Aggregate Load Controllers and Associated Methods

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

Chassin, David P.

Aggregate load controllers and associated methods are described. According to one aspect, a method of operating an aggregate load controller includes using an aggregate load controller having an initial state, applying a stimulus to a plurality of thermostatic controllers which are configured to control a plurality of respective thermostatic loads which receive electrical energy from an electrical utility to operate in a plurality of different operational modes, accessing data regarding a response of the thermostatic loads as a result of the applied stimulus, using the data regarding the response, determining a value of at least one design parameter of themore » aggregate load controller, and using the determined value of the at least one design parameter, configuring the aggregate load controller to control amounts of the electrical energy which are utilized by the thermostatic loads.« less

3D target array for pulsed multi-sourced radiography

DOEpatents

Le Galloudec, Nathalie Joelle

2016-02-23

The various technologies presented herein relate to the generation of x-rays and other charged particles. A plurality of disparate source materials can be combined on an array to facilitate fabrication of co-located mixed tips (point sources) which can be utilized to form a polychromatic cloud, e.g., a plurality of x-rays having a range of energies and or wavelengths, etc. The tips can be formed such that the x-rays are emitted in a direction different to other charged particles to facilitate clean x-ray sourcing. Particles, such as protons, can be directionally emitted to facilitate generation of neutrons at a secondary target. The various particles can be generated by interaction of a laser irradiating the array of tips. The tips can be incorporated into a plurality of 3D conical targets, the conical target sidewall(s) can be utilized to microfocus a portion of a laser beam onto the tip material.

Radar velocity determination using direction of arrival measurements

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

Doerry, Armin W.; Bickel, Douglas L.; Naething, Richard M.

The various technologies presented herein relate to utilizing direction of arrival (DOA) data to determine various flight parameters for an aircraft A plurality of radar images (e.g., SAR images) can be analyzed to identify a plurality of pixels in the radar images relating to one or more ground targets. In an embodiment, the plurality of pixels can be selected based upon the pixels exceeding a SNR threshold. The DOA data in conjunction with a measurable Doppler frequency for each pixel can be obtained. Multi-aperture technology enables derivation of an independent measure of DOA to each pixel based on interferometric analysis.more » This independent measure of DOA enables decoupling of the aircraft velocity from the DOA in a range-Doppler map, thereby enabling determination of a radar velocity. The determined aircraft velocity can be utilized to update an onboard INS, and to keep it aligned, without the need for additional velocity-measuring instrumentation.« less

Joint perceptual decision-making: a case study in explanatory pluralism

PubMed Central

Abney, Drew H.; Dale, Rick; Yoshimi, Jeff; Kello, Chris T.; Tylén, Kristian; Fusaroli, Riccardo

2014-01-01

Traditionally different approaches to the study of cognition have been viewed as competing explanatory frameworks. An alternative view, explanatory pluralism, regards different approaches to the study of cognition as complementary ways of studying the same phenomenon, at specific temporal and spatial scales, using appropriate methodological tools. Explanatory pluralism has been often described abstractly, but has rarely been applied to concrete cases. We present a case study of explanatory pluralism. We discuss three separate ways of studying the same phenomenon: a perceptual decision-making task (Bahrami et al., 2010), where pairs of subjects share information to jointly individuate an oddball stimulus among a set of distractors. Each approach analyzed the same corpus but targeted different units of analysis at different levels of description: decision-making at the behavioral level, confidence sharing at the linguistic level, and acoustic energy at the physical level. We discuss the utility of explanatory pluralism for describing this complex, multiscale phenomenon, show ways in which this case study sheds new light on the concept of pluralism, and highlight good practices to critically assess and complement approaches. PMID:24795679

Social medicalization and alternative and complementary medicine: the pluralization of health services in the Brazilian Unified Health System.

PubMed

Tesser, Charles Dalcanale; Barros, Nelson Filice de

2008-10-01

Social medicalization transforms people's habits, discourages them from finding their own solutions to certain health problems and places an excess demand on the Unified Health System. With regard to healthcare provision, an alternative to social medicalization is the pluralization of treatment provided by health institutions namely through the recognition and provision of alternative and complementary practices and medicines. The objective of the article was to analyze the potentials and difficulties of alternative and complementary practices and medicines based on clinical and institutional experiences and on the specialist literature. The research concludes that the potential of such a strategy to "demedicalize" is limited and should be included in the remit of the Unified Health System. The article highlights that the Biosciences retain a political and epistemiological hegemony over medicine and that the area of healthcare is dominated by market principles, whereby there is a trend towards the transformation of any kind of knowledge or structured practice related to health-illness processes into goods or procedures to be consumed, and this only reinforces heteronomy and medicalization.

Tablet based distributed intelligent load management

DOEpatents

Lu, Yan; Zhou, Siyuan

2018-01-09

A facility is connected to an electricity utility and is responsive to Demand Response Events. A plurality of devices is each individually connected to the electricity grid via an addressable switch connected to a secure network that is enabled to be individually switched off by a server. An occupant of a room in control of the plurality of devices provides via a Human Machine Interface on a tablet a preferred order of switching off the plurality of devices in case of a Demand Response Event. A configuration file based at least partially on the preferred order and on a severity of the Demand Response Events determines which devices which of the plurality devices will be switched off. The server accesses the configuration file and switches off the devices included in the configuration file.

How 'healthy' are healthcare organizations? Exploring employee healthcare utilization rates among Dutch healthcare organizations.

PubMed

Bronkhorst, Babette

2017-08-01

Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole.

Battery system and method for sensing and balancing the charge state of battery cells

NASA Technical Reports Server (NTRS)

Davies, Francis J. (Inventor)

2012-01-01

A battery system utilizes a plurality of transformers interconnected with the battery cells. The transformers each have at least one transformer core operable for magnetization in at least a first magnetic state with a magnetic flux in a first direction and a second magnetic state with a magnetic flux in a second direction. The transformer cores retain the first magnetic state and the second magnetic state without current flow through said plurality of transformers. Circuitry is utilized for switching a selected transformer core between the first and second magnetic states to sense voltage and/or balance particular cells or particular banks of cells.

Common data buffer system. [communication with computational equipment utilized in spacecraft operations

NASA Technical Reports Server (NTRS)

Byrne, F. (Inventor)

1981-01-01

A high speed common data buffer system is described for providing an interface and communications medium between a plurality of computers utilized in a distributed computer complex forming part of a checkout, command and control system for space vehicles and associated ground support equipment. The system includes the capability for temporarily storing data to be transferred between computers, for transferring a plurality of interrupts between computers, for monitoring and recording these transfers, and for correcting errors incurred in these transfers. Validity checks are made on each transfer and appropriate error notification is given to the computer associated with that transfer.

Arrangement for multiplexing and intensity splitting light beams for interface into fiber optic cables

DOEpatents

Johnson, Steve A.

1990-01-01

An arrangement especially suitable for use in a laser apparatus for converting a plurality of different input light beams, for example copper vapor laser beams, into a plurality of substantially identical light beams is disclosed herein. This arrangement utilizes an optical mixing bar which is preferably integrally formed as a single unit and which includes a main body for mixing light therein, a flat input surface on one end of the main body, and a multi-faceted output face on the opposite end of the main body. This arrangement also includes means for directing the plurality of different input light beams onto the input face of the mixing base, whereby to cause the different beams to mix within the main body of the mixing bar and exit the latter from its multi-faceted output face as the desired plurality of substantially identical output beams.

Traditional healers as service providers in Ghana's National Health Insurance Scheme: the wrong way forward?

PubMed

Barimah, Kofi Bobi

2013-01-01

Concerned with the negative impacts of user fees on healthcare access and utilisation, following the enactment of a law in 2003, the Ghanaian government replaced the 'cash-and-carry' system with a National Health Insurance Scheme (NHIS). Even though many Ghanaians rely on traditional medicine (TRM) for reasons of culture, cost and personal preference, the incipient NHIS does not cover the services of TRM practitioners. Consultations with health policy-makers suggest that, in as much as the government recognises the invaluable contributions of TRM practitioners and would like to incorporate them in the incipient scheme, the provision of TRM in the country is still too disorganised, with few if any formal protocols and codes of conduct. Consequently, the inclusion of TRM practitioners in the NHIS is premature. This scholarly review seeks to bring TRM and its practitioners into the mainstream of healthcare provision in Ghana. Possibilities for medical pluralism in Ghana will be discussed with reference to best practices in countries such as China, India and Vietnam. This paper promotes medical pluralism in the form of Active Collaboration Between Fully Recognised Health Systems where there will be equity, mutual respect and understanding among traditional healers and physicians.

Apparatus and procedure to characterize the surface quality of conductors by measuring the rate of cathode emission as a function of surface electric field strength

DOEpatents

Mestayer, Mac; Christo, Steve; Taylor, Mark

2014-10-21

A device and method for characterizing quality of a conducting surface. The device including a gaseous ionizing chamber having centrally located inside the chamber a conducting sample to be tested to which a negative potential is applied, a plurality of anode or "sense" wires spaced regularly about the central test wire, a plurality of "field wires" at a negative potential are spaced regularly around the sense, and a plurality of "guard wires" at a positive potential are spaced regularly around the field wires in the chamber. The method utilizing the device to measure emission currents from the conductor.

Thermal energy storage apparatus, controllers and thermal energy storage control methods

DOEpatents

Hammerstrom, Donald J.

2016-05-03

Thermal energy storage apparatus, controllers and thermal energy storage control methods are described. According to one aspect, a thermal energy storage apparatus controller includes processing circuitry configured to access first information which is indicative of surpluses and deficiencies of electrical energy upon an electrical power system at a plurality of moments in time, access second information which is indicative of temperature of a thermal energy storage medium at a plurality of moments in time, and use the first and second information to control an amount of electrical energy which is utilized by a heating element to heat the thermal energy storage medium at a plurality of moments in time.

Multi-port, optically addressed RAM

NASA Technical Reports Server (NTRS)

Johnston, Alan R. (Inventor); Nixon, Robert H. (Inventor); Bergman, Larry A. (Inventor); Esener, Sadik (Inventor)

1989-01-01

A random access memory addressing system utilizing optical links between memory and the read/write logic circuits comprises addressing circuits including a plurality of light signal sources, a plurality of optical gates including optical detectors associated with the memory cells, and a holographic optical element adapted to reflect and direct the light signals to the desired memory cell locations. More particularly, it is a multi-port, binary computer memory for interfacing with a plurality of computers. There are a plurality of storage cells for containing bits of binary information, the storage cells being disposed at the intersections of a plurality of row conductors and a plurality of column conductors. There is interfacing logic for receiving information from the computers directing access to ones of the storage cells. There are first light sources associated with the interfacing logic for transmitting a first light beam with the access information modulated thereon. First light detectors are associated with the storage cells for receiving the first light beam, for generating an electrical signal containing the access information, and for conducting the electrical signal to the one of the storage cells to which it is directed. There are holographic optical elements for reflecting the first light beam from the first light sources to the first light detectors.

Sacred spaces in public places: religious and spiritual plurality in health care.

PubMed

Reimer-Kirkham, Sheryl; Sharma, Sonya; Pesut, Barb; Sawatzky, Richard; Meyerhoff, Heather; Cochrane, Marie

2012-09-01

Several intriguing developments mark the role and expression of religion and spirituality in society in recent years. In what were deemed secular societies, flows of increased sacralization (variously referred to as 'new', 'alternative', 'emergent' and 'progressive' spiritualities) and resurgent globalizing religions (sometimes with fundamentalist expressions) are resulting in unprecedented plurality. These shifts are occurring in conjunction with increasing ethnic diversity associated with global migration, as well as other axes of difference within contemporary society. Democratic secular nations such as Canada are challenged to achieve social cohesion in the face of growing religious, spiritual and ethnic diversity. These challenges are evident in the high-paced, demanding arena of Health care. Here, religious and spiritual plurality enter in, sometimes resulting in conflict between medical services and patients' beliefs, other times provoking uncertainties on the part of healthcare professionals about what to do with their own religiously or spiritually grounded values and beliefs. In this paper, we present selected findings from a 3-year study that examined the negotiation of religious and spiritual pluralism in Health care. Our focus is on the themes of 'sacred' and 'place', exploring how the sacred - that which is attributed as special and set apart as it pertains to the divine, transcendence, God or higher power - takes form in social and material spaces in hospitals. © 2011 Blackwell Publishing Ltd.

Why We Need a Single Definition of Disruptive Behavior.

PubMed

Petrovic, Michelle A; Scholl, Adam T

2018-03-18

Disruptive behavior is known to produce a wide range of negative effects in healthcare, such as impacting patient safety, lowering employee morale, and decreasing employee retention. Healthcare organizations have worked towards eliminating disruptive behavior; however, despite countless interventions, the issue continues to be a problem today. Why then does the issue of disruptive behavior persist? We argue that one reason is the multiple ways disruptive behavior can be described, henceforth defined as the "plurality of terms", which can make it difficult to collect relevant data by doing a simple literature search. Hence, we believe having a single definition for "disruptive behavior" will improve the meta-analysis on disruptive behavior research.

Battery Cell Balancing System and Method

NASA Technical Reports Server (NTRS)

Davies, Francis J. (Inventor)

2014-01-01

A battery cell balancing system is operable to utilize a relatively small number of transformers interconnected with a battery having a plurality of battery cells to selectively charge the battery cells. Windings of the transformers are simultaneously driven with a plurality of waveforms whereupon selected battery cells or groups of cells are selected and charged. A transformer drive circuit is operable to selectively vary the waveforms to thereby vary a weighted voltage associated with each of the battery cells.

Device for reducing vehicle aerodynamic resistance

DOEpatents

Graham, Sean C.

2005-02-15

A device for a vehicle with a pair of swinging rear doors, which converts flat sheets of pliable material hinged to the sides of the vehicle adjacent the rear thereof into effective curved airfoils that reduce the aerodynamic resistance of the vehicle, when the doors are closed by hand, utilizing a plurality of stiffeners disposed generally parallel to the doors and affixed to the sheets and a plurality of collapsible tension bearings struts attached to each stiffener and the adjacent door.

Utility usage forecasting

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

Hosking, Jonathan R. M.; Natarajan, Ramesh

The computer creates a utility demand forecast model for weather parameters by receiving a plurality of utility parameter values, wherein each received utility parameter value corresponds to a weather parameter value. Determining that a range of weather parameter values lacks a sufficient amount of corresponding received utility parameter values. Determining one or more utility parameter values that corresponds to the range of weather parameter values. Creating a model which correlates the received and the determined utility parameter values with the corresponding weather parameters values.

Sealing device for providing a seal in a turbomachine

DOEpatents

Lacy, Benjamin Paul; Kottilingam, Srikanth Chandrudu; Porter, Christopher Donald; Schick, David Edward; Weber, David Wayne

2016-08-16

Sealing device for providing seals between adjacent components, and turbomachines utilizing such sealing devices, are provided. A sealing device includes a seal plate insertable between the adjacent components, the seal plate comprising a first face and an opposing second face. The sealing device further includes a plurality of pins extending from one of the first face or the second face, the plurality of pins configured to space the one of the first face or the second face from contact surfaces of the adjacent components.

Evidentiary Pluralism as a Strategy for Research and Evidence-Based Practice in Rehabilitation Psychology

PubMed Central

Tucker, Jalie A.; Reed, Geoffrey M.

2008-01-01

This paper examines the utility of evidentiary pluralism, a research strategy that selects methods in service of content questions, in the context of rehabilitation psychology. Hierarchical views that favor randomized controlled clinical trials (RCTs) over other evidence are discussed, and RCTs are considered as they intersect with issues in the field. RCTs are vital for establishing treatment efficacy, but whether they are uniformly the best evidence to inform practice is critically evaluated. We argue that because treatment is only one of several variables that influence functioning, disability, and participation over time, an expanded set of conceptual and data analytic approaches should be selected in an informed way to support an expanded research agenda that investigates therapeutic and extra-therapeutic influences on rehabilitation processes and outcomes. The benefits of evidentiary pluralism are considered, including helping close the gap between the narrower clinical rehabilitation model and a public health disability model. KEY WORDS: evidence-based practice, evidentiary pluralism, rehabilitation psychology, randomized controlled trials PMID:19649150

The moderation effect of personality on healthcare utilization in Chinese people living with HIV.

PubMed

Yu, Nancy Xiaonan; Mols, Floortje; Stewart, Sunita M; Zhang, Jianxin

2017-06-01

There is evidence that Type D personality can predict impaired quality of life and health status in various chronic conditions. The evidence is conflicting as to whether Type D is associated with increased healthcare services, and no study has reported on the healthcare utilization of people living with HIV (PLWH) who have a Type D personality. This study investigated the impact of Type D personality on healthcare utilization in a sample of Chinese PLWH and examined physical and emotional symptoms as possible mechanisms of healthcare utilization. This was a cross-sectional study of 199 PLWH in rural China. Participants completed a survey on physical symptoms, emotional symptoms, healthcare utilization, and Type D personality. Those PLWH with a Type D personality reported more physical and emotional symptoms and healthcare utilization than patients without this personality. Among PLWH who had a Type D personality, physical symptoms had a direct effect on healthcare utilization, and emotional symptoms did not significantly mediate this association. However, among PLWH without a Type D personality, emotional symptoms significantly mediated the effects of physical symptoms on healthcare utilization. PLWH with a Type D personality reported more healthcare utilization, which was attributed to their high physical symptoms rather than their emotional symptoms. These findings suggest that PLWH with a Type D personality might be bothered by intensified emotional symptoms, which might be too severe to be associated with physical symptoms and healthcare utilization. New prospective studies should focus on the pattern of healthcare utilization among patients with a Type D personality and their intensified physical and emotional symptoms.

Search systems and computer-implemented search methods

DOEpatents

Payne, Deborah A.; Burtner, Edwin R.; Hampton, Shawn D.; Gillen, David S.; Henry, Michael J.

2017-03-07

Search systems and computer-implemented search methods are described. In one aspect, a search system includes a communications interface configured to access a plurality of data items of a collection, wherein the data items include a plurality of image objects individually comprising image data utilized to generate an image of the respective data item. The search system may include processing circuitry coupled with the communications interface and configured to process the image data of the data items of the collection to identify a plurality of image content facets which are indicative of image content contained within the images and to associate the image objects with the image content facets and a display coupled with the processing circuitry and configured to depict the image objects associated with the image content facets.

Search systems and computer-implemented search methods

DOEpatents

Payne, Deborah A.; Burtner, Edwin R.; Bohn, Shawn J.; Hampton, Shawn D.; Gillen, David S.; Henry, Michael J.

2015-12-22

Search systems and computer-implemented search methods are described. In one aspect, a search system includes a communications interface configured to access a plurality of data items of a collection, wherein the data items include a plurality of image objects individually comprising image data utilized to generate an image of the respective data item. The search system may include processing circuitry coupled with the communications interface and configured to process the image data of the data items of the collection to identify a plurality of image content facets which are indicative of image content contained within the images and to associate the image objects with the image content facets and a display coupled with the processing circuitry and configured to depict the image objects associated with the image content facets.

Do senior management cultures affect performance? Evidence from Italian public healthcare organizations.

PubMed

Prenestini, Anna; Lega, Federico

2013-01-01

Healthcare organizations are often characterized by diffuse power, ambiguous goals, and a plurality of actors. In this complex and pluralistic context, senior healthcare managers are expected to provide strategic direction and lead their organizations toward their goals and performance targets. The present work explores the relationship between senior management team culture and performance by investigating Italian public healthcare organizations in the Tuscany region. Our assessment of senior management culture was accomplished through the use of an established framework and a corresponding tool, the competing values framework, which supports the idea that specific aspects of performance are related to a dominant management culture. Organizational performance was assessed using a wide range of measures collected by a multidimensional performance evaluation system, which was developed in Tuscany to measure the performance of its 12 local health authorities (LHAs) and four teaching hospitals (THs). Usable responses were received from 80 senior managers of 11 different healthcare organizations (two THs and nine LHAs). Our findings show that Tuscan healthcare organizations are characterized by various dominant cultures: developmental, clan, rational, and hierarchical. These variations in dominant culture were associated with performance measures. The implications for management theory, professional practice, and public policy are discussed.

FACTORS ASSOCIATED WITH HEALTHCARE UTILIZATION AMONG ARAB IMMIGRANTS AND REFUGEES

PubMed Central

2015-01-01

Background Arab migrants are exposed to pre- and post migration stressors that increase their risk for health problems. However, little is known regarding healthcare utilization rates or factors associated with healthcare utilization among Arab immigrants and refugees. Methods 590 participants were interviewed 1 year post-migration to the United States Factors associated with healthcare utilization including stress coping mechanisms were examined using binary logistic regressions. Results Compared to national healthcare utilization data, immigrants had significantly lower and refugees had significantly higher rates. Being a refugee, married, and having health insurance were significantly associated with medical service utilization. None of the immigrants in this study had utilized psychological services. Among refugees, the use of medications and having strategies for dealing with stress were inversely associated with utilization of psychological services. Discussion (Conclusion) Healthcare utilization was significantly higher among refugees, who also reported a greater need for services than immigrants. PMID:25331684

Cooling system for a gas turbine using a cylindrical insert having V-shaped notch weirs

DOEpatents

Grondahl, Clayton M.; Germain, Malcolm R.

1981-01-01

An improved cooling system for a gas turbine is disclosed. A plurality of V-shaped notch weirs are utilized to meter a coolant liquid from a pool of coolant into a plurality of platform and airfoil coolant channels formed in the buckets of the turbine. The V-shaped notch weirs are formed in a separately machined cylindrical insert and serve to desensitize the flow of coolant into the individual platform and airfoil coolant channels to design tolerances and non-uniform flow distribution.

Just healthcare? The moral failure of single-tier basic healthcare.

PubMed

Meadowcroft, John

2015-04-01

This article sets out the moral failure of single-tier basic healthcare. Single-tier basic healthcare has been advocated on the grounds that the provision of healthcare should be divorced from ability to pay and unequal access to basic healthcare is morally intolerable. However, single-tier basic healthcare encounters a host of catastrophic moral failings. Given the fact of human pluralism it is impossible to objectively define "basic" healthcare. Attempts to provide single-tier healthcare therefore become political processes in which interest groups compete for control of scarce resources with the most privileged possessing an inherent advantage. The focus on outputs in arguments for single-tier provision neglects the question of justice between individuals when some people provide resources for others without reciprocal benefits. The principle that only healthcare that can be provided to everyone should be provided at all leads to a leveling-down problem in which advocates of single-tier provision must prefer a situation where some individuals are made worse-off without any individual being made better-off compared to plausible multi-tier alternatives. Contemporary single-tier systems require the exclusion of noncitizens, meaning that their universalism is a myth. In the light of these pathologies, it is judged that multi-tier healthcare is morally required. © The Author 2015. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Mental health-care utilization in survivors of childhood cancer and siblings: the Swiss childhood cancer survivor study.

PubMed

Gianinazzi, Micol E; Rueegg, Corina S; von der Weid, Nicolas X; Niggli, Felix K; Kuehni, Claudia E; Michel, Gisela

2014-02-01

We aimed to (1) describe the utilization of mental health-care in survivors and siblings, the association with severity of distress, and visits to other professionals in distressed survivors not utilizing mental health-care; and (2) identify factors associated with utilization of mental health-care in distressed survivors. Within the Swiss Childhood Cancer Survivor Study, we sent postal questionnaires to all participants aged <16 years at diagnosis (1976-2003), who survived ≥5 years after diagnosis and were aged ≥16 years at study. Survivors and siblings could indicate if they utilized mental health-care in the past year. Psychological distress was assessed with the Brief Symptom Inventory-18 (BSI-18). Participants with scores T ≥ 57 on two of three scales or the Global Severity Index were considered distressed. We included 1,602 survivors and 703 siblings. Overall, 160 (10 %) and 53 (8 %), utilized mental health-care and 203 (14 %) and 127 (14 %) were considered distressed. Among these, 69 (34 %) survivors and 20 (24 %) siblings had utilized mental health-care. Participants with higher distress were more likely to utilize mental health-care. Distressed survivors not utilizing mental health-care were more likely to see a medical specialist than nondistressed. In the multivariable regression, factors associated with utilizing mental health-care were higher psychological distress and reporting late effects. Our results underline the importance of developing interventional programs and implementing psychological screening in follow-up of survivors. It is also important to systematically address siblings' needs. In follow-up, patients at risk should be informed about existing possibilities or advised to visit mental health professionals.

Separated-orbit bisected energy-recovered linear accelerator

DOEpatents

Douglas, David R.

2015-09-01

A separated-orbit bisected energy-recovered linear accelerator apparatus and method. The accelerator includes a first linac, a second linac, and a plurality of arcs of differing path lengths, including a plurality of up arcs, a plurality of downgoing arcs, and a full energy arc providing a path independent of the up arcs and downgoing arcs. The up arcs have a path length that is substantially a multiple of the RF wavelength and the full energy arc includes a path length that is substantially an odd half-integer multiple of the RF wavelength. Operation of the accelerator includes accelerating the beam utilizing the linacs and up arcs until the beam is at full energy, at full energy executing a full recirculation to the second linac using a path length that is substantially an odd half-integer of the RF wavelength, and then decelerating the beam using the linacs and downgoing arcs.

Clustering execution in a processing system to increase power savings

DOEpatents

Bose, Pradip; Buyuktosunoglu, Alper; Jacobson, Hans M.; Vega, Augusto J.

2018-03-20

Embodiments relate to clustering execution in a processing system. An aspect includes accessing a control flow graph that defines a data dependency and an execution sequence of a plurality of tasks of an application that executes on a plurality of system components. The execution sequence of the tasks in the control flow graph is modified as a clustered control flow graph that clusters active and idle phases of a system component while maintaining the data dependency. The clustered control flow graph is sent to an operating system, where the operating system utilizes the clustered control flow graph for scheduling the tasks.

Parallel-plate heat pipe apparatus having a shaped wick structure

DOEpatents

Rightley, Michael J.; Adkins, Douglas R.; Mulhall, James J.; Robino, Charles V.; Reece, Mark; Smith, Paul M.; Tigges, Chris P.

2004-12-07

A parallel-plate heat pipe is disclosed that utilizes a plurality of evaporator regions at locations where heat sources (e.g. semiconductor chips) are to be provided. A plurality of curvilinear capillary grooves are formed on one or both major inner surfaces of the heat pipe to provide an independent flow of a liquid working fluid to the evaporator regions to optimize heat removal from different-size heat sources and to mitigate the possibility of heat-source shadowing. The parallel-plate heat pipe has applications for heat removal from high-density microelectronics and laptop computers.

Methods and apparatus for managing corrosion in buildings

DOEpatents

Chey, S Jay; Hamann, Hendrik F; Klein, Levente Ioan; Schappert, Michael Alan; Stepanchuk, Andriy

2015-02-03

Principles of the invention provide methods and apparatus for providing corrosion management in buildings. In one aspect, an exemplary method includes the step of receiving first data relating corrosion rate to a plurality of environmental conditions. This first data is subsequently utilized to determine a quantitative relationship between corrosion rate and the plurality of environmental conditions. In another step, second data indicative of one or more environmental conditions within a building is received. A corrosion rate in the building is then determined at least in part by applying the determined quantitative relationship to this second data.

Radiation detector having a multiplicity of individual detecting elements

DOEpatents

Whetten, Nathan R.; Kelley, John E.

1985-01-01

A radiation detector has a plurality of detector collection element arrays immersed in a radiation-to-electron conversion medium. Each array contains a multiplicity of coplanar detector elements radially disposed with respect to one of a plurality of positions which at least one radiation source can assume. Each detector collector array is utilized only when a source is operative at the associated source position, negating the necessity for a multi-element detector to be moved with respect to an object to be examined. A novel housing provides the required containment of a high-pressure gas conversion medium.

Control apparatus for hot gas engine

DOEpatents

Stotts, Robert E.

1986-01-01

A mean pressure power control system for a hot gas (Stirling) engine utilizing a plurality of supply tanks for storing a working gas at different pressures. During pump down operations gas is bled from the engine by a compressor having a plurality of independent pumping volumes. In one embodiment of the invention, a bypass control valve system allows one or more of the compressor volumes to be connected to the storage tanks. By selectively sequencing the bypass valves, a capacity range can be developed over the compressor that allows for lower engine idle pressures and more rapid pump down rates.

Electron beam magnetic switch for a plurality of free electron lasers

DOEpatents

Schlitt, Leland G.

1984-01-01

Apparatus for forming and utilizing a sequence of electron beam segments, each of the same temporal length (substantially 15 nsec), with consecutive beams being separated by a constant time interval of the order of 3 nsec. The beam sequence is used for simultaneous inputs to a plurality of wiggler magnet systems that also accept the laser beams to be amplified by interaction with the co-propagating electron beams. The electron beams are arranged substantially in a circle to allow proper distribution of and simultaneous switching out of the beam segments to their respective wiggler magnets.

Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana.

PubMed

Duku, Stephen Kwasi Opoku; Asenso-Boadi, Francis; Nketiah-Amponsah, Edward; Arhinful, Daniel Kojo

2016-12-01

Utilization of healthcare in Ghana's novel National Health Insurance Scheme (NHIS) has been increasing since inception with associated high claims bill which threatens the scheme's financial sustainability. This paper investigates the presence of adverse selection by assessing the effect of healthcare utilization and frequency of use on NHIS renewal. Routine enrolment and utilization data from 2008 to 2013 in two regions in Ghana was analyzed. Pearson Chi-square test was performed to test if the proportion of insured who utilize healthcare in a particular year and renew membership the following year is significantly different from those who utilize healthcare and drop-out. Logistic regressions were estimated to examine the relationship between healthcare utilization and frequency of use in previous year and NHIS renewal in current year. We found evidence suggestive of the presence of adverse selection in the NHIS. Majority of insured who utilized healthcare renewed their membership whiles most of those who did not utilize healthcare dropped out. The likelihood of renewal was significantly higher for those who utilize healthcare than those who did not and also higher for those who make more health facility visits. The NHIS claims bill is high because high risk individuals who self-select into the scheme makes more health facility visits and creates financial sustainability problems. Policy makers should adopt pragmatic ways of enforcing mandatory enrolment so that low risk individuals remain enrolled; and sustainable ways of increasing revenue whiles ensuring that the societal objectives of the scheme are not compromised.

Array of titanium dioxide nanostructures for solar energy utilization

DOEpatents

Qiu, Xiaofeng; Parans Paranthaman, Mariappan; Chi, Miaofang; Ivanov, Ilia N; Zhang, Zhenyu

2014-12-30

An array of titanium dioxide nanostructures for solar energy utilization includes a plurality of nanotubes, each nanotube including an outer layer coaxial with an inner layer, where the inner layer comprises p-type titanium dioxide and the outer layer comprises n-type titanium dioxide. An interface between the inner layer and the outer layer defines a p-n junction.

Bidirectional slapper detonator

DOEpatents

McCormick, Robert N.; Boyd, Melissa D.

1984-01-01

The disclosure is directed to a bidirectional slapper detonator. One embodiment utilizes a single bridge circuit to detonate a pair of opposing initiating pellets. A line generator embodiment uses a plurality of bridges in electrical series to generate opposing cylindrical wavefronts.

Method of up-front load balancing for local memory parallel processors

NASA Technical Reports Server (NTRS)

Baffes, Paul Thomas (Inventor)

1990-01-01

In a parallel processing computer system with multiple processing units and shared memory, a method is disclosed for uniformly balancing the aggregate computational load in, and utilizing minimal memory by, a network having identical computations to be executed at each connection therein. Read-only and read-write memory are subdivided into a plurality of process sets, which function like artificial processing units. Said plurality of process sets is iteratively merged and reduced to the number of processing units without exceeding the balance load. Said merger is based upon the value of a partition threshold, which is a measure of the memory utilization. The turnaround time and memory savings of the instant method are functions of the number of processing units available and the number of partitions into which the memory is subdivided. Typical results of the preferred embodiment yielded memory savings of from sixty to seventy five percent.

How Accurate are Self-Reports? An Analysis of Self-Reported Healthcare Utilization and Absence When Compared to Administrative Data

PubMed Central

Short, Meghan E.; Pei, Xiaofei; Tabrizi, Maryam J.; Ozminkowski, Ronald J.; Gibson, Teresa B.; DeJoy, Dave M.; Wilson, Mark G.

2009-01-01

Objective To determine the accuracy of self-reported healthcare utilization and absence reported on health risk assessments (HRAs) against administrative claims and human resource records. Methods Self-reported values of healthcare utilization and absenteeism were analyzed for concordance to administrative claims values. Percent agreement, Pearson’s correlations, and multivariate logistic regression models examined the level of agreement and characteristics of participants with concordance. Results Self-report and administrative data showed greater concordance for monthly compared to yearly healthcare utilization metrics. Percent agreement ranged from 30 to 99% with annual doctor visits having the lowest percent agreement. Younger people, males, those with higher education, and healthier individuals more accurately reported their healthcare utilization and absenteeism. Conclusions Self-reported healthcare utilization and absenteeism may be used as a proxy when medical claims and administrative data are unavailable, particularly for shorter recall periods. PMID:19528832

What does quality maternity care mean in a context of medical pluralism? Perspectives of women in Nigeria

PubMed Central

Izugbara, Chimaraoke O; Wekesah, Frederick

2018-01-01

Abstract User priorities regarding quality care in contexts of medical pluralism are poorly documented. Drawing on group and individual interviews with women, we interrogate ideas of quality maternity care in the context of Nigeria’s medical pluralism. We found complex utilization patterns for conventional, complementary and alternative maternity care services as well as ideas of quality maternity care that stress effective coordination and integration of different typologies of maternity health services; socially sensitive and truthful providers; and socioeconomic, physical and parochial forms of safety. Informal providers were the commonly reported source of maternal health services in the study. Maternal health services in the country were also generally viewed as poor quality, characterized by pervasive abuse, quackery and lack of commitment to the needs and sensitivities of women. Convenience, availability and affordability of maternal health services, as well as sociocultural factors were major influences on women’s use of services. Results demonstrate the embeddedness of women’s quality of care notions in the vast socioeconomic inequities that typify Nigeria’s particular form of poorly regulated medical pluralism, raising need for strategies to strengthen the delivery, coordination and supervision of maternal health services in the country. PMID:29036530

Efficient implementation of multidimensional fast fourier transform on a distributed-memory parallel multi-node computer

DOEpatents

Bhanot, Gyan V [Princeton, NJ; Chen, Dong [Croton-On-Hudson, NY; Gara, Alan G [Mount Kisco, NY; Giampapa, Mark E [Irvington, NY; Heidelberger, Philip [Cortlandt Manor, NY; Steinmacher-Burow, Burkhard D [Mount Kisco, NY; Vranas, Pavlos M [Bedford Hills, NY

2012-01-10

The present in invention is directed to a method, system and program storage device for efficiently implementing a multidimensional Fast Fourier Transform (FFT) of a multidimensional array comprising a plurality of elements initially distributed in a multi-node computer system comprising a plurality of nodes in communication over a network, comprising: distributing the plurality of elements of the array in a first dimension across the plurality of nodes of the computer system over the network to facilitate a first one-dimensional FFT; performing the first one-dimensional FFT on the elements of the array distributed at each node in the first dimension; re-distributing the one-dimensional FFT-transformed elements at each node in a second dimension via "all-to-all" distribution in random order across other nodes of the computer system over the network; and performing a second one-dimensional FFT on elements of the array re-distributed at each node in the second dimension, wherein the random order facilitates efficient utilization of the network thereby efficiently implementing the multidimensional FFT. The "all-to-all" re-distribution of array elements is further efficiently implemented in applications other than the multidimensional FFT on the distributed-memory parallel supercomputer.

Efficient implementation of a multidimensional fast fourier transform on a distributed-memory parallel multi-node computer

DOEpatents

Bhanot, Gyan V [Princeton, NJ; Chen, Dong [Croton-On-Hudson, NY; Gara, Alan G [Mount Kisco, NY; Giampapa, Mark E [Irvington, NY; Heidelberger, Philip [Cortlandt Manor, NY; Steinmacher-Burow, Burkhard D [Mount Kisco, NY; Vranas, Pavlos M [Bedford Hills, NY

2008-01-01

The present in invention is directed to a method, system and program storage device for efficiently implementing a multidimensional Fast Fourier Transform (FFT) of a multidimensional array comprising a plurality of elements initially distributed in a multi-node computer system comprising a plurality of nodes in communication over a network, comprising: distributing the plurality of elements of the array in a first dimension across the plurality of nodes of the computer system over the network to facilitate a first one-dimensional FFT; performing the first one-dimensional FFT on the elements of the array distributed at each node in the first dimension; re-distributing the one-dimensional FFT-transformed elements at each node in a second dimension via "all-to-all" distribution in random order across other nodes of the computer system over the network; and performing a second one-dimensional FFT on elements of the array re-distributed at each node in the second dimension, wherein the random order facilitates efficient utilization of the network thereby efficiently implementing the multidimensional FFT. The "all-to-all" re-distribution of array elements is further efficiently implemented in applications other than the multidimensional FFT on the distributed-memory parallel supercomputer.

Public and private healthcare services utilization by non-institutional elderly in Hong Kong: is the inverse care law operating?

PubMed

Yam, Ho-Kwan; Mercer, Stewart W; Wong, Lai-Yi; Chan, Wan-Kin; Yeoh, Eng-Kiong

2009-08-01

To assess the factors associated with healthcare services utilization by the non-institutional elderly across five types of service utilization (Western medicine doctors in Government clinics, private Western medicine doctors, Chinese medicine practitioners, Emergency Units, and hospitalization). A secondary data analysis of a territory-wide cross-sectional survey collected by the Government among a representative sample of 4812 elderly (aged 60 and above) in Hong Kong. Our analysis, based on Anderson's behavioral framework, shows that need factors (relating to actual or perceived illness and diseases) are significantly related to the healthcare services utilization examined. However, enabling factors, such as monthly household income per capita, play a significant role in determining the utilization. Although the lower-income elderly consult more Government clinics and less private clinics than the more affluent, they have a lower total utilization of healthcare services despite having significantly greater healthcare needs. This suggests a mismatch of need and supply within the mixed economy of private and public healthcare services and suggests the existence of an 'inverse care law' in Hong Kong amongst elderly citizens. The findings raise concerns of inequities in Hong Kong's healthcare system, raising implications for future healthcare reforms.

Clustering execution in a processing system to increase power savings

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

Bose, Pradip; Buyuktosunoglu, Alper; Jacobson, Hans M.

Embodiments relate to clustering execution in a processing system. An aspect includes accessing a control flow graph that defines a data dependency and an execution sequence of a plurality of tasks of an application that executes on a plurality of system components. The execution sequence of the tasks in the control flow graph is modified as a clustered control flow graph that clusters active and idle phases of a system component while maintaining the data dependency. The clustered control flow graph is sent to an operating system, where the operating system utilizes the clustered control flow graph for scheduling themore » tasks.« less

Organic photovoltaic cells utilizing ultrathin sensitizing layer

DOEpatents

Forrest, Stephen R [Ann Arbor, MI; Yang, Fan [Piscataway, NJ; Rand, Barry P [Somers, NY

2011-09-06

A photosensitive device includes a plurality of organic photoconductive materials disposed in a stack between a first electrode and a second electrode, including a first continuous layer of donor host material, a second continuous layer of acceptor host material, and at least one other organic photoconductive material disposed as a plurality of discontinuous islands between the first continuous layer and the second continuous layer. Each of these other photoconductive materials has an absorption spectra different from the donor host material and the acceptor host material. Preferably, each of the discontinuous islands consists essentially of a crystallite of the respective organic photoconductive material, and more preferably, the crystallites are nanocrystals.

Solids fluidizer-injector

DOEpatents

Bulicz, Tytus R.

1990-01-01

An apparatus and process for fluidizing solid particles by causing rotary motion of the solid particles in a fluidizing chamber by a plurality of rotating projections extending from a rotatable cylinder end wall interacting with a plurality of fixed projections extending from an opposite fixed end wall and passing the solid particles through a radial feed orifice open to the solids fluidizing chamber on one side and a solid particle utilization device on the other side. The apparatus and process are particularly suited for obtaining intermittent feeding with continual solids supply to the fluidizing chamber. The apparatus and process are suitable for injecting solid particles, such as coal, to an internal combustion engine.

Utilization of Healthcare in the Typhoid Fever Surveillance in Africa Program.

PubMed

Panzner, Ursula; Pak, Gi Deok; Aaby, Peter; Adu-Sarkodie, Yaw; Ali, Mohammad; Aseffa, Abraham; Baker, Stephen; Bjerregaard-Andersen, Morten; Crump, John A; Deerin, Jessica; Cruz Espinoza, Ligia Maria; Gasmelseed, Nagla; Heriniaina, Jean Noël; Hertz, Julian T; Im, Justin; von Kalckreuth, Vera; Keddy, Karen H; Lankoande, Bruno; Løfberg, Sandra; Meyer, Christian G; Oresto, Michael Munishi; Park, Jin Kyung; Park, Se Eun; Rakotozandrindrainy, Raphaël; Sarpong, Nimako; Soura, Abdramane Bassiahi; Gassama Sow, Amy; Tall, Adama; Teferi, Mekonnen; Worku, Alemayehu; Yeshitela, Biruk; Wierzba, Thomas F; Marks, Florian

2016-03-15

Assessing healthcare utilization is important to identify weaknesses of healthcare systems, to outline action points for preventive measures and interventions, and to more accurately estimate the disease burden in a population. A healthcare utilization survey was developed for the Typhoid Fever Surveillance in Africa Program (TSAP) to adjust incidences of salmonellosis determined through passive, healthcare facility-based surveillance. This cross-sectional survey was conducted at 11 sites in 9 sub-Saharan African countries. Demographic data and healthcare-seeking behavior were assessed at selected households. Overall and age-stratified percentages of each study population that sought healthcare at a TSAP healthcare facility and elsewhere were determined. Overall, 88% (1007/1145) and 81% (1811/2238) of the population in Polesgo and Nioko 2, Burkina Faso, respectively, and 63% (1636/2590) in Butajira, Ethiopia, sought healthcare for fever at any TSAP healthcare facility. A far smaller proportion-namely, 20%-45% of the population in Bissau, Guinea-Bissau (1743/3885), Pikine, Senegal (1473/4659), Wad-Medani, Sudan (861/3169), and Pietermaritzburg, South Africa (667/2819); 18% (483/2622) and 9% (197/2293) in Imerintsiatosika and Isotry, Madagascar, respectively; and 4% (127/3089) in Moshi, Tanzania-sought healthcare at a TSAP healthcare facility. Patients with fever preferred to visit pharmacies in Imerintsiatosika and Isotry, and favored self-management of fever in Moshi. Age-dependent differences in healthcare utilization were also observed within and across sites. Healthcare utilization for fever varied greatly across sites, and revealed that not all studied populations were under optimal surveillance. This demonstrates the importance of assessing healthcare utilization. Survey data were pivotal for the adjustment of the program's estimates of salmonellosis and other conditions associated with fever. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Situated clinical encounters in the negotiation of religious and spiritual plurality: a critical ethnography.

PubMed

Pesut, Barbara; Reimer-Kirkham, Sheryl

2010-07-01

Despite increasingly diverse, globalized societies, little attention has been paid to the influence of religious and spiritual diversity on clinical encounters within healthcare. The purpose of the study was to analyze the negotiation of religious and spiritual plurality in clinical encounters, and the social, gendered, cultural, historical, economic and political contexts that shape that negotiation. Qualitative: critical ethnography. The study was conducted in Western Canada between 2006 and 2009. Data collection occurred on palliative, hospice, medical and renal in-patient units at two tertiary level hospitals and seven community hospitals. Participants were recruited through purposive sampling and snowball technique. Twenty healthcare professionals, seventeen spiritual care providers, sixteen patients and families and twelve administrators, representing diverse ethnicities and religious affiliations, took part in the study. Data collection included 65 in-depth interviews and over 150h of participant observation. Clinical encounters between care providers and recipients were shaped by how individual identities in relation to religion and spirituality were constructed. Importantly, these identities did not occur in isolation from other lines of social classification such as gender, race, and class. Negotiating difference was a process of seeing spirituality as a point of connection, eliciting the meaning systems of patients and creating safe spaces for the expression of that meaning. The complexity of religious and spiritual identity construction and negotiation raises important questions about language and about professional competence and boundaries in clinical encounters where religion and spirituality are relevant concerns. Copyright 2009 Elsevier Ltd. All rights reserved.

Sensor And Method For Detecting A Superstrate

NASA Technical Reports Server (NTRS)

Arndt, G. Dickey (Inventor); Cari, James R. (Inventor); Ngo, Phong H. (Inventor); Fink, Patrick W. (Inventor); Siekierski, James D. (Inventor)

2006-01-01

Method and apparatus are provided for determining a superstrate on or near a sensor, e.g., for detecting the presence of an ice superstrate on an airplane wing or a road. In one preferred embodiment, multiple measurement cells are disposed along a transmission line. While the present invention is operable with different types of transmission lines, construction details for a presently preferred coplanar waveguide and a microstrip waveguide are disclosed. A computer simulation is provided as part of the invention for predicting results of a simulated superstrate detector system. The measurement cells may be physically partitioned, nonphysically partitioned with software or firmware, or include a combination of different types of partitions. In one embodiment, a plurality of transmission lines are utilized wherein each transmission line includes a plurality of measurement cells. The plurality of transmission lines may be multiplexed with the signal from each transmission line being applied to the same phase detector. In one embodiment, an inverse problem method is applied to determine the superstrate dielectric for a transmission line with multiple measurement cells.

Healthcare Utilization Monitoring System in Korea

PubMed Central

Shin, Hyun Chul; Lee, Youn Tae; Jo, Emmanuel C.

2015-01-01

Objectives It is important to monitor the healthcare utilization of patients at the national level to make evidence-based policy decisions and manage the nation's healthcare sector. The Health Insurance Review & Assessment Service (HIRA) has run a Healthcare Utilization Monitoring System (HUMS) since 2008. The objective of this paper is to introduce HIRA's HUMS. Methods This study described the HUMS's system structure, capacity, functionalities, and output formats run by HIRA in the Republic of Korea. Regarding output formats, this study extracted diabetes related health insurance claims through the HUMS from August 1, 2014 to May 31, 2015. Results The HUMS has kept records of health insurance claim data for 4 years. It has a 14-terabyte hardware capacity and employs several easy-to-use programs for maintenance of the system, such as MSTR, SAS, etc. Regarding functionalities, users should input diseases codes, target periods, facility types, and types of attributes, such as the number of healthcare utilizations or healthcare costs. It also has a functionality to predict healthcare utilization and costs. When this study extracted diabetes related data, it was found that the trend of healthcare costs for the treatment of diabetes and the number of patients with diabetes were increasing. Conclusions HIRA's HUMS works well to monitor healthcare utilization of patients at the national level. The HUMS has a high-capacity hardware infrastructure and several operational programs that allows easy access to summaries as well as details to identify contributing factors for abnormality, but it has a limitation in that there is often a time lag between the provision of healthcare to patients and the filing of health claims. PMID:26279955

Assessing equity of healthcare utilization in rural China: results from nationally representative surveys from 1993 to 2008

PubMed Central

2013-01-01

Background The phenomenon of inequitable healthcare utilization in rural China interests policymakers and researchers; however, the inequity has not been actually measured to present the magnitude and trend using nationally representative data. Methods Based on the National Health Service Survey (NHSS) in 1993, 1998, 2003, and 2008, the Probit model with the probability of outpatient visit and the probability of inpatient visit as the dependent variables is applied to estimate need-predicted healthcare utilization. Furthermore, need-standardized healthcare utilization is assessed through indirect standardization method. Concentration index is measured to reflect income-related inequity of healthcare utilization. Results The concentration index of need-standardized outpatient utilization is 0.0486[95% confidence interval (0.0399, 0.0574)], 0.0310[95% confidence interval (0.0229, 0.0390)], 0.0167[95% confidence interval (0.0069, 0.0264)] and −0.0108[95% confidence interval (−0.0213, -0.0004)] in 1993, 1998, 2003 and 2008, respectively. For inpatient service, the concentration index is 0.0529[95% confidence interval (0.0349, 0.0709)], 0.1543[95% confidence interval (0.1356, 0.1730)], 0.2325[95% confidence interval (0.2132, 0.2518)] and 0.1313[95% confidence interval (0.1174, 0.1451)] in 1993, 1998, 2003 and 2008, respectively. Conclusions Utilization of both outpatient and inpatient services was pro-rich in rural China with the exception of outpatient service in 2008. With the same needs for healthcare, rich rural residents utilized more healthcare service than poor rural residents. Compared to utilization of outpatient service, utilization of inpatient service was more inequitable. Inequity of utilization of outpatient service reduced gradually from 1993 to 2008; meanwhile, inequity of inpatient service utilization increased dramatically from 1993 to 2003 and decreased significantly from 2003 to 2008. Recent attempts in China to increase coverage of insurance and primary healthcare could be a contributing factor to counteract the inequity of outpatient utilization, but better benefit packages and delivery strategies still need to be tested and scaled up to reduce future inequity in inpatient utilization in rural China. PMID:23688260

Inquiry-based learning as a teaching strategy for critical thinking.

PubMed

Inouye, J; Flannelly, L

1998-03-01

Changes in the healthcare system have prompted educators to rethink and revise nursing curricula. The National League for Nursing has outlined recommendations for the successful implementation of socially relevant curricula that reflect the diversity and plurality of local communities. Such revisions should better prepare graduates to function in a reformed healthcare system. Educational goals have shifted from curricula content to curricula outcomes. Beyond the mastery of content (which may quickly become outdated), the development of specific skills (critical thinking) and innovative responses to problems are now required of advanced practice nurses. Inquiry-based learning (IBL) offers an opportunity for graduate students to develop the necessary skills for effective practice. This article presents a model of IBL in graduate mental health education and an investigation of critical thinking skills as a possible outcome of the IBL method.

Health-care utilization and associated factors in Gauteng province, South Africa.

PubMed

Abera Abaerei, Admas; Ncayiyana, Jabulani; Levin, Jonathan

2017-01-01

More than a billion people, mainly in low- and middle-income countries, are unable to access needed health-care services for a variety of reasons. Possible factors influencing health-care utilization include socio-demographic and economic factors such as age, sex, education, employment and income. However, different studies have showed mixed results. Moreover, there are limited studies on health-care utilization. This study aimed to determine health-care utilization and associated factors among all residents aged 18 or over in Gauteng province, South Africa. A cross-sectional study was conducted from data collected for a Quality of Life survey which was carried out by Gauteng City-Region Observatory in 2013. Simple random sampling was used to select participants. A total of 27,490 participants have been interviewed. Data were collected via a digital data collection instrument using an open source system called Formhub. Coarsened Exact Matching (CEM) was used to improve estimation of causal effects. Stepwise multiple logistic regression was employed to identify factors associated with health-care utilization. Around 95.7% reported usually utilizing health-care services while the other 4.3% reported not having sought health-care services of any type. Around 75% of participants reported reduced quality of public health services as a major reason not to visit them. Higher odds of reported health-care utilization were associated with being female (OR = 2.18, 95% CI: 1.88-2.53; p < 0.001), being White compared to being African (OR = 2.28, 95% CI: 1.84-2.74; p < 0.001), and having medical insurance (OR = 5.41, 95% CI: 4.06-7.23; p < 0.001). Lower odds of seeking health-care were associated with being an immigrant (OR = 0.61, 95% CI: 0.53-0.70; p < 0.001). The results indicated that there is a need to improve the quality of public health-care services and perception towards them as improved health-care quality increases the choice of health-care providers.

Extraordinary electromagnetic transmission by antenna arrays and frequency selective surfaces having compound unit cells with dissimilar elements

DOEpatents

Loui, Hung; Strassner, II, Bernd H.

2018-03-20

The various embodiments presented herein relate to extraordinary electromagnetic transmission (EEMT) to enable multiple inefficient (un-matched) but coupled radiators and/or apertures to radiate and/or pass electromagnetic waves efficiently. EEMT can be utilized such that signal transmission from a plurality of antennas and/or apertures occurs at a transmission frequency different to transmission frequencies of the individual antennas and/or aperture elements. The plurality of antennas/apertures can comprise first antenna/aperture having a first radiating area and material(s) and second antenna/aperture having a second radiating area and material(s), whereby the first radiating/aperture area and second radiating/aperture area can be co-located in a periodic compound unit cell. Owing to mutual coupling between the respective antennas/apertures in their arrayed configuration, the transmission frequency of the array can be shifted from the transmission frequencies of the individual elements. EEMT can be utilized for an array of evanescent of inefficient radiators connected to a transmission line(s).

Asthma Outcomes: Healthcare Utilization and Costs

PubMed Central

Akinbami, Lara J.; Sullivan, Sean D.; Campbell, Jonathan D.; Grundmeier, Robert W.; Hartert, Tina V.; Lee, Todd A.; Smith, Robert A.

2014-01-01

Background Measures of healthcare utilization and indirect impact of asthma morbidity are used to assess clinical interventions and estimate cost. Objective National Institutes of Health (NIH) institutes and other federal agencies convened an expert group to propose standardized measurement, collection, analysis, and reporting of healthcare utilization and cost outcomes in future asthma studies. Methods We used comprehensive literature reviews and expert opinion to compile a list of asthma healthcare utilization outcomes that we classified as core (required in future studies), supplemental (used according to study aims and standardized) and emerging (requiring validation and standardization). We also have identified methodology to assign cost to these outcomes. This work was discussed at an NIH-organized workshop in March 2010 and finalized in September 2011. Results We identified 3 ways to promote comparability across clinical trials for measures of healthcare utilization, resource use, and cost: (1) specify the study perspective (patient, clinician, payer, society), (2) standardize the measurement period (ideally, 12 months), and (3) use standard units to measure healthcare utilization and other asthma-related events. Conclusions Large clinical trials and observational studies should collect and report detailed information on healthcare utilization, intervention resources, and indirect impact of asthma, so that costs can be calculated and cost-effectiveness analyses can be conducted across several studies. Additional research is needed to develop standard, validated survey instruments for collection of provider-reported and participant-reported data regarding asthma-related health care. PMID:22386509

Healthcare Cost and Utilization Project (HCUP)

Cancer.gov

The Healthcare Cost and Utilization Project is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality.

Self-Latching Piezocomposite Actuator

NASA Technical Reports Server (NTRS)

Wilkie, William K. (Inventor); Lynch, Christopher S. (Inventor); Bryant, Robert G. (Inventor)

2017-01-01

A self-latching piezocomposite actuator includes a plurality of shape memory ceramic fibers. The actuator can be latched by applying an electrical field to the shape memory ceramic fibers. The actuator remains in a latched state/shape after the electrical field is no longer present. A reverse polarity electric field may be applied to reset the actuator to its unlatched state/shape. Applied electric fields may be utilized to provide a plurality of latch states between the latched and unlatched states of the actuator. The self-latching piezocomposite actuator can be used for active/adaptive airfoils having variable camber, trim tabs, active/deformable engine inlets, adaptive or adjustable vortex generators, active optical components such as mirrors that change shapes, and other morphing structures.

Solids fluidizer-injector

DOEpatents

Bulicz, T.R.

1990-04-17

An apparatus and process are described for fluidizing solid particles by causing rotary motion of the solid particles in a fluidizing chamber by a plurality of rotating projections extending from a rotatable cylinder end wall interacting with a plurality of fixed projections extending from an opposite fixed end wall and passing the solid particles through a radial feed orifice open to the solids fluidizing chamber on one side and a solid particle utilization device on the other side. The apparatus and process are particularly suited for obtaining intermittent feeding with continual solids supply to the fluidizing chamber. The apparatus and process are suitable for injecting solid particles, such as coal, to an internal combustion engine. 3 figs.

Predictors of Healthcare Service Utilization for Mental Health Reasons

PubMed Central

Fleury, Marie-Josée; Ngamini Ngui, André; Bamvita, Jean-Marie; Grenier, Guy; Caron, Jean

2014-01-01

This study was designed to identify: (1) predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2) correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior) and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care. PMID:25321874

The upper respiratory pyramid: early factors and later treatment utilization in World Trade Center exposed firefighters.

PubMed

Niles, Justin K; Webber, Mayris P; Liu, Xiaoxue; Zeig-Owens, Rachel; Hall, Charles B; Cohen, Hillel W; Glaser, Michelle S; Weakley, Jessica; Schwartz, Theresa M; Weiden, Michael D; Nolan, Anna; Aldrich, Thomas K; Glass, Lara; Kelly, Kerry J; Prezant, David J

2014-08-01

We investigated early post 9/11 factors that could predict rhinosinusitis healthcare utilization costs up to 11 years later in 8,079 World Trade Center-exposed rescue/recovery workers. We used bivariate and multivariate analytic techniques to investigate utilization outcomes; we also used a pyramid framework to describe rhinosinusitis healthcare groups at early (by 9/11/2005) and late (by 9/11/2012) time points. Multivariate models showed that pre-9/11/2005 chronic rhinosinusitis diagnoses and nasal symptoms predicted final year healthcare utilization outcomes more than a decade after WTC exposure. The relative proportion of workers on each pyramid level changed significantly during the study period. Diagnoses of chronic rhinosinusitis within 4 years of a major inhalation event only partially explain future healthcare utilization. Exposure intensity, early symptoms and other factors must also be considered when anticipating future healthcare needs. © 2014 Wiley Periodicals, Inc.

The Upper Respiratory Pyramid: Early Factors and Later Treatment Utilization in World Trade Center Exposed Firefighters

PubMed Central

Niles, Justin K.; Webber, Mayris P.; Liu, Xiaoxue; Zeig-Owens, Rachel; Hall, Charles B.; Cohen, Hillel W.; Glaser, Michelle S.; Weakley, Jessica; Schwartz, Theresa M.; Weiden, Michael D.; Nolan, Anna; Aldrich, Thomas K.; Glass, Lara; Kelly, Kerry J.; Prezant, David J.

2015-01-01

Background We investigated early post 9/11 factors that could predict rhinosinusitis healthcare utilization costs up to 11 years later in 8,079 World Trade Center-exposed rescue/recovery workers. Methods We used bivariate and multivariate analytic techniques to investigate utilization outcomes; we also used a pyramid framework to describe rhinosinusitis healthcare groups at early (by 9/11/2005) and late (by 9/11/2012) time points. Results Multivariate models showed that pre-9/11/2005 chronic rhinosinusitis diagnoses and nasal symptoms predicted final year healthcare utilization outcomes more than a decade after WTC exposure. The relative proportion of workers on each pyramid level changed significantly during the study period. Conclusions Diagnoses of chronic rhinosinusitis within 4 years of a major inhalation event only partially explain future healthcare utilization. Exposure intensity, early symptoms and other factors must also be considered when anticipating future healthcare needs. PMID:24898816

Workplace health promotion and utilization of health services: follow-up data findings.

PubMed

Deitz, Diane; Cook, Royer; Hersch, Rebekah

2005-01-01

This article reports findings from a workplace substance abuse prevention program designed to investigate best practices. The study sought to assess the effects of the worksite wellness program and employee assistance program (EAP) on healthcare utilization and costs, identify predictors of outpatient costs and visits, and assess the effect of the intervention on health attitudes, behaviors, and behavioral health-related costs and visits. Results indicated that visits to the EAP increased as did overall healthcare visits, that utilization of healthcare services and costs were higher in the population receiving substance abuse prevention intervention, and that employees in the substance abuse prevention intervention reported lower heavy drinking and binge drinking. Data suggest that substance abuse prevention may result in higher healthcare costs and utilization in the short term, but a reduction in health risk behaviors such as heavy drinking may result in lower healthcare costs and utilization in the long term.

Immigrants' utilization of specialist mental healthcare according to age, country of origin, and migration history: a nation-wide register study in Norway.

PubMed

Abebe, Dawit Shawel; Lien, Lars; Elstad, Jon Ivar

2017-06-01

As the immigrant population rises in Norway, it becomes ever more important to consider the responsiveness of health services to the specific needs of these immigrants. It has been questioned whether access to mental healthcare is adequate among all groups of immigrants. This study aims to examine the use of specialist mental healthcare services among ethnic Norwegians and specific immigrants groups. Register data were used from the Norwegian Patient Registry and Statistics Norway. The sample (age 0-59) consisted of 3.3 million ethnic Norwegians and 200,000 immigrants from 11 countries. Poisson regression models were applied to examine variations in the use of specialist mental healthcare during 2008-2011 according to country of origin, age group, reason for immigration, and length of stay. Immigrant children and adolescents had overall significantly lower use of specialist mental healthcare than ethnic Norwegians of the same age. A distinct exception was the high utilization rate among children and youth from Iran. Among adult immigrants, utilization rates were generally lower than among ethnic Norwegians, particularly those from Poland, Somalia, Sri Lanka, and Vietnam. Adult immigrants from Iraq and Iran, however, had high utilization rates. Refugees had high utilization rates of specialist mental healthcare, while labour immigrants had low use. Utilization rates of specialist mental healthcare are lower among immigrants than Norwegians. Immigrants from Poland, Somalia, Sri Lanka, and Vietnam, had generally quite low rates, while immigrants from Iran had high utilization rates. The findings suggest that specialist mental healthcare in Norway is underutilized among considerable parts of the immigrant population.

High resolution A/D conversion based on piecewise conversion at lower resolution

DOEpatents

Terwilliger, Steve [Albuquerque, NM

2012-06-05

Piecewise conversion of an analog input signal is performed utilizing a plurality of relatively lower bit resolution A/D conversions. The results of this piecewise conversion are interpreted to achieve a relatively higher bit resolution A/D conversion without sampling frequency penalty.

Inequality and inequity in healthcare utilization in urban Nepal: a cross-sectional observational study

PubMed Central

Saito, Eiko; Gilmour, Stuart; Yoneoka, Daisuke; Gautam, Ghan Shyam; Rahman, Md Mizanur; Shrestha, Pradeep Krishna; Shibuya, Kenji

2016-01-01

Inequality in access to quality healthcare is a major health policy challenge in many low- and middle-income countries. This study aimed to identify the major sources of inequity in healthcare utilization using a population-based household survey from urban Nepal. A cross-sectional survey was conducted covering 9177 individuals residing in 1997 households in five municipalities of Kathmandu valley between 2011 and 2012. The concentration index was calculated and a decomposition method was used to measure inequality in healthcare utilization, along with a horizontal inequity index (HI) to estimate socioeconomic inequalities in healthcare utilization. Results showed a significant pro-rich distribution of general healthcare utilization in all service providers (Concentration Index: 0.062, P < 0.001; HI: 0.029, P < 0.05) and private service providers (Concentration Index: 0.070, P < 0.001; HI: 0.030, P < 0.05). The pro-rich distribution of probability in general healthcare utilization was attributable to inequalities in the level of household economic status (percentage contribution: 67.8%) and in the self-reported prevalence of non-communicable diseases such as hypertension (36.7%) and diabetes (14.4%). Despite the provision of free services by public healthcare providers, our analysis found no evidence of the poor making more use of public health services (Concentration Index: 0.041, P = 0.094). Interventions to reduce the household economic burden of major illnesses, coupled with improvement in the management of public health facilities, warrant further attention by policy-makers. PMID:26856362

Lumped transmission line avalanche pulser

DOEpatents

Booth, R.

1995-07-18

A lumped linear avalanche transistor pulse generator utilizes stacked transistors in parallel within a stage and couples a plurality of said stages, in series with increasing zener diode limited voltages per stage and decreasing balanced capacitance load per stage to yield a high voltage, high and constant current, very short pulse. 8 figs.

Lumped transmission line avalanche pulser

DOEpatents

Booth, Rex

1995-01-01

A lumped linear avalanche transistor pulse generator utilizes stacked transistors in parallel within a stage and couples a plurality of said stages, in series with increasing zener diode limited voltages per stage and decreasing balanced capacitance load per stage to yield a high voltage, high and constant current, very short pulse.

Prevalence and predictors of healthcare utilization among older people (60+): focusing on ADL dependency and risk of depression.

PubMed

Sandberg, Magnus; Kristensson, Jimmie; Midlöv, Patrik; Fagerström, Cecilia; Jakobsson, Ulf

2012-01-01

The aim of this study was to investigate healthcare utilization patterns over a six-year period among older people (60+), classified as dependent/independent in Activities of Daily Living (ADL) and/or at/not at risk of depression and to identify healthcare utilization predictors. A sample (n=1402) comprising ten age cohorts aged between 60 and 96 years was drawn from the Swedish National study on Aging and Care (SNAC). Baseline data were collected between 2001 and 2003. Number and length of hospital stays were collected for six years after baseline year. Group differences and mean changes over time were investigated. Healthcare utilization predictors were explored using multiple linear regression analysis. The results revealed that 21-24% had at least one hospital stay in the six years after baseline, 29-37% among ADL dependent subjects and 24-33% among those at risk of depression. There was a significant increase of hospital stays in all groups over time. ADL-dependent subjects and those at risk of depression had significant more hospital stays, except for those at/not at risk of depression in years 2, 4 and 5. The healthcare utilization predictors 5-6 years after baseline were mainly age, previous healthcare utilization and various symptoms and, in 1-2 and 3-4 years after baseline, age, various diagnostic groups and various physical variables. Thus healthcare utilization patterns seem to be similar for the different groups, but it is difficult to find universal predictors. This suggests that different variables should be considered, including both ADL and psychosocial variables, when trying to identify future healthcare users. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

A population-based analysis of healthcare utilization of persons with back disorders: results from the Canadian Community Health Survey 2000-2001.

PubMed

Lim, Kim-Lian; Jacobs, Philip; Klarenbach, Scott

2006-01-15

A retrospective, population-based analysis. To analyze the utilization of a variety of healthcare services for persons with and without a chronic back disorder, and to identify factors associated with specific patterns of healthcare resource use. Although there have been studies of how chronic back disorders influence the use of specific healthcare services, we do not currently have a broad, population-based overview of how this condition influences healthcare service utilization. Person-level data were taken from the 2000-2001 Canadian Community Health Survey (CCHS), a nationwide cross-sectional survey of health determinants, health status, and health system utilization of Canadians. A series of binary logistic regressions examining healthcare resource utilization were performed on a full study sample (n = 113,229), as well as a restricted sample (n = 36,713) with attention focused on subjects with a single diagnosis of a chronic back disorder. Persons with chronic back disorders were more likely to use physician resources (multivariate odds ratio [OR] = 1.2; 95% confidence interval, 1.1-1.2), and nonphysician resources (OR range, 2.1-3.6) compared with persons without the condition, with chiropractic care having an odds ratio of 3.6 (95% confidence interval, 3.5-3.8). Higher socioeconomic status, the presence of activity-limiting pain, and depressive symptoms were associated with a significant increase in utilization of almost all healthcare services. With increasing disability as indicated by the presence of pain and functional limitations, and the presence of depressive symptoms, the higher the utilization of physician and nonphysician resources, with the exception of chiropractic care, which appears to be used by those with less severe symptoms. Lower socioeconomic status was associated with significantly lower receipt of services for almost all healthcare providers.

Non-streaming high-efficiency perforated semiconductor neutron detectors, methods of making same and measuring wand and detector modules utilizing same

DOEpatents

McGregor, Douglas S.; Shultis, John K.; Rice, Blake B.; McNeil, Walter J.; Solomon, Clell J.; Patterson, Eric L.; Bellinger, Steven L.

2010-12-21

Non-streaming high-efficiency perforated semiconductor neutron detectors, method of making same and measuring wands and detector modules utilizing same are disclosed. The detectors have improved mechanical structure, flattened angular detector responses, and reduced leakage current. A plurality of such detectors can be assembled into imaging arrays, and can be used for neutron radiography, remote neutron sensing, cold neutron imaging, SNM monitoring, and various other applications.

Medical pluralism of the Chinese in London: an exploratory study.

PubMed

Rochelle, Tina L; Marks, David F

2010-11-01

This study was designed to examine the extent of medical pluralism among the Chinese in London. Members of the London Chinese community were recruited through Chinese organizations in London and participated in six focus groups. A total of 48 Chinese men and women aged 24-74 years were asked to talk about their health behaviour and health utilization patterns. Transcripts of the focus group discussions underwent thematic analysis to explore and describe the utilization of traditional Chinese medicine (TCM) and Western medicine (WM) of informants and factors that impacted on utilization. Findings focus on participants' evaluation of TCM and WM as two systems of health provision, how informants used these two health systems, and the reasons associated with use of these two systems. Utilization of TCM and WM varied. Concurrent use of TCM and WM was common. The National Health Service was generally perceived as difficult to use, with concerns over the language barrier, and communicating with and being able to trust health providers. The UK TCM trade was perceived as being aimed at the non-Chinese market and there were issues of trust related to the regulation of UK TCM. Although none of these issues are unique to the Chinese in the UK, previous experience with different approaches to health care, particularly TCM, may make the experience of such barriers more extreme.

Graphic medicine: comics as medical narrative.

PubMed

Williams, Ian C M

2012-06-01

Among the growing number of works of graphic fiction, a number of titles dealing directly with the patient experience of illness or caring for others with an illness are to be found. Thanks in part to the Medical Humanities movement, many medical schools now encourage the reading of classic literature to gain insight into the human condition. Until recently, the medium of comics (the term is used in the plural to refer to both the physical objects and the attendant philosophy and practice surrounding them) has received little attention from healthcare scholars, even though some authors argue that graphic fiction is, in fact, a form of literature. This paper suggests that it is time that the medium was examined by healthcare professionals and studies some acclaimed comic works. Drawing on the principles of narrative medicine, this paper will ask whether comics and graphic novels could be used as a resource for health professionals, patients and carers.

Method and device for producing a tactile display using an electrorheological fluid

NASA Technical Reports Server (NTRS)

Garner, H. Douglas (Inventor)

1996-01-01

A tactile display device utilizes an electrorheological fluid to activate a plurality of tactile dots. A voltage is selectively produced uniformly across an electrorheological fluid flowing between a common ground electrode and a plurality of conductive dot electrodes, thereby producing an increase in the fluid's viscosity to the extent that fluid flow between the two electrodes is restricted. The flow restriction produces a build-up of electrorheological fluid in a corresponding dot actuator chamber. The resulting pressure increase in the chamber displaces an elastic diaphragm fixed to a display surface to form a lump which can be perceived by the reader as one dot in a Braille character cell. A flow regulation system provides a continually pressurized flow system and provides for free flow of the electrorheological fluid through the plurality of dot actuator chambers when they are not activated. The device is adaptable to printed circuit techniques and can simultaneously display tactile dots representative of a full page of Braille characters stored on a medium such as a tape cassette or to display tactile dots representative of non-Braille data appearing on a computer monitor or contained on another data storage medium. In an alternate embodiment, the elastic diaphragm drives a plurality of spring-loaded pins provided with positive stops to maintain consistent displacements of the pins in both their actuated and nonactuated positions.

Tactile display device using an electrorheological fluid

NASA Technical Reports Server (NTRS)

Garner, H. Douglas (Inventor)

1994-01-01

A tactile display device utilizes an electrorheological fluid to activate a plurality of tactile dots. A voltage is selectively produced uniformly across an electrorheological fluid flowing between a common ground electrode and a plurality of conductive dot electrodes, thereby producing an increase in the fluid's viscosity to the extent that fluid flow between the two electrodes is restricted. The flow restriction produces a build-up of electrorheological fluid in a corresponding dot actuator chamber. The resulting pressure increase in the chamber displaces an elastic diaphragm fixed to a display surface to form a lump which can be perceived by the reader as one dot in a Braille character cell. A flow regulation system provides a continually pressurized flow system and provides for free flow of the electrorheological fluid through the plurality of dot actuator chambers when they are not activated. The device is adaptable to printed circuit techniques and can simultaneously display tactile dots representative of a full page of Braille characters stored on a medium such as a tape cassette or to display tactile dots representative of non-Braille data appearing on a computer monitor or contained on another data storage medium. In an alternate embodiment, the elastic diaphragm drives a plurality of spring-loaded pins provided with positive stops to maintain consistent displacements of the pins in both their actuated and nonactuated positions.

[Impact of level of physical activity on healthcare utilization among Korean adults].

PubMed

Kim, Jiyun; Park, Seungmi

2012-04-01

This study was done to identify the impact of physical activity on healthcare utilization among Korean adults. Drawing from the 2008 Korean National Health and Nutrition Examination Survey (NHANES IV-2), data from 6,521 adults who completed the Health Interview and Health Behavior Surveys were analyzed. Association between physical activity and healthcare utilization was tested using the χ²-test. Multiple logistic regression analysis was used to calculate the odds ratios of using outpatient and inpatient healthcare for different levels of physical activity after adjusting for predisposing, enabling, and need factors. A generalized linear model applying a negative binomial distribution was used to determine how the level of physical activity was related to use of outpatient and inpatient healthcare. Physically active participants were 16% less likely to use outpatient healthcare (OR, 0.84; 95% CI, 0.74-0.97) and 23% less likely to use inpatient healthcare (OR, 0.77; 95% CI, 0.63-0.93) than physically inactive participants. Levels of outpatient and inpatient healthcare use decreased as levels of physical activity increased, after adjusting for relevant factors. An independent association between being physically active and lower healthcare utilization was ascertained among Korean adults indicating a need to develop nursing intervention programs that encourage regular physical activity.

System and method for networking electrochemical devices

DOEpatents

Williams, Mark C.; Wimer, John G.; Archer, David H.

1995-01-01

An improved electrochemically active system and method including a plurality of electrochemical devices, such as fuel cells and fluid separation devices, in which the anode and cathode process-fluid flow chambers are connected in fluid-flow arrangements so that the operating parameters of each of said plurality of electrochemical devices which are dependent upon process-fluid parameters may be individually controlled to provide improved operating efficiency. The improvements in operation include improved power efficiency and improved fuel utilization in fuel cell power generating systems and reduced power consumption in fluid separation devices and the like through interstage process fluid parameter control for series networked electrochemical devices. The improved networking method includes recycling of various process flows to enhance the overall control scheme.

Inequality and inequity in healthcare utilization in urban Nepal: a cross-sectional observational study.

PubMed

Saito, Eiko; Gilmour, Stuart; Yoneoka, Daisuke; Gautam, Ghan Shyam; Rahman, Md Mizanur; Shrestha, Pradeep Krishna; Shibuya, Kenji

2016-09-01

Inequality in access to quality healthcare is a major health policy challenge in many low- and middle-income countries. This study aimed to identify the major sources of inequity in healthcare utilization using a population-based household survey from urban Nepal. A cross-sectional survey was conducted covering 9177 individuals residing in 1997 households in five municipalities of Kathmandu valley between 2011 and 2012. The concentration index was calculated and a decomposition method was used to measure inequality in healthcare utilization, along with a horizontal inequity index (HI) to estimate socioeconomic inequalities in healthcare utilization. Results showed a significant pro-rich distribution of general healthcare utilization in all service providers (Concentration Index: 0.062, P < 0.001; HI: 0.029, P < 0.05) and private service providers (Concentration Index: 0.070, P < 0.001; HI: 0.030, P < 0.05). The pro-rich distribution of probability in general healthcare utilization was attributable to inequalities in the level of household economic status (percentage contribution: 67.8%) and in the self-reported prevalence of non-communicable diseases such as hypertension (36.7%) and diabetes (14.4%). Despite the provision of free services by public healthcare providers, our analysis found no evidence of the poor making more use of public health services (Concentration Index: 0.041, P = 0.094). Interventions to reduce the household economic burden of major illnesses, coupled with improvement in the management of public health facilities, warrant further attention by policy-makers. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Utilization of healthcare services in postpartum women in the Philippines who delivered at home and the effects on their health: a cross-sectional analytical study.

PubMed

Yamashita, Tadashi; Reyes Tuliao, Maria Teresa; Concel Meana, Magdalena; Suplido, Sherri Ann; Llave, Cecilia L; Tanaka, Yuko; Matsuo, Hiroya

2017-01-01

A low ratio of utilization of healthcare services in postpartum women may contribute to maternal deaths during the postpartum period. The maternal mortality ratio is high in the Philippines. The aim of this study was to examine the current utilization of healthcare services and the effects on the health of women in the Philippines who delivered at home. This was a cross-sectional analytical study, based on a self-administrated questionnaire, conducted from March 2015 to February 2016 in Muntinlupa, Philippines. Sixty-three postpartum women who delivered at home or at a facility were enrolled for this study. A questionnaire containing questions regarding characteristics, utilization of healthcare services, and abnormal symptoms during postpartum period was administered. To analyze the questionnaire data, the sample was divided into delivery at home and delivery at a facility. Chi-square test, Fisher's exact test, and Mann-Whitney U test were used. There were significant differences in the type of birth attendant, area of residence, monthly income, and maternal and child health book usage between women who delivered at home and those who delivered at a facility ( P <0.01). There was significant difference in the utilization of antenatal checkup ( P <0.01) during pregnancy, whilst there was no significant difference in utilization of healthcare services during the postpartum period. Women who delivered at home were more likely to experience feeling of irritated eyes and headaches, and continuous abdominal pain ( P <0.05). Financial and environmental barriers might hinder the utilization of healthcare services by women who deliver at home in the Philippines. Low utilization of healthcare services in women who deliver at home might result in more frequent abnormal symptoms during postpartum.

How to interpret a healthcare economic analysis.

PubMed

Brown, Melissa M; Brown, Gary C

2005-06-01

The purpose of the review is to present guidelines to help the clinician to interpret healthcare economic analyses and review pertinent recent analysis in the ophthalmic literature. There are four variants of healthcare economic analyses: (1) cost-minimization analysis; (2) cost-benefit analysis; (3) cost-effectiveness analysis and (4) cost-utility analysis. Cost-utility utility analysis has assumed an increasingly important role in healthcare, with increasing number of analyses occurring in the peer-reviewed ophthalmic literature. These include cost-utility analyses of cataract surgery in the first and second eyes, amblyopia treatment, and cost-utility analyses encompassing the vitreoretinal interventions of the following: (1) laser photocoagulation for exudative macular degeneration; (2) laser treatment for diabetic retinopathy; (3) laser photocoagulation for branch retinal vein obstruction; (4) diabetic vitrectomy; (5) treatment of proliferative retinopathy of prematurity and (6) treatment of retinal detachment associated with proliferative vitreoretinopathy. As an increasing number of cost-utility analyses become available they will provide the information system for the practice of value-based medicine, or medicine based upon the patient-perceived value conferred by interventions. Increasing numbers of cost-utility analysis in the ophthalmic literature suggest that ophthalmic interventions, including vitreoretinal interventions, are cost effective. Cost-utility analysis is a major tool in value-based medicine, the practice of medicine based upon the patient-perceived value conferred by healthcare interventions.

Determinants of Maternity Care Services Utilization among Married Adolescents in Rural India

PubMed Central

Singh, Prashant Kumar; Rai, Rajesh Kumar; Alagarajan, Manoj; Singh, Lucky

2012-01-01

Background Coupled with the largest number of maternal deaths, adolescent pregnancy in India has received paramount importance due to early age at marriage and low contraceptive use. The factors associated with the utilization of maternal healthcare services among married adolescents in rural India are poorly discussed. Methodology/Principal Findings Using the data from third wave of National Family Health Survey (2005–06), available in public domain for the use by researchers, this paper examines the factors associated with the utilization of maternal healthcare services among married adolescent women (aged 15–19 years) in rural India. Three components of maternal healthcare service utilization were measured: full antenatal care, safe delivery, and postnatal care within 42 days of delivery for the women who gave births in the last five years preceding the survey. Considering the framework on causes of maternal mortality proposed by Thaddeus and Maine (1994), selected socioeconomic, demographic, and cultural factors influencing outcome events were included as the predictor variables. Bi-variate analyses including chi-square test to determine the difference in proportion, and logistic regression to understand the net effect of predictor variables on selected outcomes were applied. Findings indicate the significant differences in the use of selected maternal healthcare utilization by educational attainment, economic status and region of residence. Muslim women, and women belonged to Scheduled Castes, Scheduled Tribes, and Other Backward Classes are less likely to avail safe delivery services. Additionally, adolescent women from the southern region utilizing the highest maternal healthcare services than the other regions. Conclusions The present study documents several socioeconomic and cultural factors affecting the utilization of maternal healthcare services among rural adolescent women in India. The ongoing healthcare programs should start targeting household with married adolescent women belonging to poor and specific sub-groups of the population in rural areas to address the unmet need for maternal healthcare service utilization. PMID:22355386

[Geographical coverage of the Mexican Healthcare System and a spatial analysis of utilization of its General Hospitals in 1998].

PubMed

Hernández-Avila, Juan E; Rodríguez, Mario H; Rodríguez, Norma E; Santos, René; Morales, Evangelina; Cruz, Carlos; Sepúlveda-Amor, Jaime

2002-01-01

To describe the geographical coverage of the Mexican Healthcare System (MHS) services and to assess the utilization of its General Hospitals. A Geographic Information System (GIS) was used to include sociodemographic data by locality, the geographical location of all MHS healthcare services, and data on hospital discharge records. A maximum likelihood estimation model was developed to assess the utilization levels of 217 MHS General Hospitals. The model included data on human resources, additional infrastructure, and the population within a 25 km radius. In 1998, 10,806 localities with 72 million inhabitants had at least one public healthcare unit, and 97.2% of the population lived within 50 km of a healthcare unit; however, over 18 million people lived in rural localities without a healthcare unit. The mean annual hospital occupation rate was 48.5 +/- 28.5 per 100 bed/years, with high variability within and between states. Hospital occupation was significantly associated with the number of physicians in the unit, and in the Mexican Institute of Social Security units utilization was associated with additional health infrastructure, and with the population's poverty index. GIS analysis allows improved estimation of the coverage and utilization of MHS hospitals.

Miniature mechanical transfer optical coupler

DOEpatents

Abel, Philip [Overland Park, KS; Watterson, Carl [Kansas City, MO

2011-02-15

A miniature mechanical transfer (MT) optical coupler ("MMTOC") for optically connecting a first plurality of optical fibers with at least one other plurality of optical fibers. The MMTOC may comprise a beam splitting element, a plurality of collimating lenses, and a plurality of alignment elements. The MMTOC may optically couple a first plurality of fibers disposed in a plurality of ferrules of a first MT connector with a second plurality of fibers disposed in a plurality of ferrules of a second MT connector and a third plurality of fibers disposed in a plurality of ferrules of a third MT connector. The beam splitting element may allow a portion of each beam of light from the first plurality of fibers to pass through to the second plurality of fibers and simultaneously reflect another portion of each beam of light from the first plurality of fibers to the third plurality of fibers.

System for testing optical fibers

DOEpatents

Davies, Terence J.; Franks, Larry A.; Nelson, Melvin A.

1981-01-01

A system for nondestructively determining the attenuation coefficient, .alpha.(.lambda.), of low-loss optical fiber wave guides. Cerenkov light pulses are generated at a plurality of locations in the fiber by a beam of charged particles. The transit times of selected spectral components and their intensities are utilized to unfold the .alpha.(.lambda.) values over the measured spectrum.

Who Fits? A Dialog on the Politics of "Doing-Being" a Scholar

ERIC Educational Resources Information Center

Tooms, Autumn; English, Fenwick

2010-01-01

This chapter is based on heuristic research and phenomenology which honors the dialectic of personal narratives as a way to process and understand the politics of change centered on hegemony, discourse, and cultural plurality. This methodology utilizes personal narrative and dialog as way to consider the importance of reflecting on individual…

Community College Faculty Members' Perceived Multicultural Teaching Competence and Attitudes Regarding Cultural Diversity

ERIC Educational Resources Information Center

Fittz, Mia Web

2015-01-01

This study utilized the Survey of Community College Faculty (SCCF), a combined survey of the Multicultural Teaching Scale (MTS) and Pluralism and Diversity Attitude Assessment (PADAA) that framed the research. The MTS assessed self-reported cultural competencies categorized into five dimensions: (a) Content Integration, (b) Knowledge Construction,…

Impact of Private Health Insurance on Lengths of Hospitalization and Healthcare Expenditure in India: Evidences from a Quasi-Experiment Study.

PubMed

Vellakkal, Sukumar

2013-01-01

The health insurers administer retrospectively package rates for various inpatient procedures as a provider payment mechanism to empanelled hospitals in Indian healthcare market. This study analyzed the impact of private health insurance on healthcare utilization in terms of both lengths of hospitalization and per-day hospitalization expenditure in Indian healthcare market where package rates are retrospectively defined as healthcare provider payment mechanism. The claim records of 94443 insured individuals and the hospitalisation data of 32665 uninsured individuals were used. By applying stepwise and propensity score matching method, the sample of uninsured individual was matched with insured and 'average treatment effect on treated' (ATT) was estimated. Overall, the strategies of hospitals, insured and insurers for maximizing their utility were competing with each other. However, two aligning co-operative strategies between insurer and hospitals were significant with dominant role of hospitals. The hospitals maximize their utility by providing high cost healthcare in par with pre-defined package rates but align with the interest of insurers by reducing the number (length) of hospitalisation days. The empirical results show that private health insurance coverage leads to i) reduction in length of hospitalization, and ii) increase in per day hospital (health) expenditure. It is necessary to regulate and develop a competent healthcare market in the country with proper monitoring mechanism on healthcare utilization and benchmarks for pricing and provision of healthcare services.

Distributed performance counters

DOEpatents

Davis, Kristan D; Evans, Kahn C; Gara, Alan; Satterfield, David L

2013-11-26

A plurality of first performance counter modules is coupled to a plurality of processing cores. The plurality of first performance counter modules is operable to collect performance data associated with the plurality of processing cores respectively. A plurality of second performance counter modules are coupled to a plurality of L2 cache units, and the plurality of second performance counter modules are operable to collect performance data associated with the plurality of L2 cache units respectively. A central performance counter module may be operable to coordinate counter data from the plurality of first performance counter modules and the plurality of second performance modules, the a central performance counter module, the plurality of first performance counter modules, and the plurality of second performance counter modules connected by a daisy chain connection.

Vertical equity of healthcare in Taiwan: health services were distributed according to need

PubMed Central

2013-01-01

Introduction To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. Methods The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. Results People with greater health need received more healthcare services, indicating a pro-need character of healthcare distribution, conforming to the meaning of vertical equity. For outpatient service, subjects with the highest health need had higher proportion of ever use in a year than those who had the least health need and consumed more outpatient visits and expenditures per person per year. Similar patterns were observed for emergency services and hospitalization. The concentration indices of utilization for outpatient, emergency services, and hospitalization suggest that the distribution of utilization was related to health need, whereas the preventive service was less related to need. Conclusions The universal coverage plus healthcare networking system makes it possible for healthcare to be utilized according to need. Taiwan’s experience can serve as a reference for health reform. PMID:23363855

Vertical equity of healthcare in Taiwan: health services were distributed according to need.

PubMed

Wang, Shiow-Ing; Yaung, Chih-Liang

2013-01-31

To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. People with greater health need received more healthcare services, indicating a pro-need character of healthcare distribution, conforming to the meaning of vertical equity. For outpatient service, subjects with the highest health need had higher proportion of ever use in a year than those who had the least health need and consumed more outpatient visits and expenditures per person per year. Similar patterns were observed for emergency services and hospitalization. The concentration indices of utilization for outpatient, emergency services, and hospitalization suggest that the distribution of utilization was related to health need, whereas the preventive service was less related to need. The universal coverage plus healthcare networking system makes it possible for healthcare to be utilized according to need. Taiwan's experience can serve as a reference for health reform.

Pluralism as Outcome: The Ecology of Religious Resources, Suppliers, and Consumers

PubMed Central

Scheitle, Christopher P.; Finke, Roger

2014-01-01

A great deal of interest has surrounded the topic of religious pluralism and the effects of the frequently used pluralism index on outcomes such as religious participation rates. But surprisingly little work has tried to understand the sources of pluralism or what the pluralism index is actually measuring. In an attempt to reframe the debate, we treat pluralism as an outcome variable. Drawing on ideas in the organizational ecology literature and data from previous studies on pluralism and participation, we show that the pluralism of religious suppliers is a product of the pluralism of religious preferences and the number of potential adherents within an environment. This pluralism of suppliers, in turn, produces a pluralism of religious consumers. We then distinguish between expected pluralism and observed pluralism, and we argue that a relationship between pluralism and participation will be expected only when a meaningful gap between these two measures exists. We close by examining the previous research to show how this reframing of the pluralism and participation question sheds light on that literature. PMID:25750598

Bootstrap data methodology for sequential hybrid model building

NASA Technical Reports Server (NTRS)

Volponi, Allan J. (Inventor); Brotherton, Thomas (Inventor)

2007-01-01

A method for modeling engine operation comprising the steps of: 1. collecting a first plurality of sensory data, 2. partitioning a flight envelope into a plurality of sub-regions, 3. assigning the first plurality of sensory data into the plurality of sub-regions, 4. generating an empirical model of at least one of the plurality of sub-regions, 5. generating a statistical summary model for at least one of the plurality of sub-regions, 6. collecting an additional plurality of sensory data, 7. partitioning the second plurality of sensory data into the plurality of sub-regions, 8. generating a plurality of pseudo-data using the empirical model, and 9. concatenating the plurality of pseudo-data and the additional plurality of sensory data to generate an updated empirical model and an updated statistical summary model for at least one of the plurality of sub-regions.

Dutch citizens of Turkish origin who utilize healthcare services in Turkey: a qualitative study on motives and contextual factors.

PubMed

Şekercan, Aydın; Woudstra, Anke J; Peters, Ron J G; Lamkaddem, Majda; Akgün, Seval; Essink-Bot, Marie-Louise

2018-04-17

Dutch residents of Turkish origin frequently utilize healthcare in Turkey. To investigate their motives for doing so, we conducted a qualitative study among these healthcare users using semi-structured interviews. We complemented this with informal conversations with Turkish healthcare providers and observations at the registration offices and waiting rooms of outpatient clinics in several Turkish hospitals. Respondents believed their perceived needs for referral to specialist care and diagnostic assessments to quantify their health were not being met in the Netherlands. These mismatches in expectations of what constitutes "good care" led to dissatisfaction with Dutch primary care. Consequently, respondents utilized healthcare in Turkey if the opportunity arose, and were encouraged in this by their social networks. Establishing cross-border communication between healthcare providers is necessary, because there is currently no continuity of care for cross-border patients.

The healthy diver: A cross-sectional survey to evaluate the health status of recreational scuba diver members of Divers Alert Network (DAN).

PubMed

Ranapurwala, Shabbar I; Kucera, Kristen L; Denoble, Petar J

2018-01-01

Scuba diver fitness is paramount to confront environmental stressors of diving. However, the diving population is aging and the increasing prevalence of diseases may be a concern for diver fitness. The purpose of this study is to assess the demographics, lifestyle factors, disease prevalence, and healthcare access and utilization of Divers Alert Network (DAN) members and compare them with those from the general population. DAN membership health survey (DMHS) was administered online in 2011 to DAN members in the United States (US). Health status of DMHS respondents was compared with the general US population data from the Center for Disease Control and Prevention's Behavioral Risk Factor Surveillance System using two-sided student's t-tests and Mantel-Haenszel chi-square tests. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with healthcare utilization among the DMHS participants. Compared to the general US population, the DMHS population had lower prevalence of asthma, heart attack, angina, stroke, diabetes, hypertension, hypercholesterolemia, and disabilities (p<0.01); more heavy alcohol drinkers, and fewer smokers (p<0.01); and greater access and utilization (routine checkup) of healthcare (p<0.01). Healthcare utilization in males was lower than among females. Increasing age and increase in the number of chronic illnesses were associated with increased healthcare utilization. DAN members are healthier than the general US population. DAN members also have better access to healthcare and utilize healthcare for preventive purposes more often than the general population. DAN members appear to have a better fitness level than their non-diving peers.

Neutron imaging systems utilizing lithium-containing semiconductor crystals

DOEpatents

Stowe, Ashley C.; Burger, Arnold

2017-04-25

A neutron imaging system, including: a plurality of Li-III-VI.sub.2 semiconductor crystals arranged in an array, wherein III represents a Group III element and VI represents a Group VI element; and electronics operable for detecting and a charge in each of the plurality of crystals in the presence of neutrons and for imaging the neutrons. Each of the crystals is formed by: melting the Group III element; adding the Li to the melted Group III element at a rate that allows the Li and Group III element to react, thereby providing a single phase Li-III compound; and adding the Group VI element to the single phase Li-III compound and heating. Optionally, each of the crystals is also formed by doping with a Group IV element activator.

Graph modeling systems and methods

DOEpatents

Neergaard, Mike

2015-10-13

An apparatus and a method for vulnerability and reliability modeling are provided. The method generally includes constructing a graph model of a physical network using a computer, the graph model including a plurality of terminating vertices to represent nodes in the physical network, a plurality of edges to represent transmission paths in the physical network, and a non-terminating vertex to represent a non-nodal vulnerability along a transmission path in the physical network. The method additionally includes evaluating the vulnerability and reliability of the physical network using the constructed graph model, wherein the vulnerability and reliability evaluation includes a determination of whether each terminating and non-terminating vertex represents a critical point of failure. The method can be utilized to evaluate wide variety of networks, including power grid infrastructures, communication network topologies, and fluid distribution systems.

Allocating health care: cost-utility analysis, informed democratic decision making, or the veil of ignorance?

PubMed

Goold, S D

1996-01-01

Assuming that rationing health care is unavoidable, and that it requires moral reasoning, how should we allocate limited health care resources? This question is difficult because our pluralistic, liberal society has no consensus on a conception of distributive justice. In this article I focus on an alternative: Who shall decide how to ration health care, and how shall this be done to respect autonomy, pluralism, liberalism, and fairness? I explore three processes for making rationing decisions: cost-utility analysis, informed democratic decision making, and applications of the veil of ignorance. I evaluate these processes as examples of procedural justice, assuming that there is no outcome considered the most just. I use consent as a criterion to judge competing processes so that rationing decisions are, to some extent, self-imposed. I also examine the processes' feasibility in our current health care system. Cost-utility analysis does not meet criteria for actual or presumed consent, even if costs and health-related utility could be measured perfectly. Existing structures of government cannot creditably assimilate the information required for sound rationing decisions, and grassroots efforts are not representative. Applications of the veil of ignorance are more useful for identifying principles relevant to health care rationing than for making concrete rationing decisions. I outline a process of decision making, specifically for health care, that relies on substantive, selected representation, respects pluralism, liberalism, and deliberative democracy, and could be implemented at the community or organizational level.

Healthcare utilization in older patients using personal emergency response systems: an analysis of electronic health records and medical alert data : Brief Description: A Longitudinal Retrospective Analyses of healthcare utilization rates in older patients using Personal Emergency Response Systems from 2011 to 2015.

PubMed

Agboola, Stephen; Golas, Sara; Fischer, Nils; Nikolova-Simons, Mariana; Op den Buijs, Jorn; Schertzer, Linda; Kvedar, Joseph; Jethwani, Kamal

2017-04-18

Personal Emergency Response Systems (PERS) are traditionally used as fall alert systems for older adults, a population that contributes an overwhelming proportion of healthcare costs in the United States. Previous studies focused mainly on qualitative evaluations of PERS without a longitudinal quantitative evaluation of healthcare utilization in users. To address this gap and better understand the needs of older patients on PERS, we analyzed longitudinal healthcare utilization trends in patients using PERS through the home care management service of a large healthcare organization. Retrospective, longitudinal analyses of healthcare and PERS utilization records of older patients over a 5-years period from 2011-2015. The primary outcome was to characterize the healthcare utilization of PERS patients. This outcome was assessed by 30-, 90-, and 180-day readmission rates, frequency of principal admitting diagnoses, and prevalence of conditions leading to potentially avoidable admissions based on Centers for Medicare and Medicaid Services classification criteria. The overall 30-day readmission rate was 14.2%, 90-days readmission rate was 34.4%, and 180-days readmission rate was 42.2%. While 30-day readmission rates did not increase significantly (p = 0.16) over the study period, 90-days (p = 0.03) and 180-days (p = 0.04) readmission rates did increase significantly. The top 5 most frequent principal diagnoses for inpatient admissions included congestive heart failure (5.7%), chronic obstructive pulmonary disease (4.6%), dysrhythmias (4.3%), septicemia (4.1%), and pneumonia (4.1%). Additionally, 21% of all admissions were due to conditions leading to potentially avoidable admissions in either institutional or non-institutional settings (16% in institutional settings only). Chronic medical conditions account for the majority of healthcare utilization in older patients using PERS. Results suggest that PERS data combined with electronic medical records data can provide useful insights that can be used to improve health outcomes in older patients.

System and method for extracting dominant orientations from a scene

DOEpatents

Straub, Julian; Rosman, Guy; Freifeld, Oren; Leonard, John J.; Fisher, III; , John W.

2017-05-30

In one embodiment, a method of identifying the dominant orientations of a scene comprises representing a scene as a plurality of directional vectors. The scene may comprise a three-dimensional representation of a scene, and the plurality of directional vectors may comprise a plurality of surface normals. The method further comprises determining, based on the plurality of directional vectors, a plurality of orientations describing the scene. The determined plurality of orientations explains the directionality of the plurality of directional vectors. In certain embodiments, the plurality of orientations may have independent axes of rotation. The plurality of orientations may be determined by representing the plurality of directional vectors as lying on a mathematical representation of a sphere, and inferring the parameters of a statistical model to adapt the plurality of orientations to explain the positioning of the plurality of directional vectors lying on the mathematical representation of the sphere.

Healthcare utilization in adults with opioid dependence receiving extended release naltrexone compared to treatment as usual.

PubMed

Soares, William E; Wilson, Donna; Rathlev, Niels; Lee, Joshua D; Gordon, Michael; Nunes, Edward V; O'Brien, Charles P; Friedmann, Peter D

2018-02-01

Opioid use disorders have reached epidemic proportions, with overdose now the leading cause of accidental death in the United States. Extended release naltrexone (XR-NTX) has emerged as a medication treatment that reduces opioid use and craving. However, the effect of XR-NTX therapy on acute healthcare utilization, including emergency department visits and inpatient hospitalizations, remains uncertain. The objective of the current study is to evaluate hospital-based healthcare resource utilization in adults involved in the criminal justice system with a history of opioid use disorder randomized to XR-NTX therapy compared with treatment as usual (TAU) during a 6-month treatment phase and 12months post-treatment follow up. This retrospective exploratory analysis uses data collected in a published randomized trial. Comparisons of the number of emergency department visits and hospital admissions (for drug detox, psychiatric care and other medical reasons) were performed using chi square tests for any admission and negative binomial models for number of admissions. Of the 308 participants randomized, 96% had utilization data (76% complete 6months, 67% complete follow up). No significant differences were seen in overall healthcare utilization (IRR=0.88, 95%CI 0.63-1.23, p=0.45), or substance use-related drug detox hospitalizations (IRR=0.83, 95%CI 0.32-2.16, p=0.71). Despite having more participants report chronic medical problems at baseline (43% vs. 32%, p=0.05), those receiving XR-NTX generally experienced equivalent or lower rates of healthcare utilization compared to TAU. The XR-NTX group had significantly lower medical/surgical related hospital admissions (IRR=0.55, 95%CI 0.30-1.00, p=0.05) during the course of the entire study. XR-NTX did not significantly increase rates of healthcare utilization compared to TAU. Provider concerns regarding healthcare utilization should not preclude the consideration of XR-NTX as therapy for opioid use disorders. Copyright © 2018 Elsevier Inc. All rights reserved.

Measuring and Explaining Socioeconomic Inequalities in Public Healthcare Utilization in Western Iran: Evidence from a Cross-sectional Survey.

PubMed

Rezaeian, Shahab; Hajizadeh, Mohammad; Rezaei, Satar; Ahmadi, Sina; Kazemi Karyani, Ali; Salimi, Yahya

2018-05-14

Equity in healthcare utilization is a major health policy goal in all healthcare systems. This study aimed to examine socioeconomic inequalities in public healthcare utilization in Kermanshah City, western Iran. A cross-sectional study. Using convenience sampling method, 2040 adult aged 18-65 yr were enrolled from Kermanshah City in 2017. A self-administrated questionnaire was used to collect data on socio-demographic characteristics, socioeconomic status, behavioral factors, and utilization of public healthcare services (inpatient and outpatient care) over the period between from May to Aug 2017. The concentration index (C) was used to measure and decompose socioeconomic inequalities in the utilization inpatient and outpatient care in public sector. The indirect standardization method was used to estimate the horizontal inequity (HI) indices in inpatient and outpatient care use. The utilization outpatient (C=-0.121, 95% CI: -0.171, -0.071) and inpatient care in public sector (C=-0.165, 95% CI: -0.229, -0.101) were concentrated among the poor in Kermanshah, Iran. Socioeconomic status, health-related quality of life, marital status and having a chronic health condition were the main determinants of socioeconomic-related inequalities in the utilization of inpatient and outpatient care in public sector among adults. The distributions of outpatient (HI=-0.045, CI: -0.093 to 0.003) and inpatient care (HI= -0.044 95% CI: -0.102, 0.014) in Kermanshah were pro-poor. These results were not statistically significant (P<0.05). The utilization of public healthcare services in Iran are pro-poor. The pro-poor distribution of inpatient and outpatient care in public facilities calls for initiatives to increase the allocation of resources to public facilities in Iran that may greatly benefit the health outcomes of the poor.

Multiple core computer processor with globally-accessible local memories

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

Shalf, John; Donofrio, David; Oliker, Leonid

A multi-core computer processor including a plurality of processor cores interconnected in a Network-on-Chip (NoC) architecture, a plurality of caches, each of the plurality of caches being associated with one and only one of the plurality of processor cores, and a plurality of memories, each of the plurality of memories being associated with a different set of at least one of the plurality of processor cores and each of the plurality of memories being configured to be visible in a global memory address space such that the plurality of memories are visible to two or more of the plurality ofmore » processor cores.« less

Sophisticated Approval Voting, Ignorance Priors, and Plurality Heuristics: A Behavioral Social Choice Analysis in a Thurstonian Framework

ERIC Educational Resources Information Center

Regenwetter, Michel; Ho, Moon-Ho R.; Tsetlin, Ilia

2007-01-01

This project reconciles historically distinct paradigms at the interface between individual and social choice theory, as well as between rational and behavioral decision theory. The authors combine a utility-maximizing prescriptive rule for sophisticated approval voting with the ignorance prior heuristic from behavioral decision research and two…

Health insurance coverage and healthcare utilization among homeless young adults in Venice, CA

PubMed Central

Winetrobe, H.; Rice, E.; Rhoades, H.; Milburn, N.

2016-01-01

Background Homeless young adults are a vulnerable population with great healthcare needs. Under the Affordable Care Act, homeless young adults are eligible for Medicaid, in some states, including California. This study assesses homeless young adults' health insurance coverage and healthcare utilization prior to Medicaid expansion. Methods All homeless young adults accessing services at a drop-in center in Venice, CA, were invited to complete a self-administered questionnaire; 70% of eligible clients participated (n = 125). Results Within this majority White, heterosexual, male sample, 70% of homeless young adults did not have health insurance in the prior year, and 39% reported their last healthcare visit was at an emergency room. Past year unmet healthcare needs were reported by 31%, and financial cost was the main reported barrier to receiving care. Multivariable logistic regression found that homeless young adults with health insurance were almost 11 times more likely to report past year healthcare utilization. Conclusions Health insurance coverage is the sole variable significantly associated with healthcare utilization among homeless young adults, underlining the importance of insurance coverage within this vulnerable population. Service providers can play an important role by assisting homeless young adults with insurance applications and facilitating connections with regular sources of health care. PMID:25635142

Warfarin time in therapeutic range and its impact on healthcare resource utilization and costs among patients with nonvalvular atrial fibrillation.

PubMed

Deitelzweig, Steve; Evans, Michael; Hillson, Eric; Trocio, Jeffrey; Bruno, Amanda; Tan, Wilson; Lingohr-Smith, Melissa; Singh, Prianka; Lin, Jay

2016-01-01

Warfarin is efficacious for reducing stroke risk among patients with nonvalvular atrial fibrillation (NVAF). However, the efficacy and safety of warfarin are influenced by its time in therapeutic range (TTR). To assess differences in healthcare resource utilization and costs among NVAF patients with low (<60%) and high (≥60%) warfarin TTRs in an integrated delivery network (IDN) setting. Patients with NVAF were identified from an electronic medical record database. Patients were required to have ≥6 international normalized prothrombin time ratio (INR) tests. NVAF patients were grouped into two cohorts: those with warfarin TTR <60% (low TTR) and those with warfarin TTR ≥60% (high TTR). Healthcare resource utilization and costs were evaluated during a 12 month follow-up period. Multivariable regressions were used to assess the impact of different warfarin TTRs on healthcare costs. Among the study population, greater than half (54%, n = 1595) had a low TTR, and 46% (n = 1356) had a high TTR. Total all-cause healthcare resource utilization was higher among patients in the low TTR cohort vs. the high TTR cohort (number of encounters: 70.2 vs. 56.1, p < 0.001). After adjusting for patient characteristics, total all-cause healthcare costs and stroke-related healthcare costs were $2398 (p < 0.001) and $687 (p = 0.02) higher, respectively, for patients in the low TTR cohort vs. the high TTR cohort. In this retrospective study, we were only able to evaluate the association and not the causality between healthcare resource utilization and costs with the different warfarin TTRs. Many warfarin-treated NVAF patients have a low warfarin TTR. NVAF patients with low vs. patients with high warfarin TTR used healthcare resources to a greater extent, which was reflected in higher healthcare costs.

Health-related quality of life and healthcare resource utilization by COPD patients: a comparison of three instruments.

PubMed

Desikan, R; Mason, H L; Rupp, M T; Skehan, M

2002-12-01

The aim of this study was to compare the SF-36 and two disease-specific instruments--St. George's Respiratory Questionnaire (SGRQ) and Chronic Respiratory Disease Questionnaire (CRDQ) among chronic obstructive pulmonary disease (COPD) patients using healthcare utilization data. The three instruments were administered twice by telephone interview to 40 COPD patients separated by a 3-month interval. Healthcare utilization data were obtained for the 3 months immediately prior to each administration. Reliabilities for sub-scales on the three instruments ranged from 0.70 to 0.90 for the SF-36, from 0.78 to 0.85 for the SGRQ, and from 0.64 to 0.91 for the CRDQ. In general, the study sample had poor physical health, and somewhat better mental health. None of the demographic variables were significantly associated with either health status or utilization. Among the three instruments, the SF-36 explained the most variance in healthcare utilization. The aggregate scores such as the summary scores of the SF-36 and the total score of the SGRQ did not perform as well as the individual sub-scales of the respective instruments in explaining the variation in utilization. The conclusion that the SF-36 provides the best association to healthcare utilization data from among the three instruments studied should be interpreted with caution given the small sample size and relatively brief duration of the study.

Extension of the behavioral model of healthcare utilization with ethnically diverse, low-income women.

PubMed

Keenan, Lisa A; Marshall, Linda L; Eve, Susan

2002-01-01

Psychosocial vulnerabilities were added to a model of healthcare utilization. This extension was tested among low-income women with ethnicity addressed as a moderator. Structured interviews were conducted at 2 points in time, approximately 1 year apart. The constructs of psychosocial vulnerability, demographic predisposing, barriers, and illness were measured by multiple indicators to allow use of Structural Equation Modeling to analyze results. The models were tested separately for each ethnic group. Community office. African-American (N = 266), Euro-American (N = 200), and Mexican-American (N = 210) women were recruited from the Dallas Metropolitan area to participate in Project Health Outcomes of Women, a multi-year, multi-wave study. Face-to-face interviews were conducted with this sample. Participants had been in heterosexual relationships for at least 1 year, were between 20 and 49 years of age, and had incomes less than 200% of the national poverty level. Healthcare utilization, defined as physician visits and general healthcare visits. Illness mediated the effect of psychosocial vulnerability on healthcare utilization for African Americans and Euro-Americans. The model for Mexican Americans was the most complex. Psychosocial vulnerability on illness was partially mediated by barriers, which also directly affected utilization. Psychosocial vulnerabilities were significant utilization predictors for healthcare use for all low-income women in this study. The final models for the 2 minority groups, African Americans and Mexican Americans, were quite different. Hence, women of color should not be considered a homogeneous group in comparison to Euro-Americans.

Healthcare Utilization and Expenditures for Persons with Diabetes Comorbid with Mental Illnesses.

PubMed

Su, Chen-Hsiang; Chiu, Herng-Chia; Hsieh, Hui-Min; Yen, Ju-Yu; Lee, Mei-Hsuan; Li, Chih-Yi; Chang, Kao-Ping; Huang, Chun-Jen

2016-09-01

The aim of this study was to investigate healthcare utilization and expenditure for patients with diabetes comorbid with and without mental illnesses in Taiwan. People with diabetes comorbid with and without mental illnesses in 2000 were identified and followed up to 2004 to explore the healthcare utilization and expenditure. Healthcare utilization included outpatient visits and use of hospital inpatient services, and expenditure included outpatient, inpatient and total medical expenditure. General estimation equation models were used to explore the factors associated with outpatient visits and expenditure. To identify the factors associated with hospitalization, multiple logistic regressions were applied. The average number of annual outpatient visits of the patients with mental illnesses ranged from 37.01 to 41.91, and 28.83 to 31.79 times for the patients without mental illnesses from 2000 to 2004. The average annual total expenditure for patients with mental illnesses during this period ranged from NT$77,123-NT$90,790, and NT$60,793- NT$84,984 for those without mental illnesses. After controlling for covariates, the results indicated that gender, age, mental illness and time factor were associated with outpatient visits. Gender, age, and time factor were associated with total expenditure. Age and mental illness were associated with hospitalization in logistic regression. The healthcare utilization and expenditure for patients with mental illnesses was significantly higher than for patients without mental illnesses. The factors associated with healthcare utilization and expenditure included gender, age, mental illness and time trends.

Migraine disability, healthcare utilization, and expenditures following treatment in a tertiary headache center.

PubMed

Freitag, Frederick G; Lyss, Heidi; Nissan, George R

2013-10-01

Headache is among the most common disabling pain complaints. While many patients are managed in primary care or referral neurology practices, some patients have refractive situations that necessitate referral to a tertiary headache center. Increasing frequency of headache is strongly associated with increasing disability and workplace absenteeism as well as increased healthcare utilization. Previous studies have demonstrated that headache care in a dedicated tertiary center is associated with a decrease in headache frequency and improvement in other characteristics that persist over extended periods of time. Previous studies have not examined the impact of this treatment on subsequent healthcare utilization and associated expenditures. In this study we examined the changes in healthcare utilization and expenditures as well as the impact on disability and workplace productivity with treatment in a tertiary headache care center that used initial treatment settings of inpatient and outpatient care and considered the difference between those with episodic migraine and those with chronic migraine and its complications. Tertiary care was found to produce positive reductions in disability, healthcare utilization, and expenditures. These results suggest that earlier tertiary-level intervention may avoid the complications of migraine that occur in some patients and the increasing costs and utilization of care associated with higher disability.

Migraine disability, healthcare utilization, and expenditures following treatment in a tertiary headache center

PubMed Central

Lyss, Heidi; Nissan, George R.

2013-01-01

Headache is among the most common disabling pain complaints. While many patients are managed in primary care or referral neurology practices, some patients have refractive situations that necessitate referral to a tertiary headache center. Increasing frequency of headache is strongly associated with increasing disability and workplace absenteeism as well as increased healthcare utilization. Previous studies have demonstrated that headache care in a dedicated tertiary center is associated with a decrease in headache frequency and improvement in other characteristics that persist over extended periods of time. Previous studies have not examined the impact of this treatment on subsequent healthcare utilization and associated expenditures. In this study we examined the changes in healthcare utilization and expenditures as well as the impact on disability and workplace productivity with treatment in a tertiary headache care center that used initial treatment settings of inpatient and outpatient care and considered the difference between those with episodic migraine and those with chronic migraine and its complications. Tertiary care was found to produce positive reductions in disability, healthcare utilization, and expenditures. These results suggest that earlier tertiary-level intervention may avoid the complications of migraine that occur in some patients and the increasing costs and utilization of care associated with higher disability. PMID:24082410

Tolerability and Healthcare Utilization in Maintenance Hemodialysis Patients Undergoing Treatment for Tuberculosis-Related Conditions.

PubMed

Hamadah, Abdurrahman M; Beaulieu, Lynn M; Wilson, John W; Aksamit, Timothy R; Gregoire, James R; Williams, Amy W; Dillon, John J; Albright, Robert C; Onuigbo, Macaulay; Iyer, Venkateshwaran K; Hickson, LaTonya J

2016-01-01

The incidence of tuberculosis (TB) in end-stage renal disease is significantly higher than that in the general population. Among those with kidney dysfunction, anti-TB treatment is associated with increased side effects, but the effect on healthcare utilization is unknown. Methods/Aim: To assess patient-reported symptoms, adverse effects and describe changes in healthcare utilization patterns during treatment for TB, we conducted a case series (n = 12) of patients receiving maintenance hemodialysis (HD) from Mayo Clinic Dialysis Services and concurrent drug therapy for TB from January 2002 through May 2014. Healthcare utilization (hospitalizations and emergency department (ED) visits independent of hospital admission) was compared before and during treatment. Patients were treated for latent (n = 7) or active (n = 5) TB. The majority of patients with latent disease were treated with isoniazid (n = 5, 71%), while active-disease patients received a 4-drug regimen. Adverse effects were reported in 83% of patients. Compared to measurements prior to drug initiation, serum albumin and dialysis weights were similar at 3 months. Commonly reported anti-TB drug toxicities were described. More than half (58%) of the patients were hospitalized at least once. No ED or hospital admissions occurred in the period prior to drug therapy, but healthcare utilization increased during treatment in the latent disease group (hospitalization rate per person-month: pre 0 vs. post 1). Among HD patients, anti-TB therapy is associated with frequently reported symptoms and increased healthcare utilization. Among this subset, patients receiving treatment for latent disease may be those with greatest increase in healthcare use. Careful monitoring and early complication detection may help optimize medication adherence and minimize hospitalizations. © 2016 S. Karger AG, Basel.

Tolerability and Healthcare Utilization in Maintenance Hemodialysis Patients Undergoing Treatment for Tuberculosis-Related Conditions

PubMed Central

Hamadah, Abdurrahman M.; Beaulieu, Lynn M.; Wilson, John W.; Aksamit, Timothy R.; Gregoire, James R.; Williams, Amy W.; Dillon, John J.; Albright, Robert C.; Onuigbo, Macaulay; Iyer, Venkateshwaran K.; Hickson, LaTonya J.

2016-01-01

Background The incidence of tuberculosis in end-stage renal disease is significantly higher than the general population. Among those with kidney dysfunction, anti-tuberculosis treatment is associated with increased side effects, but the effect on healthcare utilization is unknown. Methods/Aim To assess patient-reported symptoms, adverse effects and describe changes in healthcare utilization patterns during treatment for tuberculosis, we conducted a case series (n=12) of patients receiving maintenance hemodialysis from Mayo Clinic Dialysis Services and concurrent drug therapy for tuberculosis from January 2002 through May 2014. Healthcare utilization (hospitalizations and emergency department visits independent of hospital admission) was compared before and during treatment. Results Patients were treated for latent (n=7) or active (n=5) tuberculosis. The majority of patients with latent disease were treated with isoniazid (n=5, 71%), while active-disease patients received a 4-drug regimen. Adverse effects were reported in 83% of patients. Compared to measurements prior to drug initiation, serum albumin and dialysis weights were similar at 3 months. Commonly reported anti-tuberculosis drug toxicities were described. More than half (58%) of patients were hospitalized at least once. No emergency department or hospital admissions occurred in the period prior to drug therapy, but healthcare utilization increased during treatment in the latent disease group (hospitalization rate per person-month: pre, 0 vs. post, 1). Conclusions Among hemodialysis patients, anti-tuberculosis therapy is associated with frequent patient-reported symptoms and increased healthcare utilization. Patients receiving treatment for latent disease may have the greatest increase in healthcare use. Careful monitoring and early complication detection may help optimize medication adherence and minimize hospitalizations. PMID:26859893

The healthy diver: A cross-sectional survey to evaluate the health status of recreational scuba diver members of Divers Alert Network (DAN)

PubMed Central

Kucera, Kristen L.; Denoble, Petar J.

2018-01-01

Background Scuba diver fitness is paramount to confront environmental stressors of diving. However, the diving population is aging and the increasing prevalence of diseases may be a concern for diver fitness. Purpose The purpose of this study is to assess the demographics, lifestyle factors, disease prevalence, and healthcare access and utilization of Divers Alert Network (DAN) members and compare them with those from the general population. Methods DAN membership health survey (DMHS) was administered online in 2011 to DAN members in the United States (US). Health status of DMHS respondents was compared with the general US population data from the Center for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System using two-sided student’s t-tests and Mantel-Haenszel chi-square tests. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with healthcare utilization among the DMHS participants. Results Compared to the general US population, the DMHS population had lower prevalence of asthma, heart attack, angina, stroke, diabetes, hypertension, hypercholesterolemia, and disabilities (p<0.01); more heavy alcohol drinkers, and fewer smokers (p<0.01); and greater access and utilization (routine checkup) of healthcare (p<0.01). Healthcare utilization in males was lower than among females. Increasing age and increase in the number of chronic illnesses were associated with increased healthcare utilization. Conclusions DAN members are healthier than the general US population. DAN members also have better access to healthcare and utilize healthcare for preventive purposes more often than the general population. DAN members appear to have a better fitness level than their non-diving peers. PMID:29566018

Women's autonomy and maternal healthcare service utilization in Ethiopia.

PubMed

Tiruneh, Fentanesh Nibret; Chuang, Kun-Yang; Chuang, Ying-Chih

2017-11-13

Most previous studies on healthcare service utilization in low-income countries have not used a multilevel study design to address the importance of community-level women's autonomy. We assessed whether women's autonomy, measured at both individual and community levels, is associated with maternal healthcare service utilization in Ethiopia. We analyzed data from the 2005 and 2011 Ethiopia Demographic and Health Surveys (N = 6058 and 7043, respectively) for measuring women's decision-making power and permissive gender norms associated with wife beating. We used Spearman's correlation and the chi-squared test for bivariate analyses and constructed generalized estimating equation logistic regression models to analyze the associations between women's autonomy indicators and maternal healthcare service utilization with control for other socioeconomic characteristics. Our multivariate analysis showed that women living in communities with a higher percentage of opposing attitudes toward wife beating were more likely to use all three types of maternal healthcare services in 2011 (adjusted odds ratios = 1.21, 1.23, and 1.18 for four or more antenatal care visits, health facility delivery, and postnatal care visits, respectively). In 2005, the adjusted odds ratios were 1.16 and 1.17 for four or more antenatal care visits and health facility delivery, respectively. In 2011, the percentage of women in the community with high decision-making power was positively associated with the likelihood of four or more antenatal care visits (adjusted odds ratio = 1.14). The association of individual-level autonomy on maternal healthcare service utilization was less profound after we controlled for other individual-level and community-level characteristics. Our study shows that women's autonomy was positively associated with maternal healthcare service utilization in Ethiopia. We suggest addressing woman empowerment in national policies and programs would be the optimal solution.

Health Literacy Impact on National Healthcare Utilization and Expenditure.

PubMed

Rasu, Rafia S; Bawa, Walter Agbor; Suminski, Richard; Snella, Kathleen; Warady, Bradley

2015-08-17

Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL) on healthcare utilization and healthcare expenditure. Database analysis used Medical Expenditure Panel Survey (MEPS) from 2005-2008 which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs) were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL). HLS ranged from 0-500. Health literacy level (HLL) and categorized in 2 groups: Below basic or basic (HLS <226) and above basic (HLS ≥226). Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER) visits and healthcare spending. Expenditures were adjusted to 2010 rates using the Consumer Price Index (CPI). A P value of 0.05 or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA® 11.0 statistical software. The study evaluated 22 599 samples representing 503 374 648 weighted individuals nationally from 2005-2008. The cohort had an average age of 49 years and included more females (57%). Caucasian were the predominant racial ethnic group (83%) and 37% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was 22.4%. Annual predicted values of physician visits, nonphysician visits, and ER visits were 6.6, 4.8, and 0.2, respectively, for basic or below basic compared to 4.4, 2.6, and 0.1 for above basic. Predicted values of office and ER visits expenditures were $1284 and $151, respectively, for basic or below basic and $719 and $100 for above basic (P < .05). The extrapolated national estimates show that the annual costs for prescription alone for adults with LHL possibly associated with basic and below basic health literacy could potentially reach about $172 billion. Health literacy is inversely associated with healthcare utilization and expenditure. Individuals with below basic or basic HLL have greater healthcare utilization and expendituresspending more on prescriptions compared to individuals with above basic HLL. Public health strategies promoting appropriate education among individuals with LHL may help to improve health outcomes and reduce unnecessary healthcare visits and costs. © 2015 by Kerman University of Medical Sciences.

[Mental Health Stigma: An Influencing Factor in Healthcare Utilization by Veterans of the German Armed Forces].

PubMed

Schuy, Katrin; Brants, Loni M; Dors, Simone; Ströhle, Andreas; Zimmermann, Peter Lutz; Willmund, Gerd Dieter; Rau, Heinrich; Siegel, Stefan

2018-05-14

 Mental illness stigma is a barrier to healthcare utilization. This study is the first to research the connection between mental illness stigma and the use of healthcare by veterans of the German Armed Forces. An overview of perceived stigma components in this sample is provided that should help understand how these factors influence healthcare utilization.  43 interviews with veterans of the German Armed Forces were conducted. The resulting data were analyzed in several coding steps. It was investigated whether the stigma experience of veterans of the German Armed Forces could be well illustrated by the theory-based stigmatization model of Link and Phelan. A set of hypotheses on stigma and healthcare utilization based on the data were developed.  All stigma components according to the model of Link and Phelan were found in the sample. Internalized stigma, perceived public stigmatization, vocational disadvantage and social exclusion as well as feared misunderstanding of the military past in the civilian sector were reported as main stigma-relevant barriers to the use of healthcare.  Recommendations for interventions are given to decrease mental illness stigma in this specific group of former soldiers. © Georg Thieme Verlag KG Stuttgart · New York.

Distribution and utilization of curative primary healthcare services in Lahej, Yemen.

PubMed

Bawazir, A A; Bin Hawail, T S; Al-Sakkaf, K A Z; Basaleem, H O; Muhraz, A F; Al-Shehri, A M

2013-09-01

No evidence-based data exist on the availability, accessibility and utilization of healthcare services in Lahej Governorate, Yemen. The aim of this study was to assess the distribution and utilization of curative services in primary healthcare units and centres in Lahej. Cross-sectional study (clustering sample). This study was conducted in three of the 15 districts in Lahej between December 2009 and August 2010. Household members were interviewed using a questionnaire to determine sociodemographic characteristics and types of healthcare services available in the area. The distribution of health centres, health units and hospitals did not match the size of the populations or areas of the districts included in this study. Geographical accessibility was the main obstacle to utilization. Factors associated with the utilization of curative services were significantly related to the time required to reach the nearest facility, seeking curative services during illness and awareness of the availability of health facilities (P < 0.01). There is an urgent need to look critically and scientifically at the distribution of healthcare services in the region in order to ensure accessibility and quality of services. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Method for utilizing decay heat from radioactive nuclear wastes

DOEpatents

Busey, H.M.

1974-10-14

Management of radioactive heat-producing waste material while safely utilizing the heat thereof is accomplished by encapsulating the wastes after a cooling period, transporting the capsules to a facility including a plurality of vertically disposed storage tubes, lowering the capsules as they arrive at the facility into the storage tubes, cooling the storage tubes by circulating a gas thereover, employing the so heated gas to obtain an economically beneficial result, and continually adding waste capsules to the facility as they arrive thereat over a substantial period of time.

Method for the purification of noble gases, nitrogen and hydrogen

DOEpatents

Baker, J.D.; Meikrantz, D.H.; Tuggle, D.G.

1997-09-23

A method and apparatus are disclosed for the purification and collection of hydrogen isotopes in a flowing inert gaseous mixture containing impurities, wherein metal alloy getters having the capability of sorbing non-hydrogen impurities such as oxygen, carbon dioxide, carbon monoxide, methane, ammonia, nitrogen and water vapor are utilized to purify the gaseous mixture of impurities. After purification hydrogen isotopes may be more efficiently collected. A plurality of parallel process lines utilizing metal getter alloys can be used to provide for the continuous purification and collection of the hydrogen isotopes. 15 figs.

Method for the purification of noble gases, nitrogen and hydrogen

DOEpatents

Baker, John D.; Meikrantz, David H.; Tuggle, Dale G.

1997-01-01

A method and apparatus for the purification and collection of hydrogen isotopes in a flowing inert gaseous mixture containing impurities, wherein metal alloy getters having the capability of sorbing non-hydrogen impurities such as oxygen, carbon dioxide, carbon monoxide, methane, ammonia, nitrogen and water vapor are utilized to purify the gaseous mixture of impurities. After purification hydrogen isotopes may be more efficiently collected. A plurality of parallel process lines utilizing metal getter alloys can be used to provide for the continuous purification and collection of the hydrogen isotopes.

Seizure Action Plans Do Not Reduce Health Care Utilization in Pediatric Epilepsy Patients

PubMed Central

Roundy, Lindsi M.; Filloux, Francis M.; Kerr, Lynne; Rimer, Alyssa; Bonkowsky, Joshua L.

2015-01-01

Management of pediatric epilepsy requires complex coordination of care. We hypothesized that an improved seizure management care plan would reduce healthcare utilization and improve outcomes. We conducted a cohort study with historical controls of 120 epilepsy patients before and after implementation of a “Seizure Action Plan.” We evaluated for differences in healthcare utilization including emergency department visits, hospitalizations, clinic visits, telephone calls, and the percentage of emergency department visits that resulted in hospitalization in patients who did or did not have a Seizure Action Plan. We found that there was no decrease in these measures of healthcare utilization, and in fact the number of follow-up clinic visits was increased in the group with Seizure Action Plans (4.2 versus 3.3, p 0.006). However, the study was underpowered to detect smaller differences. Our study suggests that pediatric epilepsy quality improvement measures may require alternative approaches to reduce healthcare utilization and improve outcomes. PMID:26245799

Trends in health-care costs and utilization for inflammatory bowel disease from 2010 to 2014 in Korea: A nationwide population-based study.

PubMed

Kim, Jung-Wook; Lee, Chang Kyun; Rhee, Sang Youl; Oh, Chi Hyuck; Shim, Jae-Jun; Kim, Hyo Jong

2018-04-01

Data regarding health-care costs and utilization for inflammatory bowel disease (IBD) at the population level are limited in Asia. We aimed to investigate the nationwide prevalence and health-care cost and utilization of IBD in Korea. We tracked the IBD-attributable health-care costs and utilization from 2010 to 2014 using the public dataset obtained from Korean National Health Insurance Service claims. We estimated the nationwide prevalence of IBD using population census data from Statistics Korea during the same period. In total, 236 106 IBD patients were analyzed. The estimated IBD prevalence significantly increased from 85.1/100 000 in 2010 to 106/100 000 in 2014. The overall annual health-care costs for IBD increased from $23.2 million (US dollars) in 2010 to $49.7 million in 2014 (P < 0.001). During the same period, the health-care cost per capita also increased from $572.3 to $983.7 (P < 0.001). The outpatient to total cost ratio increased from 45.5% in 2010 to 66.6% in 2014. Regarding health-care utilization, the outpatient to total days of service use ratio increased from 73.1% in 2010 to 76.9% in 2014. Of the total days of service used, the proportions of tertiary, general, and community hospitals increased significantly with a concomitant decrease in that of primary clinics (all P values < 0.001). This population-based study confirmed the steadily rising rate of prevalence of IBD in Korea. It also demonstrated that the shifting to outpatient care and advanced care settings are drivers for the dramatic increase in IBD-related health-care costs in Korea. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Recollection is a continuous process: Evidence from plurality memory receiver operating characteristics.

PubMed

Slotnick, Scott D; Jeye, Brittany M; Dodson, Chad S

2016-01-01

Is recollection a continuous/graded process or a threshold/all-or-none process? Receiver operating characteristic (ROC) analysis can answer this question as the continuous model and the threshold model predict curved and linear recollection ROCs, respectively. As memory for plurality, an item's previous singular or plural form, is assumed to rely on recollection, the nature of recollection can be investigated by evaluating plurality memory ROCs. The present study consisted of four experiments. During encoding, words (singular or plural) or objects (single/singular or duplicate/plural) were presented. During retrieval, old items with the same plurality or different plurality were presented. For each item, participants made a confidence rating ranging from "very sure old", which was correct for same plurality items, to "very sure new", which was correct for different plurality items. Each plurality memory ROC was the proportion of same versus different plurality items classified as "old" (i.e., hits versus false alarms). Chi-squared analysis revealed that all of the plurality memory ROCs were adequately fit by the continuous unequal variance model, whereas none of the ROCs were adequately fit by the two-high threshold model. These plurality memory ROC results indicate recollection is a continuous process, which complements previous source memory and associative memory ROC findings.

What part of the total care consumed by type 2 diabetes patients is directly related to diabetes? Implications for disease management programs.

PubMed

van Dijk, Christel E; Verheij, Robert A; Swinkels, Ilse C S; Rijken, Mieke; Schellevis, François G; Groenewegen, Peter P; de Bakker, Dinny H

2011-10-01

Disease management programs (DMP) aim at improving coordination and quality of care and reducing healthcare costs for specific chronic diseases. This paper investigates to what extent total healthcare utilization of type 2 diabetes patients is actually related to diabetes and its implications for diabetes management programs. Healthcare utilization for diabetes patients was analyzed using 2008 self-reported data (n=316) and data from electronic medical records (EMR) (n=9023), and divided whether or not care was described in the Dutch type 2 diabetes multidisciplinary healthcare standard. On average 4.3 different disciplines of healthcare providers were involved in the care for diabetes patients. Ninety-six percent contacted a GP-practice and 63% an ophthalmologist, 24% an internist, 32% a physiotherapist and 23% a dietician. Diabetes patients had on average 9.3 contacts with GP-practice of which 53% were included in the healthcare standard. Only a limited part of total healthcare utilization of diabetes patients was included in the healthcare standard and therefore theoretically included in DMPs. Organizing the care for diabetics in a DMP might harm the coordination and quality of all healthcare for diabetics. DMPs should be integrated in the overall organization of care.

The Influence of Physical Therapy Guideline Adherence on Healthcare Utilization and Costs among Patients with Low Back Pain: A Systematic Review of the Literature

PubMed Central

Liu, Xinliang; Kolber, Morey J.

2016-01-01

Background Low back pain (LBP) is common and associated healthcare costs are significant. While clinical practice guidelines have been established in an attempt to reduce costs and healthcare utilization, it is unclear if adherence to physical therapy guidelines for those with LBP is efficacious. Therefore, the purpose of this study was to assess current evidence and evaluate the impact of physical therapy guideline adherence on subsequent healthcare costs and utilization for patients with LBP. Methods An electronic search was conducted in PubMed, CINAHL (EBSCO Host), AMED (Ovid), and PEDro. Studies included in this review were published in peer reviewed journals and the primary mode of treatment was administered by a physical therapist. Also, the definition of adherence was clearly defined based on claims data and at least one measure of cost or utilization reported. Quality assessment was evaluated via a modified Downs and Black checklist. Due to the conceptual heterogeneity in variable measurements, data were qualitatively synthesized and stratified by reported utilization and cost measures. Results A total of 256 results were identified and after omitting duplicates, 4 articles were retained, which were all retrospective in nature. Quality scores ranged between 19 and 21 points out of a possible 26 on the modified Downs and Black checklist. All identified studies used the same definition of guideline adherence, which focused on billing active codes and minimizing use of passive codes. The results demonstrated trends that, with a few exceptions, suggested those patients with LBP that were treated with an adherent guideline program demonstrated decreased healthcare utilization and an overall healthcare savings. Conclusion Preliminary evidence suggests that adherence to established clinical practice guidelines may assist with decreasing healthcare utilization and costs. Additional research based on prospective randomized controlled trials are needed to provide high quality evidence regarding the impact of guideline adherence among patients with LBP. PMID:27285608

Quality Implementation in Health Physics Unit, Cosenza Hospital. Accreditation Program as Quality Improvement instrument.

PubMed

Loizzo, M; Siciliano, R

2016-01-01

Achieving high levels of quality in healthcare, which could be measurable, is increasingly important at present and is dictated by the radical changes of the welfare system imposed today by the well known economic constraints. However, even in the ongoing legislation, the practices concerning the verification and review of the quality of health care has had a major impact in the galaxy of Health. On the one hand, the citizen is developing an awareness of the possibilities of choice (Empowerment) between a plurality of providers of healthcare services, on the other hand providers themselves are obliged, within the logic of a global market, to retrain their offers to respond satisfactorily to the needs of citizens. The purpose of this study was to demonstrate how the adoption of Operational Procedures, following the granting of a certificate of accreditation to the Unit of Medical Physics, has changed the approach to the work on the part of health workers, in the direction of a dynamic quality improvement.

Determinants and patterns of service utilization and recourse to professionals for mental health reasons

PubMed Central

2014-01-01

Background This study has a dual purpose: 1) identify determinants of healthcare service utilization for mental health reasons (MHR) in a Canadian (Montreal) catchment area; 2) determine the patterns of recourse to healthcare professionals in terms of frequency of visits and type of professionals consulted, and as it relates to the most prevalent mental disorders (MD) and psychological distress. Methods Data was collected from a random sample of 1,823 individuals interviewed after a two-year follow-up period. A regression analysis was performed to identify variables associated with service utilization and complementary analyses were carried out to better understand participants’ patterns of healthcare service utilization in relation to the most prevalent MD. Results Among 243 individuals diagnosed with a MD in the 12 months preceding an interview, 113 (46.5%) reported having used healthcare services for MHR. Determinants of service utilization were emotional and legal problems, number of MD, higher personal income, lower quality of life, inability of individuals to influence events occurring in their neighborhood, female gender and, marginally, lack of alcohol dependence in the past 12 months. Emotional problems were the most significant determinant of healthcare service utilization. Frequent visits with healthcare professionals were more likely associated with major depression and number of MD with or without dependence to alcohol or drugs. People suffering from major depression, psychological distress and social phobia were more likely to consult different professionals, while individuals with panic disorders relied on their family physician only. Concerning social phobia, panic disorders and psychological distress, more frequent visits with professionals did not translate into involvement of a higher number of professionals or vice-versa. Conclusions This study demonstrates the impact of emotional problems, neighborhood characteristics and legal problems in healthcare service utilization for MHR. Interventions based on inter-professional collaboration could be prioritized to increase the ability of healthcare services to take care especially of individuals suffering from social phobia, panic disorders and psychological distress. Others actions that could be prioritized are training of family physicians in the treatment of MD, use of psychiatric consultants, internet outreach, and reimbursement of psychological consultations for individuals with low income. PMID:24712834

Self-configurable radio receiver system and method for use with signals without prior knowledge of signal defining characteristics

NASA Technical Reports Server (NTRS)

Hamkins, Jon (Inventor); Simon, Marvin K. (Inventor); Divsalar, Dariush (Inventor); Dolinar, Samuel J. (Inventor); Tkacenko, Andre (Inventor)

2013-01-01

A method, radio receiver, and system to autonomously receive and decode a plurality of signals having a variety of signal types without a priori knowledge of the defining characteristics of the signals is disclosed. The radio receiver is capable of receiving a signal of an unknown signal type and, by estimating one or more defining characteristics of the signal, determine the type of signal. The estimated defining characteristic(s) is/are utilized to enable the receiver to determine other defining characteristics. This in turn, enables the receiver, through multiple iterations, to make a maximum-likelihood (ML) estimate for each of the defining characteristics. After the type of signal is determined by its defining characteristics, the receiver selects an appropriate decoder from a plurality of decoders to decode the signal.

In situ conversion process systems utilizing wellbores in at least two regions of a formation

DOEpatents

Vinegar, Harold J [Bellaire, TX; Hsu, Chia-Fu [Granada Hills, CA

2011-09-27

A system for heating a subsurface formation is described. The system includes a plurality of elongated heaters located in a plurality of openings in the formation. At least two of the heaters are substantially parallel to each other for at least a portion of the lengths of the heaters. At least two of the heaters have first end portions in a first region of the formation and second end portions in a second region of the formation. A source of time-varying current is configured to apply time-varying current to at least two of the heaters. The first end portions of at least two heaters are configured to have substantially the same voltage applied to them. The second portions of at least two heaters are configured to have substantially the same voltage applied to them.

Regenerable MgO promoted metal oxide oxygen carriers for chemical looping combustion

DOEpatents

Siriwardane, Ranjani V.; Miller, Duane D.

2014-08-19

The disclosure provides an oxygen carrier comprised of a plurality of metal oxide particles in contact with a plurality of MgO promoter particles. The MgO promoter particles increase the reaction rate and oxygen utilization of the metal oxide when contacting with a gaseous hydrocarbon at a temperature greater than about 725.degree. C. The promoted oxide solid is generally comprised of less than about 25 wt. % MgO, and may be prepared by physical mixing, incipient wetness impregnation, or other methods known in the art. The oxygen carrier exhibits a crystalline structure of the metal oxide and a crystalline structure of MgO under XRD crystallography, and retains these crystalline structures over subsequent redox cycles. In an embodiment, the metal oxide is Fe.sub.2O.sub.3, and the gaseous hydrocarbon is comprised of methane.

Adding Qualitative and Mixed Methods Research to Health Intervention Studies: Interacting With Differences.

PubMed

Johnson, R Burke; Schoonenboom, Judith

2016-04-01

The purpose of this article is to explain how to improve intervention designs, such as randomized controlled trials (RCTs), in health science research using a process philosophy and theory known as dialectical pluralism (DP). DP views reality as plural and uses dialectical, dialogical, and hermeneutical approaches to knowledge construction. Using DP and its "both/and" logic, and its attempt to produce new creative syntheses, researchers on heterogeneous teams can better dialogue with qualitative and mixed methods approaches, concepts, paradigms, methodologies, and methods to improve their intervention research studies. The concept of reflexivity is utilized but is expanded when it is a component of DP. Examples of strategies for identifying, inviting, and creating divergence and integrative strategies for producing strong mixed methods intervention studies are provided and illustrated using real-life examples. © The Author(s) 2015.

Analysis of changes in the association of income and the utilization of curative health services in Mexico between 2000 and 2006

PubMed Central

2011-01-01

Background A common characteristic of health systems in most developing countries is unequal access to health services. As a result, members of the poorest population groups often do not receive formal attention for health services, because they cannot afford it. In 2001 in Mexico, to address income-related differences in the use of health services, the government launched a major healthcare reform, which includes a health insurance program called Seguro Popular, aimed at improving healthcare access among poor, uninsured residents. This paper analyzes the before and after changes in the demand for curative ambulatory health services focusing on the association of income-related characteristics and the utilization of formal healthcare providers vs. no healthcare service utilization. Methods By using two nationally representative health surveys (ENSA-2000 and ENSANUT-2006), we modeled an individual's decision when experiencing an illness to use services provided by the (1) Ministry of Health (MoH), (2) social security, (3) private entities, or (4) to not use formal services (no healthcare service utilization). Results Poorer individuals were more likely in 2006 than in 2000 to respond to an illness by using formal healthcare providers. Trends in provider selection differed, however. The probability of using public services from the MoH increased among the poorest population, while the findings indicated an increase in utilization of private health services among members of low- and middle-income groups. No significant change was seen among formal workers -covered by social security services-, regardless of socioeconomic status. Conclusions Overall, for 2006 the Mexican population appears less differentiated in using healthcare across economic groups than in 2000. This may be related, in part, to the implementation of Seguro Popular, which seems to be stimulating healthcare demand among the poorest and previously uninsured segment of the population. Still, public health authorities need to address the remaining income-related healthcare utilization differences, the differences in quality between public and private health services, and the general perception that MoH facilities offer inferior services. PMID:21978183

Analysis of changes in the association of income and the utilization of curative health services in Mexico between 2000 and 2006.

PubMed

Danese-Dlsantos, Laura G; Sosa-Rubí, Sandra G; Valencia-Mendoza, Atanacio

2011-10-07

A common characteristic of health systems in most developing countries is unequal access to health services. As a result, members of the poorest population groups often do not receive formal attention for health services, because they cannot afford it. In 2001 in Mexico, to address income-related differences in the use of health services, the government launched a major healthcare reform, which includes a health insurance program called Seguro Popular, aimed at improving healthcare access among poor, uninsured residents. This paper analyzes the before and after changes in the demand for curative ambulatory health services focusing on the association of income-related characteristics and the utilization of formal healthcare providers vs. no healthcare service utilization. By using two nationally representative health surveys (ENSA-2000 and ENSANUT-2006), we modeled an individual's decision when experiencing an illness to use services provided by the (1) Ministry of Health (MoH), (2) social security, (3) private entities, or (4) to not use formal services (no healthcare service utilization). Poorer individuals were more likely in 2006 than in 2000 to respond to an illness by using formal healthcare providers. Trends in provider selection differed, however. The probability of using public services from the MoH increased among the poorest population, while the findings indicated an increase in utilization of private health services among members of low- and middle-income groups. No significant change was seen among formal workers -covered by social security services-, regardless of socioeconomic status. Overall, for 2006 the Mexican population appears less differentiated in using healthcare across economic groups than in 2000. This may be related, in part, to the implementation of Seguro Popular, which seems to be stimulating healthcare demand among the poorest and previously uninsured segment of the population. Still, public health authorities need to address the remaining income-related healthcare utilization differences, the differences in quality between public and private health services, and the general perception that MoH facilities offer inferior services.

Registry data for cross-country comparisons of migrants' healthcare utilization in the EU: a survey study of availability and content

PubMed Central

2009-01-01

Background Cross-national comparable data on migrants' use of healthcare services are important to address problems in access to healthcare; to identify high risk groups for prevention efforts; and to evaluate healthcare systems comparatively. Some of the main obstacles limiting analyses of health care utilization are lack of sufficient coverage and availability of reliable and valid healthcare data which includes information allowing for identification of migrants. The objective of this paper was to reveal which registry data on healthcare utilization were available in the EU countries in which migrants can be identified; and to determine to what extent data were comparable between the EU countries. Methods A questionnaire survey on availability of healthcare utilization registries in which migrants can be identified was carried out among all national statistic agencies and other relevant national health authorities in the 27 EU countries in 2008-9 as part of the Migrant and Ethnic Minority Health Observatory-project (MEHO). The information received was compared with information from a general survey on availability of survey and registry data on migrants conducted by Agency of Public Health, Lazio Region, Italy within the MEHO-project; thus, the information on registries was double-checked to assure accuracy and verification. Results Available registry data on healthcare utilization which allow for identification on migrants on a national/regional basis were only reported in 11 EU countries: Austria, Belgium, Denmark, Finland, Greece, Italy, Luxembourg, the Netherlands, Poland, Slovenia, and Sweden. Data on hospital care, including surgical procedures, were most frequently available whereas only few countries had data on care outside the hospital. Regarding identification of migrants, five countries reported having information on both citizenship and country of birth, one reported availability of information on country of birth, and five countries reported availability of information on citizenship. Conclusion Lack of registry data in 16 EU countries, shortage of data on healthcare utilization, and the diversity in the definition of migrant status hampers cross-national comparisons and calls for an urgent establishment of registries, expansion of the existing registry information, and adoption of a common, generally acceptable definition and identification method of migrants across the EU. PMID:19922657

Factors Involved in Access and Utilization of Adult Hearing Healthcare: A Systematic Review

PubMed Central

Barnett, Margaret; Hixon, Brian; Okwiri, Neville; Irungu, Catherine; Ayugi, John; Thompson, Robin; Shinn, Jennifer B.; Bush, Matthew L.

2016-01-01

Objective/Hypothesis Hearing loss is a public health concern yet hearing healthcare disparities exist and influence utilization of rehabilitation services. The objective of this review was to systematically analyze the published literature on motivators, barriers, and compliance factors affecting adult patient access and utilization of hearing rehabilitation healthcare. Data Sources and Study Eligibility Criteria Pubmed, PsychINFO, CINAHL, Web of Science were searched for relevant articles. Eligible studies were those containing original, peer-reviewed research in English pertaining to factors affecting adult hearing healthcare access and utilization of hearing aids and cochlear implantation. The search encompassed 1990-2015. Study Appraisal and Synthesis Methods Two investigators independently reviewed all articles and extracted data. Specific variables regarding access to care and compliance to recommended care were extracted from each study. Results Thirty articles were reviewed. The factors affecting access and utilization of hearing rehabilitation could be classified into motivators, barriers, and compliance in treatment or device use. The key motivators to seek care include degree of hearing loss, self-efficacy, family support, and self-recognition of hearing loss. The primary barriers to care were financial limitations, stigma of hearing devices, inconvenience, competing chronic health problems, and unrealistic expectations. Compliance is most affected by self-efficacy, education level, and engagement in the rehabilition process. Conclusion Accessing hearing healthcare is complicated by multiple factors. Considering the current climate in healthcare policy and legislation towards improved access of care, a deeper understanding of motivators, barriers and compliance factors can aid in delivery of effective and efficient hearing healthcare. PMID:27545324

Factors involved in access and utilization of adult hearing healthcare: A systematic review.

PubMed

Barnett, Margaret; Hixon, Brian; Okwiri, Neville; Irungu, Catherine; Ayugi, John; Thompson, Robin; Shinn, Jennifer B; Bush, Matthew L

2017-05-01

Hearing loss is a public health concern, yet hearing healthcare disparities exist and influence utilization of rehabilitation services. The objective of this review was to systematically analyze the published literature on motivators, barriers, and compliance factors affecting adult patient access and utilization of hearing rehabilitation healthcare. Pubmed, PsychINFO, CINAHL, and Web of Science were searched for relevant articles. Eligible studies were those containing original, peer-reviewed research in English pertaining to factors affecting adult hearing healthcare access and utilization of hearing aids and cochlear implantation. The search encompassed 1990 to 2015. Two investigators independently reviewed all articles and extracted data. Specific variables regarding access to care and compliance to recommended care were extracted from each study. Thirty articles were reviewed. The factors affecting access and utilization of hearing rehabilitation could be classified into motivators, barriers, and compliance in treatment or device use. The key motivators to seek care include degree of hearing loss, self-efficacy, family support, and self-recognition of hearing loss. The primary barriers to care were financial limitations, stigma of hearing devices, inconvenience, competing chronic health problems, and unrealistic expectations. Compliance is most affected by self-efficacy, education level, and engagement in the rehabilitation process. Accessing hearing healthcare is complicated by multiple factors. Considering the current climate in healthcare policy and legislation toward improved access of care, a deeper understanding of motivators, barriers, and compliance factors can aid in delivery of effective and efficient hearing healthcare. Laryngoscope, 127:1187-1194, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Brown-Utility Heuristic? The Presence and Contributing Factors of Latino Linked Fate

ERIC Educational Resources Information Center

Sanchez, Gabriel R.; Masuoka, Natalie

2010-01-01

In an electoral system governed by the plurality rule, those groups who wield the greatest amount of power in the United States are those who vote as a cohesive bloc. Although the size of the Latino population is growing, it is unclear whether all Latinos perceive a shared collective identity that will be exercised in the political realm. This…

Effects of women's autonomy on maternal healthcare utilization in Bangladesh: Evidence from a national survey.

PubMed

Haider, Mohammad Rifat; Qureshi, Zaina P; Khan, M Mahmud

2017-12-01

This study aims to construct an index of women's autonomy to analyze its effect on maternal healthcare utilization in Bangladesh. Empirical modeling of the study used instrumental variable (IV) approach to correct for possible endogeneity of women's autonomy variable. Data from the Bangladesh Demographic and Health Survey (BDHS) 2011 was used for the study. Women's autonomy variable was obtained through factor analysis of variables related to autonomy in decision making regarding healthcare, financial autonomy and freedom of movement. Conditional mixed process (CMP) models were fitted for three maternal healthcare indicators: at least four antenatal care (ANC) by trained personnel, institutional delivery and postnatal care (PNC) by trained personnel. Study sample consisted of 8753 women with 5.5 mean years of schooling. Women with no formal education, of Islamic faith, from poorest wealth quintile, residing in rural areas and with low autonomy used the maternal healthcare least. Marginal effect shows that if women's autonomy score is increased by one unit, probability of maternal healthcare utilization will increase by 0.14 for ANC, 0.14 for institutional delivery, and 0.13 for PNC. Women's autonomy is an important driver of maternal healthcare utilization in Bangladesh. Results suggest that women participating in social and economic activities enhances their autonomy. Other factors affecting women's autonomy are female literacy, educational attainment and households' economic status. Copyright © 2017 Elsevier B.V. All rights reserved.

Health insurance coverage and healthcare utilization among homeless young adults in Venice, CA.

PubMed

Winetrobe, H; Rice, E; Rhoades, H; Milburn, N

2016-03-01

Homeless young adults are a vulnerable population with great healthcare needs. Under the Affordable Care Act, homeless young adults are eligible for Medicaid, in some states, including California. This study assesses homeless young adults' health insurance coverage and healthcare utilization prior to Medicaid expansion. All homeless young adults accessing services at a drop-in center in Venice, CA, were invited to complete a self-administered questionnaire; 70% of eligible clients participated (n = 125). Within this majority White, heterosexual, male sample, 70% of homeless young adults did not have health insurance in the prior year, and 39% reported their last healthcare visit was at an emergency room. Past year unmet healthcare needs were reported by 31%, and financial cost was the main reported barrier to receiving care. Multivariable logistic regression found that homeless young adults with health insurance were almost 11 times more likely to report past year healthcare utilization. Health insurance coverage is the sole variable significantly associated with healthcare utilization among homeless young adults, underlining the importance of insurance coverage within this vulnerable population. Service providers can play an important role by assisting homeless young adults with insurance applications and facilitating connections with regular sources of health care. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Predictors of public and private healthcare utilization and associated health system responsiveness among older adults in Ghana

PubMed Central

Awoke, Mamaru Ayenew; Negin, Joel; Moller, Jette; Farell, Penny; Yawson, Alfred E.; Biritwum, Richard Berko; Kowal, Paul

2017-01-01

ABSTRACT Background: Previous studies investigating factors associated with healthcare utilization by older Ghanaians lack distinction between public and private health services. The present study examined factors associated with public and private healthcare service use, and the resulting perceived health system responsiveness. Objectives: To identify factors associated with public and private healthcare utilization among older adults aged 50 and older in Ghana; and to compare perceived differences in health system responsiveness between the private and public sectors. Methods: Cross-sectional data was analyzed from the World Health Organization Study on global AGEing and adult health (SAGE) Wave 1 in Ghana. Using Andersen’s conceptual framework, public and private outpatient care utilization was examined using multinomial logistic regression to estimate and identify predictor variables associated with the type of outpatient healthcare facility accessed. Health system responsiveness was compared using chi-square tests. Results: Of 2517 respondents who used outpatient care in the 12 months preceding interview, 51.7% of respondents used a public facility, 17.8% a private facility, and 30.5% used other facilities. Older age group, higher education and higher wealth were associated with the use of private outpatient healthcare services. Using public outpatient care facilities was associated with having health insurance. Respondents with two or more chronic conditions were more likely to use public and private outpatient care than other facilities. Perceived health system responsiveness was better in private for-profit than in public and private not-for-profit healthcare facilities. Conclusions: This study suggested that higher wealth and multimorbidity were significant predictors of public and private outpatient healthcare utilization; however, health insurance was a predictor only for the use of public facilities. Future mixed-method studies could further elucidate factors influencing the choice of public and private outpatient healthcare use. PMID:28578615

Impact of comorbidity and healthcare utilization on colorectal cancer stage at diagnosis: literature review

PubMed Central

Corkum, Mark; Urquhart, Robin; Burge, Fred; Porter, Geoffrey; Johnston, Grace

2013-01-01

Purpose Individuals diagnosed with cancer close to death have low access to enrollment in palliative care programs. The purpose of this literature review was to assess the usefulness of pre-diagnostic comorbidity and healthcare utilization as indicators of late-stage colorectal cancer (CRC) diagnosis, to help with early identification of individuals who may benefit from palliative care. Methods A literature search was conducted in relevant databases using title/abstract terms which included “cancer,” “stage,” “diagnosis,” “determinants,” “predictors,” and “associated.” Included studies examined whether comorbidity and/or healthcare utilization had an impact on the stage at which CRC was diagnosed. A standardized data abstraction form was used to assess the eligibility of each study. Thirteen articles were included in the literature review. These studies were assessed and synthesized using qualitative methodology. Results We found much heterogeneity among study variables. The findings of this literature review point to the presence of comorbidity and non-emergent healthcare utilization as having no association with late-stage diagnosis. Conversely, emergency room presentation (ERP) was associated with late-stage diagnosis. Conclusions The results of this literature review did not find strong evidence to suggest that comorbidity and healthcare utilization are potential indicators of late-stage diagnosis. However, ERP may be useful as a flag for consideration of prompt referral to palliative care. Additional research is required to identify potential indicators of late-stage diagnosis that may be available in administrative databases, particularly in the area of healthcare utilization. PMID:22101505

Method and system for operating an electric motor

DOEpatents

Gallegos-Lopez, Gabriel; Hiti, Silva; Perisic, Milun

2013-01-22

Methods and systems for operating an electric motor having a plurality of windings with an inverter having a plurality of switches coupled to a voltage source are provided. A first plurality of switching vectors is applied to the plurality of switches. The first plurality of switching vectors includes a first ratio of first magnitude switching vectors to second magnitude switching vectors. A direct current (DC) current associated with the voltage source is monitored during the applying of the first plurality of switching vectors to the plurality of switches. A second ratio of the first magnitude switching vectors to the second magnitude switching vectors is selected based on the monitoring of the DC current associated with the voltage source. A second plurality of switching vectors is applied to the plurality of switches. The second plurality of switching vectors includes the second ratio of the first magnitude switching vectors to the second magnitude switching vectors.

Predicting hospital visits from geo-tagged Internet search logs.

PubMed

Agarwal, Vibhu; Han, Lichy; Madan, Isaac; Saluja, Shaurya; Shidham, Aaditya; Shah, Nigam H

2016-01-01

The steady rise in healthcare costs has deprived over 45 million Americans of healthcare services (1, 2) and has encouraged healthcare providers to look for opportunities to improve their operational efficiency. Prior studies have shown that evidence of healthcare seeking intent in Internet searches correlates well with healthcare resource utilization. Given the ubiquitous nature of mobile Internet search, we hypothesized that analyzing geo-tagged mobile search logs could enable us to machine-learn predictors of future patient visits. Using a de-identified dataset of geo-tagged mobile Internet search logs, we mined text and location patterns that are predictors of healthcare resource utilization and built statistical models that predict the probability of a user's future visit to a medical facility. Our efforts will enable the development of innovative methods for modeling and optimizing the use of healthcare resources-a crucial prerequisite for securing healthcare access for everyone in the days to come.

Program evaluation of remote heart failure monitoring: healthcare utilization analysis in a rural regional medical center.

PubMed

Riley, William T; Keberlein, Pamela; Sorenson, Gigi; Mohler, Sailor; Tye, Blake; Ramirez, A Susana; Carroll, Mark

2015-03-01

Remote monitoring for heart failure (HF) has had mixed and heterogeneous effects across studies, necessitating further evaluation of remote monitoring systems within specific healthcare systems and their patient populations. "Care Beyond Walls and Wires," a wireless remote monitoring program to facilitate patient and care team co-management of HF patients, served by a rural regional medical center, provided the opportunity to evaluate the effects of this program on healthcare utilization. Fifty HF patients admitted to Flagstaff Medical Center (Flagstaff, AZ) participated in the project. Many of these patients lived in underserved and rural communities, including Native American reservations. Enrolled patients received mobile, broadband-enabled remote monitoring devices. A matched cohort was identified for comparison. HF patients enrolled in this program showed substantial and statistically significant reductions in healthcare utilization during the 6 months following enrollment, and these reductions were significantly greater compared with those who declined to participate but not when compared with a matched cohort. The findings from this project indicate that a remote HF monitoring program can be successfully implemented in a rural, underserved area. Reductions in healthcare utilization were observed among program participants, but reductions were also observed among a matched cohort, illustrating the need for rigorous assessment of the effects of HF remote monitoring programs in healthcare systems.

Patient attitudes regarding healthcare utilization and referral: a descriptive comparison in African- and Caucasian Americans with chronic pain.

PubMed Central

Green, Carmen R.; Baker, Tamara A.; Ndao-Brumblay, S. Khady

2004-01-01

The purpose of this study was to evaluate healthcare utilization and referral patterns for pain management services in a racially and ethnically diverse population. A study-specific mail survey was directed at African- (N=324) and Caucasian Americans (N=300) receiving chronic pain treatment at a tertiary care pain center to address their healthcare access, referral, and utilization patterns. Overall, 46% (N=286) responded, with the majority of respondents being Caucasian Americans (57%) and women (68%). The majority (58%) reported asking their physicians to refer them to a pain physician. African Americans were more likely to report that chronic pain was a major reason for financial problems. They made significantly more visits to the emergency room for pain care. African Americans agreed more that ethnicity and culture affected access to healthcare and pain management. They also tended to agree more than Caucasian Americans that pain medication could not control pain. These results demonstrate significant differences in healthcare utilization, access, and attitudes amongst African- and Caucasian Americans receiving chronic pain management. In light of the socioeconomic and health consequences of chronic pain, these results suggest the need for further studies addressing variability in pain care access and utilization in diverse populations. PMID:14746352

Discrete choice experiment to evaluate factors that influence preferences for antibiotic prophylaxis in pediatric oncology.

PubMed

Regier, Dean A; Diorio, Caroline; Ethier, Marie-Chantal; Alli, Amanda; Alexander, Sarah; Boydell, Katherine M; Gassas, Adam; Taylor, Jonathan; Kellow, Charis; Mills, Denise; Sung, Lillian

2012-01-01

Bacterial and fungal infections in pediatric oncology patients cause morbidity and mortality. The clinical utility of antimicrobial prophylaxis in children is uncertain and the personal utility of these agents is disputed. Objectives were to use a discrete choice experiment to: (1) describe the importance of attributes to parents and healthcare providers when deciding between use and non-use of antibacterial and antifungal prophylaxis; and (2) estimate willingness-to-pay for prophylactic strategies. Attributes were chances of infection, death and side effects, route of administration and cost of pharmacotherapy. Respondents were randomized to a discrete choice experiment outlining hypothetical treatment options to prevent antibacterial or antifungal infections. Each respondent was presented 16 choice tasks and was asked to choose between two unlabeled treatment options and an opt-out alternative (no prophylaxis). 102 parents and 60 healthcare providers participated. For the antibacterial discrete choice experiment, frequency of administration was significantly associated with utility for parents but not for healthcare providers. Increasing chances of infection, death, side effects and cost were all significantly associated with decreased utility for parents and healthcare providers in both the antibacterial and antifungal discrete choice experiment. Parental willingness-to-pay was higher than healthcare providers for both strategies. Chances of infection, death, side effects and costs were all significantly associated with utility. Parents have higher willingness-to-pay for these strategies compared with healthcare providers. This knowledge can help to develop prophylaxis programs.

Effects of geodemographic profiles on healthcare service utilization: a case study on cardiac care in Ontario, Canada

PubMed Central

2013-01-01

Background Although literature has associated geodemographic factors with healthcare service utilization, little is known about how these factors — such as population size, age profile, service accessibility, and educational profile — interact to influence service utilization. This study fills this gap in the literature by examining both the direct and the moderating effects of geodemographic profiles on the utilization of cardiac surgery services. Methods We aggregated secondary data obtained from Statistics Canada and Cardiac Care Network of Ontario to derive the geodemographic profiles of Ontario and the corresponding cardiac surgery service utilization in the years between 2004 and 2007. We conducted a two-step test using Partial Least Squares-based structural equation modeling to investigate the relationships between geodemographic profiles and healthcare service utilization. Results Population size and age profile have direct positive effects on service utilization (β=0.737, p<0.01; β=0.284, p<0.01, respectively), whereas service accessibility is negatively associated with service utilization (β=−0.210, p<0.01). Service accessibility decreases the effect of population size on service utilization (β=−0.606, p<0.01), and educational profile weakens the effects of population size and age profile on service utilization (β=−0.595, p<0.01; β=−0.286, p<0.01, respectively). Conclusions In this study, we found that (1) service accessibility has a moderating effect on the relationship between population size and service utilization, and (2) educational profile has moderating effects on both the relationship between population size and service utilization, and the relationship between age profile and service utilization. Our findings suggest that reducing regional disparities in healthcare service utilization should take into account the interaction of geodemographic factors such as service accessibility and education. In addition, the allocation of resources for a particular healthcare service in one area should consider the geographic distribution of the same services in neighboring areas, as patients may be willing to utilize these services in areas not far from where they reside. PMID:23816201

Women with urinary incontinence in Spain: Health-related quality of life and the use of healthcare resources.

PubMed

Villoro, Renata; Merino, María; Hidalgo-Vega, Alvaro; Jiménez, Margarita; Martínez, Lucía; Aracil, Javier

2016-12-01

To describe Health-Related Quality of Life (HRQOL) and healthcare resource utilization in women aged 60 and over in Spain. Descriptive analysis of primary data from the Spanish National Health Survey, 2012. Utility indices were obtained through the EQ5D5L questionnaire included in the survey, and utilization rates of consultations, hospitalizations, emergency services, and medication intake. HRQOL and utilization rates were systematically compared between women diagnosed with UI, women diagnosed with other chronic conditions (OCC) and healthy women of the same age. Utility indices were 0.47 in UI women versus 0.78 and 0.96 in women diagnosed with OCC and healthy women, respectively. Each year 351,675 Quality Adjusted Life Years are lost in Spain due to UI in the population of women aged 60 and over. Resource utilization of these women was significantly higher than that of other women. UI has a larger impact on both HRQOL and healthcare consumption in women who are aged 60 and over, than OCC. Appropriate treatment of UI might entail an important gain in terms of HRQOL and a significant reduction in healthcare consumption in Spain. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Cathode power distribution system and method of using the same for power distribution

DOEpatents

Williamson, Mark A; Wiedmeyer, Stanley G; Koehl, Eugene R; Bailey, James L; Willit, James L; Barnes, Laurel A; Blaskovitz, Robert J

2014-11-11

Embodiments include a cathode power distribution system and/or method of using the same for power distribution. The cathode power distribution system includes a plurality of cathode assemblies. Each cathode assembly of the plurality of cathode assemblies includes a plurality of cathode rods. The system also includes a plurality of bus bars configured to distribute current to each of the plurality of cathode assemblies. The plurality of bus bars include a first bus bar configured to distribute the current to first ends of the plurality of cathode assemblies and a second bus bar configured to distribute the current to second ends of the plurality of cathode assemblies.

Test-Retest Reliability, Agreement and Responsiveness of Productivity Loss (iPCQ-VR) and Healthcare Utilization (TiCP-VR) Questionnaires for Sick Workers with Chronic Musculoskeletal Pain.

PubMed

Beemster, Timo T; van Velzen, Judith M; van Bennekom, Coen A M; Reneman, Michiel F; Frings-Dresen, Monique H W

2018-03-16

The purpose of this study was to assess test-retest reliability, agreement, and responsiveness of questionnaires on productivity loss (iPCQ-VR) and healthcare utilization (TiCP-VR) for sick-listed workers with chronic musculoskeletal pain who were referred to vocational rehabilitation. Methods Test-retest reliability and agreement was assessed with a 2-week interval. Responsiveness was assessed at discharge after a 15-week vocational rehabilitation (VR) program. Data was obtained from six Dutch VR centers. Test-retest reliability was determined with intraclass correlation coefficient (ICC) and Cohen's kappa. Agreement was determined by Standard Error of Measurement (SEM), smallest detectable changes (on group and individual level), and percentage observed, positive and negative agreement. Responsiveness was determined with area under the curve (AUC) obtained from receiver operation characteristic (ROC). Results A sample of 52 participants on test-retest reliability and agreement, and a sample of 223 on responsiveness were included in the analysis. Productivity loss (iPCQ-VR): ICCs ranged from 0.52 to 0.90, kappa ranged from 0.42 to 0.96, and AUC ranged from 0.55 to 0.86. Healthcare utilization (TiCP-VR): ICC was 0.81, and kappa values of the single healthcare utilization items ranged from 0.11 to 1.00. Conclusions The iPCQ-VR showed good measurement properties on working status, number of hours working per week and long-term sick leave, and low measurement properties on short-term sick leave and presenteeism. The TiCP-VR showed adequate reliability on all healthcare utilization items together and medication use, but showed low measurement properties on the single healthcare utilization items.

Water-soluble carbon nanotube compositions for drug delivery and medicinal applications

DOEpatents

Tour, James M.; Lucente-Schultz, Rebecca; Leonard, Ashley; Kosynkin, Dmitry V.; Price, Brandi Katherine; Hudson, Jared L.; Conyers, Jr., Jodie L.; Moore, Valerie C.; Casscells, S. Ward; Myers, Jeffrey N.; Milas, Zvonimir L.; Mason, Kathy A.; Milas, Luka

2014-07-22

Compositions comprising a plurality of functionalized carbon nanotubes and at least one type of payload molecule are provided herein. The compositions are soluble in water and PBS in some embodiments. In certain embodiments, the payload molecules are insoluble in water. Methods are described for making the compositions and administering the compositions. An extended release formulation for paclitaxel utilizing functionalized carbon nanotubes is also described.

Planar fuel cell utilizing nail current collectors for increased active surface area

DOEpatents

George, Thomas J.; Meacham, G. B. Kirby

2002-03-26

A plurality of nail current collector members are useful in the gas flow passages of an electrochemical device to optimize the active surfaces of the device and to provide structural support. In addition, the thicknesses of cathode and anode layers within the electrochemical device are varied according to current flow through the device to reduce resistance and increase operating efficiency.

Planar fuel cell utilizing nail current collectors for increased active surface area

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

George, Thomas J.; Meacham, G.B. Kirby

1999-11-26

A plurality of nail current collector members are useful in the gas flow passages of an electrochemical device to optimize the active surfaces of the device and to provide structural support. In addition, the thicknesses of cathode and anode layers within the electrochemical device are varied according to current flow through the device to reduce resistance and increase operating efficiency.

Solid Lubricants for Space Structures

DTIC Science & Technology

1993-04-17

will utilize mechanically interlocked hardware (caged bearings or bearings for ultra precision gimbals pointing mechanisms) controlled through precision...structure unless the lubricant were of low vapor pressure and/or suitably sealed to I prevent molecular effusion . While temperatures within spacecraft or...incorporation in the continuous cast system. The die made of graphite, consists of a plurality of openings or holes located in the die and positioned (unlined

Lithium battery management system

DOEpatents

Dougherty, Thomas J [Waukesha, WI

2012-05-08

Provided is a system for managing a lithium battery system having a plurality of cells. The battery system comprises a variable-resistance element electrically connected to a cell and located proximate a portion of the cell; and a device for determining, utilizing the variable-resistance element, whether the temperature of the cell has exceeded a predetermined threshold. A method of managing the temperature of a lithium battery system is also included.

Battery system including batteries that have a plurality of positive terminals and a plurality of negative terminals

DOEpatents

Dougherty, Thomas J; Symanski, James S; Kuempers, Joerg A; Miles, Ronald C; Hansen, Scott A; Smith, Nels R; Taghikhani, Majid; Mrotek, Edward N; Andrew, Michael G

2014-01-21

A lithium battery for use in a vehicle includes a container, a plurality of positive terminals extending from a first end of the lithium battery, and a plurality of negative terminals extending from a second end of the lithium battery. The plurality of positive terminals are provided in a first configuration and the plurality of negative terminals are provided in a second configuration, the first configuration differing from the second configuration. A battery system for use in a vehicle may include a plurality of electrically connected lithium cells or batteries.

Hardware efficient monitoring of input/output signals

NASA Technical Reports Server (NTRS)

Driscoll, Kevin R. (Inventor); Hall, Brendan (Inventor); Paulitsch, Michael (Inventor)

2012-01-01

A communication device comprises first and second circuits to implement a plurality of ports via which the communicative device is operable to communicate over a plurality of communication channels. For each of the plurality of ports, the communication device comprises: command hardware that includes a first transmitter to transmit data over a respective one of the plurality of channels and a first receiver to receive data from the respective one of the plurality of channels; and monitor hardware that includes a second receiver coupled to the first transmitter and a third receiver coupled to the respective one of the plurality of channels. The first circuit comprises the command hardware for a first subset of the plurality of ports. The second circuit comprises the monitor hardware for the first subset of the plurality of ports and the command hardware for a second subset of the plurality of ports.

The coordination of plural logics of action and its consequences: Evidence from plural medical systems

PubMed Central

Shim, Jae-Mahn

2017-01-01

Drawing on the theory of social action in organizational and institutional sociology, this paper examines the behavioral consequences of plural logics of action. It addresses the question based on the empirical case of plural medical systems that are composed of both biomedicine and alternative medicine. Applying mixed methods of a cross-national panel data analysis and a content analysis of medical journal articles, it finds that plural systems affect health outcomes negatively when tensions between biomedicine and alternative medicine are unaddressed. In contrast, plural systems produce tangible health benefits when biomedicine and alternative medicine are coordinated through government policies or by health care organizations/professionals. This paper proposes plurality coordination as an important mechanism that modifies the behavioral consequences of plural logics. This proposition contributes to providing theoretical answers to the sociological puzzle that plural logics of action produce inconsistent behavioral consequences. PMID:29253867

System, method and computer-readable medium for locating physical phenomena

DOEpatents

Weseman, Matthew T [Idaho Falls, ID; Rohrbaugh, David T [Idaho Falls, ID; Richardson, John G [Idaho Falls, ID

2008-02-26

A method, system and computer product for detecting the location of a deformation of a structure includes baselining a defined energy transmitting characteristic for each of the plurality of laterally adjacent conductors attached to the structure. Each of the plurality of conductors includes a plurality of segments coupled in series and having an associated unit value representative of the defined energy transmitting characteristic. The plurality of laterally adjacent conductors includes a plurality of identity groups with each identity group including at least one of the plurality of segments from each of the plurality of conductors. Each of the plurality of conductors are monitored for a difference in the defined energy transmitting characteristic when compared with a baseline energy transmitting characteristic for each of the plurality of conductors. When the difference exceeds a threshold value, a location of the deformation along the structure is calculated.

Method of Manufacturing a Light Emitting, Photovoltaic or Other Electronic Apparatus and System

NASA Technical Reports Server (NTRS)

Blanchard, Richard A. (Inventor); Lewandowski, Mark Allan (Inventor); Frazier, Donald Odell (Inventor); Ray, William Johnstone (Inventor); Fuller, Kirk A. (Inventor); Lowenthal, Mark David (Inventor); Shotton, Neil O. (Inventor)

2014-01-01

The present invention provides a method of manufacturing an electronic apparatus, such as a lighting device having light emitting diodes (LEDs) or a power generating device having photovoltaic diodes. The exemplary method includes depositing a first conductive medium within a plurality of channels of a base to form a plurality of first conductors; depositing within the plurality of channels a plurality of semiconductor substrate particles suspended in a carrier medium; forming an ohmic contact between each semiconductor substrate particle and a first conductor; converting the semiconductor substrate particles into a plurality of semiconductor diodes; depositing a second conductive medium to form a plurality of second conductors coupled to the plurality of semiconductor diodes; and depositing or attaching a plurality of lenses suspended in a first polymer over the plurality of diodes. In various embodiments, the depositing, forming, coupling and converting steps are performed by or through a printing process.

Method of manufacturing a light emitting, photovoltaic or other electronic apparatus and system

NASA Technical Reports Server (NTRS)

Fuller, Kirk A. (Inventor); Frazier, Donald Odell (Inventor); Blanchard, Richard A. (Inventor); Lowenthal, Mark D. (Inventor); Lewandowski, Mark Allan (Inventor); Ray, William Johnstone (Inventor); Shotton, Neil O. (Inventor)

2012-01-01

The present invention provides a method of manufacturing an electronic apparatus, such as a lighting device having light emitting diodes (LEDs) or a power generating device having photovoltaic diodes. The exemplary method includes depositing a first conductive medium within a plurality of channels of a base to form a plurality of first conductors; depositing within the plurality of channels a plurality of semiconductor substrate particles suspended in a carrier medium; forming an ohmic contact between each semiconductor substrate particle and a first conductor; converting the semiconductor substrate particles into a plurality of semiconductor diodes; depositing a second conductive medium to form a plurality of second conductors coupled to the plurality of semiconductor diodes; and depositing or attaching a plurality of lenses suspended in a first polymer over the plurality of diodes. In various embodiments, the depositing, forming, coupling and converting steps are performed by or through a printing process.

Local wall heat flux/temperature meter for convective flow and method of utilizing same

DOEpatents

Boyd, Ronald D.; Ekhlassi, Ali; Cofie, Penrose

2004-11-30

According to one embodiment of the invention, a method includes providing a conduit having a fluid flowing therethrough, disposing a plurality of temperature measurement devices inside a wall of the conduit, positioning at least some of the temperature measurement devices proximate an inside surface of the wall of the conduit, positioning at least some of the temperature measurement devices at different radial positions at the same circumferential location within the wall, measuring a plurality of temperatures of the wall with respective ones of the temperature measurement devices to obtain a three-dimensional temperature topology of the wall, determining the temperature dependent thermal conductivity of the conduit, and determining a multi-dimensional thermal characteristic of the inside surface of the wall of the conduit based on extrapolation of the three-dimensional temperature topology and the temperature dependent thermal conductivities.

Fast frequency divider circuit using combinational logic

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

Helinski, Ryan

The various technologies presented herein relate to performing on-chip frequency division of an operating frequency of a ring oscillator (RO). Per the various embodiments herein, a conflict between RO size versus operational frequency can be addressed by dividing the output frequency of the RO to a frequency that can be measured on-chip. A frequency divider circuit (comprising NOR gates and latches, for example) can be utilized in conjunction with the RO on the chip. In an embodiment, the frequency divider circuit can include a pair of latches coupled to the RO to facilitate dividing the oscillating frequency of the ROmore » by 2. In another embodiment, the frequency divider circuit can include four latches (operating in pairs) coupled to the RO to facilitate dividing the oscillating frequency of the RO by 4. A plurality of ROs can be MUXed to the plurality of ROs by a single oscillation-counting circuit.« less

Local wall heat flux/temperature meter for convective flow and method of utilizing same

NASA Technical Reports Server (NTRS)

Cofie, Penrose (Inventor); Ekhlassi, Ali (Inventor); Boyd, Ronald D. (Inventor)

2004-01-01

According to one embodiment of the invention, a method includes providing a conduit having a fluid flowing therethrough, disposing a plurality of temperature measurement devices inside a wall of the conduit, positioning at least some of the temperature measurement devices proximate an inside surface of the wall of the conduit, positioning at least some of the temperature measurement devices at different radial positions at the same circumferential location within the wall, measuring a plurality of temperatures of the wall with respective ones of the temperature measurement devices to obtain a three-dimensional temperature topology of the wall, determining the temperature dependent thermal conductivity of the conduit, and determining a multi-dimensional thermal characteristic of the inside surface of the wall of the conduit based on extrapolation of the three-dimensional temperature topology and the temperature dependent thermal conductivities.

Method for forming permanent magnets with different polarities for use in microelectromechanical devices

DOEpatents

Roesler, Alexander W [Tijeras, NM; Christenson, Todd R [Albuquerque, NM

2007-04-24

Methods are provided for forming a plurality of permanent magnets with two different north-south magnetic pole alignments for use in microelectromechanical (MEM) devices. These methods are based on initially magnetizing the permanent magnets all in the same direction, and then utilizing a combination of heating and a magnetic field to switch the polarity of a portion of the permanent magnets while not switching the remaining permanent magnets. The permanent magnets, in some instances, can all have the same rare-earth composition (e.g. NdFeB) or can be formed of two different rare-earth materials (e.g. NdFeB and SmCo). The methods can be used to form a plurality of permanent magnets side-by-side on or within a substrate with an alternating polarity, or to form a two-dimensional array of permanent magnets in which the polarity of every other row of the array is alternated.

Multichannel optical sensing device

DOEpatents

Selkowitz, S.E.

1985-08-16

A multichannel optical sensing device is disclosed, for measuring the outdoor sky luminance or illuminance or the luminance or illuminance distribution in a room, comprising a plurality of light receptors, an optical shutter matrix including a plurality of liquid crystal optical shutter elements operable by electrical control signals between light transmitting and light stopping conditions, fiber optical elements connected between the receptors and the shutter elements, a microprocessor based programmable control unit for selectively supplying control signals to the optical shutter elements in a programmable sequence, a photodetector including an optical integrating spherical chamber having an input port for receiving the light from the shutter matrix and at least one detector element in the spherical chamber for producing output signals corresponding to the light, and output units for utilizing the output signals including a storage unit having a control connection to the microprocessor based programmable control unit for storing the output signals under the sequence control of the programmable control unit.

Multichannel optical sensing device

DOEpatents

Selkowitz, Stephen E.

1990-01-01

A multichannel optical sensing device is disclosed, for measuring the outr sky luminance or illuminance or the luminance or illuminance distribution in a room, comprising a plurality of light receptors, an optical shutter matrix including a plurality of liquid crystal optical shutter elements operable by electrical control signals between light transmitting and light stopping conditions, fiber optic elements connected between the receptors and the shutter elements, a microprocessor based programmable control unit for selectively supplying control signals to the optical shutter elements in a programmable sequence, a photodetector including an optical integrating spherical chamber having an input port for receiving the light from the shutter matrix and at least one detector element in the spherical chamber for producing output signals corresponding to the light, and output units for utilizing the output signals including a storage unit having a control connection to the microprocessor based programmable control unit for storing the output signals under the sequence control of the programmable control unit.

Method for exponentiating in cryptographic systems

DOEpatents

Brickell, Ernest F.; Gordon, Daniel M.; McCurley, Kevin S.

1994-01-01

An improved cryptographic method utilizing exponentiation is provided which has the advantage of reducing the number of multiplications required to determine the legitimacy of a message or user. The basic method comprises the steps of selecting a key from a preapproved group of integer keys g; exponentiating the key by an integer value e, where e represents a digital signature, to generate a value g.sup.e ; transmitting the value g.sup.e to a remote facility by a communications network; receiving the value g.sup.e at the remote facility; and verifying the digital signature as originating from the legitimate user. The exponentiating step comprises the steps of initializing a plurality of memory locations with a plurality of values g.sup.xi ; computi The United States Government has rights in this invention pursuant to Contract No. DE-AC04-76DP00789 between the Department of Energy and AT&T Company.

Functionalized active-nucleus complex sensor

DOEpatents

Pines, Alexander; Wemmer, David E.; Spence, Megan; Rubin, Seth

2003-11-25

A functionalized active-nucleus complex sensor that selectively associates with one or more target species, and a method for assaying and screening for one or a plurality of target species utilizing one or a plurality of functionalized active-nucleus complexes with at least two of the functionalized active-nucleus complexes having an attraction affinity to different corresponding target species. The functionalized active-nucleus complex has an active-nucleus and a targeting carrier. The method involves functionalizing an active-nucleus, for each functionalized active-nucleus complex, by incorporating the active-nucleus into a macromolucular or molecular complex that is capable of binding one of the target species and then bringing the macromolecular or molecular complexes into contact with the target species and detecting the occurrence of or change in a nuclear magnetic resonance signal from each of the active-nuclei in each of the functionalized active-nucleus complexes.

Methodology and apparatus for diffuse photon imaging

DOEpatents

Feng, S.C.; Zeng, F.; Zhao, H.L.

1997-12-09

Non-invasive near infrared optical medical imaging devices for both hematoma detection in the brain and early tumor detection in the breast is achieved using image reconstruction which allows a mapping of the position dependent contrast diffusive propagation constants, which are related to the optical absorption coefficient and scattering coefficient in the tissue, at near infrared wavelengths. Spatial resolutions in the range of 5 mm for adult brain sizes and breast sizes can be achieved. The image reconstruction utilizes WKB approximation on most probable diffusion paths which has as lowest order approximation the straight line-of-sight between the plurality of sources and the plurality of detectors. The WKB approximation yields a set of linear equations in which the contrast optical absorption coefficients are the unknowns and for which signals can be generated to produce a pixel map of the contrast optical resolution of the scanned tissue. 58 figs.

Methodology and apparatus for diffuse photon mimaging

DOEpatents

Feng, Shechao C.; Zeng, Fanan; Zhao, Hui-Lin

1997-12-09

Non-invasive near infrared optical medical imaging devices for both hematoma detection in the brain and early tumor detection in the breast is achieved using image reconstruction which allows a mapping of the position dependent contrast diffusive propagation constants, which are related to the optical absorption coefficient and scattering coefficient in the tissue, at near infrared wavelengths. Spatial resolutions in the range of 5 mm for adult brain sizes and breast sizes can be achieved. The image reconstruction utilizes WKB approximation on most probable diffusion paths which has as lowest order approximation the straight line-of-sight between the plurality of sources and the plurality of detectors. The WKB approximation yields a set of linear equations in which the contrast optical absorption coefficients are the unknowns and for which signals can be generated to produce a pixel map of the contrast optical resolution of the scanned tissue.

Method for evaluating moisture tensions of soils using spectral data

NASA Technical Reports Server (NTRS)

Peterson, John B. (Inventor)

1982-01-01

A method is disclosed which permits evaluation of soil moisture utilizing remote sensing. Spectral measurements at a plurality of different wavelengths are taken with respect to sample soils and the bidirectional reflectance factor (BRF) measurements produced are submitted to regression analysis for development therefrom of predictable equations calculated for orderly relationships. Soil of unknown reflective and unknown soil moisture tension is thereafter analyzed for bidirectional reflectance and the resulting data utilized to determine the soil moisture tension of the soil as well as providing a prediction as to the bidirectional reflectance of the soil at other moisture tensions.

Women veterans' healthcare delivery preferences and use by military service era: findings from the National Survey of Women Veterans.

PubMed

Washington, Donna L; Bean-Mayberry, Bevanne; Hamilton, Alison B; Cordasco, Kristina M; Yano, Elizabeth M

2013-07-01

The number of women Veterans (WVs) utilizing the Veterans Health Administration (VA) has doubled over the past decade, heightening the importance of understanding their healthcare delivery preferences and utilization patterns. Other studies have identified healthcare issues and behaviors of WVs in specific military service eras (e.g., Vietnam), but delivery preferences and utilization have not been examined within and across eras on a population basis. To identify healthcare delivery preferences and healthcare use of WVs by military service era to inform program design and patient-centeredness. Cross-sectional 2008-2009 survey of a nationally representative sample of 3,611 WVs, weighted to the population. Healthcare delivery preferences measured as importance of selected healthcare features; types of healthcare services and number of visits used; use of VA or non-VA; all by military service era. Military service era differences were present in types of healthcare used, with World War II and Korea era WVs using more specialty care, and Vietnam era-to-present WVs using more women's health and mental health care. Operations Enduring Freedom, Iraqi Freedom, New Dawn (OEF/OIF/OND) WVs made more healthcare visits than WVs of earlier military eras. The greatest healthcare delivery concerns were location convenience for Vietnam and earlier WVs, and cost for Gulf War 1 and OEF/OIF/OND WVs. Co-located gynecology with general healthcare was also rated important by a sizable proportion of WVs from all military service eras. Our findings point to the importance of ensuring access to specialty services closer to home for WVs, which may require technology-supported care. Younger WVs' higher mental health care use reinforces the need for integration and coordination of primary care, reproductive health and mental health care.

Robust low-frequency spread-spectrum navigation system

DOEpatents

Smith, Stephen F [Loudon, TN; Moore, James A [Powell, TN

2012-01-03

Methods and apparatus are described for a navigation system. A process includes providing a plurality of transmitters distributed throughout a desired coverage area; locking the plurality of transmitters to a common timing reference; transmitting a signal from each of the plurality of transmitters. An apparatus includes a plurality of transmitters distributed throughout a desired coverage area; wherein each of the plurality of transmitters comprises a packet generator; and wherein the plurality of transmitters are locked to a common timing reference.

Robust low-frequency spread-spectrum navigation system

DOEpatents

Smith, Stephen F [Loudon, TN; Moore, James A [Powell, TN

2011-01-25

Methods and apparatus are described for a navigation system. A process includes providing a plurality of transmitters distributed throughout a desired coverage area; locking the plurality of transmitters to a common timing reference; transmitting a signal from each of the plurality of transmitters. An apparatus includes a plurality of transmitters distributed throughout a desired coverage area; wherein each of the plurality of transmitters comprises a packet generator; and wherein the plurality of transmitters are locked to a common timing reference.

Robust low-frequency spread-spectrum navigation system

DOEpatents

Smith, Stephen F; Moore, James A

2012-10-30

Methods and apparatus are described for a navigation system. A process includes providing a plurality of transmitters distributed throughout a desired coverage area; locking the plurality of transmitters to a common timing reference; transmitting a signal from each of the plurality of transmitters. An apparatus includes a plurality of transmitters distributed throughout a desired coverage area; wherein each of the plurality of transmitters comprises a packet generator; and wherein the plurality of transmitters are locked to a common timing reference.

Robust low-frequency spread-spectrum navigation system

DOEpatents

Smith, Stephen F [Loudon, TN; Moore, James A [Powell, TN

2009-12-01

Methods and apparatus are described for a navigation system. A process includes providing a plurality of transmitters distributed throughout a desired coverage area; locking the plurality of transmitters to a common timing reference; transmitting a signal from each of the plurality of transmitters. An apparatus includes a plurality of transmitters distributed throughout a desired coverage area; wherein each of the plurality of transmitters comprises a packet generator; and wherein the plurality of transmitters are locked to a common timing reference.

Diagnosable structured logic array

NASA Technical Reports Server (NTRS)

Whitaker, Sterling (Inventor); Miles, Lowell (Inventor); Gambles, Jody (Inventor); Maki, Gary K. (Inventor)

2009-01-01

A diagnosable structured logic array and associated process is provided. A base cell structure is provided comprising a logic unit comprising a plurality of input nodes, a plurality of selection nodes, and an output node, a plurality of switches coupled to the selection nodes, where the switches comprises a plurality of input lines, a selection line and an output line, a memory cell coupled to the output node, and a test address bus and a program control bus coupled to the plurality of input lines and the selection line of the plurality of switches. A state on each of the plurality of input nodes is verifiably loaded and read from the memory cell. A trusted memory block is provided. The associated process is provided for testing and verifying a plurality of truth table inputs of the logic unit.

A descriptive analysis of medical health services utilization of Veterans living in Ontario: a retrospective cohort study using administrative healthcare data.

PubMed

Aiken, Alice B; Mahar, Alyson L; Kurdyak, Paul; Whitehead, Marlo; Groome, Patti A

2016-08-04

Health services utilization by Veterans following release may be different than the general population as the result of occupational conditions, requirements and injuries. This study provides the first longitudinal overview of Canadian Veteran healthcare utilization in the Ontario public health system. This is a retrospective cohort study designed to use Ontario's provincial healthcare data to study the demographics and healthcare utilization of Canadian Armed Forces (CAF) & RCMP Veterans living in Ontario. Veterans were eligible for the study if they released between January 1, 1990 and March 31, 2013. Databases at the Institute for Clinical Evaluative Sciences were linked by a unique identifier to study non-mental health related hospitalizations, emergency department visits, and physician visits. Overall and age-stratified descriptive statistics were calculated in five-year intervals following the date of release. The cohort is comprised of 23, 818 CAF or RCMP Veterans. Following entry into the provincial healthcare system, 82.6 % (95 % CI 82.1-83.1) of Veterans saw their family physician at least once over the first five years following release, 60.7 % (95 % CI 60.0-61.3) saw a non-mental health specialist, 40.8 % (95 % CI 40.2-41.5) went to the emergency department in that same time period and 9.9 % (9.5-10.3) were hospitalized for non-mental health related complaints. Patterns of non-mental health services utilization appeared to be time and service dependant. Stratifying health services utilization by age of the Veteran at entry into the provincial healthcare system revealed significant differences in service use and intensity. This study provides the first description of health services utilization by Veterans, following release from the CAF or RCMP. This work will inform the planning and delivery of support to Veterans in Ontario.

Influence of socioeconomic status, wealth and financial empowerment on gender differences in health and healthcare utilization in later life: evidence from India.

PubMed

Roy, Kakoli; Chaudhuri, Anoshua

2008-05-01

Empirical studies from developed countries observe that women report worse health and higher healthcare utilization than men, but the health disadvantage diminishes with age; gender differences in self-rated health often vanish or are reversed in older ages. Comparable assessments of health during later life from developing countries are limited because of the lack of large-scale surveys that include older women. Our study attempts to address the shortage of developing country studies by examining gender differences in health and healthcare utilization among older adults in India. Both ordered and binary logit specifications were used to assess significant gender differences in subjective and objective health, and healthcare utilization after controlling for demographics, medical conditions, traditional indicators of socioeconomic status like education and income, and additional wealth indicators. The wealth indicators, measured by property ownership and economic independence, are regarded as financially empowering older adults to exercise greater control over their health and well-being. Data are drawn from a nationally representative decennial socioeconomic and health survey of 120,942 Indian households conducted during 1995-1996. The study sample comprises 34,086 older men and women aged >or= 60 years. Our results indicate that older women report worse self-rated health, higher prevalence of disabilities, marginally lower chronic conditions, and lower healthcare utilization than men. The health disadvantage and lower utilization among women cannot be explained by demographics and the differential distribution of medical conditions. While successive controls for education, income, and property ownership narrows the gender gap in both health and healthcare utilization, significant differentials still persist. Upon controlling for economic independence, gender differentials disappear or are reversed, with older women having equal or better health than otherwise similar men. Financial empowerment might confer older women the health advantage reflected in developed societies by enhancing a woman's ability to undertake primary and secondary prevention during the life course.

The Effect of Armed Conflict on the Utilization of Maternal Health Services in Uganda: A Population-based Study.

PubMed

Namasivayam, Amrita; Arcos González, Pedro; Castro Delgado, Rafael; Chi, Primus Che

2017-10-03

Maternal mortality rates can be adversely affected by armed conflict, implying a greater level of vulnerability among women, and is often linked to the lack of or limited access to maternal healthcare during conflict. Previous research in Uganda has shown that armed conflict negatively impacts women's utilization of maternal healthcare services for a multitude of reasons at the individual, health-system and political levels. This study compared aggregated Demographic and Health Surveys data from 13 districts in Northern Uganda, a conflict-affected region, with data from the rest of the country, for the use of maternal healthcare services for the years 1988, 1995, 2000, 2006 and 2011, using statistical analyses and logistic regression. Specific indicators for maternal healthcare utilization included contraceptive use, antenatal care, skilled assistance at birth and institutional delivery. Use of contraception and institutional deliveries among women in Northern Uganda was significantly lower compared to the rest of the country. However, skilled assistance at birth among women in Northern Uganda was significantly higher. The findings in this study show that armed conflict can have a negative impact on aspects of maternal healthcare such as contraceptive use and institutional deliveries; however, other indicators such as skilled assistance at birth were seen to be better among conflict-affected populations. This reiterates the complex nature of armed conflict and the interplay of different factors such as conflict intensity, existing health systems and services, and humanitarian interventions that could influence maternal healthcare utilization. Armed conflict, maternal health utilization, Northern Uganda, contraception, skilled assistance at birth, antenatal care, institutional delivery.

Impact of initiation of asenapine on patterns of utilization and cost of healthcare resources associated with the treatment of bipolar I disorder.

PubMed

Chitnis, Abhishek; Wang, Rosa; Sun, Shawn X; Dixit, Shailja; Tawah, Alie; Boulanger, Luke

2015-01-01

To assess the impact of initiation of asenapine on "real-world" levels of utilization and cost of healthcare services for the treatment of bipolar I disorder (BPD) in the US. Using two large US healthcare claims databases that collectively included commercially insured patients aged < 65 years and Medicare enrollees, this study identified all adults (≥ 18 years) with evidence of BPD who began therapy with asenapine between 2009-2012. The date of the earliest claim for asenapine during this period was deemed the 'index date', and patients without continuous enrollment for the 6-month periods before and after this date were excluded ('pre-index' and 'post-index', respectively). Healthcare claims with a BPD diagnosis, plus psychiatric medications and the costs thereof (2012 dollars) were deemed 'BPD-related'. Differences in BPD-related utilization and cost of healthcare services were compared between the pre- and post-index periods. A total of 1403 patients met all selection criteria; the mean age was 42.8 years and 70.6% were women. Relative to pre-index, significant decreases were noted in post-index use of BPD-related healthcare services, most notably admissions (from 24.0% to 12.3% during the post-index period) and emergency department visits (from 4.6% to 2.6%) (both p < 0.05). While pharmacy costs increased, mean total post-index BPD-related healthcare costs were $979 lower than pre-index ($5002 vs $5981; p < 0.05), primarily due to the decrease in BPD-related admissions. Relative to the 6-month period beforehand, levels of utilization of BPD-related healthcare services and costs decreased during the 6-month period immediately following initiation of asenapine therapy.

Acoustic source for generating an acoustic beam

DOEpatents

Vu, Cung Khac; Sinha, Dipen N.; Pantea, Cristian

2016-05-31

An acoustic source for generating an acoustic beam includes a housing; a plurality of spaced apart piezo-electric layers disposed within the housing; and a non-linear medium filling between the plurality of layers. Each of the plurality of piezoelectric layers is configured to generate an acoustic wave. The non-linear medium and the plurality of piezo-electric material layers have a matching impedance so as to enhance a transmission of the acoustic wave generated by each of plurality of layers through the remaining plurality of layers.

A Study of the Intent to Fully Utilize Electronic Personal Health Records in the Context of Privacy and Trust

ERIC Educational Resources Information Center

Richards, Rhonda J.

2012-01-01

Government initiatives called for electronic health records for each individual healthcare consumer by 2014. The purpose of the initiatives is to provide for the common exchange of clinical information between healthcare consumers, healthcare providers, third-party payers and public healthcare officials. This exchange of healthcare information…

A Bidirectional Study on the Acquisition of Plural Noun Phrase Interpretation in English and Spanish

ERIC Educational Resources Information Center

Ionin, Tania; Montrul, Silvina; Crivos, Monica

2013-01-01

This paper investigates how learners interpret definite plural noun phrases (e.g., "the tigers") and bare (article-less) plural noun phrases (e.g., "tigers") in their second language. Whereas Spanish allows definite plurals to have both generic and specific readings, English requires definite plurals to have specific, nongeneric readings. Generic…

Ethical Diversity and the Role of Conscience in Clinical Medicine

PubMed Central

Genuis, Stephen J.; Lipp, Chris

2013-01-01

In a climate of plurality about the concept of what is “good,” one of the most daunting challenges facing contemporary medicine is the provision of medical care within the mosaic of ethical diversity. Juxtaposed with escalating scientific knowledge and clinical prowess has been the concomitant erosion of unity of thought in medical ethics. With innumerable technologies now available in the armamentarium of healthcare, combined with escalating realities of financial constraints, cultural differences, moral divergence, and ideological divides among stakeholders, medical professionals and their patients are increasingly faced with ethical quandaries when making medical decisions. Amidst the plurality of values, ethical collision arises when the values of individual health professionals are dissonant with the expressed requests of patients, the common practice amongst colleagues, or the directives from regulatory and political authorities. In addition, concern is increasing among some medical practitioners due to mounting attempts by certain groups to curtail freedom of independent conscience—by preventing medical professionals from doing what to them is apparently good, or by compelling practitioners to do what they, in conscience, deem to be evil. This paper and the case study presented will explore issues related to freedom of conscience and consider practical approaches to ethical collision in clinical medicine. PMID:24455248

Biomedical practices from a patient perspective. Experiences of Polish female migrants in Barcelona, Berlin and London.

PubMed

Main, Izabella

2016-08-01

This paper focuses on the diversity in patients' experience of bio-medicine and contrasts it with the normative view characteristic of health professionals. Ethnographic fieldwork among Polish migrant women in London, Barcelona and Berlin included interviews about their experiences with local healthcare and health professionals. Themes drawn from the narratives are differences between the cities in terms of communication between patients and health professionals, respect for patients' choices and dignity, attitudes to pregnancy and birth (different levels of medicalization), and paediatric care. It is argued that patients continuously negotiate among their own views and expectations based on previous experiences and knowledge from personal communication; internet forums and publications; and the offer of medical services in the countries of their settlement. Patients experience pluralism of therapeutic traditions within and outside bio-medicine. In turn, representatives of bio-medicine are rarely aware of other medical practices and beliefs and this leads to various misunderstandings. By highlighting the pluralism of medical practices in European countries and the increasing mobility of patients, this case study has useful implications for medical anthropologists and health professionals in a broader Western context, such as raising sensitivity to different communication strategies and a diversity of curing traditions and expectations.

Low inductance power electronics assembly

DOEpatents

Herron, Nicholas Hayden; Mann, Brooks S.; Korich, Mark D.; Chou, Cindy; Tang, David; Carlson, Douglas S.; Barry, Alan L.

2012-10-02

A power electronics assembly is provided. A first support member includes a first plurality of conductors. A first plurality of power switching devices are coupled to the first support member. A first capacitor is coupled to the first support member. A second support member includes a second plurality of conductors. A second plurality of power switching devices are coupled to the second support member. A second capacitor is coupled to the second support member. The first and second pluralities of conductors, the first and second pluralities of power switching devices, and the first and second capacitors are electrically connected such that the first plurality of power switching devices is connected in parallel with the first capacitor and the second capacitor and the second plurality of power switching devices is connected in parallel with the second capacitor and the first capacitor.

Connecting node and method for constructing a connecting node

NASA Technical Reports Server (NTRS)

Johnson, Christopher J. (Inventor); Raboin, Jasen L. (Inventor); Spexarth, Gary R. (Inventor)

2011-01-01

A connecting node comprises a polyhedral structure comprising a plurality of panels joined together at its side edges to form a spherical approximation, wherein at least one of the plurality of panels comprises a faceted surface being constructed with a passage for integrating with one of a plurality of elements comprising a docking port, a hatch, and a window that is attached to the connecting node. A method for manufacturing a connecting node comprises the steps of providing a plurality of panels, connecting the plurality of panels to form a spherical approximation, wherein each edge of each panel of the plurality is joined to another edge of another panel, and constructing at least one of the plurality of panels to include a passage for integrating at least one of a plurality of elements that may be attached to the connecting node.

Electrodes including a polyphosphazene cyclomatrix, methods of forming the electrodes, and related electrochemical cells

DOEpatents

Gering, Kevin L; Stewart, Frederick F; Wilson, Aaron D; Stone, Mark L

2014-10-28

An electrode comprising a polyphosphazene cyclomatrix and particles within pores of the polyphosphazene cyclomatrix. The polyphosphazene cyclomatrix comprises a plurality of phosphazene compounds and a plurality of cross-linkages. Each phosphazene compound of the plurality of phosphazene compounds comprises a plurality of phosphorus-nitrogen units, and at least one pendant group bonded to each phosphorus atom of the plurality of phosphorus-nitrogen units. Each phosphorus-nitrogen unit is bonded to an adjacent phosphorus-nitrogen unit. Each cross-linkage of the plurality of cross-linkages bonds at least one pendant group of one phosphazene compound of the plurality of phosphazene compounds with the at least one pendant group of another phosphazene compound of the plurality of phosphazene compounds. A method of forming a negative electrode and an electrochemical cell are also described.

Evolutionary Technique for Automated Synthesis of Electronic Circuits

NASA Technical Reports Server (NTRS)

Stoica, Adrian (Inventor); Salazar-Lazaro, Carlos Harold (Inventor)

2003-01-01

A method for evolving a circuit comprising configuring a plurality of transistors using a plurality of reconfigurable switches so that each of the plurality of transistors has a terminal coupled to a terminal of another of the plurality of transistors that is controllable by a single reconfigurable switch. The plurality of reconfigurable switches being controlled in response to a chromosome pattern. The plurality of reconfigurable switches may be controlled using an annealing function. As such, the plurality of reconfigurable switches may be controlled by selecting qualitative values for the plurality of reconfigurable switches in response to the chromosomal pattern, selecting initial quantitative values for the selected qualitative values, and morphing the initial quantitative values. Typically, subsequent quantitative values will be selected more divergent than the initial quantitative values. The morphing process may continue to partially or to completely polarize the quantitative values.

The Impact of Trauma Exposure and Post-Traumatic Stress Disorder on Healthcare Utilization Among Primary Care Patients

PubMed Central

Kartha, Anand; Brower, Victoria; Saitz, Richard; Samet, Jeffrey H.; Keane, Terence M.; Liebschutz, Jane

2009-01-01

Background Trauma exposure and post-traumatic stress disorder (PTSD) increase healthcare utilization in veterans, but their impact on utilization in other populations is uncertain. Objectives To examine the association of trauma exposure and PTSD with healthcare utilization, in civilian primary care patients. Research Design Cross-sectional study. Subjects English speaking patients at an academic, urban primary care clinic. Measures Trauma exposure and current PTSD diagnoses were obtained from the Composite International Diagnostic Interview. Outcomes were nonmental health outpatient and emergency department visits, hospitalizations, and mental health outpatient visits in the prior year from an electronic medical record. Analyses included bivariate unadjusted and multivariable Poisson regressions adjusted for age, gender, income, substance dependence, depression, and comorbidities. Results Among 592 subjects, 80% had ≥1 trauma exposure and 22% had current PTSD. In adjusted regressions, subjects with trauma exposure had more mental health visits [incidence rate ratio (IRR), 3.9; 95% confidence interval (CI), 1.1–14.1] but no other increased utilization. After adjusting for PTSD, this effect of trauma exposure was attenuated (IRR, 3.2; 95% CI, 0.9–11.7). Subjects with PTSD had more hospitalizations (IRR, 2.2; 95% CI, 1.4–3.7), more hospital nights (IRR, 2.6; 95% CI, 1.4–5.0), and more mental health visits (IRR, 2.2; 95% CI, 1.1–4.1) but no increase in outpatient and emergency department visits. Conclusions PTSD is associated with more hospitalizations, longer hospitalizations, and greater mental healthcare utilization in urban primary care patients. Although trauma exposure is independently associated with greater mental healthcare utilization, PTSD mediates a portion of this association. PMID:18362818

Architecture for on-die interconnect

DOEpatents

Khare, Surhud; More, Ankit; Somasekhar, Dinesh; Dunning, David S.

2016-03-15

In an embodiment, an apparatus includes: a plurality of islands configured on a semiconductor die, each of the plurality of islands having a plurality of cores; and a plurality of network switches configured on the semiconductor die and each associated with one of the plurality of islands, where each network switch includes a plurality of output ports, a first set of the output ports are each to couple to the associated network switch of an island via a point-to-point interconnect and a second set of the output ports are each to couple to the associated network switches of a plurality of islands via a point-to-multipoint interconnect. Other embodiments are described and claimed.

The effects of citizenship status on service utilization and general satisfaction with healthcare: a cross-cultural study.

PubMed

Khaled, Salma M; Shockley, Bethany; Abdul Rahim, Hanan F

2017-02-01

To explore the role of citizenship status as a predictor of general satisfaction with healthcare services in Qatar, including potential interaction with utilization and health insurance coverage type. A cross-sectional survey conducted in 2012. A household survey in the State of Qatar in the Arab Gulf. A nationally representative sample of 2750 citizens and noncitizens aged 18 years and older. General satisfaction status with Qatar's healthcare system. Citizenship status, healthcare utilization, health insurance type. Citizens were significantly less likely to be satisfied with Qatar's healthcare system than noncitizens (odds ratio (OR) = 0.30, P < 0.001). The association between private health insurance and overall satisfaction was not significantly different between citizens and noncitizens (P = 0.19). However, the association between utilization of healthcare services and overall satisfaction was moderated by citizenship (P < 0.001). Among citizens, non-users were less likely to be satisfied than recent users (OR = 1.88, P < 0.05), while the opposite pattern was observed among noncitizens (OR = 0.51, P < 0.05). These patterns persisted even after controlling for potential confounders. The study revealed significant population differences in satisfaction between recent users and non-users within citizenship groups. These differences may stem from different expectations with respect to healthcare services. Understanding these expectations may have important policy implications for cross-cultural contexts. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Auto-Routable, Configurable, Daisy Chainable Data Acquisition System

NASA Technical Reports Server (NTRS)

Shuler, Robert L. (Inventor)

2005-01-01

A method and apparatus for an acquisition system includes a plurality of sensor input signal lines. At least one of the plurality of sensor input signal lines operatively connects to at least one of a plurality of amplifier circuits. At least one of the plurality of amplifier circuits operatively connects to at least one of a plurality of filter circuits.

An open system approach to process reengineering in a healthcare operational environment.

PubMed

Czuchry, A J; Yasin, M M; Norris, J

2000-01-01

The objective of this study is to examine the applicability of process reengineering in a healthcare operational environment. The intake process of a mental healthcare service delivery system is analyzed systematically to identify process-related problems. A methodology which utilizes an open system orientation coupled with process reengineering is utilized to overcome operational and patient related problems associated with the pre-reengineered intake process. The systematic redesign of the intake process resulted in performance improvements in terms of cost, quality, service and timing.

Thermoelectric energy converter for generation of electricity from low-grade heat

DOEpatents

Jayadev, T.S.; Benson, D.K.

1980-05-27

A thermoelectric energy conversion device which includes a plurality of thermoelectric elements is described. A hot liquid is supplied to one side of each element and a cold liquid is supplied to the other side of each element. The thermoelectric generator may be utilized to produce power from low-grade heat sources such as ocean thermal gradients, solar ponds, and low-grade geothermal resources. (WHK)

Collective field accelerator

DOEpatents

Luce, John S.

1978-01-01

A collective field accelerator which operates with a vacuum diode and utilizes a grooved cathode and a dielectric anode that operates with a relativistic electron beam with a .nu./.gamma. of .about. 1, and a plurality of dielectric lenses having an axial magnetic field thereabout to focus the collectively accelerated electrons and ions which are ejected from the anode. The anode and lenses operate as unoptimized r-f cavities which modulate and focus the beam.

Method of determining interwell oil field fluid saturation distribution

DOEpatents

Donaldson, Erle C.; Sutterfield, F. Dexter

1981-01-01

A method of determining the oil and brine saturation distribution in an oil field by taking electrical current and potential measurements among a plurality of open-hole wells geometrically distributed throughout the oil field. Poisson's equation is utilized to develop fluid saturation distributions from the electrical current and potential measurement. Both signal generating equipment and chemical means are used to develop current flow among the several open-hole wells.

Social Responsibility and the State's Duty to provide Healthcare: An Islamic Ethico-Legal Perspective.

PubMed

Padela, Aasim I

2017-12-01

The United Nations Educational, Scientific and Cultural Organization's (UNESCO) Declaration on Bioethics and Human Rights asserts that governments are morally obliged to promote health and to provide access to quality healthcare, essential medicines and adequate nutrition and water to all members of society. According to UNESCO, this obligation is grounded in a moral commitment to promoting fundamental human rights and emerges from the principle of social responsibility. Yet in an era of ethical pluralism and contentions over the universality of human rights conventions, the extent to which the UNESCO Declaration can motivate behaviors and policies rests, at least in part, upon accepting the moral arguments it makes. In this essay I reflect on a state's moral obligation to provide healthcare from the perspective of Islamic moral theology and law. I examine how Islamic ethico-legal conceptual analogues for human rights and communal responsibility, ḥuqūq al-'ibād and farḍ al-kifāyah and other related constructs might be used to advance a moral argument for healthcare provision by the state. Moving from theory to application, I next illustrate how notions of human rights and social responsibility were used by Muslim stakeholders to buttress moral arguments to support American healthcare reform. In this way, the paper advance discourses on a universal bioethics and common morality by bringing into view the concordances and discordances between Islamic ethico-legal constructs and moral arguments advanced by transnational health policy advocates. It also provides insight into applied Islamic bioethics by demonstrating how Islamic ethico-legal values might inform the discursive outputs of Muslim organizations. © 2016 John Wiley & Sons Ltd.

Storing files in a parallel computing system based on user or application specification

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

Faibish, Sorin; Bent, John M.; Nick, Jeffrey M.

2016-03-29

Techniques are provided for storing files in a parallel computing system based on a user-specification. A plurality of files generated by a distributed application in a parallel computing system are stored by obtaining a specification from the distributed application indicating how the plurality of files should be stored; and storing one or more of the plurality of files in one or more storage nodes of a multi-tier storage system based on the specification. The plurality of files comprise a plurality of complete files and/or a plurality of sub-files. The specification can optionally be processed by a daemon executing on onemore » or more nodes in a multi-tier storage system. The specification indicates how the plurality of files should be stored, for example, identifying one or more storage nodes where the plurality of files should be stored.« less

Automated cassette-to-cassette substrate handling system

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

Kraus, Joseph Arthur; Boyer, Jeremy James; Mack, Joseph

2014-03-18

An automated cassette-to-cassette substrate handling system includes a cassette storage module for storing a plurality of substrates in cassettes before and after processing. A substrate carrier storage module stores a plurality of substrate carriers. A substrate carrier loading/unloading module loads substrates from the cassette storage module onto the plurality of substrate carriers and unloads substrates from the plurality of substrate carriers to the cassette storage module. A transport mechanism transports the plurality of substrates between the cassette storage module and the plurality of substrate carriers and transports the plurality of substrate carriers between the substrate carrier loading/unloading module and amore » processing chamber. A vision system recognizes recesses in the plurality of substrate carriers corresponding to empty substrate positions in the substrate carrier. A processor receives data from the vision system and instructs the transport mechanism to transport substrates to positions on the substrate carrier in response to the received data.« less

Rapid detection and identification of energetic materials with surface enhanced raman spectrometry (SERS)

DOEpatents

Han, Thomas Yong-Jin; Valdez, Carlos A; Olson, Tammy Y; Kim, Sung Ho; Satcher, Jr., Joe H

2015-04-21

In one embodiment, a system includes a plurality of metal nanoparticles functionalized with a plurality of organic molecules tethered thereto, wherein the plurality of organic molecules preferentially interact with one or more analytes when placed in proximity therewith. According to another embodiment, a method for detecting analytes includes contacting a fluid having one or more analytes of interest therein with a plurality of metal nanoparticles, each metal nanoparticle having a plurality of organic molecules tethered thereto, and detecting Raman scattering from an analyte of interest from the fluid, the analyte interacting with one or more of the plurality of organic molecules. In another embodiment, a method includes chemically modifying a plurality of cyclodextrin molecules at a primary hydroxyl moiety to create a chemical handle, and tethering the plurality of cyclodextrin molecules to a metal nanoparticle using the chemical handle. Other systems and methods for detecting analytes are also described.

Systems and methods for forming microchannel plate (MCP) photodetector assemblies

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

Xia, Lei; Zhao, Huyue; Wagner, Robert G.

A MCP photodetector assembly includes an anode plate including a plurality of electrical traces positioned thereon, a plurality of MCPs and a plurality of grid spacers. The MCPs are positioned between the grid spacers. The grid spacers have a grid spacer shape defining at least one aperture. A plurality of shims are positioned between the grid spacers and the MCPs so as to form a stack positioned on the anode plate. Each of the plurality of shims have a shim shape which is the same as the grid spacer shape such that each of the plurality of shims and eachmore » of the plurality of grid spacers overlap so as to define at least one MCP aperture. At least a portion of the plurality of MCPs are positioned within the MCP aperture. The shims are structured to electrically couple the MCPs to the anode plate.« less

Silicon Carbide High Temperature Anemometer and Method for Assembling the Same

NASA Technical Reports Server (NTRS)

Okojie, Robert S. (Inventor); Fralick, Gustave C. (Inventor); Saad, George J. (Inventor)

2003-01-01

A high temperature anemometer includes a pair of substrates. One of the substrates has a plurality of electrodes on a facing surface, while the other of the substrates has a sensor cavity on a facing surface. A sensor is received in the sensor cavity, wherein the sensor has a plurality of bondpads, and wherein the bond pads contact the plurality of electrodes when the facing surfaces are mated with one another. The anemometer further includes a plurality of plug-in pins, wherein the substrate with the cavity has a plurality of trenches with each one receiving a plurality of plug-in pins. The plurality of plug-in pins contact the plurality of electrodes when the substrates are mated with one another. The sensor cavity is at an end of one of the substrates such that the sensor partially extends from the substrate. The sensor and the substrates are preferably made of silicon carbide.

[Use of migrant's remittances from California on dependent's healthcare in Mexico].

PubMed

González-Block, Miguel Ángel; de la Sierra-de la Vega, Luz Angélica; Vargas-Bustamante, Arturo

2013-01-01

This paper focuses on public and private healthcare utilization among dependents living in Mexico of Mexican migrants in California, analyzing the link between remittances and enrollment in Seguro Popular, a social health insurance plan. We surveyed 1353 migrants who visited the Mexican consulate of Los Angeles in 2010. 53.9% sent remittances; 72.2% of households receiving remittances used a share of remittances for health care and 74.4% of them were covered by Seguro Popular. The annual median with private health care expenditure was USD 825, compared to USD 293 for public providers. The main predictors remittances utilization for healthcare were having a sick dependent, purchase of prescription drugs, experiencing problems paying for health care and time of U.S. residence. Seguro Popular increases healthcare utilization with public providers, which provides an opportunity to reallocate the use of migrant's remittances for health purposes.

The Utility of a Connecting Framework to Facilitate Understanding of and Reduce the Disparities in Hospice Care Experienced by Racial and Ethnic Minorities.

PubMed

Chilton, Janice A; Wong-Kim, Evaon C; Guidry, Jeffrey J; Gor, Beverly J; Jones, Lovell A

2008-10-01

Rapidly changing demographics in the United States and diverse cultural beliefs impact hospice utilization and end-of-life care. Healthcare professionals and clinicians need a connecting framework to understand patients' and their family's perspectives regarding utilization of those services. This framework will assist healthcare workers in providing culturally sensitive and appropriate information to patients nearing the end of life, so that they and their loved ones can make informed decisions for optimal care during this passage of life. Considering the variables in this framework may also help facilitate communication between healthcare professionals and patients and reduce misunderstanding among the surviving family members.

Conceptual plural information is used to guide early parsing decisions: Evidence from garden-path sentences with reciprocal verbs.

PubMed

Patson, Nikole D; Ferreira, Fernanda

2009-05-01

In three eyetracking studies, we investigated the role of conceptual plurality in initial parsing decisions in temporarily ambiguous sentences with reciprocal verbs (e.g., While the lovers kissed the baby played alone). We varied the subject of the first clause using three types of plural noun phrases: conjoined noun phrases (the bride and the groom), plural definite descriptions (the lovers), and numerically quantified noun phrases (the two lovers). We found no evidence for garden-path effects when the subject was conjoined (Ferreira & McClure, 1997), but traditional garden-path effects were found with the other plural noun phrases. In addition, we tested plural anaphors that had a plural antecedent present in the discourse. We found that when the antecedent was conjoined, garden-path effects were absent compared to cases in which the antecedent was a plural definite description. Our results indicate that the parser is sensitive to the conceptual representation of a plural constituent. In particular, it appears that a Complex Reference Object (Moxey et al., 2004) automatically activates a reciprocal reading of a reciprocal verb.

Evaluating the Impact of Integrated Care on Service Utilization in Serious Mental Illness.

PubMed

Waters, Heidi C; Furukawa, Michael F; Jorissen, Shari L

2018-06-14

Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality, and use of high-cost healthcare services including hospitalizations and emergency department visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study assessed whether there was a predictive relationship between integrated healthcare clinic enrollment and inpatient and emergency department utilization for consumers with SMI when controlling for demographic characteristics and disease severity. While findings indicated no statistically significant impact of integrated care clinic enrollment on utilization, the sample had lower levels of utilization than would have been expected. Since policy and payment structures continue to support integrated care models, further research on different programs are encouraged, as each setting and practice pattern is unique.

Comorbidity Prevalence, Healthcare Utilization, and Expenditures of Medicaid Enrolled Adults with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Vohra, Rini; Madhavan, Suresh; Sambamoorthi, Usha

2017-01-01

A retrospective data analysis using 2000-2008 three state Medicaid Analytic eXtract was conducted to examine the prevalence and association of comorbidities (psychiatric and non-psychiatric) with healthcare utilization and expenditures of fee-for-service enrolled adults (22-64 years) with and without autism spectrum disorders (International…

Health, Healthcare Utilization and Psychiatric Disorder in People with Intellectual Disability in Taiwan

ERIC Educational Resources Information Center

Lin, J. D.; Yen, C. F.; Li, C. W.; Wu, J. L.

2005-01-01

The aims of the present study were to examine health characteristics and healthcare utilization in relation to people with intellectual disability (ID) having psychiatric disorders in Taiwan. A cross-sectional study was employed; study subjects were recruited from the National Disability Registration Database. Taiwan, stratified by administrative…

Predictors of Health-Care Utilization Among Children 6–59 Months of Age in Zambézia Province, Mozambique

PubMed Central

Bayham, Mary; Blevins, Meridith; Lopez, Melanie; Olupona, Omo; González-Calvo, Lazaro; Ndatimana, Elisée; Green, Ann F.; Moon, Troy D.

2017-01-01

Globally, approximately 5.9 million children under 5 years of age died in 2015, a reduction of over 50% since 1990. Millennium Development Goal 4 established the goal of reducing child mortality by two-thirds by 2015. Multiple countries have surpassed this goal; however, regional and within-country inequities exist. We sought to study determinants of health-care utilization among children 6–59 months of age with fever, diarrhea, and respiratory symptoms in Zambézia Province, Mozambique. We conducted a population-based cross-sectional survey of female heads of household between April and May 2014. Mobile teams conducted interviews in 262 enumeration areas, with three distinct districts being oversampled for improved precision. Descriptive statistics and logistic regression using Stata 13.1 and R 3.2.2 were used to examine factors associated with health-care utilization. A total of 2,317 children were evaluated in this study. Mothers' median age was 26 years, whereas child median age was 24 months. The proportion of children reporting fever, diarrhea, or respiratory illness in the prior 30 days was 44%, 22%, and 22%, respectively. Health-care utilization varied with 65% seeking health care for fever, compared with 57% for diarrhea and 25% for respiratory illness. In multivariable logistic regression, the characteristics most associated with health-care utilization across illnesses were delivery of last child at a facility, higher maternal education, and household ownership of a radio. The decision or ability to use health care is a multifaceted behavior swayed by societal norms, values, socioeconomics, and perceived need. Recognizing the predictors of a particular population may offer useful information to increase uptake in health-care services. PMID:27821686

Mental health status and healthcare utilization among community dwelling older adults.

PubMed

Adepoju, Omolola; Lin, Szu-Hsuan; Mileski, Michael; Kruse, Clemens Scott; Mask, Andrew

2018-04-27

Shifts in mental health utilization patterns are necessary to allow for meaningful access to care for vulnerable populations. There have been long standing issues in how mental health is provided, which has caused problems in that care being efficacious for those seeking it. To assess the relationship between mental health status and healthcare utilization among adults ≥65 years. A negative binomial regression model was used to assess the relationship between mental health status and healthcare utilization related to office-based physician visits, while a two-part model, consisting of logistic regression and negative binomial regression, was used to separately model emergency visits and inpatient services. The receipt of care in office-based settings were marginally higher for subjects with mental health difficulties. Both probabilities and counts of inpatient hospitalizations were similar across mental health categories. The count of ER visits was similar across mental health categories; however, the probability of having an emergency department visit was marginally higher for older adults who reported mental health difficulties in 2012. These findings are encouraging and lend promise to the recent initiatives on addressing gaps in mental healthcare services.

A systematic literature review of the economic implications of chemotherapy-induced diarrhea and its impact on quality of life.

PubMed

Tarricone, Rosanna; Abu Koush, Dana; Nyanzi-Wakholi, Barbara; Medina-Lara, Antonieta

2016-03-01

Chemotherapy-induced diarrhea (CID) diminishes physical performance, raises anxiety and depression levels, and increases healthcare resource utilization. To understand the impact that CID has on health-related quality of life (HRQoL) and on healthcare resource utilization. Systematic searches were conducted in MEDLINE, EMBASE, DARE, and the NHS EED databases. A total of 22 articles were retrieved for full review (n=17, HRQoL; n=5 healthcare resource utilization). Only 2 studies had assessed HRQoL in patients experiencing CID, while cost studies demonstrated that CID episodes are unnecessarily expensive and can be avoided if diagnosed and treated early. Better management of CID has the potential to reduce overall economic burden and improve patients' HRQoL. Available evidence also relays the need to conduct larger studies that assess HRQoL and consider cost beyond direct medical costs in order to understand the full impact of CID on HRQoL and healthcare resource utilization. Crown Copyright © 2016. Published by Elsevier Ireland Ltd. All rights reserved.

The association between physical activity and healthcare costs in children--results from the GINIplus and LISAplus cohort studies.

PubMed

Idler, Nadja; Teuner, Christina M; Hunger, Matthias; Holle, Rolf; Ortlieb, Sandra; Schulz, Holger; Bauer, Carl-Peter; Hoffmann, Ute; Koletzko, Sibylle; Lehmann, Irina; von Berg, Andrea; Berdel, Dietrich; Hoffmann, Barbara; Schaaf, Beate; Heinrich, Joachim; Wolfenstetter, Silke B

2015-04-29

Physical inactivity in children is an important risk factor for the development of various morbidities and mortality in adulthood, physical activity already has preventive effects during childhood. The objective of this study is to estimate the association between physical activity, healthcare utilization and costs in children. Cross-sectional data of 3356 children aged 9 to 12 years were taken from the 10-year follow-up of the birth cohort studies GINIplus and LISAplus, including information on healthcare utilization and physical activity given by parents via self-administered questionnaires. Using a bottom-up approach, direct costs due to healthcare utilization and indirect costs resulting from parental work absence were estimated for the base year 2007. A two-step regression model compared effects on healthcare utilization and costs for a higher (≥ 7 h/week) versus a lower (<7 h/week) level of moderate-to-vigorous physical activity (MVPA) adjusted for age, gender, BMI, education and income of parents, single parenthood and study region. Recycled predictions estimated adjusted mean costs per child and activity group. The analyses for the association between physical activity, healthcare utilization and costs showed no statistically significant results. Different directions of estimates were noticeable throughout cost components in the first step as well as the second step of the regression model. For higher MVPA (≥ 7 h/week) compared with lower MVPA (< 7 h/week) total direct costs accounted for 392 EUR (95% CI: 342-449 EUR) versus 398 EUR (95% CI: 309-480 EUR) and indirect costs accounted for 138 EUR (95% CI: 124-153 EUR) versus 127 EUR (95% CI: 111-146 EUR). The results indicate that childhood might be too early in life, to detect significant preventive effects of physical activity on healthcare utilization and costs, as diseases attributable to lacking physical activity might first occur later in life. This underpins the importance of clarifying the long-term effects of physical activity as it may strengthen the promotion of physical activity in children from a health economic perspective.

Comparing Healthcare Utilization and Costs Among Medicaid-Insured Patients with Chronic Noncancer Pain with and without Opioid-Induced Constipation: A Retrospective Analysis.

PubMed

Olufade, Tope; Kong, Amanda M; Princic, Nicole; Juneau, Paul; Kulkarni, Rucha; Zhang, Kui; Datto, Catherine

2017-04-01

Constipation is a common adverse effect of opioid use and has been associated with increased healthcare utilization and costs among patients receiving opioids for pain management. To compare the healthcare utilization and costs of Medicaid patients with chronic noncancer pain with and without constipation who were receiving opioids. This retrospective, claims-based study was conducted using data from the Truven Health MarketScan Medicaid Multi-State database. Patients with no evidence of cancer who initiated opioid therapy between January 1, 2009, and June 30, 2013, were eligible for the study. Patients had to have continuous enrollment in the database in the 6 months before and 12 months after opioid initiation, with no evidence of substance abuse or functional or inflammatory bowel disease. Medical and pharmacy claims during the 12 months after opioid initiation were evaluated for a diagnosis of constipation or for prescription or over-the-counter medications indicative of constipation. All-cause healthcare utilization and costs were measured over the same period and were compared between propensity score-matched cohorts of patients with evidence of constipation and patients without constipation. Of the 25,744 patients meeting the study inclusion criteria, 2716 (10.5%) had evidence of constipation. After 1:1 propensity score matching, the 2 cohorts had similar demographic and clinical characteristics (ie, mean age, 47 years; 26%-27% male). During the 12-month follow-up period, healthcare utilization was more frequent among patients with constipation, including inpatient admissions and emergency department visits, than in the matched patients without constipation. The total all-cause mean healthcare costs were substantially higher among the patients with constipation ($28,234; 95% confidence interval [CI], $24,307-$32,160) than in the patients without constipation ($13,709; 95% CI, $12,618-$14,801), with a median cost difference of $4166 per patient ( P <.001). Among Medicaid enrollees who receive opioids for chronic noncancer pain, constipation is associated with increased all-cause healthcare utilization and costs.

Comparing Healthcare Utilization and Costs Among Medicaid-Insured Patients with Chronic Noncancer Pain with and without Opioid-Induced Constipation: A Retrospective Analysis

PubMed Central

Olufade, Tope; Kong, Amanda M.; Princic, Nicole; Juneau, Paul; Kulkarni, Rucha; Zhang, Kui; Datto, Catherine

2017-01-01

Background Constipation is a common adverse effect of opioid use and has been associated with increased healthcare utilization and costs among patients receiving opioids for pain management. Objective To compare the healthcare utilization and costs of Medicaid patients with chronic noncancer pain with and without constipation who were receiving opioids. Methods This retrospective, claims-based study was conducted using data from the Truven Health MarketScan Medicaid Multi-State database. Patients with no evidence of cancer who initiated opioid therapy between January 1, 2009, and June 30, 2013, were eligible for the study. Patients had to have continuous enrollment in the database in the 6 months before and 12 months after opioid initiation, with no evidence of substance abuse or functional or inflammatory bowel disease. Medical and pharmacy claims during the 12 months after opioid initiation were evaluated for a diagnosis of constipation or for prescription or over-the-counter medications indicative of constipation. All-cause healthcare utilization and costs were measured over the same period and were compared between propensity score–matched cohorts of patients with evidence of constipation and patients without constipation. Results Of the 25,744 patients meeting the study inclusion criteria, 2716 (10.5%) had evidence of constipation. After 1:1 propensity score matching, the 2 cohorts had similar demographic and clinical characteristics (ie, mean age, 47 years; 26%–27% male). During the 12-month follow-up period, healthcare utilization was more frequent among patients with constipation, including inpatient admissions and emergency department visits, than in the matched patients without constipation. The total all-cause mean healthcare costs were substantially higher among the patients with constipation ($28,234; 95% confidence interval [CI], $24,307–$32,160) than in the patients without constipation ($13,709; 95% CI, $12,618–$14,801), with a median cost difference of $4166 per patient (P <.001). Conclusion Among Medicaid enrollees who receive opioids for chronic noncancer pain, constipation is associated with increased all-cause healthcare utilization and costs. PMID:28626504

Multi-tube fuel nozzle with mixing features

DOEpatents

Hughes, Michael John

2014-04-22

A system includes a multi-tube fuel nozzle having an inlet plate and a plurality of tubes adjacent the inlet plate. The inlet plate includes a plurality of apertures, and each aperture includes an inlet feature. Each tube of the plurality of tubes is coupled to an aperture of the plurality of apertures. The multi-tube fuel nozzle includes a differential configuration of inlet features among the plurality of tubes.

Nanostructured layers of thermoelectric materials

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

Urban, Jeffrey J.; Lynch, Jared; Coates, Nelson

This disclosure provides systems, methods, and apparatus related to thermoelectric materials. In one aspect, a method includes providing a plurality of nanostructures. The plurality of nanostructures comprise a thermoelectric material, with each nanostructure of the plurality of nanostructures having first ligands disposed on a surface of the nanostructure. The plurality of nanostructures is mixed with a solution containing second ligands and a ligand exchange process occurs in which the first ligands disposed on the plurality of nanostructures are replaced with the second ligands. The plurality of nanostructures is deposited on a substrate to form a layer. The layer is thermallymore » annealed.« less

Artificial Neural Network with Hardware Training and Hardware Refresh

NASA Technical Reports Server (NTRS)

Duong, Tuan A. (Inventor)

2003-01-01

A neural network circuit is provided having a plurality of circuits capable of charge storage. Also provided is a plurality of circuits each coupled to at least one of the plurality of charge storage circuits and constructed to generate an output in accordance with a neuron transfer function. Each of a plurality of circuits is coupled to one of the plurality of neuron transfer function circuits and constructed to generate a derivative of the output. A weight update circuit updates the charge storage circuits based upon output from the plurality of transfer function circuits and output from the plurality of derivative circuits. In preferred embodiments, separate training and validation networks share the same set of charge storage circuits and may operate concurrently. The validation network has a separate transfer function circuits each being coupled to the charge storage circuits so as to replicate the training network s coupling of the plurality of charge storage to the plurality of transfer function circuits. The plurality of transfer function circuits may be constructed each having a transconductance amplifier providing differential currents combined to provide an output in accordance with a transfer function. The derivative circuits may have a circuit constructed to generate a biased differential currents combined so as to provide the derivative of the transfer function.

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review.

PubMed

Jack, Helen E; Arabadjis, Sophia D; Sun, Lucy; Sullivan, Erin E; Phillips, Russell S

2017-03-01

As the US transitions to value-based healthcare, physicians and payers are incentivized to change healthcare delivery to improve quality of care while controlling costs. By assisting with the management of common chronic conditions, community health workers (CHWs) may improve healthcare quality, but physicians and payers who are making choices about care delivery also need to understand their effects on healthcare spending. We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PsycINFO, Embase, and Web of Science from the inception of each database to 22 June 2015. We included US-based studies that evaluated a CHW intervention for patients with at least one chronic health condition and reported cost or healthcare utilization outcomes. We evaluated studies using tools specific to study design. Our search yielded 2,941 studies after removing duplicates. Thirty-four met inclusion and methodological criteria. Sixteen studies (47%) were randomized controlled trials (RCTs). RCTs typically had less positive outcomes than other study designs. Of the 16 RCTs, 12 reported utilization outcomes, of which 5 showed a significant reduction in one or more of ED visits, hospitalizations and/or urgent care visits. Significant reductions reported in ED visits ranged from 23%-51% and in hospitalizations ranged from 21%-50%, and the one significant reduction in urgent care visits was recorded at 60% (p < 0.05 for all). Our results suggest that CHW interventions have variable effects, but some may reduce costs and preventable utilization. These findings suggest that it is possible to achieve reductions in care utilization and cost savings by integrating CHWs into chronic care management. However, variations in cost and utilization outcomes suggest that CHWs alone do not make an intervention successful. The paucity of rigorous studies and heterogeneity of study designs limited conclusions about factors associated with reduced utilization.

The direct and indirect costs of Dravet Syndrome.

PubMed

Whittington, Melanie D; Knupp, Kelly G; Vanderveen, Gina; Kim, Chong; Gammaitoni, Arnold; Campbell, Jonathan D

2018-03-01

The objective of this study was to estimate the annual direct and indirect costs associated with Dravet Syndrome (DS). A survey was electronically administered to the caregivers of patients with DS treated at Children's Hospital Colorado. Survey domains included healthcare utilization of the patient with DS and DS caregiver work productivity and activity impairment. Patient healthcare utilization was measured using modified questions from the National Health Interview Survey; caregiver work productivity and activity impairment were measured using modified questions from the Work Productivity and Activity Impairment questionnaire. Direct costs were calculated by multiplying the caregiver-reported healthcare utilization rates by the mean unit cost for each healthcare utilization category. Indirect costs included lost productivity, income loss, and lost leisure time. The indirect costs were a function of caregiver-reported hours spent caregiving and an hourly unit cost. The survey was emailed to 60 DS caregivers, of which 34 (57% response rate) responded. Direct costs on average were $27,276 (95% interval: $15,757, $41,904) per patient with DS. Hospitalizations ($11,565 a year) and in-home medical care visits ($9894 a year) were substantial cost drivers. Additionally, caregivers reported extensive time spent providing care to an individual with DS. This caregiver time resulted in average annual indirect costs of $81,582 (95% interval: $57,253, $110,151), resulting in an average total annual financial burden of $106,378 (95% interval: $78,894, $137,906). Dravet Syndrome results in substantial healthcare utilization, financial burden, and time commitment. Establishing evidence on the financial burden of DS is essential to understanding the overall impact of DS, identifying potential areas for support needs, and assessing the impact of novel treatments as they become available. Based on the study findings, in-home visits, hospitalizations, and lost productivity and leisure time of caregivers are key domains for DS economic evaluations. Future research should extend these estimates to include the potential additional healthcare utilization of the DS caregiver. Copyright © 2018 Elsevier Inc. All rights reserved.

Examining quality and efficiency of the U.S. healthcare system.

PubMed

Kumar, Sameer; Ghildayal, Neha S; Shah, Ronak N

2011-01-01

The fundamental concern of this research study is to learn the quality and efficiency of U.S. healthcare services. It seeks to examine the impact of quality and efficiency on various stakeholders to achieve the best value for each dollar spent for healthcare. The study aims to offer insights on quality reformation efforts, contemporary healthcare policy and a forthcoming change shaped by the Federal healthcare fiscal policy and to recommend the improvement objective by comparing the U.S. healthcare system with those of other developed nations. The US healthcare system is examined utilizing various data on recent trends in: spending, budgetary implications, economic indicators, i.e., GDP, inflation, wage and population growth. Process maps, cause and effect diagrams and descriptive data statistics are utilized to understand the various drivers that influence the rising healthcare cost. A proposed cause and effect diagram is presented to offer potential solutions, for significant improvement in U.S. healthcare. At present, the US healthcare system is of vital interest to the nation's economy and government policy (spending). The U.S. healthcare system is characterized as the world's most expensive yet least effective compared with other nations. Growing healthcare costs have made millions of citizens vulnerable. Major drivers of the healthcare costs are institutionalized medical practices and reimbursement policies, technology-induced costs and consumer behavior. Reviewing many articles, congressional reports, internet websites and related material, a simplified process map of the US healthcare system is presented. The financial process map is also created to further understand the overall process that connects the stakeholders in the healthcare system. Factors impacting healthcare are presented by a cause and effect diagram to further simplify the complexities of healthcare. This tool can also be used as a guide to improve efficiency by removing the "waste" from the system. Trend analyses are presented that display the crucial relationship between economic growth and healthcare spending. There are many articles and reports published on the US healthcare system. However, very few articles have explored, in a comprehensive manner, the links between the economic indicators and measures of the healthcare system and how to reform this system. As a result of the US healthcare system's complex structure, process map and cause-effect diagrams are utilized to simplify, address and understand. This study linked top-level factors, i.e., the societal, government policies, healthcare system comparison, potential reformation solutions and the enormity of the recent trends by presenting serious issues associated with U.S. healthcare.

Healthcare rationing: issues and implications.

PubMed

Cypher, D P

1997-01-01

What methods, if any, should be used to practice healthcare rationing? This article looks at healthcare rationing in the United States, identifies ethical issues associated with implementing healthcare rationing, and addresses legal implications. The author utilizes sources from published literature and her own experience. Society must recognize that it does not have the resources available to fulfill all healthcare needs of all its members. Resolution will bring conflict and compromise.

The effect of cognitive impairment on mental healthcare costs for individuals with severe psychiatric illness.

PubMed

Mackin, R Scott; Delucchi, Kevin L; Bennett, Robert W; Areán, Patricia A

2011-02-01

This study was conducted to determine the effect of cognitive impairment (CI) on mental healthcare costs for older low-income adults with severe psychiatric illness. Data were collected from 62 ethnically diverse low-income older adults with severe psychiatric illness who were participating in day programming at a large community mental health center. CI was diagnosed by a neuropsychologist utilizing the Mattis Dementia Rating Scale-Second Edition and structured ratings of functional impairment (Clinical Dementia Rating Scale). Mental healthcare costs for 6, 12, and 24-month intervals before cognitive assessments were obtained for each participant. Substance abuse history was evaluated utilizing a structured questionnaire, depression symptom severity was assessed utilizing the Hamilton Depression Rating Scale, and psychiatric diagnoses were obtained through medical chart abstraction. CI was exhibited by 61% of participants and was associated with significantly increased mental healthcare costs during 6, 12, and 24-month intervals. Results of a regression analysis indicated that ethnicity and CI were both significant predictors of log transformed mental healthcare costs over 24 months with CI accounting for 13% of the variance in cost data. CI is a significant factor associated with increased mental healthcare costs in patients with severe psychiatric illness. Identifying targeted interventions to accommodate CI may lead to improving treatment outcomes and reducing the burden of mental healthcare costs for individuals with severe psychiatric illness.

Heat pump apparatus

DOEpatents

Nelson, Paul A.; Horowitz, Jeffrey S.

1983-01-01

A heat pump apparatus including a compact arrangement of individual tubular reactors containing hydride-dehydride beds in opposite end sections, each pair of beds in each reactor being operable by sequential and coordinated treatment with a plurality of heat transfer fluids in a plurality of processing stages, and first and second valves located adjacent the reactor end sections with rotatable members having multiple ports and associated portions for separating the hydride beds at each of the end sections into groups and for simultaneously directing a plurality of heat transfer fluids to the different groups. As heat is being generated by a group of beds, others are being regenerated so that heat is continuously available for space heating. As each of the processing stages is completed for a hydride bed or group of beds, each valve member is rotated causing the heat transfer fluid for the heat processing stage to be directed to that bed or group of beds. Each of the end sections are arranged to form a closed perimeter and the valve member may be rotated repeatedly about the perimeter to provide a continuous operation. Both valves are driven by a common motor to provide a coordinated treatment of beds in the same reactors. The heat pump apparatus is particularly suitable for the utilization of thermal energy supplied by solar collectors and concentrators but may be used with any source of heat, including a source of low-grade heat.

Maternal depressive symptoms and healthcare expenditures for publicly insured children with chronic health conditions.

PubMed

Brooks, Jada L; Beil, Heather; Beeber, Linda S

2015-04-01

This study estimated the prevalence of maternal depressive symptoms and tested associations between maternal depressive symptoms and healthcare utilization and expenditures among United States publicly insured children with chronic health conditions (CCHC). A total of 6,060 publicly insured CCHC from the 2004-2009 Medical Expenditure Panel Surveys were analyzed using negative binomial models to compare healthcare utilization for CCHC of mothers with and without depressive symptoms. Annual healthcare expenditures for both groups were compared using a two-part model with a logistic regression and generalized linear model. The prevalence of depressive symptoms among mothers with CCHC was 19 %. There were no differences in annual healthcare utilization for CCHC of mothers with and without depressive symptoms. Maternal depressive symptoms were associated with greater odds of ED expenditures [odds ratio (OR) 1.26; 95 % CI 1.03-1.54] and lesser odds of dental expenditures (OR 0.81; 95 % CI 0.66-0.98) and total expenditures (OR 0.71; 95 % CI 0.51-0.98). Children of symptomatic mothers had lower predicted outpatient expenditures and higher predicted expenditures for total health, prescription medications, dental care; and office based, inpatient and ED visits. Mothers with CCHC were more likely to report depressive symptoms than were mothers with children without chronic health conditions. There were few differences in annual healthcare utilization and expenditures between CCHC of mothers with and without depressive symptoms. However, having a mother with depressive symptoms was associated with higher ED expenditures and higher predicted healthcare expenditures in a population of children who comprise over three-fourths of the top decile of Medicaid spending.

Health care service utilization among patients with bladder pain syndrome/interstitial cystitis in a single payer healthcare system.

PubMed

Chung, Shiu-Dong; Liu, Shih-Ping; Li, Hsien-Chang; Lin, Herng-Ching

2014-01-01

This study aims to investigate the differences in the utilization of healthcare services between patients with bladder pain syndrome/interstitial cystitis (BPS/IC) and patients without using a population-based database in Taiwan. This study comprised of 350 patients with BPS/IC and 1,750 age-matched controls. Healthcare resource utilization was evaluated in the one-year follow-up period as follows: number of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatment. A multivariate regression analysis was used to evaluate the relationship between BPS/IC and total costs of health care services. For urological services, patients with BPS/IC had a significantly higher number of outpatient visits (2.5 vs. 0.2, p<0.001) as well as significantly higher outpatient costs ($US166 vs. $US6.8, p<0.001) than the controls. For non-urologic services, patients with BPS/IC had a significantly high number of outpatient visits (35.0 vs. 21.3, p<0.001) as well as significantly higher outpatient cots ($US912 vs. $US675, p<0.001) as compared to the controls. Overall, patients with BPS/IC had 174% more outpatient visits and 150% higher total costs than the controls. Multiple-regression-analyses also showed that the patients with BPS/IC had significantly higher total costs for all healthcare services than the controls. This study found that patients with BPS/IC have a significantly higher number of healthcare related visits, and have significantly higher healthcare related costs than age-matched controls. The high level of healthcare services utilization accrued with BPS/IC was not necessarily exclusive for BPS/IC, but may have also been associated with medical co-morbidities.

The clinical utility of health-related quality of life screening in a pediatric inflammatory bowel disease clinic.

PubMed

Ryan, Jamie L; Mellon, Michael W; Junger, Katherine W F; Hente, Elizabeth A; Denson, Lee A; Saeed, Shehzad A; Hommel, Kevin A

2013-11-01

Adjusting to symptom flares, treatment regimens, and side effects places youth with inflammatory bowel disease (IBD) at increased risk for emotional and behavioral problems and adverse disease outcomes. Implementation of psychosocial screening into clinical practice remains a challenge. This study examines the clinical utility of health-related quality of life (HRQOL) screening in predicting disease outcome and healthcare utilization. One hundred twelve youth of 7 to 18 years diagnosed with IBD and their parents. Youth completed standardized measures of HRQOL and depression. Parents completed a proxy report of HRQOL. Pediatric gastroenterologists provided the Physician Global Assessment. Families were recruited from a pediatric gastroenterology clinic. Retrospective chart reviews examined disease outcome and healthcare utilization for 12 months after baseline measurement. Linear regressions, controlling for demographic and disease parameters, revealed that baseline measurement of youth and parent proxy-reported HRQOL predicted the number of IBD-related hospital admissions, gastroenterology clinic visits, emergency department visits, psychology clinic visits, telephone contacts, and pain management referrals over the next 12 months. Disease outcome was not significant. Lower HRQOL was predictive of increased healthcare utilization among youth with IBD. Regular HRQOL screening may be the impetus to providing better case management and allocating resources based on ongoing care needs and costs. Proactive interventions focused on patients with poor HRQOL may be an efficient approach to saving on healthcare costs and resource utilization.

Navigating the health-care system in community: Perspectives from Asian immigrant parents of children with special health-care needs.

PubMed

Son, Esther; Moring, Nechama Sammet; Igdalsky, Leah; Parish, Susan L

2018-06-01

Children with special health-care needs (CSHCNs) face notable barriers to health-care access and to receiving quality and family-centered care, despite higher health-care utilization rates. Within the population of CSHCNs, there are significant inequities in health-care quality impacting immigrants who have migrated to the United States. However, little is known about the experiences and needs of Asian immigrant families who have CSHCNs. This study aimed to explore how Asian immigrant parents of CSHCNs view their child's health-care access, quality, and utilization. We conducted semi-structured qualitative interviews with 22 Vietnamese- and Cantonese-speaking parents of CSHCNs. Participants were recruited through community partners. Interviews were transcribed, translated, and coded using content analysis. Participants were generally satisfied with their children's care and had strong relationships with their primary care doctors who were often culturally 'matched'. However, participants experienced several important and culturally specific barriers, including gaps in their understanding of the health-care system, language barriers, and a sense of alienation. Parents frequently turned to informal and community supports for assistance in navigating the US health-care system. Further research to understand the drivers of health disparities and policy level solutions is warranted.

Direct-to-digital holography reduction of reference hologram noise and fourier space smearing

DOEpatents

Voelkl, Edgar

2006-06-27

Systems and methods are described for reduction of reference hologram noise and reduction of Fourier space smearing, especially in the context of direct-to-digital holography (off-axis interferometry). A method of reducing reference hologram noise includes: recording a plurality of reference holograms; processing the plurality of reference holograms into a corresponding plurality of reference image waves; and transforming the corresponding plurality of reference image waves into a reduced noise reference image wave. A method of reducing smearing in Fourier space includes: recording a plurality of reference holograms; processing the plurality of reference holograms into a corresponding plurality of reference complex image waves; transforming the corresponding plurality of reference image waves into a reduced noise reference complex image wave; recording a hologram of an object; processing the hologram of the object into an object complex image wave; and dividing the complex image wave of the object by the reduced noise reference complex image wave to obtain a reduced smearing object complex image wave.

Apparatus and method for determining microscale interactions based on compressive sensors such as crystal structures

DOEpatents

McAdams, Harley; AlQuraishi, Mohammed

2015-04-21

Techniques for determining values for a metric of microscale interactions include determining a mesoscale metric for a plurality of mesoscale interaction types, wherein a value of the mesoscale metric for each mesoscale interaction type is based on a corresponding function of values of the microscale metric for the plurality of the microscale interaction types. A plurality of observations that indicate the values of the mesoscale metric are determined for the plurality of mesoscale interaction types. Values of the microscale metric are determined for the plurality of microscale interaction types based on the plurality of observations and the corresponding functions and compressed sensing.

Dynamic pluralism: A pluralist framework for science

NASA Astrophysics Data System (ADS)

Ferret, Juan

The problem of measurement in quantum physics is one of the most recalcitrant problems of science. Part of the problem lies in the fact that several conflicting interpretations that account for how measurement takes place have endured. Most theorists of science assume that one of the available interpretations, or a future variation of one, will prove to be the true interpretation. What I argue in this dissertation is that the proper response to this problem may be to have a framework in which different relevant interpretations can coexist and offer critical examinations of the conceptual issues related to the problem of measurement. This pluralism of interpretations is not the result of some flaw or inadequacy in quantum physics. From this alternative framework, pluralism in the problem of measurement can be understood as an acceptable, even necessary, response to the process of theorizing and experimentation in quantum mechanics. An important claim in this dissertation is that contemporary versions of pluralism in philosophy of science do not provide an account that recognizes the viability of all the interpretations of the problem of measurement. After showing how these versions of pluralism in philosophy of science fall short, as they apply to the problem of measurement, I argue for several conditions that a pluralism needs to satisfy in order to serve as a pluralistic framework for the evaluation of all interpretations of the problem of measurement. I develop an alternative version of pluralism that does account for the existing and future plurality of interpretations of the problem of measurement. My proposal is that a version of pluralism based on the work of William James and Paul Feyerabend will meet these conditions. Specifically, after introducing the complex pluralism of James as a version of pluralism that comes close to accounting for the multiplicity of interpretations of the problem of measurement, I argue that his version of pluralism does not fulfill a few of the necessary conditions. Next, I use the work on pluralism of Feyerabend to fill in the lacunas left in James's account. Finally, I show how the emerging pluralist framework, what I term dynamic pluralism, satisfies the conditions for a pluralism that can serve as a framework for understanding all of the possible interpretations of the problem of measurement.

Methods and apparatus for rotor load control in wind turbines

DOEpatents

Moroz, Emilian Mieczyslaw

2006-08-22

A wind turbine having a rotor, at least one rotor blade, and a plurality of generators, of which a first generator is configured to provide power to an electric grid and a second generator is configured to provide power to the wind turbine during times of grid loss. The wind turbine is configured to utilize power provided by the second generator to reduce loads on the wind turbine during times of grid loss.

Multiple-image oscilloscope camera

DOEpatents

Yasillo, Nicholas J.

1978-01-01

An optical device for placing automatically a plurality of images at selected locations on one film comprises a stepping motor coupled to a rotating mirror and lens. A mechanical connection from the mirror controls an electronic logical system to allow rotation of the mirror to place a focused image at the desired preselected location. The device is of especial utility when used to place four images on a single film to record oscilloscope views obtained in gamma radiography.

Changes in Healthcare Utilization After Etanercept Initiation in Patients with Rheumatoid Arthritis: A Retrospective Claims Analysis.

PubMed

Accortt, Neil A; Schenfeld, Jennifer; Chang, Eunice; Papoyan, Elya; Broder, Michael S

2017-09-01

Effective treatment for rheumatoid arthritis (RA) may lead to lower overall and RA-related healthcare utilization. We evaluated healthcare utilization before and after initiation of the tumor necrosis factor inhibitor etanercept in patients with moderate to severe RA. This retrospective cohort study used data from the MarketScan ® claims database. Data from adult patients with RA newly exposed to etanercept between January 1, 2010 and December 31, 2013 were analyzed. Patients had at least one inpatient or outpatient claim for RA and at least one claim for etanercept (first claim was index date). Etanercept compliance was determined on the basis of proportion of days covered (PDC). Primary outcome was change in overall and RA-related healthcare utilization in the year before and year after etanercept initiation. McNemar's test and paired t test, respectively, were used to determine statistical significance for dichotomous and continuous variables. Data from 6737 patients were analyzed; mean age was 49.8 years and 77.3% were female. Overall outpatient services, office visits, outpatient hospital services, laboratory visits, and emergency department visits were significantly lower in the post-index period compared to pre-index. RA-related pharmacotherapy use (oral corticosteroids, opioid analgesics, nonsteroidal anti-inflammatory drugs, and nonbiologic disease-modifying antirheumatic drugs) was significantly lower in the post-index period compared to pre-index. Rates of RA-related total joint arthroplasty, joint reconstructions, and soft tissue procedures were similar in pre-index and post-index periods. High etanercept compliance (PDC ≥80%) was associated with significantly lower rates of RA-related outpatient services, office visits, diagnostic imaging studies, and joint reconstructions compared with noncompliance. Overall healthcare utilization decreased after etanercept initiation. Patients who were most compliant with etanercept had significantly lower utilization than less compliant patients. Amgen, Inc.

Diabetes knowledge and utilization of healthcare services among patients with type 2 diabetes mellitus in Dhaka, Bangladesh.

PubMed

Siddique, Md Kaoser Bin; Islam, Sheikh Mohammed Shariful; Banik, Palash Chandra; Rawal, Lal B

2017-08-22

Diabetes is a significant global public health concern. Poor knowledge of disease and healthcare utilization is associated with worse health outcomes, leading to increasing burden of diabetes in many developing countries. This study aimed to determine diabetes related knowledge and factors affecting utilization of healthcare services among patients with type 2 diabetes mellitus in Bangladesh. This analytical study was conducted among 318 patients with type 2 diabetes (T2DM) attending two large tertiary hospitals in Dhaka, Bangladesh between August 2014 and January 2015. Interviewer assisted semi-structured survey questionnaire was used to collect data on diabetes knowledge (measured by a validated Likert scale) and self-reported utilization of service for diabetes. Univariate and bivariate analyses were conducted to determine the factors associated with diabetes knowledge and healthcare utilization. The mean (±SD) age of participants was 52 (±10) years. Majority of the participants were females (58%) and urban residents (74%). Almost two-third (66%) of the participants had an average level of knowledge of T2DM. One-fifth (21%) of the participants had poor knowledge which was significantly associated with gender (P < 0.002), education (P < 0 .001) and income (P < 0.001). The median travel and waiting time at the facility was 30 and 45 min respectively. More than one-third (37%) of the participants checked their blood glucose monthly. Most patients were satisfied regarding the family (55%) and hospital (67%) support. T2DM patients had average knowledge of diabetes which might affect the utilization of healthcare services for diabetes management. Innovations in increasing diabetes knowledge and health behavior change are recommended specially for females, those with lower education and less income.

Utilization of Antenatal HealthCare Services among Fishermen Population in Kanchipuram District, Tamil Nadu: A Cross-sectional Study.

PubMed

Danasekaran, Raja; Raja, Pavithra; Ranganathan, Karnaboopathy

2017-01-01

Considering the global and national level commitments in improving the maternal health as well as reducing the maternal mortality, assessment of factors influencing the delivery of antenatal healthcare services becomes essential. The aim is to assess the utilization of antenatal health services and to identify the factors influencing their utilization among women of fishermen population in Kanchipuram district, Tamil Nadu. The cross-sectional study was carried out among the mothers in Kovalam area of Kanchipuram district. Details were collected using a pretested questionnaire and analyzed using statistical software. The study included 284 mothers, of which 35% were illiterates. Nearly 60.21% have got registered with the Government sector, 59.51% of the mothers had three or more antenatal visits, 64.08% have received two doses of tetanus toxoid, and 73.24% have taken iron and folic acid tablets. Factors which were identified to have statistically significant association with better utilization of antenatal health services were age >30 years, higher educational status, skilled workers, those having their first child, and higher socioeconomic class. This study has reported the fact that antenatal healthcare services were not utilized fully by the community and the fishermen population being a special group has to be given the needed attention from the healthcare delivery system.

Impact of socioeconomic status and medical conditions on health and healthcare utilization among aging Ghanaians.

PubMed

Saeed, Bashiru Ii; Xicang, Zhao; Yawson, Alfred Edwin; Nguah, Samuel Blay; Nsowah-Nuamah, Nicholas N N

2015-03-20

This study attempts to examine the impact of socioeconomic and medical conditions in health and healthcare utilization among older adults in Ghana. Five separate models with varying input variables were estimated for each response variable. Data (Wave 1 data) were drawn from the World Health Organization Global Ageing and Adult Health (SAGE) conducted during 2007-2008 and included a total of 4770 respondents aged 50+ and 803 aged 18-49 in Ghana. Ordered logits was estimated for self-rated health, and binary logits for functional limitation and healthcare utilization. Our results show that the study provides enough grounds for further research on the interplay between socioeconomic and medical conditions on one hand and the health of the aged on the other. Controlling for socioeconomic status substantially contributes significantly to utilization. Also, aged women experience worse health than men, as shown by functioning assessment, self-rated health, chronic conditions and functional limitations. Women have higher rates of healthcare utilization, as shown by significantly higher rates of hospitalization and outpatient encounters. Expansion of the national health insurance scheme to cover the entire older population--for those in both formal and informal employments--is likely to garner increased access and improved health states for the older population.

Capillary electrophoresis systems and methods

DOEpatents

Dorairaj, Rathissh [Hillsboro, OR; Keynton, Robert S [Louisville, KY; Roussel, Thomas J [Louisville, KY; Crain, Mark M [Georgetown, IN; Jackson, Douglas J [New Albany, IN; Walsh, Kevin M [Louisville, KY; Naber, John F [Goshen, KY; Baldwin, Richard P [Louisville, KY; Franco, Danielle B [Mount Washington, KY

2011-08-02

An embodiment of the invention is directed to a capillary electrophoresis apparatus comprising a plurality of separation micro-channels. A sample loading channel communicates with each of the plurality of separation channels. A driver circuit comprising a plurality of electrodes is configured to induce an electric field across each of the plurality of separation channels sufficient to cause analytes in the samples to migrate along each of the channels. The system further comprises a plurality of detectors configured to detect the analytes.

Factors influencing healthcare utilization among children with pneumonia in Muntinlupa City, the Philippines.

PubMed

Kim, Soon Ae; Capeding, Maria Rosario Z; Kilgore, Paul E

2014-05-01

We evaluated the factors influencing healthcare utilization among children aged < 5 years with pneumonia symptoms in Muntinlupa City, the Philippines. We interviewed 1,330 caregivers from 190 households per district in seven districts from March to April, 2009 using a standardized questionnaire to obtain information about demographic characteristics, access to healthcare facilities, and potential barriers to healthcare utilization. The mean age of the children was 32 months; 54.7% were boys. Seventy-four point three percents (n = 972) of caregivers stated when their child had pneumonia symptoms they brought them to a government health center, 14.1% (n = 184) went to a private clinic, 8.0% (n = 104) went to a hospital, 3% (n = 40) were treated at home and 0.5% (n = 7) received traditional medicine from a local healer. Caregivers required an average of 12 minutes to reach a healthcare facility. Reasons given by caregivers for their choice of healthcare facility were low cost (47.5%), availability and accessibility to transportation (29.6%) and perceived good quality of care (16.5%). In conclusion, nearly three quarters of caregivers interviewed brought their child with pneumonia symptoms to a government health center for treatment. Cost was the main factor influencing choice, followed by transportation availability and quality of care.

Impact of Atrial Fibrillation on Healthcare Utilization in the Community: The Atherosclerosis Risk in Communities Study

PubMed Central

Bengtson, Lindsay G. S.; Lutsey, Pamela L.; Loehr, Laura R.; Kucharska‐Newton, Anna; Chen, Lin Y.; Chamberlain, Alanna M.; Wruck, Lisa M.; Duval, Sue; Stearns, Sally C.; Alonso, Alvaro

2014-01-01

Background Atrial fibrillation (AF) is associated with increased risk of hospitalization. Little is known about the impact of AF on utilization of noninpatient health care or about sex or race differences in AF‐related utilization. We examined rates of inpatient and outpatient utilization by AF status in the Atherosclerosis Risk in Communities study. Methods and Results Participants with incident AF enrolled in fee‐for‐service Medicare for at least 12 continuous months between 1991 and 2009 (n=932) were matched on age, sex, race and field center with up to 3 participants without AF (n=2729). Healthcare utilization was ascertained from Medicare claims and classified by primary International Classification of Diseases, ninth revision code. The average annual numbers of days hospitalized were 13.2 (95% CI 11.6 to 15.0) and 2.8 (95% CI 2.5 to 3.1) for those with and without AF, respectively. The corresponding numbers of annual outpatient claims were 53.3 (95% CI 50.5 to 56.3) and 22.9 (95% CI 22.1 to 23.8) for those with and without AF, respectively. Most utilization among AF patients was attributable to non‐AF conditions. The adjusted rate ratio for annual days hospitalized for other cardiovascular disease–related reasons was 4.58 (95% CI: 3.41 to 6.16) for those with AF versus those without AF. The association between AF and healthcare utilization was similar among men and women and among white and black participants. Conclusions Participants with AF had considerably greater healthcare utilization, and the difference in utilization for other cardiovascular disease–related reasons was substantial. In addition to rate or rhythm treatment, AF management should focus on the accompanying cardiovascular comorbidities. PMID:25359400

Hot gas path component cooling system

DOEpatents

Lacy, Benjamin Paul; Bunker, Ronald Scott; Itzel, Gary Michael

2014-02-18

A cooling system for a hot gas path component is disclosed. The cooling system may include a component layer and a cover layer. The component layer may include a first inner surface and a second outer surface. The second outer surface may define a plurality of channels. The component layer may further define a plurality of passages extending generally between the first inner surface and the second outer surface. Each of the plurality of channels may be fluidly connected to at least one of the plurality of passages. The cover layer may be situated adjacent the second outer surface of the component layer. The plurality of passages may be configured to flow a cooling medium to the plurality of channels and provide impingement cooling to the cover layer. The plurality of channels may be configured to flow cooling medium therethrough, cooling the cover layer.

Knowledge Management Implementation and the Tools Utilized in Healthcare for Evidence-Based Decision Making: A Systematic Review.

PubMed

Shahmoradi, Leila; Safadari, Reza; Jimma, Worku

2017-09-01

Healthcare is a knowledge driven process and thus knowledge management and the tools to manage knowledge in healthcare sector are gaining attention. The aim of this systematic review is to investigate knowledge management implementation and knowledge management tools used in healthcare for informed decision making. Three databases, two journals websites and Google Scholar were used as sources for the review. The key terms used to search relevant articles include: "Healthcare and Knowledge Management"; "Knowledge Management Tools in Healthcare" and "Community of Practices in healthcare". It was found that utilization of knowledge management in healthcare is encouraging. There exist numbers of opportunities for knowledge management implementation, though there are some barriers as well. Some of the opportunities that can transform healthcare are advances in health information and communication technology, clinical decision support systems, electronic health record systems, communities of practice and advanced care planning. Providing the right knowledge at the right time, i.e., at the point of decision making by implementing knowledge management in healthcare is paramount. To do so, it is very important to use appropriate tools for knowledge management and user-friendly system because it can significantly improve the quality and safety of care provided for patients both at hospital and home settings.

Recent Social Movements and Theories of Power in America.

ERIC Educational Resources Information Center

McFarland, Andrew S.

A number of propositions about power in America--taken from the work of Olson, Lowi, McConnell, Schattschneider, and Edelman--are presented and discussed. These propositions comprise an alternative theory to pluralism, which is termed "plural elitism." But neither pluralism nor plural elitism explains the emergence and effects of the…

Evidence in Support of a Scalar Implicature Account of Plurality

ERIC Educational Resources Information Center

Patson, Nikole D.

2016-01-01

There is increasing evidence that the plural is semantically unmarked for number such that a plural can be interpreted as meaning "at least one." The 2 experiments reported here used a picture matching paradigm to investigate the conceptual representations built during the comprehension of sentences with plural definite descriptions…

Reflective echo tomographic imaging using acoustic beams

DOEpatents

Kisner, Roger; Santos-Villalobos, Hector J

2014-11-25

An inspection system includes a plurality of acoustic beamformers, where each of the plurality of acoustic beamformers including a plurality of acoustic transmitter elements. The system also includes at least one controller configured for causing each of the plurality of acoustic beamformers to generate an acoustic beam directed to a point in a volume of interest during a first time. Based on a reflected wave intensity detected at a plurality of acoustic receiver elements, an image of the volume of interest can be generated.

Evolvable circuit with transistor-level reconfigurability

NASA Technical Reports Server (NTRS)

Stoica, Adrian (Inventor); Salazar-Lazaro, Carlos Harold (Inventor)

2004-01-01

An evolvable circuit includes a plurality of reconfigurable switches, a plurality of transistors within a region of the circuit, the plurality of transistors having terminals, the plurality of transistors being coupled between a power source terminal and a power sink terminal so as to be capable of admitting power between the power source terminal and the power sink terminal, the plurality of transistors being coupled so that every transistor terminal to transistor terminal coupling within the region of the circuit comprises a reconfigurable switch.

Evolutionary Technique for Automated Synthesis of Electronic Circuits

NASA Technical Reports Server (NTRS)

Stoica, Adrian (Inventor); Salazar-Lazaro, Carlos Harold (Inventor)

2007-01-01

An evolvable circuit includes a plurality of reconfigurable switches, a plurality of transistors within a region of the circuit, the plurality of transistors having terminals, the plurality of transistors being coupled between a power source terminal and a power sink terminal so as to be capable of admitting power between the power source terminal and the power sink terminal, the plurality of transistors being coupled so that every transistor to transistor terminal coupling within the region of the circuit comprises a reconfigurable switch.

Association of obesity with healthcare utilization and costs in a Medicare population.

PubMed

Suehs, Brandon T; Kamble, Pravin; Huang, Joanna; Hammer, Mette; Bouchard, Jonathan; Costantino, Mary E; Renda, Andrew

2017-12-01

To examine the association of obesity with healthcare resource utilization and costs in a Medicare population. This study was a retrospective cohort study using Humana Medicare Advantage (MA) claims data. Body mass index (BMI) was assessed using ICD-9-CM status codes (V85 hierarchy) that have been validated in the data source to classify patients into BMI categories: normal (N), overweight (Ow), obese class I (ObI), obese class II (ObII), and obese class III (ObIII). Healthcare resource utilization (HRU) and costs were determined based on claims data. Descriptive statistics were used to examine baseline characteristics and HRU across BMI classes. Multivariable analysis was used to examine the association between BMI class and outcome measures. Among the 172,866 patients aged ≥65 years that were identified, BMI distribution was: N, 21%; Ow 37%; ObI, 24%, ObII, 10%; and ObIII, 9%. Inpatient, emergency department and outpatient utilization increased with greater BMI level, and greater BMI level was associated with higher total healthcare, medical and pharmacy costs. Greater prevalence of several cardiometabolic conditions, total medication use, and use of specific medication classes was observed with increasing BMI class. Greater BMI was associated with greater HRU and costs and observed increase in prevalence of cardiometabolic conditions. These results reflect an urgent need to address the epidemic of obesity and the resulting excessive clinical and economic burden on the healthcare system.

Effect of a nurse-led psychoeducational intervention on healthcare service utilization among adults with advanced cancer

PubMed Central

Martinez, Kathryn A.; Friese, Christopher; Kershaw, Trace; Given, Charles W.; Fendrick, A. Mark; Northouse, Laurel

2015-01-01

Purpose/Objectives To examine differences in healthcare service utilization among patients with advanced cancer participating in a nurse-led psychoeducational intervention. Design Secondary analysis of trial data. Setting Four Michigan cancer centers. Sample 484 patients with advanced cancer. Methods Patients were randomized to three groups: brief intervention, extensive intervention, or control. Medical chart review took place at baseline, three months, and six months to measure patients’ healthcare service utilization, defined as emergency department (ED) visits or inpatient hospitalizations. Multivariable logistic regression was used to examine the odds, by study arm, of visiting the ED and being hospitalized, controlling for patient sociodemographic and health status factors, as well as baseline health-related quality of life (QOL). Main Research Variables Study arm (brief, extensive, or control), ED visitation (one or more times versus none), inpatient hospitalizations (one or more times versus none), and covariates. Findings No significant differences in ED visits or inpatient hospitalizations were observed among study arms. ED visits were more frequent for patients with lung or colorectal cancer, more comorbidities, and lower baseline QOL. Baseline QOL was associated with inpatient hospitalizations in the adjusted analysis. Conclusions The psychoeducational intervention, either in brief or extensive format, is unlikely to increase healthcare service utilization. Implications for Nursing Efficacious nurse-led psychoeducational interventions to improve QOL do not place undue burdens on the healthcare system and may improve care. PMID:26148327

Randomized study of the effect of video education on heart failure healthcare utilization, symptoms, and self-care behaviors.

PubMed

Albert, Nancy M; Buchsbaum, Robin; Li, Jianbo

2007-12-01

Adherence to self-care behaviors improves heart failure (HF) morbidity and life quality. We examined short-term impact of video education (VE) in addition to standard education (SE) on HF healthcare utilization and self-care behavior adherence. One hundred and twelve hospitalized patients were randomly assigned to SE (n=53) or SE plus VE (n=59). Differences between groups were analyzed in patients who underwent 3-month follow-up (39 SE and 37 VE patients). Mean age was 60+/-14 years; mean HF length was 57 months. Three-month healthcare utilization was similar between groups but VE patients needed less extra diuretic dosing (P<0.02), received more HF literature (P<0.03), and had less healthcare team telephone communication (P<0.04). VE patients had greater sign/symptom reduction (P<0.04); especially related to edema (P<0.01) and fatigue (P<0.01) and initiated more actions for edema (P<0.05) and dyspnea (with exercise or rest, both P<0.01). Overall, VE patients had a higher mean self-care behavior score (P<0.01), reflecting greater self-care adherence. Video education prompts self-care behavior adherence to control worsening signs/symptoms of volume overload. During 3-month follow-up, utilization of most healthcare resources was unchanged. VE is a useful adjunct to in-person education.

Photovoltaic solar cell

DOEpatents

Nielson, Gregory N; Cruz-Campa, Jose Luis; Okandan, Murat; Resnick, Paul J

2014-05-20

A photovoltaic solar cell for generating electricity from sunlight is disclosed. The photovoltaic solar cell comprises a plurality of spaced-apart point contact junctions formed in a semiconductor body to receive the sunlight and generate the electricity therefrom, the plurality of spaced-apart point contact junctions having a first plurality of regions having a first doping type and a second plurality of regions having a second doping type. In addition, the photovoltaic solar cell comprises a first electrical contact electrically connected to each of the first plurality of regions and a second electrical contact electrically connected to each of the second plurality of regions, as well as a passivation layer covering major surfaces and sidewalls of the photovoltaic solar cell.

Transparent conductive nano-composites

DOEpatents

Geohegan, David Bruce; Ivanov, Ilia N; Puretzky, Alexander A; Jesse, Stephen; Hu, Bin; Garrett, Matthew; Zhao, Bin

2013-09-24

The present invention, in one embodiment, provides a method of forming an organic electric device that includes providing a plurality of carbon nanostructures; and dispersing the plurality of carbon nanostructures in a polymeric matrix to provide a polymeric composite, wherein when the plurality of carbon nanostructures are present at a first concentration an interface of the plurality of carbon nanostructures and the polymeric matrix is characterized by charge transport when an external energy is applied, and when the plurality of carbon nanostructures are present at a second concentration the interface of the plurality of carbon nanostructures and the polymeric matrix are characterized by exciton dissociation when an external energy is applied, wherein the first concentration is less than the second concentration.

Photovoltaic solar cell

DOEpatents

Nielson, Gregory N; Okandan, Murat; Cruz-Campa, Jose Luis; Resnick, Paul J

2013-11-26

A photovoltaic solar cell for generating electricity from sunlight is disclosed. The photovoltaic solar cell comprises a plurality of spaced-apart point contact junctions formed in a semiconductor body to receive the sunlight and generate the electicity therefrom, the plurality of spaced-apart point contact junctions having a first plurality of regions having a first doping type and a second plurality of regions having a second doping type. In addition, the photovoltaic solar cell comprises a first electrical contact electrically connected to each of the first plurality of regions and a second electrical contact electrically connected to each of the second plurality of regions, as well as a passivation layer covering major surfaces and sidewalls of the photovoltaic solar cell.

Transparent conductive nano-composites

DOEpatents

Geohegan, David Bruce [Knoxville, TN; Ivanov, Ilia N [Knoxville, TN; Puretzky, Alexander A [Knoxville, TN; Jesse, Stephen [Knoxville, TN; Hu, Bin [Knoxville, TN; Garrett, Matthew [Knoxville, TN; Zhao, Bin [Easley, SC

2011-04-12

The present invention, in one embodiment, provides a method of forming an organic electric device that includes providing a plurality of carbon nanostructures; and dispersing the plurality of carbon nanostructures in a polymeric matrix to provide a polymeric composite, wherein when the plurality of carbon nanostructures are present at a first concentration an interface of the plurality of carbon nanostructures and the polymeric matrix is characterized by charge transport when an external energy is applied, and when the plurality of carbon nanostructures are present at a second concentration the interface of the plurality of carbon nanostructures and the polymeric matrix are characterized by exciton dissociation when an external energy is applied, wherein the first concentration is less than the second concentration.

Multi-robot control interface

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

Bruemmer, David J; Walton, Miles C

Methods and systems for controlling a plurality of robots through a single user interface include at least one robot display window for each of the plurality of robots with the at least one robot display window illustrating one or more conditions of a respective one of the plurality of robots. The user interface further includes at least one robot control window for each of the plurality of robots with the at least one robot control window configured to receive one or more commands for sending to the respective one of the plurality of robots. The user interface further includes amore » multi-robot common window comprised of information received from each of the plurality of robots.« less

Self-reliance, mental health need, and the use of mental healthcare among island Puerto Ricans.

PubMed

Ortega, Alexander N; Alegría, Margarita

2002-09-01

This paper examines the relationship between self-reliance (preference to solve emotional problems on one's own) and 5 mental healthcare utilization outcomes for Puerto Ricans living in low-income areas. A random probability community sample of noninstitutionalized Puerto Ricans, ages 18-69, living in low-income areas of the island were selected and interviewed in 1992-93 and 1993-94. A series of logistic regression models tested the association between self-reliance and 5 mental health utilization measures, after adjusting for covariates measuring predisposing, enabling, need and barrier factors: any use of mental health services, any use of general health services for mental healthcare, any use of specialty care, use of psychotropic medications, and retention in mental healthcare. Self-reliance was found to be negatively associated with all 5 dependent service utilization measures. Those with a positive self-reliant attitude were 40% less likely to use care on any of the 5 outcome measures. An interaction was also observed between definite need for mental healthcare and having a self-reliant attitude when predicting mental health service use. Definite needers with a self-reliant attitude were 54%-58% less likely to use mental health services compared with definite needers who did not have a self-reliant attitude. Further, decreases in self-reliant attitude over the two data collection periods were associated with increases in mental health service use. Our findings suggest that self-reliance is a significant and robust predictor of mental healthcare utilization among Puerto Ricans living in low-income areas of the island.

Patterns and predictors of health service utilization in adolescents with pain: comparison between a community and a clinical pain sample.

PubMed

Toliver-Sokol, Marisol; Murray, Caitlin B; Wilson, Anna C; Lewandowski, Amy; Palermo, Tonya M

2011-07-01

There is limited research describing the patterns of healthcare utilization in adolescents with chronic pain. This study describes healthcare utilization in a clinical chronic pain sample, and compares the patterns of service use of this group to a community sample with intermittent pain complaints. We also investigated demographic and clinical factors that predicted healthcare visits and medication use in the clinical sample. Data on 117 adolescents (aged 12-18; n = 59 clinical pain sample, n = 58 community) were collected. Caregivers and adolescents reported on sociodemographics, medical visits, current medications, pain, activity limitations, and depression. As hypothesized, the clinical pain sample had higher rates of healthcare consultation on all types of medical visits (general, specialty care, complementary medicine, mental health, OT/PT), and higher medication use compared to the community sample. Regression analyses revealed that higher annual income, greater pain frequency, and higher levels of caregiver-reported activity limitations were associated with a greater number of healthcare visits for the total sample. Within the clinical pain sample, higher pain frequency and greater activity limitations (caregiver report) predicted more specialty care visits. Additionally, higher income and greater levels of depressive symptoms predicted a higher number of prescribed medications. This study contributes to the limited available data on health service and medication use in a clinical chronic pain sample versus a community sample of adolescents. We also identify clinical factors (pain frequency, parent-reported activity limitations, depressive symptoms) and demographic factors (gender, income) associated with healthcare utilization. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

Electrically operated magnetic switch designed to display reduced leakage inductance

DOEpatents

Cook, Edward G.

1994-01-01

An electrically operated magnetic switch is disclosed herein for use in opening and closing a circuit between two terminals depending upon the voltage across these terminals. The switch so disclosed is comprised of a ferrite core in the shape of a toroid having opposing ends and opposite inner and outer sides and an arrangement of electrically conductive components defining at least one current flow path which makes a number of turns around the core. This arrangement of components includes a first plurality of electrically conducive rigid rods parallel with and located outside the outer side of the core and a second plurality of electrically conductive rigid rods parallel with and located inside the inner side of the core. The arrangement also includes means for electrically connecting these rods together so that the define the current flow path. In one embodiment, this latter means uses rigid cross-tab means. In another, preferred embodiment, printed circuits on rigid dielectric substrates located on opposite ends of the core are utilized to interconnect the rods together.

Photovoltaic driven multiple quantum well optical modulator

NASA Technical Reports Server (NTRS)

Maserjian, Joseph (Inventor)

1990-01-01

Multiple quantum well (MQW) structures (12) are utilized to provide real-time, reliable, high-performance, optically-addressed spatial-light modulators (SLM) (10). The optically-addressed SLM comprises a vertical stack of quantum well layers (12a) within the penetration depth of an optical write signal 18, a plurality of space charge barriers (12b) having predetermined tunneling times by control of doping and thickness. The material comprising the quantum well layers has a lower bandgap than that of the space charge barrier layers. The write signal modulates a read signal (20). The modulation sensitivity of the device is high and no external voltage source is required. In a preferred embodiment, the SLM having interleaved doped semiconductor layers for driving the MQW photovoltaically is characterized by the use of a shift analogous to the Moss-Burnstein shift caused by the filling of two-dimensional states in the multiple quantum wells, thus allowing high modulation sensitivity in very narrow wells. Arrays (30) may be formed with a plurality of the modulators.

Stimulus sensitive gel with radioisotope and methods of making

DOEpatents

Weller, Richard E.; Lind, Michael A.; Fisher, Darrell R.; Gutowska, Anna; Campbell, Allison A.

2005-03-22

The present invention is a thermally reversible stimulus-sensitive gel or gelling copolymer radioisotope carrier that is a linear random copolymer of an [meth-]acrylamide derivative and a hydrophilic comonomer, wherein the linear random copolymer is in the form of a plurality of linear chains having a plurality of molecular weights greater than or equal to a minimum gelling molecular weight cutoff. Addition of a biodegradable backbone and/or a therapeutic agent imparts further utility. The method of the present invention for making a thermally reversible stimulus-sensitive gelling copolymer radionuclcide carrier has the steps of: (a) mixing a stimulus-sensitive reversible gelling copolymer with an aqueous solvent as a stimulus-sensitive reversible gelling solution; and (b) mixing a radioisotope with said stimulus-sensitive reversible gelling solution as said radioisotope carrier. The gel is enhanced by either combining it with a biodegradable backbone and/or a therapeutic agent in a gelling solution made by mixing the copolymer with an aqueous solvent.

Stimulus sensitive gel with radioisotope and methods of making

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

Weller, Richard E; Lind, Michael A; Fisher, Darrell R

2001-10-02

The present invention is a thermally reversible stimulus-sensitive gel or gelling copolymer radioisotope carrier that is a linear random copolymer of an [meth]acrylamide derivative and a hydrophilic comonomer, wherein the linear random copolymer is in the form of a plurality of linear chains having a plurality of molecular weights greater than or equal to a minimum gelling molecular weight cutoff. Addition of a biodegradable backbone and/or a therapeutic agent imparts further utility. The method of the present invention for making a thermally reversible stimulus-sensitive gelling copolymer radionuclcide carrier has the steps of: (a) mixing a stimulus-sensitive reversible gelling copolymer withmore » an aqueous solvent as a stimulus-sensitive reversible gelling solution; and (b) mixing a radioisotope with said stimulus-sensitive reversible gelling solution as said radioisotope carrier. The gel is enhanced by either combining it with a biodegradable backbone and/or a therapeutic agent in a gelling solution made by mixing the copolymer with an aqueous solvent.« less

A neural network with modular hierarchical learning

NASA Technical Reports Server (NTRS)

Baldi, Pierre F. (Inventor); Toomarian, Nikzad (Inventor)

1994-01-01

This invention provides a new hierarchical approach for supervised neural learning of time dependent trajectories. The modular hierarchical methodology leads to architectures which are more structured than fully interconnected networks. The networks utilize a general feedforward flow of information and sparse recurrent connections to achieve dynamic effects. The advantages include the sparsity of units and connections, the modular organization. A further advantage is that the learning is much more circumscribed learning than in fully interconnected systems. The present invention is embodied by a neural network including a plurality of neural modules each having a pre-established performance capability wherein each neural module has an output outputting present results of the performance capability and an input for changing the present results of the performance capabilitiy. For pattern recognition applications, the performance capability may be an oscillation capability producing a repeating wave pattern as the present results. In the preferred embodiment, each of the plurality of neural modules includes a pre-established capability portion and a performance adjustment portion connected to control the pre-established capability portion.

Constant pressure high throughput membrane permeation testing system

DOEpatents

Albenze, Erik J.; Hopkinson, David P.; Luebke, David R.

2014-09-02

The disclosure relates to a membrane testing system for individual evaluation of a plurality of planar membranes subjected to a feed gas on one side and a sweep gas on a second side. The membrane testing system provides a pressurized flow of a feed and sweep gas to each membrane testing cell in a plurality of membrane testing cells while a stream of retentate gas from each membrane testing cell is ported by a retentate multiport valve for sampling or venting, and a stream of permeate gas from each membrane testing cell is ported by a permeate multiport valve for sampling or venting. Back pressure regulators and mass flow controllers act to maintain substantially equivalent gas pressures and flow rates on each side of the planar membrane throughout a sampling cycle. A digital controller may be utilized to position the retentate and permeate multiport valves cyclically, allowing for gas sampling of different membrane cells over an extended period of time.

Projection optics box

DOEpatents

Hale, Layton C.; Malsbury, Terry; Hudyma, Russell M.; Parker, John M.

2000-01-01

A projection optics box or assembly for use in an optical assembly, such as in an extreme ultraviolet lithography (EUVL) system using 10-14 nm soft x-ray photons. The projection optics box utilizes a plurality of highly reflective optics or mirrors, each mounted on a precision actuator, and which reflects an optical image, such as from a mask, in the EUVL system onto a point of use, such as a target or silicon wafer, the mask, for example, receiving an optical signal from a source assembly, such as a developed from laser system, via a series of highly reflective mirrors of the EUVL system. The plurality of highly reflective optics or mirrors are mounted in a housing assembly comprised of a series of bulkheads having wall members secured together to form a unit construction of maximum rigidity. Due to the precision actuators, the mirrors must be positioned precisely and remotely in tip, tilt, and piston (three degrees of freedom), while also providing exact constraint.

Microbend fiber-optic temperature sensor

DOEpatents

Weiss, J.D.

1995-05-30

A temperature sensor is made of optical fiber into which quasi-sinusoidal microbends have been permanently introduced. In particular, the present invention includes a graded-index optical fiber directing steady light through a section of the optical fiber containing a plurality of permanent microbends. The microbend section of the optical fiber is contained in a thermally expansive sheath, attached to a thermally expansive structure, or attached to a bimetallic element undergoing temperature changes and being monitored. The microbend section is secured to the thermally expansive sheath which allows the amplitude of the microbends to decrease with temperature. The resultant increase in the optical fiber`s transmission thus allows temperature to be measured. The plural microbend section of the optical fiber is secured to the thermally expansive structure only at its ends and the microbends themselves are completely unconstrained laterally by any bonding agent to obtain maximum longitudinal temperature sensitivity. Although the permanent microbends reduce the transmission capabilities of fiber optics, the present invention utilizes this phenomenon as a transduction mechanism which is optimized to measure temperature. 5 figs.

Microbend fiber-optic temperature sensor

DOEpatents

Weiss, Jonathan D.

1995-01-01

A temperature sensor is made of optical fiber into which quasi-sinusoidal microbends have been permanently introduced. In particular, the present invention includes a graded-index optical fiber directing steady light through a section of the optical fiber containing a plurality of permanent microbends. The microbend section of the optical fiber is contained in a thermally expansive sheath, attached to a thermally expansive structure, or attached to a bimetallic element undergoing temperature changes and being monitored. The microbend section is secured to the thermally expansive sheath which allows the amplitude of the microbends to decrease with temperature. The resultant increase in the optical fiber's transmission thus allows temperature to be measured. The plural microbend section of the optical fiber is secured to the thermally expansive structure only at its ends and the microbends themselves are completely unconstrained laterally by any bonding agent to obtain maximum longitudinal temperature sensitivity. Although the permanent microbends reduce the transmission capabilities of fiber optics, the present invention utilizes this phenomenon as a transduction mechanism which is optimized to measure temperature.

Storing files in a parallel computing system based on user-specified parser function

DOEpatents

Faibish, Sorin; Bent, John M; Tzelnic, Percy; Grider, Gary; Manzanares, Adam; Torres, Aaron

2014-10-21

Techniques are provided for storing files in a parallel computing system based on a user-specified parser function. A plurality of files generated by a distributed application in a parallel computing system are stored by obtaining a parser from the distributed application for processing the plurality of files prior to storage; and storing one or more of the plurality of files in one or more storage nodes of the parallel computing system based on the processing by the parser. The plurality of files comprise one or more of a plurality of complete files and a plurality of sub-files. The parser can optionally store only those files that satisfy one or more semantic requirements of the parser. The parser can also extract metadata from one or more of the files and the extracted metadata can be stored with one or more of the plurality of files and used for searching for files.

Extruder system and method for treatment of a gaseous medium

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

Silvi, Norberto; Perry, Robert James; Singh, Surinder Prabhjot

A system for treatment of a gaseous medium, comprises an extruder having a barrel. The extruder further comprises a first inlet port, a second inlet port, and a plurality of outlet ports coupled to the barrel. The first inlet port is configured for feeding a lean sorbent, the second inlet port is configured for feeding a gaseous medium, and the plurality of outlet ports are configured for releasing a plurality of components removed from the gaseous medium. Further, the extruder comprises a plurality of helical elements coupled to a plurality of kneading elements, mounted on a shaft, and disposed withinmore » the barrel. The barrel and the plurality of helical and kneading elements together form an absorption unit and a desorption unit. The first and second inlet ports are formed in the absorption unit and the plurality of outlet ports are formed in the absorption and desorption units.« less

Early comprehension of the Spanish plural*

PubMed Central

Arias-Trejo, Natalia; Cantrell, Lisa M.; Smith, Linda B.; Alva Canto, Elda A.

2015-01-01

Understanding how linguistic cues map to the environment is crucial for early language comprehension and may provide a way for bootstrapping and learning words. Research has suggested that learning how plural syntax maps to the perceptual environment may show a trajectory in which children first learn surrounding cues (verbs, modifiers) before a full mastery of the noun morpheme alone. The Spanish plural system of simple codas, dominated by one allomorph -s, and with redundant agreement markers, may facilitate early understanding of how plural linguistic cues map to novel referents. Two-year-old Mexican children correctly identified multiple novel object referents when multiple verbal cues in a phrase indicated plurality as well as in instances when the noun morphology in novel nouns was the ONLY indicator of plurality. These results demonstrate Spanish-speaking children’s ability to use plural noun inflectional morphology to infer novel word referents which may have implications for their word learning. PMID:24560441

High Density Faraday Cup Array or Other Open Trench Structures and Method of Manufacture Thereof

NASA Technical Reports Server (NTRS)

Gilchrist, Kristin Hedgepath (Inventor); Bower, Christopher A. (Inventor); Stoner, Brian R. (Inventor)

2014-01-01

A detector array and method for making the detector array. The detector array includes a substrate including a plurality of trenches formed therein, and a plurality of collectors electrically isolated from each other, formed on the walls of the trenches, and configured to collect charged particles incident on respective ones of the collectors and to output from the collectors signals indicative of charged particle collection. In the detector array, adjacent ones of the plurality of trenches are disposed in a staggered configuration relative to one another. The method forms in a substrate a plurality of trenches across a surface of the substrate such that adjacent ones of the trenches are in a staggered sequence relative to one another, forms in the plurality of trenches a plurality of collectors, and connects a plurality of electrodes respectively to the collectors.

Anxiety and fear of cancer recurrence and its association with supportive care needs and health-care service utilization in cancer patients.

PubMed

Sarkar, Susanne; Sautier, Leon; Schilling, Georgia; Bokemeyer, Carsten; Koch, Uwe; Mehnert, Anja

2015-12-01

We investigated the relationship between fear of cancer recurrence (FCR), anxiety, supportive care needs, and utilization of health-care services in a mixed sample of 335 cancer patients. We used validated questionnaires including the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the General Anxiety Disorder Scale (GAD-7) and the Supportive Care Needs Survey (SCNS-SF34). Health-care services utilization was measured by a self-constructed questionnaire recording the use of 22 health and supportive care offers. In our sample, 3.9% of patients were classified as having high anxiety and 5.1% had high FCR. Patients reported the highest unmet supportive care needs in the domain health system and information followed by psychological needs. Integrated care and complementary support services were the most frequently used (32%) followed by medical (31%), psychological (23%), spiritual and religious (8%) and other support services (9%). Whereas anxiety was related to both unmet psychological and physical/daily living needs (p < 0.01), FCR was associated with unmet supportive care needs in all five domains further including needs with regard to health system and information, patient care, and sexuality (p < 0.01). However, higher levels of anxiety and FCR were not related to higher utilization of health-care services. Our findings show that FCR plays a significant role in unmet supportive care needs in cancer patients but not for health-care service utilization. We recommend that clinicians monitor supportive care needs in patients struggling with FCR and anxiety.

Association between switching antiepileptic drug products and healthcare utilization: A systematic review.

PubMed

Kwan, Patrick; Palmini, André

2017-08-01

There is ongoing concern whether switching between different antiepileptic drug (AED) products may compromise patient care. We systematically reviewed changes in healthcare utilization following AED switch. We searched MEDLINE and EMBASE databases (1980-October 2016) for studies that assessed the effect of AED switching in patients with epilepsy on outpatient visits, emergency room visits, hospitalization and hospital stay duration. A total of 14 articles met the inclusion criteria. All were retrospective studies. Four provided findings for specific AEDs only (lamotrigine, topiramate, phenytoin and divalproex), 9 presented pooled findings from multiple AEDs, and 1 study provided both specific (lamotrigine, topiramate, oxcarbazepine, and levetiracetam) and pooled findings. Three studies found an association between a switch of topiramate and an increase in healthcare utilization. Another three studies found that a brand-to-generic lamotrigine switch was not associated with an increased risk of emergently treated events (ambulance use, ER visits or hospitalization). The outcomes of the pooled AED switch studies were inconsistent; 5 studies reported an increased healthcare utilization while 5 studies did not. Studies that have examined the association between an AED switch and a change in healthcare utilization report conflicting findings. Factors that may explain these inconsistent outcomes include inter-study differences in the type of analysis undertaken (pooled vs individual AED data), the covariates used for data adjustment, and the type of switch examined. Future medical claim database studies employing a prospective design are encouraged to address these and other factors in order to enhance inter-study comparability and extrapolation of findings. Copyright © 2017 Elsevier Inc. All rights reserved.

Medicare claims indicators of healthcare utilization differences after hospitalization for ischemic stroke: Race, gender, and caregiving effects.

PubMed

Roth, David L; Sheehan, Orla C; Huang, Jin; Rhodes, James D; Judd, Suzanne E; Kilgore, Meredith; Kissela, Brett; Bettger, Janet Prvu; Haley, William E

2016-10-01

Background Differences in healthcare utilization after stroke may partly explain race or gender differences in stroke outcomes and identify factors that might reduce post-acute stroke care costs. Aim To examine systematic differences in Medicare claims for healthcare utilization after hospitalization for ischemic stroke in a US population-based sample. Methods Claims were examined over a six-month period after hospitalization for 279 ischemic stroke survivors 65 years or older from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Statistical analyses examined differences in post-acute healthcare utilization, adjusted for pre-stroke utilization, as a function of race (African-American vs. White), gender, age, stroke belt residence, income, Medicaid dual-eligibility, Charlson comorbidity index, and whether the person lived with an available caregiver. Results After adjusting for covariates, women were more likely than men to receive home health care and to use emergency department services during the post-acute care period. These effects were maintained even after further adjustment for acute stroke severity. African-Americans had more home health care visits than Whites among patients who received some home health care. Having a co-residing caregiver was associated with reduced acute hospitalization length of stay and fewer post-acute emergency department and primary care physician visits. Conclusions Underutilization of healthcare after stroke does not appear to explain poorer long-term stroke outcomes for women and African-Americans in this epidemiologically-derived sample. Caregiver availability may contribute to reduced formal care and cost during the post-acute period.

Acoustic Investigations into the Later Acquisition of Syllabic "-es" Plurals

ERIC Educational Resources Information Center

Mealings, Kiri T.; Cox. Felicity; Demuth, Katherine

2013-01-01

Purpose: Children acquire /-ez/ syllabic plurals (e.g., buses) later than /-s, -z/ segmental plurals (e.g., cats,dogs). In this study, the authors explored whether increased syllable number or segmental factors best explains poorer performance with syllabic plurals. Method: An elicited imitation experiment was conducted with 14 two-year-olds…

Assessing Plural Morphology in Children Acquiring /S/-Leniting Dialects of Spanish

ERIC Educational Resources Information Center

Miller, Karen

2014-01-01

Purpose: To examine the production of plural morphology in children acquiring a dialect of Spanish with syllable-final /s/ lenition with the goal of comparing how plural marker omissions in the speech of these children compare with plural marker omissions in children with language impairment acquiring other varieties of Spanish. Method: Three…

Acquisition of German Pluralization Rules in Monolingual and Multilingual Children

ERIC Educational Resources Information Center

Zaretsky, Eugen; Lange, Benjamin P.; Euler, Harald A.; Neumann, Katrin

2013-01-01

Existing studies on plural acquisition in German have relied on small samples and thus hardly deliver generalizable and differentiated results. Here, overgeneralizations of certain plural allomorphs and other tendencies in the acquisition of German plural markers are described on the basis of test data from 7,394 3- to 5-year-old monolingual…

Is "Two" a Plural Marker in Early Child Language?

ERIC Educational Resources Information Center

Barner, David; Lui, Toni; Zapf, Jennifer

2012-01-01

Is "two" ever a plural marker in child language? By some accounts, children bootstrap the distinction between the words "one" and "two" by observing their use with singular-plural marking ("one ball/two balls"). Others argue that the numeral "two" marks plurality before children begin using numerals to denote precise quantities. We tested the…

DISTINCTIVE FEATURES IN THE PLURALIZATION RULES OF ENGLISH SPEAKERS.

ERIC Educational Resources Information Center

ANISFELD, MOSHE; AND OTHERS

FIRST AND SECOND GRADERS, GIVEN "CVC" SINGULAR NONSENSE WORDS (E.G., NAR) ORALLY AND ASKED TO CHOOSE BETWEEN TWO PLURALS (NARF-NARK), PREFERRED FINAL SOUNDS SHARING WITH /Z/ (THE MOST COMMON SHAPE OF THE PLURAL MORPHEME IN ENGLISH) THE STRIDENCY OR CONTINUANCE FEATURES. THIS SUGGESTS THAT THEIR PLURALIZATION RULES ARE FORMULATED IN TERMS OF…

Stanwix House Vocabulary Study: Plurals. Investigative Report Number 7227.

ERIC Educational Resources Information Center

Wood, Penelope; Bond, Jack H.

Research analyzed: 1) the treatment of plurals in the Functional Basic Word List for Special Pupils (Stanwix House List), and 2) plural recognition by educable mentally handicapped (EMH) students. Review of the Stanwix House List revealed that plurals were treated as discrete vocabulary items. Using a small sample of EMH subjects, the researchers…

Two-Year-Olds' Sensitivity to Inflectional Plural Morphology: Allomorphic Effects

ERIC Educational Resources Information Center

Davies, Benjamin; Xu Rattanasone, Nan; Demuth, Katherine

2017-01-01

Many English-speaking children use plural nominal forms in spontaneous speech before the age of two, and display some understanding of plural inflection in production tasks. However, results from an intermodal preferential study suggested a lack of "comprehension" of nominal plural morphology at 24 months of age (Kouider, Halberda, Wood,…

Track with overlapping links for dry coal extrusion pumps

DOEpatents

Saunders, Timothy; Brady, John D

2014-01-21

A chain for a particulate material extrusion pump includes a plurality of links, each of the plurality of links having a link body and a link ledge, wherein each link ledge of the plurality of links at least partially overlaps the link body of an adjacent one of the plurality of links.

A study of perceived racial discrimination in Black men who have sex with men (MSM) and its association with healthcare utilization and HIV testing.

PubMed

Irvin, R; Wilton, L; Scott, H; Beauchamp, G; Wang, L; Betancourt, J; Lubensky, M; Wallace, J; Buchbinder, S

2014-07-01

In HPTN 061, a study of Black men who have sex with men (MSM), we evaluated the association of healthcare-specific racial discrimination with healthcare utilization and HIV testing among 1167 HIV-negative participants. Median age was 38 years, 41 % were uninsured, and 38 % had an annual household income <$10,000. Overall, 19 % reported healthcare-specific racial discrimination directed toward family, friend, or self; 61 % saw a healthcare provider in the previous 6 months and 81 % HIV tested within the past year. Healthcare-specific racial discrimination was positively associated with seeing a provider [adjusted odds ratio (AOR) = 1.4 (1.0, 2.0)] and HIV testing [AOR = 1.6 (1.1, 2.4)] suggesting that barriers other than racial discrimination may be driving health disparities related to access to medical care and HIV testing among Black MSM. These results contrast with previous studies, possibly due to measurement or cohort differences, strategies to overcome discrimination, or because of greater exposure to healthcare.

Developing and deploying a community healthcare worker-driven, digitally- enabled integrated care system for municipalities in rural Nepal.

PubMed

Citrin, David; Thapa, Poshan; Nirola, Isha; Pandey, Sachit; Kunwar, Lal Bahadur; Tenpa, Jasmine; Acharya, Bibhav; Rayamazi, Hari; Thapa, Aradhana; Maru, Sheela; Raut, Anant; Poudel, Sanjaya; Timilsina, Diwash; Dhungana, Santosh Kumar; Adhikari, Mukesh; Khanal, Mukti Nath; Pratap Kc, Naresh; Acharya, Bhim; Karki, Khem Bahadur; Singh, Dipendra Raman; Bangura, Alex Harsha; Wacksman, Jeremy; Storisteanu, Daniel; Halliday, Scott; Schwarz, Ryan; Schwarz, Dan; Choudhury, Nandini; Kumar, Anirudh; Wu, Wan-Ju; Kalaunee, S P; Chaudhari, Pushpa; Maru, Duncan

2018-06-04

Integrating care at the home and facility level is a critical yet neglected function of healthcare delivery systems. There are few examples in practice or in the academic literature of affordable, digitally-enabled integrated care approaches embedded within healthcare delivery systems in low- and middle-income countries. Simultaneous advances in affordable digital technologies and community healthcare workers offer an opportunity to address this challenge. We describe the development of an integrated care system involving community healthcare worker networks that utilize a home-to-facility electronic health record platform for rural municipalities in Nepal. Key aspects of our approach of relevance to a global audience include: community healthcare workers continuously engaging with populations through household visits every three months; community healthcare workers using digital tools during the routine course of clinical care; individual and population-level data generated routinely being utilized for program improvement; and being responsive to privacy, security, and human rights concerns. We discuss implementation, lessons learned, challenges, and opportunities for future directions in integrated care delivery systems. Copyright © 2018 Elsevier Inc. All rights reserved.

38 CFR 17.500 - General.

Code of Federal Regulations, 2014 CFR

2014-07-01

... of Healthcare Quality Assurance Review Records § 17.500 General. (a) Section 5705, title 38, United... §§ 17.500 through 17.511, the VA's medical quality assurance program consists of systematic healthcare... utilization of healthcare resources in VA medical facilities. These review activities may involve continuous...

38 CFR 17.500 - General.

Code of Federal Regulations, 2013 CFR

2013-07-01

... of Healthcare Quality Assurance Review Records § 17.500 General. (a) Section 5705, title 38, United... §§ 17.500 through 17.511, the VA's medical quality assurance program consists of systematic healthcare... utilization of healthcare resources in VA medical facilities. These review activities may involve continuous...

38 CFR 17.500 - General.

Code of Federal Regulations, 2011 CFR

2011-07-01

... of Healthcare Quality Assurance Review Records § 17.500 General. (a) Section 5705, title 38, United... §§ 17.500 through 17.511, the VA's medical quality assurance program consists of systematic healthcare... utilization of healthcare resources in VA medical facilities. These review activities may involve continuous...

38 CFR 17.500 - General.

Code of Federal Regulations, 2012 CFR

2012-07-01

... of Healthcare Quality Assurance Review Records § 17.500 General. (a) Section 5705, title 38, United... §§ 17.500 through 17.511, the VA's medical quality assurance program consists of systematic healthcare... utilization of healthcare resources in VA medical facilities. These review activities may involve continuous...

38 CFR 17.500 - General.

Code of Federal Regulations, 2010 CFR

2010-07-01

... of Healthcare Quality Assurance Review Records § 17.500 General. (a) Section 5705, title 38, United... §§ 17.500 through 17.511, the VA's medical quality assurance program consists of systematic healthcare... utilization of healthcare resources in VA medical facilities. These review activities may involve continuous...

Measuring HIV-related stigma among healthcare providers: a systematic review.

PubMed

Alexandra Marshall, S; Brewington, Krista M; Kathryn Allison, M; Haynes, Tiffany F; Zaller, Nickolas D

2017-11-01

In the United States, HIV-related stigma in the healthcare setting is known to affect the utilization of prevention and treatment services. Multiple HIV/AIDS stigma scales have been developed to assess the attitudes and behaviors of the general population in the U.S. towards people living with HIV/AIDS, but fewer scales have been developed to assess HIV-related stigma among healthcare providers. This systematic review aimed to identify and evaluate the measurement tools used to assess HIV stigma among healthcare providers in the U.S. The five studies selected quantitatively assessed the perceived HIV stigma among healthcare providers from the patient or provider perspective, included HIV stigma as a primary outcome, and were conducted in the U.S. These five studies used adapted forms of four HIV stigma scales. No standardized measure was identified. Assessment of HIV stigma among providers is valuable to better understand how this phenomenon may impact health outcomes and to inform interventions aiming to improve healthcare delivery and utilization.

Understanding the Psychosocial and Environmental Factors and Barriers Affecting Utilization of Maternal Healthcare Services in Kalomo, Zambia: A Qualitative Study

ERIC Educational Resources Information Center

Sialubanje, Cephas; Massar, Karlijn; Hamer, Davidson H.; Ruiter, Robert A. C.

2014-01-01

This qualitative study aimed to identify psychosocial and environmental factors contributing to low utilization of maternal healthcare services in Kalomo, Zambia. Twelve focus group discussions (n = 141) and 35 in-depth interviews were conducted in six health centre catchment areas. Focus group discussions comprised women of reproductive age…

From web search to healthcare utilization: privacy-sensitive studies from mobile data.

PubMed

White, Ryen; Horvitz, Eric

2013-01-01

We explore relationships between health information seeking activities and engagement with healthcare professionals via a privacy-sensitive analysis of geo-tagged data from mobile devices. We analyze logs of mobile interaction data stripped of individually identifiable information and location data. The data analyzed consist of time-stamped search queries and distances to medical care centers. We examine search activity that precedes the observation of salient evidence of healthcare utilization (EHU) (ie, data suggesting that the searcher is using healthcare resources), in our case taken as queries occurring at or near medical facilities. We show that the time between symptom searches and observation of salient evidence of seeking healthcare utilization depends on the acuity of symptoms. We construct statistical models that make predictions of forthcoming EHU based on observations about the current search session, prior medical search activities, and prior EHU. The predictive accuracy of the models varies (65%-90%) depending on the features used and the timeframe of the analysis, which we explore via a sensitivity analysis. We provide a privacy-sensitive analysis that can be used to generate insights about the pursuit of health information and healthcare. The findings demonstrate how large-scale studies of mobile devices can provide insights on how concerns about symptomatology lead to the pursuit of professional care. We present new methods for the analysis of mobile logs and describe a study that provides evidence about how people transition from mobile searches on symptoms and diseases to the pursuit of healthcare in the world.

Healthcare avoidance: a critical review.

PubMed

Byrne, Sharon K

2008-01-01

The purpose of this study is to provide a critical review and synthesis of theoretical and research literature documenting the impact of avoidance on healthcare behaviors, identify the factors that influence healthcare avoidance and delay in the adult population, and propose a direction for future research. The Theory of Reasoned Action, Theory of Planned Behavior, Theory of Care-Seeking Behavior, the Transtheoretical Model, and the Behavioral Model of Health Services Use/Utilization are utilized to elaborate on the context within which individual intention to engage in healthcare behaviors occurs. Research literature on the concept of healthcare avoidance obtained by using computerized searches of CINAHL, MEDLINE, PSYCH INFO, and HAPI databases, from 1995 to 2007, were reviewed. Studies were organized by professional disciplines. Healthcare avoidance is a common and highly variable experience. Multiple administrative, demographic, personal, and provider factors are related to healthcare avoidance, for example, distrust of providers and/or the science community, health beliefs, insurance status, or socioeconomic/income level. Although the concept is recognized by multiple disciplines, limited research studies address its impact on healthcare decision making. More systematic research is needed to determine correlates of healthcare avoidance. Such studies will help investigators identify patients at risk for avoidant behaviors and provide the basis for health-promoting interventions. Methodological challenges include identification of characteristics of individuals and environments that hinder healthcare behaviors, as well as, the complexity of measuring healthcare avoidance. Studies need to systematically explore the influence of avoidance behaviors on specific healthcare populations at risk.

Remembering Plurals: Unit of Coding and Form of Coding during Serial Recall.

ERIC Educational Resources Information Center

Van Der Molen, Hugo; Morton, John

1979-01-01

Adult females recalled lists of six words, including some plural nouns, presented visually in sequence. A frequent error was to detach the plural from its root. This supports a morpheme-based as opposed to a unitary word code. Evidence for a primarily phonological coding of the plural morpheme was obtained. (Author/RD)

On Plurality Category and Teaching in Turkish

ERIC Educational Resources Information Center

Alyilmaz, Semra

2017-01-01

When discussing about "plurality" of nouns in Turkish, it reminds /+lar/ affix after nouns (morpheme) and the subject is undervalued. Whereas, plurality and formation of plurality is not simple as it is thought as well as it is not made up of /+lar/ affix. It is because /+lar/ affix is only one of the linguistic elements in the…

Hardware compression using common portions of data

DOEpatents

Chang, Jichuan; Viswanathan, Krishnamurthy

2015-03-24

Methods and devices are provided for data compression. Data compression can include receiving a plurality of data chunks, sampling at least some of the plurality of data chunks extracting a common portion from a number of the plurality of data chunks based on the sampling, and storing a remainder of the plurality of data chunks in memory.

Educating beyond Cultural Diversity: Redrawing the Boundaries of a Democratic Plurality

ERIC Educational Resources Information Center

Todd, Sharon

2011-01-01

In this paper I draw some distinctions between the terms "cultural diversity" and "plurality" and argue that a radical conception of plurality is needed in order both to re-imagine the boundaries of democratic education and to address more fully the political aspects of conflict that plurality gives rise to. This paper begins…

Syntactic Fast Mapping: The Korean Extrinsic Plural Marker

ERIC Educational Resources Information Center

Kim, Chae-Eun; O'Grady, William; Deen, Kamil; Kim, Kitaek

2017-01-01

This article shows that the Korean Extrinsic Plural Marker (EPM) may be acquired by children on the basis of very little evidence. The EPM marks distributivity, unlike the Instrinsic Plural Marker, which marks plurality. Thirty monolingual learners of Korean aged 5;03 to 6;09 (mean age 6;01) were tested using a series of Truth Value Judgment Tasks…

Canonical and Epenthetic Plural Marking in Spanish-Speaking Children with Specific Language Impairment

ERIC Educational Resources Information Center

Grinstead, John; Cantu-Sanchez, Myriam; Flores-Avalos, Blanca

2008-01-01

In this study, we investigate whether specific language impairment (SLI) manifests itself grammatically in the same way in Spanish and English with respect to nominal plural marking. English-speaking children with SLI are very proficient at marking plural on nouns. Spanish has two main nominal plural allomorphs: /s/ and /es/. The /es/ allomorph…

High-density, fail-in-place switches for computer and data networks

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

Coteus, Paul W.; Doany, Fuad E.; Hall, Shawn A.

A structure for a network switch. The network switch may include a plurality of spine chips arranged on a plurality of spine cards, where one or more spine chips are located on each spine card; and a plurality of leaf chips arranged on a plurality of leaf cards, wherein one or more leaf chips are located on each leaf card, where each spine card is connected to every leaf chip and the plurality of spine chips are surrounded on at least two sides by leaf cards.

Microcomponent sheet architecture

DOEpatents

Wegeng, Robert S.; Drost, M. Kevin; McDonald, Carolyn E.

1997-01-01

The invention is a microcomponent sheet architecture wherein macroscale unit processes are performed by microscale components. The sheet architecture may be a single laminate with a plurality of separate microcomponent sections or the sheet architecture may be a plurality of laminates with one or more microcomponent sections on each laminate. Each microcomponent or plurality of like microcomponents perform at least one unit operation. A first laminate having a plurality of like first microcomponents is combined with at least a second laminate having a plurality of like second microcomponents thereby combining at least two unit operations to achieve a system operation.

Turbomachine combustor nozzle including a monolithic nozzle component and method of forming the same

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

Stoia, Lucas John; Melton, Patrick Benedict; Johnson, Thomas Edward

A turbomachine combustor nozzle includes a monolithic nozzle component having a plate element and a plurality of nozzle elements. Each of the plurality of nozzle elements includes a first end extending from the plate element to a second end. The plate element and plurality of nozzle elements are formed as a unitary component. A plate member is joined with the nozzle component. The plate member includes an outer edge that defines first and second surfaces and a plurality of openings extending between the first and second surfaces. The plurality of openings are configured and disposed to register with and receivemore » the second end of corresponding ones of the plurality of nozzle elements.« less

Optical profile determining apparatus and associated methods including the use of a plurality of wavelengths in the reference beam and a plurality of wavelengths in a reflective transit beam

NASA Technical Reports Server (NTRS)

Montgomery, Robert M. (Inventor)

2006-01-01

An optical profile determining apparatus includes an optical detector and an optical source. The optical source generates a transmit beam including a plurality of wavelengths, and generates a reference beam including the plurality of wavelengths. Optical elements direct the transmit beam to a target, direct a resulting reflected transmit beam back from the target to the optical detector, and combine the reference beam with the reflected transmit beam so that a profile of the target is based upon fringe contrast produced by the plurality of wavelengths in the reference beam and the plurality of wavelengths in the reflected transmit beam.

Temperature detection in a gas turbine

DOEpatents

Lacy, Benjamin; Kraemer, Gilbert; Stevenson, Christian

2012-12-18

A temperature detector includes a first metal and a second metal different from the first metal. The first metal includes a plurality of wires and the second metal includes a wire. The plurality of wires of the first metal are connected to the wire of the second metal in parallel junctions. Another temperature detector includes a plurality of resistance temperature detectors. The plurality of resistance temperature detectors are connected at a plurality of junctions. A method of detecting a temperature change of a component of a turbine includes providing a temperature detector include ing a first metal and a second metal different from the first metal connected to each other at a plurality of junctions in contact with the component; and detecting any voltage change at any junction.

Injector having multiple fuel pegs

DOEpatents

Hadley, Mark Allan; Felling, David Kenton

2013-04-30

A fuel injector is provided, including a fuel injector body, a plurality of fuel vanes, and a plurality of fuel pegs. The injector body includes a manifold and an inlet. The manifold is configured for receiving fuel, and the inlet is configured for receiving air. The fuel vanes are located within the injector body and are positioned in a direction that is generally parallel with a longitudinal axis of the injector body to orient the air flowing from the inlet. The plurality of fuel pegs are fluidly connected to the manifold and are arranged within the plurality of fuel vanes. The plurality of fuel pegs are each spaced at a distance that is about equal between each of the plurality of fuel pegs.

Method for detection of antibodies for metallic elements

DOEpatents

Barrick, C.W.; Clarke, S.M.; Nordin, C.W.

1993-11-30

An apparatus and method for detecting antibodies specific to non-protein antigens. The apparatus is an immunological plate containing a plurality of plastic projections coated with a non-protein material. Assays utilizing the plate are capable of stabilizing the non-protein antigens with detection levels for antibodies specific to the antigens on a nanogram level. A screening assay with the apparatus allows for early detection of exposure to non-protein materials. Specifically metallic elements are detected. 10 figures.

Load cell having strain gauges of arbitrary location

DOEpatents

Spletzer, Barry [Albuquerque, NM

2007-03-13

A load cell utilizes a plurality of strain gauges mounted upon the load cell body such that there are six independent load-strain relations. Load is determined by applying the inverse of a load-strain sensitivity matrix to a measured strain vector. The sensitivity matrix is determined by performing a multivariate regression technique on a set of known loads correlated to the resulting strains. Temperature compensation is achieved by configuring the strain gauges as co-located orthogonal pairs.

Wavelength independent interferometer

NASA Technical Reports Server (NTRS)

Hochberg, Eric B. (Inventor); Page, Norman A. (Inventor)

1991-01-01

A polychromatic interferometer utilizing a plurality of parabolic reflective surfaces to properly preserve the fidelity of light wavefronts irrespective of their wavelengths as they pass through the instrument is disclosed. A preferred embodiment of the invention utilizes an optical train which comprises three off-axis parabolas arranged in conjunction with a beam-splitter and a reference mirror to form a Twyman-Green interferometer. An illumination subsystem is provided and comprises a pair of lasers at different preselected wavelengths in the visible spectrum. The output light of the two lasers is coaxially combined by means of a plurality of reflectors and a grating beam combiner to form a single light source at the focal point of the first parabolic reflection surface which acts as a beam collimator for the rest of the optical train. By using visible light having two distinct wavelengths, the present invention provides a long equivalent wavelength interferogram which operates at visible light wherein the effective wavelength is equal to the product of the wavelengths of the two laser sources divided by their difference in wavelength. As a result, the invention provides the advantages of what amounts to long wavelength interferometry but without incurring the disadvantage of the negligible reflection coefficient of the human eye to long wavelength frequencies which would otherwise defeat any attempt to form an interferogram at that low frequency using only one light source.

Clinical risks and healthcare utilization of hematopoietic cell transplantation for sickle cell disease in the USA using merged databases

PubMed Central

Arnold, Staci D.; Brazauskas, Ruta; He, Naya; Li, Yimei; Aplenc, Richard; Jin, Zhezhen; Hall, Matt; Atsuta, Yoshiko; Dalal, Jignesh; Hahn, Theresa; Khera, Nandita; Bonfim, Carmem; Majhail, Navneet S.; Diaz, Miguel Angel; Freytes, Cesar O.; Wood, William A.; Savani, Bipin N.; Kamble, Rammurti T.; Parsons, Susan; Ahmed, Ibrahim; Sullivan, Keith; Beattie, Sara; Dandoy, Christopher; Munker, Reinhold; Marino, Susana; Bitan, Menachem; Abdel-Azim, Hisham; Aljurf, Mahmoud; Olsson, Richard F.; Joshi, Sarita; Buchbinder, Dave; Eckrich, Michael J.; Hashmi, Shahrukh; Lazarus, Hillard; Marks, David I.; Steinberg, Amir; Saad, Ayman; Gergis, Usama; Krishnamurti, Lakshmanan; Abraham, Allistair; Rangarajan, Hemalatha G.; Walters, Mark; Lipscomb, Joseph; Saber, Wael; Satwani, Prakash

2017-01-01

Advances in allogeneic hematopoietic cell transplantation for sickle cell disease have improved outcomes, but there is limited analysis of healthcare utilization in this setting. We hypothesized that, compared to late transplantation, early transplantation (at age <10 years) improves outcomes and decreases healthcare utilization. We performed a retrospective study of children transplanted for sickle cell disease in the USA during 2000–2013 using two large databases. Univariate and Cox models were used to estimate associations of demographics, sickle cell disease severity, and transplant-related variables with mortality and chronic graft-versus-host disease, while Wilcoxon, Kruskal-Wallis, or linear trend tests were applied for the estimates of healthcare utilization. Among 161 patients with a 2-year overall survival rate of 90% (95% confidence interval [CI] 85–95%) mortality was significantly higher in those who underwent late transplantation versus early (hazard ratio (HR) 21, 95% CI 2.8–160.8, P=0.003) and unrelated compared to matched sibling donor transplantation (HR 5.9, 95% CI 1.7–20.2, P=0.005). Chronic graftversus host disease was significantly more frequent among those translanted late (HR 1.9, 95% CI 1.0–3.5, P=0.034) and those who received an unrelated graft (HR 2.5, 95% CI 1.2–5.4; P=0.017). Merged data for 176 patients showed that the median total adjusted transplant cost per patient was $467,747 (range: $344,029–$799,219). Healthcare utilization was lower among recipients of matched sibling donor grafts and those with low severity disease compared to those with other types of donor and disease severity types (P<0.001 and P=0.022, respectively); no association was demonstrated with late transplantation (P=0.775). Among patients with 2-year pre- and post-transplant data (n=41), early transplantation was associated with significant reductions in admissions (P<0.001), length of stay (P<0.001), and cost (P=0.008). Early transplant outcomes need to be studied prospectively in young children without severe disease and an available matched sibling to provide conclusive evidence for the superiority of this approach. Reduced post-transplant healthcare utilization inpatient care indicates that transplantation may provide a sustained decrease in healthcare costs over time. PMID:28818869

Healthcare resource utilization and economic impact of a ≥2 g/dL decrease in hemoglobin in osteoarthritis patients.

PubMed

Goldstein, Jay L; Luo, Xuemei; Cappelleri, Joseph C; Sands, George H

2013-01-01

In non-steroidal anti-inflammatory drug (NSAID) users, chronic occult blood loss may lead to decreases in hemoglobin, which may lead to increased healthcare expenditures. This study, therefore, sought to quantify healthcare resource utilization of ≥2 g/dL hemoglobin decrease in osteoarthritis patients. Using a large US managed care database, osteoarthritis patients aged ≥18 years who had exposure to ≥90 days of non-selective or selective COX-2 NSAID use, a hemoglobin value within 6 months before index NSAID, and at least one hemoglobin value 24 months after were evaluated. Resource utilization was evaluated in those with ≥2 g/dL hemoglobin drop vs patients with ≤0.5 g/dL hemoglobin drop (control). Of 1800 NSAID users meeting inclusion criteria, 228 patients [mean (SD) = 59.8 (9.3) years] had ≥2 g/dL hemoglobin drop vs 1572 controls [mean (SD) = 58.3 (8.0) years]. Despite relatively low absolute rates, endoscopic procedures were more commonly observed in the ≥2 g/dL hemoglobin drop group [endoscopy: 37/228 (16.2%) vs 65/1572 (4.1%); adjusted odds ratio (AOR) 3.5, (95% confidence interval [CI] = 2.1-6.0); colonoscopy: 36/228 (15.8%) vs 137/1572 (8.7%); AOR 2.0 (95% CI 1.2-3.2)]. During the 12-month follow-up, patients with ≥2 g/dL hemoglobin drop utilized significantly more healthcare resources [adjusted relative risk (95% CI) for hospitalization, 2.1 (1.5-2.9); outpatient visits, 1.4 (1.3-1.5); physician visits, 1.3 (1.1-1.4)] and charges (total adjusted charges $47,766 vs $23,342) across major categories of healthcare services. This was a retrospective analysis with baseline demographic differences. The source or cause of the hemoglobin drops could not be verified; and it is assumed that they are related to occult gastrointestinal loss. Differences with healthcare utilization and charges were not linked to hemoglobin-associated complications. In patients exposed to NSAIDs, those with significant hemoglobin drops experienced higher subsequent healthcare utilization and charges than controls who did not have a significant hemoglobin drop.

Factors associated with maternal healthcare services utilization in nine high focus states in India: a multilevel analysis based on 14 385 communities in 292 districts.

PubMed

Singh, Prashant Kumar; Kumar, Chandan; Rai, Rajesh Kumar; Singh, Lucky

2014-08-01

Studies have often ignored examining the role of community- and district-level factors in the utilization of maternity healthcare services, particularly in Indian contexts. The Social Determinants of Health framework emphasizes the role of governance and government policies, the measures for which are rarely incorporated in single-level individual analysis. This study examines factors associated with maternal healthcare utilization in nine high focus states in India, which shares more than half of the total maternal deaths in the country; accounting for individual-, household-, community- and district-level characteristics. The required data are extracted from the third round of the nationally representative District Level Household and Facility Survey conducted during 2007-08. Multilevel analyses were applied to three maternity outcomes, namely, four or more antenatal care visits, skilled birth attendance and post-natal care after birth. Results show that along with individual-/household-level factors, community and district-level factors influence the pattern of utilization of maternal healthcare services significantly. At the community level, the odds of maternal healthcare utilization were lower in rural areas and in communities with a high concentration of poor and illiterate women. Moreover, the average population coverage of primary health centres (PHCs), availability of labour room in PHC and percentage of registered pregnancies were significant factors at the district level that influenced the use of maternity care services. The study also found a strong association between the extent of previous use of maternal healthcare and its effect on subsequent usage patterns. This study highlights the role of strengthening public health infrastructure at district level in the study area, and promoting awareness about available healthcare services and subsidized schemes in the community. To reach out to rural and underprivileged communities and to apply a participatory approach from the programme officials are issues to delve into. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

The relationship between health literacy with health status and healthcare utilization in 18-64 years old people in Isfahan.

PubMed

Karimi, Saeed; Keyvanara, Mahmoud; Hosseini, Mohsen; Jazi, Marzie Jafarian; Khorasani, Elahe

2014-01-01

Today, much attention has been paid to the patient role as the central factor in the management of their own health. It is focused on the issue that the patient has a more critical role compared with the health-care provider in controlling the patient own health. defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. The objective of this study was to determine health literacy, health status, healthcare utilization and the relationship between them in 18 - 64 years old people in Isfahan. This study was a descriptive analytical survey, which was conducted on 300 subjects of 18-64 years old in Isfahan with Multi-stage sampling method proportional to selected sample size. For collecting the data, questionnaire adapted from CHAP (Consumer Assessment of Healthcare Providers and Systems) health literacy questionnaire was used. Health status was measured based on an assessment of the physical and mental health over the past 6 months by 5° Likert scale. Data analysis was performed by using SPSS 18, descriptive statistics, Chi-square test and multivariate analysis of variance. There was no significant correlation between health literacy, health status and healthcare utilization. Utilization was less in the urban area No. 6 of the city. In the bachelor's degree group, the health status was lower than the other groups in these cases: Older ages, married, women, large family size, undergraduates, and urban area No. 14. Due to the average prevalence of health literacy in 18-64 years old individuals in Isfahan and low- healthcare utilization, the followings are recommended: Necessity of more attention to the issue of health literacy, improving the physician-patient relationship and community awareness, whether through health promotion programs or media for the optimum use of available resources.

The effect of Employee Assistance Programs use on healthcare utilization.

PubMed

Zarkin, G A; Bray, J W; Qi, J

2000-04-01

To estimate the effect of Employee Assistance Program (EAP) use on healthcare utilization as measured by health claims. A unique data set that combines individual-level information on EAP utilization, demographic information, and health insurance claims from 1991 to 1995 for all employees of a large midwestern employer. Using "fixed-effect" econometric models that control for unobserved differences between individuals' propensities to use healthcare resources and the EAP, we perform our analyses in two steps. First, for those employees who visited the EAP, we test whether post-EAP claims differ from pre-EAP claims. Second, we combine claims data of individuals who went to an EAP with those of individuals who did not use an EAP to test whether differences in utilization exist between EAP users and nonusers. From the EAP we obtained the date of first EAP contact for all employees who used the service, and from the company's human resources department we obtained limited demographic data on all employees. We obtained healthcare utilization claims data on all employees and their dependents from the company's two healthcare plans: a fee-for-service (FFS) plan and a health maintenance organization (HMO) plan. We found that going to an EAP substantially increases both the probability of an alcohol, drug abuse, or mental health (ADM) claim and the number of ADM claims in the same quarter as EAP contact. The increased probability of an ADM claim persists for approximately 11 quarters after the initial contact, while the increased ADM charges persist for approximately six quarters after the initial EAP contact. Our results strongly suggest that the EAP is able to identify behavioral and other health problems that may affect workplace performance and prompt EAP users to access ADM and other healthcare. Consistent with the stated goals of many EAPs, including the one examined in this study, this process should improve individuals' health, family functioning, and workplace performance.

The effect of Employee Assistance Programs use on healthcare utilization.

PubMed Central

Zarkin, G A; Bray, J W; Qi, J

2000-01-01

OBJECTIVE: To estimate the effect of Employee Assistance Program (EAP) use on healthcare utilization as measured by health claims. DATA SOURCES: A unique data set that combines individual-level information on EAP utilization, demographic information, and health insurance claims from 1991 to 1995 for all employees of a large midwestern employer. STUDY DESIGN: Using "fixed-effect" econometric models that control for unobserved differences between individuals' propensities to use healthcare resources and the EAP, we perform our analyses in two steps. First, for those employees who visited the EAP, we test whether post-EAP claims differ from pre-EAP claims. Second, we combine claims data of individuals who went to an EAP with those of individuals who did not use an EAP to test whether differences in utilization exist between EAP users and nonusers. DATA COLLECTION METHODS: From the EAP we obtained the date of first EAP contact for all employees who used the service, and from the company's human resources department we obtained limited demographic data on all employees. We obtained healthcare utilization claims data on all employees and their dependents from the company's two healthcare plans: a fee-for-service (FFS) plan and a health maintenance organization (HMO) plan. PRINCIPAL FINDINGS: We found that going to an EAP substantially increases both the probability of an alcohol, drug abuse, or mental health (ADM) claim and the number of ADM claims in the same quarter as EAP contact. The increased probability of an ADM claim persists for approximately 11 quarters after the initial contact, while the increased ADM charges persist for approximately six quarters after the initial EAP contact. CONCLUSIONS: Our results strongly suggest that the EAP is able to identify behavioral and other health problems that may affect workplace performance and prompt EAP users to access ADM and other healthcare. Consistent with the stated goals of many EAPs, including the one examined in this study, this process should improve individuals' health, family functioning, and workplace performance. PMID:10778825

The Link Between Everyday Discrimination, Healthcare Utilization, and Health Status Among a National Sample of Women.

PubMed

Fazeli Dehkordy, Soudabeh; Hall, Kelli S; Dalton, Vanessa K; Carlos, Ruth C

2016-10-01

Research has not adequately examined the potential negative effects of perceiving routine discrimination on general healthcare utilization or health status, especially among reproductive-aged women. We sought to evaluate the association between everyday discrimination, health service use, and perceived health among a national sample of women in the United States. Data were drawn from the Women's Healthcare Experiences and Preferences survey, a randomly selected, national probability sample of 1078 U.S. women aged 18-55 years. We examined associations between everyday discrimination (via a standardized scale) on frequency of health service utilization and perceived general health status using chi-square and multivariable logistic regression modeling. Compared with women who reported healthcare visits every 3 years or less (reference group), each one-point increase in discrimination score was associated with higher odds of having healthcare visits annually or more often (odds ratio [OR] = 1.36, confidence interval [95% CI] = 1.01-1.83). Additionally, each one-point increase in discrimination score was significantly associated with lower odds of having excellent/very good perceived health (OR = 0.65; 95% CI = 0.54-0.80). Perceived discrimination was associated with increased exposure to the healthcare setting among this national sample of women. Perceived discrimination was also inversely associated with excellent/very good perceived health status.

Healthcare cost differences with participation in a community-based group physical activity benefit for medicare managed care health plan members.

PubMed

Ackermann, Ronald T; Williams, Barbara; Nguyen, Huong Q; Berke, Ethan M; Maciejewski, Matthew L; LoGerfo, James P

2008-08-01

To determine whether participation in a physical activity benefit by Medicare managed care enrollees is associated with lower healthcare utilization and costs. Retrospective cohort study. Medicare managed care. A cohort of 1,188 older adult health maintenance organization enrollees who participated at least once in the EnhanceFitness (EF) physical activity benefit and a matched group of enrollees who never used the program. Healthcare costs and utilization were estimated. Ordinary least squares regression was used, adjusting for demographics, comorbidity, indicators of preventive service use, and baseline utilization or cost. Robustness of findings was tested in sensitivity analyses involving continuous propensity score adjustment and generalized linear models with nonconstant variance assumptions. EF participants had similar total healthcare costs during Year 1 of the program, but during Year 2, adjusted total costs were $1,186 lower (P=.005) than for non-EF users. Differences were partially attributable to lower inpatient costs (-$3,384; P=.02), which did not result from high-cost outliers. Enrollees who attended EF an average of one visit or more per week had lower adjusted total healthcare costs in Year 1 (-$1,929; P<.001) and Year 2 (-$1,784; P<.001) than nonusers. Health plan coverage of a preventive physical activity benefit for seniors is a promising strategy to avoid significant healthcare costs in the short term.

The Interpretation of Plural Morphology and (Non-)Obligatory Number Marking: An Argument from Artificial Language Learning

ERIC Educational Resources Information Center

Liter, Adam; Heffner, Christopher C.; Schmitt, Cristina

2017-01-01

We present an artificial language experiment investigating (i) how speakers of languages such as English with two-way obligatory distinctions between singular and plural learn a system where singular and plural are only optionally marked, and (ii) how learners extend their knowledge of the plural morpheme when under the scope of negation without…

Women's Healthcare Utilization Following Routine Screening for Past-Year Intimate Partner Violence in the Veterans Health Administration.

PubMed

Dichter, Melissa E; Sorrentino, Anneliese E; Haywood, Terri N; Bellamy, Scarlett L; Medvedeva, Elina; Roberts, Christopher B; Iverson, Katherine M

2018-06-01

Experience of intimate partner violence (IPV) can have adverse health impacts and has been associated with elevated rates of healthcare service utilization. Healthcare encounters present opportunities to identify IPV-related concerns and connect patients with services. The Veterans Health Administration (VHA) conducts IPV screening within an integrated healthcare system. The objectives of this study were to compare service utilization in the 6 months following IPV screening between those screening positive and negative for past-year IPV (IPV+, IPV-) and to examine the timing and types of healthcare services accessed among women screening IPV+. A retrospective chart review was conducted for 8888 female VHA patients across 13 VHA facilities who were screened for past-year IPV between April 2014 and April 2016. Demographic characteristics (age, race, ethnicity, marital status, veteran status), IPV screening response, and healthcare encounters (based on visit identification codes). In the 6 months following routine screening for past-year IPV, patients screening IPV+ were more likely to utilize outpatient care (aOR = 1.85 [CI 1.26, 2.70]), including primary care or psychosocial care, and to have an inpatient stay (aOR = 2.09 [CI 1.23, 3.57]), compared with patients screening IPV-. Among those with any utilization, frequency of outpatient encounters within the 6-month period following screening was higher among those screening IPV+ compared with those screening IPV-. The majority of patients screening positive for past-year IPV returned for an outpatient visit within a brief time frame following the screening visit (> 70% within 14 days, >95% within 6 months). More than one in four patients screening IPV+ had an emergency department visit within the 6 months following screening. Women who screen positive for past-year IPV have high rates of return to outpatient visits following screening, presenting opportunities for follow-up support. Higher rates of emergency department utilization and inpatient stays among women screening IPV+ may indicate adverse health outcomes related to IPV experience.

The effect of increasing the coinsurance rate on outpatient utilization of healthcare services in South Korea.

PubMed

Lee, Hyo Jung; Jang, Sung-In; Park, Eun-Cheol

2017-02-20

The Korean healthcare system is composed of costly and inefficient structures that fail to adequately divide the functions and roles of medical care organizations. To resolve this matter, the government reformed the cost-sharing policy in November of 2011 for the management of outpatients visiting general or tertiary hospitals with comparatively mild diseases. The purpose of the present study was to examine the impact of increasing the coinsurance rate of prescription drug costs for 52 mild diseases at general or tertiary hospitals on outpatient healthcare service utilization. The present study used health insurance claim data collected from 2010 to 2013. The study population consisted of 505,691 outpatients and was defined as those aged 20-64 years who had visited medical care organizations for the treatment of 52 diseases both before and after the program began. To examine the effect of the cost-sharing policy on outpatient healthcare service utilization (percentage of general or tertiary hospital utilization, number of outpatient visits, and outpatient medical costs), a segmented regression analysis was performed. After the policy to increase the coinsurance rate on prescription drug costs was implemented, the number of outpatient visits at general or tertiary hospitals decreased (β = -0.0114, p < 0.0001); however, the number increased at hospitals and clinics (β = 0.0580, p < 0.0001). Eventually, the number of outpatient visits to hospitals and clinics began to decrease after policy initiation (β = -0.0018, p < 0.0001). Outpatient medical costs decreased for both medical care organizations (general or tertiary hospitals: β = -2913.4, P < 0.0001; hospitals or clinics: β = -591.35, p < 0.0001), and this decreasing trend continued with time. It is not clear that decreased utilization of general or tertiary hospitals has transferred to that of clinics or hospitals due to the increased cost-sharing policy of prescription drug costs. This result indicates the cost-sharing policy, intended to change patient behaviors for healthcare service utilization, has had limited effects on rebuilding the healthcare system and the function of medical care organizations.

Healthcare resource utilization with ixazomib or placebo plus lenalidomide-dexamethasone in the randomized, double-blind, phase 3 TOURMALINE-MM1 study in relapsed/refractory multiple myeloma.

PubMed

Hari, Parameswaran; Lin, Huamao Mark; Zhu, Yanyan; Berg, Deborah; Richardson, Paul G; Moreau, Philippe

2018-05-29

The aim of this analysis was to assess healthcare resource utilization in the pivotal phase 3 TOURMALINE-MM1 study of the oral proteasome inhibitor ixazomib or placebo plus lenalidomide and dexamethasone (Rd) in relapsed and/or refractory multiple myeloma (RRMM). In this double-blind, placebo-controlled, randomized study (NCT01564537), 722 patients with RRMM following 1-3 prior lines of therapy received Rd plus ixazomib (ixazomib-Rd; n = 360) or matching placebo (placebo-Rd; n = 362) until disease progression or unacceptable toxicity. Healthcare resource utilization data were captured on Day 1 of each 28-day cycle, every 4 weeks during follow-up for progression-free survival, and every 12 weeks during subsequent follow-up, and included medical encounters (length of stay, inpatient, outpatient, and reason) and number of missing days from work or other activities for patients and caregivers. Exposure-adjusted rates of hospitalization were similar between the ixazomib-Rd and placebo-Rd arms, at 0.530 and 0.564 per patient year (ppy), respectively, as were outpatient visit rates (3.305 and 3.355 ppy). Mean length of hospitalization per patient was 10.0 and 10.8 days, respectively. In both arms, hospitalization and outpatient visit rates were higher in patients with two or three prior lines of treatment (ixazomib-Rd: 0.632 and 3.909 ppy; placebo-Rd: 0.774 and 3.539 ppy) compared with patients with one prior line (ixazomib-Rd: 0.460 and 2.888 ppy; placebo-Rd: 0.436 and 3.243 ppy). Patients and their caregivers who missed any work or other activity missed a median of 7 and 5 days in the ixazomib-Rd arm, respectively, vs 8 and 4 days with placebo-Rd. The study was not powered for a statistical comparison of healthcare resource utilization between treatment arms, nor did it capture costs associated with utilization of the identified healthcare resources. This pre-specified analysis demonstrated that the all-oral triplet regimen of ixazomib added to Rd did not increase healthcare resource utilization compared with placebo-Rd.

Low thermal stress ceramic turbine nozzle

DOEpatents

Glezer, Boris; Bagheri, Hamid; Fierstein, Aaron R.

1996-01-01

A turbine nozzle vane assembly having a preestablished rate of thermal expansion is positioned in a gas turbine engine and being attached to conventional metallic components. The metallic components having a preestablished rate of thermal expansion being greater than the preestablished rate of thermal expansion of the turbine nozzle vane assembly. The turbine nozzle vane assembly includes an outer shroud and an inner shroud having a plurality of vanes therebetween. Each of the plurality of vanes have a device for heating and cooling a portion of each of the plurality of vanes. Furthermore, the inner shroud has a plurality of bosses attached thereto. A cylindrical member has a plurality of grooves formed therein and each of the plurality of bosses are positioned in corresponding ones of the plurality of grooves. The turbine nozzle vane assembly provides an economical, reliable and effective ceramic component having a preestablished rate of thermal expansion being greater than the preestablished rate of thermal expansion of the other component.

Low thermal stress ceramic turbine nozzle

DOEpatents

Glezer, B.; Bagheri, H.; Fierstein, A.R.

1996-02-27

A turbine nozzle vane assembly having a preestablished rate of thermal expansion is positioned in a gas turbine engine and is attached to conventional metallic components, the metallic components having a preestablished rate of thermal expansion greater than the preestablished rate of thermal expansion of the turbine nozzle vane assembly. The turbine nozzle vane assembly includes an outer shroud and an inner shroud having a plurality of vanes there between. Each of the plurality of vanes have a device for heating and cooling a portion of each of the plurality of vanes. Furthermore, the inner shroud has a plurality of bosses attached thereto. A cylindrical member has a plurality of grooves formed therein and each of the plurality of bosses are positioned in corresponding ones of the plurality of grooves. The turbine nozzle vane assembly provides an economical, reliable and effective ceramic component having a preestablished rate of thermal expansion being greater than the preestablished rate of thermal expansion of the other component. 4 figs.

Shared performance monitor in a multiprocessor system

DOEpatents

Chiu, George; Gara, Alan G.; Salapura, Valentina

2012-07-24

A performance monitoring unit (PMU) and method for monitoring performance of events occurring in a multiprocessor system. The multiprocessor system comprises a plurality of processor devices units, each processor device for generating signals representing occurrences of events in the processor device, and, a single shared counter resource for performance monitoring. The performance monitor unit is shared by all processor cores in the multiprocessor system. The PMU comprises: a plurality of performance counters each for counting signals representing occurrences of events from one or more the plurality of processor units in the multiprocessor system; and, a plurality of input devices for receiving the event signals from one or more processor devices of the plurality of processor units, the plurality of input devices programmable to select event signals for receipt by one or more of the plurality of performance counters for counting, wherein the PMU is shared between multiple processing units, or within a group of processors in the multiprocessing system. The PMU is further programmed to monitor event signals issued from non-processor devices.

Apparatus and method for intra-layer modulation of the material deposition and assist beam and the multilayer structure produced therefrom

NASA Technical Reports Server (NTRS)

Wadley, Hadyn N. G. (Inventor); Zhou, Xiaowang (Inventor); Quan, Junjie (Inventor)

2002-01-01

A method of producing a multilayer structure that has reduced interfacial roughness and interlayer mixing by using a physical-vapor deposition apparatus. In general the method includes forming a bottom layer having a first material wherein a first plurality of monolayers of the first material is deposited on an underlayer using a low incident adatom energy. Next, a second plurality of monolayers of the first material is deposited on top of the first plurality of monolayers of the first material using a high incident adatom energy. Thereafter, the method further includes forming a second layer having a second material wherein a first plurality of monolayers of the second material is deposited on the second plurality of monolayers of the first material using a low incident adatom energy. Next, a second plurality of monolayers of the second material is deposited on the first plurality of monolayers of the second material using a high incident adatom energy.

Wedge edge ceramic combustor tile

DOEpatents

Shaffer, J.E.; Holsapple, A.C.

1997-06-10

A multipiece combustor has a portion thereof being made of a plurality of ceramic segments. Each of the plurality of ceramic segments have an outer surface and an inner surface. Each of the plurality of ceramic segments have a generally cylindrical configuration and including a plurality of joints. The joints define joint portions, a first portion defining a surface being skewed to the outer surface and the inner surface. The joint portions have a second portion defining a surface being skewed to the outer surface and the inner surface. The joint portions further include a shoulder formed intermediate the first portion and the second portion. The joints provide a sealing interlocking joint between corresponding ones of the plurality of ceramic segments. Thus, the multipiece combustor having the plurality of ceramic segment with the plurality of joints reduces the physical size of the individual components and the degradation of the surface of the ceramic components in a tensile stress zone is generally eliminated reducing the possibility of catastrophic failures. 7 figs.

Wedge edge ceramic combustor tile

DOEpatents

Shaffer, James E.; Holsapple, Allan C.

1997-01-01

A multipiece combustor has a portion thereof being made of a plurality of ceramic segments. Each of the plurality of ceramic segments have an outer surface and an inner surface. Each of the plurality of ceramic segments have a generally cylindrical configuration and including a plurality of joints. The joints define joint portions, a first portion defining a surface being skewed to the outer surface and the inner surface. The joint portions have a second portion defining a surface being skewed to the outer surface and the inner surface. The joint portions further include a shoulder formed intermediate the first portion and the second portion. The joints provide a sealing interlocking joint between corresponding ones of the plurality of ceramic segments. Thus, the multipiece combustor having the plurality of ceramic segment with the plurality of joints reduces the physical size of the individual components and the degradation of the surface of the ceramic components in a tensile stress zone is generally eliminated reducing the possibility of catastrophic failures.

Cloud object store for checkpoints of high performance computing applications using decoupling middleware

DOEpatents

Bent, John M.; Faibish, Sorin; Grider, Gary

2016-04-19

Cloud object storage is enabled for checkpoints of high performance computing applications using a middleware process. A plurality of files, such as checkpoint files, generated by a plurality of processes in a parallel computing system are stored by obtaining said plurality of files from said parallel computing system; converting said plurality of files to objects using a log structured file system middleware process; and providing said objects for storage in a cloud object storage system. The plurality of processes may run, for example, on a plurality of compute nodes. The log structured file system middleware process may be embodied, for example, as a Parallel Log-Structured File System (PLFS). The log structured file system middleware process optionally executes on a burst buffer node.

Insulation assembly for electric machine

DOEpatents

Rhoads, Frederick W.; Titmuss, David F.; Parish, Harold; Campbell, John D.

2013-10-15

An insulation assembly is provided that includes a generally annularly-shaped main body and at least two spaced-apart fingers extending radially inwards from the main body. The spaced-apart fingers define a gap between the fingers. A slot liner may be inserted within the gap. The main body may include a plurality of circumferentially distributed segments. Each one of the plurality of segments may be operatively connected to another of the plurality of segments to form the continuous main body. The slot liner may be formed as a single extruded piece defining a plurality of cavities. A plurality of conductors (extendable from the stator assembly) may be axially inserted within a respective one of the plurality of cavities. The insulation assembly electrically isolates the conductors in the electric motor from the stator stack and from other conductors.

Processor-in-memory-and-storage architecture

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

DeBenedictis, Erik

A method and apparatus for performing reliable general-purpose computing. Each sub-core of a plurality of sub-cores of a processor core processes a same instruction at a same time. A code analyzer receives a plurality of residues that represents a code word corresponding to the same instruction and an indication of whether the code word is a memory address code or a data code from the plurality of sub-cores. The code analyzer determines whether the plurality of residues are consistent or inconsistent. The code analyzer and the plurality of sub-cores perform a set of operations based on whether the code wordmore » is a memory address code or a data code and a determination of whether the plurality of residues are consistent or inconsistent.« less

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

Lacy, Benjamin Paul; Ziminsky, Willy Steve; Johnson, Thomas Edward

A turbomachine includes a compressor, a combustor operatively connected to the compressor, an end cover mounted to the combustor, and an injection nozzle assembly operatively connected to the combustor. The injection nozzle assembly includes a cap member having a first surface that extends to a second surface. The cap member further includes a plurality of openings. A plurality of bundled mini-tube assemblies are detachably mounted in the plurality of openings in the cap member. Each of the plurality of bundled mini-tube assemblies includes a main body section having a first end section and a second end section. A fluid plenummore » is arranged within the main body section. A plurality of tubes extend between the first and second end sections. Each of the plurality of tubes is fluidly connected to the fluid plenum.« less

Side Effects of CV Medications Following Hospitalization for ACS Are Associated With More Frequent Health-Care Contacts.

PubMed

Le, Rachel J; Cullen, Michael W; Lahr, Brian D; Wright, R Scott; Kopecky, Stephen L

2017-05-01

Patients hospitalized for first acute coronary syndrome (ACS) are frequently discharged on multiple new medications. The short-term tolerability of these medications is unknown. This single-center cohort study assessed 30-day health-care utilization and how it may be impacted by medication prescribing trends. We included Olmsted County patients presenting with ACS and previously undiagnosed coronary artery disease in 2008 to 2009. All health-care contacts were reviewed 30 days after index hospital discharge for potential adverse medication effects including documented hypotension or bradycardia, or symptoms likely attributed to the medications. The study included 86 patients; their mean age was 63 (standard deviation: 15.5 years). Antianginal or antihypertensive cardiovascular (CV) medications were prescribed to 98% of patients at discharge; 76% were prescribed 2 or more. There were 233 health-care contacts in 30 days; 90 (39%) of these contacts were unscheduled. More CV medications tended to be prescribed to patients with unscheduled contacts, both pre-ACS ( P = .045) and upon hospital discharge ( P = .051). Hypotension and/or bradycardia at follow-up occurred in 52 patients (60%). Surprisingly, there was no association between hypotension and/or bradycardia at follow-up and increased health-care utilization ( P = .12). Potential adverse drug effects were reported in 34 (40%) patients. These patients had significantly more total health-care contacts ( P < .001) and unscheduled health-care contacts (median 0 vs 1.5; P < .001). Symptoms of adverse drug effects were associated with more frequent health-care utilization after ACS. Clinicians need to consider this while striving to increase patient compliance with post-ACS medications and optimize care transitions.

Healthcare Barriers and Utilization Among Adolescents and Young Adults Accessing Services for Homeless and Runaway Youth.

PubMed

Chelvakumar, Gayathri; Ford, Nancy; Kapa, Hillary M; Lange, Hannah L H; McRee, Annie-Laurie; Bonny, Andrea E

2017-06-01

Homeless and runaway youth are at disproportionate risk for adverse health outcomes. Many barriers to accessing healthcare have been documented; however, the relative impact of discrete barriers on homeless youth healthcare utilization behavior is not firmly established. We administered a survey examining reported barriers and healthcare utilization among adolescents and young adults accessing services at three community centers for homeless and runaway youth. Of 180 respondents, 57 % were male, 80 % non-White, and 21 % identified as a sexual minority. Stepwise logistic regression models, controlling for age and study site, explored associations between barriers and 3 healthcare utilization outcomes (doctor visit in past 12 months; regular care provider; frequent emergency department (ED) visits). The most commonly reported barriers were "don't have a ride" (27.2 %), "no insurance" (23.3 %), and "costs too much" (22.8 %). All fear-based barriers (e.g., "I don't trust the doctors") were reported by <5 % of surveyed youth. Significant predictors of having seen a doctor in the past 12 months included sexual minority status (OR 2.8, p = 0.04) and possession of health insurance (OR 4.9, p < 0.001). Female sex (OR 5.2, p < 0.001) and reported external barriers other than health insurance (OR 0.2, p < 0.001) were associated with having a regular care provider. Fear-based concerns were associated (OR 3.8, p = 0.02) with frequent ED visits, as was being insured (OR 2.2, p = 0.03). These results underscore the need to clearly define healthcare outcomes when investigating barriers to care among homeless and runaway youth as the impact of discrete barriers varies depending on outcome of focus.

An analytical approach to determining the competitive advantage of TQM in health care.

PubMed

Yasin, M M; Alavi, J

1999-01-01

The utilization of total quality management (TQM) is advocated by some experts, as a partial remedy to the ills of the healthcare industry. However, some healthcare administrators are not yet sold on TQM. Some healthcare administrators still question the impact of TQM on the operational, financial and strategic health of their institutions. They consider the investment in TQM as unjustifiable because the return on such investment in their mind is questionable. This study illustrates how the constant market share model can be utilized to show the competitive benefits of TQM. Based on the results of this study, it is concluded that the fears of some healthcare administrators are unfounded. Not only that TQM does not compromise organizational effectiveness, but it actually improves it, as it contributes to increasing market share.

Meta-structure and tunable optical device including the same

DOEpatents

Han, Seunghoon; Papadakis, Georgia Theano; Atwater, Harry

2017-12-26

A meta-structure and a tunable optical device including the same are provided. The meta-structure includes a plurality of metal layers spaced apart from one another, an active layer spaced apart from the plurality of metal layers and having a carrier concentration that is tuned according to an electric signal applied to the active layer and the plurality of metal layers, and a plurality of dielectric layers spaced apart from one another and each having one surface contacting a metal layer among the plurality of metal layers and another surface contacting the active layer.

Microcomponent chemical process sheet architecture

DOEpatents

Wegeng, Robert S.; Drost, M. Kevin; Call, Charles J.; Birmingham, Joseph G.; McDonald, Carolyn Evans; Kurath, Dean E.; Friedrich, Michele

1998-01-01

The invention is a microcomponent sheet architecture wherein macroscale unit processes are performed by microscale components. The sheet architecture may be a single laminate with a plurality of separate microcomponent sections or the sheet architecture may be a plurality of laminates with one or more microcomponent sections on each laminate. Each microcomponent or plurality of like microcomponents perform at least one chemical process unit operation. A first laminate having a plurality of like first microcomponents is combined with at least a second laminate having a plurality of like second microcomponents thereby combining at least two unit operations to achieve a system operation.

Microcomponent sheet architecture

DOEpatents

Wegeng, R.S.; Drost, M.K..; McDonald, C.E.

1997-03-18

The invention is a microcomponent sheet architecture wherein macroscale unit processes are performed by microscale components. The sheet architecture may be a single laminate with a plurality of separate microcomponent sections or the sheet architecture may be a plurality of laminates with one or more microcomponent sections on each laminate. Each microcomponent or plurality of like microcomponents perform at least one unit operation. A first laminate having a plurality of like first microcomponents is combined with at least a second laminate having a plurality of like second microcomponents thereby combining at least two unit operations to achieve a system operation. 14 figs.

Microcomponent chemical process sheet architecture

DOEpatents

Wegeng, R.S.; Drost, M.K.; Call, C.J.; Birmingham, J.G.; McDonald, C.E.; Kurath, D.E.; Friedrich, M.

1998-09-22

The invention is a microcomponent sheet architecture wherein macroscale unit processes are performed by microscale components. The sheet architecture may be a single laminate with a plurality of separate microcomponent sections or the sheet architecture may be a plurality of laminates with one or more microcomponent sections on each laminate. Each microcomponent or plurality of like microcomponents perform at least one chemical process unit operation. A first laminate having a plurality of like first microcomponents is combined with at least a second laminate having a plurality of like second microcomponents thereby combining at least two unit operations to achieve a system operation. 26 figs.

The impact of healthcare-associated methicillin-resistant Staphylococcus aureus infections on post-discharge healthcare costs and utilization.

PubMed

Nelson, Richard E; Jones, Makoto; Liu, Chuan-Fen; Samore, Matthew H; Evans, Martin E; Graves, Nicholas; Lee, Bruce; Rubin, Michael A

2015-05-01

Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) infections are a major cause of morbidity, mortality, and cost among hospitalized patients. Little is known about their impact on post-discharge resource utilization. The purpose of this study was to estimate post-discharge healthcare costs and utilization attributable to positive MRSA cultures during a hospitalization. Our study cohort consisted of patients with an inpatient admission lasting longer than 48 hours within the US Department of Veterans Affairs (VA) system between October 1, 2007, and November 30, 2010. Of these patients, we identified those with a positive MRSA culture from microbiology reports in the VA electronic medical record. We used propensity score matching and multivariable regression models to assess the impact of positive culture on post-discharge outpatient, inpatient, and pharmacy costs and utilization in the 365 days following discharge. Our full cohort included 369,743 inpatients, of whom, 3,599 (1.0%) had positive MRSA cultures. Our final analysis sample included 3,592 matched patients with and without positive cultures. We found that, in the 12 months following hospital discharge, having a positive culture resulted in increases in post-discharge pharmacy costs ($776, P<.0001) and inpatient costs ($12,167, P<.0001). Likewise, having a positive culture increased the risk of a readmission (odds ratio [OR]=1.396, P<.0001), the number of prescriptions (incidence rate ratio [IRR], 1.138; P<.0001) and the number of inpatient days (IRR, 1.204; P<.0001,) but decreased the number of subsequent outpatient encounters (IRR, 0.941; P<.008). The results of this study indicate that MRSA infections are associated with higher levels of post-discharge healthcare cost and utilization. These findings indicate that financial benefits resulting from infection prevention efforts may extend beyond the initial hospital stay.

Food insecurity and low self-efficacy are associated with increased healthcare utilization among adults with type II diabetes mellitus.

PubMed

Becerra, Monideepa B; Allen, Nickolas L; Becerra, Benjamin J

Food insecurity has been shown to negatively impact health outcomes, disease management and hospitalizations. Despite the increasing burden of type II diabetes mellitus (T2DM) in the United States, little research exists on the role of food insecurity and its association to T2DM-related healthcare utilization. The purpose of our study was to address such a gap in the literature by evaluating the role of food insecurity and T2DM-related past 12-month hospitalization or emergency department (ED) admission among adults with healthcare professional diagnosed T2DM. We utilized the California Health Interview Survey (CHIS), 2009, 2011/2012 data to select CHIS participants who were aged 18 or older and reported doctor diagnosis of T2DM; resulting in a total of 8252 participants. Food insecurity was defined as: living at or above 200% federal poverty level (FPL), living below 200% FPL but food secure, living below 200% FPL and food insecure. A secondary exposure variable of interest was self-efficacy, based on the CHIS-provided variable of confidence to manage T2DM. All analyses were survey weighted with alpha less than .05 noting significance. Those with low food security (12.96%) and low-self efficacy (15.14%), reported significantly higher prevalence of T2DM-related healthcare utilization, as compared to their counterparts. Both living with low food security and having low self-efficacy were also associated with over two-fold increase in healthcare utilization. Our results demonstrate the cumulative need for community-based resources to improve the continuum of care and ensure that such at-risk populations have adequate resources for disease management. Copyright © 2016 Elsevier Inc. All rights reserved.

Real-world health outcomes in adults with moderate-to-severe psoriasis in the United States: a population study using electronic health records to examine patient-perceived treatment effectiveness, medication use, and healthcare resource utilization.

PubMed

Armstrong, April W; Foster, Shonda A; Comer, Brian S; Lin, Chen-Yen; Malatestinic, William; Burge, Russel; Goldblum, Orin

2018-06-28

Little is known regarding real-world health outcomes data among US psoriasis patients, but electronic health records (EHR) that collect structured data at point-of-care may provide opportunities to investigate real-world health outcomes among psoriasis patients. Our objective was to investigate patient-perceived treatment effectiveness, patterns of medication use (duration, switching, and/or discontinuation), healthcare resource utilization, and medication costs using real-world data from psoriasis patients. Data for adults (≥18-years) with a dermatology provider-given diagnosis of psoriasis from 9/2014-9/2015 were obtained from dermatology practices using a widely used US dermatology-specific EHR containing over 500,000 psoriasis patients. Disease severity was captured by static physician's global assessment and body surface area. Patient-perceived treatment effectiveness was assessed by a pre-defined question. Treatment switching and duration were documented. Reasons for discontinuations were assessed using pre-defined selections. Healthcare resource utilization was defined by visit frequency and complexity. From 82,621 patients with psoriasis during the study period, patient-perceived treatment effectiveness was investigated in 2200 patients. The proportion of patients reporting "strongly agree" when asked if their treatment was effective was highest for biologics (73%) and those reporting treatment adherence (55%). In 16,000 patients who received oral systemics and 21,087 patients who received biologics, median treatment duration was longer for those who received biologics (160 vs. 113 days, respectively). Treatment switching was less frequent among patients on systemic monotherapies compared to those on combination therapies. The most common reason for discontinuing biologics was loss of efficacy; the most common reason for discontinuing orals was side effects. In 28,754 patients, higher disease severity was associated with increased healthcare resource utilization (increased visit frequency and complexity). When compared between treatment groups (n = 10,454), healthcare resource utilization was highest for phototherapy. Annual medication costs were higher for biologics ($21,977) than oral systemics ($3413). Real-world research using a widely implemented dermatology EHR provided valuable insights on patient perceived treatment effectiveness, patterns of medication usage, healthcare resource utilization, and medication costs for psoriasis patients in the US. This study and others utilizing EHRs for real-world research may assist clinical and payer decisions regarding the management of psoriasis.

Gas cooled traction drive inverter

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

Chinthavali, Madhu Sudhan

The present invention provides a modular circuit card configuration for distributing heat among a plurality of circuit cards. Each circuit card includes a housing adapted to dissipate heat in response to gas flow over the housing. In one aspect, a gas-cooled inverter includes a plurality of inverter circuit cards, and a plurality of circuit card housings, each of which encloses one of the plurality of inverter cards.

Method for wiring allocation and switch configuration in a multiprocessor environment

DOEpatents

Aridor, Yariv [Zichron Ya'akov, IL; Domany, Tamar [Kiryat Tivon, IL; Frachtenberg, Eitan [Jerusalem, IL; Gal, Yoav [Haifa, IL; Shmueli, Edi [Haifa, IL; Stockmeyer, legal representative, Robert E.; Stockmeyer, Larry Joseph [San Jose, CA

2008-07-15

A method for wiring allocation and switch configuration in a multiprocessor computer, the method including employing depth-first tree traversal to determine a plurality of paths among a plurality of processing elements allocated to a job along a plurality of switches and wires in a plurality of D-lines, and selecting one of the paths in accordance with at least one selection criterion.

Gas cooled traction drive inverter

DOEpatents

Chinthavali, Madhu Sudhan

2013-10-08

The present invention provides a modular circuit card configuration for distributing heat among a plurality of circuit cards. Each circuit card includes a housing adapted to dissipate heat in response to gas flow over the housing. In one aspect, a gas-cooled inverter includes a plurality of inverter circuit cards, and a plurality of circuit card housings, each of which encloses one of the plurality of inverter cards.

Using Smart City Technology to Make Healthcare Smarter.

PubMed

Cook, Diane J; Duncan, Glen; Sprint, Gina; Fritz, Roschelle

2018-04-01

Smart cities use information and communication technologies (ICT) to scale services include utilities and transportation to a growing population. In this article we discuss how smart city ICT can also improve healthcare effectiveness and lower healthcare cost for smart city residents. We survey current literature and introduce original research to offer an overview of how smart city infrastructure supports strategic healthcare using both mobile and ambient sensors combined with machine learning. Finally, we consider challenges that will be faced as healthcare providers make use of these opportunities.

From web search to healthcare utilization: privacy-sensitive studies from mobile data

PubMed Central

Horvitz, Eric

2013-01-01

Objective We explore relationships between health information seeking activities and engagement with healthcare professionals via a privacy-sensitive analysis of geo-tagged data from mobile devices. Materials and methods We analyze logs of mobile interaction data stripped of individually identifiable information and location data. The data analyzed consist of time-stamped search queries and distances to medical care centers. We examine search activity that precedes the observation of salient evidence of healthcare utilization (EHU) (ie, data suggesting that the searcher is using healthcare resources), in our case taken as queries occurring at or near medical facilities. Results We show that the time between symptom searches and observation of salient evidence of seeking healthcare utilization depends on the acuity of symptoms. We construct statistical models that make predictions of forthcoming EHU based on observations about the current search session, prior medical search activities, and prior EHU. The predictive accuracy of the models varies (65%–90%) depending on the features used and the timeframe of the analysis, which we explore via a sensitivity analysis. Discussion We provide a privacy-sensitive analysis that can be used to generate insights about the pursuit of health information and healthcare. The findings demonstrate how large-scale studies of mobile devices can provide insights on how concerns about symptomatology lead to the pursuit of professional care. Conclusion We present new methods for the analysis of mobile logs and describe a study that provides evidence about how people transition from mobile searches on symptoms and diseases to the pursuit of healthcare in the world. PMID:22661560

The use of reproductive healthcare at commune health stations in a changing health system in Vietnam.

PubMed

Ngo, Anh D; Hill, Peter S

2011-09-27

With health sector reform in Vietnam moving towards greater pluralism, commune health stations (CHSs) have been subject to growing competition from private health services and increasing numbers of patients bypassing CHSs for higher-level health facilities. This study describes the pattern of reproductive health (RH) and family planning (FP) service utilization among women at CHSs and other health facilities, and explores socio-demographic determinants of RH service utilization at the CHS level. This study was based on a cross-sectional survey conducted in Thua Thien Hue and Vinh Long provinces, using a multi-stage cluster sampling technique. Questionnaire-based interviews with 978 ever-married women at reproductive age provided data on socio-demographic characteristics, current use of FP methods, history of RH service use, and the health facility attended for their most recent services. Multiple logistic regression analyses were used to identify socio-demographic determinants of their use of CHS RH services. Eighty nine percent of ever-married women reported current use of birth control with 49% choosing intra-uterine device (IUD). Eighty nine percent of pregnant women attended facility-based antenatal care (ANC) with 62% having at least 3 check-ups during their latest pregnancy. Ninety one percent of mothers had their last delivery in a health facility. Seventy-one percent of respondents used CHS for IUD insertion, 55% for antenatal check-ups, and 77% gynecological examination. District and provincial/central hospitals dominated the provision of delivery service, used by 57% of mothers for their latest delivery. The percentage of women opting for private ANC services was reported at 35%, though the use of private delivery services was low (11%). Women who were farmers, earning a lower income, having more than 2 children, and living in a rural area were more likely than others to use ANC, delivery, and/or gynecological check-up services at the CHS. Women choice of providers for FP and RH services that help them plan and protect their pregnancies is driven by socio-economic factors. While the CHS retains significant utilization rates, it is under challenge by preferences for hospital-based delivery and the growing use of private ANC services.

Good relations with technology: Empirical ethics and aesthetics in care.

PubMed

Pols, Jeannette

2017-01-01

This article is a written version of the lecture for the IPONS conference in Stockholm. The article starts from the claim that there is no such thing as technology, only different variations of technologies. These technologies, plural, all have their specific workings that we can only learn about by studying these empirically, by analysing the relations between people and their technologies. These relations are always unpredictable, as it is not given beforehand what values the participants pursue. Studying and understanding the workings of healthcare technology is a crucial task for nursing studies, as nurses are often key actors in making these devices work. The article hands the reader some tools to engage in the study of technologies in practice, using an empirical ethics approach. © 2016 John Wiley & Sons Ltd.

Wealth from Health: an incentive program for disease and population management: a 12-year project.

PubMed

Ratner, D; Louria, D; Sheffet, A; Fain, R; Curran, J; Saed, N; Bhaskar, S; Quereshi, M; Cable, G

2001-01-01

The future of healthcare is linked with its ability to face the challenges of consumerism. Disease and population management will represent the dominant style of healthcare delivery in the future. This article describes the Wealth from Health programs which utilize current and future technologies to help the healthcare system become a leader in healthcare delivery and to assist many communities at an affordable cost.

Explaining public satisfaction with health-care systems: findings from a nationwide survey in China.

PubMed

Munro, Neil; Duckett, Jane

2016-06-01

To identify factors associated with health-care system satisfaction in China. Recent research suggests that socio-demographic characteristics, self-reported health, income and insurance, ideological beliefs, health-care utilization, media use and perceptions of services may affect health-care system satisfaction, but the relative importance of these factors is poorly understood. New data from China offer the opportunity to test theories about the sources of health-care system satisfaction. Stratified nationwide survey sample analysed using multilevel logistic regression. 3680 Chinese adults residing in family dwellings between 1 November 2012 and 17 January 2013. Satisfaction with the way the health-care system in China is run. We find only weak associations between satisfaction and socio-demographic characteristics, self-reported health and income. We do, however, find that satisfaction is strongly associated with having insurance and belief in personal responsibility for meeting health-care costs. We also find it is negatively associated with utilization, social media use, perceptions of access as unequal and perceptions of service providers as unethical. To improve satisfaction, Chinese policymakers - and their counterparts in countries with similar health-care system characteristics - should improve insurance coverage and the quality of health services, and tackle unethical medical practices. © 2015 The Authors. Health Expectations published by John Wiley & Sons Ltd.

Utilization patterns of insulin therapy and healthcare services among Japanese insulin initiators during their first year: a descriptive analysis of administrative hospital data.

PubMed

Ikeda, Shunya; Crawford, Bruce; Sato, Masayo

2016-01-12

Type 2 diabetes poses an increasing healthcare burden in Japan. Although insulin treatment has diversified in recent years, the literature on the utilization of healthcare services among patients with type 2 diabetes undergoing different insulin therapy regimens is scarce. The current study aimed to characterize the real-world insulin treatment patterns and associated utilization of healthcare services among patients with type 2 diabetes who initiated insulin therapy during the study period. We examined data from a hospital-based database consisting of administrative and laboratory data from 121 acute-phase hospitals throughout Japan from April 2008 to August 2012. Patients diagnosed with type 2 diabetes and receiving continuous insulin therapy, defined by three insulin claims or more, were included in the analysis. Of the 2,145 insulin initiators, at initiation 46.5% received rapid-acting insulin alone, 36.6% received an intensive regimen, 11.4% received long-acting insulin alone, and 5.5% received pre-mixed insulin alone. Patients treated with rapid-acting insulin alone were older, experienced more comorbid conditions, had lower HbA1c, and more often had initiated their insulin treatment at inpatient admission, compared to patients treated with other types of insulin. Inpatient admission was more common and longer for patients taking rapid-acting insulin and an intensive regimen than those taking long-acting or pre-mixed insulin, and most were readmitted within 1 year. Utilization of outpatient clinics was approximately once per month, and emergency department visits were observed to be rare. This retrospective observational descriptive study found varied treatment and healthcare service utilization patterns, as well as disparities in patient characteristics across insulin regimens. Future research should assess the basis for these various utilization patterns associated with insulin to conduct robust analyses of clinical and economic outcomes.

Comparison of Healthcare Utilization Among Patients Treated With Alcoholism Medications

PubMed Central

Mark, Tami L.; Montejano, Leslie B.; Kranzler, Henry R.; Chalk, Mady; Gastfriend, David R.

2014-01-01

Objectives To determine in a large claims database the healthcare utilization and costs associated with treatment of alcohol dependence with medications vs no medication and across 4 US Food and Drug Administration (FDA)–approved medications. Study Design Claims database analysis. Methods Eligible adults with alcohol dependence claims (n = 27,135) were identified in a commercial database (MarketScan; Thomson Reuters Inc, Chicago, Illinois). Following propensity score–based matching and inverse probability weighting on demographic, clinical, and healthcare utilization variables, patients who had used an FDA-approved medication for alcohol dependence (n = 2977) were compared with patients who had not (n = 2977). Patients treated with oral naltrexone hydrochloride (n = 2064), oral disulfiram (n = 2076), oral acamprosate calcium (n = 5068), or extended-release injectable naltrexone (naltrexone XR) (n = 295) were also compared for 6-month utilization rates of alcoholism medication, inpatient detoxification days, alcoholism-related inpatient days, and outpatient services, as well as inpatient charges. Results Patients who received alcoholism medications had fewer inpatient detoxification days (706 vs 1163 days per 1000 patients, P <.001), alcoholism-related inpatient days (650 vs 1086 days, P <.001), and alcoholism-related emergency department visits (127 vs 171, P = .005). Among 4 medications, the use of naltrexone XR was associated with fewer inpatient detoxification days (224 days per 1000 patients) than the use of oral naltrexone (552 days, P = .001), disulfiram (403 days, P = .049), or acamprosate (525 days, P <.001). The group receiving naltrexone XR also had fewer alcoholism-related inpatient days than the groups receiving disulfiram or acamprosate. More patients in the naltrexone XR group had an outpatient substance abuse visit compared with patients in the oral alcoholism medication groups. Conclusion Patients who received an alcoholism medication had lower healthcare utilization than patients who did not. Naltrexone XR showed an advantage over oral medications in healthcare utilization and costs. PMID:21348558

Insulation Materials Comprising Fibers Having a Partially Cured Polymer Coating Thereon, Articles Including Such Insulation Materials, and Methods of Forming Such Materials and Articles

NASA Technical Reports Server (NTRS)

Morgan, Richard E. (Inventor); Meeks, Craig L. (Inventor)

2017-01-01

Insulation materials have a coating of a partially cured polymer on a plurality of fibers, and the plurality of coated fibers in a cross-linked polymeric matrix. Insulation may be formed by applying a preceramic polymer to a plurality of fibers, heating the preceramic polymer to form a partially cured polymer over at least portions of the plurality of fibers, disposing the plurality of fibers in a polymeric material, and curing the polymeric material. A rocket motor may be formed by disposing a plurality of coated fibers in an insulation precursor, curing the insulation precursor to form an insulation material without sintering the partially cured polymer, and providing an energetic material over the polymeric material. An article includes an insulation material over at least one surface.

Cloud object store for archive storage of high performance computing data using decoupling middleware

DOEpatents

Bent, John M.; Faibish, Sorin; Grider, Gary

2015-06-30

Cloud object storage is enabled for archived data, such as checkpoints and results, of high performance computing applications using a middleware process. A plurality of archived files, such as checkpoint files and results, generated by a plurality of processes in a parallel computing system are stored by obtaining the plurality of archived files from the parallel computing system; converting the plurality of archived files to objects using a log structured file system middleware process; and providing the objects for storage in a cloud object storage system. The plurality of processes may run, for example, on a plurality of compute nodes. The log structured file system middleware process may be embodied, for example, as a Parallel Log-Structured File System (PLFS). The log structured file system middleware process optionally executes on a burst buffer node.

Taxel-addressable matrix of vertical nanowire piezotronic transistors

DOEpatents

Wang, Zhong Lin; Wu, Wenzhuo; Wen, Xiaonan

2015-05-05

A tactile sensing matrix includes a substrate, a first plurality of elongated electrode structures, a plurality of vertically aligned piezoelectric members, an insulating layer infused into the piezoelectric members and a second plurality of elongated electrode structures. The first plurality of elongated electrode structures is disposed on the substrate along a first orientation. The vertically aligned piezoelectric members is disposed on the first plurality of elongated electrode structures and form a matrix having columns of piezoelectric members disposed along the first orientation and rows of piezoelectric members disposed along a second orientation that is transverse to the first orientation. The second plurality of elongated electrode structures is disposed on the insulating layer along the second orientation. The elongated electrode structures form a Schottky contact with the piezoelectric members. When pressure is applied to the piezoelectric members, current flow therethrough is modulated.

Solar panel truss mounting systems and methods

DOEpatents

Al-Haddad, Tristan Farris; Cavieres, Andres; Gentry, Russell; Goodman, Joseph; Nolan, Wade; Pitelka, Taylor; Rahimzadeh, Keyan; Brooks, Bradley; Lohr, Joshua; Crooks, Ryan; Porges, Jamie; Rubin, Daniel

2015-10-20

An exemplary embodiment of the present invention provides a solar panel truss mounting system comprising a base and a truss assembly coupled to the base. The truss assembly comprises a first panel rail mount, second panel rail mount parallel to the first panel rail mount, base rail mount parallel to the first and second panel rail mounts, and a plurality of support members. A first portion of the plurality of support members extends between the first and second panel rail mounts. A second portion of the plurality of support members extends between the first panel rail mount and the base rail mount. A third portion of the plurality of support members extends between the second panel rail mount and the base rail mount. The system can further comprise a plurality of connectors for coupling a plurality of photovoltaic solar panels to the truss assembly.

Solar panel truss mounting systems and methods

DOEpatents

Al-Haddad, Tristan Farris; Cavieres, Andres; Gentry, Russell; Goodman, Joseph; Nolan, Wade; Pitelka, Taylor; Rahimzadeh, Keyan; Brooks, Bradley; Lohr, Joshua; Crooks, Ryan; Porges, Jamie; Rubin, Daniel

2016-06-28

An exemplary embodiment of the present invention provides a solar panel truss mounting system comprising a base and a truss assembly coupled to the base. The truss assembly comprises a first panel rail mount, second panel rail mount parallel to the first panel rail mount, base rail mount parallel to the first and second panel rail mounts, and a plurality of support members. A first portion of the plurality of support members extends between the first and second panel rail mounts. A second portion of the plurality of support members extends between the first panel rail mount and the base rail mount. A third portion of the plurality of support members extends between the second panel rail mount and the base rail mount. The system can further comprise a plurality of connectors for coupling a plurality of photovoltaic solar panels to the truss assembly.

OLED panel with fuses

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

Levermore, Levermore; Pang, Huiqing; Rajan, Kamala

2014-09-16

Embodiments may provide a first device that may comprise a substrate, a plurality of conductive bus lines disposed over the substrate, and a plurality of OLED circuit elements disposed on the substrate, where each of the OLED circuit elements comprises one and only one pixel electrically connected in series with a fuse. Each pixel may further comprise a first electrode, a second electrode, and an organic electroluminescent (EL) material disposed between the first and the second electrodes. The fuse of each of the plurality of OLED circuit elements may electrically connect each of the OLED circuit elements to at leastmore » one of the plurality of bus lines. Each of the plurality of bus lines may be electrically connected to a plurality of OLED circuit elements that are commonly addressable and at least two of the bus lines may be separately addressable.« less

Method and apparatus for a multibeam beacon laser assembly for optical communications

NASA Technical Reports Server (NTRS)

Biswas, Abhijit (Inventor); Sanji, Babak (Inventor); Wright, Malcolm W. (Inventor); Page, Norman Alan (Inventor)

2005-01-01

An optical beacon is comprised of a telescope having a primary focal plane or Coud? focal plane, a plurality of fiber coupled laser sources for generating a plurality of beams, a collimator for collimating the plurality of beams, and optics for combining and focusing the plurality of collimated beams onto the primary or Coud? focal plane of the telescope. The telescope propagates the optical beacon, which is arranged into a ring of incoherent plurality of collimated beams. The apparatus further comprises fiber splitters coupled to each laser source to provide at least eight beams from at least four laser sources. The optics comprises a prism assembly, a combiner lens, a focusing lens and a field lens for focusing the plurality of collimated beams onto the primary focal plane or Coud? focal plane of the telescope.

Beyond medical pluralism: characterising health-care delivery of biomedicine and traditional medicine in rural Guatemala.

PubMed

Hoyler, Elizabeth; Martinez, Roxana; Mehta, Kurren; Nisonoff, Hunter; Boyd, David

2018-04-01

Although approximately one half of Guatemalans are indigenous, the Guatemalan Maya account for 72% of the extremely poor within the country. While some biomedical services are available in these communities, many Maya utilise traditional medicine as a significant, if not primary, source of health care. While existing medical anthropological research characterises these modes of medicine as medically dichotomous or pluralistic, our research in a Maya community of the Western Highlands, Concepción Huista, builds on previous studies and finds instead a syncretistic, imbricated local health system. We find significant overlap and interpenetration of the biomedical and traditional medical models that are described best as a framework where practitioners in both settings employ elements of the other in order to best meet community needs. By focusing on the practitioner's perspective, we demonstrate that in addition to patients' willingness to seek care across health systems, practitioners converse across seemingly distinct systems via incorporation of certain elements of the 'other'. Interventions to date have not accounted for this imbrication. Guatemalan governmental policies to support local healers have led to little practical change in the health-care landscape of the country. Therefore, understanding this complex imbrication is crucial for interventions and policy changes.

At the margins of biomedicine: the ambiguous position of 'Registered Medical Practitioners' in rural Indian healthcare.

PubMed

Nahar, Papreen; Kannuri, Nanda Kishore; Mikkilineni, Sitamma; Murthy, G V S; Phillimore, Peter

2017-05-01

This analysis challenges a tendency in public health and the social sciences to associate India's medical pluralism with a distinction between biomedicine, as a homogeneous entity, and its non-biomedical 'others'. We argue that this overdrawn dichotomy obscures the important part played by 'informal' biomedical practice, an issue with salience well beyond India. Based on a qualitative study in rural Andhra Pradesh, South India, we focus on a figure little discussed in the academic literature - the Registered Medical Practitioner (RMP) - who occupies a niche in the medical market-place as an informal exponent of biomedical treatment. We explore the significance of these practitioners by tracking diagnosis and treatment of one increasingly prominent medical 'condition', namely diabetes. The RMP, who despite the title is rarely registered, sheds light on the supposed formal-informal sector divide in India's healthcare system, and its permeability in practice. We develop our analysis by contrasting two distinctive conceptualisations of 'informality' in relation to the state in India - one Sarah Pinto's, the other Ananya Roy's. © 2016 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.

Effect of an imaging-based streamlined electronic healthcare process on quality and costs.

PubMed

Bui, Alex A T; Taira, Ricky K; Goldman, Dana; Dionisio, John David N; Aberle, Denise R; El-Saden, Suzie; Sayre, James; Rice, Thomas; Kangarloo, Hooshang

2004-01-01

A streamlined process of care supported by technology and imaging may be effective in managing the overall healthcare process and costs. This study examined the effect of an imaging-based electronic process of care on costs and rates of hospitalization, emergency room (ER) visits, specialist diagnostic referrals, and patient satisfaction. A healthcare process was implemented for an employer group, highlighting improved patient access to primary care plus routine use of imaging and teleconsultation with diagnostic specialists. An electronic infrastructure supported patient access to physicians and communication among healthcare providers. The employer group, a self-insured company, manages a healthcare plan for its employees and their dependents: 4,072 employees were enrolled in the test group, and 7,639 in the control group. Outcome measures for expenses and frequency of hospitalizations, ER visits, traditional specialist referrals, primary care visits, and imaging utilization rates were measured using claims data over 1 year. Homogeneity tests of proportions were performed with a chi-square statistic, mean differences were tested by two-sample t-tests. Patient satisfaction with access to healthcare was gauged using results from an independent firm. Overall per member/per month costs post-implementation were lower in the enrolled population (126 dollars vs 160 dollars), even though occurrence of chronic/expensive diseases was higher in the enrolled group (18.8% vs 12.2%). Lower per member/per month costs were seen for inpatient (33.29 dollars vs 35.59 dollars); specialist referrals (21.36 dollars vs 26.84 dollars); and ER visits (3.68 dollars vs 5.22 dollars). Moreover, the utilization rate for hospital admissions, ER visits, and traditional specialist referrals were significantly lower in the enrolled group, although primary care and imaging utilization were higher. Comparison to similar employer groups showed that the company's costs were lower than national averages (119.24 dollars vs 146.32 dollars), indicating that the observed result was not attributable to normalization effects. Patient satisfaction with access to healthcare ranked in the top 21st percentile. A streamlined healthcare process supported by technology resulted in higher patient satisfaction and cost savings despite improved access to primary care and higher utilization of imaging.

Low health literacy and healthcare utilization among immigrants and non-immigrants in Switzerland.

PubMed

Mantwill, Sarah; Schulz, Peter J

2017-11-01

This study aimed at investigating the association between functional health literacy and knowledge on when to seek medical help for potentially harmless (overutilization) or serious (underutilization) situations among immigrants and non-immigrants in Switzerland. Data was collected among three immigrant groups and the native population (N=1146) in the German- and Italian-speaking part of Switzerland. Health literacy was assessed with the Short Test of Functional Health Literacy (S-TOFHLA) and three Brief Health Literacy Screeners. Over- and underutilization of healthcare services was assessed with items asking participants about when to seek medical help for minor, respectively major, physical symptoms. Immigrants were more likely to seek medical help when unwarranted (overutilization). Health literacy, when assessed with the S-TOFHLA, was significantly associated with over- and underutilization. Yet, once controlled for covariates, the association between health literacy and overutilization was negative. Immigration background and micro-cultural differences emerged as important predictors of utilization. Results suggest that functional health literacy is directly related to healthcare utilization. The effects might be amplified by (micro-)cultural differences. Healthcare providers should be aware of differences in health literacy and utilization patterns among different population groups. Communication between patients and providers should be literacy and culturally sensitive. Copyright © 2017 Elsevier B.V. All rights reserved.

Effect of diabetic case management intervention on health service utilization in Korea.

PubMed

Shin, Soon Ae; Kim, Hyeongsu; Lee, Kunsei; Lin, Vivian; Liu, George

2015-12-01

This study is to estimate the effectiveness of a diabetic case management programme on health-care service utilization. The study population included 6007 as the intervention group and 956,766 as the control group. As the indicators of health-care service utilization, numbers of medical ambulatory consultations, days of medication prescribed and medical expenses for one year were used, and we analysed the claim data of the health insurance from 2005 to 2007. The study population was classified into three subgroups based on the number of medical ambulatory consultations per year before this intervention. In the under-serviced subgroup, the intervention group showed a significant increase in the number of consultations (3.2), days of prescribed medication (66.4) and medical expenses (287,900 KRW) compared with the control group. Conversely, in the over-serviced subgroup, the intervention group showed a less decrease days of prescribed medication (1.6) compared with the control group. This showed that the case management programme led the intervention group to optimize their utilization of health-care services by subgroups. It is necessary to evaluate the appropriateness of health-care usage and clinical outcome to show the direct effectiveness of the case management programme by subgroups. © 2014 Wiley Publishing Asia Pty Ltd.

Healthcare Utilization by Older Age Groups in Northern States of Peninsular Malaysia: The Role of Predisposing, Enabling and Need Factors.

PubMed

Samsudin, Shamzaeffa; Abdullah, Norehan

2017-06-01

Determining factors that affect healthcare utilization by the elderly is vital for the health system to be more responsive in providing care to this vulnerable group. The main objective of this paper is to identify the effect of the predisposing, enabling, and need factors on doctor visits and in-patient care for the elderly residing in the northern region of Malaysia. A multistage cluster sampling was used in selecting the sample for the study. A total of 1414 respondents aged 60 and over were interviewed face-to-face using a structured questionnaire. A probit model was used in estimating the utilization equations. At a significance level of 0.05, except for age, all predisposing and enabling factors were not statistically significant in affecting the doctor visits. On the other hand, being a male, smoker, medical insurance holder or had not actively involved in social interaction within the reference period increases the likelihood of being in-patient. Health-related variables remain the most significant factors that determine healthcare utilization, including both doctor visits and in-patient stays, in the area of study, which suggests that government policies to improve population health may influence the level of healthcare use in the future.

Older Adults Seeking Healthcare Information on the Internet

ERIC Educational Resources Information Center

Hardt, Jeffrey H.; Hollis-Sawyer, Lisa

2007-01-01

Due to an aging population and increases in healthcare costs, particular attention needs to be focused on developing Internet sites that provide older adults with credible and accurate healthcare information. Present research findings suggest that motivation is only one factor that influences whether or not older adults utilize the World Wide Web…

Resource utilization with insulin pump therapy for type 2 diabetes mellitus.

PubMed

Lynch, Peter M; Riedel, Aylin Altan; Samant, Navendu; Fan, Ying; Peoples, Tim; Levinson, Jennifer; Lee, Scott W

2010-01-01

To evaluate the effects of switching from multiple daily injection (MDI) therapy to insulin pump therapy, also called continuous subcutaneous insulin infusion (CSII), on antidiabetic drug and healthcare resource utilization. This study was a retrospective analysis of administrative claims data from a large geographically diverse health plan in the United States from January 1, 2005, through April 30, 2008. Changes in antidiabetic drug use, antidiabetic drug switching and augmentation, and healthcare utilization during the baseline period and after CSII initiation were assessed using paired t test. There were 3649 possible subjects, of whom 943 met the criteria for analysis. The mean number of antidiabetic drugs used decreased by 46% after CSII initiation, and the mean reduction in antidiabetic drug utilization was 0.67; both were statistically significant. More than one-third of subjects who were taking antidiabetic drugs before CSII initiation discontinued oral therapy after CSII initiation. The number of subjects using multiple antidiabetic drugs significantly decreased after CSII initiation by 58%, and rates of switching or augmenting significantly decreased from 42% at baseline to 25% after CSII initiation.The rates of emergency department visits and inpatient admissions significantly decreased, and the rate of ambulatory visits significantly increased. CSII was associated with significant decreases in antidiabetic drug and healthcare resource utilization, contributing to stability of care. The evidence from this study indicates that CSII should be considered as an option for patients with type 2 diabetes mellitus who are using MDI and are experiencing a high degree of antidiabetic drug and healthcare resource utilization.

Greater healthcare utilization and costs among Black persons compared to White persons with aphasia in the North Carolina stroke belt.

PubMed

Ellis, Charles; Hardy, Rose Y; Lindrooth, Richard C

2017-05-15

To examine racial differences in healthcare utilization and costs for persons with aphasia (PWA) being treated in acute care hospitals in North Carolina (NC). NC Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) data from 2011-2012 were analyzed to examine healthcare utilization and costs of care for stroke patients with aphasia. Analyses emphasized length of stay, charges and cost of general hospital services. Generalized linear models (GLM) were constructed to determine the impact of demographic characteristics, stroke/illness severity, and observed hospital characteristics on utilization and costs. Hospital fixed effects were included to yield within-hospital estimates of disparities. GLM models demonstrated that Blacks with aphasia experienced 1.9days longer lengths of stay compared to Whites with aphasia after controlling for demographic characteristics, 1.4days controlling for stroke/illness severity, 1.2days controlling for observed hospital characteristics, and ~1 extra day controlling for unobserved hospital characteristics. Similarly, Blacks accrued ~$2047 greater total costs compared to Whites after controlling for demographic characteristics, $1659 controlling for stroke/illness severity, $1338 controlling for observed hospital characteristics, and ~$1311 greater total costs after controlling for unobserved hospital characteristics. In the acute hospital setting, Blacks with aphasia utilize greater hospital services during longer hospitalizations and at substantially higher costs in the state of NC. A substantial portion of the adjusted difference was related to the hospital treating the patient. However, even after controlling for the hospital, the differences remained clinically and statistically significant. Copyright © 2017 Elsevier B.V. All rights reserved.

Adaptive search in mobile peer-to-peer databases

NASA Technical Reports Server (NTRS)

Wolfson, Ouri (Inventor); Xu, Bo (Inventor)

2010-01-01

Information is stored in a plurality of mobile peers. The peers communicate in a peer to peer fashion, using a short-range wireless network. Occasionally, a peer initiates a search for information in the peer to peer network by issuing a query. Queries and pieces of information, called reports, are transmitted among peers that are within a transmission range. For each search additional peers are utilized, wherein these additional peers search and relay information on behalf of the originator of the search.

Ionization chamber dosimeter

DOEpatents

Renner, Tim R.; Nyman, Mark A.; Stradtner, Ronald

1991-01-01

A method for fabricating an ion chamber dosimeter collecting array of the type utilizing plural discrete elements formed on a uniform collecting surface which includes forming a thin insulating layer over an aperture in a frame having surfaces, forming a predetermined pattern of through holes in the layer, plating both surfaces of the layer and simultaneously tilting and rotating the frame for uniform plate-through of the holes between surfaces. Aligned masking and patterned etching of the surfaces provides interconnects between the through holes and copper leads provided to external circuitry.

Eddy current nondestructive testing device for measuring variable characteristics of a sample utilizing Walsh functions

DOEpatents

Libby, Hugo L.; Hildebrand, Bernard P.

1978-01-01

An eddy current testing device for measuring variable characteristics of a sample generates a signal which varies with variations in such characteristics. A signal expander samples at least a portion of this generated signal and expands the sampled signal on a selected basis of square waves or Walsh functions to produce a plurality of signal components representative of the sampled signal. A network combines these components to provide a display of at least one of the characteristics of the sample.

A Large Scale Study of the Assessment of the Social Environment of Middle and Secondary Schools: The Validity and Utility of Teachers' Ratings of School Climate, Cultural Pluralism, and Safety Problems for Understanding School Effects and School Improvement

ERIC Educational Resources Information Center

Brand, Stephen; Felner, Robert D.; Seitsinger, Anne; Burns, Amy; Bolton, Natalie

2008-01-01

Due to changes in state and federal policies, as well as logistical and fiscal limitations, researchers must increasingly rely on teachers' reports of school climate dimensions in order to investigate the developmental impact of these dimensions, and to evaluate efforts to enhance the impact of school environments on the development of young…

Coupling Inductor Based Hybrid Millimeter-Wave Switch

NASA Technical Reports Server (NTRS)

Gu, Qun (Inventor); Drouin, Brian J. (Inventor); Tang, Adrian J. (Inventor); Shu, Ran (Inventor)

2017-01-01

A switch comprising a plurality of inductors and a plurality of shunt transistors is described. Each inductor can be electrically coupled between adjacent shunt transistors to form a distributed switch structure. At least two inductors in the plurality of inductors can be inductively coupled with each other. The plurality of inductors can correspond to portions of a coupling inductor, wherein the coupling inductor can have an irregular octagonal shape.

System and method for advanced power management

DOEpatents

Atcitty, Stanley [Albuquerque, NM; Symons, Philip C [Surprise, AZ; Butler, Paul C [Albuquerque, NM; Corey, Garth P [Albuquerque, NM

2009-07-28

A power management system is provided that includes a power supply means comprising a plurality of power supply strings, a testing means operably connected to said plurality of power supply strings for evaluating performance characteristics of said plurality of power supply strings, and a control means for monitoring power requirements and comprising a switching means for controlling switching of said plurality of power supply strings to said testing means.

Methodological issues on the use of administrative data in healthcare research: the case of heart failure hospitalizations in Lombardy region, 2000 to 2012.

PubMed

Mazzali, Cristina; Paganoni, Anna Maria; Ieva, Francesca; Masella, Cristina; Maistrello, Mauro; Agostoni, Ornella; Scalvini, Simonetta; Frigerio, Maria

2016-07-08

Administrative data are increasingly used in healthcare research. However, in order to avoid biases, their use requires careful study planning. This paper describes the methodological principles and criteria used in a study on epidemiology, outcomes and process of care of patients hospitalized for heart failure (HF) in the largest Italian Region, from 2000 to 2012. Data were extracted from the administrative data warehouse of the healthcare system of Lombardy, Italy. Hospital discharge forms with HF-related diagnosis codes were the basis for identifying HF hospitalizations as clinical events, or episodes. In patients experiencing at least one HF event, hospitalizations for any cause, outpatient services utilization, and drug prescriptions were also analyzed. Seven hundred one thousand, seven hundred one heart failure events involving 371,766 patients were recorded from 2000 to 2012. Once all the healthcare services provided to these patients after the first HF event had been joined together, the study database totalled about 91 million records. Principles, criteria and tips utilized in order to minimize errors and characterize some relevant subgroups are described. The methodology of this study could represent the basis for future research and could be applied in similar studies concerning epidemiology, trend analysis, and healthcare resources utilization.

Environmental continuous air monitor inlet with combined preseparator and virtual impactor

DOEpatents

Rodgers, John C [Santa Fe, NM

2007-06-19

An inlet for an environmental air monitor is described wherein a pre-separator interfaces with ambient environment air and removes debris and insects commonly associated with high wind outdoors and a deflector plate in communication with incoming air from the pre-separator stage, that directs the air radially and downward uniformly into a plurality of accelerator jets located in a manifold of a virtual impactor, the manifold being cylindrical and having a top, a base, and a wall, with the plurality of accelerator jets being located in the top of the manifold and receiving the directed air and accelerating directed air, thereby creating jets of air penetrating into the manifold, where a major flow is deflected to the walls of the manifold and extracted through ports in the walls. A plurality of receiver nozzles are located in the base of the manifold coaxial with the accelerator jets, and a plurality of matching flow restrictor elements are located in the plurality of receiver nozzles for balancing and equalizing the total minor flow among all the plurality of receiver nozzles, through which a lower, fractional flow extracts large particle constituents of the air for collection on a sample filter after passing through the plurality of receiver nozzles and the plurality of matching flow restrictor elements.

Laser multiplexing system

DOEpatents

Johnson, Steve A.; English, Jr., Ronald Edward; White, Ronald K.

2001-01-01

A plurality of copper lasers, as radiant power sources, emits a beam of power carrying radiation. A plurality of fiber injection assemblies receives power from the plurality of copper lasers and injects such power into a plurality of fibers for individually transmitting the received power to a plurality of power-receiving devices. The power-transmitting fibers of the system are so arranged that power is delivered therethrough to each of the power-receiving devices such that, even if a few of the radiant power sources and/or fibers fail, the power supply to any of the power receiving devices will not completely drop to zero but will drop by the same proportionate amount.

High power RF solid state power amplifier system

NASA Technical Reports Server (NTRS)

Sims, III, William Herbert (Inventor); Chavers, Donald Gregory (Inventor); Richeson, James J. (Inventor)

2011-01-01

A high power, high frequency, solid state power amplifier system includes a plurality of input multiple port splitters for receiving a high-frequency input and for dividing the input into a plurality of outputs and a plurality of solid state amplifier units. Each amplifier unit includes a plurality of amplifiers, and each amplifier is individually connected to one of the outputs of multiport splitters and produces a corresponding amplified output. A plurality of multiport combiners combine the amplified outputs of the amplifiers of each of the amplifier units to a combined output. Automatic level control protection circuitry protects the amplifiers and maintains a substantial constant amplifier power output.

Network based management for multiplexed electric vehicle charging

DOEpatents

Gadh, Rajit; Chung, Ching Yen; Qui, Li

2017-04-11

A system for multiplexing charging of electric vehicles, comprising a server coupled to a plurality of charging control modules over a network. Each of said charging modules being connected to a voltage source such that each charging control module is configured to regulate distribution of voltage from the voltage source to an electric vehicle coupled to the charging control module. Data collection and control software is provided on the server for identifying a plurality of electric vehicles coupled to the plurality of charging control modules and selectively distributing charging of the plurality of charging control modules to multiplex distribution of voltage to the plurality of electric vehicles.

Data Acquisition for Modular Biometric Monitoring System

NASA Technical Reports Server (NTRS)

Grodsinsky, Carlos M. (Inventor); Chmiel, Alan J. (Inventor); Humphreys, Bradley T. (Inventor)

2014-01-01

A modular system for acquiring biometric data includes a plurality of data acquisition modules configured to sample biometric data from at least one respective input channel at a data acquisition rate. A representation of the sampled biometric data is stored in memory of each of the plurality of data acquisition modules. A central control system is in communication with each of the plurality of data acquisition modules through a bus. The central control system is configured to collect data asynchronously, via the bus, from the memory of the plurality of data acquisition modules according to a relative fullness of the memory of the plurality of data acquisition modules.

Feed network and electromagnetic radiation source

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

Ardavan, Arzhang; Singleton, John; Linehan, Kevin E.

An antenna may include a volume polarization current radiator and a feed network. The volume polarization current radiator, includes a dielectric solid (such as a dielectric strip), and a plurality of closely-spaced excitation elements (24), each excitation element (24) being configured to induce a volume polarization current distribution in the dielectric solid proximate to the excitation element when a voltage is applied to the excitation element. The feed network is coupled to the volume polarization current radiator. The feed network also includes a plurality of passive power divider elements (32) and a plurality of passive delay elements (d1-d6) coupling themore » first port (30) and the plurality of second ports (108, 109, 164), the plurality of power divider elements (32) and the plurality of phase delay elements (d1-d6) being configured such that a radio-frequency signal that is applied to the first port (30) experiences a progressive change of phase as it is coupled to the plurality of second ports (108, 109, 164) so as to cause the volume polarization current distribution to propagate along the dielectric solid.« less

[Which complementary and alternative medicine modalities are integrated within Israeli healthcare organizations and do they match the public's preferences?].

PubMed

Keshet, Yael; Ben-Arye, Eran

2011-08-01

Complementary and alternative medicine (CAM) is a broad term that encompasses diverse healthcare modalities that emanate from a variety of healing cultures. One of the basic principles of CAM is the promotion of cultural pluralism and openness to diverse cultural aspects of health and illness. Some CAM modalities have been integrated into Israeli healthcare organizations over the past two decades. The objective of this research was to examine whether the integrated CAM modalities match the preferences of Israel's diverse ethnic groups. The research was conducted in northern Israel, an area marked by ethnic and religious diversity. We gathered information about the types of CAM modalities included in the clinics of all four public health funds health maintenance organizations (HMOs)--by means of a telephone survey. This data was assessed in relation to previous data regarding patients' preferences on integrating CAM in community care. The 4 HMOs offer 24 CAM modalities within 58 clinics in northern Israel. The most common CAM modalities are: reflexology, Chinese Medicine and acupuncture, massage, shiatsu, twina, homeopathy and naturopathy. These modalities partly match the Jewish and Arab populations' preferences concerning Chinese medicine and touch/movement modalities. The Arab population, however, which reports greater use of folk-traditional medicine, such as consultation with healers and use of herbal medicine, do not have these treatment options available within healthcare organizations. Western-oriented CAM modalities are integrated within the IsraeLi HMOs, while local folk-traditional medicine is not. The integrated modalities accord with the Jewish populations' preferences more than with those of the Arab population. Some of the factors that influence integration are discussed. Certain homegrown traditional healthcare modalities, such as use of local medicinal herbs, should be considered for addition to current CAM practices. Developing integrative medicine within a common Jewish-Arabic space could have medical as well as social-cultural advantages.

A qualitative study examining the perceived barriers and facilitators to medical healthcare services among women with a serious mental illness.

PubMed

Borba, Christina P C; DePadilla, Lara; McCarty, Frances A; von Esenwein, Silke A; Druss, Benjamin G; Sterk, Claire E

2012-03-01

This qualitative study investigates the barriers and facilitators to accessing and utilizing healthcare services among women with a serious mental illness (SMI). A purposive sample of 30 poor, urban, predominantly African-American women with a diagnosis of an SMI was recruited. Interviews were audio-taped and transcribed verbatim. Data analysis was guided by a modified constant comparison approach. The findings highlight a variety of nonmedical factors that serve as both barriers and facilitators to accessing and utilizing medical healthcare services, such as a trusting relationship with a mental health provider and a women's social network. Nonmedical factors and personal circumstances seem to be important factors influencing pathways to healthcare services among women with an SMI. Efforts to better engage and retain women with an SMI into healthcare will need to better acknowledge and incorporate the larger social context of the women's lives. Copyright © 2012 Jacobs Institute of Women

When should managed care firms terminate private benefits for chronically mentally ill patients?

PubMed

Gerson, S N

1994-01-01

Corporate America's healthcare cost crisis and the country's budget deficit are forcing limits on the resources used to finance healthcare, including mental healthcare. At the same time, the 1990 Americans with Disabilities Act bars discrimination against patients with chronic illnesses, including chronic mental illness. Therefore, corporate benefits managers need guidance on how to ethically and rationally allocate scarce clinical resources to those high-morbidity insureds who utilize disproportionate amounts of these resources. In particular, how should we define the public/private interface: When do patients who repeatedly fail to respond to treatment fall out of the private sector's responsibility? The author, medical director for a leading behavioral healthcare utilization management company, offers the following guidelines recommending reasonable and practical limitations on trials of treatment for seven common categories of difficult psychiatric patients.

Lead-time reduction utilizing lean tools applied to healthcare: the inpatient pharmacy at a local hospital.

PubMed

Al-Araidah, Omar; Momani, Amer; Khasawneh, Mohammad; Momani, Mohammed

2010-01-01

The healthcare arena, much like the manufacturing industry, benefits from many aspects of the Toyota lean principles. Lean thinking contributes to reducing or eliminating nonvalue-added time, money, and energy in healthcare. In this paper, we apply selected principles of lean management aiming at reducing the wasted time associated with drug dispensing at an inpatient pharmacy at a local hospital. Thorough investigation of the drug dispensing process revealed unnecessary complexities that contribute to delays in delivering medications to patients. We utilize DMAIC (Define, Measure, Analyze, Improve, Control) and 5S (Sort, Set-in-order, Shine, Standardize, Sustain) principles to identify and reduce wastes that contribute to increasing the lead-time in healthcare operations at the pharmacy understudy. The results obtained from the study revealed potential savings of > 45% in the drug dispensing cycle time.

Comparison of Multiple Chronic Obstructive Pulmonary Disease (COPD) Indices in Chinese COPD Patients.

PubMed

Zhang, Jinsong; Miller, Anastasia; Li, Yongxia; Lan, Qinqin; Zhang, Ning; Chai, Yanling; Hai, Bing

2018-04-01

Chronic obstructive pulmonary disease (COPD) is a serious chronic condition with a global impact. Symptoms of COPD include progressive dyspnea, breathlessness, cough, and sputum production, which have a considerable impact on the lives of patients. In addition to the human cost of living with COPD and the resulting death, COPD entails a huge economic burden on the Chinese population, with patients spending up to one-third of the average family income on COPD management in some regions is clinically beneficial to adopt preventable measures via prudent COPD care utilization, monetary costs, and hospitalizations. Toward this end, this study compared the relative effectiveness of six indices in predicting patient healthcare utilization, cost of care, and patient health outcome. The six assessment systems evaluated included the three multidimensional Body mass index, Obstruction, Dyspnea, Exercise capacity index, Dyspnea, Obstruction, Smoking, Exacerbation (DOSE) index, and COPD Assessment Test index, or the unidimensional measures that best predict the future of patient healthcare utilization, cost of care, and patient health outcome among Chinese COPD patients. Multiple linear regression models were created for each healthcare utilization, cost, and outcome including a single COPD index and the same group of demographic variables for each of the outcomes. We conclude that the DOSE index facilitates the prediction of patient healthcare utilization, disease expenditure, and negative clinical outcomes. Our study indicates that the DOSE index has a potential role beyond clinical predictions. Copyright©2018. The Korean Academy of Tuberculosis and Respiratory Diseases.

Camel milk, amoxicillin, and a prayer: medical pluralism and medical humanitarian aid in the Somali Region of Ethiopia.

PubMed

Carruth, Lauren

2014-11-01

This paper details how exposure to new clinics, diagnostic technologies, and pharmaceuticals during humanitarian relief operations in the Somali Region of Ethiopia shaped local pluralistic health systems and altered the ways in which residents subsequently conceived of and treated illness and disease. Despite rising demand for pharmaceuticals and diagnostic technologies among Somalis in Ethiopia, local ethnophysiologies continued to draw upon popular ideas about humoral flows, divine action, and spirit possession. Demands for therapeutic camel milk, Qur'anic spiritual healing, herbal remedies, and other historically popular therapies persisted, but were shaped by concurrent demands for and understandings of diagnostic biotechnologies and pharmaceutical medications. The reverse was also true: contemporary understandings and uses of non-biomedical healing modalities among Somalis shaped evaluations of clinical care, including healthcare during humanitarian responses. To illustrate these phenomena, based on ethnographic research in eastern Ethiopia between 2007 and 2009, this paper explores three topics vital to Somalis' pluralistic healthcare systems: camel milk and the management of digestive bile; women's experiences and clinical presentations with pain and disorder in their reproductive systems; and the rising popularity of high-tech diagnostic tests. I conclude that medical humanitarian aid never happens in a vacuum or among truly treatment-naïve populations. Instead, aid unfolds within ever-changing and pluralistic health cultures, and it permanently alters and is altered by the frames within which people evaluate and make future decisions about healthcare. Copyright © 2014 Elsevier Ltd. All rights reserved.

Being pragmatic about healthcare complexity: our experiences applying complexity theory and pragmatism to health services research.

PubMed

Long, Katrina M; McDermott, Fiona; Meadows, Graham N

2018-06-20

The healthcare system has proved a challenging environment for innovation, especially in the area of health services management and research. This is often attributed to the complexity of the healthcare sector, characterized by intersecting biological, social and political systems spread across geographically disparate areas. To help make sense of this complexity, researchers are turning towards new methods and frameworks, including simulation modeling and complexity theory. Herein, we describe our experiences implementing and evaluating a health services innovation in the form of simulation modeling. We explore the strengths and limitations of complexity theory in evaluating health service interventions, using our experiences as examples. We then argue for the potential of pragmatism as an epistemic foundation for the methodological pluralism currently found in complexity research. We discuss the similarities between complexity theory and pragmatism, and close by revisiting our experiences putting pragmatic complexity theory into practice. We found the commonalities between pragmatism and complexity theory to be striking. These included a sensitivity to research context, a focus on applied research, and the valuing of different forms of knowledge. We found that, in practice, a pragmatic complexity theory approach provided more flexibility to respond to the rapidly changing context of health services implementation and evaluation. However, this approach requires a redefinition of implementation success, away from pre-determined outcomes and process fidelity, to one that embraces the continual learning, evolution, and emergence that characterized our project.

Marketing Authorization Procedures for Advanced Cancer Drugs: Exploring the Views of Patients, Oncologists, Healthcare Decision Makers, and Citizens in France.

PubMed

Protiére, Christel; Baker, Rachel; Genre, Dominique; Goncalves, Anthony; Viens, Patrice

2017-07-01

The past decades have seen advances in cancer treatments in terms of toxicity and side effects but progress in the treatment of advanced cancer has been modest. New drugs have emerged improving progression free survival but with little impact on overall survival, raising questions about the criteria on which to base decisions to grant marketing authorizations and about the authorization procedure itself. For decisions to be fair, transparent and accountable, it is necessary to consider the views of those with relevant expertise and experience. We conducted a Q-study to explore the views of a range of stakeholders in France, involving: 54 patients (18 months after diagnosis); 50 members of the general population; 27 oncologists; 19 healthcare decision makers; and 2 individuals from the pharmaceutical industry. Three viewpoints emerged, focussing on different dimensions entitled: 1) 'Quality of life (QoL), opportunity cost and participative democracy'; 2)'QoL and patient-centeredness'; and 3) 'Length of life'. Respondents from all groups were associated with each viewpoint, except for healthcare decision makers, who were only associated with the first one. Our results highlight plurality in the views of stakeholders, emphasize the need for transparency in decision making processes, and illustrate the importance of a re-evaluation of treatments for all 3 viewpoints. In the context of advanced cancer, our results suggest that QoL should be more prominent amongst authorization criteria, as it is a concern for 2 of the 3 viewpoints.

Learnability and generalisation of Arabic broken plural nouns

PubMed Central

Dawdy-Hesterberg, Lisa Garnand; Pierrehumbert, Janet Breckenridge

2014-01-01

The noun plural system in Modern Standard Arabic lies at a nexus of critical issues in morphological learnability. The suffixing “sound” plural competes with as many as 31 non-concatenative “broken” plural patterns. Our computational analysis of singular–plural pairs in the Corpus of Contemporary Arabic explores what types of linguistic information are statistically relevant to morphological generalisation for this highly complex system. We show that an analogical approach with the generalised context model is highly successful in predicting the plural form for any given singular form. This model proves to be robust to variation, as evidenced by its stability across 10 rounds of cross-validation. The predictive power is carried almost entirely by the CV template, a representation which specifies a segment's status as a consonant or vowel only, providing further support for the abstraction of prosodic templates in the Arabic morphological system as proposed by McCarthy and Prince. PMID:25346932

Engine with exhaust gas recirculation system and variable geometry turbocharger

DOEpatents

Keating, Edward J.

2015-11-03

An engine assembly includes an intake assembly, an internal combustion engine defining a plurality of cylinders and configured to combust a fuel and produce exhaust gas, and an exhaust assembly in fluid communication with a first subset of the plurality of cylinders. Each of the plurality of cylinders are provided in fluid communication with the intake assembly. The exhaust assembly is provided in fluid communication with a first subset of the plurality of cylinders, and a dedicated exhaust gas recirculation system in fluid communication with both a second subset of the plurality of cylinders and with the intake assembly. The dedicated exhaust gas recirculation system is configured to route all of the exhaust gas from the second subset of the plurality of cylinders to the intake assembly. Finally, the engine assembly includes a turbocharger having a variable geometry turbine in fluid communication with the exhaust assembly.

Apparatus and method for high dose rate brachytherapy radiation treatment

DOEpatents

Macey, Daniel J.; Majewski, Stanislaw; Weisenberger, Andrew G.; Smith, Mark Frederick; Kross, Brian James

2005-01-25

A method and apparatus for the in vivo location and tracking of a radioactive seed source during and after brachytherapy treatment. The method comprises obtaining multiple views of the seed source in a living organism using: 1) a single PSPMT detector that is exposed through a multiplicity of pinholes thereby obtaining a plurality of images from a single angle; 2) a single PSPMT detector that may obtain an image through a single pinhole or a plurality of pinholes from a plurality of angles through movement of the detector; or 3) a plurality of PSPMT detectors that obtain a plurality of views from different angles simultaneously or virtually simultaneously. The plurality of images obtained from these various techniques, through angular displacement of the various acquired images, provide the information required to generate the three dimensional images needed to define the location of the radioactive seed source within the body of the living organism.

Solar panel truss mounting systems and methods

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

Al-Haddad, Tristan Farris; Cavieres, Andres; Gentry, Russell

An exemplary embodiment of the present invention provides a solar panel truss mounting system comprising a base and a truss assembly coupled to the base. The truss assembly comprises a first panel rail mount, second panel rail mount parallel to the first panel rail mount, base rail mount parallel to the first and second panel rail mounts, and a plurality of support members. A first portion of the plurality of support members extends between the first and second panel rail mounts. A second portion of the plurality of support members extends between the first panel rail mount and the basemore » rail mount. A third portion of the plurality of support members extends between the second panel rail mount and the base rail mount. The system can further comprise a plurality of connectors for coupling a plurality of photovoltaic solar panels to the truss assembly.« less

Measuring the Efficient Utilization of Medical Personnel at Navy Military Treatment Facilities

DTIC Science & Technology

1990-06-01

measures of effectiveness (MOE) for utilizing manpower at a medical treatment facility by analyzing data from Navy hospitals. The MOE will be able to...at Navy facili- ties will be used to compare alternative MOEs., The data resources are categorized into expenditures, Naval health-care statistics ...of years., At the Office of the Chief of Naval Operations, OP-801 maintains financial data of medical budgets, 2. NAVAL HEALTH-CARE STATISTICS The

Increased Burden of Healthcare Utilization and Cost Associated with Opioid-Related Constipation Among Patients with Noncancer Pain

PubMed Central

Fernandes, Ancilla W.; Kern, David M.; Datto, Catherine; Chen, Yen-Wen; McLeskey, Charles; Tunceli, Ozgur

2016-01-01

Background Opioids are widely accepted as treatment for moderate to severe pain, and opioid-induced constipation is one of the most common side effects of opioids. This side effect negatively affects pain management and patients’ quality of life, which could result in increased healthcare utilization and costs. Objective To assess healthcare utilization and costs (all-cause, constipation-related, and pain-related) for individuals with and without opioid-induced constipation during the 12 months after initiation of opioid therapy for noncancer pain. Methods This retrospective cohort study was conducted using administrative claims data from HealthCore Integrated Research Environment between January 1, 2006, and June 30, 2014. The analysis was limited to patients aged ≥18 years who filled a prescription for continuous opioid treatment (≥28 days) for noncancer pain. Propensity scores were used to match opioid users with constipation (cohort 1) and opioid users without constipation (cohort 2), using a 1:1 ratio. Generalized linear models were used to estimate all-cause, constipation-related, and pain-related healthcare utilization and costs during the 12 months after the initiation of opioid therapy. Results After matching and balancing for all prespecified variables, 17,384 patients were retained in each cohort (mean age, 56 years; 63% female). Opioid users with constipation were twice as likely as those without constipation to have ≥1 inpatient hospitalizations (odds ratio, 2.28; 95% confidence interval [CI], 2.17–2.39) during the 12 months. The total mean adjusted overall costs per patient during the study period were $12,413 higher for patients with constipation versus those without it (95% CI, $11,726–$13,116). The total mean adjusted overall pain-related costs per patient were $6778 (95% CI, $6293–$7279) higher for the patients with constipation than those without. Among patients using opioids for noncancer pain, the annual mean constipation-related costs per patient totaled $4646 (total average plan-paid costs, $4424; total patient-paid costs, $222). Conclusions Patients using opioids with newly diagnosed constipation had significantly greater healthcare utilization and costs than patients without constipation; these costs accounted for approximately 16% of the total healthcare costs per patient during the 12-month study period. Recognition and effective treatment of opioid-induced constipation may decrease healthcare utilization for patients with chronic noncancer pain and may reduce the economic burden of pain therapy. PMID:27606040

SEMPATH Ontology: modeling multidisciplinary treatment schemes utilizing semantics.

PubMed

Alexandrou, Dimitrios Al; Pardalis, Konstantinos V; Bouras, Thanassis D; Karakitsos, Petros; Mentzas, Gregoris N

2012-03-01

A dramatic increase of demand for provided treatment quality has occurred during last decades. The main challenge to be confronted, so as to increase treatment quality, is the personalization of treatment, since each patient constitutes a unique case. Healthcare provision encloses a complex environment since healthcare provision organizations are highly multidisciplinary. In this paper, we present the conceptualization of the domain of clinical pathways (CP). The SEMPATH (SEMantic PATHways) Oontology comprises three main parts: 1) the CP part; 2) the business and finance part; and 3) the quality assurance part. Our implementation achieves the conceptualization of the multidisciplinary domain of healthcare provision, in order to be further utilized for the implementation of a Semantic Web Rules (SWRL rules) repository. Finally, SEMPATH Ontology is utilized for the definition of a set of SWRL rules for the human papillomavirus) disease and its treatment scheme. © 2012 IEEE

Impact of an Onsite Clinic on Utilization of Preventive Services.

PubMed

Ostovari, Mina; Yu, Denny; Yih, Yuehwern; Steele-Morris, Charlotte Joy

2017-07-01

To assess impact of an onsite clinic on healthcare utilization of preventive services for employees of a public university and their dependents. Descriptive statistics, logistic regression and classification tree techniques were used to assess health claim data to identify changes in patterns of healthcare utilization and factors impacting usage of onsite clinic. Utilization of preventive services significantly increased for women and men employees by 9% and 14% one year after implementation of the onsite clinic. Hourly-paid employees, employees without diabetes, employees with spouse opt out or no coverage were more likely to go to the onsite clinic. Adapted framework for assessing performance of onsite clinics based on usage of health informatics would help to identify health utilization patterns and interaction between onsite clinic and offsite health providers.

Comorbidity profile and healthcare utilization in elderly patients with serious mental illnesses.

PubMed

Hendrie, Hugh C; Lindgren, Donald; Hay, Donald P; Lane, Kathleen A; Gao, Sujuan; Purnell, Christianna; Munger, Stephanie; Smith, Faye; Dickens, Jeanne; Boustani, Malaz A; Callahan, Christopher M

2013-12-01

Patients with serious mental illness are living longer. Yet, there remain few studies that focus on healthcare utilization and its relationship with comorbidities in these elderly mentally ill patients. Comparative study. Information on demographics, comorbidities, and healthcare utilization was taken from an electronic medical record system. Wishard Health Services senior care and community mental health clinics. Patients age 65 years and older-255 patients with serious mental illness (schizophrenia, major recurrent depression, and bipolar illness) attending a mental health clinic and a representative sample of 533 nondemented patients without serious mental illness attending primary care clinics. Patients having serious mental illness had significantly higher rates of medical emergency department visits (p = 0.0027) and significantly longer lengths of medical hospitalizations (p <0.0001) than did the primary care control group. The frequency of medical comorbidities such as diabetes, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, thyroid disease, and cancer was not significantly different between the groups. Hypertension was lower in the mentally ill group (p <0.0001). Reported falls (p <0.0001), diagnoses of substance abuse (p = 0.02), and alcoholism (p = 0.0016) were higher in the seriously mentally ill. The differences in healthcare utilization between the groups remained significant after adjusting for comorbidity levels, lifestyle factors, and attending primary care. Our findings of higher rates of emergency care, longer hospitalizations, and increased frequency of falls, substance abuse, and alcoholism suggest that seriously mentally ill older adults remain a vulnerable population requiring an integrated model of healthcare. Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Racial/Ethnic Differences in Cigarette Use: The Roles of Mental Illness and Health-Care Access/Utilization.

PubMed

Lo, Celia C; Yang, Fan; Ash-Houchen, William; Cheng, Tyrone C

2018-06-07

Empirical evidence supports a hypothesis that cigarettes may be used to cope with mental illness. Little research, however, addresses how race/ethnicity is linked to mental health and cigarette use. This study applied the self-medication hypothesis. It asked whether mental status was associated, via health-care access/utilization, with the cigarette use outcomes of four racial/ethnic groups. It also tested whether race/ethnicity moderated any such associations. We used nationally representative data from the 2009-2010 and 2011-2012 National Health and Nutrition Examination Surveys to link cigarette use to mental status and health-care access/utilization. The final sample included 3827 White respondents, 1635 African-American respondents, 1144 Mexican-American respondents, and 781 Hispanic American (other than Mexican-American) respondents. Consistent with earlier research and the self-medication hypothesis, we observed a positive relationship between cigarette use and mental status. Associations of cigarette use and health-care access/utilization sometimes failed to take expected directions. We concluded from the findings that race/ethnicity's moderating role in associations between cigarette use and health-care access was generally more advantageous to Whites than other groups examined. Where treatment is delayed by lack of access to, or lack of trust in, care providers, mental health may worsen-and it is often minority Americans who lack access and trust. If minority Americans' health is to improve, shrinking racial health disparities, then access to adequate health care must be available to them, facilitating prompt treatment of mental and other illness.

Healthcare utilization and cost of Stevens-Johnson syndrome and toxic epidermal necrolysis management in Thailand.

PubMed

Dilokthornsakul, P; Sawangjit, R; Inprasong, C; Chunhasewee, S; Rattanapan, P; Thoopputra, T; Chaiyakunapruk, N

2016-01-01

Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life-threatening dermatologic conditions. Although, the incidence of SJS/TEN in Thailand is high, information on cost of care for SJS/TEN is limited. This study aims to estimate healthcare resource utilization and cost of SJS/TEN in Thailand, using hospital perspective. A retrospective study using an electronic health database from a university-affiliated hospital in Thailand was undertaken. Patients admitted with SJS/TEN from 2002 to 2007 were included. Direct medical cost was estimated by the cost-to-charge ratio. Cost was converted to 2013 value by consumer price index, and converted to $US using 31 Baht/ 1 $US. The healthcare resource utilization was also estimated. A total of 157 patients were included with average age of 45.3±23.0 years. About 146 patients (93.0%) were diagnosed as SJS and the remaining (7.0%) were diagnosed as TEN. Most of the patients (83.4%) were treated with systemic corticosteroids. Overall, mortality rate was 8.3%, while the average length of stay (LOS) was 10.1±13.2 days. The average cost of managing SJS/TEN for all patients was $1,064±$2,558. The average cost for SJS patients was $1,019±$2,601 while that for TEN patients was $1,660±$1,887. Healthcare resource utilization and cost of care for SJS/TEN in Thailand were tremendous. The findings are important for policy makers to allocate healthcare resources and develop strategies to prevent SJS/TEN which could decrease length of stay and cost of care.

Stators with improved conductor assembly and method of making same

DOEpatents

Dang, Dang Dinh; Blissenbach, Rolf; Schauer, David; Wattleworth, John; Milani, Michael; Hatch, Erik

2013-07-30

A stator includes a stator core, a plurality of slots, and a conductor. The plurality of slots are formed within the stator core. The conductor is disposed continuously within at least two of the plurality of openings.

Plasmon resonance imaging apparatus having nano-lycurgus-cup arrays and methods of use

DOEpatents

Liu, Gang Logan; Gartia, Manas Ranjan; Hsiao, Austin Yin Kyai

2016-10-11

Apparatus and methods are disclosed that are configured to permit nanoplasmonic spectroscopy sensing in the form of colorimetric sensing. An example apparatus involves: (a) an array layer having a top surface and a bottom surface, wherein a plurality of nanoholes are defined in the top surface of the array layer, wherein the plurality of nanoholes each have at least one sidewall surface and a bottom surface, (b) a thin metal film disposed on the top surface of the array layer and on the bottom surface of each of the plurality of nanoholes, and (c) a plurality of nanoparticles disposed on the at least one sidewall surface of the plurality of nanoholes.

Thermal Analysis System

NASA Technical Reports Server (NTRS)

DiStefano, III, Frank James (Inventor); Wobick, Craig A. (Inventor); Chapman, Kirt Auldwin (Inventor); McCloud, Peter L. (Inventor)

2014-01-01

A thermal fluid system modeler including a plurality of individual components. A solution vector is configured and ordered as a function of one or more inlet dependencies of the plurality of individual components. A fluid flow simulator simulates thermal energy being communicated with the flowing fluid and between first and second components of the plurality of individual components. The simulation extends from an initial time to a later time step and bounds heat transfer to be substantially between the flowing fluid, walls of tubes formed in each of the individual components of the plurality, and between adjacent tubes. Component parameters of the solution vector are updated with simulation results for each of the plurality of individual components of the simulation.

Measuring Resource Utilization: A Systematic Review of Validated Self-Reported Questionnaires.

PubMed

Leggett, Laura E; Khadaroo, Rachel G; Holroyd-Leduc, Jayna; Lorenzetti, Diane L; Hanson, Heather; Wagg, Adrian; Padwal, Raj; Clement, Fiona

2016-03-01

A variety of methods may be used to obtain costing data. Although administrative data are most commonly used, the data available in these datasets are often limited. An alternative method of obtaining costing is through self-reported questionnaires. Currently, there are no systematic reviews that summarize self-reported resource utilization instruments from the published literature.The aim of the study was to identify validated self-report healthcare resource use instruments and to map their attributes.A systematic review was conducted. The search identified articles using terms like "healthcare utilization" and "questionnaire." All abstracts and full texts were considered in duplicate. For inclusion, studies had to assess the validity of a self-reported resource use questionnaire, to report original data, include adult populations, and the questionnaire had to be publically available. Data such as type of resource utilization assessed by each questionnaire, and validation findings were extracted from each study.In all, 2343 unique citations were retrieved; 2297 were excluded during abstract review. Forty-six studies were reviewed in full text, and 15 studies were included in this systematic review. Six assessed resource utilization of patients with chronic conditions; 5 assessed mental health service utilization; 3 assessed resource utilization by a general population; and 1 assessed utilization in older populations. The most frequently measured resources included visits to general practitioners and inpatient stays; nonmedical resources were least frequently measured. Self-reported questionnaires on resource utilization had good agreement with administrative data, although, visits to general practitioners, outpatient days, and nurse visits had poorer agreement.Self-reported questionnaires are a valid method of collecting data on healthcare resource utilization.

Kaizen newspaper

NASA Technical Reports Server (NTRS)

Shearer, Scott C. (Inventor); Proferes, John Nicholas (Inventor); Baker, Sr., Mitchell D. (Inventor); Reilly, Kenneth B. (Inventor); Tiwari, Vijai K. (Inventor)

2013-01-01

Systems, computer program products, and methods are disclosed for tracking an improvement event. An embodiment includes an event interface configured to receive a plurality of entries related to each of a plurality of improvement events. The plurality of entries includes a project identifier for the improvement event, a creation date, an objective, an action related to reaching the objective, and a first deadline related to the improvement event. A database interface is configured to store the plurality of entries in an event database.

Vehicular impact absorption system

NASA Technical Reports Server (NTRS)

Knoell, A. C.; Wilson, A. H. (Inventor)

1978-01-01

An improved vehicular impact absorption system characterized by a plurality of aligned crash cushions of substantially cubic configuration is described. Each consists of a plurality of voided aluminum beverage cans arranged in substantial parallelism within a plurality of superimposed tiers and a covering envelope formed of metal hardware cloth. A plurality of cables is extended through the cushions in substantial parallelism with an axis of alignment for the cushions adapted to be anchored at each of the opposite end thereof.

Utility and direct costs: ankylosing spondylitis compared with rheumatoid arthritis.

PubMed

Verstappen, S M M; Jacobs, J W G; van der Heijde, D M; van der Linden, Sj; Verhoef, C M; Bijlsma, J W J; Boonen, A

2007-06-01

To compare utility and disease-specific direct costs between patients with ankylosing spondylitis (AS) and patients with rheumatoid arthritis (RA) in the Netherlands. Patients with AS and those with RA completed questions on disease characteristics, the EuroQol-5D (EQ-5D) to assess utility, and questionnaire resource utilisation. Resource utilisation was assessed prospectively in AS, but retrospectively in RA. True cost estimates (2003) were used to calculate the costs. Differences in disease characteristics between AS and RA were described, and determinants of EQ-5D utility and costs were explored by Cox proportional hazard regressions. 576 patients with RA and 132 with AS completed the questionnaires. EQ-5D utility (0.63 vs 0.7) was lower, and annual direct costs higher in RA (euro5167 vs euro2574). In multivariate Cox proportional hazard regressions, there was no difference in utility between the diagnostic groups, but patients with RA incurred higher direct costs after controlling for age, gender and disease duration. In patients with RA and patients with AS, who are under the care of a rheumatologist, utility is equally reduced, but healthcare costs are higher in RA after controlling for age, gender and disease duration. These data can be helpful to provide insights into the differences and similarities between the healthcare needs of both patient groups and to identify issues for further research and for policy in healthcare organisations.

Reduction in maximum time uncertainty of paired time signals

DOEpatents

Theodosiou, G.E.; Dawson, J.W.

1983-10-04

Reduction in the maximum time uncertainty (t[sub max]--t[sub min]) of a series of paired time signals t[sub 1] and t[sub 2] varying between two input terminals and representative of a series of single events where t[sub 1][<=]t[sub 2] and t[sub 1]+t[sub 2] equals a constant, is carried out with a circuit utilizing a combination of OR and AND gates as signal selecting means and one or more time delays to increase the minimum value (t[sub min]) of the first signal t[sub 1] closer to t[sub max] and thereby reduce the difference. The circuit may utilize a plurality of stages to reduce the uncertainty by factors of 20--800. 6 figs.

Reduction in maximum time uncertainty of paired time signals

DOEpatents

Theodosiou, George E.; Dawson, John W.

1983-01-01

Reduction in the maximum time uncertainty (t.sub.max -t.sub.min) of a series of paired time signals t.sub.1 and t.sub.2 varying between two input terminals and representative of a series of single events where t.sub.1 .ltoreq.t.sub.2 and t.sub.1 +t.sub.2 equals a constant, is carried out with a circuit utilizing a combination of OR and AND gates as signal selecting means and one or more time delays to increase the minimum value (t.sub.min) of the first signal t.sub.1 closer to t.sub.max and thereby reduce the difference. The circuit may utilize a plurality of stages to reduce the uncertainty by factors of 20-800.

Impact of China's Public Hospital Reform on Healthcare Expenditures and Utilization: A Case Study in ZJ Province

PubMed Central

Zhang, Hao; Hu, Huimei; Wu, Christina; Yu, Hai; Dong, Hengjin

2015-01-01

Background High drug costs due to supplier-induced demand (SID) obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices. Methods A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization. Results Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID); this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase. Conclusion The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research. It is recommended that comprehensive measures that control SID and promote physician enthusiasm be carried out concurrently. PMID:26588244

Impact of China's Public Hospital Reform on Healthcare Expenditures and Utilization: A Case Study in ZJ Province.

PubMed

Zhang, Hao; Hu, Huimei; Wu, Christina; Yu, Hai; Dong, Hengjin

2015-01-01

High drug costs due to supplier-induced demand (SID) obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices. A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization. Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID); this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase. The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research. It is recommended that comprehensive measures that control SID and promote physician enthusiasm be carried out concurrently.

Comparing treatment persistence, healthcare resource utilization, and costs in adult patients with major depressive disorder treated with escitalopram or citalopram.

PubMed

Wu, Eric Q; Greenberg, Paul E; Ben-Hamadi, Rym; Yu, Andrew P; Yang, Elaine H; Erder, M Haim

2011-03-01

Major depressive disorder is the most common type of depression, affecting 6.6% of adults in the United States annually. Citalopram and escitalopram are common second-generation antidepressants used for the treatment of patients with this disorder. Because citalopram is available in generic forms that have lower acquisition costs compared with the branded escitalopram, some health plans may provide incentives to encourage the use of the generic option. Decisions based solely on drug acquisition costs may encourage the use of a therapy that is less cost-effective when treatment persistence, healthcare utilization, and overall costs are factored in. To compare, in a real-world setting, the treatment persistence, healthcare utilization, and overall costs of managing adult patients with major depressive disorder who are treated with escitalopram or citalopram. Administrative claims data (from January 1, 2003, to June 30, 2005) were analyzed for patients with major depressive disorder aged ≥18 years. Patients filled ≥1 prescriptions for citalopram or for escitalopram (first-fill time was defined as the index date) and had no second-generation antidepressant use during the 6-month preindex period. Treatment persistence, healthcare utilization, and healthcare costs were measured over the 6-month preindex and 6-month postindex periods and compared between patients treated with citalopram or escitalopram, using unadjusted and multivariate analyses. Patients receiving escitalopram (N = 10,465) were less likely to discontinue the treatment (hazard ratio 0.94; P = .005) and switch to another second-generation antidepressant (hazard ratio 0.83; P <.001) than patients receiving citalopram (N = 4212). Patients receiving escitalopram were also less likely to have a hospital admission (odds ratio 0.88; P = .036) or an emergency department visit and had lower total healthcare costs (-$1174) and major depressive disorder-related costs (-$109; P <.001) during the study period. Although the drug acquisition costs are lower for generic citalopram than for the brand-name escitalopram, patients treated with escitalopram had better treatment persistence, lower healthcare utilization, and lower overall costs compared with patients treated with citalopram over the study period. This may suggest that other considerations, in addition to acquisition cost, may need to be factored in to assess the cost-effectiveness of drug therapy.

Comparing Treatment Persistence, Healthcare Resource Utilization, and Costs in Adult Patients with Major Depressive Disorder Treated with Escitalopram or Citalopram

PubMed Central

Wu, Eric Q.; Greenberg, Paul E.; Ben-Hamadi, Rym; Yu, Andrew P.; Yang, Elaine H.; Erder, M. Haim

2011-01-01

Background Major depressive disorder is the most common type of depression, affecting 6.6% of adults in the United States annually. Citalopram and escitalopram are common second-generation antidepressants used for the treatment of patients with this disorder. Because citalopram is available in generic forms that have lower acquisition costs compared with the branded escitalopram, some health plans may provide incentives to encourage the use of the generic option. Decisions based solely on drug acquisition costs may encourage the use of a therapy that is less cost-effective when treatment persistence, healthcare utilization, and overall costs are factored in. Objective To compare, in a real-world setting, the treatment persistence, healthcare utilization, and overall costs of managing adult patients with major depressive disorder who are treated with escitalopram or citalopram. Methods Administrative claims data (from January 1, 2003, to June 30, 2005) were analyzed for patients with major depressive disorder aged ≥18 years. Patients filled ≥1 prescriptions for citalopram or for escitalopram (first-fill time was defined as the index date) and had no second-generation antidepressant use during the 6-month preindex period. Treatment persistence, healthcare utilization, and healthcare costs were measured over the 6-month preindex and 6-month postindex periods and compared between patients treated with citalopram or escitalopram, using unadjusted and multivariate analyses. Results Patients receiving escitalopram (N = 10,465) were less likely to discontinue the treatment (hazard ratio 0.94; P = .005) and switch to another second-generation antidepressant (hazard ratio 0.83; P <.001) than patients receiving citalopram (N = 4212). Patients receiving escitalopram were also less likely to have a hospital admission (odds ratio 0.88; P = .036) or an emergency department visit and had lower total healthcare costs (−$1174) and major depressive disorder–related costs (−$109; P <.001) during the study period. Conclusion Although the drug acquisition costs are lower for generic citalopram than for the brand-name escitalopram, patients treated with escitalopram had better treatment persistence, lower healthcare utilization, and lower overall costs compared with patients treated with citalopram over the study period. This may suggest that other considerations, in addition to acquisition cost, may need to be factored in to assess the cost-effectiveness of drug therapy. PMID:25126340

Healthcare costs and resource utilization of patients with binge-eating disorder and eating disorder not otherwise specified in the Department of Veterans Affairs.

PubMed

Bellows, Brandon K; DuVall, Scott L; Kamauu, Aaron W C; Supina, Dylan; Babcock, Thomas; LaFleur, Joanne

2015-12-01

The objective of this study was to compare the one-year healthcare costs and utilization of patients with binge-eating disorder (BED) to patients with eating disorder not otherwise specified without BED (EDNOS-only) and to matched patients without an eating disorder (NED). A natural language processing (NLP) algorithm identified adults with BED from clinical notes in the Department of Veterans Affairs (VA) electronic health record database from 2000 to 2011. Patients with EDNOS-only were identified using ICD-9 code (307.50) and those with NLP-identified BED were excluded. First diagnosis date defined the index date for both groups. Patients with NED were randomly matched 4:1, as available, to patients with BED on age, sex, BMI, depression diagnosis, and index month. Patients with cost data (2005-2011) were included. Total healthcare, inpatient, outpatient, and pharmacy costs were examined. Generalized linear models were used to compare total one-year healthcare costs while adjusting for baseline patient characteristics. There were 257 BED, 743 EDNOS-only, and 823 matched NED patients identified. The mean (SD) total unadjusted one-year costs, in 2011 US dollars, were $33,716 ($38,928) for BED, $37,052 ($40,719) for EDNOS-only, and $19,548 ($35,780) for NED patients. When adjusting for patient characteristics, BED patients had one-year total healthcare costs $5,589 higher than EDNOS-only (p = 0.06) and $18,152 higher than matched NED patients (p < 0.001). This study is the first to use NLP to identify BED patients and quantify their healthcare costs and utilization. Patients with BED had similar one-year total healthcare costs to EDNOS-only patients, but significantly higher costs than patients with NED. © 2015 Wiley Periodicals, Inc.

Electrically operated magnetic switch designed to display reduced leakage inductance

DOEpatents

Cook, E.G.

1994-05-10

An electrically operated magnetic switch is disclosed herein for use in opening and closing a circuit between two terminals depending upon the voltage across these terminals. The switch so disclosed is comprised of a ferrite core in the shape of a toroid having opposing ends and opposite inner and outer sides and an arrangement of electrically conductive components defining at least one current flow path which makes a number of turns around the core. This arrangement of components includes a first plurality of electrically conducive rigid rods parallel with and located outside the outer side of the core and a second plurality of electrically conductive rigid rods parallel with and located inside the inner side of the core. The arrangement also includes means for electrically connecting these rods together so that the define the current flow path. In one embodiment, this latter means uses rigid cross-tab means. In another, preferred embodiment, printed circuits on rigid dielectric substrates located on opposite ends of the core are utilized to interconnect the rods together. 10 figures.

MicrofluIdic circuit designs for performing electrokinetic manipulations that reduce the number of voltage sources and fluid reservoirs

DOEpatents

Jacobson, Stephen C.; Ramsey, J. Michael

2000-01-01

A microfabricated device and method for proportioning and mixing electrokinetically manipulated biological or chemical materials is disclosed. The microfabricated device mixes a plurality of materials in volumetric proportions controlled by the electrical resistances of tributary reagent channels through which the materials are transported. The microchip includes two or more tributary reagent channels combining at one or more junctions to form one or more mixing channels. By varying the geometries of the channels (length, cross section, etc.), a plurality of reagent materials can be mixed at a junction such that the proportions of the reagent materials in the mixing channel depend on a ratio of the channel geometries and material properties. Such an approach facilitates voltage division on the microchip without relying on external wiring schemes and voltage division techniques external to the microchip. Microchannel designs that provide the necessary voltage division to accomplish electrokinetic valving operations using a single voltage source and a switch are also described. In addition, microchannel designs that accomplish fluidic operation utilizing a minimal number of fluidic reservoirs are disclosed.

Microfluidic circuit designs for performing fluidic manipulations that reduce the number of pumping sources and fluid reservoirs

DOEpatents

Jacobson, Stephen C [Knoxville, TN; Ramsey, J Michael [Knoxville, TN

2001-01-01

A microfabricated device and method for proportioning and mixing biological or chemical materials by pressure- or vacuum-driven flow is disclosed. The microfabricated device mixes a plurality of materials in volumetric proportions controlled by the flow resistances of tributary reagent channels through which the materials are transported. The microchip includes two or more tributary reagent channels combining at one or more junctions to form one or more mixing channels. By varying the geometries of the channels (length, cross section, etc.), a plurality of reagent materials can be mixed at a junction such that the proportions of the reagent materials in the mixing channel depend on a ratio of the channel geometries and material properties. Such an approach facilitates flow division on the microchip without relying on techniques external to the microchip. Microchannel designs that provide the necessary flow division to accomplish valving operations using a minimum of pressure or vacuum sources are also described. In addition, microchannel designs that accomplish fluidic operation utilizing a minimal number of fluidic reservoirs are disclosed.

Modular robot

DOEpatents

Ferrante, Todd A.

1997-01-01

A modular robot may comprise a main body having a structure defined by a plurality of stackable modules. The stackable modules may comprise a manifold, a valve module, and a control module. The manifold may comprise a top surface and a bottom surface having a plurality of fluid passages contained therein, at least one of the plurality of fluid passages terminating in a valve port located on the bottom surface of the manifold. The valve module is removably connected to the manifold and selectively fluidically connects the plurality of fluid passages contained in the manifold to a supply of pressurized fluid and to a vent. The control module is removably connected to the valve module and actuates the valve module to selectively control a flow of pressurized fluid through different ones of the plurality of fluid passages in the manifold. The manifold, valve module, and control module are mounted together in a sandwich-like manner and comprise a main body. A plurality of leg assemblies are removably connected to the main body and are removably fluidically connected to the fluid passages in the manifold so that each of the leg assemblies can be selectively actuated by the flow of pressurized fluid in different ones of the plurality of fluid passages in the manifold.

Understanding the context of healthcare utilization: assessing environmental and provider-related variables in the behavioral model of utilization.

PubMed Central

Phillips, K A; Morrison, K R; Andersen, R; Aday, L A

1998-01-01

OBJECTIVE: The behavioral model of utilization, developed by Andersen, Aday, and others, is one of the most frequently used frameworks for analyzing the factors that are associated with patient utilization of healthcare services. However, the use of the model for examining the context within which utilization occurs-the role of the environment and provider-related factors-has been largely neglected. OBJECTIVE: To conduct a systematic review and analysis to determine if studies of medical care utilization that have used the behavioral model during the last 20 years have included environmental and provider-related variables and the methods used to analyze these variables. We discuss barriers to the use of these contextual variables and potential solutions. DATA SOURCES: The Social Science Citation Index and Science Citation Index. We included all articles from 1975-1995 that cited any of three key articles on the behavioral model, that included all articles that were empirical analyses and studies of formal medical care utilization, and articles that specifically stated their use of the behavioral model (n = 139). STUDY DESIGN: Design was a systematic literature review. DATA ANALYSIS: We used a structured review process to code articles on whether they included contextual variables: (1) environmental variables (characteristics of the healthcare delivery system, external environment, and community-level enabling factors); and (2) provider-related variables (patient factors that may be influenced by providers and provider characteristics that interact with patient characteristics to influence utilization). We also examined the methods used in studies that included contextual variables. PRINCIPAL FINDINGS: Forty-five percent of the studies included environmental variables and 51 percent included provider-related variables. Few studies examined specific measures of the healthcare system or provider characteristics or used methods other than simple regression analysis with hierarchical entry of variables. Only 14 percent of studies analyzed the context of healthcare by including both environmental and provider-related variables as well as using relevant methods. CONCLUSIONS: By assessing whether and how contextual variables are used, we are able to highlight the contributions made by studies using these approaches, to identify variables and methods that have been relatively underused, and to suggest solutions to barriers in using contextual variables. PMID:9685123

Diabetes diagnosis, resource utilization, and health outcomes.

PubMed

Gulliford, Martin C; Latinovic, Radoslav; Charlton, Judith

2008-01-01

To determine the effect of a clinical diagnosis of diabetes mellitus (DM) on healthcare utilization and health outcomes. Cohort study. A total of 197 United Kingdom family practices with 4974 subjects (mean age, 62.8 years; 52.2% men) with type 2 DM and 9948 matched nondiabetic control subjects. Healthcare utilization and the occurrence of complications were estimated from 2 years before to 2 years after the first clinical diagnosis of DM. From 24 months before the DM diagnosis, primary care consultations were increased in prediagnosis cases compared with controls (relative rate [RR], 1.31; 95% confidence interval [CI], 1.27-1.35), as were emergency and hospital care consultations, hospital specialist referrals, and prescription drug items. At diagnosis of DM, utilization of all forms of healthcare was increased (RR, 4.27; 95% CI, 4.17-4.36 for primary care consultations; RR, 2.49; 95% CI, 2.46-2.52 for prescription drug items). In the quarter following diagnosis, healthcare utilization was increased for acute myocardial infarction (RR, 6.29; 95% CI, 2.69-14.73), cerebrovascular disease (RR, 5.14; 95% CI, 3.37-7.84), ischemic heart disease (RR, 3.65; 95% CI, 2.77-4.80), and peripheral nerve disorders (RR, 5.01; 95% CI, 2.81-8.95). First diagnoses of myocardial infarction, cerebrovascular disease, and peripheral nerve disorders were increased during the period from 6 months before to 6 months after diagnosis. Clinical diagnosis of DM is often the end of a process leading to established complications and is associated with greatly increased utilization of care. This adds to the justification of strategies for earlier detection of hyperglycemic states.

Utilization of Health Services Among Adults With Recurrent Clostridium difficile Infection: A 12-Year Population-Based Study

PubMed Central

Kuntz, Jennifer L.; Baker, Jennifer M.; Kipnis, Patricia; Li, Sherian Xu; Liu, Vincent; Xie, Yang; Marcella, Stephen; Escobar, Gabriel J.

2017-01-01

BACKGROUND Considerable efforts have been dedicated to developing strategies to prevent and treat recurrent Clostridium difficile infection (rCDI); however, evidence of the impact of rCDI on patient healthcare utilization and outcomes is limited. OBJECTIVE To compare healthcare utilization and 1-year mortality among adults who had rCDI, nonrecurrent CDI, or no CDI. METHODS We performed a nested case-control study among adult Kaiser Foundation Health Plan members from September 1, 2001, through December 31, 2013. We identified CDI through the presence of a positive laboratory test result and divided patients into 3 groups: patients with rCDI, defined as CDI in the 14–57 days after initial CDI; patients with nonrecurrent CDI; and patients who never had CDI. We conducted 3 matched comparisons: (1) rCDI vs no CDI; (2) rCDI vs nonrecurrent CDI; (3) nonrecurrent CDI vs no CDI. We followed patients for 1 year and compared healthcare utilization between groups, after matching patients on age, sex, and comorbidity. RESULTS We found that patients with rCDI consistently have substantially higher levels of healthcare utilization in various settings and greater 1-year mortality risk than both patients who had nonrecurrent CDI and patients who never had CDI. CONCLUSIONS Patients who develop an initial CDI are generally characterized by excess underlying, severe illness and utilization. However, patients with rCDI experience even greater adverse consequences of their disease than patients who do not experience rCDI. Our results further support the need for continued emphasis on identifying and using novel approaches to prevent and treat rCDI. PMID:27760583

Utilization of Health Services Among Adults With Recurrent Clostridium difficile Infection: A 12-Year Population-Based Study.

PubMed

Kuntz, Jennifer L; Baker, Jennifer M; Kipnis, Patricia; Li, Sherian Xu; Liu, Vincent; Xie, Yang; Marcella, Stephen; Escobar, Gabriel J

2017-01-01

BACKGROUND Considerable efforts have been dedicated to developing strategies to prevent and treat recurrent Clostridium difficile infection (rCDI); however, evidence of the impact of rCDI on patient healthcare utilization and outcomes is limited. OBJECTIVE To compare healthcare utilization and 1-year mortality among adults who had rCDI, nonrecurrent CDI, or no CDI. METHODS We performed a nested case-control study among adult Kaiser Foundation Health Plan members from September 1, 2001, through December 31, 2013. We identified CDI through the presence of a positive laboratory test result and divided patients into 3 groups: patients with rCDI, defined as CDI in the 14-57 days after initial CDI; patients with nonrecurrent CDI; and patients who never had CDI. We conducted 3 matched comparisons: (1) rCDI vs no CDI; (2) rCDI vs nonrecurrent CDI; (3) nonrecurrent CDI vs no CDI. We followed patients for 1 year and compared healthcare utilization between groups, after matching patients on age, sex, and comorbidity. RESULTS We found that patients with rCDI consistently have substantially higher levels of healthcare utilization in various settings and greater 1-year mortality risk than both patients who had nonrecurrent CDI and patients who never had CDI. CONCLUSIONS Patients who develop an initial CDI are generally characterized by excess underlying, severe illness and utilization. However, patients with rCDI experience even greater adverse consequences of their disease than patients who do not experience rCDI. Our results further support the need for continued emphasis on identifying and using novel approaches to prevent and treat rCDI. Infect Control Hosp Epidemiol. 2016;1-8.

Healthcare Cost and Impact of Persistent Orofacial Pain: The DEEP Study Cohort.

PubMed

Durham, J; Shen, J; Breckons, M; Steele, J G; Araujo-Soares, V; Exley, C; Vale, L

2016-09-01

Few data are available on the healthcare costs of those suffering from persistent orofacial pain (POFP). This cohort and cost analysis study examined the direct costs of POFP from the perspective of the healthcare provider (specifically, the UK National Health Service) in 2012 pounds sterling and sought to identify whether dichotomized (high, IIb to IV; low, 0 to IIa) graded chronic pain scale (GCPS) status is predictive of the total cost of healthcare over the last 6 mo. The healthcare utilization data of 198 patients with POFP were collected using a structured interview and a validated "use of services and productivity" questionnaire. Unit costs were used with these utilization data to calculate direct healthcare costs in 3 categories: consultation, medication, and appliances and interventions. Consultation costs were a significant proportion of cumulative healthcare cost (P < 0.001). Dichotomized GCPS status was predictive of increased healthcare cost over the last 6 mo, accounting for an average increase of £366 (95% confidence interval, 135 to 598; P < 0.01) when moving from a low GCPS status to a high GCPS status. Given the predictive capability of dichotomized GCPS status and the success of stratified models of care for other persistent pain conditions, dichotomized GCPS status may offer an opportunity to help determine stratification of care for patients with POFP. © International & American Associations for Dental Research 2016.

Healthcare information technology and medical-surgical nurses: the emergence of a new care partnership.

PubMed

Moore, An'Nita; Fisher, Kathleen

2012-03-01

Healthcare information technology in US hospitals and ambulatory care centers continues to expand, and nurses are expected to effectively and efficiently utilize this technology. Researchers suggest that clinical information systems have expanded the realm of nursing to integrate technology as an element as important in nursing practice as the patient or population being served. This study sought to explore how medical surgical nurses make use of healthcare information technology in their current clinical practice and to examine the influence of healthcare information technology on nurses' clinical decision making. A total of eight medical surgical nurses participated in the study, four novice and four experienced. A conventional content analysis was utilized that allowed for a thematic interpretation of participant data. Five themes emerged: (1) healthcare information technology as a care coordination partner, (2) healthcare information technology as a change agent in the care delivery environment, (3) healthcare information technology-unable to meet all the needs, of all the people, all the time, (4) curiosity about healthcare information technology-what other bells and whistles exist, and (5) Big Brother is watching. The results of this study indicate that a new care partnership has emerged as the provision of nursing care is no longer supplied by a single practitioner but rather by a paired team, consisting of nurses and technology, working collaboratively in an interdependent relationship to achieve established goals.

Methods for making nucleotide probes for sequencing and synthesis

DOEpatents

Church, George M; Zhang, Kun; Chou, Joseph

2014-07-08

Compositions and methods for making a plurality of probes for analyzing a plurality of nucleic acid samples are provided. Compositions and methods for analyzing a plurality of nucleic acid samples to obtain sequence information in each nucleic acid sample are also provided.

System and method having multi-tube fuel nozzle with differential flow

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

Hughes, Michael John; Johnson, Thomas Edward; Berry, Jonathan Dwight

A system includes a multi-tube fuel nozzle with a fuel nozzle body and a plurality of tubes. The fuel nozzle body includes a nozzle wall surrounding a chamber. The plurality of tubes extend through the chamber, wherein each tube of the plurality of tubes includes an air intake portion, a fuel intake portion, and an air-fuel mixture outlet portion. The multi-tube fuel nozzle also includes a differential configuration of the air intake portions among the plurality of tubes.

Reducing power consumption while performing collective operations on a plurality of compute nodes

DOEpatents

Archer, Charles J [Rochester, MN; Blocksome, Michael A [Rochester, MN; Peters, Amanda E [Rochester, MN; Ratterman, Joseph D [Rochester, MN; Smith, Brian E [Rochester, MN

2011-10-18

Methods, apparatus, and products are disclosed for reducing power consumption while performing collective operations on a plurality of compute nodes that include: receiving, by each compute node, instructions to perform a type of collective operation; selecting, by each compute node from a plurality of collective operations for the collective operation type, a particular collective operation in dependence upon power consumption characteristics for each of the plurality of collective operations; and executing, by each compute node, the selected collective operation.

Systems and Methods for Providing Insulation

NASA Technical Reports Server (NTRS)

Golden, Johnny L. (Inventor)

2015-01-01

Systems and methods provide a multi-layer insulation (MLI) that includes a plurality of sealed metalized volumes in a stacked arrangement, wherein the plurality of sealed metalized volumes encapsulate a gas therein, with the gas having one of a thermal insulating property, an acoustic insulating property, or a combination insulating property thereof. The MLI also includes at least one spacer between adjacent sealed metalized volumes of the plurality of sealed metalized volumes and a protective cover surrounding the plurality of sealed metalized volumes.

Methods and Apparatus for Deployable Swirl Vanes

NASA Technical Reports Server (NTRS)

Shah, Parthiv N. (Inventor)

2017-01-01

An aircraft control structure for drag management includes a nozzle structure configured to exhaust a swirling fluid stream. A plurality of swirl vanes are positioned within the nozzle structure, and an actuation subsystem is configured to cause the plurality of swirl vanes to move from a deployed state to a non-deployed state. In the non-deployed state, the plurality of swirl vanes are substantially flush with the inner surface of the nozzle structure. In the deployed state, the plurality of swirl vanes produce the swirling fluid stream.

Catalytic reforming methods

DOEpatents

Tadd, Andrew R; Schwank, Johannes

2013-05-14

A catalytic reforming method is disclosed herein. The method includes sequentially supplying a plurality of feedstocks of variable compositions to a reformer. The method further includes adding a respective predetermined co-reactant to each of the plurality of feedstocks to obtain a substantially constant output from the reformer for the plurality of feedstocks. The respective predetermined co-reactant is based on a C/H/O atomic composition for a respective one of the plurality of feedstocks and a predetermined C/H/O atomic composition for the substantially constant output.

Accessibility and utilization patterns of a mobile medical clinic among vulnerable populations.

PubMed

Gibson, Britton A; Ghosh, Debarchana; Morano, Jamie P; Altice, Frederick L

2014-07-01

We mapped mobile medical clinic (MMC) clients for spatial distribution of their self-reported locations and travel behaviors to better understand health-seeking and utilization patterns of medically vulnerable populations in Connecticut. Contrary to distance decay literature, we found that a small but significant proportion of clients was traveling substantial distances to receive repeat care at the MMC. Of 8404 total clients, 90.2% lived within 5 miles of a MMC site, yet mean utilization was highest (5.3 visits per client) among those living 11-20 miles of MMCs, primarily for those with substance use disorders. Of clients making >20 visits, 15.0% traveled >10 miles, suggesting that a significant minority of clients traveled to MMC sites because of their need-specific healthcare services, which are not only free but available at an acceptable and accommodating environment. The findings of this study contribute to the important research on healthcare utilization among vulnerable population by focusing on broader dimensions of accessibility in a setting where both mobile and fixed healthcare services coexist. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Impact of Worksite Clinics on Teacher Healthcare Utilization and Cost, Self-reported Health Status, and Student Academic Achievement growth in a Public School District.

PubMed

Engberg, John B; Harris-Shapiro, Jon; Hines, David; McCarver, Patti; Liu, Harry H

2018-05-29

To examine the impact of worksite clinics on healthcare utilization and cost, self-reported health status, and student achievement growth in a public school district. We used insurance claims, health risk assessment, and student achievement growth data for active teachers during 2007-2015. A difference-in-differences approach was applied to measure the impact of worksite clinics. Compared to using a community-based clinic as the usual source of primary care, using a worksite clinic was associated with significantly lower inpatient admissions (53 vs. 31 per 1,000 teacher years), annual healthcare cost ($5,043 vs. $4,298 in 2016 US dollars, a difference of $62 per teacher per month), and annual absent work hours (63 vs. 61). No significant differences were detected in self-reported health status or student achievement growth. Worksite clinics reduce teacher healthcare cost and absenteeism.

Improving the delivery of care and reducing healthcare costs with the digitization of information.

PubMed

Noffsinger, R; Chin, S

2000-01-01

In the coming years, the digitization of information and the Internet will be extremely powerful in reducing healthcare costs while assisting providers in the delivery of care. One example of healthcare inefficiency that can be managed through information digitization is the process of prescription writing. Due to the handwritten and verbal communication surrounding prescription writing, as well as the multiple tiers of authorizations, the prescription drug process causes extensive financial waste as well as medical errors, lost time, and even fatal accidents. Electronic prescription management systems are being designed to address these inefficiencies. By utilizing new electronic prescription systems, physicians not only prescribe more accurately, but also improve formulary compliance thereby reducing pharmacy utilization. These systems expand patient care by presenting proactive alternatives at the point of prescription while reducing costs and providing additional benefits for consumers and healthcare providers.

Determinants of elevated healthcare utilization in patients with COPD.

PubMed

Simon-Tuval, Tzahit; Scharf, Steven M; Maimon, Nimrod; Bernhard-Scharf, Barbara J; Reuveni, Haim; Tarasiuk, Ariel

2011-01-13

Chronic obstructive pulmonary disease (COPD) imparts a substantial economic burden on western health systems. Our objective was to analyze the determinants of elevated healthcare utilization among patients with COPD in a single-payer health system. Three-hundred eighty-nine adults with COPD were matched 1:3 to controls by age, gender and area of residency. Total healthcare cost 5 years prior recruitment and presence of comorbidities were obtained from a computerized database. Health related quality of life (HRQoL) indices were obtained using validated questionnaires among a subsample of 177 patients. Healthcare utilization was 3.4-fold higher among COPD patients compared with controls (p < 0.001). The "most-costly" upper 25% of COPD patients (n = 98) consumed 63% of all costs. Multivariate analysis revealed that independent determinants of being in the "most costly" group were (OR; 95% CI): age-adjusted Charlson Comorbidity Index (1.09; 1.01-1.2), history of: myocardial infarct (2.87; 1.5-5.5), congestive heart failure (3.52; 1.9-6.4), mild liver disease (3.83; 1.3-11.2) and diabetes (2.02; 1.1-3.6). Bivariate analysis revealed that cost increased as HRQoL declined and severity of airflow obstruction increased but these were not independent determinants in a multivariate analysis. Comorbidity burden determines elevated utilization for COPD patients. Decision makers should prioritize scarce health care resources to a better care management of the "most costly" patients.

Does distrust in providers affect health-care utilization in China?

PubMed Central

Duckett, Jane; Hunt, Kate; Munro, Neil; Sutton, Matt

2016-01-01

How trust affects health-care utilization is not well-understood, especially in low- and middle-income countries. This article focuses on China, a middle-income country where low trust in health-care settings has become a prominent issue, but actual levels of distrust and their implications for utilization are unknown. We conducted a nationally representative survey of the Chinese population (November 2012 to January 2013), which resulted in a sample of 3680 adult men and women. Respondents rated their trust in different types of health-care providers. Using multivariate logistic and negative binomial regression models, we estimated the association between distrust in clinics and respondents’ hospital visits in the last year; whether they had sought hospital treatment first for two common symptoms (headache, cold) in the last 2 months; and whether they said they would go first to a hospital if they had a minor or major illness. We analysed these associations before and after adjusting for performance evaluations of clinics and hospitals, controlling for sex, age, education, income, insurance status, household registration and self-assessed health. We found that distrust in hospitals is low, but distrust in clinics is high and strongly associated with increased hospital utilization, especially for minor symptoms and illnesses. Further research is needed to understand the reasons for distrust in clinics because its effects are not fully accounted for by poor evaluations of their competence. PMID:27117483

Photovoltaic power generation system free of bypass diodes

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

Lentine, Anthony L.; Okandan, Murat; Nielson, Gregory N.

A photovoltaic power generation system that includes a solar panel that is free of bypass diodes is described herein. The solar panel includes a plurality of photovoltaic sub-modules, wherein at least two of photovoltaic sub-modules in the plurality of photovoltaic sub-modules are electrically connected in parallel. A photovoltaic sub-module includes a plurality of groups of electrically connected photovoltaic cells, wherein at least two of the groups are electrically connected in series. A photovoltaic group includes a plurality of strings of photovoltaic cells, wherein a string of photovoltaic cells comprises a plurality of photovoltaic cells electrically connected in series. The stringsmore » of photovoltaic cells are electrically connected in parallel, and the photovoltaic cells are microsystem-enabled photovoltaic cells.« less

Scheduling applications for execution on a plurality of compute nodes of a parallel computer to manage temperature of the nodes during execution

DOEpatents

Archer, Charles J; Blocksome, Michael A; Peters, Amanda E; Ratterman, Joseph D; Smith, Brian E

2012-10-16

Methods, apparatus, and products are disclosed for scheduling applications for execution on a plurality of compute nodes of a parallel computer to manage temperature of the plurality of compute nodes during execution that include: identifying one or more applications for execution on the plurality of compute nodes; creating a plurality of physically discontiguous node partitions in dependence upon temperature characteristics for the compute nodes and a physical topology for the compute nodes, each discontiguous node partition specifying a collection of physically adjacent compute nodes; and assigning, for each application, that application to one or more of the discontiguous node partitions for execution on the compute nodes specified by the assigned discontiguous node partitions.

Lubricant-impregnated surfaces for electrochemical applications, and devices and systems using same

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

Solomon, Brian Richmond; Chen, Xinwei; Chiang, Yet-Ming

In certain embodiments, the invention relates to an electrochemical device having a liquid lubricant impregnated surface. At least a portion of the interior surface of the electrochemical device includes a portion that includes a plurality of solid features disposed therein. The plurality of solid features define a plurality of regions therebetween. A lubricant is disposed in the plurality of regions which retain the liquid lubricant in the plurality of regions during operation of the device. An electroactive phase comes in contact with at least the portion of the interior surface. The liquid lubricant impregnated surface introduces a slip at themore » surface when the electroactive phase flows along the surface. The electroactive phase may be a yield stress fluid.« less

Massively parallel diffuse optical tomography

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

Sandusky, John V.; Pitts, Todd A.

Diffuse optical tomography systems and methods are described herein. In a general embodiment, the diffuse optical tomography system comprises a plurality of sensor heads, the plurality of sensor heads comprising respective optical emitter systems and respective sensor systems. A sensor head in the plurality of sensors heads is caused to act as an illuminator, such that its optical emitter system transmits a transillumination beam towards a portion of a sample. Other sensor heads in the plurality of sensor heads act as observers, detecting portions of the transillumination beam that radiate from the sample in the fields of view of themore » respective sensory systems of the other sensor heads. Thus, sensor heads in the plurality of sensors heads generate sensor data in parallel.« less

Effect of patient selection method on provider group performance estimates.

PubMed

Thorpe, Carolyn T; Flood, Grace E; Kraft, Sally A; Everett, Christine M; Smith, Maureen A

2011-08-01

Performance measurement at the provider group level is increasingly advocated, but different methods for selecting patients when calculating provider group performance have received little evaluation. We compared 2 currently used methods according to characteristics of the patients selected and impact on performance estimates. We analyzed Medicare claims data for fee-for-service beneficiaries with diabetes ever seen at an academic multispeciality physician group in 2003 to 2004. We examined sample size, sociodemographics, clinical characteristics, and receipt of recommended diabetes monitoring in 2004 for the groups of patients selected using 2 methods implemented in large-scale performance initiatives: the Plurality Provider Algorithm and the Diabetes Care Home method. We examined differences among discordantly assigned patients to determine evidence for differential selection regarding these measures. Fewer patients were selected under the Diabetes Care Home method (n=3558) than the Plurality Provider Algorithm (n=4859). Compared with the Plurality Provider Algorithm, the Diabetes Care Home method preferentially selected patients who were female, not entitled because of disability, older, more likely to have hypertension, and less likely to have kidney disease and peripheral vascular disease, and had lower levels of predicted utilization. Diabetes performance was higher under Diabetes Care Home method, with 67% versus 58% receiving >1 A1c tests, 70% versus 65% receiving ≥1 low-density lipoprotein (LDL) test, and 38% versus 37% receiving an eye examination. The method used to select patients when calculating provider group performance may affect patient case mix and estimated performance levels, and warrants careful consideration when comparing performance estimates.

Medical Conditions and Healthcare Utilization among Adults with Intellectual Disabilities Living in Group Homes in New York City

ERIC Educational Resources Information Center

Levy, Joel M.; Botuck, Shelly; Damiani, Marco R.; Levy, Philip H.; Dern, Thomas A.; Freeman, Stephen E.

2006-01-01

The shift in living situations for adults with intellectual and other developmental disabilities (IDDD) from family homes to group homes has raised questions about their healthcare needs and access to appropriate healthcare services. This study was undertaken to describe the disability characteristics and medical conditions in a sample of adults…

Strategies to improve healthcare websites.

PubMed

Johnson, Constance; Peterson, Susan K; Turley, James P; Ensor, Joe; Amos, Christopher; Spitz, Margaret; Levin, Bernard; Berry, Donald

2006-01-01

Healthcare websites that are influential in healthcare decision-making must be evaluated for accuracy, readability and understandability by the average population. Most existing frameworks for designing and evaluating interactive websites focus on the utility and usability of the site. Although these are significant to the design of the basic site, they are not sufficient. We have developed an iterative framework that considers additional attributes.

Healthcare Policy Statement on the Utility of Coronary Computed Tomography for Evaluation of Cardiovascular Conditions and Preventive Healthcare: From the Health Policy Working Group of the Society of Cardiovascular Computed Tomography.

PubMed

Slim, Ahmad M; Jerome, Scott; Blankstein, Ron; Weigold, Wm Guy; Patel, Amit R; Kalra, Dinesh K; Miller, Ryan; Branch, Kelley; Rabbat, Mark G; Hecht, Harvey; Nicol, Edward D; Villines, Todd C; Shaw, Leslee J

The rising cost of healthcare is prompting numerous policy and advocacy discussions regarding strategies for constraining growth and creating a more efficient and effective healthcare system. Cardiovascular imaging is central to the care of patients at risk of, and living with, heart disease. Estimates are that utilization of cardiovascular imaging exceeds 20 million studies per year. The Society of Cardiovascular CT (SCCT), alongside Rush University Medical Center, and in collaboration with government agencies, regional payers, and industry healthcare experts met in November 2016 in Chicago, IL to evaluate obstacles and hurdles facing the cardiovascular imaging community and how they can contribute to efficacy while maintaining or even improving outcomes and quality. The summit incorporated inputs from payers, providers, and patients' perspectives, providing a platform for all voices to be heard, allowing for a constructive dialogue with potential solutions moving forward. This article outlines the proceedings from the summit, with a detailed review of past hurdles, current status, and potential solutions as we move forward in an ever-changing healthcare landscape. Copyright © 2017 Society of Cardiovascular Computed Tomography. All rights reserved.

47 CFR 80.109 - Transmission to a plurality of mobile stations by a public coast station.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 5 2010-10-01 2010-10-01 false Transmission to a plurality of mobile stations... Procedures Operating Procedures-Land Stations § 80.109 Transmission to a plurality of mobile stations by a... mobile stations. ...

Method and system employing graphical electric load categorization to identify one of a plurality of different electric load types

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

Yang, Yi; Du, Liang

A system for different electric loads includes sensors structured to sense voltage and current signals for each of the different electric loads; a hierarchical load feature database having a plurality of layers, with one of the layers including a plurality of different load categories; and a processor. The processor acquires voltage and current waveforms from the sensors for a corresponding one of the different electric loads; maps a voltage-current trajectory to a grid including a plurality of cells, each of which is assigned a binary value of zero or one; extracts a plurality of different features from the mapped gridmore » of cells as a graphical signature of the corresponding one of the different electric loads; derives a category of the corresponding one of the different electric loads from the database; and identifies one of a plurality of different electric load types for the corresponding one of the different electric loads.« less

[High utilization of health insurance services by the elderly--analysis of hospital and drug utilization data].

PubMed

Nordheim, Johanna; Maaz, Asja; Winter, Maik H J; Kuhlmey, Adelheid; Hofmann, Werner

2006-01-01

The present contribution discusses the utilization of the healthcare system by elderly patients in Germany. First, the paper focuses on the detailed characterization of a group of people aged 60 years or more (N = 73,454). Second, the objective is to analyze the data for high utilization of healthcare services by older men and women. The analysis is based on data regularly recorded by a German health insurance agency for the year 2000. High utilization is operationalized by a 10% cutoff for users with the highest number of treatments, highest costs and/or other criteria depending on the respective health service sector. The insured group investigated received approximately 1.4 million prescriptions, producing costs of 42 million E. High utilizers account for 32% of all prescriptions and 44% of the costs, respectively. At the same time, the age groups with the highest prescription rates do not cause the highest costs: So the relationship between age and prescription drug expenses as well as between age and prescription rates does not display an arithmetically increasing pattern. Within the timeframe investigated 26,000 hospital treatments were accounted for by 21.75% of the elderly under research. In total, they caused expenses of 88 million E. High utilization in the hospital sector was operationalized by four criteria. Sex- and age-specific analysis of high utilization of hospital treatment revealed that the four different criteria apply to different insured groups. In summary, the high utilization of healthcare services appears to be a multidimensional phenomenon.

Can home care for homebound patients with chronic heart failure reduce hospitalizations and costs?

PubMed

Punchik, Boris; Komarov, Roman; Gavrikov, Dmitry; Semenov, Anna; Freud, Tamar; Kagan, Ella; Goldberg, Yury; Press, Yan

2017-01-01

Congestive heart failure (CHF), a common problem in adults, is associated with multiple hospitalizations, high mortality rates and high costs. To evaluate whether home care for homebound patients with CHF reduces healthcare service utilization and overall costs. A retrospective study of healthcare utilization among homebound patients who received home care for CHF from 2012-1015. The outcome measures were number of hospital admissions per month, total number of hospitalization days and days for CHF only, emergency room visits, and overall costs. A comparison was conducted between the 6-month period prior to entry into home care and the time in home care. Over the study period 196 patients were treated by home care for CHF with a mean age of 79.4±9.5 years. 113 (57.7%) were women. Compared to the six months prior to home care, there were statistically significant decreases in hospitalizations (46.3%), in the number of total in-hospital days (28.7%), in the number of in-hospital days for CHF (66.7%), in emergency room visits (47%), and in overall costs (23.9%). Home care for homebound adults with CHF can reduce healthcare utilization and healthcare costs.

Healthcare utilization and costs in persons with insomnia in a managed care population.

PubMed

Anderson, Louise H; Whitebird, Robin R; Schultz, Jennifer; McEvoy, Charlene E; Kreitzer, Mary Jo; Gross, Cynthia R

2014-05-01

To better understand the direct costs of insomnia. Our study aimed to compare healthcare costs and utilization of patients diagnosed with insomnia who received care in a managed care organization with a set of matched controls. Our observational, retrospective cohort study compared 7647 adults with an insomnia diagnosis with an equally sized matched cohort of health plan members without an insomnia diagnosis between 2003 and 2006. We also compared a subset of patients diagnosed with and treated for insomnia with those diagnosed with insomnia but not treated. A large Midwestern health plan with more than 600,000 members. Multivariate analysis was used to estimate the association between insomnia diagnosis and costs, controlling for covariates, in the baseline and follow-up periods. Although we cannot conclude a causal relationship between insomnia and healthcare costs, our analysis found that insomnia diagnosis was associated with 26% higher costs in the baseline and 46% in the 12 months after diagnosis. When comorbidities were recognized, the insomnia cohort had 80% higher costs, on average, than the matched control cohort. These outcomes suggest the need to look beyond the direct cost of insomnia to how its interaction with comorbid conditions drives healthcare cost and utilization.

Addressing Health Insurance Literacy Gaps in an Urban African American Population: A Qualitative Study.

PubMed

Ali, Nida M; Combs, Ryan M; Muvuka, Baraka; Ayangeakaa, Suur D

2018-06-20

Health insurance and health systems literacy needs are evolving with changes to the U.S. healthcare system. Following the implementation of the Affordable Care Act, many residents in West Louisville, Kentucky, a predominantly African American community, gained health insurance coverage for the first time. A qualitative study was conducted to assess residents' health insurance and health systems needs and to identify ways of assisting residents with navigating the healthcare system and utilizing their health insurance coverage. Twelve focus groups were conducted with a total of eighty-seven residents. Round one explored participants' experiences with health insurance, and round two examined their health information delivery preferences. An inductive thematic analysis was performed. Participants revealed the complexity of the health insurance system, many citing difficulty understanding health insurance concepts and finding suitable healthcare providers. High costs, mistrust in the healthcare system, and perceived public-private disparities were barriers to effective health insurance utilization. Health insurance materials in their current form have limited value in translating health insurance and health systems information to the West Louisville population. Alternative forms of information delivery, such as locally accessible and culturally competent community health workers may be better received and more successfully utilized by the community.

Healthcare use for acute gastrointestinal illness in two Inuit communities: Rigolet and Iqaluit, Canada†

PubMed Central

Harper, Sherilee L.; Edge, Victoria L.; Ford, James; Thomas, M. Kate; Pearl, David; Shirley, Jamal; McEwen, Scott A.

2015-01-01

Background The incidence of self-reported acute gastrointestinal illness (AGI) in Rigolet, Nunatsiavut, and Iqaluit, Nunavut, is higher than reported elsewhere in Canada; as such, understanding AGI-related healthcare use is important for healthcare provision, public health practice and surveillance of AGI. Objectives This study described symptoms, severity and duration of self-reported AGI in the general population and examined the incidence and factors associated with healthcare utilization for AGI in these 2 Inuit communities. Design Cross-sectional survey data were analysed using multivariable exact logistic regression to examine factors associated with individuals’ self-reported healthcare and over-the-counter (OTC) medication utilization related to AGI symptoms. Results In Rigolet, few AGI cases used healthcare services [4.8% (95% CI=1.5–14.4%)]; in Iqaluit, some cases used healthcare services [16.9% (95% CI=11.2–24.7%)]. Missing traditional activities due to AGI (OR=3.8; 95% CI=1.18–12.4) and taking OTC medication for AGI symptoms (OR=3.8; 95% CI=1.2–15.1) were associated with increased odds of using healthcare services in Iqaluit. In both communities, AGI severity and secondary symptoms (extreme tiredness, headache, muscle pains, chills) were significantly associated with increased odds of taking OTC medication. Conclusions While rates of self-reported AGI were higher in Inuit communities compared to non-Inuit communities in Canada, there were lower rates of AGI-related healthcare use in Inuit communities compared to other regions in Canada. As such, the rates of healthcare use for a given disease can differ between Inuit and non-Inuit communities, and caution should be exercised in making comparisons between Inuit and non-Inuit health outcomes based solely on clinic records and healthcare use. PMID:26001982

Healthcare use for acute gastrointestinal illness in two Inuit communities: Rigolet and Iqaluit, Canada.

PubMed

Harper, Sherilee L; Edge, Victoria L; Ford, James; Thomas, M Kate; Pearl, David; Shirley, Jamal; McEwen, Scott A

2015-01-01

The incidence of self-reported acute gastrointestinal illness (AGI) in Rigolet, Nunatsiavut, and Iqaluit, Nunavut, is higher than reported elsewhere in Canada; as such, understanding AGI-related healthcare use is important for healthcare provision, public health practice and surveillance of AGI. This study described symptoms, severity and duration of self-reported AGI in the general population and examined the incidence and factors associated with healthcare utilization for AGI in these 2 Inuit communities. Cross-sectional survey data were analysed using multivariable exact logistic regression to examine factors associated with individuals' self-reported healthcare and over-the-counter (OTC) medication utilization related to AGI symptoms. In Rigolet, few AGI cases used healthcare services [4.8% (95% CI=1.5-14.4%)]; in Iqaluit, some cases used healthcare services [16.9% (95% CI=11.2-24.7%)]. Missing traditional activities due to AGI (OR=3.8; 95% CI=1.18-12.4) and taking OTC medication for AGI symptoms (OR=3.8; 95% CI=1.2-15.1) were associated with increased odds of using healthcare services in Iqaluit. In both communities, AGI severity and secondary symptoms (extreme tiredness, headache, muscle pains, chills) were significantly associated with increased odds of taking OTC medication. While rates of self-reported AGI were higher in Inuit communities compared to non-Inuit communities in Canada, there were lower rates of AGI-related healthcare use in Inuit communities compared to other regions in Canada. As such, the rates of healthcare use for a given disease can differ between Inuit and non-Inuit communities, and caution should be exercised in making comparisons between Inuit and non-Inuit health outcomes based solely on clinic records and healthcare use.

Utility-preserving privacy protection of textual healthcare documents.

PubMed

Sánchez, David; Batet, Montserrat; Viejo, Alexandre

2014-12-01

The adoption of ITs by medical organisations makes possible the compilation of large amounts of healthcare data, which are quite often needed to be released to third parties for research or business purposes. Many of this data are of sensitive nature, because they may include patient-related documents such as electronic healthcare records. In order to protect the privacy of individuals, several legislations on healthcare data management, which state the kind of information that should be protected, have been defined. Traditionally, to meet with current legislations, a manual redaction process is applied to patient-related documents in order to remove or black-out sensitive terms. This process is costly and time-consuming and has the undesired side effect of severely reducing the utility of the released content. Automatic methods available in the literature usually propose ad-hoc solutions that are limited to protect specific types of structured information (e.g. e-mail addresses, social security numbers, etc.); as a result, they are hardly applicable to the sensitive entities stated in current regulations that do not present those structural regularities (e.g. diseases, symptoms, treatments, etc.). To tackle these limitations, in this paper we propose an automatic sanitisation method for textual medical documents (e.g. electronic healthcare records) that is able to protect, regardless of their structure, sensitive entities (e.g. diseases) and also those semantically related terms (e.g. symptoms) that may disclose the former ones. Contrary to redaction schemes based on term removal, our approach improves the utility of the protected output by replacing sensitive terms with appropriate generalisations retrieved from several medical and general-purpose knowledge bases. Experiments conducted on highly sensitive documents and in coherency with current regulations on healthcare data privacy show promising results in terms of the practical privacy and utility of the protected output. Copyright © 2014 Elsevier Inc. All rights reserved.

High speed sampler and demultiplexer

DOEpatents

McEwan, Thomas E.

1995-01-01

A high speed sampling demultiplexer based on a plurality of sampler banks, each bank comprising a sample transmission line for transmitting an input signal, a strobe transmission line for transmitting a strobe signal, and a plurality of sampling gates at respective positions along the sample transmission line for sampling the input signal in response to the strobe signal. Strobe control circuitry is coupled to the plurality of banks, and supplies a sequence of bank strobe signals to the strobe transmission lines in each of the plurality of banks, and includes circuits for controlling the timing of the bank strobe signals among the banks of samplers. Input circuitry is included for supplying the input signal to be sampled to the plurality of sample transmission lines in the respective banks. The strobe control circuitry can repetitively strobe the plurality of banks of samplers such that the banks of samplers are cycled to create a long sample length. Second tier demultiplexing circuitry is coupled to each of the samplers in the plurality of banks. The second tier demultiplexing circuitry senses the sample taken by the corresponding sampler each time the bank in which the sampler is found is strobed. A plurality of such samples can be stored by the second tier demultiplexing circuitry for later processing. Repetitive sampling with the high speed transient sampler induces an effect known as "strobe kickout". The sample transmission lines include structures which reduce strobe kickout to acceptable levels, generally 60 dB below the signal, by absorbing the kickout pulses before the next sampling repetition.

Learning language from the input: why innate constraints can't explain noun compounding.

PubMed

Ramscar, Michael; Dye, Melody

2011-02-01

Do the production and interpretation of patterns of plural forms in noun-noun compounds reveal the workings of innate constraints that govern morphological processing? The results of previous studies on compounding have been taken to support a number of important theoretical claims: first, that there are fundamental differences in the way that children and adults learn and process regular and irregular plurals, second, that these differences reflect formal constraints that govern the way the way regular and irregular plurals are processed in language, and third, that these constraints are unlikely to be the product of learning. In a series of seven experiments, we critically assess the evidence that is cited in support of these arguments. The results of our experiments provide little support for the idea that substantively different factors govern the patterns of acquisition, production and interpretation patterns of regular and irregular plural forms in compounds. Once frequency differences between regular and irregular plurals are accounted for, we find no evidence of any qualitative difference in the patterns of interpretation and production of regular and irregular plural nouns in compounds, in either adults or children. Accordingly, we suggest that the pattern of acquisition of both regular and irregular plurals in compounds is consistent with a simple account, in which children learn the conventions that govern plural compounding using evidence that is readily available in the distribution patterns of adult speech. Copyright © 2010 Elsevier Inc. All rights reserved.

Mental healthcare need and service utilization in older adults living in public housing.

PubMed

Simning, Adam; van Wijngaarden, Edwin; Fisher, Susan G; Richardson, Thomas M; Conwell, Yeates

2012-05-01

Anxiety and depression in socioeconomically disadvantaged older adults frequently go unrecognized and untreated. This study aims to characterize mental illness and its treatment in older adult public housing residents who have many risk factors for anxiety and depression. Cross-sectional study. Public housing high-rises in Rochester, New York. One hundred ninety residents aged 60 years and older. Anxiety and depression were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, GAD-7, and Patient Health Questionnaire. We obtained information on mental healthcare from medication review and self-report. Participants had a median age of 66 years, 58% were women, 80% were black, and 92% lived alone. Many participants (31%) were in need of mental healthcare: 21% had syndromal and 11% had subsyndromal anxiety or depression. Mental healthcare need was associated with younger age; intact cognitive functioning; impairments in instrumental activities of daily living (IADL); more medical illness; decreased mobility; smaller social network size; more severe life events; and increased utilization of medical, human, and informal services. Of those with mental healthcare need, most were not receiving it. Compared with residents receiving mental healthcare, residents with untreated need were more likely to be men and have less IADL impairment, medical illness, severe life events, onsite social worker use, and human services utilization. Mental illness was common and largely untreated in public housing residents. Increasing collaboration between medical, mental, and human services is needed to improve identification, treatment, and ultimately prevention of late-life mental illness in this community setting.

Challenges to neurosurgery service delivery. Who moved my cheese?

PubMed

Palmer, J D

2007-04-01

The change programme in the National Health Service has moved the Acute Trusts providing neurosurgical services to very different ways of delivering healthcare. The process of reform has been supported by investment but the next few years will see far less additional money, and success and failure of services will be dependent upon the approach to those reforms. The 'payment by results' system of funding through tariff, the 'plurality of providers' policy of forcing commissioners to purchase activity from independent providers, the 'patient choice' process of encouraging patients to select treatment from a number of providers, and the '18-week wait' target of bringing down referral to treatment times are all major shifts in the way services are delivered and developed. The reforms have not been made with neurosurgery in mind, how will they affect the way this small specialty is delivered?

Association of hypoglycaemia severity with clinical, patient‐reported and economic outcomes in US patients with type 2 diabetes using basal insulin

PubMed Central

Lee, Lulu K.; Gupta, Shaloo; Preblick, Ron

2018-01-01

Aims To evaluate the clinical and patient‐reported outcomes and healthcare utilization and costs associated with patient‐reported hypoglycaemia in US adults with type 2 diabetes (T2D) treated with basal insulin. Materials and methods This was an observational, cross‐sectional, survey‐based study of adults with T2D on basal insulin ± oral antidiabetes drugs (OADs) or rapid‐acting/premixed insulin, who had in the past ever experienced hypoglycaemia, using US data from the National Health and Wellness Survey. Eligible patients were categorized as having no hypoglycaemia (38.7%), non‐severe hypoglycaemia (55.1%), or severe hypoglycaemia (6.2%) in the preceding 3 months. Outcomes included health‐related quality of life (HRQoL), work productivity and activity impairment, healthcare resource utilization, and estimated direct and indirect costs. Multivariable regression models were performed to control for patient characteristics. Results Patients who experienced severe hypoglycaemia had significantly (P < .05) lower HRQoL scores, greater overall impairment of work productivity and activity, greater healthcare resource utilization, and higher costs compared with those who experienced non‐severe or no hypoglycaemia. Patients with non‐severe hypoglycaemia also reported an impact on the number of provider visits, indirect costs, and HRQoL. Conclusions Patients with T2D using basal insulin ± OADs or rapid‐acting/premixed insulin in the United States who experienced severe hypoglycaemia had greater impairment of activity and work productivity, utilized more healthcare resources, and incurred higher associated costs than those with non‐severe or no hypoglycaemia. The study also demonstrated the impact that non‐severe hypoglycaemic events have on economic and HRQoL outcomes. Reducing the incidence and severity of hypoglycaemia could lead to clinically meaningful improvements in HRQoL and may result in lower healthcare utilization and associated costs. PMID:29316141

Is larger scoliosis curve magnitude associated with increased perioperative health-care resource utilization?: a multicenter analysis of 325 adolescent idiopathic scoliosis curves.

PubMed

Miyanji, Firoz; Slobogean, Gerard P; Samdani, Amer F; Betz, Randal R; Reilly, Christopher W; Slobogean, Bronwyn L; Newton, Peter O

2012-05-02

The treatment of patients with large adolescent idiopathic scoliosis curves has been associated with increased surgical complexity. The purpose of this study was to determine whether surgical correction of larger adolescent idiopathic scoliosis curves increased the utilization of health-care resources and to identify potential predictors associated with increased perioperative health-care resource utilization. A nested cohort of patients with adolescent idiopathic scoliosis with Lenke type 1A and 1B curves were identified from a prospective longitudinal multicenter database. Four perioperative outcomes were selected as the primary health-care resource utilization outcomes of interest: operative time, number of vertebral levels instrumented, duration of hospitalization, and allogeneic blood transfusion. The effect of curve magnitude on these outcomes was assessed with use of univariate and multivariate regression. Three hundred and twenty-five patients with a mean age of 15 ± 2 years were included. The mean main thoracic curve was 54.4° ± 7.8°. Larger curves were associated with longer operative time (p = 0.03), a greater number of vertebral levels instrumented (p = 0.0005), and the need for blood transfusion (with every 10° increase associated with 1.5 times higher odds of receiving a transfusion). In addition to curve magnitude, surgical center, bone graft method, and upper and lower instrumented levels were strong predictors of operative time (R2 = 0.76). The duration of hospitalization was influenced by the surgical center and intraoperative blood loss (R2 < 0.4), whereas the number of levels instrumented was influenced by the curve magnitude, curve correction percentage, upper instrumented vertebra, and surgical center (R2 = 0.64). Correction of larger curves was associated with increased utilization of perioperative health-care resources, specifically longer operative time, a greater number of vertebral levels instrumented, and higher odds of receiving a blood transfusion.

Expanding the scope beyond mortality: burden and missed opportunities in maternal morbidity in Indonesia.

PubMed

Widyaningsih, Vitri; Khotijah; Balgis

2017-01-01

Indonesia still faces challenges in maternal health. Specifically, the lack of information on community-level maternal morbidity. The relatively high maternal healthcare non-utilization in Indonesia intensifies this problem. To describe the burden of community-level maternal morbidity in Indonesia. Additionally, to evaluate the extent and determinants of missed opportunities in women with maternal morbidity. We used three cross-sectional surveys (Indonesian Demographic and Health Survey, IDHS 2002, 2007 and 2012). Crude and adjusted proportions of maternal morbidity burden were estimated from 43,782 women. We analyzed missed opportunities in women who experienced maternal morbidity during their last birth (n = 19,556). Multilevel mixed-effects logistic regressions were used to evaluate the determinants of non-utilization in IDHS 2012 (n = 6762). There were significant increases in the crude and adjusted proportion of maternal morbidity from IDHS 2002 to IDHS 2012 (p < 0.05). In 2012, the crude proportion of maternal morbidity was 53.7%, with adjusted predicted probability of 51.4%. More than 90% of these morbidities happened during labor. There were significant decreases in non-utilization of maternal healthcare among women with morbidity. In 2012, 20.0% of these women did not receive World Health Organization (WHO) standard antenatal care. In addition, 7.1% did not have a skilled provider at birth, and 25.0% delivered outside of health facilities. Higher proportions of non-utilization happened in women who were younger, multiparous, of low socioeconomic status (SES), and living in less-developed areas. In multilevel analyses, missed opportunities in healthcare utilization were strongly related to low SES and low-resource areas in Indonesia. The prevalence of maternal morbidity in Indonesia is relatively high, especially during labor. This condition is amplified by the concerning missed opportunities in maternal healthcare. Efforts are needed to identify risk factors for maternal morbidity, as well as increasing healthcare coverage for the vulnerable population.

Expanding the scope beyond mortality: burden and missed opportunities in maternal morbidity in Indonesia

PubMed Central

Widyaningsih, Vitri; Khotijah; Balgis

2017-01-01

ABSTRACT Background: Indonesia still faces challenges in maternal health. Specifically, the lack of information on community-level maternal morbidity. The relatively high maternal healthcare non-utilization in Indonesia intensifies this problem. Objective: To describe the burden of community-level maternal morbidity in Indonesia. Additionally, to evaluate the extent and determinants of missed opportunities in women with maternal morbidity. Methods: We used three cross-sectional surveys (Indonesian Demographic and Health Survey, IDHS 2002, 2007 and 2012). Crude and adjusted proportions of maternal morbidity burden were estimated from 43,782 women. We analyzed missed opportunities in women who experienced maternal morbidity during their last birth (n = 19,556). Multilevel mixed-effects logistic regressions were used to evaluate the determinants of non-utilization in IDHS 2012 (n = 6762). Results: There were significant increases in the crude and adjusted proportion of maternal morbidity from IDHS 2002 to IDHS 2012 (p < 0.05). In 2012, the crude proportion of maternal morbidity was 53.7%, with adjusted predicted probability of 51.4%. More than 90% of these morbidities happened during labor. There were significant decreases in non-utilization of maternal healthcare among women with morbidity. In 2012, 20.0% of these women did not receive World Health Organization (WHO) standard antenatal care. In addition, 7.1% did not have a skilled provider at birth, and 25.0% delivered outside of health facilities. Higher proportions of non-utilization happened in women who were younger, multiparous, of low socioeconomic status (SES), and living in less-developed areas. In multilevel analyses, missed opportunities in healthcare utilization were strongly related to low SES and low-resource areas in Indonesia. Conclusion: The prevalence of maternal morbidity in Indonesia is relatively high, especially during labor. This condition is amplified by the concerning missed opportunities in maternal healthcare. Efforts are needed to identify risk factors for maternal morbidity, as well as increasing healthcare coverage for the vulnerable population. PMID:28649930

From health search to healthcare: explorations of intention and utilization via query logs and user surveys

PubMed Central

White, Ryen W; Horvitz, Eric

2014-01-01

Objective To better understand the relationship between online health-seeking behaviors and in-world healthcare utilization (HU) by studies of online search and access activities before and after queries that pursue medical professionals and facilities. Materials and methods We analyzed data collected from logs of online searches gathered from consenting users of a browser toolbar from Microsoft (N=9740). We employed a complementary survey (N=489) to seek a deeper understanding of information-gathering, reflection, and action on the pursuit of professional healthcare. Results We provide insights about HU through the survey, breaking out its findings by different respondent marginalizations as appropriate. Observations made from search logs may be explained by trends observed in our survey responses, even though the user populations differ. Discussion The results provide insights about how users decide if and when to utilize healthcare resources, and how online health information seeking transitions to in-world HU. The findings from both the survey and the logs reveal behavioral patterns and suggest a strong relationship between search behavior and HU. Although the diversity of our survey respondents is limited and we cannot be certain that users visited medical facilities, we demonstrate that it may be possible to infer HU from long-term search behavior by the apparent influence that health concerns and professional advice have on search activity. Conclusions Our findings highlight different phases of online activities around queries pursuing professional healthcare facilities and services. We also show that it may be possible to infer HU from logs without tracking people's physical location, based on the effect of HU on pre- and post-HU search behavior. This allows search providers and others to develop more robust models of interests and preferences by modeling utilization rather than simply the intention to utilize that is expressed in search queries. PMID:23666794

Non-hip, non-spine fractures drive healthcare utilization following a fracture: the Global Longitudinal study of Osteoporosis in Women (GLOW)

PubMed Central

Ioannidis, G.; Flahive, J.; Pickard, L.; Papaioannou, A.; Chapurlat, R. D.; Saag, K. G.; Silverman, S.; Anderson, F. A.; Gehlbach, S. H.; Hooven, F. H.; Boonen, S.; Compston, J. E.; Cooper, C.; Díez-Perez, A.; Greenspan, S. L.; LaCroix, A. Z.; Lindsay, R.; Netelenbos, J. C.; Pfeilschifter, J.; Rossini, M.; Roux, C.; Sambrook, P. N.; Siris, E. S.; Watts, N. B.

2016-01-01

Summary We evaluated healthcare utilization associated with treating different fracture types in over 51,000 women aged ≥55 years. Over the course of 1 year, there were five times more non-hip, non-spine fractures than hip or spine fractures, resulting in twice as many days of hospitalization and rehabilitation/nursing home care for non-hip, non-spine fractures. Purpose To evaluate the medical healthcare utilization associated with treating several types of fractures in women aged 55 years or older from various geographic regions. Methods Information from the Global Longitudinal study of Osteoporosis in Women (GLOW) was collected via self-administered patient questionnaires at baseline and year 1 (n=51,491). Self-reported clinically recognized low-trauma fractures at year 1 were classified as incident spine, hip, wrist/hand, arm/shoulder, pelvis, rib, leg, and other fractures. Healthcare utilization data were self-reported and included whether the fracture was treated at a doctor’s office/clinic or at a hospital. Patients were also asked if they had undergone surgery or been treated at a rehabilitation center or nursing home. Results Over the 1-year study period, there were 195 spine, 134 hip, and 1,654 non-hip, non-spine fractures. In the GLOW cohort, clinical vertebral fractures resulted in 617 days of hospitalization and 512 days of rehabilitation/nursing home care, while hip fractures accounted for 1,306 days of hospitalization and 1,650 days of rehabilitation/nursing home care. Of particular interest is the result that non-hip, non-spine fractures resulted in 3,805 days in hospital and 5,186 days of rehabilitation/nursing home care. Conclusions While hip and vertebral fractures are well recognized for their associated increase in health resource utilization, non-hip, non-spine fractures, by virtue of their 5-fold greater number, require significantly more healthcare resources. PMID:22525976

The Similarity of Plural Endings and Linking Elements in Regional Speech Variants of Dutch

ERIC Educational Resources Information Center

Hanssen, Esther; Banga, Arina; Neijt, Anneke; Schreuder, Robert

2012-01-01

The plural suffix "-en" ("noot"+"en", "nuts") is pronounced differently by speakers coming from different regions of the Netherlands. In this study, we compared the pronunciation of the plural suffix "-en" in phrases ("noot"+"en kraken", "to crack nuts") with linking…

The rehabilitation enhancing aging through connected health (REACH) study: study protocol for a quasi-experimental clinical trial.

PubMed

Ni, Meng; Brown, Lorna G; Lawler, Danielle; Ellis, Terry D; Deangelis, Tamara; Latham, Nancy K; Perloff, Jennifer; Atlas, Steve J; Percac-Lima, Sanja; Bean, Jonathan F

2017-09-20

Mobility limitations among older adults increase the risk for disability and healthcare utilization. Rehabilitative care is identified as the most efficacious treatment for maintaining physical function. However, there is insufficient evidence identifying a healthcare model that targets prevention of mobility decline among older adults. The objective of this study is to evaluate the preliminary effectiveness of a physical therapy program, augmented with mobile tele-health technology, on mobility function and healthcare utilization among older adults. This is a quasi-experimental 12-month clinical trial conducted within a metropolitan-based healthcare system in the northeastern United States. It is in parallel with an existing longitudinal cohort study evaluating mobility decline among community-dwelling older adult primary care patients over one year. Seventy-five older adults (≥ 65-95 years) are being recruited using identical inclusion/exclusion criteria to the cohort study. Three aims will be evaluated: the effect of our program on 1) physical function, 2) healthcare utilization, and 3) healthcare costs. Changes in patient-reported function over 1 year in those receiving the intervention (aim 1) will be compared to propensity score matched controls (N = 150) from the cohort study. For aims 2 and 3, propensity scores, derived from logistic regression model that includes demographic and diagnostic information available through claims and enrollment information, will be used to match treatment and control patients in a ratio of 1:2 or 1:3 from a Medicare Claims Registry derived from the same geographic region. The intervention consists of a one-year physical therapy program that is divided between a combination of outpatient and home visits (6-10 total visits) and is augmented on a computerized tablet using of a commercially available application to deliver a progressive home-based exercise program emphasizing lower-extremity function and a walking program. Incorporating mobile health into current healthcare models of rehabilitative care has the potential to decrease hospital visits and provide a longer duration of care. If the hypotheses are supported and demonstrate improved mobility and reduced healthcare utilization, this innovative care model would be applicable for optimizing the maintenance of functional independence among community-dwelling older adults. ClinicalTrial.gov Identifier: NCT02580409 (Date of registration October 14, 2015).

Impact of glycemic control on healthcare resource utilization and costs of type 2 diabetes: current and future pharmacologic approaches to improving outcomes.

PubMed

Banerji, Mary Ann; Dunn, Jeffrey D

2013-09-01

The incidence and prevalence of type 2 diabetes continue to grow in the United States and worldwide, along with the growing prevalence of obesity. Patients with type 2 diabetes are at greater risk for comorbid cardiovascular (CV) disease (CVD), which dramatically affects overall healthcare costs. To review the impact of glycemic control and medication adherence on morbidity, mortality, and healthcare costs of patients with type 2 diabetes, and to highlight the need for new drug therapies to improve outcomes in this patient population. This comprehensive literature search was conducted for the period between 2000 and 2013, using MEDLINE, to identify published articles that report the associations between glycemic control, medication adherence, CV morbidity and mortality, and healthcare utilization and costs. Search terms included "type 2 diabetes," "adherence," "compliance," "nonadherence," "drug therapy," "resource use," "cost," and "cost-effectiveness." Despite improvements in the management of CV risk factors in patients with type 2 diabetes, outcomes remain poor. The costs associated with the management of type 2 diabetes are increasing dramatically as the prevalence of the disease increases. Medication adherence to long-term drug therapy remains poor in patients with type 2 diabetes and contributes to poor glycemic control in this patient population, increased healthcare resource utilization and increased costs, as well as increased rates of comorbid CVD and mortality. Furthermore, poor adherence to established evidence-based guidelines for type 2 diabetes, including underdiagnosis and undertreatment, contributes to poor outcomes. New approaches to the treatment of patients with type 2 diabetes currently in development have the potential to improve medication adherence and consequently glycemic control, which in turn will help to reduce associated costs and healthcare utilization. As the prevalence of type 2 diabetes and its associated comorbidities grows, healthcare costs will continue to increase, indicating a need for better approaches to achieve glycemic control and manage comorbid conditions. Drug therapies are needed that enhance patient adherence and persistence levels far above levels reported with currently available drugs. Improvements in adherence to treatment guidelines and greater rates of lifestyle modifications also are needed. A serious unmet need exists for greatly improved patient outcomes, more effective and more tolerable drugs, as well as marked improvements in adherence to treatment guidelines and drug therapy to positively impact healthcare costs and resource use.

Covariates of depression and high utilizers of healthcare: Impact on resource use and costs.

PubMed

Robinson, Rebecca L; Grabner, Michael; Palli, Swetha Rao; Faries, Douglas; Stephenson, Judith J

2016-06-01

To characterize healthcare costs, resource use, and treatment patterns of survey respondents with a history of depression who are high utilizers (HUds) of healthcare and to identify factors associated with high utilization. Adults with two or more depression diagnoses identified from the HealthCore Integrated Research Database were invited to participate in the CODE study, which links survey data with 12-month retrospective claims data. Patient surveys provided data on demographics, general health, and symptoms and/or comorbidities associated with depression. Similar clinical conditions also were identified from the medical claims. Factors associated with high utilization were identified using logistic regression models. Of 3132 survey respondents, 1921 were included, 193 of whom were HUds (defined as those who incurred the top 10% of total all-cause costs in the preceding 12months). Mean total annual healthcare costs were eightfold greater for HUds than for non-HUds ($US56,145 vs. $US6,954; p<.0001). HUds incurred more inpatient encounters (p<.0001) and emergency department (p=.01) and physician office visits (p<.0001). Similar findings were observed for mental healthcare costs/resource use. HUds were prescribed twice as many medications (total mean: 16.86 vs. 8.32; psychotropic mean: 4.11 vs. 2.61; both p<.0001). HUds reported higher levels of depression severity, fatigue, sleep difficulties, pain, high alcohol consumption, and anxiety. Predictors of becoming a HUd included substance use, obesity, cardiovascular disease, comorbidity severity, psychiatric conditions other than depression, and pain. Focusing on pain, substance use, and psychiatric conditions beyond depression may be effective approaches to reducing high costs in patients with depression. Copyright © 2016 Eli Lilly and Company. Published by Elsevier Inc. All rights reserved.

Favorable Cardiovascular Risk Profile Is Associated With Lower Healthcare Costs and Resource Utilization: The 2012 Medical Expenditure Panel Survey.

PubMed

Valero-Elizondo, Javier; Salami, Joseph A; Ogunmoroti, Oluseye; Osondu, Chukwuemeka U; Aneni, Ehimen C; Malik, Rehan; Spatz, Erica S; Rana, Jamal S; Virani, Salim S; Blankstein, Ron; Blaha, Michael J; Veledar, Emir; Nasir, Khurram

2016-03-01

The American Heart Association's 2020 Strategic Goals emphasize the value of optimizing risk factor status to reduce the burden of morbidity and mortality. In this study, we aimed to quantify the overall and marginal impact of favorable cardiovascular risk factor (CRF) profile on healthcare expenditure and resource utilization in the United States among those with and without cardiovascular disease (CVD). The study population was derived from the 2012 Medical Expenditure Panel Survey (MEPS). Direct and indirect costs were calculated for all-cause healthcare resource utilization. Variables of interest included CVD diagnoses (coronary artery disease, stroke, peripheral artery disease, dysrhythmias, or heart failure), ascertained by International Classification of Diseases, Ninth Edition, Clinical Modification codes, and CRF profile (hypertension, diabetes mellitus, hypercholesterolemia, smoking, physical activity, and obesity). Two-part econometric models were used to study expenditure data. The final study sample consisted of 15 651 MEPS participants (58.5±12 years, 54% female). Overall, 5921 (37.8%) had optimal, 7002 (44.7%) had average, and 2728 (17.4%) had poor CRF profile, translating to 54.2, 64.1, and 24.9 million adults in United States, respectively. Significantly lower health expenditures were noted with favorable CRF profile across CVD status. Among study participants with established CVD, overall healthcare expenditures with optimal and average CRF profile were $5946 and $3731 less compared with those with poor CRF profile. The respective differences were $4031 and $2560 in those without CVD. Favorable CRF profile is associated with significantly lower medical expenditure and healthcare utilization among individuals with and without established CVD. © 2016 American Heart Association, Inc.

Healthcare utilization and cost of Stevens-Johnson syndrome and toxic epidermal necrolysis management in Thailand

PubMed Central

Dilokthornsakul, P; Sawangjit, R; Inprasong, C; Chunhasewee, S; Rattanapan, P; Thoopputra, T; Chaiyakunapruk, N

2016-01-01

Background: Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life-threatening dermatologic conditions. Although, the incidence of SJS/TEN in Thailand is high, information on cost of care for SJS/TEN is limited. This study aims to estimate healthcare resource utilization and cost of SJS/TEN in Thailand, using hospital perspective. Methods: A retrospective study using an electronic health database from a university-affiliated hospital in Thailand was undertaken. Patients admitted with SJS/TEN from 2002 to 2007 were included. Direct medical cost was estimated by the cost-to-charge ratio. Cost was converted to 2013 value by consumer price index, and converted to $US using 31 Baht/1 $US. The healthcare resource utilization was also estimated. Results: A total of 157 patients were included with average age of 45.3±23.0 years. About 146 patients (93.0%) were diagnosed as SJS and the remaining (7.0%) were diagnosed as TEN. Most of the patients (83.4%) were treated with systemic corticosteroids. Overall, mortality rate was 8.3%, while the average length of stay (LOS) was 10.1±13.2 days. The average cost of managing SJS/TEN for all patients was $1,064±$2,558. The average cost for SJS patients was $1,019±$2,601 while that for TEN patients was $1,660±$1,887. Conclusions: Healthcare resource utilization and cost of care for SJS/TEN in Thailand were tremendous. The findings are important for policy makers to allocate healthcare resources and develop strategies to prevent SJS/TEN which could decrease length of stay and cost of care. PMID:27089110

Multidimensional social support is associated with healthcare utilization among older Mexican adults.

PubMed

Salinas-Rodríguez, Aarón; Moreno-Tamayo, Karla; Hernández-Serrato, María; Enríquez-Rosas, María Del Rocío; Manrique-Espinoza, Betty Soledad

2018-03-01

In this study, we aimed to estimate the association between social support and healthcare utilization among older Mexican adults. We conducted a prospective study with 4027 older adults aged 65-74 in rural areas in seven Mexican states. Data were collected at baseline (2007) and 14 months later (2009). Healthcare utilization was defined as number of visits to a physician for preventive or curative purposes in the last 6 months. Multidimensional social support was operationalized into two components: structural (living arrangements, marital status and network size) and functional (perceived availability of support; and perceived support across emotional, instrumental, economic and information domains). Mixed-effects regression models were used to estimate the probability of healthcare use and to examine the association between social support and the number of visits to a physician. Results showed that perceived availability of social support was associated with the probability of visits to a physician (OR 1.44; p  < .01). Meanwhile, the following domains of functional component of social support were associated with the probability of visits to a physician: instrumental (OR 1.55; p  < .01), economic (OR 1.19; p  = .03) and informational (OR 1.39; p  < .01); and also with the number of visits to a physician: instrumental (e β  = 1.27; p  < .01), economic (e β  = 1.14; p  = .01) and informational (e β  = 1.12; p  < .10). Our findings suggest that a significant association exists between social support, measured from a multidimensional viewpoint, and healthcare utilization, in which greater social support was related to a greater extent of use of health services.

Use of drospirenone/ethinyl estradiol (DRSP/EE) among women with acne reduces acne treatment-related resources.

PubMed

Joish, Vijay N; Boklage, Susan; Lynen, Richard; Schmidt, Anja; Lin, Jay

2011-01-01

Acne is a common dermatologic condition that extends into middle age, particularly among women, and is associated with substantial healthcare resource utilization. Drospirenone (DRSP), a synthetic progestin, has anti-androgenic activity, and women using DRSP 3.0 mg/ethinyl estradiol (EE) 0.02 mg as a 24/4 regimen (DRSP/EE-24/4) for contraception also may use it for treatment of moderate acne. The study used a US national healthcare database to assess acne-related healthcare resource utilization among women aged 18-45 years before (pre-index) and after (post-index) initiation of DRSP/EE-24/4. Resource utilization and costs were evaluated by age group (18-25, 26-35, or 36-45 years) and by type of acne medication (systemic antibiotic, topical, or anti-androgen). Data for 1340 women were evaluated. Overall, drug costs, medical costs, and total costs were decreased by 38%, 37%, and 37%, respectively (p<0.0001 for all) between the pre-index and post-index periods; significant differences were evident across age groups and acne medication categories. Total costs were significantly decreased for patients (41%) and healthcare plans (36%; p<0.0001 for both) overall and across age groups and drug classes. Acne-related claims and number of days using acne medication were reduced (by 37% each; p<0.0001 for both). The study was retrospective in design and had a limited follow-up period. Database limitations restricted assessment of medication compliance and adherence. DRSP/EE-24/4 use was associated with substantial reductions in acne-related healthcare resource utilization, and reductions occurred regardless of age or type of acne medication. DRSP/EE-24/4 therefore represents a cost-effective option for the treatment of acne among women using DRSP/EE-24/4 for oral contraception.

Using mobile technology to improve healthcare service quality.

PubMed

Chao, Chia Chen; Jen, Wen Yuan; Li, Yu-Chuan; Chi, Y P; Chen, Chang-I; Feng, Chen Chjeh

2005-01-01

Improving healthcare service quality for illness of treatment, illness prevention and patient service is difficult for most hospitals because the hospitals are lack adequate resources and labor. In order to provide better healthcare service quality for patients, mobile technology can be used to manage healthcare in a way that provides the optimal healthcare service for patients. Pursuing utilization of mobile technology for better patient service, Taipei Medical University Municipal W. F. Teaching Hospital has implemented a mobile healthcare service (m-HS) system to increase healthcare service quality. The m-HS system improves the quality of medical care as well as healthcare service. The m-HS is a multi-functional healthcare management agent, meets the mobile tendency of the present society. This study seeks to discuss the m-HS architecture and workflow processes. We believe the m-HS does have the potential to improve healthcare service quality. Finally, the conclusions and suggestions for the m-HS are given.

Validation of the conceptual research utilization scale: an application of the standards for educational and psychological testing in healthcare.

PubMed

Squires, Janet E; Estabrooks, Carole A; Newburn-Cook, Christine V; Gierl, Mark

2011-05-19

There is a lack of acceptable, reliable, and valid survey instruments to measure conceptual research utilization (CRU). In this study, we investigated the psychometric properties of a newly developed scale (the CRU Scale). We used the Standards for Educational and Psychological Testing as a validation framework to assess four sources of validity evidence: content, response processes, internal structure, and relations to other variables. A panel of nine international research utilization experts performed a formal content validity assessment. To determine response process validity, we conducted a series of one-on-one scale administration sessions with 10 healthcare aides. Internal structure and relations to other variables validity was examined using CRU Scale response data from a sample of 707 healthcare aides working in 30 urban Canadian nursing homes. Principal components analysis and confirmatory factor analyses were conducted to determine internal structure. Relations to other variables were examined using: (1) bivariate correlations; (2) change in mean values of CRU with increasing levels of other kinds of research utilization; and (3) multivariate linear regression. Content validity index scores for the five items ranged from 0.55 to 1.00. The principal components analysis predicted a 5-item 1-factor model. This was inconsistent with the findings from the confirmatory factor analysis, which showed best fit for a 4-item 1-factor model. Bivariate associations between CRU and other kinds of research utilization were statistically significant (p < 0.01) for the latent CRU scale score and all five CRU items. The CRU scale score was also shown to be significant predictor of overall research utilization in multivariate linear regression. The CRU scale showed acceptable initial psychometric properties with respect to responses from healthcare aides in nursing homes. Based on our validity, reliability, and acceptability analyses, we recommend using a reduced (four-item) version of the CRU scale to yield sound assessments of CRU by healthcare aides. Refinement to the wording of one item is also needed. Planned future research will include: latent scale scoring, identification of variables that predict and are outcomes to conceptual research use, and longitudinal work to determine CRU Scale sensitivity to change.

The healthcare utilization and cost of treating patients experiencing inappropriate implantable cardioverter defibrillator shocks: a propensity score study.

PubMed

Bhavnani, Sanjeev P; Giedrimiene, Dalia; Coleman, Craig I; Guertin, Danette; Azeem, Meena; Kluger, Jeffrey

2014-10-01

Inappropriate shocks (IASs) from implantable cardioverter defibrillators (ICDs) are associated with decreased quality of life, but whether they increase healthcare utilization and treatment costs is unknown. We sought to determine the impact of IASs on subsequent healthcare utilization and treatment costs. We conducted a case-control analysis of ICD patients at a single institution from 1997 to 2010 and who had ≥12 months of post-ICD implant follow-up. Cases included all patients experiencing an IAS during the first 12 months after implantation. Eligible control patients did not receive a shock of any kind during the 12 months after implantation. Propensity scores based on 36 covariates (area under curve = 0.78) were used to match cases to controls. We compared the rate (occurrences/person year [PY]) of healthcare utilization immediately following IAS to the end of the 12-month follow-up period to the rate in the no-shock group over 12 months of follow-up. We also compared 12-month postimplant treatment (outpatient clinic, emergency room, and hospitalization) costs in both groups. A total of 76 patients experiencing ≥1 IAS during the first 12 months after implant (contributing 48 PYs) were matched to 76 no-shock patients (contributing 76 PYs). Cardiovascular (CV)-related clinic visit and hospitalization rates were increased following an IAS compared to those not receiving a shock (4.0 vs 3.3 and 0.7 vs 0.5, respectively, P = 0.02 for both). CV-related emergency room visitation (0.15 vs 0.08) rates were also numerically higher following an IAS, but did not reach statistical significance (P = 0.26). Patients experiencing an IAS accrued greater treatment costs during the 12 months postimplant compared to no-shock patients ($13,973 ± $46,345 vs $6,790 ± $19,091, P = 0.001). Recipients of IAS utilize the healthcare system more frequently following an IAS than patients not experiencing a shock. This increased utilization results in higher costs of treating IAS patients during the 12 months postimplant. ©2014 Wiley Periodicals, Inc.

What Plurals and Compounds Reveal about Constraints in Word Formation

ERIC Educational Resources Information Center

Jaensch, Carol; Heyer, Vera; Gordon, Peter; Clahsen, Harald

2014-01-01

Morphological systems are constrained in how they interact with each other. One case that has been widely studied in the psycholinguistic literature is the avoidance of plurals inside compounds (e.g. *"rats eater" vs. "rat eater") in English and other languages, the so-called "plurals-in-compounds effect." Several…

Polite Plurals and Predicate Agreement

ERIC Educational Resources Information Center

Comrie, Bernard

1975-01-01

Data from a number of language (Slavic, Romance, Modern Greek) concerning predicate agreement with the polite plural (semantically singular, but plural in surface structure) suggest that more verb-like predicates tend to agree with the surface subject, while more noun-like predicates tend to agree with the underlying subject. (Author/KM)

Defending Religious Pluralism for Religious Education

ERIC Educational Resources Information Center

Davis, Andrew

2010-01-01

Religious exclusivism, or the idea that only one religion can be true, fuels hatred and conflict in the modern world. Certain objections to religious pluralism, together with associated defences of exclusivism are flawed. I defend a moderate religious pluralism, according to which the truth of one religion does not automatically imply the falsity…

Optical Tunable-Based Transmitter for Multiple Radio Frequency Bands

NASA Technical Reports Server (NTRS)

Nguyen, Hung (Inventor); Simons, Rainee N. (Inventor); Wintucky, Edwin G. (Inventor); Freeman, Jon C. (Inventor)

2016-01-01

An optical tunable transmitter is used to transmit multiple radio frequency bands on a single beam. More specifically, a tunable laser is configured to generate a plurality of optical wavelengths, and an optical tunable transmitter is configured to modulate each of the plurality of optical wavelengths with a corresponding radio frequency band. The optical tunable transmitter is also configured to encode each of the plurality of modulated optical wavelengths onto a single laser beam for transmission of a plurality of radio frequency bands using the single laser beam.

Small file aggregation in a parallel computing system

DOEpatents

Faibish, Sorin; Bent, John M.; Tzelnic, Percy; Grider, Gary; Zhang, Jingwang

2014-09-02

Techniques are provided for small file aggregation in a parallel computing system. An exemplary method for storing a plurality of files generated by a plurality of processes in a parallel computing system comprises aggregating the plurality of files into a single aggregated file; and generating metadata for the single aggregated file. The metadata comprises an offset and a length of each of the plurality of files in the single aggregated file. The metadata can be used to unpack one or more of the files from the single aggregated file.

Multithreading in vector processors

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

Evangelinos, Constantinos; Kim, Changhoan; Nair, Ravi

In one embodiment, a system includes a processor having a vector processing mode and a multithreading mode. The processor is configured to operate on one thread per cycle in the multithreading mode. The processor includes a program counter register having a plurality of program counters, and the program counter register is vectorized. Each program counter in the program counter register represents a distinct corresponding thread of a plurality of threads. The processor is configured to execute the plurality of threads by activating the plurality of program counters in a round robin cycle.