …. None of the additional PGOM observations reported byGrellet-Tinner et al. (2016)are inconsistent with a Genyornis parent;. Here we take the opportunity to respond to their critique, the basis of which resolves into a few points, which we address in turn.

Additional funding mechanisms for Public Hospitals in Greece: the case of Chania Mental Health Hospital

PubMed Central

2010-01-01

Objectives To investigate whether the long term lease of public hospital owned land could be an additional financing mechanism for Greek public (mental) health hospitals. Methods We performed a financial analysis of the official 2008 data of a case - study hospital (Mental Health Hospital of Chania). We used a capital budgeting approach to investigate whether value is created for the public hospital by engaging its assets in a project for the development of a private renal dialysis Unit. Results The development of the private unit in hospital owned land is a good investment decision, as it generates high project Net Present Value and Internal Rate of Return. When the project commences generating operating cash flows, nearly €400.000 will be paid annually to the Mental Health Hospital of Chania as rent, thereby gradually decreasing the annual deficit of the hospital. Conclusions Revenue generated from the long term lease of public hospital land is crucial to gradually eliminate hospital deficit. The Ministry of Health should encourage similar forms of Public Private Partnerships in order to ensure the sustainability of public (mental) hospitals. PMID:21067580

Hospital-acquired listeriosis.

PubMed

Graham, J C; Lanser, S; Bignardi, G; Pedler, S; Hollyoak, V

2002-06-01

We report four cases of listeriosis that occurred over a two-month period in north east England. Due to the apparent nosocomial acquisition of infection and the clustering of cases in time and place, extended epidemiological investigation was performed and the outbreak was traced to a caterer who was providing sandwiches for hospital shops. We discuss the difficulties in preventing food-borne listeriosis in the hospital setting. Copyright 2002 The Hospital Infection Society.

Mowafak Al-Jassim | NREL

Science.gov Websites

Mowafak Al-Jassim Photo of Mowafak Al-Jassim Mowafak Al-Jassim Group Research Manager III-Materials researcher and advancing to a principal scientist and a technical manager. His research group has contributed numerous international conferences. Research Interests His research interests include the multiscale

Data supporting Al-Abed et al., Environ. Sci.: Nano, 2016,

EPA Pesticide Factsheets

Data files representing each of the Figures and Tables published in Al-Abed et al., Environ. Sci.: Nano, 2016,3, 593. The data file names identify the Figure or Table and each file contains an internal set of data definitionsThis dataset is associated with the following publication:Al-Abed, S.R., J. Virkutyte, J. Ortenzio , R.M. McCarrick, L. Degn, R. Zucker , N. Coates , K. Cleveland, H. Ma, S. Diamond, K. Dreher , and W. Boyes. Environmental aging alters AI(OH)3 coating of TiO2 nanoparticles enhancing their photocatalytic and phototoxicity activities. Environmental Science: Nano. RSC Publishing, Cambridge, UK, N/A, (2016).

Logistics in hospitals: a case study of some Singapore hospitals.

PubMed

Pan, Zhi Xiong; Pokharel, Shaligram

2007-01-01

The purpose of this paper is to investigate logistics activities in Singapore hospitals. It defines various types of activities handled by a logistics division. Inventory management policy and the use of information and communication technologies (ICT) for logistics purposes are also discussed. The study identifies the nature of strategic alliances in Singapore's health care industry. This study was conducted by utilizing a framework for data collection, pre-testing the questionnaire and conducting interviews. Various relevant literature was reviewed to design the questionnaire. This study finds that logistics division carry out many related activities and some of them also provide engineering services. The hospitals make use of ICT. The hospitals are clustered under various groups to minimize the cost of operation, including the logistics related costs. However, hospitals do not see alliances with suppliers as a strategic option; rather they focus on outsourcing of logistics services. The findings also show that Singapore hospitals have a good stocking policy for both medical and non-medical items so that changes in patient mix can be easily handled. Singapore is continuously improving its health care industry and therefore, the findings will help hospitals in other regions to adopt some of the practices, like concentrating on local vendors, outsourcing, clustering, and maximum use of information technology as competitive factors that can improve the service and reduce the cost of operation. The paper suggests motivators and barriers to the use of ICT in logistics in the health care industry.

Variability in Costs across Hospital Wards. A Study of Chinese Hospitals

PubMed Central

Adam, Taghreed; Evans, David B.; Ying, Bian; Murray, Christopher J. L.

2014-01-01

Introduction Analysts estimating the costs or cost-effectiveness of health interventions requiring hospitalization often cut corners because they lack data and the costs of undertaking full step-down costing studies are high. They sometimes use the costs taken from a single hospital, sometimes use simple rules of thumb for allocating total hospital costs between general inpatient care and the outpatient department, and sometimes use the average cost of an inpatient bed-day instead of a ward-specific cost. Purpose In this paper we explore for the first time the extent and the causes of variation in ward-specific costs across hospitals, using data from China. We then use the resulting model to show how ward-specific costs for hospitals outside the data set could be estimated using information on the determinants identified in the paper. Methodology Ward-specific costs estimated using step-down costing methods from 41 hospitals in 12 provinces of China were used. We used seemingly unrelated regressions to identify the determinants of variability in the ratio of the costs of specific wards to that of the outpatient department, and explain how this can be used to generate ward-specific unit costs. Findings Ward-specific unit costs varied considerably across hospitals, ranging from 1 to 24 times the unit cost in the outpatient department — average unit costs are not a good proxy for costs at specialty wards in general. The most important sources of variability were the number of staff and the level of capacity utilization. Practice Implications More careful hospital costing studies are clearly needed. In the meantime, we have shown that in China it is possible to estimate ward-specific unit costs taking into account key determinants of variability in costs across wards. This might well be a better alternative than using simple rules of thumb or using estimates from a single study. PMID:24874566

Two-Phase (TiAl+TiCrAl) Coating Alloys for Titanium Aluminides

NASA Technical Reports Server (NTRS)

Brady, Michael P. (Inventor); Smialek, James L. (Inventor); Brindley, William J. (Inventor)

1998-01-01

A coating for protecting titanium aluminide alloys, including the TiAl gamma + Ti3Al (alpha(sub 2)) class, from oxidative attack and interstitial embrittlement at temperatures up to at least 1000 C. is disclosed. This protective coating consists essentially of titanium, aluminum. and chromium in the following approximate atomic ratio: Ti(41.5-34.5)Al(49-53)Cr(9.5-12.5)

Nursing Home Residents at Risk of Hospitalization and the Characteristics of Their Hospital Stays.

ERIC Educational Resources Information Center

Murtaugh, Christopher M.; Freiman, Marc P.

1995-01-01

Analysis of national medical data identified elderly nursing home residents with an elevated risk of hospitalization and the characteristics of their hospital stays. Findings indicate an elevated risk of hospitalization for residents diagnosed with one of several different primary diagnoses. Infections accounted for over 25% of hospital stays.…

78 FR 64953 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-30

... 0938-AR59 Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services.... SUMMARY: This notice announces the inpatient hospital deductible and the hospital and extended care... lifetime reserve days; and $152 for the 21st through 100th day of extended care services in a skilled...

77 FR 69848 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-21

... 0938-AR14 Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services.... SUMMARY: This notice announces the inpatient hospital deductible and the hospital and extended care... lifetime reserve days; and $148 for the 21st through 100th day of extended care services in a skilled...

Hospital boards and hospital strategic focus: the impact of board involvement in strategic decision making.

PubMed

Ford-Eickhoff, Karen; Plowman, Donde Ashmos; McDaniel, Reuben R

2011-01-01

Despite pressures to change the role of hospital boards, hospitals have made few changes in board composition or director selection criteria. Hospital boards have often continued to operate in their traditional roles as either "monitors" or "advisors." More attention to the direct involvement of hospital boards in the strategic decision-making process of the organizations they serve, the timing and circumstances under which board involvement occurs, and the board composition that enhances their abilities to participate fully is needed. We investigated the relationship between broader expertise among hospital board members, board involvement in the stages of strategic decision making, and the hospital's strategic focus. We surveyed top management team members of 72 nonacademic hospitals to explore the participation of critical stakeholder groups such as the board of directors in the strategic decision-making process. We used hierarchical regression analysis to explore our hypotheses that there is a relationship between both the nature and involvement of the board and the hospital's strategic orientation. Hospitals with broader expertise on their boards reported an external focus. For some of their externally-oriented goals, hospitals also reported that their boards were involved earlier in the stages of decision making. In light of the complex and dynamic environment of hospitals today, those charged with developing hospital boards should match the variety in the external issues that the hospital faces with more variety in board makeup. By developing a board with greater breadth of expertise, the hospital responds to its complex environment by absorbing that complexity, enabling a greater potential for sensemaking and learning. Rather than acting only as monitors and advisors, boards impact their hospitals' strategic focus through their participation in the strategic decision-making process.

Al Qaeda in the Arabian Peninsula (AQAP): An Al Qaeda Affiliate Case Study

DTIC Science & Technology

2017-10-01

Underwear Bombing ” and an unsuccessful 2010 plan to put parcel bombs on U.S.-bound airplanes. AQAP also seeks to inspire “lone jihad” attacks in the... bomb -maker,5 and Sudanese national Ibrahim al-Qosi, a former bookkeeper for Osama Bin Laden.6 Below the emir are regional commanders and heads of...5 “Profile: Al-Qaeda ‘ Bomb Maker’ Ibrahim al-Asiri,” BBC News, July 4, 2014, http://www.bbc.com/news/world-middle-east-11662143. See also al-Asiri

Review: interventions to increase influenza vaccination among healthcare workers in hospitals

PubMed Central

Hollmeyer, Helge; Hayden, Frederick; Mounts, Anthony; Buchholz, Udo

2012-01-01

Please cite this paper as: Hollmeyer et al. (2012) Review: interventions to increase influenza vaccination among healthcare workers in hospitals. Influenza and Other Respiratory Viruses 7(4), 604–621. Annual influenza vaccination rates among hospital healthcare workers (HCW) are almost universally low despite recommendations from WHO and public health authorities in many countries. To assist in the development of successful vaccination programmes, we reviewed studies where interventions aimed to increase the uptake of influenza vaccination among hospital HCW. We searched PUBMED from 1990 up to December 2011 for publications with predetermined search strategies and of pre‐defined criteria for inclusion or exclusion. We evaluated a large number of ‘intervention programmes’ each employing one or more ‘intervention components’ or strategies, such as easy access to vaccine or educational activities, with the goal to raise influenza vaccine uptake rates in hospital HCW during one influenza season. Included studies reported results of intervention programmes and compared the uptake with the season prior to the intervention (historical control) or to another intervention programme within the same season that started from the same set of baseline activities. Twenty‐five studies performed in eight countries met our selection criteria and described 45 distinct intervention programmes. Most studies used their own facility as historical control and evaluated only one season. The following elements were used in intervention programmes that increased vaccine uptake: provision of free vaccine, easy access to the vaccine (e.g. through mobile carts or on‐site vaccination), knowledge and behaviour modification through educational activities and/or reminders and/or incentives, management or organizational changes, such as the assignment of personnel dedicated to the intervention programme, long‐term implementation of the strategy, requiring active declination and

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.

Results of a hospital waste survey in private hospitals in Fars province, Iran

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

Askarian, Mehrdad; Vakili, Mahmood; Kabir, Gholamhosein

2004-07-01

Hospital waste is considered dangerous because it may possess pathogenic agents and can cause undesirable effects on human health and the environment. In Iran, neither rules have been compiled nor does exact information exist regarding hospital waste management. The survey presented in this article was carried out in all 15 private hospitals of Fars province (Iran) from the total numbers of 50 governmental and private hospitals located in this province, in order to determine the amount of different kinds of waste produced and the present situation of waste management. The results indicated that the waste generation rate is 4.45 kg/bed/day,more » which includes 1830 kg (71.44%) of domestic waste, 712 kg (27.8%) of infectious waste, and 19.6 kg (0.76%) of sharps. Segregation of the different types of waste is not carried out perfectly. Two (13.3%) of the hospitals use containers without lids for on-site transport of wastes. Nine (60%) of the hospitals are equipped with an incinerator and six of them (40%) have operational problems with the incinerators. In all hospitals municipal workers transport waste outside the hospital premises daily or at the most on alternative days. In the hospitals under study, there aren't any training courses about hospital waste management and the hazards associated with them. The training courses that are provided are either ineffective or unsuitable. Performing extensive studies all over the country, compiling and enacting rules, establishing standards and providing effective personnel training are the main challenges for the concerned authorities and specialists in this field.« less

[Epidemiological profile of respiratory diseases in children hospitalized at the Rabat Children's Hospital, Morocco].

PubMed

Benchekroun, Ilham; Boubkraoui, Mohamed El Mahdi; Mekaoui, Nour; Karboubi, Lamia; Mahraoui, Chafiq; Dakhama, Badr Sououd Benjelloun

2017-01-01

Respiratory diseases are a common cause of pediatric hospitalization. This study aimed to evaluate the epidemiological profile of respiratory diseases among children at the Rabat Children's Hospital, Morocco. We conducted an observational-cross sectional study of all children aged 3 months to 15 years hospitalized for respiratory disease at the Department of Pneumoallergology and Pediatric Infectious Diseases at the Rabat Children's Hospital, Morocco over a one-year period, from 1 January 2014 to 31 December 2014. Out of 3537 hospitalized patients, 2493 (70.5%) had respiratory disease. Hospitalizations due to asthmatic exacerbation (p < 0.001), acute bronchiolitis (p < 0.001) and laryngeal dyspnoea (p = 0.004) were more frequent among boys, while hospitalizations due to acute pneumonia (p = 0.005), inhalation of a foreign body (p = 0.007) and pertussis (p = 0.020) were frequent among girls. Hospitalizations due to acute pneumonia (p < 0.001), exacerbation of serious viral disease sequelae (p < 0.001) and pertussis (p < 0.001) were more frequent among infants. Hospitalizations due to acute pneumonia (p < 0.001) and pertussis (p = 0.015) were more frequent during the autumn-winter period. The causes of hospitalization were dominated by asthmatic exacerbations and acute bronchiolitis, which were more frequent among boys. Respiratory infections, such as acute pneumonitis and pertussis, were more frequent during the autumn-winter period and mainly affected the infants.

Support for hospital-based HIV testing and counseling: a national survey of hospital marketing executives.

PubMed Central

Boscarino, J A; Steiber, S R

1995-01-01

Today, hospitals are involved extensively in social marketing and promotional activities. Recently, investigators from the Centers for Disease Control and Prevention (CDC) estimated that routine testing of hospital patients for human immunodeficiency virus (HIV) could identify more than 100,000 patients with previously unrecognized HIV infections. Several issues are assessed in this paper. These include hospital support for voluntary HIV testing and AIDS education and the impact that treating AIDS patients has on the hospital's image. Also tested is the hypothesis that certain hospitals, such as for-profit institutions and those outside the AIDS epicenters, would be less supportive of hospital-based AIDS intervention strategies. To assess these issues, a national random sample of 193 executives in charge of hospital marketing and public relations were surveyed between December 1992 and January 1993. The survey was part of an ongoing annual survey of hospitals and included questions about AIDS, health education, marketing, patient satisfaction, and hospital planning. Altogether, 12.4 percent of executives indicated their hospital had a reputation for treating AIDS patients. Among hospitals without an AIDS reputation, 34.1 percent believed developing one would be harmful to the hospital's image, in contrast to none in hospitals that had such a reputation (chi 2 = 11.676, df = 1, P = .0006). Although 16.6 percent did not know if large-scale HIV testing should be implemented, a near majority (47.7 percent) expressed some support. In addition, 15 percent reported that HIV-positive physicians on the hospital's medical staff should not be allowed to practice medicine, but 32.1 percent indicated that they should.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7638335

Pre-hospitalization, hospitalization, and post-hospitalization costs of patients with neurocysticercosis treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN) in Mexico City, Mexico.

PubMed

Bhattarai, Rachana; Carabin, Hélène; Flores-Rivera, Jose; Corona, Teresa; Proaño, Jefferson V; Flisser, Ana; Budke, Christine M

2018-01-01

The objective of this study was to estimate the direct costs associated with the diagnosis and treatment of neurocysticercosis (NCC) during pre-hospitalization, hospitalization, and post-hospitalization periods for 108 NCC patients treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN) in Mexico City, Mexico. Information on clinical manifestations, diagnostic tests, hospitalizations, surgical procedures, prescription medication, and other treatments was collected via medical chart reviews. Uncertain values for costs and frequency of treatments were imputed using bootstrap techniques. The average per-patient pre-hospitalization and hospitalization costs were US$ 257 (95% CI: 185 - 329) and US$ 2,576 (95% CI: 2,244 - 2,908), respectively. Post-hospitalization costs tended to decrease over time, with estimates for the first five years post-hospitalization of US$ 475 (95% CI: 423 - 527), US$ 228 (95% CI: 167 - 288), US$ 157 (95% CI: 111 - 202), US$ 150 (95% CI: 106 - 204), and US$ 91 (95% CI: 27 - 154), respectively. NCC results in a significant economic burden for patients requiring hospitalization, with this burden continuing years post-hospitalization.

Migrant-friendly hospitals: a paediatric perspective - improving hospital care for migrant children

PubMed Central

2013-01-01

Background The European Union (EU) Migrant-Friendly Hospital (MFH) Initiative, introduced in 2002, promotes the adoption of care approaches adapted to meet the service needs of migrants. However, for paediatric hospitals, no specific recommendations have been offered for MFH care for children. Using the Swiss MFH project as a case study, this paper aims to identify hospital-based care needs of paediatric migrants (PMs) and good service approaches. Methods Semi-structured interviews were conducted with principal project leaders of five paediatric hospitals participating in the Swiss MFH project. A review of the international literature on non-clinical hospital service needs and service responses of paediatric MFHs was conducted. Results Paediatric care can be complex, usually involving both the patient and the patient’s family. Key challenges include differing levels of acculturation between parents and children; language barriers; cultural differences between patient and provider; and time constraints. Current service and infrastructural responses include interpretation services for PMs and parents, translated information material, and special adaptations to ensure privacy, e.g., during breastfeeding. Clear standards for paediatric migrant-friendly hospitals (P-MFH) are lacking. Conclusions International research on hospital care for migrant children is scarce. The needs of paediatric migrants and their families may differ from guidance for adults. Paediatric migrant needs should be systematically identified and used to inform paediatric hospital care approaches. Hospital processes from admission to discharge should be revised to ensure implementation of migrant-sensitive approaches suitable for children. Staff should receive adequate support, such as training, easily available interpreters and sufficient consultation time, to be able to provide migrant-friendly paediatric services. The involvement of migrant groups may be helpful. Improving the quality of care

Has competition lowered hospital prices?

PubMed

Zwanziger, Jack; Mooney, Cathleen

2005-01-01

On Jan. 1, 1997, New York ended its regulation of hospital prices with the intent of using competitive markets to control prices and increase efficiency. This paper uses data that come from annual reports filed by all health maintenance organizations (HMOs) operating in New York and include payments to and usage in the major hospitals in an HMO's network. We estimate the relationship between implied prices and hospital, plan, and market characteristics. The models show that after 1997, hospitals in more competitive markets paid less. Partially offsetting these price reductions were price increases associated with hospital mergers that reduced the competitiveness of the local market. Hospital deregulation was successful, at least in the short run, in using price competition to reduce hospital payments; it is unclear whether this success will be undermined by the structural changes taking place in the hospital industry.

Screw dislocation-induced growth spirals as emissive exciton localization centers in Al-rich AlGaN/AlN quantum wells

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

Funato, Mitsuru, E-mail: funato@kuee.kyoto-u.ac.jp; Banal, Ryan G.; Kawakami, Yoichi

2015-11-15

Screw dislocations in Al-rich AlGaN/AlN quantum wells cause growth spirals with an enhanced Ga incorporation, which create potential minima. Although screw dislocations and their surrounding potential minima suggest non-radiative recombination processes within growth spirals, in reality, screw dislocations are not major non-radiative sinks for carriers. Consequently, carriers localized within growth spirals recombine radiatively without being captured by non-radiative recombination centers, resulting in intense emissions from growth spirals.

Transformation to Ni5Al3 in a 63.0 at. pct Ni-Al alloy

NASA Technical Reports Server (NTRS)

Khadkikar, P. S.; Locci, I. E.; Vedula, K.; Michal, G. M.

1993-01-01

Microstructures of 63 at. pct P/M Ni-Al alloys with a composition close to the stoichiometry of the Ni5Al3 phase were investigated using homogenized and quenched specimens aged at low temperatures for various times. Results of analyses of XRD data and electron microscopy observations were used for quantitative phase analysis, performed to calculate the (NiAl + Ni5Al3)/Ni5Al3 phase boundary locations. The measured lattice parameters of Ni5Al3 phase formed at 823, 873, and 923 K indicated an increase in tetragonality of the phase with increasing nickel content.

Formation of Al3Ti/Mg composite by powder metallurgy of Mg-Al-Ti system.

PubMed

Yang, Zi R; Qi Wang, Shu; Cui, Xiang H; Zhao, Yu T; Gao, Ming J; Wei, Min X

2008-07-01

An in situ titanium trialuminide (Al 3 Ti)-particle-reinforced magnesium matrix composite has been successfully fabricated by the powder metallurgy of a Mg-Al-Ti system. The reaction processes and formation mechanism for synthesizing the composite were studied by differential scanning calorimetry (DSC), x-ray diffractometry (XRD), scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDS). Al 3 Ti particles are found to be synthesized in situ in the Mg alloy matrix. During the reaction sintering of the Mg-Al-Ti system, Al 3 Ti particles are formed through the reaction of liquid Al with as-dissolved Ti around the Ti particles. The formed intermetallic particles accumulate at the original sites of the Ti particles. As sintering time increases, the accumulated intermetallic particles disperse and reach a relatively homogeneous distribution in the matrix. It is found that the reaction process of the Mg-Al-Ti system is almost the same as that of the Al-Ti system. Mg also acts as a catalytic agent and a diluent in the reactions and shifts the reactions of Al and Ti to lower temperatures. An additional amount of Al is required for eliminating residual Ti and solid-solution strengthening of the Mg matrix.