10 CFR 436.37 - Annual energy audits.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 3 2014-01-01 2014-01-01 false Annual energy audits. 436.37 Section 436.37 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methods and Procedures for Energy Savings Performance Contracting § 436.37 Annual energy audits. (a) After contractor...

10 CFR 436.37 - Annual energy audits.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 3 2013-01-01 2013-01-01 false Annual energy audits. 436.37 Section 436.37 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methods and Procedures for Energy Savings Performance Contracting § 436.37 Annual energy audits. (a) After contractor...

10 CFR 436.37 - Annual energy audits.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 3 2011-01-01 2011-01-01 false Annual energy audits. 436.37 Section 436.37 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methods and Procedures for Energy Savings Performance Contracting § 436.37 Annual energy audits. (a) After contractor...

10 CFR 436.37 - Annual energy audits.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Annual energy audits. 436.37 Section 436.37 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methods and Procedures for Energy Savings Performance Contracting § 436.37 Annual energy audits. (a) After contractor...

Eye lens exposure to medical staff during endoscopic retrograde cholangiopancreatography.

PubMed

Zagorska, A; Romanova, K; Hristova-Popova, J; Vassileva, J; Katzarov, K

2015-11-01

The paper presents a study of the radiation doses to eye lens of medical staff during endoscopic retrograde cholangiopancreatography (ERCP) procedures performed in a busy gastroenterology department. For each procedure the dose equivalent to the eye, exposure time, dose rate, Kerma Area Product and fluoroscopy time were recorded. Measurements were performed for a period of two months in four main positions of the operating staff, and then extrapolated to estimate annual doses. The fluoroscopy time per ERCP procedure varied between 1.0 min and 28.8 min, with a mean value of 4.6 min. The calculated mean eye dose per procedure varied between 34.9 μSv and 93.3 μSv. The results demonstrated that if eye protection is not used, annual doses to the eye lens of the gastroenterologist performing the procedure and the anesthesiologist can exceed the dose limit of 20 mSv per year. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

A comparison of case volumes among urologic surgeons identified on an industry-sponsored website to an all provider peer group.

PubMed

See, William A; Jacobson, Kenneth; Derus, Sue; Langenstroer, Peter

2014-11-01

Industry-sponsored websites for robotic surgery direct to surgeons listed as performing specific robotic surgical procedures. The purpose of this study was to compare average annual, surgeon-specific, case volumes for those procedures for which they were listed as performing on the commercial website with the volumes of all providers performing these same procedures across a defined geographic region. A list of providers within the state of Wisconsin cited as performing specific urologic procedures was obtained through the Intuitive Surgical website 〈http://www.davincisurgery.com/da-vinci-urology/〉. Surgeon-specific annual case volumes from 2009 to 2013 for these same cases were obtained for all Wisconsin providers through DataBay Resources (Warrendale, PA) based on International classification of diseases-9 codes. Procedural activity was rank ordered, and surgeons were placed in "volume deciles" derived from the total annual number of cases performed by all surgeons. The distribution of commercially listed surgeon volumes, both 5-year average and most recent year, was compared with the average and 2013 volumes of all surgeons performing a specific procedure. A total of 35 individual urologic surgeons listed as performing robotic surgery in Wisconsin were identified through a "search" using the Intuitive Surgical website. Specific procedure analysis returned 5, 12, 9, and 15 surgeon names for cystectomy, partial nephrectomy, radical nephrectomy, and prostatectomy, respectively. This compared with the total number of surgeons who had performed the listed procedure in Wisconsin at least 1 time during the prior 5 years of 123, 153, 242, and 165, respectively. When distributed by surgeon-volume deciles, surgeons listed on industry-sponsored sites varied widely in their respective volume decile. More than half of site-listed, procedure-specific surgeons fell below the fifth decile for surgeon volume. Data analysis based solely on 2013 case volumes had no effect on the number of website-listed surgeons whose volumes fell below the fifth decile. Surgeons listed on an industry-sponsored website demonstrate wide variation in the actual volume of specific procedures performed. The inferred endorsement of competence by commercial sites has the potential to mislead patients seeking surgical expertise. Providers should consider the ethical and legal implications of these commercial advertising that do not have volume or outcome data. Published by Elsevier Inc.

Adrenal venous sampling: the learning curve of a single interventionalist with 282 consecutive procedures.

PubMed

Jakobsson, Hugo; Farmaki, Katerina; Sakinis, Augustinas; Ehn, Olof; Johannsson, Gudmundur; Ragnarsson, Oskar

2018-01-01

Primary aldosteronism (PA) is a common cause of secondary hypertension. Adrenal venous sampling (AVS) is the gold standard for assessing laterality of PA, which is of paramount importance to decide adequate treatment. AVS is a technically complicated procedure with success rates ranging between 30% and 96%. The aim of this study was to investigate the success rate of AVS over time, performed by a single interventionalist. This was a retrospective study based on consecutive AVS procedures performed by a single operator between September 2005 and June 2016. Data on serum concentrations of aldosterone and cortisol from right and left adrenal vein, inferior vena cava, and peripheral vein were collected and selectivity index (SI) calculated. Successful AVS was defined as SI > 5. In total, 282 AVS procedures were performed on 269 patients, 168 men (62%) and 101 women (38%), with a mean age of 55±11 years (range, 26-78 years). Out of 282 AVS procedures, 259 were successful, giving an overall success rate of 92%. The most common reason for failure was inability to localize the right adrenal vein (n=16; 76%). The success rates were 63%, 82%, and 94% during the first, second, and third years, respectively. During the last 8 years the success rate was 95%, and on average 27 procedures were performed annually. Satisfactory AVS success rate was achieved after approximately 36 procedures and satisfactory success rate was maintained by performing approximately 27 procedures annually. AVS should be limited to few operators that perform sufficiently large number of procedures to achieve, and maintain, satisfactory AVS success rate.

Adrenal venous sampling: the learning curve of a single interventionalist with 282 consecutive procedures

PubMed Central

Jakobsson, Hugo; Farmaki, Katerina; Sakinis, Augustinas; Ehn, Olof; Johannsson, Gudmundur; Ragnarsson, Oskar

2018-01-01

PURPOSE Primary aldosteronism (PA) is a common cause of secondary hypertension. Adrenal venous sampling (AVS) is the gold standard for assessing laterality of PA, which is of paramount importance to decide adequate treatment. AVS is a technically complicated procedure with success rates ranging between 30% and 96%. The aim of this study was to investigate the success rate of AVS over time, performed by a single interventionalist. METHODS This was a retrospective study based on consecutive AVS procedures performed by a single operator between September 2005 and June 2016. Data on serum concentrations of aldosterone and cortisol from right and left adrenal vein, inferior vena cava, and peripheral vein were collected and selectivity index (SI) calculated. Successful AVS was defined as SI >5. RESULTS In total, 282 AVS procedures were performed on 269 patients, 168 men (62%) and 101 women (38%), with a mean age of 55±11 years (range, 26–78 years). Out of 282 AVS procedures, 259 were successful, giving an overall success rate of 92%. The most common reason for failure was inability to localize the right adrenal vein (n=16; 76%). The success rates were 63%, 82%, and 94% during the first, second, and third years, respectively. During the last 8 years the success rate was 95%, and on average 27 procedures were performed annually. CONCLUSION Satisfactory AVS success rate was achieved after approximately 36 procedures and satisfactory success rate was maintained by performing approximately 27 procedures annually. AVS should be limited to few operators that perform sufficiently large number of procedures to achieve, and maintain, satisfactory AVS success rate. PMID:29467114

Hysterectomy trends in Australia, 2000-2001 to 2013-2014: joinpoint regression analysis.

PubMed

Wilson, Louise F; Pandeya, Nirmala; Mishra, Gita D

2017-10-01

Hysterectomy is a common gynecological procedure, particularly in middle and high income countries. The aim of this paper was to describe and examine hysterectomy trends in Australia from 2000-2001 to 2013-2014. For women aged 25 years and over, data on the number of hysterectomies performed in Australia annually were sourced from the National Hospital and Morbidity Database. Age-specific and age-standardized hysterectomy rates per 10 000 women were estimated with adjustment for hysterectomy prevalence in the population. Using joinpoint regression analysis, we estimated the average annual percentage change over the whole study period (2000-2014) and the annual percentage change for each identified trend line segment. A total of 431 162 hysterectomy procedures were performed between 2000-2001 and 2013-2014; an annual average of 30 797 procedures (for women aged 25+ years). The age-standardized hysterectomy rate, adjusted for underlying hysterectomy prevalence, decreased significantly over the whole study period [average annual percentage change -2.8%; 95% confidence interval (CI) -3.5%, -2.2%]. The trend was not linear with one joinpoint detected in 2008-2009. Between 2000-2001 and 2008-2009 there was a significant decrease in incidence (annual percentage change -4.4%; 95% CI -5.2%, -3.7%); from 2008-2009 to 2013-2014 the decrease was minimal and not significantly different from zero (annual percentage change -0.1%; 95% CI -1.7%, 1.5%). A similar change in trend was seen in all age groups. Hysterectomy rates in Australian women aged 25 years and over have declined in the first decade of the 21st century. However, in the last 5 years, rates appear to have stabilized. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

Redo surgery after permanent pacemaker implantation: performance indicator of surgical techniques and pacing technology.

PubMed

Bharat, Vijaya

2004-01-01

The incidence of permanent pacemaker-related complications is reducing due to advancement of technology and increasing operator experience. There are only few series from India reporting the annual complication rates from a single center over the years. This is a series of 782 pacemakers implanted over 20 years in a secondary healthcare set-up. Eighty-two patients underwent redo surgery, either for a procedure-related complication (n=34) or for replacement of a malfunctioning/end-of-life pacemaker (n=48). Through critical analysis and corrective measures, all the procedural complications were reduced to less than 4% of the annual implantations. The introduction of a pacemaker follow-up clinic contributed to reducing the rate of elective replacement for battery depletion from 19.17% of the implanted VVI pacemakers to 0.63%. Despite being a low-volume center, with less than 100 pacemakers implanted annually, the performance of our pacing practice has shown continuous improvement.

New gasoline regulations require annual attestations

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

Leger, M.W.; Lott, L.H.

1995-03-27

The US Environmental Protection Agency's new reformulated fuels regulations impose a myriad of new record keeping and reporting requirements, in addition to the new quality standards. These requirements include an annual procedures review, or attestation. The attestation is part of EPA's enforcement plan and is required of all refiners, importers, and oxygenate blenders. This annual report is due May 31 of the year following the covered period and must be performed by a certified public accountant or a certified internal auditor. The attestation procedure is too complicated and detailed to be explained fully here, but the main points covered bymore » the attestation are outlined to inform refiners who may be unaware of the requirements.« less

The Annual Trends between Neurointerventional and Neurosurgical Procedures in Korea: Analysis using HIRA Data from 2010 to 2016

PubMed Central

2017-01-01

Purpose The purpose of this study was to evaluate the annual trend for several neurosurgical and neurointerventional procedures (NIPs) in Korea between 2010 and 2016 by using medical claim data. Materials and Methods All data during the recent 7 years were collected from Bigdata Hub provided by the Health Insurance Review & Assessment Service (HIRA). Using several codes for medical practice, we estimated the number of in-patients for each practice and calculated the annual variation of each procedure. These data were compared between each NIP versus the equivalent surgical procedure and analyzed according to the geographic distribution and the hospital grade. Results During the past 7 years, the average growth rate of all stroke in-patients is 2.05%, and the number of in-patients with ischemic stroke is 5.2 times higher than those with hemorrhagic stroke. While clipping accounted for 53.7% (5,209/9,700) of total patients in 2010, 61.9% of patients (9,146/14,781) are currently undergoing coiling procedure in 2016. MT for acute ischemic stroke has grown annually by an average of 35.9% during the past 3 years. Stenting and angioplasty for carotid artery and intracranial artery showed relatively stable growth during the past 7 years. Especially, carotid artery stenting is rapidly increasing in secondary general hospitals, where more than 50% of these procedures were performed after 2014. Conclusion In this study, we found that most of NIPs has increased annually over the past 7 years and that NIPs are rapidly replacing conventional surgical maneuvers in Korea. PMID:28955509

The Annual Trends between Neurointerventional and Neurosurgical Procedures in Korea: Analysis using HIRA Data from 2010 to 2016.

PubMed

Suh, Sang Hyun

2017-09-01

The purpose of this study was to evaluate the annual trend for several neurosurgical and neurointerventional procedures (NIPs) in Korea between 2010 and 2016 by using medical claim data. All data during the recent 7 years were collected from Bigdata Hub provided by the Health Insurance Review & Assessment Service (HIRA). Using several codes for medical practice, we estimated the number of in-patients for each practice and calculated the annual variation of each procedure. These data were compared between each NIP versus the equivalent surgical procedure and analyzed according to the geographic distribution and the hospital grade. During the past 7 years, the average growth rate of all stroke in-patients is 2.05%, and the number of in-patients with ischemic stroke is 5.2 times higher than those with hemorrhagic stroke. While clipping accounted for 53.7% (5,209/9,700) of total patients in 2010, 61.9% of patients (9,146/14,781) are currently undergoing coiling procedure in 2016. MT for acute ischemic stroke has grown annually by an average of 35.9% during the past 3 years. Stenting and angioplasty for carotid artery and intracranial artery showed relatively stable growth during the past 7 years. Especially, carotid artery stenting is rapidly increasing in secondary general hospitals, where more than 50% of these procedures were performed after 2014. In this study, we found that most of NIPs has increased annually over the past 7 years and that NIPs are rapidly replacing conventional surgical maneuvers in Korea.

Proceedings of the tenth annual DOE low-level waste management conference: Session 2: Site performance assessment

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

Not Available

1988-12-01

This document contains twelve papers on various aspects of low-level radioactive waste management. Topics of this volume include: performance assessment methodology; remedial action alternatives; site selection and site characterization procedures; intruder scenarios; sensitivity analysis procedures; mathematical models for mixed waste environmental transport; and risk assessment methodology. Individual papers were processed separately for the database. (TEM)

20 CFR 666.120 - What are the procedures for negotiating annual levels of performance?

Code of Federal Regulations, 2010 CFR

2010-04-01

... performance for each core indicator and the customer satisfaction indicators. In negotiating these levels, the... customer satisfaction; (3) The extent to which the levels of performance promote continuous improvement and... Governor must reach agreement on levels of performance for each core indicator and the customer...

Feasibility study of a synthesis procedure for array feeds to improve radiation performance of large distorted reflector antennas

NASA Technical Reports Server (NTRS)

Stutzman, W. L.; Takamizawa, K.; Werntz, P.; Lapean, J.; Barts, R.; Shen, B.

1992-01-01

Virginia Tech has several articles which support the NASA Langley effort in the area of large aperture radiometric antenna systems. This semi-annual report reports on the following activities: a feasibility study of a synthesis procedure for array feeds to improve radiation performance of large distorted reflector antennas and the design of array feeds for large reflector antennas.

Percutaneous closure of patent foramen ovale and atrial septal defect in adults: the impact of clinical variables and hospital procedure volume on in-hospital adverse events.

PubMed

Opotowsky, Alexander R; Landzberg, Michael J; Kimmel, Stephen E; Webb, Gary D

2009-05-01

Percutaneous closure of patent foramen ovale/atrial septal defect (PFO/ASD) is an increasingly common procedure perceived as having minimal risk. There are no population-based estimates of in-hospital adverse event rates of percutaneous PFO/ASD closure. We used nationally representative data from the 2001-2005 Nationwide Inpatient Sample to identify patients >or-=20 years old admitted to an acute care hospital with an International Classification of Diseases, Ninth Revision code designating percutaneous PFO/ASD closure on the first or second hospital day. Variables analyzed included age, sex, number of comorbidities, year, same-day use of intracardiac or other echocardiography, same-day left heart catheterization, hospital size and teaching status, PFO/ASD procedural volume, and coronary intervention volume. Outcomes of interest included length of stay, charges, and adverse events. The study included 2,555 (weighted to United States population: 12,544 +/- 1,987) PFO/ASD closure procedures. Mean age was 52.0 +/- 0.4 years, and 57.3% +/- 1.0% were women. Annual hospital volume averaged 40.8 +/- 7.7 procedures (range, 1-114). Overall, 8.2 +/- 0.8% of admissions involved an adverse event. Older patients and those with comorbidities were more likely to sustain adverse events. Use of intracardiac echocardiography was associated with fewer adverse events. The risk of adverse events was inversely proportional to annual hospital volume (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.86-0.96, per 10 procedures), even after limiting the analysis to hospitals performing >or=10 procedures annually (OR 0.91, 95% CI 0.85-0.98). Adverse events were more frequent at hospitals in the lowest volume quintile as compared with the highest volume quintile (13.3% vs 5.4%, OR 2.42, 95% CI 1.55-3.78). The risk of adverse events of percutaneous PFO/ASD closure is inversely correlated with hospital volume. This relationship applies even to hospitals meeting the current guidelines, performing >or=10 procedures annually.

Utilization of Public System for Gastric Bands Placed by Private Providers: a 4-Year Population-Based Analysis in Ontario, Canada.

PubMed

Prabhu, Kristel Lobo; Okrainec, Allan; Maeda, Azusa; Saskin, Refik; Urbach, David; Bell, Chaim M; Jackson, Timothy D

2018-06-16

Laparoscopic adjustable gastric band (LAGB) placement remains a common bariatric procedure. While LAGB procedure is performed within private clinics in most Canadian provinces, public health care is often utilized for LAGB-related reoperations. We identified 642 gastric band removal procedures performed in Ontario from 2011 to 2014 using population-level administrative data. The number of procedures performed increased annually from 101 in 2011 to 220 in 2014. Notably, 54.7% of the patients required laparotomy, and 17.6% of patients underwent a subsequent bariatric surgery. Our findings demonstrated that LAGB placement in private clinics resulted in a large number of band removal procedures performed within the public system. This represents a significant public health concern that may result in significant health care utilization and patient morbidity.

Use of Key Performance Indicators to Improve Milestone Assessment in Semi-Annual Clinical Competency Committee Meetings.

PubMed

Chen, Fei; Arora, Harendra; Martinelli, Susan M

2017-01-01

The Accreditation Council for Graduate Medical Education's Next Accreditation System requires residency programs to semiannually submit composite milestone data on each resident's performance. This report describes and evaluates a new assessment review procedure piloted in our departmental Clinical Competency Committee (CCC) semi-annual meeting in June 2016. A modified Delphi technique was utilized to develop key performance indicators (KPI) linking milestone descriptors to clinical practice. In addition, the CCC identified six specific milestone sub-competencies that would be prescored with objective data prior to the meeting. Each resident was independently placed on the milestones by 3 different CCC faculty members. Milestone placement data of the same cohort of 42 residents (Clinical Anesthesia Years 1-3) were collected to calculate inter-rater reliability of the assessment procedures before and after the implemented changes. A survey was administrated to collect CCC feedback on the new procedure. The procedure assisted in reducing meeting time from 8 to 3.5 hours. Survey of the CCC members revealed positive perception of the procedure. Higher inter-rater reliability of the milestone placement was obtained using the implemented KPIs (Intraclass correlation coefficient [ICC] single measure range: before=.53-.94, after=.74-.98). We found the new assessment procedure beneficial to the efficiency and transparency of the assessment process. Further improvement of the procedure involves refinement of KPIs and additional faculty development on KPIs to allow non-CCC faculty to provide more accurate resident evaluations.

Use of Key Performance Indicators to Improve Milestone Assessment in Semi-Annual Clinical Competency Committee Meetings

PubMed Central

Arora, Harendra; Martinelli, Susan M.

2017-01-01

Background: The Accreditation Council for Graduate Medical Education's Next Accreditation System requires residency programs to semiannually submit composite milestone data on each resident's performance. This report describes and evaluates a new assessment review procedure piloted in our departmental Clinical Competency Committee (CCC) semi-annual meeting in June 2016. Methods: A modified Delphi technique was utilized to develop key performance indicators (KPI) linking milestone descriptors to clinical practice. In addition, the CCC identified six specific milestone sub-competencies that would be prescored with objective data prior to the meeting. Each resident was independently placed on the milestones by 3 different CCC faculty members. Milestone placement data of the same cohort of 42 residents (Clinical Anesthesia Years 1–3) were collected to calculate inter-rater reliability of the assessment procedures before and after the implemented changes. A survey was administrated to collect CCC feedback on the new procedure. Results: The procedure assisted in reducing meeting time from 8 to 3.5 hours. Survey of the CCC members revealed positive perception of the procedure. Higher inter-rater reliability of the milestone placement was obtained using the implemented KPIs (Intraclass correlation coefficient [ICC] single measure range: before=.53–.94, after=.74–.98). Conclusion: We found the new assessment procedure beneficial to the efficiency and transparency of the assessment process. Further improvement of the procedure involves refinement of KPIs and additional faculty development on KPIs to allow non-CCC faculty to provide more accurate resident evaluations. PMID:29766033

Contemporary trends in urinary tract stone surgery, a regional perspective: Auckland, New Zealand.

PubMed

Acland, George; Zargar-Shoshtari, Kamran; Rice, Michael

2016-04-01

The aim of the study is to assess the contemporary patterns of utilization of various therapeutic options for the management of nephrolithiasis in our tertiary referral institution in Auckland, New Zealand. A retrospective audit was conducted for all urinary stone procedures between January 2007 and December 2013. Procedure-related information was collected for each year. All elective and emergency procedures were included. Data were collected on the elective waiting lists for each procedure. A total of 5512 stone-related cases were performed during the study period. Six hundred and fifty-three cases were performed in 2007 compared with 945 in 2013. Total number of percutaneous nephrolithotomy (PCNLs) performed, as well as the proportion of PCNL cases, demonstrated a significant decline from 84 (12.9%) in 2007 to 67 (7.1%) in 2013. While the annual numbers of extracorporeal shock wave lithotripsy (ESWLs) have increased, the percentage of ESWLs performed relative to total stone procedures has declined from 33% to 23% over the last 4 years of this audit. There has been a significant rise in the numbers of rigid and flexible ureteroscopies, with these now being the most utilized procedure. The number of patients awaiting elective procedures declined over the duration of this audit, with an associated improvement in meeting annual demand for treatment of nephrolithiasis from 78% in 2007 to 91% in 2013. A proportional decline in PCNL and ESWL utilization with a significant increase in flexible and rigid ureteroscopic procedures has been observed over this time and this pattern has been associated with improved adherence to surgical targets despite an increasing number of cases. © 2015 Royal Australasian College of Surgeons.

Expert opinions and scientific evidence for colonoscopy key performance indicators.

PubMed

Rees, Colin J; Bevan, Roisin; Zimmermann-Fraedrich, Katharina; Rutter, Matthew D; Rex, Douglas; Dekker, Evelien; Ponchon, Thierry; Bretthauer, Michael; Regula, Jaroslaw; Saunders, Brian; Hassan, Cesare; Bourke, Michael J; Rösch, Thomas

2016-12-01

Colonoscopy is a widely performed procedure with procedural volumes increasing annually throughout the world. Many procedures are now performed as part of colorectal cancer screening programmes. Colonoscopy should be of high quality and measures of this quality should be evidence based. New UK key performance indicators and quality assurance standards have been developed by a working group with consensus agreement on each standard reached. This paper reviews the scientific basis for each of the quality measures published in the UK standards. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

40 CFR 35.3025 - Overview of State performance under delegation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... performance of a delegated State through an annual overview program, developed in accordance with procedures... year. (1) Priority objectives will include both program and management objectives. In developing the... OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Construction Grants Program Delegation to States...

Radiation exposure to the eye lens of orthopaedic surgeons during various orthopaedic procedures.

PubMed

Romanova, K; Vassileva, J; Alyakov, M

2015-07-01

The aim of the present study was to assess the radiation dose to the eye lens of orthopaedic surgeons during various orthopaedic procedures and to make efforts to ensure that radiation protection is optimised. The study was performed for Fractura femoris and Fractura cruris procedures performed in orthopaedic operating theatres, as well as for fractures of wrist, ankle and hand/shoulder performed in the emergency trauma room. The highest mean value of the eye lens dose of 47.2 μSv and higher mean fluoroscopy time of 3 min, as well as the corresponding highest maximum values of 77.1 μSv and 5.0 min were observed for the Fractura femoris procedure performed with the Biplanar 500e fluoroscopy systems. At a normal workload, the estimated mean annual dose values do not exceed the annual occupational dose limit for the lens of eye, but at a heavy workload in the department, this dose limit could be achieved or exceeded. The use of protective lead glasses is recommended as they could reduce the radiation exposure of the lens of the eye. The phantom measurements demonstrated that the use of half-dose mode could additionally reduce dose to the operator's eye lens. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Schools without Fear. Proceedings of the Annual International Alliance for Invitational Education Conference (14th). International Alliance for Invitational Education.

ERIC Educational Resources Information Center

Francis, Adrianna Hayes, Ed.

Papers presented at the fourteenth Annual Conference of the Alliance for Invitational Education are (1) "Caring, Sharing, Daring: Three Tests to Help Develop More Inviting Policies, Programmes, and Procedures" (M. Ayers); (2) "Project: Gentlemen on the Move - Combating the Poor Academic and Social Performance of African American Male Youth" (D. F.…

Trends in Medicare Reimbursement for Orthopedic Procedures: 2000 to 2016.

PubMed

Eltorai, Adam E M; Durand, Wesley M; Haglin, Jack M; Rubin, Lee E; Weiss, Arnold-Peter C; Daniels, Alan H

2018-03-01

Understanding trends in reimbursement is critical to the financial sustainability of orthopedic practices. Little research has examined physician fee trends over time for orthopedic procedures. This study evaluated trends in Medicare reimbursements for orthopedic surgical procedures. The Medicare Physician Fee Schedule was examined for Current Procedural Terminology code values for the most common orthopedic and nonorthopedic procedures between 2000 and 2016. Prices were adjusted for inflation to 2016-dollar values. To assess mean growth rate for each procedure and subspecialty, compound annual growth rates were calculated. Year-to-year dollar amount changes were calculated for each procedure and subspecialty. Reimbursement trends for individual procedures and across subspecialties were compared. Between 2000 and 2016, annual reimbursements decreased for all orthopedic procedures examined except removal of orthopedic implant. The orthopedic procedures with the greatest mean annual decreases in reimbursement were shoulder arthroscopy/decompression, total knee replacement, and total hip replacement. The orthopedic procedures with the least annual reimbursement decreases were carpal tunnel release and repair of ankle fracture. Rate of Medicare procedure reimbursement change varied between subspecialties. Trauma had the smallest decrease in annual change compared with spine, sports, and hand. Annual reimbursement decreased at a significantly greater rate for adult reconstruction procedures than for any of the other subspecialties. These findings indicate that reimbursement for procedures has steadily decreased, with the most rapid decrease seen in adult reconstruction. [Orthopedics. 2018; 41(2):95-102.]. Copyright 2018, SLACK Incorporated.

Medicaid management information systems performance standards: Health Care Financing Administration. Notice with comment period.

PubMed

1981-06-30

This notice contains performance standards (review elements and factors). We are required by section 1903(r)(6)(E) of the Social Security Act to notify all States of proposed procedures, standards, and other requirements at least one quarter prior to the fiscal year in which the procedures, standards, and other requirements will be used for Medicaid Management Information Systems reapproval reviews. This Notice meets that statutory requirements. By October 1, 1981, we will use the performance standards and existing systems requirements when conducting the annual review of State system performance.

Anticipating Mathematics Performance: A Cross-Validation Comparison of AID3 and Regression. AIR 1988 Annual Forum Paper.

ERIC Educational Resources Information Center

Bloom, Allan M.; And Others

In response to the increasing importance of student performance in required classes, research was conducted to compare two prediction procedures, linear modeling using multiple regression and nonlinear modeling using AID3. Performance in the first college math course (College Mathematics, Calculus, or Business Calculus Matrices) was the dependent…

7 CFR 1773.38 - Scope of engagement.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 1773.45 be performed annually by the CPA during the audit of the RUS borrowers' financial statements, which audit procedures may be in addition to the conduct of a GAGAS audit. (b) The CPA must exercise...

7 CFR 1773.38 - Scope of engagement.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 1773.45 be performed annually by the CPA during the audit of the RUS borrowers' financial statements, which audit procedures may be in addition to the conduct of a GAGAS audit. (b) The CPA must exercise...

7 CFR 1773.38 - Scope of engagement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 1773.45 be performed annually by the CPA during the audit of the RUS borrowers' financial statements, which audit procedures may be in addition to the conduct of a GAGAS audit. (b) The CPA must exercise...

7 CFR 1773.38 - Scope of engagement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 1773.45 be performed annually by the CPA during the audit of the RUS borrowers' financial statements, which audit procedures may be in addition to the conduct of a GAGAS audit. (b) The CPA must exercise...

7 CFR 1773.38 - Scope of engagement.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 1773.45 be performed annually by the CPA during the audit of the RUS borrowers' financial statements, which audit procedures may be in addition to the conduct of a GAGAS audit. (b) The CPA must exercise...

National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data.

PubMed

DeFrances, Carol J; Cullen, Karen A; Kozak, Lola Jean

2007-12-01

This report presents 2005 national estimates and selected trend data on the use of nonfederal short-stay hospitals in the United States. Estimates are provided by selected patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Estimates of diagnoses and procedures are presented according to International Classification of Diseases, Ninth Revision, Clinical Modification codes. The estimates are based on data collected through the National Hospital Discharge Survey. The survey has been conducted annually since 1965. In 2005, data were collected for approximately 375,000 discharges. Of the 473 eligible nonfederal short-stay hospitals in the sample, 444 (94 percent) responded to the survey. An estimated 34.7 million discharges from nonfederal short-stay hospitals occurred in 2005. Discharges used 165.9 million days of care and had an average length of stay of 4.8 days. Persons 65 years and over accounted for 38 percent of the hospital discharges and 44 percent of the days of care. The proportion of discharges whose status was described as routine discharge or discharged to the patient's home declined with age, from 91 percent for inpatients under 45 years of age to 41 percent for those 85 years and over. Hospitalization for malignant neoplasms decreased from 1990-2005. The hospitalization rate for asthma was the highest for children under 15 years of age and those 65 years of age and over. The rate was lowest for those 15-44 years of age. Thirty-eight percent of hospital discharges had no procedures performed, whereas 12 percent had four or more procedures performed. An episiotomy was performed during a majority of vaginal deliveries in 1980 (64 percent), but by 2005, it was performed during less than one of every five vaginal deliveries (19 percent).

Screening Mammography and Digital Breast Tomosynthesis: Utilization Updates.

PubMed

Boroumand, Gilda; Teberian, Ida; Parker, Laurence; Rao, Vijay M; Levin, David C

2018-05-01

There have been many recent developments in breast imaging, including the 2009 revision of the U.S. Preventive Services Task Force's breast cancer screening guidelines and the approval of digital breast tomosynthesis (DBT) for clinical use in 2011. The objective of this study is to evaluate screening mammography utilization trends among the Medicare population from 2005 to 2015 and examine the volume of DBT studies performed in 2015, the first year for which procedural billing codes for DBT are available. We reviewed national Medicare Part B Physician/Supplier Procedure Summary master files from 2005 to 2015, to determine the annual utilization rate of screening mammography on the basis of procedure codes used for film-screen and digital screening mammography. We also used the Physician/Supplier Procedure Summary master files to determine the volume of screening and diagnostic DBT studies performed in 2015. The utilization rate of screening mammography per 1000 women in the Medicare fee-for-service population increased gradually every year, from 311.5 examinations in 2005 to a peak of 322.9 examinations in 2009, representing a compound annual growth rate of 0.9%. In 2010, the utilization rate abruptly decreased by 4.3% to 309.2 examinations, and it has not since recovered to pre-2010 levels. In 2015, 18.9% of screening and 16.2% of diagnostic digital mammography examinations included DBT as an add-on procedure. In contrast to the annual increase in screening mammography utilization from 2005 to 2009, an abrupt sustained decline in screening occurred beginning in 2010, coinciding with the release of U.S. Preventive Services Task Force recommendations. DBT utilization was somewhat limited in 2015, occurring in conjunction with less than 20% of digital mammography examinations.

Half a billion surgical cases: Aligning surgical delivery with best-performing health systems.

PubMed

Shrime, Mark G; Daniels, Kimberly M; Meara, John G

2015-07-01

Surgical delivery varies 200-fold across countries. No direct correlation exists, however, between surgical delivery and health outcomes, making it difficult to pinpoint a goal for surgical scale-up. This report determines the amount of surgery that would be delivered worldwide if the world aligned itself with countries providing the best health outcomes. Annual rates of surgical delivery have been published previously for 129 countries. Five health outcomes were plotted against reported surgical delivery. Univariate and multivariate polynomial regression curves were fit, and the optimal point on each regression curve was determined by solving for first-order conditions. The country closest to the optimum for each health outcome was taken as representative of the best-performing health system. Monetary inputs to and surgical procedures provided by these systems were scaled to the global population. For 3 of the 5 health outcomes, optima could be found. Globally, 315 million procedures currently are provided annually. If global delivery mirrored the 3 best-performing countries, between 360 million and 460 million cases would be provided annually. With population growth, this will increase to approximately half a billion cases by 2030. Health systems delivering these outcomes spend approximately 10% of their GDP on health. This is the first study to provide empirical evidence for the surgical output that an ideal health system would provide. Our results project ideal delivery worldwide of approximately 550 million annual surgical cases by 2030. Copyright © 2015 Elsevier Inc. All rights reserved.

Half a billion surgical cases: Aligning surgical delivery with best-performing health systems

PubMed Central

Shrime, Mark G.; Daniels, Kimberly M.; Meara, John G.

2015-01-01

Background Surgical delivery varies 200-fold across countries. No direct correlation exists, however, between surgical delivery and health outcomes, making it difficult to pinpoint a goal for surgical scale-up. This report determines the amount of surgery that would be delivered worldwide if the world aligned itself with countries providing the best health outcomes. Methods Annual rates of surgical delivery have been published previously for 129 countries. Five health outcomes were plotted against reported surgical delivery. Univariate and multivariate polynomial regression curves were fit, and the optimal point on each regression curve was determined by solving for first-order conditions. The country closest to the optimum for each health outcome was taken as representative of the best-performing health system. Monetary inputs to and surgical procedures provided by these systems were scaled to the global population. Results For 3 of the 5 health outcomes, optima could be found. Globally, 315 million procedures currently are provided annually. If global delivery mirrored the 3 best-performing countries, between 360 million and 460 million cases would be provided annually. With population growth, this will increase to approximately half a billion cases by 2030. Health systems delivering these outcomes spend approximately 10% of their GDP on health. Conclusion This is the first study to provide empirical evidence for the surgical output that an ideal health system would provide. Our results project ideal delivery worldwide of approximately 550 million annual surgical cases by 2030. PMID:25934078

Past and present work practices of European interventional cardiologists in the context of radiation protection of the eye lens-results of the EURALOC study.

PubMed

Domienik-Andrzejewska, Joanna; Ciraj-Bjelac, Olivera; Askounis, Panagiotis; Covens, Peter; Dragusin, Octavian; Jacob, Sophie; Farah, Jad; Gianicolo, Emilio; Padovani, Renato; Teles, Pedro; Widmark, Anders; Struelens, Lara

2018-05-21

This paper investigates over five decades of work practices in interventional cardiology, with an emphasis on radiation protection. The analysis is based on data from more than 400 cardiologists from various European countries recruited for a EURALOC study and collected in the period from 2014 to 2016. Information on the types of procedures performed and their annual mean number, fluoroscopy time, access site choice, x-ray units and radiation protection means used was collected using an occupational questionnaire. Based on the specific European data, changes in each parameter have been analysed over decades, while country-specific data analysis has allowed us to determine the differences in local practices. In particular, based on the collected data, the typical workload of a European cardiologist working in a haemodynamic room and an electrophysiology room was specified for various types of procedures. The results showed that when working in a haemodynamic room, a transparent ceiling-suspended lead shield or lead glasses are necessary in order to remain below the recommended eye lens dose limit of 20 mSv. Moreover, the analysis revealed that new, more complex cardiac procedures such as chronic total occlusion, valvuloplasty and pulmonary vein isolation for atrial fibrillation ablation might contribute substantially to annual doses, although they are relatively rarely performed. The results revealed that considerable progress has been made in the use of radiation protection tools. While their use in electrophysiology procedures is not generic, the situation in haemodynamic procedures is rather encouraging, as ceiling-suspended shields are used in 90% of cases, while the combination of ceiling shield and lead glasses is noted in more than 40% of the procedures. However, we find that still 7% of haemodynamic procedures are performed without any radiation protection tools.

National Hospital Discharge Survey: 2003 annual summary with detailed diagnosis and procedure data.

PubMed

Kozak, Lola Jean; Lees, Karen A; DeFrances, Carol J

2006-05-01

This report presents 2003 national estimates and trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Estimates of diagnoses and procedures are presented according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually since 1965. In 2003, data were collected for approximately 320,000 discharges. Of the 479 eligible non-Federal short-stay hospitals in the sample, 426 (89 percent) responded to the survey. An estimated 34.7 million inpatients were discharged from non-Federal short-stay hospitals in 2003. They used 167.3 million days of care and had an average length of stay of 4.8 days. Females used almost one-third more days of hospital care than males. Patients with five or more diagnoses rose from 29 percent of discharges in 1990 to 57 percent in 2003. The leading diagnostic category was respiratory diseases for children under 15 years, childbirth for 15-44 year olds, and circulatory diseases for patients 45 years of age and over. Only surgical procedures were performed for 27 percent of discharges, 18 percent had surgical and nonsurgical procedures, and 16 percent had only nonsurgical procedures. A total of 664,000 coronary angioplasties were performed, and stents were inserted during 86 percent of these procedures with drug-eluting stents used in 28 percent. The number and rate of total and primary cesarean deliveries rose from 1995 to 2003. The rate of vaginal birth after cesarean delivery dropped 58 percent, from 35.5 in 1995 to 14.8 in 2003.

20 CFR 663.540 - What kind of performance and cost information is required for determinations of subsequent...

Code of Federal Regulations, 2010 CFR

2010-04-01

... EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR ADULT AND DISLOCATED WORKER ACTIVITIES UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT Eligible Training Providers § 663.540 What kind of performance... of training services must submit, at least annually, under procedures established by the Governor...

20 CFR 663.540 - What kind of performance and cost information is required for determinations of subsequent...

Code of Federal Regulations, 2011 CFR

2011-04-01

... EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR ADULT AND DISLOCATED WORKER ACTIVITIES UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT Eligible Training Providers § 663.540 What kind of performance... of training services must submit, at least annually, under procedures established by the Governor...

The effect of work system on the hand exposure of workers in 18F-FDG production centres.

PubMed

Wrzesień, Małgorzata

2018-05-07

The production of the 18 F isotope-the marker of deoxyglucose ( 18 F-FDG)-the radiopharmaceutical most commonly used in the oncological diagnostic technique of positron emission tomography, requires a cyclotron device. At present, there are nine facilities working in Poland that are equipped with cyclotrons used for producing the short-lived isotopes. The aim of the paper is to determine the hand exposure of workers employed in the two 18 F-FDG production centres taking in to account the production procedures and work system in those facilities. Measurements, which included all professional workers exposed to ionizing radiation that were employed in two facilities, were performed by using high-sensitivity thermoluminescent detectors during the routine activities of the personnel. The work system used at the production centre has an impact on the level of the recorded doses. Among the production procedures performed by the staff, the highest ionizing radiation doses have been received by the staff during the 18 F-FDG quality control. The maximum estimated annual Hp(0.07) for chemists from the quality control department can exceed the annual skin limit dose (500 mSv). The source of lowest doses on the hands are the cyclotron operating procedure and the 18 F-FDG production, provided that these procedures can't be combined with other production procedures.

Trends in Aortic Valve Replacement Procedures Between 2009 and 2015: Has Transcatheter Aortic Valve Replacement Made a Difference?

PubMed

Culler, Steven D; Cohen, David J; Brown, Phillip P; Kugelmass, Aaron D; Reynolds, Matthew R; Ambrose, Karen; Schlosser, Michael L; Simon, April W; Katz, Marc R

2018-04-01

This study reports trends in volume and adverse events associated with isolated aortic valve procedures performed in Medicare beneficiaries between 2009 and 2015. This retrospective study used the annual fiscal year Medicare Provider Analysis and Review file to identify all Medicare beneficiaries undergoing an isolated aortic valve procedure. Outcome measures included three mortality rates and nine in-hospital adverse events. The final study population consisted of 233,660 hospitalizations. During the study period, Medicare beneficiaries undergoing an aortic valve procedure increased from 22,076 to 49,362, for an average annual growth rate of 14.45%. Transcatheter aortic valve replacement (TAVR) procedures per 100,000 Medicare beneficiaries grew from 10.7 in 2012 to 41.1 in 2015. Overall, in-hospital mortality rates, cumulative 30-day mortality rates, and 90-day postdischarge mortality rates declined annually during the study period. However, the 90-day mortality rate for TAVR was nearly double the rate for the tissue surgical aortic valve replacement group. Nearly 68% of Medicare beneficiaries experienced at least one in-hospital adverse event during their index hospitalization. Medicare beneficiaries undergoing TAVR had the lowest observed adverse events rates among the aortic valve procedures in 2015. The total number of Medicare beneficiaries undergoing isolated aortic valve procedures increased from 47.5 to 88.9 per 100,000 Medicare beneficiaries during the study period. Aortic valve procedures increased significantly during this study period primarily due to the increase in TAVR, with clinical outcomes improving as well. Although long-term outcomes of TAVR are still under investigation, these results are promising. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Practice patterns of post-radical prostatectomy incontinence surgery in Ontario

PubMed Central

Wallis, Christopher J.D.; Herschorn, Sender; Liu, Ying; Carr, Lesley K.; Kodama, Ronald T.; Klotz, Laurence H.; Saskin, Refik; Nam, Robert K.

2014-01-01

Introduction: We assess the practice patterns of artificial urinary sphincter (AUS) and urethral sling insertion after radical prostatectomy (RP) from a large population-based cohort. Methods: We examined 25 346 men in Ontario, Canada who underwent RP between 1993 and 2006. Using hospital and cancer registry data, we identified patients who subsequently underwent an incontinence procedure. We characterized the practice patterns of post-prostatectomy incontinence procedures across Ontario during the study interval. Results: A total of 703 (2.8%) men underwent subsequent insertion of an AUS and 282 (1.1%) underwent a urethral sling procedure (985 total incontinence procedures, 3.9%) over the study period. During the study period, 121 hospitals performed RP. Among them, 32 (26%) hospitals performed both RP and AUS/sling procedures, and 89 (74%) performed RP only. Four hospitals performed AUS/sling procedures but not RP. Of the 36 institutions that performed AUS/sling procedures, the median annual case volume was 0.29 (interquartile range: 0.083-0.75). Of all incontinence procedures, 56% were performed at 3 academic institutions. When examining observed rates of AUS/sling procedures compared with expected rates from the overall cohort, 15 of 32 hospitals (47%) performed significantly fewer incontinence procedures than expected given their RP case volume (p range: <0.0001–0.0390) and 5 (16%) performed significantly more (p range: <0.0001–0.038). Conclusions: A small number of academic institutions provide most of the surgical care for men with incontinence following RP in Ontario. Many centres that perform RP refer out to other centres to surgically manage their patients’ incontinence. PMID:25408805

THE EPIDEMIOLOGY OF EMERGENCY DEPARTMENT THORACOTOMY IN A STATEWIDE TRAUMA SYSTEM: DOES CENTER VOLUME MATTER?

PubMed

Dumas, Ryan P; Seamon, Mark J; Smith, Brian P; Yang, Wei; Cannon, Jeremy W; Schwab, C William; Reilly, Patrick M; Holena, Daniel N

2018-04-17

The relationship between high volume and improved outcomes has been described for a host of elective high-impact, low-frequency procedures, but there are little data to support such a relationship in high-impact low-frequency procedures in trauma. Using emergency department thoracotomy (EDT) as a model, we hypothesized that patients presenting to centers with higher institutional volumes of EDT would have improved survival referent to those presenting to lower volume institutions. We queried the Pennsylvania Trauma Outcomes Study (PTOS) registry from 2007-2015 for all EDTs performed at level I and II centers identified by ICD-9 procedure codes and a location stamp indicating the emergency department. We examined patient-level risk factors for survival in univariate regression and multivariable regression models. Centers were divided into tertiles of mean annual EDT volume and the association between mean annual EDT volume and patient survival was examined using logistic regression after controlling for patient factors. 1,399 emergency department thoracotomies were performed at 28 centers. Overall survival was 6.8%. After controlling for patient age, mechanism of injury, signs of life, and injury severity, patients presenting to centers in the highest tertile of volume had significantly higher odds of survival compared to patients presenting to centers in the lowest tertile of volume (OR 4.56, 95% CI 1.43-14.50). Patients presenting to centers with higher mean annual volume of EDTs have improved survival compared to those presenting to institutions with lower mean annual EDT volume. Efforts to understand the etiology of this finding may lead to interventions to improve outcomes at lower volume centers. Level 3: Retrospective cohort study.

How much tumor surgery do early-career orthopaedic oncologists perform?

PubMed

Miller, Benjamin J; Rajani, Rajiv; Leddy, Lee; Carmody Soni, Emily E; White, Jeremy R

2015-02-01

There are few data on the types of procedures orthopaedic oncologists perform in their first years of practice. Because fellowships are graduating fellows each year and the number of tumor patients is limited, defining the practice patterns of early-career orthopaedic oncologists may help diminish early employment discontent and enhance workforce discussions. The aim of the study was to use the objective case log volumes of a cross-section of early career orthopaedic oncologists to describe (1) the number of operations performed annually; (2) the proportion of tumor, trauma, adult reconstruction, and other operations for individual participants, (3) individual practice characteristics that were associated with the number of tumor procedures; and (4) the sources of satisfaction and challenges in each individual's career and surgical practice. Fifteen fellowship-trained orthopaedic oncologists out of a potential pool of 33 (45%) in their first 4 years of practice responded to a survey by submitting complete operative case lists for a 2-year period. We recorded the type of procedure and determined associations between the annual number of tumor operations and total operative caseload, years in practice, and some details of individual practice patterns. Each participant completed a survey regarding practice-related sources of stress and satisfaction. A total of 5611 surgical cases were available for review. For the entire cohort, there were 3303 (59%) tumor procedures, 973 (17%) trauma, 890 (16%) adult reconstruction, and 445 (8%) other. The median annual number of total operations was 214 (range, 63-356) and median annual number of tumor operations was 135 (range, 47-216). The median proportion of tumor operations in an individual practice was 56% (range, 43%-94%). The annual number of tumor operations correlated with the total annual number of operations (r = 0.73, p < 0.001). Sources of stress and satisfaction were similar to the general membership of the Musculoskeletal Tumor Society (MSTS), apart from more early-career surgeons regarding case volume as important (29 of 104 [28%] of MSTS versus 11 of 15 [73%] of early-career, p < 0.001). The typical early-career orthopaedic tumor surgeon had fewer than 60% of his or her operative procedures directly related to the subject of his or her fellowship training in orthopaedic oncology. Overall, the challenges and rewards of clinical practice are similar to oncologic surgeons later in their career. This study is a first step in assessing early practice characteristics and may be of value to the prospective orthopaedic oncologist, fellowship educators, and the society in workforce discussions. Early-career practice patterns have not been previously presented, to our knowledge, for any subspecialty of orthopaedic surgery, and we hope that this study will stimulate similar efforts throughout the field. Level IV, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.

A mathematical procedure to predict optical performance of CPCs

NASA Astrophysics Data System (ADS)

Yu, Y. M.; Yu, M. J.; Tang, R. S.

2016-08-01

To evaluate the optical performance of a CPC based concentrating photovoltaic system, it is essential to find the angular dependence of optical efficiency of compound parabolic concentrator (CPC-θe ) where the incident angle of solar rays on solar cells is restricted within θe for the radiation over its acceptance angle. In this work, a mathematical procedure was developed to calculate the optical efficiency of CPC-θe for radiation incident at any angle based radiation transfer within CPC-θe . Calculations show that, given the acceptance half-angle (θa ), the annual radiation of full CPC-θe increases with the increase of θe and the CPC without restriction of exit angle (CPC-90) annually collects the most radiation due to large geometry (Ct ); whereas for truncated CPCs with identical θa and Ct , the annual radiation collected by CPC-θe is almost identical to that by CPC-90, even slightly higher. Calculations also indicate that the annual radiation on the absorber of CPC-θe at the angle larger than θe decrease with the increase of θe but always less than that of CPC-90, and this implies that the CPC-θe based PV system is more efficient than CPC-90 based PV system because the radiation on solar cells incident at large angle is poorly converted into electricity.

SU-E-T-468: Implementation of the TG-142 QA Process for Seven Linacs with Enhanced Beam Conformance

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

Woollard, J; Ayan, A; DiCostanzo, D

2015-06-15

Purpose: To develop a TG-142 compliant QA process for 7 Varian TrueBeam linear accelerators (linacs) with enhanced beam conformance and dosimetrically matched beam models. To ensure consistent performance of all 7 linacs, the QA process should include a common set of baseline values for use in routine QA on all linacs. Methods: The TG 142 report provides recommended tests, tolerances and frequencies for quality assurance of medical accelerators. Based on the guidance provided in the report, measurement tests were developed to evaluate each of the applicable parameters listed for daily, monthly and annual QA. These tests were then performed onmore » each of our 7 new linacs as they came on line at our institution. Results: The tolerance values specified in TG-142 for each QA test are either absolute tolerances (i.e. ±2mm) or require a comparison to a baseline value. The results of our QA tests were first used to ensure that all 7 linacs were operating within the suggested tolerance values provided in TG −142 for those tests with absolute tolerances and that the performance of the linacs was adequately matched. The QA test results were then used to develop a set of common baseline values for those QA tests that require comparison to a baseline value at routine monthly and annual QA. The procedures and baseline values were incorporated into a spreadsheets for use in monthly and annual QA. Conclusion: We have developed a set of procedures for daily, monthly and annual QA of our linacs that are consistent with the TG-142 report. A common set of baseline values was developed for routine QA tests. The use of this common set of baseline values for comparison at monthly and annual QA will ensure consistent performance of all 7 linacs.« less

46 CFR Appendix C to Part 404 - Procedures for Annual Review of Base Pilotage Rates

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Procedures for Annual Review of Base Pilotage Rates C Appendix C to Part 404 Shipping COAST GUARD (GREAT LAKES PILOTAGE), DEPARTMENT OF HOMELAND SECURITY GREAT LAKES PILOTAGE RATEMAKING Pt. 404, App. C Appendix C to Part 404—Procedures for Annual Review of Base...

46 CFR Appendix C to Part 404 - Procedures for Annual Review of Base Pilotage Rates

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Procedures for Annual Review of Base Pilotage Rates C Appendix C to Part 404 Shipping COAST GUARD (GREAT LAKES PILOTAGE), DEPARTMENT OF HOMELAND SECURITY GREAT LAKES PILOTAGE RATEMAKING Pt. 404, App. C Appendix C to Part 404—Procedures for Annual Review of Base...

Hip arthroscopy utilization and associated complications: a population-based analysis

PubMed Central

Bernard, Johnathan A.; Pan, Ting J.; Ranawat, Anil S.; Nawabi, Danyal H.; Kelly, Bryan T.; Lyman, Stephen

2017-01-01

Abstract The purpose of this study is to review the trends in hip arthroscopy using data from a statewide database, focusing on utilization rates, patient demographics and complication rates. The Statewide Planning and Research Cooperative System (SPARCS) database for New York State was queried for cases of hip arthroscopy from 1998 to 2012. Patient demographics and procedural details were collected. Patients were subsequently reviewed for complications and readmissions within 30 and 90 days. In total, 12 194 hip arthroscopy procedures were performed by 295 surgeons in 137 centers between 1998 and 2012. There was a 95-fold increase in the annual frequency of hip arthroscopy procedures between 1998 (n = 24) and 2012 (n = 2296). Thirty-day complication rates were 0.2% (n = 19), whereas the 90-day complication rate was 0.3% (n = 30). The all-cause 30-day readmission rate was 0.5% (n = 66), whereas the 90-day rate was 1.6% (n = 200). The number of surgeons performing hip arthroscopy increased 7-fold over the observation period. However, only 14.9% (n = 44) of surgeons performed more than 30 procedures annually. Lower volume surgeons (<102 cases/year) demonstrated significantly higher 90-day readmission rates, compared with higher volume surgeons (>163 cases/year, P < 0.0060); however, complication rates and readmission rates did not differ based on surgeon volume. Our findings confirm our hypothesis, demonstrating a significant increase in utilization of hip arthroscopy in the State of New York. We did not identify an associated increase in annual complication rates as hypothesized with increasing utilization, although there was an association of higher readmission rates among lower volume surgeons. Further study is needed to define rates of failure requiring revision hip arthroscopy or conversion to arthroplasty, and to clarify the relationship between complication rates and surgeon volume and case complexity. Level of Evidence: III, retrospective cohort series. PMID:28948036

25 CFR 36.42 - Standard XV-Counseling services.

Code of Federal Regulations, 2014 CFR

2014-04-01

... objective assessment of student academic performance. Required formal tests shall be administered annually... standards, schools may use the state mandated academic achievement tests and accompanying requirements. These formal tests and their subtest contents, as well as the test-related procedures, shall include...

25 CFR 36.42 - Standard XV-Counseling services.

Code of Federal Regulations, 2012 CFR

2012-04-01

... objective assessment of student academic performance. Required formal tests shall be administered annually... standards, schools may use the state mandated academic achievement tests and accompanying requirements. These formal tests and their subtest contents, as well as the test-related procedures, shall include...

25 CFR 36.42 - Standard XV-Counseling services.

Code of Federal Regulations, 2013 CFR

2013-04-01

... objective assessment of student academic performance. Required formal tests shall be administered annually... standards, schools may use the state mandated academic achievement tests and accompanying requirements. These formal tests and their subtest contents, as well as the test-related procedures, shall include...

25 CFR 36.42 - Standard XV-Counseling services.

Code of Federal Regulations, 2010 CFR

2010-04-01

... objective assessment of student academic performance. Required formal tests shall be administered annually... standards, schools may use the state mandated academic achievement tests and accompanying requirements. These formal tests and their subtest contents, as well as the test-related procedures, shall include...

25 CFR 36.42 - Standard XV-Counseling services.

Code of Federal Regulations, 2011 CFR

2011-04-01

... objective assessment of student academic performance. Required formal tests shall be administered annually... standards, schools may use the state mandated academic achievement tests and accompanying requirements. These formal tests and their subtest contents, as well as the test-related procedures, shall include...

German Heart Surgery Report 2016: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery.

PubMed

Beckmann, Andreas; Funkat, Anne-Katrin; Lewandowski, Jana; Frie, Michael; Ernst, Markus; Hekmat, Khosro; Schiller, Wolfgang; Gummert, Jan F; Harringer, Wolfgang

2017-10-01

Based on a long-standing voluntary registry founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS), well-defined data of all cardiac, thoracic, and vascular surgery procedures performed in 78 German heart surgery departments during the year 2016 are analyzed. In 2016, a total of 103,128 heart surgery procedures (implantable defibrillator, pacemaker, and extracardiac procedures excluded) were submitted to the registry. Approximately 15.7% of the patients were at least 80 years of age, resulting in an increase of 0.9% compared with the data of 2015. For 37,614 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 4.4:1), an unadjusted in-hospital mortality of 2.9% was observed. Concerning the 33,451 isolated heart valve procedures (including 11,701 catheter-based procedures), the unadjusted in-hospital mortality was 4.3%. This annual updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, describes advancements in heart medicine, and is a basis for internal and external quality assurances for all participants. In addition, the registry demonstrates that the provision of cardiac surgery in Germany is appropriate and patients are treated nationwide at all times.

24 CFR 266.510 - HFA responsibilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.510 HFA responsibilities. (a) Inspections. The HFA must perform inspections in accordance with the physical inspection procedures in 24 CFR part 5, subpart G. (b) Annual audits of projects...

24 CFR 266.510 - HFA responsibilities.

Code of Federal Regulations, 2014 CFR

2014-04-01

... HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.510 HFA responsibilities. (a) Inspections. The HFA must perform inspections in accordance with the physical inspection procedures in 24 CFR part 5, subpart G. (b) Annual audits of projects...

24 CFR 266.510 - HFA responsibilities.

Code of Federal Regulations, 2011 CFR

2011-04-01

... HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.510 HFA responsibilities. (a) Inspections. The HFA must perform inspections in accordance with the physical inspection procedures in 24 CFR part 5, subpart G. (b) Annual audits of projects...

24 CFR 266.510 - HFA responsibilities.

Code of Federal Regulations, 2012 CFR

2012-04-01

... HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.510 HFA responsibilities. (a) Inspections. The HFA must perform inspections in accordance with the physical inspection procedures in 24 CFR part 5, subpart G. (b) Annual audits of projects...

24 CFR 266.510 - HFA responsibilities.

Code of Federal Regulations, 2013 CFR

2013-04-01

... HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.510 HFA responsibilities. (a) Inspections. The HFA must perform inspections in accordance with the physical inspection procedures in 24 CFR part 5, subpart G. (b) Annual audits of projects...

32 CFR 104.6 - Procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... whenever called to duty for a contingency operation, advise Service members who are participating in a... component who perform or participate on a voluntary or involuntary basis in active duty, active duty for special work, initial active duty for training, active duty for training, inactive duty training, annual...

Occupational dose in interventional radiology procedures.

PubMed

Chida, Koichi; Kaga, Yuji; Haga, Yoshihiro; Kataoka, Nozomi; Kumasaka, Eriko; Meguro, Taiichiro; Zuguchi, Masayuki

2013-01-01

Interventional radiology tends to involve long procedures (i.e., long fluoroscopic times). Therefore, radiation protection for interventional radiology staff is an important issue. This study describes the occupational radiation dose for interventional radiology staff, especially nurses, to clarify the present annual dose level for interventional radiology nurses. We compared the annual occupational dose (effective dose and dose equivalent) among interventional radiology staff in a hospital where 6606 catheterization procedures are performed annually. The annual occupational doses of 18 physicians, seven nurses, and eight radiologic technologists were recorded using two monitoring badges, one worn over and one under their lead aprons. The annual mean ± SD effective dose (range) to the physicians, nurses, and radiologic technologists using two badges was 3.00 ± 1.50 (0.84-6.17), 1.34 ± 0.55 (0.70-2.20), and 0.60 ± 0.48 (0.02-1.43) mSv/y, respectively. Similarly, the annual mean ± SD dose equivalent range was 19.84 ± 12.45 (7.0-48.5), 4.73 ± 0.72 (3.9-6.2), and 1.30 ± 1.00 (0.2-2.7) mSv/y, respectively. The mean ± SD effective dose for the physicians was 1.02 ± 0.74 and 3.00 ± 1.50 mSv/y for the one- and two-badge methods, respectively (p < 0.001). Similarly, the mean ± SD effective dose for the nurses (p = 0.186) and radiologic technologists (p = 0.726) tended to be lower using the one-badge method. The annual occupational dose for interventional radiology staff was in the order physicians > nurses > radiologic technologists. The occupational dose determined using one badge under the apron was far lower than the dose obtained with two badges in both physicians and nonphysicians. To evaluate the occupational dose correctly, we recommend use of two monitoring badges to evaluate interventional radiology nurses as well as physicians.

Current operator volumes of invasive coronary procedures in Medicare patients: implications for future manpower needs in the catheterization laboratory.

PubMed

Maroney, Justin; Khan, Saba; Powell, Wayne; Klein, Lloyd W

2013-01-01

We seek to assess the per-operator volume of diagnostic catheterizations and percutaneous coronary interventions (PCI) among US cardiologists, and its implication for future manpower needs in the catheterization laboratory. The number of annual Medicare PCIs peaked in 2004 and has trended downward since, however the total number of catheterization laboratories nationwide has increased. It is unknown whether these trends have resulted in a dilution of per-operator volumes, and whether the current supply of interventional cardiologists is appropriate to meet future needs. We analyzed the Centers for Medicare and Medicaid Services 2008 Medicare 5% sample file, and extracted the total number of Medicare fee-for-service (Medicare FFS) diagnostic catheterizations and PCIs performed in 2008. We then determined per-physician procedure volumes using National Provider Identifier numbers. There were 1,198,610 Medicare FFS diagnostic catheterizations performed by 11,029 diagnostic cardiologists, and there were 378,372 Medicare FFS PCIs performed by 6,443 interventional cardiologists in 2008. The data reveal a marked difference in the 2008 distribution of diagnostic catheterizations and PCIs among operators. Just over 10% of diagnostic catheterizations were performed by operators performing 40 or fewer Medicare FFS diagnostic catheterizations, contrasted with almost 30% of PCIs performed by operators with 40 of fewer Medicare FFS PCIs. A significant majority of interventional cardiologists (61%) performed 40 or fewer Medicare FFS PCIs in 2008. There is a high percentage of low-volume operators performing PCI, raising questions regarding annual volume recommendations for procedural skill maintenance, and the future manpower requirements in the catheterization laboratory. Copyright © 2012 Wiley Periodicals, Inc.

Solar Field Optical Characterization at Stillwater Geothermal/Solar Hybrid Plant

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

Zhu, Guangdong; Turchi, Craig

Concentrating solar power (CSP) can provide additional thermal energy to boost geothermal plant power generation. For a newly constructed solar field at a geothermal power plant site, it is critical to properly characterize its performance so that the prediction of thermal power generation can be derived to develop an optimum operating strategy for a hybrid system. In the past, laboratory characterization of a solar collector has often extended into the solar field performance model and has been used to predict the actual solar field performance, disregarding realistic impacting factors. In this work, an extensive measurement on mirror slope error andmore » receiver position error has been performed in the field by using the optical characterization tool called Distant Observer (DO). Combining a solar reflectance sampling procedure, a newly developed solar characterization program called FirstOPTIC and public software for annual performance modeling called System Advisor Model (SAM), a comprehensive solar field optical characterization has been conducted, thus allowing for an informed prediction of solar field annual performance. The paper illustrates this detailed solar field optical characterization procedure and demonstrates how the results help to quantify an appropriate tracking-correction strategy to improve solar field performance. In particular, it is found that an appropriate tracking-offset algorithm can improve the solar field performance by about 15%. The work here provides a valuable reference for the growing CSP industry.« less

Solar Field Optical Characterization at Stillwater Geothermal/Solar Hybrid Plant

DOE PAGES

Zhu, Guangdong; Turchi, Craig

2017-01-27

Concentrating solar power (CSP) can provide additional thermal energy to boost geothermal plant power generation. For a newly constructed solar field at a geothermal power plant site, it is critical to properly characterize its performance so that the prediction of thermal power generation can be derived to develop an optimum operating strategy for a hybrid system. In the past, laboratory characterization of a solar collector has often extended into the solar field performance model and has been used to predict the actual solar field performance, disregarding realistic impacting factors. In this work, an extensive measurement on mirror slope error andmore » receiver position error has been performed in the field by using the optical characterization tool called Distant Observer (DO). Combining a solar reflectance sampling procedure, a newly developed solar characterization program called FirstOPTIC and public software for annual performance modeling called System Advisor Model (SAM), a comprehensive solar field optical characterization has been conducted, thus allowing for an informed prediction of solar field annual performance. The paper illustrates this detailed solar field optical characterization procedure and demonstrates how the results help to quantify an appropriate tracking-correction strategy to improve solar field performance. In particular, it is found that an appropriate tracking-offset algorithm can improve the solar field performance by about 15%. The work here provides a valuable reference for the growing CSP industry.« less

Annual banned-substance review: analytical approaches in human sports drug testing.

PubMed

Thevis, Mario; Kuuranne, Tiia; Geyer, Hans; Schänzer, Wilhelm

2010-04-01

The annual update of the list of prohibited substances and doping methods as issued by the World Anti-Doping Agency (WADA) allows the implementation of most recent considerations of performance manipulation and emerging therapeutics into human sports doping control programmes. The annual banned-substance review for human doping controls critically summarizes recent innovations in analytical approaches that support the efforts of convicting cheating athletes by improved or newly established methods that focus on known as well as newly outlawed substances and doping methods. In the current review, literature published between October 2008 and September 2009 reporting on new and/or enhanced procedures and techniques for doping analysis, as well as aspects relevant to the doping control arena, was considered to complement the 2009 annual banned-substance review.

Comparison of three-parameter probability distributions for representing annual extreme and partial duration precipitation series

NASA Astrophysics Data System (ADS)

Wilks, Daniel S.

1993-10-01

Performance of 8 three-parameter probability distributions for representing annual extreme and partial duration precipitation data at stations in the northeastern and southeastern United States is investigated. Particular attention is paid to fidelity on the right tail, through use of a bootstrap procedure simulating extrapolation on the right tail beyond the data. It is found that the beta-κ distribution best describes the extreme right tail of annual extreme series, and the beta-P distribution is best for the partial duration data. The conventionally employed two-parameter Gumbel distribution is found to substantially underestimate probabilities associated with the larger precipitation amounts for both annual extreme and partial duration data. Fitting the distributions using left-censored data did not result in improved fits to the right tail.

76 FR 42116 - National Policy for Distinguishing Serious From Non-Serious Injuries of Marine Mammals

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-18

... transparent process for effective conservation of marine mammal stocks and management of human activities... performance under existing processes, and gather the best available and current scientific information... The draft Procedural Directive describes the annual process for making and documenting injury...

78 FR 19409 - Annual Charge Filing Procedures for Natural Gas Pipelines

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-01

...; Order No. 776] Annual Charge Filing Procedures for Natural Gas Pipelines AGENCY: Federal Energy... Commission (Commission or FERC) is amending its regulations to revise the filing requirements for natural gas...) clause. Currently, natural gas pipelines utilizing an ACA clause must make an annual tariff filing to...

Higher surgeon annual volume, but not years of experience, is associated with reduced rates of postoperative complications and reoperations after open abdominal aortic aneurysm repair.

PubMed

Dubois, Luc; Allen, Britney; Bray-Jenkyn, Krista; Power, Adam H; DeRose, Guy; Forbes, Thomas L; Duncan, Audra; Shariff, Salimah Z

2018-06-01

Volume-outcome relationships for open abdominal aortic aneurysm (AAA) repair have received less attention in publicly funded health systems. Furthermore, the roles of surgeon seniority (years of experience) and composite volume (encompassing all major arterial cases) on outcomes after open AAA repair are less well known. We sought to determine the effects of surgeon volume, surgeon years of experience, and composite volume on outcomes after elective open AAA repairs performed in Ontario, Canada. Using a population-based, prospectively collected health administrative database, all elective open AAA repairs occurring in the province of Ontario from 2005 to 2014 were identified. Surgeon annual volume was classified by quintiles, with the highest volume quintile acting as the reference category. Multivariable logistic regression modeling was used, adjusting for patient factors (age, sex, comorbidities, year of procedure, income) to investigate the relationship between surgeon annual volume and 30-day mortality, 30-day major complications, 30-day reoperations, 1-year mortality, and 1-year reoperations (related to index procedure). The potential effects of annual surgeon composite volume and surgeon years of experience on postoperative outcomes were also explored. A total of 7211 elective open AAA repairs performed by 101 surgeons were identified between 2005 and 2014. Most of the operations were performed by vascular surgeons (81.5%), followed by cardiac (12.1%) and general surgeons (6.1%). Median number of procedures in the lowest quintile group was 3 repairs/y, whereas the highest quintile group performed 54 repairs/y. Overall 30-day mortality was 3%. No difference in mortality was detected in comparing the lowest with the highest volume groups (1.89% vs 3.01%; adjusted odds ratio [OR], 0.60; 95% confidence interval [CI], 0.27-1.33). The lowest volume group exhibited a higher 30-day complication rate (28.0% vs 20.4%; OR, 1.54; 95% CI, 1.15-2.06) and 30-day reoperation rate (10.53% vs 6.73%; OR, 1.64; 95% CI, 1.13-2.38) compared with the highest volume group. No effect of surgeon volume on 1-year mortality or 1-year reoperation was observed. Similarly, composite volume and surgeon years of experience were not associated with postoperative outcomes. In a single-payer system with a relatively high number of open AAA repairs/surgeon per year, surgeon annual volume had no effect on postoperative mortality but was associated with lower postoperative complication and reoperation rates. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

40 CFR 98.275 - Procedures for estimating missing data.

Code of Federal Regulations, 2010 CFR

2010-07-01

... measurements of heat content and carbon content of spent pulping liquor. A re-test must be performed if the data from any annual measurements are determined to be invalid. (b) For missing measurements of the... accounting records, production rates). The owner or operator shall document and keep records of the...

Made to Measure: Early Career Academics in the Canadian University Workplace

ERIC Educational Resources Information Center

Acker, Sandra; Webber, Michelle

2017-01-01

While Canada lacks explicit central directives towards research productivity, academics experience frequent and intense reviews of their research, teaching and service through mechanisms such as elaborate tenure and promotion procedures and annual performance reviews. Given that newer academics are sometimes thought to be especially susceptible to…

Kansas Center for Research in Early Childhood Education. Annual Report (Part I) FY'73.

ERIC Educational Resources Information Center

Kansas Univ., Lawrence. Kansas Center for Research in Early Childhood Education.

This report includes five documents, three on child care research, and two concerning individual differences and discriminative abilities in newborn and young infants. "The Organization of Infant Day Care Environments: Feedback-Produced Improvements in Staff Job Performance" reports on the effectiveness of monitoring procedures as…

Radiation exposure in interventional radiology

NASA Astrophysics Data System (ADS)

Pinto, N. G. V.; Braz, D.; Vallim, M. A.; Filho, L. G. P.; Azevedo, F. S.; Barroso, R. C.; Lopes, R. T.

2007-09-01

The aim of this study is to evaluate dose values in patients and staff involved in some interventional radiology procedures. Doses have been measured using thermoluminescent dosemeters for single procedures (such as renal and cerebral arteriography, transjungular intrahepatic portasystemic shunt (TIPS) and chemoembolization). The magnitude of doses through the hands of interventional radiologists has been studied. Dose levels were evaluated in three points for patients (eye, thyroid and gonads). The dose-area product (DAP) was also investigated using a Diamentor (PTW-M2). The dose in extremities was estimated for a professional who generally performed one TIPS, two chemoembolizations, two cerebral arteriographies and two renal arteriographies in a week. The estimated annual radiation dose was converted to effective dose as suggested by the 453-MS/Brazil norm The annual dose values were 137.25 mSv for doctors, 40.27 mSv for nurses and 51.95 mSv for auxiliary doctors, and all these annual dose values are below the limit established. The maximum values of the dose obtained for patients were 6.91, 10.92 and 15.34 mGy close to eye, thyroid and gonads, respectively. The DAP values were evaluated for patients in the same interventional radiology procedures. The dose and DAP values obtained are in agreement with values encountered in the literature.

20 CFR 638.532 - Annual leave.

Code of Federal Regulations, 2010 CFR

2010-04-01

... only once per year of enrollment. (e) Students shall not be charged annual leave for travel time to and... Director shall issue procedures to administer the accrual and use of student leave. Such procedures shall provide that: (a) Except for the initial pay period, students shall accrue annual leave at the rate of one...

Deep Venous Procedures Performed in the National Health Service in England between 2005 and 2015.

PubMed

Lim, C S; Shalhoub, J; Davies, A H

2017-10-01

Recent advances in imaging technology and endovenous interventions have revolutionised the management of specific groups of patients with deep venous pathology. This study aimed to examine data published by Hospital Episode Statistics (HES) to assess trends in the number of endovascular and open surgical deep venous procedures performed in National Health Service (NHS) hospitals in England between 2005 and 2015. The main diagnosis of deep venous thrombosis (DVT), and total number of primary open and percutaneous procedures for deep venous pathology for patients admitted to the NHS hospitals in England from 2005 to 2015 were retrieved from the HES database and analysed. An overall declining trend in the annual number of admissions for a primary diagnosis of DVT was observed (linear regression r 2  = 0.9, p < .0001). The number of open surgical procedures for removal of thrombus remained largely unchanged (range 26-70); the frequency of percutaneous procedures increased steadily over the study period (range 0-311). The number of open surgical procedures relating to the vena cava fell between 2005 and 2009, and remained around 50 per year thereafter. Annual numbers of cases of deep venous bypass (range 17-33) and venous valve surgery (range 8-47) remained similar in trend over this period. The number of vena cava stent (range 0-405), other venous stent (range 0-316), and percutaneous venoplasty (range 0-972) procedures increased over the first 5 years of the study period. There is an increasing trend in relation to endovenous procedures but not open surgery, being carried out for deep venous pathology in the last decade in NHS hospitals in England. Despite a number of limitations with HES, the increase in the number of endovenous procedures shown is likely to have significant implications for the provision of care and healthcare resources for patients with deep venous pathology. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

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

Smith, T; Graham, C L; Sundsmo, T

This procedure provides instructions for the calibration and use of the Canberra iSolo Low Background Alpha/Beta Counting System (iSolo) that is used for counting air filters and swipe samples. This detector is capable of providing radioisotope identification (e.g., it can discriminate between radon daughters and plutonium). This procedure includes step-by-step instructions for: (1) Performing periodic or daily 'Background' and 'Efficiency QC' checks; (2) Setting-up the iSolo for counting swipes and air filters; (3) Counting swipes and air filters for alpha and beta activity; and (4) Annual calibration.

Estimation of the collective ionizing dose in the Portuguese population for the years 2011 and 2012, due to nuclear medicine exams.

PubMed

Costa, F; Teles, P; Nogueira, A; Barreto, A; Santos, A I; Carvalho, A; Martins, B; Oliveira, C; Gaspar, C; Barros, C; Neves, D; Costa, D; Rodrigues, E; Godinho, F; Alves, F; Cardoso, G; Cantinho, G; Conde, I; Vale, J; Santos, J; Isidoro, J; Pereira, J; Salgado, L; Rézio, M; Vieira, M; Simãozinho, P; Almeida, P; Castro, R; Parafita, R; Pintão, S; Lúcio, T; Reis, T; Vaz, P

2015-01-01

In 2009-2010 a Portuguese consortium was created to implement the methodologies proposed by the Dose Datamed II (DDM2) project, aiming to collect data from diagnostic X-ray and nuclear medicine (NM) procedures, in order to determine the most frequently prescribed exams and the associated ionizing radiation doses for the Portuguese population. The current study is the continuation of this work, although it focuses only on NM exams for the years 2011 and 2012. The annual frequency of each of the 28 selected NM exams and the average administered activity per procedure was obtained by means of a nationwide survey sent to the 35 NM centres in Portugal. The results show a reduction of the number of cardiac exams performed in the last two years compared with 2010, leading to a reduction of the annual average effective dose of Portuguese population due to NM exams from 0.08 mSv ± 0.017 mSv/caput to 0.059 ± 0.011 mSv/caput in 2011 and 0.054 ± 0.011 mSv/caput in 2012. Portuguese total annual average collective effective dose due to medical procedures was estimated to be 625.6 ± 110.9 manSv in 2011 and 565.1 ± 117.3 manSv in 2012, a reduction in comparison with 2010 (840.3 ± 183.8 manSv). The most frequent exams and the ones that contributed the most for total population dose were the cardiac and bone exams, although a decrease observed in 2011 and in 2012 was verified. The authors intend to perform this study periodically to identify trends in the annual Portuguese average effective dose and to help to raise awareness about the potential dose optimization. Copyright © 2014 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

Activity-based cost analysis of hepatic tumor ablation using CT-guided high-dose rate brachytherapy or CT-guided radiofrequency ablation in hepatocellular carcinoma.

PubMed

Schnapauff, D; Collettini, F; Steffen, I; Wieners, G; Hamm, B; Gebauer, B; Maurer, M H

2016-02-25

To analyse and compare the costs of hepatic tumor ablation with computed tomography (CT)-guided high-dose rate brachytherapy (CT-HDRBT) and CT-guided radiofrequency ablation (CT-RFA) as two alternative minimally invasive treatment options of hepatocellular carcinoma (HCC). An activity based process model was created determining working steps and required staff of CT-RFA and CT-HDRBT. Prorated costs of equipment use (purchase, depreciation, and maintenance), costs of staff, and expenditure for disposables were identified in a sample of 20 patients (10 treated by CT-RFA and 10 by CT-HDRBT) and compared. A sensitivity and break even analysis was performed to analyse the dependence of costs on the number of patients treated annually with both methods. Costs of CT-RFA were nearly stable with mean overall costs of approximately 1909 €, 1847 €, 1816 € and 1801 € per patient when treating 25, 50, 100 or 200 patients annually, as the main factor influencing the costs of this procedure was the single-use RFA probe. Mean costs of CT-HDRBT decreased significantly per patient ablation with a rising number of patients treated annually, with prorated costs of 3442 €, 1962 €, 1222 € and 852 € when treating 25, 50, 100 or 200 patients, due to low costs of single-use disposables compared to high annual fix-costs which proportionally decreased per patient with a higher number of patients treated annually. A break-even between both methods was reached when treating at least 55 patients annually. Although CT-HDRBT is a more complex procedure with more staff involved, it can be performed at lower costs per patient from the perspective of the medical provider when treating more than 55 patients compared to CT-RFA, mainly due to lower costs for disposables and a decreasing percentage of fixed costs with an increasing number of treatments.

Surgical Care Required for Populations Affected by Climate-related Natural Disasters: A Global Estimation.

PubMed

Lee, Eugenia E; Stewart, Barclay; Zha, Yuanting A; Groen, Thomas A; Burkle, Frederick M; Kushner, Adam L

2016-08-10

Climate extremes will increase the frequency and severity of natural disasters worldwide.  Climate-related natural disasters were anticipated to affect 375 million people in 2015, more than 50% greater than the yearly average in the previous decade. To inform surgical assistance preparedness, we estimated the number of surgical procedures needed.   The numbers of people affected by climate-related disasters from 2004 to 2014 were obtained from the Centre for Research of the Epidemiology of Disasters database. Using 5,000 procedures per 100,000 persons as the minimum, baseline estimates were calculated. A linear regression of the number of surgical procedures performed annually and the estimated number of surgical procedures required for climate-related natural disasters was performed. Approximately 140 million people were affected by climate-related natural disasters annually requiring 7.0 million surgical procedures. The greatest need for surgical care was in the People's Republic of China, India, and the Philippines. Linear regression demonstrated a poor relationship between national surgical capacity and estimated need for surgical care resulting from natural disaster, but countries with the least surgical capacity will have the greatest need for surgical care for persons affected by climate-related natural disasters. As climate extremes increase the frequency and severity of natural disasters, millions will need surgical care beyond baseline needs. Countries with insufficient surgical capacity will have the most need for surgical care for persons affected by climate-related natural disasters. Estimates of surgical are particularly important for countries least equipped to meet surgical care demands given critical human and physical resource deficiencies.

Annual update of data for estimating ESALs.

DOT National Transportation Integrated Search

2006-10-01

A revised procedure for estimating equivalent single axleloads (ESALs) was developed in 1985. This procedure used weight, classification, and traffic volume data collected by the Transportation Cabinet's Division of Planning. : Annual updates of data...

Editor's choice--Use of disposable radiation-absorbing surgical drapes results in significant dose reduction during EVAR procedures.

PubMed

Kloeze, C; Klompenhouwer, E G; Brands, P J M; van Sambeek, M R H M; Cuypers, P W M; Teijink, J A W

2014-03-01

Because of the increasing number of interventional endovascular procedures with fluoroscopy and the corresponding high annual dose for interventionalists, additional dose-protecting measures are desirable. The purpose of this study was to evaluate the effect of disposable radiation-absorbing surgical drapes in reducing scatter radiation exposure for interventionalists and supporting staff during an endovascular aneurysm repair (EVAR) procedure. This was a randomized control trial in which 36 EVAR procedures were randomized between execution with and without disposable radiation-absorbing surgical drapes (Radpad: Worldwide Innovations & Technologies, Inc., Kansas City, US, type 5511A). Dosimetric measurements were performed on the interventionalist (hand and chest) and theatre nurse (chest) with and without the use of the drapes to obtain the dose reduction and effect on the annual dose caused by the drapes. Use of disposable radiation-absorbing surgical drapes resulted in dose reductions of 49%, 55%, and 48%, respectively, measured on the hand and chest of the interventionalist and the chest of the theatre nurse. The use of disposable radiation-absorbing surgical drapes significantly reduces scatter radiation exposure for both the interventionalist and the supporting staff during EVAR procedures. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Annual Performance Report. 2002-2003. Wyoming Department of Education.

ERIC Educational Resources Information Center

Wyoming State Department of Education, 2004

2004-01-01

Wyoming's Department of Education (WDE?s) Special Programs Unit conducts compliance monitoring for all IDEA procedural requirements on a five-year cycle. The current process began for Wyoming?s school districts in 1999-2000 and will be completed in 2004-05. The special education monitoring process is a comprehensive program review. The process…

Annual update of data for estimating ESALs : draft.

DOT National Transportation Integrated Search

2008-10-01

A revised procedure for estimating equivalent single axleloads (ESALs) was developed in 1985. This procedure used weight, classification, and traffic volume data collected by the Transportation Cabinet's Division of Planning. : Annual updates of data...

Temporal Trends and Treatment Outcomes of Flexible Ureteroscopy for Lower Pole Stones in a Tertiary Referral Stone Center.

PubMed

Orywal, Ann Kathrin; Knipper, Ann Sophie; Tiburtius, Christian; Gross, Andreas J; Netsch, Christopher

2015-12-01

To evaluate trends in efficacy and safety of flexible ureteroscopy (fURS) for the treatment of lower pole stones (LPS) over a 6-year period and to compare the annual outcomes after one fURS procedure retrospectively. Four hundred nine patients were treated for pure LPS. An analysis of the annual outcomes regarding patient characteristics, operative parameters, stone-free rates (SFRs), and complication rates (CRs) was performed. The SFR was stratified according to stone size and number of stones per patient. Patient data are expressed as mean±standard deviation. There were no annual differences regarding age, body-mass index, stone size (7.09±4.31 mm), number of stones per patient (1.66±2.86), operative time (52.93±33.58 minutes), use of postoperative stents (59.2%), and the Ho:YAG laser lithotripsy rate (49.4%) during the 6-year period. Total primary SFR (annual range) of 97.6% (88.2%-100%), 89.1% (82.9%-96.3%), 71% (60%-78.6%) for urinary calculi <5 mm (3.43±0.78 mm), 5-9 mm (6.69±1.34 mm), and ≥10 mm (13.09±6.02 mm) could be demonstrated over the 6-year period. The total SFR differed significantly between urinary calculi <5 mm, 5-9 mm, and those ≥10 mm (p<0.0179). The SFR (annual range) decreased from 90% (86.2%-95.4%) in patients with 1 stone to 84.1% (60%-100%) in those with ≥3 stones. Perioperative complications (annual range) occurred in 9.7% (6%-13.6%) of the patients (Clavien I 5.1% [1.2%-8.6%], Clavien II 2% [0%-4.9%], Clavien IIIa 0.9% [0%-3.4%], Clavien IIIb 1.7% [1.2%-4.8%]) without differences in the annual CR. fURS is a safe and efficacious procedure for the treatment of LPS with high primary SFR and low CR. fURS in larger LPS (≥10 mm) is associated with the risk for staged procedures.

Occupational radiation procedures and doses in South Korean dentists.

PubMed

Kim, Yoon-Ji; Cha, Eun Shil; Lee, Won Jin

2016-10-01

Dentistry is among the occupations involving chronic exposure to ionizing radiation. Although several cohort studies on medical radiation workers have been conducted in some countries, only a few epidemiological studies on dentists have been performed to examine occupational radiation exposure worldwide. The aim of this study was to investigate occupational characteristics and radiation exposures in South Korean dentists. A total of 658 dentists were surveyed from April 2012 to May 2013, and survey data were linked with dosimetry data from the National Dose Registry. Multiple linear regression analysis was used to identify the relationship between demographic or occupational factors and individual radiation doses. Of the dentists sampled, 78% were men, 51% were younger than age 40, and 61% began employment after 2000. The most frequent procedures performed by dentists were panoramic radiography, followed by intraoral and portable dental radiography. Male dentists were more frequently involved in radiation procedures, and a higher proportion of male than female dentists wore a lead apron for diagnostic radiology. The average annual effective dose was 0.18 mSv for male and 0.13 mSv for female dentists. Female dentists working in provincial areas had significantly higher average annual and cumulative effective doses than those in metropolitan areas. The cumulative effective doses were significantly greater for older dentists, those who entered the field in the 1990s, and those with longer employment duration. Our findings provided detailed information on work practices, number of procedures performed on a weekly basis, and occupational radiation doses, which enabled in-depth evaluation of occupational radiation exposure and work status among dentists. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Cost-consequence analysis of different active flowable hemostatic matrices in cardiac surgical procedures.

PubMed

Makhija, D; Rock, M; Xiong, Y; Epstein, J D; Arnold, M R; Lattouf, O M; Calcaterra, D

2017-06-01

A recent retrospective comparative effectiveness study found that use of the FLOSEAL Hemostatic Matrix in cardiac surgery was associated with significantly lower risks of complications, blood transfusions, surgical revisions, and shorter length of surgery than use of SURGIFLO Hemostatic Matrix. These outcome improvements in cardiac surgery procedures may translate to economic savings for hospitals and payers. The objective of this study was to estimate the cost-consequence of two flowable hemostatic matrices (FLOSEAL or SURGIFLO) in cardiac surgeries for US hospitals. A cost-consequence model was constructed using clinical outcomes from a previously published retrospective comparative effectiveness study of FLOSEAL vs SURGIFLO in adult cardiac surgeries. The model accounted for the reported differences between these products in length of surgery, rates of major and minor complications, surgical revisions, and blood product transfusions. Costs were derived from Healthcare Cost and Utilization Project's National Inpatient Sample (NIS) 2012 database and converted to 2015 US dollars. Savings were modeled for a hospital performing 245 cardiac surgeries annually, as identified as the average for hospitals in the NIS dataset. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to test model robustness. The results suggest that if FLOSEAL is utilized in a hospital that performs 245 mixed cardiac surgery procedures annually, 11 major complications, 31 minor complications, nine surgical revisions, 79 blood product transfusions, and 260.3 h of cumulative operating time could be avoided. These improved outcomes correspond to a net annualized saving of $1,532,896. Cost savings remained consistent between $1.3m and $1.8m and between $911k and $2.4m, even after accounting for the uncertainty around clinical and cost inputs, in a one-way and probabilistic sensitivity analysis, respectively. Outcome differences associated with FLOSEAL vs SURGIFLO that were previously reported in a comparative effectiveness study may result in substantial cost savings for US hospitals.

Projected financial impact of noncoverage of elective circumcision by Louisiana medicaid in boys 0 to 5 years old.

PubMed

Ortenberg, Joseph; Roth, Christopher C

2013-10-01

Several states, including Louisiana since 2005, no longer cover elective circumcision under Medicaid programs. The recent AAP (American Academy of Pediatrics) policy statement recognizes the medical benefits of circumcision and recommends the removal of financial barriers to this procedure. Cost savings are a factor in the limitation of circumcision coverage, although to our knowledge the actual cost savings to Medicaid programs have not been reported. We analyzed the number of circumcisions performed before and after the policy change to determine an accurate cost of such procedures and whether the increased procedure expense mitigates the initial savings. We analyzed the number of neonatal and nonneonatal circumcisions in boys 0 to 5 years old to determine trends during the selected period. A cost model for each procedure was created. Neonatal procedure cost was based on professional fees. Nonneonatal procedure cost was based on professional (surgeon and anesthesia) plus facility fees. The number and cost of procedures were compared before (2002 to 2004) and after (2006 to 2010) the policy change. Linear regression was used to predict future costs. The average annual number and expense of neonatal circumcisions were significantly decreased after the policy change. There was no significant decrease in nonneonatal procedures and expense. Cost per procedure ranged from $88.34 for neonatal to $486.76 for nonneonatal circumcision. Secondary to the increasing number of more costly nonneonatal procedures, the annual expense was predicted to exceed pre-policy levels by 2015. The number of nonneonatal circumcisions is increasing and such procedures place a higher financial burden on the health care system. As a result, the financial benefits of noncoverage of elective circumcision are decreasing. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Percutaneous adhesiolysis procedures in the medicare population: analysis of utilization and growth patterns from 2000 to 2011.

PubMed

Manchikanti, Laxmaiah; Helm Ii, Standiford; Pampati, Vidyasagar; Racz, Gabor B

2014-01-01

Multiple reviews have shown that interventional techniques for chronic pain have increased dramatically over the years. Of these interventional techniques, both sacroiliac joint injections and facet joint interventions showed explosive growth, followed by epidural procedures. Percutaneous adhesiolysis procedures have not been assessed for their utilization patterns separately from epidural injections. An analysis of the utilization patterns of percutaneous adhesiolysis procedures in managing chronic low back pain in the Medicare population from 2000 to 2011. To assess the utilization and growth patterns of percutaneous adhesiolysis in managing chronic low back pain. The study was performed utilizing the Centers for Medicare and Medicaid Services (CMS) Physician Supplier Procedure Summary Master of Fee-For-Service (FFS) Data from 2000 to 2011. Percutaneous adhesiolysis procedures increased 47% with an annual growth rate of 3.6% in the FFS Medicare population from 2000 to 2011. These growth rates are significantly lower than the growth rates for sacroiliac joint injections (331%), facet joint interventions (308%), and epidural injections (130%), but substantially lower than lumbar transforaminal injections (665%) and lumbar facet joint neurolysis (544%). Study limitations include lack of inclusion of Medicare Advantage patients. In addition, the statewide data is based on claims which may include the contiguous or other states. Percutaneous adhesiolysis utilization increased moderately in Medicare beneficiaries from 2000 to 2011. Overall, there was an increase of 47% in the utilization of adhesiolysis procedures per 100,000 Medicare beneficiaries, with an annual geometric average increase of 3.6%.

National Hospital Discharge Survey: 2002 annual summary with detailed diagnosis and procedure data.

PubMed

Kozak, Lola J; Owings, Maria F; Hall, Margaret J

2005-03-01

This report presents 2002 national estimates and selected trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by selected patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Estimates of diagnoses and procedures are presented according to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually since 1965. In 2002, data were collected for approximately 327,000 discharges. Of the 474 eligible non-Federal short-stay hospitals in the sample, 445 (94 percent) responded to the survey. An estimated 33.7 million inpatients were discharged from non-Federal short-stay hospitals in 2002. They used 164.2 million days of care and had an average length of stay of 4.9 days. Common first-listed discharge diagnoses included delivery, ischemic heart disease, psychoses, pneumonia, and malignant neoplasms. Inpatients had 6.8 million cardiovascular procedures and 6.6 million obstetric procedures. Males had higher rates for cardiac procedures such as cardiac catheterization and coronary artery bypass graft, but males and females had similar rates of pacemaker procedures. The number and rate of all cesarean deliveries, primary and repeat, rose from 1995 to 2002; the rate of vaginal birth after cesarean delivery dropped from 35.5 in 1995 to 15.8 in 2002.

Monitoring of the Quality of the Defense Contract Audit Agency FY 2010 Audits

DTIC Science & Technology

2013-03-07

performed by regional audit managers include reviewing high risk assignments and reports prior to their issuance, performing post-issuance reviews, or...brainstorming procedure requires the audit team ( managers , supervisors, and auditors) to discuss the risk of fraud for that engagement and to discuss the risk ...auditors to make inquiries of contractor management of management’s knowledge of fraud risks during its annual planning meeting with major contractors

Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014.

PubMed

Angrisani, L; Santonicola, A; Iovino, P; Vitiello, A; Zundel, N; Buchwald, H; Scopinaro, N

2017-09-01

Several bariatric surgery worldwide surveys have been previously published to illustrate the evolution of bariatric surgery in the last decades. The aim of this survey is to report an updated overview of all bariatric procedures performed in 2014.For the first time, a special section on endoluminal techniques was added. The 2014 International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) survey form evaluating the number and the type of surgical and endoluminal bariatric procedures was emailed to all IFSO societies. Trend analyses from 2011 to 2014 were also performed. There were 56/60 (93.3%) responders. The total number of bariatric/metabolic procedures performed in 2014 consisted of 579,517 (97.6%) surgical operations and 14,725 (2.4%) endoluminal procedures. The most commonly performed procedure in the world was sleeve gastrectomy (SG) that reached 45.9%, followed by Roux-en-Y gastric bypass (RYGB) (39.6%), and adjustable gastric banding (AGB) (7.4%). The annual percentage changes from 2013 revealed the increase of SG and decrease of RYGB in all the IFSO regions (USA/Canada, Europe, and Asia/Pacific) with the exception of Latin/South America, where SG decreased and RYGB represented the most frequent procedure. There was a further increase in the total number of bariatric/metabolic procedures in 2014 and SG is currently the most frequent surgical procedure in the world. This is the first survey that describes the endoluminal procedures, but the accuracy of provided data should be hopefully improved in the next future. We encourage the creation of further national registries and their continuous updates taking into account all new bariatric procedures including the endoscopic procedures that will obtain increasing importance in the near future.

40 CFR Appendix A to Part 503 - Procedure To Determine the Annual Whole Sludge Application Rate for a Sewage Sludge

Code of Federal Regulations, 2010 CFR

2010-07-01

... Whole Sludge Application Rate for a Sewage Sludge A Appendix A to Part 503 Protection of Environment.... 503, App. A Appendix A to Part 503—Procedure To Determine the Annual Whole Sludge Application Rate for... application to the land and the annual whole sludge application rate (AWSAR) for the sewage sludge not cause...

40 CFR 60.2210 - What information must I include in my annual report?

Code of Federal Regulations, 2012 CFR

2012-07-01

... Performance for Commercial and Industrial Solid Waste Incineration Units for Which Construction Is Commenced..., time, and duration that each CMS was inoperative, except for zero (low-level) and high-level checks. (3... procedure in 40 CFR part 60, appendix F of this part, as if any of the following occur. (1) The zero (low...

40 CFR 60.2210 - What information must I include in my annual report?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Performance for Commercial and Industrial Solid Waste Incineration Units for Which Construction Is Commenced..., time, and duration that each CMS was inoperative, except for zero (low-level) and high-level checks. (3... procedure in 40 CFR part 60, appendix F of this part, as if any of the following occur. (1) The zero (low...

Estimation of annual energy production using dynamic wake meandering in combination with ambient CFD solutions

NASA Astrophysics Data System (ADS)

Hahn, S.; Machefaux, E.; Hristov, Y. V.; Albano, M.; Threadgill, R.

2016-09-01

In the present study, combination of the standalone dynamic wake meandering (DWM) model with Reynolds-averaged Navier-Stokes (RANS) CFD solutions for ambient ABL flows is introduced, and its predictive performance for annual energy production (AEP) is evaluated against Vestas’ SCADA data for six operating wind farms over semi-complex terrains under neutral conditions. The performances of conventional linear and quadratic wake superposition techniques are also compared, together with the in-house implemention of successive hierarchical merging approaches. As compared to our standard procedure based on the Jensen model in WindPRO, the overall results are promising, leading to a significant improvement in AEP accuracy for four of the six sites. While the conventional linear superposition shows the best performance for the improved four sites, the hierarchical square superposition shows the least deteriorated result for the other two sites.

Combining Follicular Unit Extraction and Scalp Micropigmentation for the Cosmetic Treatment of Alopecias

PubMed Central

Pak, Jae; Kim, Jino

2017-01-01

Two relatively new modalities, follicular unit extraction (FUE) and scalp micropigmentation have changed the treatment of hair loss, to reduce the number of procedures and the total costs of the hair restoration process. These 2 modalities augment each other when treating patients with thinning hair and balding. The explosion of FUE procedures (which reflected 52.6% of the hair transplant procedures performed in 2016, up from 48.5%) and the appearance of more and more new physicians offering hair restoration technologies employing FUE have caused a 20% annual growth in this industry over the past few years. This article reviews the use of FUE and scalp micropigmentation when used in combination. PMID:29263945

High altitude is an independent risk factor for venous thromboembolism following arthroscopic rotator cuff repair: a matched case-control study in Medicare patients.

PubMed

Cancienne, Jourdan M; Burrus, M Tyrrell; Diduch, David R; Werner, Brian C

2017-01-01

Although the risk of venous thromboembolism (VTE) following elective shoulder arthroscopy is low, the large volume of procedures performed each year yields a significant annual burden of patients with thromboembolic complications. The purpose of this study was to evaluate the association of high procedural altitude with the incidence of postoperative VTE following arthroscopic rotator cuff repair. A Medicare database was queried for all patients undergoing arthroscopic rotator cuff repair from 2005 to 2012. All patients with procedures performed at an altitude of 4000 feet or higher were grouped into the "high-altitude" study cohort. Patients with procedures performed at an altitude of 100 feet or lower were then matched to patients in the high-altitude cohort on the basis of age, gender, and medical comorbidities. The rate of VTE was then assessed for both the high-altitude and matched low-altitude cohorts within 90 days postoperatively. The rates of combined VTE (odds ratio [OR], 2.6; P < .0001), pulmonary embolism (OR, 4.3; P < .0001), and lower extremity deep venous thrombosis within 90 days (OR, 2.2; P = .029) were all significantly higher in patients with procedures performed at high altitude compared with matched patients with the same procedures performed at low altitude. Procedural altitude >4000 feet is associated with significantly increased rates of postoperative VTE, including deep venous thrombosis and pulmonary embolism, compared with age-, gender-, and comorbidity-matched patients undergoing the same procedures at altitudes <100 feet. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Comparison of methods for extracting annual cycle with changing amplitude in climate science

NASA Astrophysics Data System (ADS)

Deng, Q.; Fu, Z.

2017-12-01

Changes of annual cycle gains a growing concern recently. The basic hypothesis regards annual cycle as constant. Climatology mean within a time period is usually used to depict the annual cycle. Obviously this hypothesis contradicts with the fact that annual cycle is changing every year. For the lack of a unified definition about annual cycle, the approaches adopted in extracting annual cycle are various and may lead to different results. The precision and validity of these methods need to be examined. In this work we numerical experiments with known monofrequent annual cycle are set to evaluate five popular extracting methods: fitting sinusoids, complex demodulation, Ensemble Empirical Mode Decomposition (EEMD), Nonlinear Mode Decomposition (NMD) and Seasonal trend decomposition procedure based on loess (STL). Three different types of changing amplitude will be generated: steady, linear increasing and nonlinearly varying. Comparing the annual cycle extracted by these methods with the generated annual cycle, we find that (1) NMD performs best in depicting annual cycle itself and its amplitude change, (2) fitting sinusoids, complex demodulation and EEMD methods are more sensitive to long-term memory(LTM) of generated time series thus lead to overfitting annual cycle and too noisy amplitude, oppositely the result of STL underestimate the amplitude variation (3)all of them can present the amplitude trend correctly in long-time scale but the errors on account of noise and LTM are common in some methods over short time scales.

40 CFR 60.2210 - What information must I include in my annual report?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Performance for Commercial and Industrial Solid Waste Incineration Units Recordkeeping and Reporting § 60.2210..., time, and duration that each CMS was inoperative, except for zero (low-level) and high-level checks. (3... procedure in 40 CFR part 60, appendix F of this part, as if any of the following occur. (1) The zero (low...

Association between hospital procedure volume and early complications after pacemaker implantation: results from a large, unselected, contemporary cohort of the German nationwide obligatory external quality assurance programme.

PubMed

Nowak, Bernd; Tasche, Karl; Barnewold, Linda; Heller, Günther; Schmidt, Boris; Bordignon, Stefano; Chun, K R Julian; Fürnkranz, Alexander; Mehta, Rajendra H

2015-05-01

Several studies demonstrated an inverse relationship between cardioverter-defibrillator implantation volume and complication rates, suggesting better outcomes for higher volume centres. However, the association of institutional procedural volume with patient outcomes for permanent pacemaker (PPM) implantation remains less known, especially in decentralized implantation systems. We performed retrospective examination of data on patients undergoing PPM from the German obligatory quality assurance programme (2007-12) to evaluate the relationship of hospital PPM volume (categorized into quintiles of their mean annual volume) with risk-adjusted in-hospital surgical complications (composite of pneumothorax, haemothorax, pericardial effusion, or pocket haematoma, all requiring intervention, or device infection) and pacemaker lead dislocation. Overall 430 416 PPM implantations were documented in 1226 hospitals. Systems included dual (72.8%) and single (25.8%) chamber PPM and cardiac resynchronization therapy (CRT) devices (1.1%). Complications included surgical (0.92%), and ventricular (0.99%), and atrial (1.22%) lead dislocation. Despite an increase in relatively complex procedures (dual chamber, CRT), there was a significant decrease in the procedural and fluoroscopy times and complications from lowest to highest implantation volume quintiles (P for trend <0.0001). The greatest difference was observed between the lowest (1-50 implantations/year-reference group) and the second-lowest (51-90 implantations/year) quintile: surgical complications [odds ratio (OR) 0.69; confidence interval (CI) 0.60-0.78], atrial lead dislocations (OR 0.69; CI 0.59-0.80), and ventricular lead dislocations (OR 0.73; CI 0.63-0.84). Hospital annual PPM volume was directly related to indication-based implantation of relatively more complex PPM and yet inversely with procedural times and rates of early surgical complications and lead dislocations. Thus, our data suggest better performance and lower complications with increasing procedural volume. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

[A re-evaluation of the program for diabetes mellitus type 2. A proposal for quality indices].

PubMed

Espinàs, J; Salla, R M; Bellvehí, M; Reig, E; Iruela, T; Muñoz, E; Isern, R; Molas, M

1993-02-28

To find out how accurate our records are and the state of health of the patients with diabetes mellitus type II (DM) in our Base Health Area (BHA) in Osona county (Barcelona), both before and after introducing a new procedure. Quality control study based on the medical records (PCMR) of DM patients. The evaluation took place between 1.1.90 and 31.12.90; and the re-evaluation between 1.1.91 and 31.12.91, after the DM procedure had been put in place as a corrective measure. 198 patients: all of those suffering from DM type II. 110 women and 88 men, with an average age of 65.4 +/- 11.9, were under study. We observed from the records of attendance that 94.4% were or had been smokers, whereas the question of the eye fundus was only mentioned in 36.8%. The introduction of a procedure has improved the records in almost every parameter. In 1991, 36.8% of the patients had normal-weight criteria, 33.3% had good biochemical control and 15.6% fulfilled both these criteria. Those tests which could be performed with few instruments were carried out much better than those which needed more complex technology or specialist support. Arising from this study, the authors propose four indicators of quality control: 1) Weight normality. 2) Annual plasmatic fructosamine. 3) Annual eye fundus check. 4) Annual proteinuria check.

77 FR 65508 - Annual Charge Filing Procedures for Natural Gas Pipelines

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-29

...] Annual Charge Filing Procedures for Natural Gas Pipelines AGENCY: Federal Energy Regulatory Commission... FERC) is proposing to amend its regulations to revise the filing requirements for natural gas pipelines...) clause. Currently, natural gas pipelines utilizing an ACA clause must make a tariff filing to reflect a...

Utilization of apical vaginal support procedures at time of inpatient hysterectomy performed for benign conditions: a national estimate.

PubMed

Ross, Whitney Trotter; Meister, Melanie R; Shepherd, Jonathan P; Olsen, Margaret A; Lowder, Jerry L

2017-10-01

Apical vaginal support is considered the keystone of pelvic organ support. Level I evidence supports reestablishment of apical support at time of hysterectomy, regardless of whether the hysterectomy is performed for prolapse. National rates of apical support procedure performance at time of inpatient hysterectomy have not been well described. We sought to estimate trends and factors associated with use of apical support procedures at time of inpatient hysterectomy for benign indications in a large national database. The National (Nationwide) Inpatient Sample was used to identify hysterectomies performed from 2004 through 2013 for benign indications. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to select both procedures and diagnoses. The primary outcome was performance of an apical support procedure at time of hysterectomy. Descriptive and multivariable analyses were performed. There were 3,509,230 inpatient hysterectomies performed for benign disease from 2004 through 2013. In both nonprolapse and prolapse groups, there was a significant decrease in total number of annual hysterectomies performed over the study period (P < .0001). There were 2,790,652 (79.5%) hysterectomies performed without a diagnosis of prolapse, and an apical support procedure was performed in only 85,879 (3.1%). There was a significant decrease in the proportion of hysterectomies with concurrent apical support procedure (high of 4.0% in 2004 to 2.5% in 2013, P < .0001). In the multivariable logistic regression model, increasing age, hospital type (urban teaching), hospital bed size (large and medium), and hysterectomy type (vaginal and laparoscopically assisted vaginal) were associated with performance of an apical support procedure. During the study period, 718,578 (20.5%) inpatient hysterectomies were performed for prolapse diagnoses and 266,743 (37.1%) included an apical support procedure. There was a significant increase in the proportion of hysterectomies with concurrent apical support procedure (low of 31.3% in 2005 to 49.3% in 2013, P < .0001). In the multivariable logistic regression model, increasing age, hospital type (urban teaching), hospital bed size (medium and large), and hysterectomy type (total laparoscopic and laparoscopic supracervical) were associated with performance of an apical support procedure. This national database study demonstrates that apical support procedures are not routinely performed at time of inpatient hysterectomy regardless of presence of prolapse diagnosis. Educational efforts are needed to increase awareness of the importance of reestablishing apical vaginal support at time of hysterectomy regardless of indication. Copyright © 2017 Elsevier Inc. All rights reserved.

Surgical Approach and Anesthetic Modality for Carpal Tunnel Release: A Nationwide Database Study With Health Care Cost Implications.

PubMed

Foster, Brock D; Sivasundaram, Lakshmanan; Heckmann, Nathanael; Cohen, Jeremiah R; Pannell, William C; Wang, Jeffrey C; Ghiassi, Alidad

2017-03-01

Background: Carpal tunnel release (CTR) is commonly performed for carpal tunnel syndrome once conservative treatment has failed. Operative technique and anesthetic modality vary by surgeon preference and patient factors. However, CTR practices and anesthetic trends have, to date, not been described on a nationwide scale in the United States. Methods: The PearlDiver Patient Records Database was used to search Current Procedural Terminology codes for elective CTR from 2007 to 2011. Anesthetic modality (eg, general and regional anesthesia vs local anesthesia) and surgical approach (eg, endoscopic vs open) were recorded for this patient population. Cost analysis, patient demographics, regional variation, and annual changes in CTR surgery were evaluated. Results: We identified 86 687 patients who underwent carpal tunnel surgery during this 5-year time period. In this patient sample, 80.5% of CTR procedures were performed using general or regional anesthesia, compared with 19.5% of procedures performed using local anesthesia; 83.9% of all CTR were performed in an open fashion, and 16.1% were performed using an endoscopic technique. Endoscopic surgery was on average $794 more expensive than open surgery, and general or regional anesthesia was $654 more costly than local anesthesia. Conclusions: In the United States, open CTR under local anesthesia is the most cost-effective way to perform a CTR. However, only a small fraction of elective CTR procedures are performed with this technique, representing a potential area for significant health care cost savings. In addition, regional and age variations exist in procedure and anesthetic type utilized.

16 CFR 305.5 - Determinations of estimated annual energy consumption, estimated annual operating cost, and...

Code of Federal Regulations, 2010 CFR

2010-01-01

... consumption, estimated annual operating cost, and energy efficiency rating, and of water use rate. 305.5... energy efficiency rating, and of water use rate. (a) Procedures for determining the estimated annual energy consumption, the estimated annual operating costs, the energy efficiency ratings, and the efficacy...

Assessing patient safety in Canadian ambulatory surgery facilities: A national survey

PubMed Central

Ahmad, Jamil; Ho, Olivia A; Carman, Wayne W; Thoma, Achilles; Lalonde, Donald H; Lista, Frank

2014-01-01

BACKGROUND: There has been increased interest regarding patient safety and standards of care in Canadian ambulatory surgery facilities where surgical procedures are performed. The Canadian Association for Accreditation of Ambulatory Surgical Facilities (CAAASF) is a national organization formed to establish and maintain standards to ensure that surgical procedures conducted outside of public hospitals are performed safely. OBJECTIVE: To determine how many procedures are performed annually at CAAASF member sites, and to examine complication rates and several key patient safety practices. METHODS: All 69 facilities accredited by the CAAASF were surveyed. The survey focused on procedural data, complication rates and patient safety interventions. RESULTS: In 2010, 40,240 estimated procedures were performed. A total of 263 (0.007%) complications were reported. Sixteen (0.0004%) patients required reoperations in hospital and 19 (0.0004%) patients required transfer to hospital on the day of surgery. There were only two mortalities within 30 days of surgery reported in the past five years. With regard to patient safety practices, 93% used antimicrobial prophylaxis, 100% used strategies to maintain normothermia and 82% used measures for venous thromboembolism prevention. CONCLUSION: The present study is the first to report on the Canadian experience in ambulatory surgery facilities and provides insight into current practices at these facilities. Appropriate accreditation of ambulatory surgery facilities, well-established patient safety-related standards of care, careful patient selection and procedures performed by qualified health care professionals with appropriate certification practicing within the scope of their practice form the basis for safe and effective ambulatory surgery. PMID:25152645

26 CFR 1.442-1 - Change of annual accounting period.

Code of Federal Regulations, 2010 CFR

2010-04-01

... business purpose for the requested annual accounting period and agrees to the Commissioner's prescribed... retain an annual accounting period. These administrative procedures will describe the business purpose... 26 Internal Revenue 6 2010-04-01 2010-04-01 false Change of annual accounting period. 1.442-1...

Improving Gas Furnace Performance: A Field and Laboratory Study at End of Life

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

Brand, L.; Yee, S.; Baker, J.

2015-02-01

In 2010, natural gas provided 54% of total residential space heating energy the U.S. on a source basis, or 3.5 Quadrillion Btu. Natural gas burned in furnaces accounted for 92% of that total, and boilers and other equipment made up the remainder. A better understanding of installed furnace performance is a key to energy savings for this significant energy usage. Natural gas furnace performance can be measured in many ways. The annual fuel utilization efficiency (AFUE) rating provides a fixed value under specified conditions, akin to the EPA miles per gallon rating for new vehicles. The AFUE rating is providedmore » by the manufacturer to the consumer and is a way to choose between models tested on the same basis. This value is commonly used in energy modeling calculations. ASHRAE 103 is a consensus furnace testing standard developed by the engineering community. The procedure provided in the standard covers heat-up, cool down, condensate heat loss, and steady-state conditions and an imposed oversize factor. The procedure can be used to evaluate furnace performance with specified conditions or with some variation chosen by the tester. In this report the ASHRAE 103 test result will be referred to as Annualized Efficiency (AE) to avoid confusion, and any non-standard test conditions will be noted. Aside from these two laboratory tests, steady state or flue loss efficiency can be measured in the field under many conditions; typically as found or tuned to the manufacturers recommended settings. In this report, AE and steady-state efficiency will be used as measures of furnace performance.« less

Cataract surgery among Medicare beneficiaries.

PubMed

Schein, Oliver D; Cassard, Sandra D; Tielsch, James M; Gower, Emily W

2012-10-01

To present descriptive epidemiology of cataract surgery among Medicare recipients in the United States. Cataract surgery performed on Medicare beneficiaries in 2003 and 2004. Medicare claims data were used to identify all cataract surgery claims for procedures performed in the United States in 2003-2004. Standard assumptions were used to limit the claims to actual cataract surgery procedures performed. Summary statistics were created to determine the number of procedures performed for each outcome of interest: cataract surgery rates by age, sex, race and state; surgical volume by facility type and surgeon characteristics; time interval between first- and second-eye cataract surgery. The national cataract surgery rate for 2003-2004 was 61.8 per 1000 Medicare beneficiary person-years. The rate was significantly higher for females and for those aged 75-84 years. After adjustment for age and sex, blacks had approximately a 30% lower rate of surgery than whites. While only 5% of cataract surgeons performed more than 500 cataract surgeries annually, these surgeons performed 26% of the total cataract surgeries. Increasing surgical volume was found to be highly correlated with use of ambulatory surgical centers and reduced time interval between first- and second-eye surgery in the same patient. The epidemiology of cataract surgery in the United States Medicare population documents substantial variation in surgical rates by race, sex, age, and by certain provider characteristics.

General surgery workloads and practice patterns in the United States, 2007 to 2009: a 10-year update from the American Board of Surgery.

PubMed

Valentine, R James; Jones, Andrew; Biester, Thomas W; Cogbill, Thomas H; Borman, Karen R; Rhodes, Robert S

2011-09-01

To assess changes in general surgery workloads and practice patterns in the past decade. Nearly 80% of graduating general surgery residents pursue additional training in a surgical subspecialty. This has resulted in a shortage of general surgeons, especially in rural areas. The purpose of this study is to characterize the workloads and practice patterns of general surgeons versus certified surgical subspecialists and to compare these data with those from a previous decade. The surgical operative logs of 4968 individuals recertifying in surgery 2007 to 2009 were reviewed. Data from 3362 (68%) certified only in Surgery (GS) were compared with 1606 (32%) with additional American Board of Medical Specialties certificates (GS+). Data from GS surgeons were also compared with data from GS surgeons recertifying 1995 to 1997. Independent variables were compared using factorial ANOVA. GS surgeons performed a mean of 533 ± 365 procedures annually. Women GS performed far more breast operations and fewer abdomen, alimentary tract and laparoscopic procedures compared to men GS (P < 0.001). GS surgeons recertifying at 10 years performed more abdominal, alimentary tract and laparoscopic procedures compared to those recertifying at 20 or 30 years (P < 0.001). Rural GS surgeons performed far more endoscopic procedures and fewer abdominal, alimentary tract, and laparoscopic procedures than urban counterparts (P < 0.001). The United States medical school graduates had similar workloads and distribution of operations to international medical graduates. Compared to 1995 to 1997, GS surgeons from 2007 to 2009 performed more procedures, especially endoscopic and laparoscopic. GS+ surgeons performed 15% to 33% of all general surgery procedures. GS practice patterns are heterogeneous; gender, age, and practice setting significantly affect operative caseloads. A substantial portion of general surgery procedures currently are performed by GS+ surgeons, whereas GS surgeons continue to perform considerable numbers of specialty operations. Reduced general surgery operative experience in GS+ residencies may negatively impact access to general surgical care. Similarly, narrowing GS residency operative experience may impair specialty operation access.

Assessment of eye lens doses for workers during interventional radiology procedures.

PubMed

Urboniene, A; Sadzeviciene, E; Ziliukas, J

2015-07-01

The assessment of eye lens doses for workers during interventional radiology (IR) procedures was performed using a new eye lens dosemeter. In parallel, the results of routine individual monitoring were analysed and compared with the results obtained from measurements with a new eye lens dosemeter. The eye lens doses were assessed using Hp(3) measured at the level of the eyes and were compared with Hp(10) measured with the whole-body dosemeter above the lead collar. The information about use of protective measures, the number of performed interventional procedures per month and their fluoroscopy time was also collected. The assessment of doses to the lens of the eye was done for 50 IR workers at 9 Lithuanian hospitals for the period of 2012-2013. If the use of lead glasses is not taken into account, the estimated maximum annual dose equivalent to the lens of the eye was 82 mSv. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Cosmetic surgery growth and correlations with financial indices: a comparative study of the United Kingdom and United States from 2002-2011.

PubMed

Nassab, Reza; Harris, Paul

2013-05-01

Over the past 10 years, there has been significant fluctuation in the yearly growth rates for cosmetic surgery procedures in both the United States and the United Kingdom. The authors compare cosmetic surgical procedure rates in the United Kingdom and United States with the macroeconomic climate of each region to determine whether there is a direct relationship between cosmetic surgery rates and economic health. The authors analyzed annual cosmetic surgery statistics from the British Association of Aesthetic Plastic Surgeons and the American Society for Aesthetic Plastic Surgery for 2002-2011 against economic indices from both regions, including the gross domestic product (GDP), consumer prices indices (CPI), and stock market reports. There was a 285.9% increase in the United Kingdom and a 1.1% increase in the United States in the number of procedures performed between 2002 and 2011. There were significant positive correlations between the number of cosmetic procedures performed in the United Kingdom and both the GDP (r = 0.986, P < .01) and CPI (r = 0.955, P < .01). Analysis of the US growth rates failed to show a significant relationship with any indices. UK interest rates showed a significant negative correlation (r = -0.668, P < .05) with procedures performed, whereas US interest rates showed a significant positive correlation. Data from the United States and United Kingdom suggest 2 very different growth patterns in the number of cosmetic surgeries being performed as compared with the economy in each region. Economic indices are accurate indicators of numbers of procedures being performed in the United Kingdom, whereas rates in the United States seem independent of those factors.

Change of practice patterns in urology with the introduction of the Da Vinci surgical system: the Greek NHS experience in debt crisis era.

PubMed

Deligiannis, Dimitros; Anastasiou, Ioannis; Mygdalis, Vasileios; Fragkiadis, Evangelos; Stravodimos, Konstantinos

2015-03-31

To determine the attitudinal change for urologic surgery in Greece since the introduction of the da Vinci Surgical System (DVS). We describe contemporary trends at public hospital level, the initial Greek experience, while at the same time Greece is in economic crisis and funding is under austerity measures. We retrospectively analyzed annualized case log data on urologic procedures, between 2008 (installation of the DVS) and 2013, from "Laiko'' Hospital in Athens. We evaluated, using summary statistics, trends and institutional status regarding robot-assisted surgery (RAS). We also analyzed the relationship between the introduction of RAS and change in total volume of procedures performed. 1578 of the urological procedures performed at "Laiko'' Hospital were pooled, 1342 (85%) being open and 236 RAS (15%). We observed a 6-fold increase in the number of RAS performed, from 7% of the total procedural volume (14/212) in 2008 to 30% (96/331) in 2013. For radical prostatectomy, in 2008 2% were robot-assisted and 98% open while in 2013, 46% and 54% respectively. Pyeloplasty was performed more often using the robot-assisted method since 2010. RAS-dedicated surgeons increased both RAS and the total number of procedures they performed. From 86 in 2008 to 145 in 2013, with 57% of them being RAS in 2013 as compared to 13 % in 2008. Robot-assisted surgery has integrated into the armamentarium for urologic surgery in Greece at public hospital level. Surgical robot acquisition is also associated with increased volume of procedures, especially prostatectomy, despite the ongoing debate over cost-effectiveness, during economic crisis and International Monetary Fund (IFN) era.

The 12th Annual International Meeting on Simulation Healthcare (IMSH) 2012

DTIC Science & Technology

2012-03-01

Title: Videorecording of Simulated Technical Errors as an Instructional Modality in a Central Venous Catheterization Course Sub Content: Knowledge...bedside procedures, such as insertion of peripheral and central venous catheters, are performed routinely by a wide spectrum of healthcare providers...with Chest Tubes and a Central Venous Line Monday January 30th 2012 4:00 pm – 5:15 pm Training Education and Assessment Shelby Marx, Donald

Non-Cardiac Surgery in Developing Countries: Epidemiological Aspects and Economical Opportunities – The Case of Brazil

PubMed Central

Yu, Pai Ching; Calderaro, Daniela; Gualandro, Danielle Menosi; Marques, Andre Coelho; Pastana, Adriana Feio; Prandini, Joao Carlos; Caramelli, Bruno

2010-01-01

Background Worldwide distribution of surgical interventions is unequal. Developed countries account for the majority of surgeries and information about non-cardiac operations in developing countries is scarce. The purpose of our study was to describe the epidemiological data of non-cardiac surgeries performed in Brazil in the last years. Methods and Findings This is a retrospective cohort study that investigated the time window from 1995 to 2007. We collected information from DATASUS, a national public health system database. The following variables were studied: number of surgeries, in-hospital expenses, blood transfusion related costs, length of stay and case fatality rates. The results were presented as sum, average and percentage. The trend analysis was performed by linear regression model. There were 32,659,513 non-cardiac surgeries performed in Brazil in thirteen years. An increment of 20.42% was observed in the number of surgeries in this period and nowadays nearly 3 million operations are performed annually. The cost of these procedures has increased tremendously in the last years. The increment of surgical cost was almost 200%. The total expenses related to surgical hospitalizations were more than $10 billion in all these years. The yearly cost of surgical procedures to public health system was more than $1.27 billion for all surgical hospitalizations, and in average, U$445.24 per surgical procedure. The total cost of blood transfusion was near $98 million in all years and annually approximately $10 million were spent in perioperative transfusion. The surgical mortality had an increment of 31.11% in the period. Actually, in 2007, the surgical mortality in Brazil was 1.77%. All the variables had a significant increment along the studied period: r square (r2) = 0.447 for the number of surgeries (P = 0.012), r2 = 0.439 for in-hospital expenses (P = 0.014) and r2 = 0.907 for surgical mortality (P = 0.0055). Conclusion The volume of surgical procedures has increased substantially in Brazil through the past years. The expenditure related to these procedures and its mortality has also increased as the number of operations. Better planning of public health resource and strategies of investment are needed to supply the crescent demand of surgery in Brazil. PMID:20485549

Non-cardiac surgery in developing countries: epidemiological aspects and economical opportunities--the case of Brazil.

PubMed

Yu, Pai Ching; Calderaro, Daniela; Gualandro, Danielle Menosi; Marques, Andre Coelho; Pastana, Adriana Feio; Prandini, Joao Carlos; Caramelli, Bruno

2010-05-12

Worldwide distribution of surgical interventions is unequal. Developed countries account for the majority of surgeries and information about non-cardiac operations in developing countries is scarce. The purpose of our study was to describe the epidemiological data of non-cardiac surgeries performed in Brazil in the last years. This is a retrospective cohort study that investigated the time window from 1995 to 2007. We collected information from DATASUS, a national public health system database. The following variables were studied: number of surgeries, in-hospital expenses, blood transfusion related costs, length of stay and case fatality rates. The results were presented as sum, average and percentage. The trend analysis was performed by linear regression model. There were 32,659,513 non-cardiac surgeries performed in Brazil in thirteen years. An increment of 20.42% was observed in the number of surgeries in this period and nowadays nearly 3 million operations are performed annually. The cost of these procedures has increased tremendously in the last years. The increment of surgical cost was almost 200%. The total expenses related to surgical hospitalizations were more than $10 billion in all these years. The yearly cost of surgical procedures to public health system was more than $1.27 billion for all surgical hospitalizations, and in average, U$445.24 per surgical procedure. The total cost of blood transfusion was near $98 million in all years and annually approximately $10 million were spent in perioperative transfusion. The surgical mortality had an increment of 31.11% in the period. Actually, in 2007, the surgical mortality in Brazil was 1.77%. All the variables had a significant increment along the studied period: r square (r(2)) = 0.447 for the number of surgeries (P = 0.012), r(2) = 0.439 for in-hospital expenses (P = 0.014) and r(2) = 0.907 for surgical mortality (P = 0.0055). The volume of surgical procedures has increased substantially in Brazil through the past years. The expenditure related to these procedures and its mortality has also increased as the number of operations. Better planning of public health resource and strategies of investment are needed to supply the crescent demand of surgery in Brazil.

Retroperitoneal laparoscopic nephrectomy: the effect of the learning curve, and concentrating expertise, on operating times.

PubMed

Skinner, Adrian; Maoate, Kiki; Beasley, Spencer

2010-05-01

Laparoscopic nephrectomy is an accepted alternative to open nephrectomy. We analyzed our first 80 procedures of laparoscopic nephrectomy to evaluate the effect of experience and configuration of service on operative times. A retrospective review of 80 consecutive children who underwent retroperitoneal laparoscopic nephrectomy or heminephrectomy during an 11-year period from 1997 at Christchurch Hospital (Christchurch, New Zealand) was conducted. Operative times, in relation to the experience of the surgeon for this procedure, were analyzed. Four surgeons, assisted by an annually rotating trainee registrar, performed the procedure in 26 girls and 54 boys (range, 8 months to 15 years). Operating times ranged from 38 to 225 minutes (mean, 104). The average operative time fell from 105 to 90 minutes. One surgeon performed 40% of the procedures and assisted with a further 55%. The operative times for all surgeons showed a tendency to reduce, but this was not marked. Most procedures were performed by two surgeons working together, although one surgeon was involved in the majority of cases. The lead surgeon is often assisted by a fellow consultant colleague. Operative times were influenced by experience, but not markedly so. The shorter operative times and minimal "learning curve," compared with other reported series, may, in part, be due to the involvement of two surgeons experienced in laparoscopy for the majority of cases.

Computer-aided placement of deep brain stimulators: from planning to intraoperative guidance

NASA Astrophysics Data System (ADS)

D'Haese, Pierre-Francois; Pallavaram, Srivatsan; Kao, Chris; Konrad, Peter E.; Dawant, Benoit M.

2005-04-01

The long term objective of our research is to develop a system that will automate as much as possible DBS implantation procedures. It is estimated that about 180,000 patients/year would benefit from DBS implantation. Yet, only 3000 procedures are performed annually. This is so because the combined expertise required to perform the procedure successfully is only available at a limited number of sites. Our goal is to transform this procedure into a procedure that can be performed by a general neurosurgeon at a community hospital. In this work we report on our current progress toward developing a system for the computer-assisted pre-operative selection of target points and for the intra-operative adjustment of these points. The system consists of a deformable atlas of optimal target points that can be used to select automatically the pre-operative target, of an electrophysiological atlas, and of an intra-operative interface. The atlas is deformed using a rigid then a non-rigid registration algorithm developed at our institution. Results we have obtained show that automatic prediction of target points is an achievable goal. Our results also indicate that electrophysiological information can be used to resolve structures not visible in anatomic images, thus improving both pre-operative and intra-operative guidance. Our intra-operative system has reached the stage of a working prototype that is clinically used at our institution.

46 CFR Appendix C to Part 404 - Procedures for Annual Review of Base Pilotage Rates

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Procedures for Annual Review of Base Pilotage Rates C... Pilotage Rates The ratemaking methodology detailed in appendix A is used by the Director to determine base pilotage rates at least once every five years, as required by § 404.1. In the intervening years the...

47 CFR 1.981 - Reports, annual and semiannual.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 1 2011-10-01 2011-10-01 false Reports, annual and semiannual. 1.981 Section 1.981 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Wireless Radio... use of radio station facilities must submit annually an audited financial statement reflecting the...

Occupational radiation exposure in vascular interventional radiology: A complete evaluation of different body regions.

PubMed

Bacchim Neto, Fernando Antonio; Alves, Allan Felipe Fattori; Mascarenhas, Yvone Maria; Nicolucci, Patrícia; Pina, Diana Rodrigues de

2016-08-01

To perform a complete evaluation on radiation doses, received by primary and assistant medical staff, while performing different vascular interventional radiology procedures. We evaluated dose received in different body regions during three categories of vascular procedures: lower limb angiography (Angiography), lower limb percutaneous transluminal angioplasty (Angioplasty) and stent graft placement for abdominal aortic aneurysm treatment (A. A. A. Treatment). We positioned the dosimeters near the eye lens, thyroid, chest, abdomen, hands, and feet of the interventional physicians. Equivalent dose was compared with annual dose limits for workers in order to determine the maximum number of procedures per year that each physician could perform. We assessed 90 procedures. We found the highest equivalent doses in the A. A. A. Treatment, in which 90% of the evaluations indicated at least one region receiving more than 1mSv per procedure. Angioplasty was the only procedural modality that provided statistically different doses for different professionals, which is an important aspect on regards to radiological protection strategies. In comparison with the dose limits, the most critical region in all procedures was the eye lens. Since each body region of the interventionist is exposed to different radiation levels, dose distribution measurements are essential for radiological protection strategies. These results indicate that dosimeters placed in abdomen instead of chest may represent more accurately the whole body doses received by the medical staff. Additional dosimeters and a stationary shield for the eye lens are strongly recommended. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Annual Forest Inventories for the North Central Region of the United States

Treesearch

Ronald E. McRoberts; Mark H. Hansen

1999-01-01

The primary objective in developing procedures for annual forest inventories for the north central region of the United States is to establish the capability of producing standard forest inventory and analysis estimates on an annual basis. The inventory system developed to accomplish this objective features several primary functions, including (1) an annual sample of...

Analysis of utilization patterns and associated costs of the breast imaging and diagnostic procedures after screening mammography.

PubMed

Vlahiotis, Anna; Griffin, Brian; Stavros, A Thomas; Margolis, Jay

2018-01-01

Little data exist on real-world patterns and associated costs of downstream breast diagnostic procedures following an abnormal screening mammography or clinical exam. To analyze the utilization patterns in real-world clinical settings for breast imaging and diagnostic procedures, including the frequency and volume of patients and procedures, procedure sequencing, and associated health care expenditures. Using medical claims from 2011 to 2015 MarketScan Commercial and Medicare Databases, adult females with breast imaging/diagnostic procedures (diagnostic mammography, ultrasound, molecular breast imaging, tomosynthesis, magnetic resonance imaging, or biopsy) other than screening mammography were selected. Continuous health plan coverage without breast diagnostic procedures was required for ≥13 months before the first found breast diagnostic procedure (index event), with a 13-month post-index follow-up period. Key outcomes included diagnostic procedure volumes, sequences, and payments. Results reported descriptively were projected to provide US national patient and procedure volumes. The final sample of 875,526 patients was nationally projected to 12,394,432 patients annually receiving 8,732,909 diagnostic mammograms (53.3% of patients), 6,987,399 breast ultrasounds (42.4% of patients), and 1,585,856 biopsies (10.3% of patients). Following initial diagnostic procedures, 49.4% had second procedures, 20.1% followed with third procedures, and 10.0% had a fourth procedure. Mean (SD) costs for diagnostic mammograms of US$349 ($493), ultrasounds US$132 ($134), and biopsies US$1,938 ($2,343) contributed US$3.05 billion, US$0.92 billion, and US$3.07 billion, respectively, to annual diagnostic breast expenditures estimated at US$7.91 billion. The volume and expense of additional breast diagnostic testing, estimated at US$7.91 billion annually, underscores the need for technological improvements in the breast diagnostic landscape.

National Hospital Discharge Survey: 2001 annual summary with detailed diagnosis and procedure data.

PubMed

Kozak, Lola Jean; Owings, Maria F; Hall, Margaret J

2004-06-01

This report presents 2001 national estimates and selected trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by selected patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Admission source and type, collected for the first time in the 2001 National Hospital Discharge Survey, are shown. The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually since 1965. In 2001, data were collected for approximately 330,000 discharges. Of the 477 eligible non-Federal short-stay hospitals in the sample, 448 (94 percent) responded to the survey. Estimates of diagnoses and procedures are presented according to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code numbers. Rates are computed with 2001 population estimates based on the 2000 census. The appendix includes a comparison of rates computed with 1990 and 2000 census-based population estimates. An estimated 32.7 million inpatients were discharged from non-Federal short-stay hospitals in 2001. They used 159.4 million days of care and had an average length of stay of 4.9 days. Common first-listed discharge diagnoses included delivery, psychoses, pneumonia, malignant neoplasm, and coronary atherosclerosis. Males had higher rates for procedures such as cardiac catheterization and coronary artery bypass graft, and females had higher rates for procedures such as cholecystectomy and total knee replacement. The rates of all cesarean deliveries, primary and repeat, rose from 1995 to 2001; the rate of vaginal birth after cesarean delivery dropped 37 percent during this period.

Feasibility and optical performance of one axis three positions sun-tracking polar-axis aligned CPCs for photovoltaic applications

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

Tang, Runsheng; Yu, Yamei

2010-09-15

A new design concept, called one axis three positions sun-tracking polar-axis aligned CPCs (3P-CPCs, in short), was proposed and theoretically studied in this work for photovoltaic applications. The proposed trough-like CPC is oriented in the polar-axis direction, and the aperture is daily adjusted eastward, southward, and westward in the morning, noon and afternoon, respectively, by rotating the CPC trough, to ensure efficient collection of beam radiation nearly all day. To investigate the optical performance of such CPCs, an analytical mathematical procedure is developed to estimate daily and annual solar gain captured by such CPCs based on extraterrestrial radiation and monthlymore » horizontal radiation. Results show that the acceptance half-angle of 3P-CPCs is a unique parameter to determine their optical performance according to extraterrestrial radiation, and the annual solar gain stays constant if the acceptance half-angle, {theta}{sub a}, is less than one third of {omega}{sub 0,min}, the sunset hour angle in the winter solstice, otherwise decreases with the increase of {theta}{sub a}. For 3P-CPCs used in China, the annual solar gain, depending on the climatic conditions in site, decreased with the acceptance half-angle, but such decrease was slow for the case of {theta}{sub a}{<=}{omega}{sub 0,min}/3, indicating that the acceptance half-angle should be less than one third of {omega}{sub 0,min} for maximizing annual energy collection. Compared to fixed east-west aligned CPCs (EW-CPCs) with a yearly optimal acceptance half-angle, the fixed south-facing polar-axis aligned CPCs (1P-CPCs) with the same acceptance half-angle as the EW-CPCs annually collected about 65-74% of that EW-CPCs did, whereas 3P-CPCs annually collected 1.26-1.45 times of that EW-CPCs collected, indicating that 3P-CPCs were more efficient for concentrating solar radiation onto their coupling solar cells. (author)« less

16 CFR 16.11 - Annual comprehensive review.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Annual comprehensive review. 16.11 Section 16.11 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE ADVISORY COMMITTEE MANAGEMENT § 16.11 Annual comprehensive review. (a) The Commission shall conduct an...

45 CFR 1801.54 - Annual report.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.54 Annual report. (a) Scholars with remaining eligibility for scholarship stipends must submit no later than July 15 an annual report to the...

45 CFR 1801.54 - Annual report.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.54 Annual report. (a) Scholars with remaining eligibility for scholarship stipends must submit no later than July 15 an annual report to the...

45 CFR 1801.54 - Annual report.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.54 Annual report. (a) Scholars with remaining eligibility for scholarship stipends must submit no later than July 15 an annual report to the...

Building and Retaining the Career Force: New Procedures for Accessing and Assigning Army Enlisted Personnel: Annual Report 1990 Fiscal Year

DTIC Science & Technology

1992-05-01

researched, valid measure of general cognitive abilities. However, many critical Army tasks appear to require psychomotor and perceptual skills for their...temperament (achievement, discipline, stress toler- ance), psychomotor ability (e.g., eye-hand coordination), and spatial ability to job performance...answered: (1) What combinations of aptitude, temperament, psychomotor ability, and spatial ability, measured at or before entry into the Army, best

Environmental Release Prevention and Control Plan (ERP and CP) annual review and update for 1993

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

Jannik, G.T.; Mamatey, A.; Arnett, M.

1993-10-05

In the Environmental Release Prevention and Control Plan (ERP and CP), WSRC made a commitment to conduct the following follow-up activities and actions: (1) Complete the action items developed in response to the findings and recommendation of the Environmental Release Prevention Taskteam (WSRC-RP-92-356). (2) Complete all batch and continuous release procedure revisions to incorporate the attributes that WSRC senior management required of each procedure. (3) DOE-SR Assistance Managers and WSRC counterparts to reach consensus and closure on the identified engineered solutions documented in the ERP and CP, develop and drive implementation of facility changes per the agreements. (4) Continue tomore » analyze releases and monitor performance in accordance with the ERP and CP, and utilize the ALARA Release Guides Committee to drive improvements. (5) Conduct annual re-evaluations of the cost benefit analyses of the identified engineered solutions, and identify new options and alternatives for each outfall in response to site mission and facility changes. This report documents the efforts that have been completed over the past year in response to these commitments.« less

Missed surgical intensive care unit billing: potential financial impact of 24/7 faculty presence.

PubMed

Hendershot, Kimberly M; Bollins, John P; Armen, Scott B; Thomas, Yalaunda M; Steinberg, Steven M; Cook, Charles H

2009-07-01

To efficiently capture evaluation and management (E&M) and procedural billing in our surgical intensive care unit (SICU), we have developed an electronic billing system that links to the electronic medical record (EMR). In this system, only notes electronically signed and coded by an attending generate billing charges. We hypothesized that capture of missed billing during nighttime and weekends might be sufficient to subsidize 24/7 in-house attending coverage. A retrospective chart EMR review was performed of the EMRs for all SICU patients during a 2-month period. Note type, date, time, attending signature, and coding were analyzed. Notes without attending signature, diagnosis, or current procedural terminology (CPT) code were considered incomplete and identified as "missed billing." Four hundred and forty-three patients had 465 admissions generating 2,896 notes. Overall, 76% of notes were signed and coded by an attending and billed. Incomplete (not billed) notes represented an overall missed billing opportunity of $159,138 for the 2-month time period (approximately $954,000 annually). Unbilled E&M encounters during weekdays totaled $54,758, whereas unbilled E&M and procedures from weeknights and weekends totaled $88,408 ($44,566 and $43,842, respectively). Missed billing after-hours thus represents approximately $530K annually, extrapolating to approximately $220K in collections from our payer mix. Surprisingly, missed E&M and procedural billing during weekdays totaled $70,730 (approximately $425K billing, approximately $170K collections annually), and typically represented patients seen, but transferred from the SICU before attending documentation was completed. Capture of nighttime and weekend ICU collections alone may be insufficient to add faculty or incentivize in-house coverage, but could certainly complement other in-house derived revenues to such ends. In addition, missed daytime billing in busy modern ICUs can be substantial, and use of an EMR to identify missed billing opportunities can help create solutions to recover these revenues.

10 CFR 765.23 - Annual report.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Annual report. 765.23 Section 765.23 Energy DEPARTMENT OF ENERGY REIMBURSEMENT FOR COSTS OF REMEDIAL ACTION AT ACTIVE URANIUM AND THORIUM PROCESSING SITES Procedures for Submitting and Processing Reimbursement Claims § 765.23 Annual report. The Department shall...

10 CFR 765.23 - Annual report.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Annual report. 765.23 Section 765.23 Energy DEPARTMENT OF ENERGY REIMBURSEMENT FOR COSTS OF REMEDIAL ACTION AT ACTIVE URANIUM AND THORIUM PROCESSING SITES Procedures for Submitting and Processing Reimbursement Claims § 765.23 Annual report. The Department shall...

10 CFR 765.23 - Annual report.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Annual report. 765.23 Section 765.23 Energy DEPARTMENT OF ENERGY REIMBURSEMENT FOR COSTS OF REMEDIAL ACTION AT ACTIVE URANIUM AND THORIUM PROCESSING SITES Procedures for Submitting and Processing Reimbursement Claims § 765.23 Annual report. The Department shall...

10 CFR 765.23 - Annual report.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Annual report. 765.23 Section 765.23 Energy DEPARTMENT OF ENERGY REIMBURSEMENT FOR COSTS OF REMEDIAL ACTION AT ACTIVE URANIUM AND THORIUM PROCESSING SITES Procedures for Submitting and Processing Reimbursement Claims § 765.23 Annual report. The Department shall...

10 CFR 765.23 - Annual report.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Annual report. 765.23 Section 765.23 Energy DEPARTMENT OF ENERGY REIMBURSEMENT FOR COSTS OF REMEDIAL ACTION AT ACTIVE URANIUM AND THORIUM PROCESSING SITES Procedures for Submitting and Processing Reimbursement Claims § 765.23 Annual report. The Department shall...

Cataract Surgery among Medicare Beneficiaries

PubMed Central

Schein, Oliver D.; Cassard, Sandra D.; Tielsch, James M.; Gower, Emily W.

2014-01-01

Purpose To present descriptive epidemiology of cataract surgery among Medicare recipients in the United States. Setting Cataract surgery performed on Medicare beneficiaries in 2003 and 2004. Methods Medicare claims data were used to identify all cataract surgery claims for procedures performed in the United States in 2003-2004. Standard assumptions were used to limit the claims to actual cataract surgery procedures performed. Summary statistics were created to determine the number of procedures performed for each outcome of interest: cataract surgery rates by age, race, and gender; surgical volume by facility type, surgeon characteristics, and state; time interval between first- and second-eye cataract surgery. Results The national cataract surgery rate for 2003-2004 was 61.8 per 1000 Medicare beneficiary person-years. The rate was significantly higher for females and for those 75-84. After adjustment for age and gender, blacks had approximately a 30% lower rate of surgery than whites. While only 5% of cataract surgeons performed more than 500 cataract surgeries annually, these surgeons performed 26% of the total cataract surgeries. Increasing surgical volume was found to be highly correlated with use of ambulatory surgical centers and reduced time interval between first- and second-eye surgery in the same patient. Conclusions The epidemiology of cataract surgery in the United States Medicare population documents substantial variation in surgical rates by race, gender, age, and by certain provider characteristics. PMID:22978526

"Gear mechanism" of bariatric interventions revealed by untargeted metabolomics.

PubMed

Samczuk, Paulina; Luba, Magdalena; Godzien, Joanna; Mastrangelo, Annalaura; Hady, Hady Razak; Dadan, Jacek; Barbas, Coral; Gorska, Maria; Kretowski, Adam; Ciborowski, Michal

2018-03-20

Mechanisms responsible for metabolic gains after bariatric surgery are not entirely clear. The purpose of this study was evaluation of metabolic changes after laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy in semi-annual follow up. The study participants were selected from obese patients with T2DM who underwent one of the mentioned bariatric procedures. Serum metabolic fingerprinting by use of liquid and gas chromatography with mass spectrometry detection was performed on samples obtained from studied patients before, one, and six months post-surgery. Performed analyses resulted in 49 significant and identified metabolites. Comparison of the two described procedures has allowed to detect metabolites linked with numerous pathways, processes and diseases. Based on the metabolites detected and pathways affected, we propose a "gear mechanism" showing molecular changes evoked by both bariatric procedures. Critical evaluation of clinical data and obtained metabolomics results enables us to conclude that both procedures are very similar in terms of general clinical outcome, but they strongly differ from each other in molecular mechanisms leading to the final effect. For the first time general metabolic effect of bariatric procedures is described. New hypotheses concerning molecular mechanisms induced by bariatric surgeries and new gut microbiota modulations are presented. Copyright © 2018 Elsevier B.V. All rights reserved.

Using Medical Claims for Policy Effectiveness Surveillance: Reimbursement and Utilization of Abdomen/Pelvis Computed Tomography Scans.

PubMed

Horný, Michal; Morgan, Jake R; Merker, Vanessa L

2015-12-01

To quantify changes in private insurance payments for and utilization of abdominal/pelvic computed tomography scans (CTs) after 2011 changes in CPT coding and Medicare reimbursement rates, which were designed to reduce costs stemming from misvalued procedures. TruvenHealth Analytics MarketScan Commercial Claims and Encounters database. We used difference-in-differences models to compare combined CTs of the abdomen/pelvis to CTs of the abdomen or pelvis only. Our main outcomes were inflation-adjusted log payments per procedure, daily utilization rates, and total annual payments. Claims data were extracted for all abdominal/pelvic CTs performed in 2009-2011 within noncapitated, employer-sponsored private plans. Adjusted payments per combined CTs of the abdomen/pelvis dropped by 23.8 percent (p < .0001), and their adjusted daily utilization rate accelerated by 0.36 percent (p = .034) per month after January 2011. Utilization rate of abdominal-only or pelvic-only CTs dropped by 5.0 percent (p < .0001). Total annual payments for combined CTs of the abdomen/pelvis decreased in 2011 despite the increased utilization. Private insurance payments for combined CTs of the abdomen/pelvis declined and utilization accelerated significantly after 2011 policy changes. While growth in total annual payments was contained in 2011, it may not be sustained if 2011 utilization trends persist. © Health Research and Educational Trust.

Pediatric hospitalizations for inflammatory bowel disease based on annual case volume: results from the Kids' Inpatient Database 2012.

PubMed

Pant, Chaitanya; Deshpande, Abhishek; Sferra, Thomas J; Almadhoun, Osama; Batista, Daisy; Pervez, Asad; Nutalapati, Venkat; Olyaee, Mojtaba

2017-01-01

To study differences related to pediatric inflammatory bowel disease (IBD) care among hospitals that were stratified based on annual case volume. This is a cross-sectional study using data from the United States Healthcare Cost and Utilization Project Kids' Inpatient Database (KID). IBD-related hospitalizations were identified using International Classification of Diseases-9-Clinical Modification codes. Hospital volume was divided into low or high by assigning cut-off values of 1-20 and >20 annual IBD hospitalizations. We assessed a total of 8647 pediatric IBD discharges during 2012 from 660 hospitals in the USA. 107 of these hospitals were classified as high-volume centers (HVCs) for pediatric IBD care and 553 low-volume centers (LVCs). HVCs were more likely to be associated with an academic teaching status compared to LVCs (97.1% vs 67.6%, p<0.001). The incidence of transfer of medical care from LVCs to other hospitals was 5.5% but only 0.7% for HVCs (p<0.001). The median number of procedures (medical and surgical) performed on children admitted with IBD was higher at HVCs (2 vs 1, p<0.001). IBD admissions at HVCs were more likely to undergo surgical procedures compared to LVCs (17% vs 10%, p<0.001). The incidence of postoperative complications was not significantly different. There were significantly greater hospital costs (median US$11,000 vs US$6,000, p<0.001) and lengths of stay (median 5 days vs 4 days, p<0.001) associated with HVCs compared to LVCs. Pediatric admissions to HVCs for IBD undergo a greater number of medical and surgical procedures and are associated with higher costs and lengthier hospital stays. Copyright © 2016 American Federation for Medical Research.

45 CFR 1801.54 - Annual report.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 4 2012-10-01 2012-10-01 false Annual report. 1801.54 Section 1801.54 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.54 Annual report. (a) Scholars with remaining eligibility for scholarship...

Fast correlation method for passive-solar design

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

Wray, W.O.; Biehl, F.A.; Kosiewicz, C.E.

1982-01-01

A passive-solar design manual for single-family detached residences and dormitory-type buildings is being developed. The design procedure employed in the manual is a simplification of the original monthly solar load ratio (SLR) method. The new SLR correlations involve a single constant for each system. The correlation constant appears as a scale factor permitting the use of a universal performance curve for all passive systems. Furthermore, by providing location-dependent correlations between the annual solar heating fraction (SHF) and the minimum monthly SHF, we have eliminated the need to perform an SLR calculation for each month of the heating season.

A passive-solar design manual for the United States Navy

NASA Astrophysics Data System (ADS)

Wray, W. O.; Biehl, F. A.; Kosiewicz, C. E.; Miles, C. E.; Durlak, E. R.

1982-06-01

A passive solar design manual for single-family detached residences and dormitory-type buildings is developed. The design procedure employed in the manual is a simplification of the original monthly solar load ratio (SLR) method. The new SLR correlations involve a single constant for each system. The correlation constant appears as a scale factor permitting the use of a universal performance curve for all passive systems. Furthermore, by providing location-dependent correlations between the annual solar heating fraction (SHF) and the minimum monthly SHF, the need to perform an SLR calculation for each month of the heating season is eliminated.

Passive-solar design manual for the United States Navy

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

Wray, W.O.; Biehl, F.A.; Kosiewicz, C.R.

1982-01-01

A passive solar design manual for single-family detached residences and dormitory-type buildings is being developed. The design procedure employed in the manual is a simplification of the original monthly solar load ratio (SLR) method. The new SLR correlations involve a single constant for each system. The correlation constant appears as a scale factor permitting the use of a universal performance curve for all passive systems. Furthermore, by providing location-dependent correlations between the annual solar heating fraction (SHF)* and the minimum monthly SHF, we have eliminated the need to perform an SLR calculation for each month of the heating season.

Trends in radical prostatectomy: centralization, robotics, and access to urologic cancer care.

PubMed

Stitzenberg, Karyn B; Wong, Yu-Ning; Nielsen, Matthew E; Egleston, Brian L; Uzzo, Robert G

2012-01-01

Robotic surgery has been widely adopted for radical prostatectomy. We hypothesized that this change is rapidly shifting procedures away from hospitals that do not offer robotics and consequently increasing patient travel. A population-based observational study of all prostatectomies for cancer in New York, New Jersey, and Pennsylvania from 2000 to 2009 was performed using hospital discharge data. Hospital procedure volume was defined as the number of prostatectomies performed for cancer in a given year. Straight-line travel distance to the treating hospital was calculated for each case. Hospitals were contacted to determine the year of acquisition of the first robot. From 2000 to 2009, the total number of prostatectomies performed annually increased substantially. The increase occurred almost entirely at the very high-volume centers (≥ 106 prostatectomies/year). The number of hospitals performing prostatectomy fell 37% from 2000 to 2009. By 2009, the 9% (21/244) of hospitals that had very high volume performed 57% of all prostatectomies, and the 35% (86/244) of hospitals with a robot performed 85% of all prostatectomies. The median travel distance increased 54% from 2000 to 2009 (P<.001). The proportion of patients traveling ≥ 15 miles increased from 24% to 40% (P < .001). Over the past decade, the number of radical prostatectomies performed has risen substantially. These procedures have been increasingly centralized at high-volume centers, leading to longer patient travel distances. Few prostatectomies are now performed at hospitals that do not offer robotic surgery. Copyright © 2011 American Cancer Society.

Femtosecond phacoemulsification: the business and the medicine.

PubMed

Uy, Harvey S; Edwards, Keith; Curtis, Nick

2012-01-01

PURPOSE FOR REVIEW: Phacoemulsification is the preferred method for cataract surgery in the developed world. The number of phacoemulsification procedures performed annually is expected to increase as the population ages. Femtosecond cataract surgery offers several surgical advantages over conventional phacoemulsification and has already attained commercial application in some countries. The purpose of this review is to outline the benefits, risks and commercial issues of femtosecond lasers as applied to cataract surgery. Cataract surgeons are adopting femtosecond technology to perform laser capsulotomy, lens fragmentation, clear cornea incisions and limbal relaxing incisions. Femtosecond lasers clearly perform these surgical steps with greater precision and reproducibility. Further benefits such as improved postoperative refractive results and reduced complication rates are being investigated. Commercial issues have invariably arisen such as cost of installation and operation, value proposition and return on investment. Femtosecond cataract surgery is an evolving procedure that can potentially lead to better and safer surgical outcomes. This review presents the currently available scientific evidence and discusses some of the relevant financial issues concerning this technology.

Trends and drivers of the aesthetic market during a turbulent economy.

PubMed

Wilson, Stelios C; Soares, Marc A; Reavey, Patrick L; Saadeh, Pierre B

2014-06-01

Aesthetic procedures are significant sources of revenue for plastic surgeons. With the popularity of nonsurgical aesthetic procedures, many plastic surgeons question how to best tailor their aesthetic practice. Revenue generated from surgical and minimally invasive aesthetic procedures performed in the United States between 2000 and 2011 was calculated from the American Society of Plastic Surgeons' annual reports. Regression analysis was performed against six commonly cited economic indicators. In 2011, revenue from minimally invasive procedures increased from $3.0 billion to $5.7 billion (90 percent growth), whereas revenue from surgical procedures decreased from $6.6 billion to $6.0 billion (10 percent decline). Between 2000 and 2011, minimally invasive procedure market share grew from 30 percent to nearly 50 percent. Linear regression analysis revealed significant correlations between surgical procedure revenue and indicators of macroeconomic climate: Dow Jones Industrial Average (R = 0.72; p < 0.01), Standard & Poor's 500 Index (R = 0.64, p < 0.05), and unemployment rate (R = -0.81; p < 0.001). Minimally invasive procedure revenue was significantly correlated with indicators related to microeconomic decision trends: disposable income per capita (R = 0.93; p < 0.001), real gross domestic product per capita (R = 0.88; p < 0.001), and home price index (R = 0.63; p < 0.05). No economic indicator in this study was found to be significantly correlated with both surgical and minimally invasive revenue. Despite economic turbulence, minimally invasive procedures are the most rapidly growing source of revenue and are poised to be the dominant source of revenue in the aesthetic market.

[The state of pediatric anesthesia in Japan: an analysis of the Japanese society of anesthesiologists survey of critical incidents in the operating room].

PubMed

Irita, Kazuo; Tsuzaki, Koichi; Sawa, Tomohiro; Sanuki, Michiyoshi; Nakatsuka, Hideki; Makita, Koshi; Morita, Kiyoshi

2007-01-01

The Japanese Society of Anesthesiologists (JSA) survey of critical incidents in the operating room and other reports have shown that pediatric patients undergoing anesthesia are at an increased risk. Purpose was to examine the state of pediatric anesthesia in Japan. This might clarify the role of children's hospitals for pediatric anesthesia, and the relationship between critical incidents and volume of pediatric anesthetic procedures. The JSA has conducted annual surveys of critical incidents in the operating room by sending to and collecting confidential questionnaires from all JSA Certified Training Hospitals. From 1999 to 2003, 342,840 pediatric (0-5 yr) anesthetic procedures were registered. During this period, only 15 cardiac arrests and 3 deaths within 7 postoperative days totally attributable to anesthetic management were reported. Therefore, we analyzed cardiac arrests and deaths due to all etiologies. The hospitals were classified as children's hospitals, university hospitals, and other hospitals, and the incidence of cardiac arrest, the recovery rate from cardiac arrest without any sequelae, and the mortality rate were compared according to types of the hospitals. The relationship between death due to intraoperative critical incidents and the volume of pediatric anesthetic procedures was examined using data from the 2003 survey, the recovery rate of which was 85.7%. In 2003, 739 JSA Certified Training Hospitals responded to the survey: 7 children's hospitals, 109 university hospitals, and 623 other hospitals. Among these hospitals, 707 and 270 hospitals conducted pediatric and newborn (<1 mo) anesthesia, respectively. In 2003, 4,630 newborn, 17,890 infant (<1 yr), and 60,524 child (1-5 yr) anesthetic procedures were registered. Odds ratios were determined to compare the risks among the hospital groups, and the 95% confidential interval (CI) was shown. The Chi square test was used to compare the background of patients with cardiac arrest. P values less than 0.05 were considered significant. In 2003, 95.7% and 36.5% of JSA Certified Training Hospitals which responded to the survey had conducted pediatric and newborn anesthesia, respectively. Children's hospitals, university hospitals, and other hospitals were responsible for 10.7%, 31.0%, and 58.3% of pediatric anesthetic procedures, respectively. Seven children's hospitals (100.0%), 54 university hospitals (50.5%), and 54 other hospitals (9.1%) conducted more than 201 annual pediatric anesthetic procedures, respectively, and these 115 hospitals conducted 62.5% of all pediatric anesthetic procedures in Japan. There was no significant difference between the overall mortality rate in hospitals with an annual pediatric anesthetic volume of less than 200 and that in hospitals with an annual pediatric anesthetic volume of more than 201 (5.46 versus 7.12/10,000 anesthetic procedures). However, the overall mortality rate was 4.87 times higher (95% confidential interval: 1.53-15.66) in hospitals with an annual pediatric anesthetic volume of more than 101 (7.91/10,000 anesthetic procedures) than in those with an annual pediatric anesthetic volume of less than 100 (1.62/10,000 anesthetic procedures). The situation was quite different when we focused on newborn anesthetic procedures : the overall mortality was 2.63 times higher (95% confidential interval : 1.19-5.84) in hospitals with an annual newborn anesthetic volume of less than 12 (126.6/ 10,000 anesthetic procedures) than those with an annual newborn anesthetic volume of more than 13 (48.5/10,000 anesthetic procedures). Between 1999 and 2003, the incidences of cardiac arrest in children's hospitals, university hospitals, and other hospitals were 9.54 (1.89 times higher than the other hospitals; CI 1.31-2.67), 10.30, and 5.11/10,000 anesthetic procedures, respectively. Among the children who developed cardiac arrest, the ratio of poor preoperative conditions with an American Society of Anesthesiologists physical status classification of more than 3 was significantly lower in the children's hospitals (68.9%) than the university hospitals (84.3%) and the other hospitals (84.0%). The recovery rate from cardiac arrest was 51.1% (2.49 times higher than the university hospitals; CI 1.23-5.06, and 3.05 times higher than the other hospitals ; CI 1.45-6.43), 29.6%, and 25.5%, respectively. The mortality rate was 9.54 (1.77 times higher than the other hospitals; CI 1.25-2.52), 8.87, and 5.38/10,000 anesthetic procedures in children's hospitals, university hospitals and other hospitals, respectively. Almost all JSA Certified Training Hospitals conducted pediatric anesthesia, although only 15.6% of them had an annual pediatric anesthetic volume of more than 200. It was suggested that general pediatric anesthesia was conduced safely in JSA Certified Training Hospitals, even if they had a low annual pediatric anesthetic volume. The exception was newborn anesthetic procedures : the mortality was high in hospitals with an annual newborn anesthetic volume of less than 12. Analysis of critical incidents in the operating room failed to show the superiority of children's hospitals in comparison with the university hospitals and other hospitals. Collecting and analyzing data including the patients without critical incidents are required for further analysis.

Reproducibility in light microscopy: Maintenance, standards and SOPs.

PubMed

Deagle, Rebecca C; Wee, Tse-Luen Erika; Brown, Claire M

2017-08-01

Light microscopy has grown to be a valuable asset in both the physical and life sciences. It is a highly quantitative method available in individual research laboratories and often centralized in core facilities. However, although quantitative microscopy is becoming a customary tool in research, it is rarely standardized. To achieve accurate quantitative microscopy data and reproducible results, three levels of standardization must be considered: (1) aspects of the microscope, (2) the sample, and (3) the detector. The accuracy of the data is only as reliable as the imaging system itself, thereby imposing the need for routine standard performance testing. Depending on the task some maintenance procedures should be performed once a month, some before each imaging session, while others conducted annually. This text should be implemented as a resource for researchers to integrate with their own standard operating procedures to ensure the highest quality quantitative microscopy data. Copyright © 2017. Published by Elsevier Ltd.

Proceedings of the Annual Symposium on Frequency Control (37th). 1-3 June 1983, Marriott Hotel, Philadelphia, Pennsylvania.

DTIC Science & Technology

1983-06-03

current not power. inspection groups . The experimental procedure for the resistance TABLE I non -linearity inspection will be to condition the crystal...comparatively small [24]. By eali effect, the precision with which the effect micht controlling the experimental conditions we estimate be controlled ...intended to be a accepted on an individual basis for Group A predictor of long term performance. It is another testing. check on process control

SU-E-T-649: Quality Assurances for Proton Therapy Delivery Equipment

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

Arjomandy, B; Kase, Y; Flanz, J

2015-06-15

Purpose: The number of proton therapy centers has increased dramatically over the past decade. Currently, there is no comprehensive set of guidelines that addresses quality assurance (QA) procedures for the different technologies used for proton therapy. The AAPM has charged task group 224 (TG-224) to provide recommendations for QA required for accurate and safe dose delivery, using existing and next generation proton therapy delivery equipment. Methods: A database comprised of QA procedures and tolerance limits was generated from many existing proton therapy centers in and outside of the US. These consist of proton therapy centers that possessed double scattering, uniformmore » scanning, and pencil beams delivery systems. The diversity in beam delivery systems as well as the existing devices to perform QA checks for different beam parameters is the main subject of TG-224. Based on current practice at the clinically active proton centers participating in this task group, consensus QA recommendations were developed. The methodologies and requirements of the parameters that must be verified for consistency of the performance of the proton beam delivery systems are discussed. Results: TG-224 provides procedures and QA checks for mechanical, imaging, safety and dosimetry requirements for different proton equipment. These procedures are categorized based on their importance and their required frequencies in order to deliver a safe and consistent dose. The task group provides daily, weekly, monthly, and annual QA check procedures with their tolerance limits. Conclusions: The procedures outlined in this protocol provide sufficient information to qualified medical physicists to perform QA checks for any proton delivery system. Execution of these procedures should provide confidence that proton therapy equipment is functioning as commissioned for patient treatment and delivers dose safely and accurately within the established tolerance limits. The report will be published in late 2015.« less

Benchmarking a geostatistical procedure for the homogenisation of annual precipitation series

NASA Astrophysics Data System (ADS)

Caineta, Júlio; Ribeiro, Sara; Henriques, Roberto; Soares, Amílcar; Costa, Ana Cristina

2014-05-01

The European project COST Action ES0601, Advances in homogenisation methods of climate series: an integrated approach (HOME), has brought to attention the importance of establishing reliable homogenisation methods for climate data. In order to achieve that, a benchmark data set, containing monthly and daily temperature and precipitation data, was created to be used as a comparison basis for the effectiveness of those methods. Several contributions were submitted and evaluated by a number of performance metrics, validating the results against realistic inhomogeneous data. HOME also led to the development of new homogenisation software packages, which included feedback and lessons learned during the project. Preliminary studies have suggested a geostatistical stochastic approach, which uses Direct Sequential Simulation (DSS), as a promising methodology for the homogenisation of precipitation data series. Based on the spatial and temporal correlation between the neighbouring stations, DSS calculates local probability density functions at a candidate station to detect inhomogeneities. The purpose of the current study is to test and compare this geostatistical approach with the methods previously presented in the HOME project, using surrogate precipitation series from the HOME benchmark data set. The benchmark data set contains monthly precipitation surrogate series, from which annual precipitation data series were derived. These annual precipitation series were subject to exploratory analysis and to a thorough variography study. The geostatistical approach was then applied to the data set, based on different scenarios for the spatial continuity. Implementing this procedure also promoted the development of a computer program that aims to assist on the homogenisation of climate data, while minimising user interaction. Finally, in order to compare the effectiveness of this methodology with the homogenisation methods submitted during the HOME project, the obtained results were evaluated using the same performance metrics. This comparison opens new perspectives for the development of an innovative procedure based on the geostatistical stochastic approach. Acknowledgements: The authors gratefully acknowledge the financial support of "Fundação para a Ciência e Tecnologia" (FCT), Portugal, through the research project PTDC/GEO-MET/4026/2012 ("GSIMCLI - Geostatistical simulation with local distributions for the homogenization and interpolation of climate data").

Beauty and the beast: management of breast cancer after plastic surgery.

PubMed

Bleicher, Richard J; Topham, Neal S; Morrow, Monica

2008-04-01

Cosmetic surgery procedures increase in incidence annually, with 11 million performed in 2006. Because breast cancer is the most frequently occurring malignancy in women, a personal history of cosmetic surgery in those undergoing treatment for breast cancer is becoming more common. This review identified key studies from the PubMed database, to consolidate existing data related to treatment of breast cancer after plastic surgery. Data were reviewed for factors affecting breast cancer treatment after breast augmentation, breast reduction, abdominoplasty, and suction lipectomy. There are little comprehensive data on the management of breast cancer after plastic surgical procedures. Plastic surgery may affect diagnostic imaging, surgical options, and radiotherapy management. Breast augmentation and reduction are two of the most common cosmetic procedures performed and knowledge of their influence on the incidence, diagnosis, and treatment of breast cancer is important for proper management. Plastic surgery does not significantly affect breast cancer outcomes but does present management challenges that must be anticipated when deciding various treatment options. Knowledge of the existing literature may be helpful in discussing those options with patients and planning the multidisciplinary approach to this malignancy.

Forest statistics for Northwest Florida, 1987

Treesearch

Mark J. Brown

1987-01-01

The Forest Inventory and Analysis (Forest Survey) Research Work Unit at the Southeastern Forest Experiment Station recently conducted a review of its data processing procedures. During this process, a computer error was discovered which led to inflated estimates of annual removals, net annual growth, and annual mortality for the 1970-1980 remeasurement period in...

Evaluating imputation and modeling in the North Central region

Treesearch

Ronald E. McRoberts

2000-01-01

The objectives of the North Central Research Station, USDA Forest Service, in developing procedures for annual forest inventories include establishing the capability of producing annual estimates of timber volume and related variables. The inventory system developed to accomplish these objectives features an annual sample of measured field plots and techniques for...

4D Dynamic RNP Annual Interim Report-Year 1

NASA Technical Reports Server (NTRS)

Finkelsztein, Daniel M.; Sturdy, James L.; Alaverdi, Omeed; Chung, William W.; Salvano, Daniel; Klooster, Joel; Hochwarth, Joachim K.

2010-01-01

This Annual Interim Report summarizes the activities led by Raytheon, in collaboration with GE Aviation and SAIC, and presents the results obtained during the first year of this research effort to expand the RNP concept to 4 dimensions relative to a dynamic frame of reference. Joint Program Development Office (JPDO)Concepts of Operations for the Next Generation Air Transportation System (NextGen) considers 4 Dimension Trajectory (4DT) procedures a key enabler to Trajectory Based Operations (TBO). The JPDO defines 4DT as a precise description of an aircraft path in space and time . While NextGen assumes that this path is defined within an Earth-reference frame, many 4DT procedure implementations will require an aircraft to precisely navigate relative to a moving reference such as another aircraft to form aggregate flows or a weather cell to allow for flows to shift. Current methods of implementing routes and flight paths rely on aircraft meeting a Required Navigation Performance (RNP) specification and being equipped with a monitoring and alerting capability to annunciate when the aircraft system is unable to meet the performance specification required for the operation. Since all aircraft today operate within the NAS relative to fixed reference points, the current RNP definition is deemed satisfactory. However, it is not well understood how the current RNP construct will support NextGen 4DT procedures where aircraft operate relative to each other or to other dynamic frames of reference. The objective of this research effort is to analyze candidate 4DT procedures from both an Air Navigation Service Provider (ANSP) and aircraft perspective, to identify their specific navigational requirements, assess the shortcomings of the current RNP construct to meet these requirements, to propose an extended 4 Dimensional Dynamic RNP (4D Dynamic RNP) construct that accounts for the dynamic spatial and temporal nature of the selected 4DT procedures, and finally, to design an experiment using the Airspace and Traffic Operations Simulation (ATOS) system to validate the 4D Dynamic RNP construct. This Annual Interim Report summarizes the activities led by Raytheon, in collaboration with GE Aviation and SAIC, and presents the results obtained during the first year of this research effort to expand the RNP concept to 4 dimensions relative to a dynamic frame of reference. A comprehensive assessment of the state-of-the-art international implementation of current RNP was completed and presented in the Contractor Report RNP State-of-the-Art Assessment, Version 4, 17 December 2008 . The team defined in detail two 4DT operations, Airborne Precision Spacing and Self-Separation, that are ideally suited to be supported by 4D Dynamic RNP and developed their respective conceptual frameworks, Required Interval Management Performance (RIMP) Version 1.1, 13 April 2009 and Required Self Separation Performance (RSSP) Version 1.1, 13 April 2009 . Finally, the team started the development of a mathematical model and simulation tool for RIMP and RSSP scheduled to be delivered during the second year of this research effort.

Variations in inpatient pediatric anesthesia in California from 2000 to 2009: a caseload and geographic analysis.

PubMed

Mudumbai, Seshadri C; Honkanen, Anita; Chan, Jia; Schmitt, Susan; Saynina, Olga; Hackel, Alvin; Gregory, George; Phibbs, Ciaran S; Wise, Paul H

2014-12-01

Regional referral systems are considered important for children hospitalized for surgery, but there is little information on existing systems. To examine geographic variations in anesthetic caseloads in California for surgical inpatients ≤6 years and to evaluate the feasibility of regionalizing anesthetic care. We reviewed California's unmasked patient discharge database between 2000 and 2009 to determine surgical procedures, dates, and inpatient anesthetic caseloads. Hospitals were classified as urban or rural and were further stratified as low, intermediate, high, and very high volume. We reviewed 257,541 anesthetic cases from 402 hospitals. Seventeen California Children's Services (CCS) hospitals conducted about two-thirds of all inpatient anesthetics; 385 non-CCS hospitals accounted for the rest. Urban hospitals comprised 82% of low- and intermediate-volume centers (n = 297) and 100% of the high- and very high-volume centers (n = 41). Ninety percent (n = 361) of hospitals performed <100 cases annually. Although potentially lower risk procedures such as appendectomies were the most frequent in urban low- and intermediate-volume hospitals, fairly complex neurosurgical and general surgeries were also performed. The median distance from urban lower-volume hospitals to the nearest high- or very high-volume center was 12 miles. Up to 98% (n = 40,316) of inpatient anesthetics at low- or intermediate-volume centers could have been transferred to higher-volume centers within 25 miles of smaller centers. Many urban California hospitals maintained low annual inpatient anesthetic caseloads for children ≤6 years while conducting potentially more complex procedures. Further efforts are necessary to define the scope of pediatric anesthetic care at urban low- and intermediate-volume hospitals in California. © 2014 John Wiley & Sons Ltd.

An analysis of leading, lagging, and coincident economic indicators in the United States and its relationship to the volume of plastic surgery procedures performed.

PubMed

Hoppe, Ian C; Pastor, Craig J; Paik, Angie M

2012-10-01

In plastic surgery, 2 predominant practice environments exist, namely, the academic setting and private practice. These 2 groups cater their practice toward the needs and demands of 2 very different patient populations. The goal of this paper is to examine well-established economic indicators and delineate their relationship, if any, with the volume of different plastic surgical procedures performed in the United States. Information from the American Society of Plastic Surgeons' annual reports on plastic surgery statistics was collected from the year 2000 through 2010 and compared to readily available and established economic indicators. There was a significant positive relationship with total cosmetic procedures and gross domestic product (GDP), GDP per capita, personal income, consumer price index (CPI) (all), and CPI (medical). There was a significant positive relationship between cosmetic surgical procedures and the issuance of new home permits and the average prime rate charged by banks. There was a significant positive relationship with cosmetic minimally invasive procedures and GDP, GDP per capita, personal income, CPI (all), and CPI (medical). There was a significant negative relationship between reconstructive procedures and GDP, GDP per capita, personal income, CPI (all), and CPI (medical). Cosmetic minimally invasive procedures seem to be decided on relatively quickly during good economic times. Cosmetic surgical procedures seem to be more planned and less related to the economic environment. The plastic surgeon may use this relationship to tailor the focus of his or her practice to be best situated for economic fluctuations.

Cost-Minimization Analysis of Open and Endoscopic Carpal Tunnel Release.

PubMed

Zhang, Steven; Vora, Molly; Harris, Alex H S; Baker, Laurence; Curtin, Catherine; Kamal, Robin N

2016-12-07

Carpal tunnel release is the most common upper-limb surgical procedure performed annually in the U.S. There are 2 surgical methods of carpal tunnel release: open or endoscopic. Currently, there is no clear clinical or economic evidence supporting the use of one procedure over the other. We completed a cost-minimization analysis of open and endoscopic carpal tunnel release, testing the null hypothesis that there is no difference between the procedures in terms of cost. We conducted a retrospective review using a private-payer and Medicare Advantage database composed of 16 million patient records from 2007 to 2014. The cohort consisted of records with an ICD-9 (International Classification of Diseases, Ninth Revision) diagnosis of carpal tunnel syndrome and a CPT (Current Procedural Terminology) code for carpal tunnel release. Payer fees were used to define cost. We also assessed other associated costs of care, including those of electrodiagnostic studies and occupational therapy. Bivariate comparisons were performed using the chi-square test and the Student t test. Data showed that 86% of the patients underwent open carpal tunnel release. Reimbursement fees for endoscopic release were significantly higher than for open release. Facility fees were responsible for most of the difference between the procedures in reimbursement: facility fees averaged $1,884 for endoscopic release compared with $1,080 for open release (p < 0.0001). Endoscopic release also demonstrated significantly higher physician fees than open release (an average of $555 compared with $428; p < 0.0001). Occupational therapy fees associated with endoscopic release were less than those associated with open release (an average of $237 per session compared with $272; p = 0.07). The total average annual reimbursement per patient for endoscopic release (facility, surgeon, and occupational therapy fees) was significantly higher than for open release ($2,602 compared with $1,751; p < 0.0001). Our data showed that the total average fees per patient for endoscopic release were significantly higher than those for open release, although there currently is no strong evidence supporting better clinical outcomes of either technique. Value-based health-care models that favor delivering high-quality care and improving patient health, while also minimizing costs, may favor open carpal tunnel release.

Trends in radiation exposure from clinical nuclear medicine procedures in Shanghai, China.

PubMed

Yi, Yanling; Zheng, Junzheng; Zhuo, Weihai; Gao, Linfeng

2012-03-01

This study was designed to assess the trends in the frequencies of nuclear medicine procedures in Shanghai, China, and to determine their contributions to the per capita effective dose to the Shanghai population. The mean activities of radionuclides administered by nuclear medicine departments were compared with the Chinese national guidelines on diagnostic reference levels. On the basis of the three surveys carried out by Shanghai Municipal Center for Disease Control and Prevention in 1996, 1998, and 2008, the typically administered radiopharmaceuticals, levels of activity, the number of procedures, and population were systematically analyzed to assess the frequencies of nuclear medicine procedures and the per capita effective dose. The frequencies were approximately 2.77, 3.46, and 6.63 per 1000 people in 1996, 1998, and 2008, respectively. The annual per capita doses from diagnostic nuclear medicine were estimated to be 0.016, 0.022, and 0.032 mSv in 1996, 1998, and 2008, respectively. The annual frequency of therapeutic nuclear medicine procedures increased from 0.131 to 0.430 per 1000 people in the intervening 12 years. In the 12 years before 2008, diagnostic and therapeutic procedures in nuclear medicine in Shanghai increased continuously, and the annual per capita dose doubled. Increases in PET imaging and bone scans were the major contributors to the increasing frequency and magnitude of radiation exposure to the population. The activities administered for most diagnostic procedures were generally consistent with the designated reference levels.

Direct and indirect costs among employees with diabetic retinopathy in the United States.

PubMed

Lee, Lauren J; Yu, Andrew P; Cahill, Kevin E; Oglesby, Alan K; Tang, Jackson; Qiu, Ying; Birnbaum, Howard G

2008-05-01

To examine, from the employer perspective, the direct (healthcare) and indirect (workloss) costs of employees with diabetic retinopathy (DR) compared to control non-DR employees with diabetes, and within DR subgroups. Compared annual costs using claims data from 17 large companies (1999-2004). 'DR employees' (n = 2098) had >or= 1 DR (International Classification of Disease, 9th Revision [ICD-9]) diagnosis; DR subgroups included employees with diabetic macular edema (DME), proliferative DR (PDR), and employees receiving photocoagulation or vitrectomy procedures. Descriptive and multivariate tests were performed. DR employee annual direct costs were $18,218 (indirect = $3548) compared to $11,898 (indirect = $2374) for controls (Delta = $2032 (adjusted); p < 0.0001). Costs differences were larger across DR employee subgroups: DME/non-DME ($28,606/$16,363); PDR/non-PDR ($30,135/$13,445; p < 0.0001); DR with/without photocoagulation ($34,539/$16,041; p < 0.0001); and DR with/without vitrectomy ($63,933/$17,239; p < 0.0001). This study examined the incremental costs of treating DR employees, which may be higher than the incremental costs of DR itself. Some measures of diabetes severity (e.g., duration of diabetes) were not available in the claims data, and were therefore not included in the multivariate models. The cost of photocoagulation and vitrectomy procedures pertain to individuals who underwent these procedures, and not the cost of the procedures themselves. DR employees had significantly higher costs than controls, and larger differences existed within DR subgroups. Indirect costs accounted for about 20% of total cost.

Comparison of three annual inventory designs, a periodic design, and a midcycle design

Treesearch

Stanford L. Arner

2000-01-01

Three annual inventory designs, a periodic design, and a periodic measurement with midcycle update design are compared using a population created from 14,754 remeasured Forest Inventory and Analysis plots. Two of the annual designs and the midcycle update design allow updating of plots using sampling with partial replacement procedures. Individual year and moving...

Issues related to panel creep

Treesearch

Paul C. Van Deusen

2002-01-01

The annual inventory system was designed under the assumption that a fixed percentage of plots would be measured annually in each State. The initial plan was to assign plots to panels to provide systematic coverage of a State. One panel would be measured each year to allow for annual updates of each State using simple estimation procedures. The reality is that...

Annual Systems Engineering Conference: Focusing on Improving Performance of Defense Systems Programs (10th). Volume 3. Thursday Presentations

DTIC Science & Technology

2007-10-25

the Phit <.0001 requirement) restricts tactical delivery conditions, the probability of a fragment hit may be further qualified by considering only...Pkill – UK uses “self damage” metric • Risk Analysis: “If the above procedures ( Phit or Pkill <.0001) still result in restricting tactical delivery...10 (From NAWCWD Briefing) 4 Safe Escape Analysis Requirements Calculate Phit ,Pkill, and Pdet Is Phit <= .0001 for all launch conditions Done NO YES

Psycho-Motor and Error Enabled Simulations Modeling Vulnerable Skills in the Pre-Mastery Phase - Medical Practice Initiative Procedural Skill Decay and Maintenance (MPI-PSD)

DTIC Science & Technology

2015-04-01

and execution of Performance Review Tool; Organization, coding, and transcribing of collected data; Analysis of qualitative survey and quantitative...University of Wisconsin System Madison, WI 53715-1218 REPORT DATE: April 2015 TYPE OF REPORT: Annual PREPARED FOR: U.S. Army Medical Research and...MONITOR’S ACRONYM(S) U.S. Army Medical Research and Material Command Fort Detrick, Maryland 21702-5012 11. SPONSOR/MONITOR’S REPORT NUMBER

The history of neurosurgery at the University of Alabama at Birmingham.

PubMed

Foreman, Paul M; Markert, James M; Diethelm, Arnold G; Hadley, Mark N

2014-10-01

: The Division of Neurosurgery at the University of Alabama at Birmingham was formally founded in 1954 under the leadership of James Garber Galbraith. The following 60 years would see neurosurgery at the forefront of the development of a nationally recognized medical center in the heart of Birmingham, Alabama. The Department of Neurosurgery now employs 14 faculty members, performs more than 4500 neurosurgical procedures annually, is active in clinical and laboratory research, and boasts a contemporary, comprehensive residency training program.

Basics of Hematopoietic Cell Transplantation for Primary Care Physicians and Internists.

PubMed

Hashmi, Shahrukh Khurshid

2016-12-01

More than 60,000 hematopoietic cell transplantations (HCTs) are annually performed worldwide to treat a variety of malignant and nonmalignant conditions. Although HCT is complicated and risky, a majority of the HCT recipients are surviving for many years post-transplant. This article presents the basics of transplantation, HCT types/stem cell sources, mobilization and conditioning procedures, indications for HCT, conditioning regimens, engraftment, graft-versus-host-disease, and survivorship issues. Copyright © 2016 Elsevier Inc. All rights reserved.

Use of artificial neural network for spatial rainfall analysis

NASA Astrophysics Data System (ADS)

Paraskevas, Tsangaratos; Dimitrios, Rozos; Andreas, Benardos

2014-04-01

In the present study, the precipitation data measured at 23 rain gauge stations over the Achaia County, Greece, were used to estimate the spatial distribution of the mean annual precipitation values over a specific catchment area. The objective of this work was achieved by programming an Artificial Neural Network (ANN) that uses the feed-forward back-propagation algorithm as an alternative interpolating technique. A Geographic Information System (GIS) was utilized to process the data derived by the ANN and to create a continuous surface that represented the spatial mean annual precipitation distribution. The ANN introduced an optimization procedure that was implemented during training, adjusting the hidden number of neurons and the convergence of the ANN in order to select the best network architecture. The performance of the ANN was evaluated using three standard statistical evaluation criteria applied to the study area and showed good performance. The outcomes were also compared with the results obtained from a previous study in the area of research which used a linear regression analysis for the estimation of the mean annual precipitation values giving more accurate results. The information and knowledge gained from the present study could improve the accuracy of analysis concerning hydrology and hydrogeological models, ground water studies, flood related applications and climate analysis studies.

First Annual Report: NASA-ONERA Collaboration on Human Factors in Aviation Accidents and Incidents

NASA Technical Reports Server (NTRS)

Srivastava, Ashok; Fabiani, Patrick

2012-01-01

This is the first annual report jointly prepared by NASA and ONERA on the work performed under the agreement to collaborate on a study of the human factors entailed in aviation accidents and incidents particularly focused on consequences of decreases in human performance associated with fatigue. The objective of this Agreement is to generate reliable, automated procedures that improve understanding of the levels and characteristics of flight-crew fatigue factors whose confluence will likely result in unacceptable crew performance. This study entails the analyses of numerical and textual data collected during operational flights. NASA and ONERA are collaborating on the development and assessment of automated capabilities for extracting operationally significant information from very large, diverse (textual and numerical) databases much larger than can be handled practically by human experts. This report presents the approach that is currently expected to be used in processing and analyzing the data for identifying decrements in aircraft performance and examining their relationships to decrements in crewmember performance due to fatigue. The decisions on the approach were based on samples of both the numerical and textual data that will be collected during the four studies planned under the Human Factors Monitoring Program (HFMP). Results of preliminary analyses of these sample data are presented in this report.

In-office diagnostic arthroscopy for knee and shoulder intra-articular injuries its potential impact on cost savings in the United States

PubMed Central

2014-01-01

Background The purpose of this analysis was to determine whether in office diagnostic needle arthroscopy (Visionscope Imaging System [VSI]) can provide for improved diagnostic assessment and; more cost effective care. Methods Data on arthroscopy procedures in the US for deep seated pathology in the knee and shoulder were used (Calendar Year 2012). These procedures represent approximately 25-30% of all arthroscopic procedures performed annually. Sensitivities, specificities, positive predictive, and negative predictive values for MRI analysis of this deep seated pathology from systematic reviews and meta-analyses were used in assessing for false positive and false negative MRI findings. The costs of performing diagnostic and surgical arthroscopy procedures (using 2013 Medicare reimbursement amounts); costs associated with false negative findings; and the costs for treating associated complications arising from diagnostic and therapeutic arthroscopy procedures were then assessed. Results In patients presenting with medial meniscal pathology (ICD9CM diagnosis 836.0 over 540,000 procedures in CY 2012); use of the VSI system in place of MRI assessment (standard of care) resulted in a net cost savings to the system of $151 million. In patients presenting with rotator cuff pathology (ICD9CM 840.4 over 165,000 procedures in CY2012); use of VSI in place of MRI similarly saved $59 million. These savings were realized along with more appropriate care as; fewer patients were exposed to higher risk surgical arthroscopic procedures. Conclusions The use of an in-office arthroscopy system can: possibly save the US healthcare system money; shorten the diagnostic odyssey for patients; potentially better prepare clinicians for arthroscopic surgery (when needed) and; eliminate unnecessary outpatient arthroscopy procedures, which commonly result in surgical intervention. PMID:24885678

Trends in Radical Prostatectomy: Centralization, Robotics, and Access to Urologic Cancer Care

PubMed Central

Stitzenberg, Karyn B.; Wong, Yu-Ning; Nielsen, Matthew E.; Egleston, Brian L.; Uzzo, Robert G.

2011-01-01

Background Robotic surgery has been widely adopted for radical prostatectomy. We hypothesize that this change is rapidly shifting procedures away from hospitals that do not offer robotics and consequently increasing patient travel. Methods A population-based observational study of all prostatectomies for cancer in NY, NJ, and PA from 2000–2009 was performed using hospital discharge data. Hospital procedure volume was defined as the number of prostatectomies performed for cancer in a given year. Straight-line travel distance to treating hospital was calculated for each case. Hospitals were contacted to determine year of acquisition of first robot. Results From 2000–2009, the total number of prostatectomies performed annually increased substantially. The increase occurred almost entirely at the very high volume centers (≥106 prostatectomies/year). The number of hospitals performing prostatectomy fell 37% from 2000–2009. By 2009, the 9% (21/244) of hospitals that had very high volume performed 57% of all prostatectomies, and the 35% (86/244) of hospitals with a robot performed 85% of all prostatectomies. Median travel increased 54% from 2000–2009, p<0.001. The proportion of patients traveling ≥15 miles increased from 24% to 40%, p<0.001. Conclusions Over the past decade, the number of radical prostatectomies performed has risen substantially. These procedures have been increasingly centralized at high volume centers, leading to longer patient travel distances. Few prostatectomies are now performed at hospitals that do not offer robotic surgery. Future work should focus on the impact of these trends on cancer control, functional outcomes, access to care and cost. PMID:21717436

Cost-Benefit Analysis of the Age One Dental Visit for the Privately Insured.

PubMed

Kolstad, Cecilia; Zavras, Athanasios; Yoon, Richard K

2015-01-01

The purpose of this study was to perform a cost-benefit analysis of the age one dental visit for privately insured patients. A major insurance company provided claims from various states submitted between 2006-2012. Data provided included numbers of procedures and respective costs from the first visit until age six years. Data was organized into five groups based on age, for which the first D0145/D0150 code was submitted [(1) age younger than one year old; (2) age one or older but younger than two years old; (3) age two or older but younger than three years old; (4) age three or older but younger than four years old; and (5) age four or older but younger than five years old]. The ratio of procedures per child and average costs per child were calculated. Claims for 94,574 children were analyzed; only one percent of these children had their first dental visit by age one. The annual cost for children who had their first dental visit by age one was significantly less than for children who waited until an older age. There is an annual cost benefit in establishing a dental home by age one for privately insured patients.

48 CFR 307.104 - General procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false General procedures. 307... ACQUISITION PLANNING ACQUISITION PLANNING Acquisition Planning 307.104 General procedures. (a) Each contracting activity shall prepare an Annual Acquisition Plan (AAP) as far in advance of each fiscal year as...

Hospital volume and the risk of revision in Oxford unicompartmental knee arthroplasty in the Nordic countries -an observational study of 14,496 cases.

PubMed

Badawy, Mona; Fenstad, Anne M; Bartz-Johannessen, Christoffer A; Indrekvam, Kari; Havelin, Leif I; Robertsson, Otto; W-Dahl, Annette; Eskelinen, Antti; Mäkelä, Keijo; Pedersen, Alma B; Schrøder, Henrik M; Furnes, Ove

2017-09-07

High procedure volume and dedication to unicompartmental knee arthroplasty (UKA) has been suggested to improve revision rates. This study aimed to quantify the annual hospital volume effect on revision risk in Oxfordu nicompartmental knee arthroplasty in the Nordic countries. 14,496 cases of cemented medial Oxford III UKA were identified in 126 hospitals in the four countries included in the Nordic Arthroplasty Register Association (NARA) database from 2000 to 2012. Hospitals were divided by quartiles into 4 annual procedure volume groups (≤11, 12-23, 24-43 and ≥44). The outcome was revision risk after 2 and 10 years calculated using Kaplan Meier method. Multivariate Cox regression analysis was used to assess the Hazard Ratio (HR) of any revision due to specific reasons with 95% confidence intervals (CI). The implant survival was 80% at 10 years in the volume group ≤11 procedures per year compared to 83% in other volume groups. The HR adjusted for age category, sex, year of surgery and nation was 0.87 (95% CI: 0.76-0.99, p = 0.036) for the group 12-23 procedures per year, 0.78 (95% CI: 0.68-0.91, p = 0.002) for the group 24-43 procedures per year and 0.82 (95% CI: 0.70-0.94, p = 0.006) for the group ≥44 procedures per year compared to the low volume group. Log-rank test was p = 0.003. The risk of revision for unexplained pain was 40-50% higher in the low compared with other volume groups. Low volume hospitals performing ≤11 Oxford III UKAs per year were associated with an increased risk of revision compared to higher volume hospitals, and unexplained pain as revision cause was more common in low volume hospitals.

Cosmetic surgery procedures as luxury goods: measuring price and demand in facial plastic surgery.

PubMed

Alsarraf, Ramsey; Alsarraf, Nicole W; Larrabee, Wayne F; Johnson, Calvin M

2002-01-01

To evaluate the relationship between cosmetic facial plastic surgery procedure price and demand, and to test the hypothesis that these procedures function as luxury goods in the marketplace, with an upward-sloping demand curve. Data were derived from a survey that was sent to every (N = 1727) active fellow, member, or associate of the American Academy of Facial Plastic and Reconstructive Surgery, assessing the costs and frequency of 4 common cosmetic facial plastic surgery procedures (face-lift, brow-lift, blepharoplasty, and rhinoplasty) for 1999 and 1989. An economic analysis was performed to assess the relationship of price and demand for these procedures. A significant association was found between increasing surgeons' fees and total charges for cosmetic facial plastic surgery procedures and increasing demand for these procedures, as measured by their annual frequency (P

40 CFR 63.9816 - What records must I keep?

Code of Federal Regulations, 2010 CFR

2010-07-01

... with a catalytic oxidizer, records of annual checks of catalyst activity levels and subsequent... approved alternative monitoring method(s) or test procedure(s). (8) Records of maintenance activities and...

40 CFR 63.9816 - What records must I keep?

Code of Federal Regulations, 2011 CFR

2011-07-01

... with a catalytic oxidizer, records of annual checks of catalyst activity levels and subsequent... approved alternative monitoring method(s) or test procedure(s). (8) Records of maintenance activities and...

Congenital heart surgery: surgical performance according to the Aristotle complexity score.

PubMed

Arenz, Claudia; Asfour, Boulos; Hraska, Viktor; Photiadis, Joachim; Haun, Christoph; Schindler, Ehrenfried; Sinzobahamvya, Nicodème

2011-04-01

Aristotle score methodology defines surgical performance as 'complexity score times hospital survival'. We analysed how this performance evolved over time and in correlation with case volume. Aristotle basic and comprehensive complexity scores and corresponding basic and comprehensive surgical performances were determined for primary (main) procedures carried out from 2006 to 2009. Surgical case volume performance described as unit performance was estimated as 'surgical performance times the number of primary procedures'. Basic and comprehensive complexity scores for the whole cohort of procedures (n=1828) were 7.74±2.66 and 9.89±3.91, respectively. With an early survival of 97.5% (1783/1828), mean basic and comprehensive surgical performances reached 7.54±2.54 and 9.64±3.81, respectively. Basic surgical performance varied little over the years: 7.46±2.48 in 2006, 7.43±2.58 in 2007, 7.50±2.76 in 2008 and 7.79±2.54 in 2009. Comprehensive surgical performance decreased from 9.56±3.91 (2006) to 9.22±3.94 (2007), and then to 9.13±3.77 (2008), thereafter increasing up to 10.62±3.67 (2009). No significant change of performance was observed for low comprehensive complexity levels 1-3. Variation concerned level 4 (p=0.048) which involved the majority of procedures (746, or 41% of cases) and level 6 (p<0.0001) which included a few cases (20, or 1%), whereas for level 5, statistical significance was almost attained: p=0.079. With a mean annual number of procedures of 457, mean basic and comprehensive unit performance was estimated at 3447±362 and 4405±577, respectively. Basic unit performance increased year to year from 3036 (2006, 100%) to 3254 (2007, 107.2%), then 3720 (2008, 122.5%), up to 3793 (2009, 124.9%). Comprehensive unit performance also increased: from 3891 (2006, 100%) to 4038 (2007, 103.8%), 4528 (2008, 116.4%) and 5172 (2009, 132.9%). Aristotle scoring of surgical performance allows quality assessment of surgical management of congenital heart disease over time. The newly defined unit performance appears to well reflect the trend of activity and efficiency of a congenital heart surgery department. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

78 FR 49607 - Energy Conservation Program: Test Procedures for Residential Clothes Dryers

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-14

... reasonably designed to produce test results which measure energy efficiency, energy use or estimated annual... Energy Conservation Program: Test Procedures for Residential Clothes Dryers; Final Rule #0;#0;Federal... Conservation Program: Test Procedures for Residential Clothes Dryers AGENCY: Office of Energy Efficiency and...

Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre.

PubMed

Schroeder, R P J; Chrzan, R J; Klijn, A J; Kuijper, C F; Dik, P; de Jong, T P V M

2015-10-01

Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS procedures performed in the low-volume specialty of paediatric urology will offer insufficient training potential for surgeons. To assess the MIS training potential of a highly specialized, tertiary care, paediatric urology training centre that has been accredited by the Joint Committee of Paediatric Urology (JCPU). The clinical activity of the department was retrospectively reviewed by extracting the annual number of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative procedures (nephrectomy) and reconstructive procedures (pyeloplasty) were analysed with reference to the patients' ages. The centre policy is not to perform major MIS in children who are under 2 years old or who weigh less than 12 kg. Every year, this institution provides approximately 4300 out-patient consultations, 600 admissions, and 1300 procedures under general anaesthesia for children with urological problems. In 2012, 35 patients underwent major intricate MIS: 16 pyeloplasties, eight nephrectomies and 11 operations for incontinence (seven Burch, and four bladder neck procedures). In children ≥2 years of age, 16/21 of the pyeloplasties and 8/12 of the nephrectomies were performed laparoscopically. The remaining MIS procedures included 25 orchidopexies and one intravesical ureteral reimplantation. There is no consensus on how to assess laparoscopic training. It would be valuable to reach a consensus on a standardized laparoscopic training programme in paediatric urology. Often training potential is based on operation numbers only. In paediatric urology no minimum requirement has been specified. The number of procedures quoted for proficiency in MIS remains controversial. The MIS numbers for this centre correspond to, or exceed, numbers mentioned in other literature. To provide high-quality MIS training, exposure to laparoscopic procedures should be expanded. This may be achieved by centralizing patients into a common centre, collaborating with other specialities, modular training and training outside the operating theatre. Even in a high-volume, paediatric urology educational centre, the number of major MIS procedures performed remains relatively low, leading to limited training potential. Copyright © 2015. Published by Elsevier Ltd.

Analyses of flood-flow frequency for selected gaging stations in South Dakota

USGS Publications Warehouse

Benson, R.D.; Hoffman, E.B.; Wipf, V.J.

1985-01-01

Analyses of flood flow frequency were made for 111 continuous-record gaging stations in South Dakota with 10 or more years of record. The analyses were developed using the log-Pearson Type III procedure recommended by the U.S. Water Resources Council. The procedure characterizes flood occurrence at a single site as a sequence of annual peak flows. The magnitudes of the annual peak flows are assumed to be independent random variables following a log-Pearson Type III probability distribution, which defines the probability that any single annual peak flow will exceed a specified discharge. By considering only annual peak flows, the flood-frequency analysis becomes the estimation of the log-Pearson annual-probability curve using the record of annual peak flows at the site. The recorded data are divided into two classes: systematic and historic. The systematic record includes all annual peak flows determined in the process of conducting a systematic gaging program at a site. In this program, the annual peak flow is determined for each and every year of the program. The systematic record is intended to constitute an unbiased and representative sample of the population of all possible annual peak flows at the site. In contrast to the systematic record, the historic record consists of annual peak flows that would not have been determined except for evidence indicating their unusual magnitude. Flood information acquired from historical sources almost invariably refers to floods of noteworthy, and hence extraordinary, size. Although historic records form a biased and unrepresentative sample, they can be used to supplement the systematic record. (Author 's abstract)

Systematic influences of gamma-ray spectrometry data near the decision threshold for radioactivity measurements in the environment.

PubMed

Zorko, Benjamin; Korun, Matjaž; Mora Canadas, Juan Carlos; Nicoulaud-Gouin, Valerie; Chyly, Pavol; Blixt Buhr, Anna Maria; Lager, Charlotte; Aquilonius, Karin; Krajewski, Pawel

2016-07-01

Several methods for reporting outcomes of gamma-ray spectrometric measurements of environmental samples for dose calculations are presented and discussed. The measurement outcomes can be reported as primary measurement results, primary measurement results modified according to the quantification limit, best estimates obtained by the Bayesian posterior (ISO 11929), best estimates obtained by the probability density distribution resembling shifting, and the procedure recommended by the European Commission (EC). The annual dose is calculated from the arithmetic average using any of these five procedures. It was shown that the primary measurement results modified according to the quantification limit could lead to an underestimation of the annual dose. On the other hand the best estimates lead to an overestimation of the annual dose. The annual doses calculated from the measurement outcomes obtained according to the EC's recommended procedure, which does not cope with the uncertainties, fluctuate between an under- and overestimation, depending on the frequency of the measurement results that are larger than the limit of detection. In the extreme case, when no measurement results above the detection limit occur, the average over primary measurement results modified according to the quantification limit underestimates the average over primary measurement results for about 80%. The average over best estimates calculated according the procedure resembling shifting overestimates the average over primary measurement results for 35%, the average obtained by the Bayesian posterior for 85% and the treatment according to the EC recommendation for 89%. Copyright © 2016 Elsevier Ltd. All rights reserved.

High-temperature thermal treatment of the uterus

NASA Astrophysics Data System (ADS)

Ryan, Thomas P.; Xiao, Jia Hua; Chung, Juh Yun

2003-06-01

More than 200,000 hysterectomies are performed annually in the US due to abnormal uterine bleeding from excessive menstrual flow. A minimally invasive procedure has been developed using thermal treatment combined with pressure to the endometrial lining of the uterus. Results from a 3-D finite element model will be shown, as well as experimental data. Good correlation was seen between simulations and experiments. The study found similar results then temperatures were increased and times for treatment were shortened.More than 200,000 hysterectomies are performed annually in the US due to abnormal uterine bleeding from excessive menstrual flow. A minimally invasive procedure has been developed using a balloon-based thermal treatment combined with pressure to the endometrial lining of the uterus. A 3D finite element model was set up to simulate the balloon ablation device in the human uterus as used in over 150,000 patients to date. Several additional simulations were made at higher temperatures to seek alternative combinations with higher temperature and shorter time intervals for the same depth of penetration, or deeper penetration at longer times and elevated temperatures. A temperature range of 87 to 150°C was explored. The Bioheat Equation was used in the simulations to predict temperature distributions in tissue. The Damage Integral was also used to characterize the location at depth of irreversible damage in the uterus. Treatment safety issues were also analyzed as the simulations showed the depth of penetration into the myometrium, towards the serosa.

Suggested revisions to the annual highway safety work program in Virginia.

DOT National Transportation Integrated Search

1976-01-01

This paper describes some suggested revisions in the format of and method and procedures for compiling the Annual Highway Safety Work Program (AHSWP) required of the states by the National Highway Traffic Safety Administration (NHTSA). Prior to fisca...

Hospitals with greater diversities of physiologically complex procedures do not achieve greater surgical growth in a market with stable numbers of such procedures.

PubMed

Dexter, Franklin; Epstein, Richard H; Lubarsky, David A

2018-05-01

Although having a large diversity of types of procedures has a substantial operational impact on the surgical suites of hospitals, the strategic importance is unknown. In the current study, we used longitudinal data for all hospitals and patient ages in the State of Florida to evaluate whether hospitals with greater diversity of types of physiologically complex major therapeutic procedures (PCMTP) also had greater rates of surgical growth. Observational cohort study. 1479 combinations of hospitals in the State of Florida and fiscal years, 2008-2015. The types of International Classification of Diseases, Ninth revision, Clinical Modification (ICD-9-CM) procedures studied were PCMT, defined as: a) major therapeutic procedure; b) >7 American Society of Anesthesiologists base units; and c) performed during a hospitalization with a Diagnosis Related Group with a mean length of stay ≥4.0days. The number of procedures of each type of PCMTP commonly performed at each hospital was calculated by taking 1/Herfindahl index (i.e., sum of the squares of the proportions of all procedures of each type of PCMTP). Over the 8 successive years studied, there was no change in the number of PCMTP being performed (Kendall's τ b =-0.014±0.017 [standard error], P=0.44; N=1479 hospital×years). Busier and larger hospitals commonly performed more types of PCMTP, respectively categorized based on performed PCMTP (τ=0.606±0.017, P<0.0001) or hospital beds (τ=0.524±0.017, P<0.0001). There was no association between greater diversity of types of PCMTP commonly performed and greater annual growth in numbers of PCMTP (τ=0.002±0.019, P=0.91; N=1295 hospital×years). Conclusions were the same with multiple sensitivity analyses. Post hoc, it was recognized that hospitals performing a greater diversity of PCMTP were more similar to the aggregate of other hospitals within the same health district (τ=0.550±0.017, P<0.0001). During a period with no overall growth in PCMTP, hospitals with greater diversities of types of PCMTP had growth that was, at most, minimally larger than that of the smaller hospitals, and vice-versa. Diversity is important operationally. From the perspective of delivering surgical care within a market, the unique contributions of each large teaching hospital performing many different types of PCMTP needs to be considered relative to the combined capabilities of other hospitals in its region. Copyright © 2018 Elsevier Inc. All rights reserved.

42 CFR 485.725 - Condition of participation: Infection control.

Code of Federal Regulations, 2010 CFR

2010-10-01

... procedures for effective aseptic techniques. The procedures are reviewed annually and revised if necessary to... handled, stored, processed, and transported in such a manner as to prevent the spread of infection. (e...

25 CFR 30.116 - If a school fails to achieve its annual measurable objectives, what other methods may it use to...

Code of Federal Regulations, 2011 CFR

2011-04-01

... participated in the assessment. (b) Method B—Uniform Averaging Procedure. A school may use uniform averaging... 25 Indians 1 2011-04-01 2011-04-01 false If a school fails to achieve its annual measurable... Adequate Yearly Progress § 30.116 If a school fails to achieve its annual measurable objectives, what other...

25 CFR 30.116 - If a school fails to achieve its annual measurable objectives, what other methods may it use to...

Code of Federal Regulations, 2012 CFR

2012-04-01

... participated in the assessment. (b) Method B—Uniform Averaging Procedure. A school may use uniform averaging... 25 Indians 1 2012-04-01 2011-04-01 true If a school fails to achieve its annual measurable... Adequate Yearly Progress § 30.116 If a school fails to achieve its annual measurable objectives, what other...

25 CFR 30.116 - If a school fails to achieve its annual measurable objectives, what other methods may it use to...

Code of Federal Regulations, 2013 CFR

2013-04-01

... participated in the assessment. (b) Method B—Uniform Averaging Procedure. A school may use uniform averaging... 25 Indians 1 2013-04-01 2013-04-01 false If a school fails to achieve its annual measurable... Adequate Yearly Progress § 30.116 If a school fails to achieve its annual measurable objectives, what other...

25 CFR 30.116 - If a school fails to achieve its annual measurable objectives, what other methods may it use to...

Code of Federal Regulations, 2010 CFR

2010-04-01

... participated in the assessment. (b) Method B—Uniform Averaging Procedure. A school may use uniform averaging... 25 Indians 1 2010-04-01 2010-04-01 false If a school fails to achieve its annual measurable... Adequate Yearly Progress § 30.116 If a school fails to achieve its annual measurable objectives, what other...

25 CFR 30.116 - If a school fails to achieve its annual measurable objectives, what other methods may it use to...

Code of Federal Regulations, 2014 CFR

2014-04-01

... participated in the assessment. (b) Method B—Uniform Averaging Procedure. A school may use uniform averaging... 25 Indians 1 2014-04-01 2014-04-01 false If a school fails to achieve its annual measurable... Adequate Yearly Progress § 30.116 If a school fails to achieve its annual measurable objectives, what other...

Annual national direct and indirect cost estimates of the prevention and treatment of cervical cancer in Brazil

PubMed Central

Novaes, Hillegonda Maria Dutilh; Itria, Alexander; Silva, Gulnar Azevedo e; Sartori, Ana Marli Christovam; Rama, Cristina Helena; de Soárez, Patrícia Coelho

2015-01-01

OBJECTIVE: To estimate the annual direct and indirect costs of the prevention and treatment of cervical cancer in Brazil. METHODS: This cost description study used a "gross-costing" methodology and adopted the health system and societal perspectives. The estimates were grouped into sets of procedures performed in phases of cervical cancer care: the screening, diagnosis and treatment of precancerous lesions and the treatment of cervical cancer. The costs were estimated for the public and private health systems, using data from national health information systems, population surveys, and literature reviews. The cost estimates are presented in 2006 USD. RESULTS: From the societal perspective, the estimated total costs of the prevention and treatment of cervical cancer amounted to USD $1,321,683,034, which was categorized as follows: procedures (USD $213,199,490), visits (USD $325,509,842), transportation (USD $106,521,537) and productivity losses (USD $676,452,166). Indirect costs represented 51% of the total costs, followed by direct medical costs (visits and procedures) at 41% and direct non-medical costs (transportation) at 8%. The public system represented 46% of the total costs, and the private system represented 54%. CONCLUSION: Our national cost estimates of cervical cancer prevention and treatment, indicating the economic importance of cervical cancer screening and care, will be useful in monitoring the effect of the HPV vaccine introduction and are of interest in research and health care management. PMID:26017797

Financial impact of emergency department ultrasound.

PubMed

Soremekun, Olanrewaju A; Noble, Vicki E; Liteplo, Andrew S; Brown, David F M; Zane, Richard D

2009-07-01

There is limited information on the financial implications of an emergency department ultrasound (ED US) program. The authors sought to perform a fiscal analysis of an integrated ED US program. A retrospective review of billing data was performed for fiscal year (FY) 2007 for an urban academic ED with an ED US program. The ED had an annual census of 80,000 visits and 1,101 ED trauma activations. The ED is a core teaching site for a 4-year emergency medicine (EM) residency, has 35 faculty members, and has 24-hour availability of all radiology services including formal US. ED US is utilized as part of evaluation of all trauma activations and for ED procedures. As actual billing charges and reimbursement rates are institution-specific and proprietary information, relative value units (RVUs) and reimbursement based on the Centers for Medicare & Medicaid Services (CMS) 2007 fee schedule (adjusted for fixed diagnosis-related group [DRG] payments and bad debt) was used to determine revenue generated from ED US. To estimate potential volume, assumptions were made on improvement in documentation rate for diagnostic scans (current documentation rates based on billed volume versus diagnostic studies in diagnostic image database), with no improvements assumed for procedural ED US. Expenses consist of three components-capital costs, training costs, and ongoing operational costs-and were determined by institutional experience. Training costs were considered sunken expenses by this institution and were thus not included in the original return on investment (ROI) calculation, although for this article a second ROI calculation was done with training cost estimates included. For the purposes of analysis, certain key assumptions were made. We utilized a collection rate of 45% and hospitalization rates (used to adjust for fixed DRG payments) of 33% for all diagnostic scans, 100% for vascular access, and 10% for needle placement. An optimal documentation rate of 95% was used to estimate potential revenue. In FY 2007, 486 limited echo exams of abdomen (current procedural terminology [CPT] 76705) and 480 limited echo cardiac exams were performed (CPT 93308) while there were 78 exams for US-guided vascular access (CPT 76937) and 36 US-guided needle placements when performing paracentesis, thoracentesis, or location of abscess for drainage (CPT 76492). Applying the 2007 CMS fee schedule and above assumptions, the revenue generated was 578 RVUs and $35,541 ($12,934 in professional physician fees and $22,607 in facility fees). Assuming optimal documentation rates for diagnostic ED US scans, ED US could have generated 1,487 RVUs and $94,593 ($33,953 in professional physician fees and $60,640 in facility fees). Program expenses include an initial capital expense (estimated at $120,000 for two US machines) and ongoing operational costs ($68,640 per year to cover image quality assurance review, continuing education, and program maintenance). Based on current revenue, there would be an annual operating loss, and thus an ROI cannot be calculated. However, if potential revenue is achieved, the annual operating income will be $22,846 per year with an ROI of 4.9 years to break even with initial investment. Determining an ROI is a required procedure for any business plan for establishing an ED US program. Our analysis demonstrates that an ED US program that captures charges for trauma and procedural US and achieves the potential billing volume breaks even in less than 5 years, at which point it would generate a positive margin.

Research for Progress in Education. Annual Report: Fiscal Year 1970.

ERIC Educational Resources Information Center

National Center for Educational Research and Development (DHEW/OE), Washington, DC.

This annual report begins with a brief overview of cooperative research objectives and background. The five major sections are 1) "Cooperative Research Authorization" including the basic authorizations and subsequent amendments; 2) "Management Policies and Procedures;" 3) "Definitions and Distinctions" covering major…

10 CFR 205.325 - Annual report.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 3 2011-01-01 2011-01-01 false Annual report. 205.325 Section 205.325 Energy DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports... Construction, Connection, Operation, and Maintenance of Facilities for Transmission of Electric Energy at...

The economic impact of rural family physicians practicing obstetrics.

PubMed

Avery, Daniel M; Hooper, Dwight E; McDonald, John T; Love, Michael W; Tucker, Melanie T; Parton, Jason M

2014-01-01

The economic impact of a family physician practicing family medicine in rural Alabama is $1,000,000 a year in economic benefit to the community. The economic benefit of those rural family physicians practicing obstetrics has not been studied. This study was designed to determine whether there was any added economic benefit of rural family physicians practicing obstetrics in rural, underserved Alabama. The Alabama Family Practice Rural Health Board has funded the University of Alabama Family Medicine Obstetrics Fellowship since its beginning in 1986. Family medicine obstetrics fellowship graduates who practice obstetrics in rural, underserved areas were sent questionnaires and asked to participate in the study. The questions included the most common types and average annual numbers of obstetrics/gynecological procedures they performed. Ten physicians, or 77% of the graduates asked to participate in the study, returned the questionnaire. Fourteen common obstetrics/gynecological procedures performed by the graduates were identified. A mean of 115 deliveries were performed. The full-time equivalent reduction in family medicine time to practice obstetrics was 20%. A family physician practicing obstetrics in a rural area adds an additional $488,560 in economic benefit to the community in addition to the $1,000,000 from practicing family medicine, producing a total annual benefit of $1,488,560. The investment of $616,385 from the Alabama Family Practice Rural Health Board resulted in a $399 benefit to the community for every dollar invested. The cumulative effect of fellowship graduates practicing both family medicine and obstetrics in rural, underserved areas over the 26 years studied was $246,047,120. © Copyright 2014 by the American Board of Family Medicine.

Specialization and utilization after hepatectomy in academic medical centers.

PubMed

Shaw, Joshua J; Santry, Heena P; Shah, Shimul A

2013-11-01

Specialized procedures such as hepatectomy are performed by a variety of specialties in surgery. We aimed to determine whether variation exists among utilization of resources, cost, and patient outcomes by specialty, surgeon case volume, and center case volume for hepatectomy. We queried centers (n = 50) in the University Health Consortium database from 2007-2010 for patients who underwent elective hepatectomy in which specialty was designated general surgeon (n = 2685; 30%) or specialist surgeon (n = 6277; 70%), surgeon volume was designated high volume (>38 cases annually) and center volume was designated high volume (>100 cases annually). We then stratified our cohort by primary diagnosis, defined as primary tumor (n = 2241; 25%), secondary tumor (n = 5466; 61%), and benign (n = 1255; 14%). Specialist surgeons performed more cases for primary malignancy (primary 26% versus 15%) while general surgeons operated more for secondary malignancies (67% versus 61%) and benign disease (18% versus 13%). Specialists were associated with a shorter total length of stay (LOS) (5 d versus 6 d; P < 0.01) and lower in-hospital morbidity (7% versus 11%; P < 0.01). Patients treated by high volume surgeons or at high volume centers were less likely to die than those treated by low volume surgeons or at low volume centers, (OR 0.55; 95% CI 0.33-0.89) and (OR 0.44; 95% CI 0.13-0.56). Surgical specialization, surgeon volume and center volume may be important metrics for quality and utilization in complex procedures like hepatectomy. Further studies are necessary to link direct factors related to hospital performance in the changing healthcare environment. Copyright © 2013 Elsevier Inc. All rights reserved.

Autotransplantation of third molars as treatment in advanced periodontal disease.

PubMed

Kristerson, L; Johansson, L A; Kisch, J; Stadler, L E

1991-08-01

The aim of this study was to investigate the prognosis of replacing molars with advanced periodontitis by autotransplanted fully developed third molars. The patient sample consisted of 18 subjects, 24-58 years of age. The patients selected had at least 1 molar with advanced periodontal tissue destruction. After extraction of the diseased molar, autotransplantation of a third molar was immediately performed. After a splinting and healing period of 2-3 weeks, endodontic treatment was carried out. The follow-up included recordings of the clinical parameters, probing periodontal pocket depth, probing attachment level, percussion sound, and mobility. Radiographs were taken immediately after the surgical procedure, after 6 months, 1 year, and thereafter annually. The results of this study indicate that autotransplantation may be an alternative treatment procedure for molars with advanced periodontal disease.

[Cost analysis for navigation in knee endoprosthetics].

PubMed

Cerha, O; Kirschner, S; Günther, K-P; Lützner, J

2009-12-01

Total knee arthroplasty (TKA) is one of the most frequent procedures in orthopaedic surgery. The outcome depends on a range of factors including alignment of the leg and the positioning of the implant in addition to patient-associated factors. Computer-assisted navigation systems can improve the restoration of a neutral leg alignment. This procedure has been established especially in Europe and North America. The additional expenses are not reimbursed in the German DRG system (Diagnosis Related Groups). In the present study a cost analysis of computer-assisted TKA compared to the conventional technique was performed. The acquisition expenses of various navigation systems (5 and 10 year depreciation), annual costs for maintenance and software updates as well as the accompanying costs per operation (consumables, additional operating time) were considered. The additional operating time was determined on the basis of a meta-analysis according to the current literature. Situations with 25, 50, 100, 200 and 500 computer-assisted TKAs per year were simulated. The amount of the incremental costs of the computer-assisted TKA depends mainly on the annual volume and the additional operating time. A relevant decrease of the incremental costs was detected between 50 and 100 procedures per year. In a model with 100 computer-assisted TKAs per year an additional operating time of 14 mins and a 10 year depreciation of the investment costs, the incremental expenses amount to 300-395 depending on the navigation system. Computer-assisted TKA is associated with additional costs. From an economical point of view an amount of more than 50 procedures per year appears to be favourable. The cost-effectiveness could be estimated if long-term results will show a reduction of revisions or a better clinical outcome.

77 FR 8724 - Natural Gas Pipelines; Project Cost and Annual Limits

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-15

...] Natural Gas Pipelines; Project Cost and Annual Limits February 9, 2012. AGENCY: Federal Energy Regulatory... limits for natural gas pipelines blanket construction certificates for each calendar year. DATES: This... CFR Part 157 Administrative practice and procedure, Natural gas, Reporting and recordkeeping...

Single-incision laparoscopic cholecystectomy: a systematic review of methodology and outcomes.

PubMed

Yamazaki, Masato; Yasuda, Hideki; Koda, Keiji

2015-05-01

(1) To survey the dissemination of SILC; (2) to determine which SILC method has become mainstream; (3) to determine whether the characteristic complications vary according to the type of procedure. An electronic search of PubMed, Databases@Ovid, and SciVerse Scopus between 2003/01/01 and 2012/12/31 was performed. The peak number of annually published articles was 70 in 2011. The most common procedures were single skin incision, the use of a SILS Port(®), suture suspension and a 5-mm oblique scope. The intraoperative complications rate was 1.69 %. Postoperative complications occurred in 213/5283 cases. According to the surgical procedure, five factors (approach; P = 0.0017, gallbladder anchorage; P < 0.001, size; P = 0.049 and type; P < 0.001 of the scope, and size of the clip applier; P = 0.074) significantly affected the incidence of wound infection. The incidence of wound seroma/bleeding was significantly influenced by gallbladder anchorage (P = 0.009), the use of curved/articulated instruments (P = 0.048), and the diameter of the clip applier (P < 0.001). To determine the best operative procedure for SILC, an analysis of uniform operative procedures is needed.

The Association of Unfavorable Outcomes with the Intensity of Neurosurgical Care in the United States

PubMed Central

2014-01-01

Object There is wide regional variability in the volume of procedures performed for similar surgical patients throughout the United States. We investigated the association of the intensity of neurosurgical care (defined as the average annual number of neurosurgical procedures per capita) with mortality, length of stay (LOS), and rate of unfavorable discharge for inpatients after neurosurgical procedures. Methods We performed a retrospective cohort study involving the 202,518 patients who underwent cranial neurosurgical procedures from 2005–2010 and were registered in the National Inpatient Sample (NIS) database. Regression techniques were used to investigate the association of the average intensity of neurosurgical care with the average mortality, LOS, and rate of unfavorable discharge. Results The inpatient neurosurgical mortality, rate of unfavorable discharge, and average LOS varied significantly among several states. In a multivariate analysis male gender, coverage by Medicaid, and minority racial status were associated with increased mortality, rate of unfavorable discharge, and LOS. The opposite was true for coverage by private insurance, higher income, fewer comorbidities and small hospital size. There was no correlation of the intensity of neurosurgical care with the mortality (Pearson's ρ = −0.18, P = 0.29), rate of unfavorable discharge (Pearson's ρ = 0.08, P = 0.62), and LOS of cranial neurosurgical procedures (Pearson's ρ = −0.21, P = 0.22). Conclusions We observed significant disparities in mortality, LOS, and rate of unfavorable discharge for cranial neurosurgical procedures in the United States. Increased intensity of neurosurgical care was not associated with improved outcomes. PMID:24647225

Prospective Study of Combined Colon and Endometrial Cancer Screening in Women With Lynch Syndrome: A Patient-Centered Approach

PubMed Central

Huang, Marilyn; Sun, Charlotte; Boyd-Rogers, Stephanie; Burzawa, Jennifer; Milbourne, Andrea; Keeler, Elizabeth; Yzquierdo, Rebecca; Lynch, Patrick; Peterson, Susan K.; Lu, Karen

2011-01-01

Background: Endometrial and colorectal cancers are the most common cancers in Lynch syndrome. Consensus guidelines recommend annual endometrial biopsy (EMB) and regular colonoscopies. We assessed the feasibility of concurrently performing EMB and colonoscopy and evaluated women's perception of pain, satisfaction, and acceptability. Methods: From July 2002 to December 2009, women who had a gene mutation for Lynch syndrome, met the Amsterdam II criteria, or had a high-risk situation that required screening were prospectively enrolled. After conscious sedation, the procedures were sequentially performed. Patients completed pre- and postprocedure questionnaires assessing pain, level of satisfaction, and acceptability. The Wilcoxon rank test and Mann-Whitney test were used to compare pain scores. Results: Forty-two women completed the study. Median age was 37 years (range, 25 to 73). Nineteen had previously had an EMB in the office setting. Women reported significantly lower median levels of pain in the combined procedure compared with previous office setting biopsies (P < .001). Regardless of parity, women reported significantly less pain for an EMB as part of the combined screen compared with an office EMB (parous, P = .003; nulliparous, P = .026). Women also reported a high level of satisfaction and more convenience in the combined procedure. All participants preferred combined to separately scheduled procedures and would recommend the combined procedure to their relatives. Conclusion: Combined colon and endometrial cancer screening is a patient-centered approach that is feasible, acceptable, and may improve adherence to Lynch syndrome screening recommendations. PMID:21532810

48 CFR 28.104 - Annual performance bonds.

Code of Federal Regulations, 2010 CFR

2010-10-01

... CONTRACTING REQUIREMENTS BONDS AND INSURANCE Bonds and Other Financial Protections 28.104 Annual performance bonds. (a) Annual performance bonds only apply to non-construction contracts. They shall provide a gross... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Annual performance bonds...

Impact of HPV testing, HPV vaccine development, and changing screening frequency on national Pap test volume: projections from the National Health Interview Survey (NHIS).

PubMed

Eltoum, Isam A; Roberson, Janie

2007-02-25

The frequently cited number of 50 million annual Papanicolaou cervical screening (Pap) tests performed in the US was based on the National Health Interview Survey (NHIS) of the 1980s. Since then, monumental changes have occurred. More change will soon follow when primary human papilloma virus (HPV) testing and/or HPV vaccine delivery are fully accepted and implemented. The objectives of this study were 1) to estimate the total annual Pap tests performed in the US based on recent NHIS surveys, and 2) to estimate the potential change in the total annual Pap volume produced by changing demographics, reduced screening frequency, HPV testing, and the HPV vaccine. In the NHIS 2000 and NHIS 2005, women were asked to report the frequency of their Pap tests for the 6 years prior to the interview and to report whether they had abnormal findings. The authors analyzed the survey respondents answers to these questions by using SAS Survey Procedures (SAS Institute, NC). The results were stratified by age, and the total national volume was then extrapolated from a similarly stratified 2000 US census. The projected increase of total Pap tests for the next 25 years was determined by using the projected census data. Potential reductions of Pap tests performed secondarily to HPV testing of women >30 years old and of HPV vaccination were also determined. Based on NHIS 2000 and NHIS 2005, 66 million (95% CI, 65-68) and 65 million (95% CI, 64-67) Pap tests were performed in the US, respectively. Had HPV testing been performed in women older than 30 years who had both negative HPV and negative 3-year Pap tests, then 30% (95% CI, 29-32%) of Pap tests would not have been performed. If both HPV testing and vaccination are performed, the total number of Pap tests performed annually is predicted to be reduced by 43% (95% CI, 35-38%). Therefore, despite an expected increase in the population of women eligible for Pap tests, the total number will likely decrease substantially in the future. This, in turn, will decrease the demand for a traditionally trained cytotechnology workforce. (c) 2007 American Cancer Society.

77 FR 65740 - Self-Regulatory Organizations; BATS Exchange, Inc.; Notice of Filing of Proposed Rule Change To...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-30

... written policies and procedures reasonably designed to prevent violation, by the investment adviser and...) implemented, at a minimum, an annual review regarding the adequacy of the policies and procedures established... individual (who is a supervised person) responsible for administering the policies and procedures adopted...

Economic Implications of Widespread Expansion of Frozen Section Margin Analysis to Guide Surgical Resection in Women With Breast Cancer Undergoing Breast-Conserving Surgery.

PubMed

Boughey, Judy C; Keeney, Gary L; Radensky, Paul; Song, Christine P; Habermann, Elizabeth B

2016-04-01

In the current health care environment, cost effectiveness is critically important in policy setting and care of patients. This study performed a health economic analysis to assess the implications to providers and payers of expanding the use of frozen section margin analysis to minimize reoperations for patients undergoing breast cancer lumpectomy. A health care economic impact model was built to assess annual costs associated with breast lumpectomy procedures with and without frozen section margin analysis to avoid reoperation. If frozen section margin analysis is used in 20% of breast lumpectomies and under a baseline assumption that 35% of initial lumpectomies without frozen section analysis result in reoperations, the potential annual cost savings are $18.2 million to payers and $0.4 million to providers. Under the same baseline assumption, if 100% of all health care facilities adopted the use of frozen section margin analysis for breast lumpectomy procedures, the potential annual cost savings are $90.9 million to payers and $1.8 million to providers. On the basis of 10,000 simulations, use of intraoperative frozen section margin analysis yields cost saving for payers and is cost neutral to slightly cost saving for providers. This economic analysis indicates that widespread use of frozen section margin evaluation intraoperatively to guide surgical resection in breast lumpectomy cases and minimize reoperations would be beneficial to cost savings not only for the patient but also for payers and, in most cases, for providers. Copyright © 2016 by American Society of Clinical Oncology.

Ambulatory surgery centers and interventional techniques: a look at long-term survival.

PubMed

Manchikanti, Laxmaiah; Parr, Allan T; Singh, Vijay; Fellows, Bert

2011-01-01

With health care expenditures skyrocketing, coupled with pervasive quality deficits, pressures to provide better and more proficient care continue to shape the landscape of the U.S. health care system. Payers, both federal and private, have laid out several initiatives designed to curtail costs, including value-based reimbursement programs, cost-shifting expenses to the consumer, reducing reimbursements for physicians, steering health care to more efficient settings, and finally affordable health care reform. Consequently, one of the major aspects in the expansion of health care for improving quality and reducing the costs is surgical services. Nearly 57 million outpatient procedures are performed annually in the United States, 14 million of which occur in elderly patients. Increasing use of these minor, yet common, procedures contributes to rising health care expenditures. Once exclusive within hospitals, more and more outpatient procedures are being performed in freestanding ambulatory surgery centers (ASCs), physician offices, visits to which have increased over 300% during the past decade. Concurrent with this growing demand, the number of ASCs has more than doubled since the 1990s, with more than 5,000 facilities currently in operation nationwide. Further, total surgical center ASC payments have increased from $1.2 billion in 1999 to $3.2 billion in 2009, a 167% increase. On the same lines, growth and expenditures for hospital outpatient department (HOPD) services and office procedures also have been evident at similar levels. Recent surveys have illustrated on overall annual growth per capita in Medicare allowed ASC services of pain management of 23%, with 27% growth seen in ASCs and 16% of the growth seen in HOPD. Further, the proportion of interventional pain management which was 4% of Medicare ASC spending in 2000 has increase to 10% in 2007. Thus, interventional pain management as an evolving specialty is one of the most commonly performed procedures in ASC settings apart from HOPDs and well-equipped offices. In June 1998, the Health Care Financing Administration (HCFA), proposed an ASC rule in which at least 60% of interventional procedures were eliminated from ASCs and the remaining 40% faced substantial cuts in payments. Following the publication of this rule, based on public comments and demand, Congress intervened and delayed implementation of the rule for several years. The Centers for Medicare and Medicaid Services (CMS) published its proposed outpatient prospective system for ASCs in 2006, setting ASC payments at 62% of HOPD payments. Following multiple changes, the rule was incorporated with a 4-year transition formula which ended in 2010, with full effect taking effect in 2011 with ASCs reimbursed at 57% of HOPD payments. Thus, the landscape of interventional pain management in ambulatory surgery centers has been constantly changing with declining reimbursements, issues of fraud and abuse, and ever-increasing regulations.

Eye lens radiation exposure of the medical staff performing interventional urology procedures with an over-couch X-ray tube.

PubMed

Medici, S; Pitzschke, A; Cherbuin, N; Boldini, M; Sans-Merce, M; Damet, J

2017-11-01

The purpose of this work was to estimate the eye lens radiation exposure of the medical staff during interventional urology procedures. The measurements were carried out for six medical staff members performing 33 fluoroscopically-guided procedures. All procedures were performed with the X-ray tube positioned over the couch. The dose equivalents (H p (0.07)) were measured at the eye level using optically stimulated luminescent (OSL) dosimeters and at the chest level with OSL dosimeters placed over the protective apron. The ratio of the dose measured close to the eye lens and on the chest was determined. The annual eye lens dose was estimated based on the workload in the service. For the physician and the instrumentalist nurse, the eye to chest dose ratios were 0.9±0.4 and 2.6±1.6 (k = 2), respectively. The average doses per procedure received by the eye lens were 78±24 μSv and 38±18 μSv, respectively. The eye lens dose per DAP was 8.4±17.5 μSv/(Gy·cm 2 ) for the physician and 4.1±8.7 μSv/(Gy·cm 2 ) for the instrumentalist nurse. The results indicate that the eye lens to chest dose ratio greatly varies according to the staff function and that the dose equivalent measured by the personal dosimeter worn on the chest may underestimate the eye lens dose of some medical staff members. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

78 FR 37531 - Agency Information Collection Activities; Comment Request; Annual Performance Reporting (APR...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-21

...; Comment Request; Annual Performance Reporting (APR) System for NIDRR Grantees (RERCs, RRTCS, FIPs, ARRTs... of Collection: Annual Performance Reporting (APR) System for NIDRR Grantees (RERCs, RRTCS, FIPs... requests an extension of the Annual Performance Reporting (APR) System for NIDRR Grantees (RERCs, RRTCS...

Alabama Commission on Higher Education 1986 Annual Report.

ERIC Educational Resources Information Center

Alabama State Commission on Higher Education, Montgomery.

The 1986 annual report outlines planning and coordination activities and student financial aid programs. The following planning and coordination activities are considered: statewide planning and facilities planning, a new program approval procedure, approval of off-campus offerings, studies of the state's engineering programs and needs and allied…

State Compensatory Education Annual Report, 1982-83.

ERIC Educational Resources Information Center

Georgia State Dept. of Education, Atlanta. Office of Instructional Services.

This document compiles compensatory education program data submitted to the Georgia State Department by local school systems in their 1982-83 annual reports. The first section describes state administration of grant funds (i.e., appropriations bills, procedures for allocating funds, program plans, and program monitoring). Specifically mentioned…

76 FR 8293 - Natural Gas Pipelines; Project Cost and Annual Limits

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-14

...] Natural Gas Pipelines; Project Cost and Annual Limits February 8, 2011. AGENCY: Federal Energy Regulatory... for natural gas pipelines blanket construction certificates for each calendar year. DATES: Effective... of Subjects in 18 CFR Part 157 Administrative practice and procedure, Natural Gas, Reporting and...

34 CFR 668.46 - Institutional security policies and crime statistics.

Code of Federal Regulations, 2010 CFR

2010-07-01

... a voluntary, confidential basis for inclusion in the annual disclosure of crime statistics, and, if... procedures to report crimes on a voluntary, confidential basis for inclusion in the annual disclosure of... the victim's actual or perceived race, gender, religion, sexual orientation, ethnicity, or disability...

10 CFR 205.308 - Filing schedule and annual reports.

Code of Federal Regulations, 2010 CFR

2010-01-01

....308 Energy DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System... to Transmit Electric Energy to A Foreign Country § 205.308 Filing schedule and annual reports. (a) Persons authorized to transmit electric energy from the United States shall promptly file all supplements...

10 CFR 205.308 - Filing schedule and annual reports.

Code of Federal Regulations, 2011 CFR

2011-01-01

....308 Energy DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System... to Transmit Electric Energy to A Foreign Country § 205.308 Filing schedule and annual reports. (a) Persons authorized to transmit electric energy from the United States shall promptly file all supplements...

An analysis of leading, lagging, and coincident economic indicators in the United States and its relationship to the volume of plastic surgery procedures performed: an update for 2012.

PubMed

Paik, Angie M; Hoppe, Ian C; Pastor, Craig J

2013-09-01

As physician compensation and reimbursement tightens throughout the United States, it is important for physicians to be aware of the influence that the economic environment has on the unique medical field of plastic and reconstructive surgery. This study will attempt to determine a relationship between the volume of different plastic surgical procedures and various economic indicators. Information from the American Society of Plastic Surgeons' annual reports on plastic surgery statistics available on the Internet (http://www.plasticsurgery.org/Media/Statistics.html) was collected from the years 2000 through 2011. Yearly economic indicators were collected from readily available Web sites. In terms of the total number of plastic surgery procedures performed, there was a significant positive relationship with GDP, GDP per capita, personal income, consumer price index (CPI) (all), and CPI (medical), and a significant negative relationship with the issuance of new home permits. There was a significant positive relationship with total cosmetic procedures and GDP, GDP per capita, personal income, CPI (all), and CPI (medical), and a significant negative relationship with the issuance of new home permits. There was a significant positive relationship between cosmetic surgical procedures and the issuance of new home permits and the average prime rate charged by banks. There was a significant positive relationship with cosmetic minimally invasive procedures and GDP, GDP per capita, personal income, CPI (all), and CPI (medical), and a significant negative relationship with the issuance of new home permits. There was a significant negative relationship between reconstructive procedures and GDP, GDP per capita, personal income, CPI (all), and CPI (medical). Cosmetic minimally invasive procedures involve less downtime, are generally less expensive than surgical options, and are widely available, making it easier for patients to decide on them quickly during good economic times. Furthermore, it is apparent that plastic surgeons must be proficient at performing minimally invasive cosmetic procedures to maintain a clientele and offer patients a more affordable option during tough economic times. This may lead to further business growth during more favorable economic times.

The surgical management of urogenital tuberculosis our experience and long-term follow-up.

PubMed

Bansal, Punit; Bansal, Neeru

2015-01-01

Urogenital tuberculosis (TB) is common in developing countries. We present our experience of surgically managed cases of genitourinary TB (GUTB). We retrospectively reviewed 60 cases GUTB who underwent surgery at our center from January 2003 to January 2010. Mode of presentation, organ involvement, investigation, surgical treatment and follow-up were studied. There were 38 males and 22 females with a mean age of 32.5 years. The most common symptom was irritative voiding symptoms. The most common organ involved was bladder in 33 cases, and next most common was kidney in 30 cases. Preoperative bacteriologic diagnosis was confirmed in only 19 cases. A total of 66 procedures were performed as some patients needed more than one procedure. These included 35 ablative procedures and 31 reconstructive procedures. All the patients were followed-up with renal function test (RFT) at 3, 6 and 12 months. The intravenous urography and diethylenetriamine pentaacetic acid scan were performed at 3 months when indicated. Then the patients were followed with RFT and ultrasonography 6 monthly for 3 years and then annual RFT. Many patients of urogenital TB present late with cicatrisation sequelae. Multidrug chemotherapy with judicious surgery as and when indicated is the ideal treatment. The results of reconstructive surgery are good and should be done when possible. Rigorous and long term follow-up is necessary in patients undergoing reconstructive surgery.

Radiation dose to physicians’ eye lens during interventional radiology

NASA Astrophysics Data System (ADS)

Bahruddin, N. A.; Hashim, S.; Karim, M. K. A.; Sabarudin, A.; Ang, W. C.; Salehhon, N.; Bakar, K. A.

2016-03-01

The demand of interventional radiology has increased, leading to significant risk of radiation where eye lens dose assessment becomes a major concern. In this study, we investigate physicians' eye lens doses during interventional procedures. Measurement were made using TLD-100 (LiF: Mg, Ti) dosimeters and was recorded in equivalent dose at a depth of 0.07 mm, Hp(0.07). Annual Hp(0.07) and annual effective dose were estimated using workload estimation for a year and Von Boetticher algorithm. Our results showed the mean Hp(0.07) dose of 0.33 mSv and 0.20 mSv for left and right eye lens respectively. The highest estimated annual eye lens dose was 29.33 mSv per year, recorded on left eye lens during fistulogram procedure. Five physicians had exceeded 20 mSv dose limit as recommended by international commission of radiological protection (ICRP). It is suggested that frequent training and education on occupational radiation exposure are necessary to increase knowledge and awareness of the physicians’ thus reducing dose during the interventional procedure.

Trends of Concurrent Ankle Arthroscopy at the Time of Operative Treatment of Ankle Fracture: A National Database Review.

PubMed

Ackermann, Jakob; Fraser, Ethan J; Murawski, Christopher D; Desai, Payal; Vig, Khushdeep; Kennedy, John G

2016-04-01

The purpose of this study was to report trends associated with concurrent ankle arthroscopy at the time of operative treatment of ankle fracture. The current procedural terminology (CPT) billing codes were used to search the PearlDiver Patient Record Database and identify all patients who were treated for acute ankle fracture in the United States. The Medicare Standard Analytic Files were searchable between 2005 and 2011 and the United Healthcare Orthopedic Dataset from 2007 to 2011. Annual trends were expressed only between 2007 and 2011, as it was the common time period among both databases. Demographic factors were identified for all procedures as well as the cost aspect using the Medicare data set. In total, 32 307 patients underwent open reduction internal fixation (ORIF) of an ankle fracture, of whom 313 (1.0%) had an ankle arthroscopy performed simultaneously. Of those 313 cases, 70 (22.4%) patients received microfracture treatment. Between 2005 and 2011, 85 203 patients were treated for an ankle fracture whether via ORIF or closed treatment. Of these, a total of 566 patients underwent arthroscopic treatment within 7 years. The prevalence of arthroscopy after ankle fracture decreased significantly by 45% from 2007 to 2011 (P< .0001). When ORIF and microfracture were performed concurrently, the total average charge for both procedures drops to $4253.00 and average reimbursement to $818.00 compared with approximately $4964.00 and $1069.00, respectively, when they were performed subsequently. Despite good evidence in favor of arthroscopy at the time of ankle fracture treatment, it appears that only a small proportion of surgeons in the United States perform these procedures concurrently. Therapeutic, Level IV: Retrospective. © 2015 The Author(s).

NASA-ONERA Collaboration on Human Factors in Aviation Accidents and Incidents

NASA Technical Reports Server (NTRS)

Srivastava, Ashok N.; Fabiani, Patrick

2012-01-01

This is the first annual report jointly prepared by NASA and ONERA on the work performed under the agreement to collaborate on a study of the human factors entailed in aviation accidents and incidents, particularly focused on the consequences of decreases in human performance associated with fatigue. The objective of this agreement is to generate reliable, automated procedures that improve understanding of the levels and characteristics of flight-crew fatigue factors whose confluence will likely result in unacceptable crew performance. This study entails the analyses of numerical and textual data collected during operational flights. NASA and ONERA are collaborating on the development and assessment of automated capabilities for extracting operationally significant information from very large, diverse (textual and numerical) databases; much larger than can be handled practically by human experts.

Validation of a national hydrological model

NASA Astrophysics Data System (ADS)

McMillan, H. K.; Booker, D. J.; Cattoën, C.

2016-10-01

Nationwide predictions of flow time-series are valuable for development of policies relating to environmental flows, calculating reliability of supply to water users, or assessing risk of floods or droughts. This breadth of model utility is possible because various hydrological signatures can be derived from simulated flow time-series. However, producing national hydrological simulations can be challenging due to strong environmental diversity across catchments and a lack of data available to aid model parameterisation. A comprehensive and consistent suite of test procedures to quantify spatial and temporal patterns in performance across various parts of the hydrograph is described and applied to quantify the performance of an uncalibrated national rainfall-runoff model of New Zealand. Flow time-series observed at 485 gauging stations were used to calculate Nash-Sutcliffe efficiency and percent bias when simulating between-site differences in daily series, between-year differences in annual series, and between-site differences in hydrological signatures. The procedures were used to assess the benefit of applying a correction to the modelled flow duration curve based on an independent statistical analysis. They were used to aid understanding of climatological, hydrological and model-based causes of differences in predictive performance by assessing multiple hypotheses that describe where and when the model was expected to perform best. As the procedures produce quantitative measures of performance, they provide an objective basis for model assessment that could be applied when comparing observed daily flow series with competing simulated flow series from any region-wide or nationwide hydrological model. Model performance varied in space and time with better scores in larger and medium-wet catchments, and in catchments with smaller seasonal variations. Surprisingly, model performance was not sensitive to aquifer fraction or rain gauge density.

A new composite measure of colonoscopy: the Performance Indicator of Colonic Intubation (PICI).

PubMed

Valori, Roland M; Damery, Sarah; Gavin, Daniel R; Anderson, John T; Donnelly, Mark T; Williams, J Graham; Swarbrick, Edwin T

2018-01-01

 Cecal intubation rate (CIR) is an established performance indicator of colonoscopy. In some patients, cecal intubation with acceptable tolerance is only achieved with additional sedation. This study proposes a composite Performance Indicator of Colonic Intubation (PICI), which combines CIR, comfort, and sedation. METHODS : Data from 20 085 colonoscopies reported in the 2011 UK national audit were analyzed. PICI was defined as the percentage of procedures achieving cecal intubation with median dose (2 mg) of midazolam or less, and nurse-assessed comfort score of 1 - 3/5. Multivariate logistic regression analysis evaluated possible associations between PICI and patient, unit, colonoscopist, and diagnostic factors. RESULTS : PICI was achieved in 54.1 % of procedures. PICI identified factors affecting performance more frequently than single measures such as CIR and polyp detection, or CIR + comfort alone. Older age, male sex, adequate bowel preparation, and a positive fecal occult blood test as indication were associated with a higher PICI. Unit accreditation, the presence of magnetic imagers in the unit, greater annual volume, fewer years' experience, and higher training/trainer status were associated with higher PICI rates. Procedures in which PICI was achieved were associated with significantly higher polyp detection rates than when PICI was not achieved. CONCLUSIONS : PICI provides a simpler picture of performance of colonoscopic intubation than separate measures of CIR, comfort, and sedation. It is associated with more factors that are amenable to change that might improve performance and with higher likelihood of polyp detection. It is proposed that PICI becomes the key performance indicator for intubation of the colon in colonoscopy quality improvement initiatives. © Georg Thieme Verlag KG Stuttgart · New York.

Managing Corporate Annual Reports. SPEC Kit 258.

ERIC Educational Resources Information Center

O'Connor, Lisa, Comp.

2000-01-01

The purpose of the survey for this SPEC (Systems and Procedures Exchange Center) Kit was to assess the current print corporate annual report collection practices of ARL (Association of Research Libraries) libraries, describe the effects of these collections, and recommend best practices for preserving these significant historical documents. The…

43 CFR 2521.5 - Annual proof.

Code of Federal Regulations, 2013 CFR

2013-10-01

... OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) DESERT-LAND ENTRIES Procedures § 2521.5 Annual proof. (a) Showing required. (1) In order to test the sincerity and good faith of claimants under the desert... a desert-land entry unless made on account of that particular entry, and expenditures once credited...

43 CFR 2521.5 - Annual proof.

Code of Federal Regulations, 2012 CFR

2012-10-01

... OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) DESERT-LAND ENTRIES Procedures § 2521.5 Annual proof. (a) Showing required. (1) In order to test the sincerity and good faith of claimants under the desert... a desert-land entry unless made on account of that particular entry, and expenditures once credited...

43 CFR 2521.5 - Annual proof.

Code of Federal Regulations, 2014 CFR

2014-10-01

... OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) DESERT-LAND ENTRIES Procedures § 2521.5 Annual proof. (a) Showing required. (1) In order to test the sincerity and good faith of claimants under the desert... a desert-land entry unless made on account of that particular entry, and expenditures once credited...

33 CFR 138.240 - Procedure for calculating limit of liability adjustments for inflation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... calculating limit of liability adjustments for inflation. (a) Formula for calculating a cumulative percent... Current Period), using the following escalation formula: Percent change in the Annual CPI-U = [(Annual CPI.... This cumulative percent change value is rounded to one decimal place. (b) Significance threshold. Not...

77 FR 43903 - Proposed Collection; Comment Request for Reporting, Procedures and Penalties Regulations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-26

...-keepers affected by the information collections contained in part 501 are financial institutions, business... burden is approximately 47,780 hours. The estimated annual burden per respondent/record-keeper varies... hours. The estimated number of respondents and/or record- keepers is 38,224. The estimated annual...

What provides a better value for your time? The use of relative value units to compare posterior segmental instrumentation of vertebral segments.

PubMed

Orr, R Douglas; Sodhi, Nipun; Dalton, Sarah E; Khlopas, Anton; Sultan, Assem A; Chughtai, Morad; Newman, Jared M; Savage, Jason; Mroz, Thomas E; Mont, Michael A

2018-02-02

Relative value units (RVUs) are a compensation model based on the effort required to provide a procedure or service to a patient. Thus, procedures that are more complex and require greater technical skill and aftercare, such as multilevel spine surgery, should provide greater physician compensation. However, there are limited data comparing RVUs with operative time. Therefore, this study aims to compare mean (1) operative times; (2) RVUs; and (3) RVU/min between posterior segmental instrumentation of 3-6, 7-12, and ≥13 vertebral segments, and to perform annual cost difference analysis. A total of 437 patients who underwent instrumentation of 3-6 segments (Cohort 1, current procedural terminology [CPT] code: 22842), 67 patients who had instrumentation of 7-12 segments (Cohort 2, CPT code: 22843), and 16 patients who had instrumentation of ≥13 segments (Cohort 3, CPT code: 22844) were identified from the National Surgical Quality Improvement Program (NSQIP) database. Mean operative times, RVUs, and RVU/min, as well as an annualized cost difference analysis, were calculated and compared using Student t test. This study received no funding from any party or entity. Cohort 1 had shorter mean operative times than Cohorts 2 and 3 (217 minutes vs. 325 minutes vs. 426 minutes, p<.05). Cohort 1 had a lower mean RVU than Cohorts 2 and 3 (12.6 vs. 13.4 vs. 16.4). Cohort 1 had a greater RVU/min than Cohorts 2 and 3 (0.08 vs. 0.05, p<.05; vs. 0.08 vs. 0.05, p>.05). A $112,432.12 annualized cost difference between Cohorts 1 and 2, a $176,744.76 difference between Cohorts 1 and 3, and a $64,312.55 difference between Cohorts 2 and 3 were calculated. The RVU/min takes into account not just the value provided but also the operative times required for highly complex cases. The RVU/min for fewer vertebral level instrumentation being greater (0.08 vs. 0.05), as well as the $177,000 annualized cost difference, indicates that compensation is not proportional to the added time, effort, and skill for more complex cases. Copyright © 2018 Elsevier Inc. All rights reserved.

Revision Anterior Cruciate Ligament Reconstruction

PubMed Central

Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.

2014-01-01

Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483

7 CFR 1220.209 - Procedure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SOYBEAN PROMOTION, RESEARCH, AND CONSUMER INFORMATION Soybean Promotion and Research Order United Soybean Board § 1220.209 Procedure. (a) At... on annual average soybean production of the three previous years. If a unit is represented by more...

7 CFR 1220.209 - Procedure.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SOYBEAN PROMOTION, RESEARCH, AND CONSUMER INFORMATION Soybean Promotion and Research Order United Soybean Board § 1220.209 Procedure. (a) At... on annual average soybean production of the three previous years. If a unit is represented by more...

Delayed vaginal and urethral mesh exposure: 10 years after TVT surgery.

PubMed

Khanuengkitkong, Siwatchaya; Lo, Tsia-Shu; Dass, Anil Krishna

2013-03-01

Delayed mesh exposure after tension-free vaginal tape (TVT) procedure is rare. We report a case of mesh exposure into the vagina and urethra that developed 10 years after TVT surgery. A 58-year-old postmenopausal woman presented with mixed urinary incontinence. She was investigated, and her stress urinary incontinence was cured with a TVT procedure 10 years ago. She was then scheduled follow-up annually. Two years postsurgery, a granulation tissue was observed and excised at the vaginal incision site. Vaginal examination 10 years postsurgery showed vaginal mesh erosion 0.5 cm from urethral meatus. Cystoscopy revealed concomitant urethral erosion at the posterior urethral wall. Mesh excision was performed, and urethra and vagina were repaired in layers. Postoperative recovery was uneventful. This finding shows that, although rare, complications can occur even after 10 years of TVT surgery.

Breast self-examination: importance of technique in early diagnosis.

PubMed Central

Hislop, T G; Coldman, A J; Skippen, D H

1984-01-01

Shortly after diagnosis of breast cancer 416 patients were interviewed about their use of screening procedures and the method of tumour detection. Although 72% reported that they performed breast self-examination (BSE), only 12% actually inspected and palpated their breasts monthly. BSE was not significantly associated with tumour size or involvement of the lymph nodes; however, thorough inspection was associated with smaller tumours, and careful palpation with the absence of palpable nodes. Of those who no longer or never had examined their breasts 40% reported having annual breast examinations by their physician and had significantly smaller tumours than did the others. Most of the women (86%) reported having detected their own tumours, and BSE did not significantly increase the likelihood of self-detection. The frequency of use of screening procedures was similar in a sample of women without breast cancer. PMID:6498686

The costs and benefits of bone marrow transplantation.

PubMed

Beard, M E; Inder, A B; Allen, J R; Hart, D N; Heaton, D C; Spearing, R L

1991-07-24

The average direct costs of performing a bone marrow transplant (BMT), including the subsequent year, was found to be NZ$27,074 for 43 consecutive transplants. In 29 BMTs a full two year period of follow up was available and a quality of life analysis was carried out on these patients. It was calculated that 59 quality adjusted life years (QALYs) had been gained by the BMT procedure at the time of analysis. By combining these two analyses the cost of each QALY gained by BMT is NZ$13,272. The relatively low cost of BMT is partly due to the extremely low annual costs in second and subsequent years post BMT. In our patients this cost amounted to $195 per year. The costs and benefits of BMT compare very favourably with other complex medical procedures.

An Analysis of Cesarean Section and Emergency Hernia Ratios as Markers of Surgical Capacity in Low-Income Countries Affected by Humanitarian Emergencies from 2008 - 2014 at Médecins sans Frontières Operations Centre Brussels Projects.

PubMed

Stewart, Barclay; Wong, Evan; Papillon-Smith, Jessica; Trelles Centurion, Miguel Antonio; Dominguez, Lynette; Ao, Supongmeren; Jean-Paul, Basimuoneye Kahutsi; Kamal, Mustafa; Helmand, Rahmatullah; Naseer, Aamer; Kushner, Adam L

2015-03-27

Surgical capacity assessments in low-income countries have demonstrated critical deficiencies. Though vital for planning capacity improvements, these assessments are resource intensive and impractical during the planning phase of a humanitarian crisis. This study aimed to determine cesarean sections to total operations performed (CSR) and emergency herniorrhaphies to all herniorrhaphies performed (EHR) ratios from Médecins Sans Frontières Operations Centre Brussels (MSF-OCB) projects and examine if these established metrics are useful proxies for surgical capacity in low-income countries affected by crisis. All procedures performed in MSF-OCB operating theatres from July 2008 through June 2014 were reviewed. Projects providing only specialty care, not fully operational or not offering elective surgeries were excluded. Annual CSRs and EHRs were calculated for each project. Their relationship was assessed with linear regression. After applying the exclusion criteria, there were 47,472 cases performed at 13 sites in 8 countries. There were 13,939 CS performed (29% of total cases). Of the 4,632 herniorrhaphies performed (10% of total cases), 30% were emergency procedures. CSRs ranged from 0.06 to 0.65 and EHRs ranged from 0.03 to 1.0. Linear regression of annual ratios at each project did not demonstrate statistical evidence for the CSR to predict EHR [F(2,30)=2.34, p=0.11, R2=0.11]. The regression equation was: EHR = 0.25 + 0.52(CSR) + 0.10(reason for MSF-OCB assistance). Surgical humanitarian assistance projects operate in areas with critical surgical capacity deficiencies that are further disrupted by crisis. Rapid, accurate assessments of surgical capacity are necessary to plan cost- and clinically-effective humanitarian responses to baseline and acute unmet surgical needs in LICs affected by crisis. Though CSR and EHR may meet these criteria in 'steady-state' healthcare systems, they may not be useful during humanitarian emergencies. Further study of the relationship between direct surgical capacity improvements and these ratios is necessary to document their role in humanitarian settings.

An Analysis of Cesarean Section and Emergency Hernia Ratios as Markers of Surgical Capacity in Low-Income Countries Affected by Humanitarian Emergencies from 2008 – 2014 at Médecins sans Frontières Operations Centre Brussels Projects

PubMed Central

Stewart, Barclay; Wong, Evan; Papillon-Smith, Jessica; Trelles Centurion, Miguel Antonio; Dominguez, Lynette; Ao, Supongmeren; Jean-Paul, Basimuoneye Kahutsi; Kamal, Mustafa; Helmand, Rahmatullah; Naseer, Aamer; Kushner, Adam L.

2015-01-01

Background: Surgical capacity assessments in low-income countries have demonstrated critical deficiencies. Though vital for planning capacity improvements, these assessments are resource intensive and impractical during the planning phase of a humanitarian crisis. This study aimed to determine cesarean sections to total operations performed (CSR) and emergency herniorrhaphies to all herniorrhaphies performed (EHR) ratios from Médecins Sans Frontières Operations Centre Brussels (MSF-OCB) projects and examine if these established metrics are useful proxies for surgical capacity in low-income countries affected by crisis. Methods: All procedures performed in MSF-OCB operating theatres from July 2008 through June 2014 were reviewed. Projects providing only specialty care, not fully operational or not offering elective surgeries were excluded. Annual CSRs and EHRs were calculated for each project. Their relationship was assessed with linear regression. Results: After applying the exclusion criteria, there were 47,472 cases performed at 13 sites in 8 countries. There were 13,939 CS performed (29% of total cases). Of the 4,632 herniorrhaphies performed (10% of total cases), 30% were emergency procedures. CSRs ranged from 0.06 to 0.65 and EHRs ranged from 0.03 to 1.0. Linear regression of annual ratios at each project did not demonstrate statistical evidence for the CSR to predict EHR [F(2,30)=2.34, p=0.11, R2=0.11]. The regression equation was: EHR = 0.25 + 0.52(CSR) + 0.10(reason for MSF-OCB assistance). Conclusion: Surgical humanitarian assistance projects operate in areas with critical surgical capacity deficiencies that are further disrupted by crisis. Rapid, accurate assessments of surgical capacity are necessary to plan cost- and clinically-effective humanitarian responses to baseline and acute unmet surgical needs in LICs affected by crisis. Though CSR and EHR may meet these criteria in ‘steady-state’ healthcare systems, they may not be useful during humanitarian emergencies. Further study of the relationship between direct surgical capacity improvements and these ratios is necessary to document their role in humanitarian settings. PMID:25905025

High-Performance Integrated Control of water quality and quantity in urban water reservoirs

NASA Astrophysics Data System (ADS)

Galelli, S.; Castelletti, A.; Goedbloed, A.

2015-11-01

This paper contributes a novel High-Performance Integrated Control framework to support the real-time operation of urban water supply storages affected by water quality problems. We use a 3-D, high-fidelity simulation model to predict the main water quality dynamics and inform a real-time controller based on Model Predictive Control. The integration of the simulation model into the control scheme is performed by a model reduction process that identifies a low-order, dynamic emulator running 4 orders of magnitude faster. The model reduction, which relies on a semiautomatic procedural approach integrating time series clustering and variable selection algorithms, generates a compact and physically meaningful emulator that can be coupled with the controller. The framework is used to design the hourly operation of Marina Reservoir, a 3.2 Mm3 storm-water-fed reservoir located in the center of Singapore, operated for drinking water supply and flood control. Because of its recent formation from a former estuary, the reservoir suffers from high salinity levels, whose behavior is modeled with Delft3D-FLOW. Results show that our control framework reduces the minimum salinity levels by nearly 40% and cuts the average annual deficit of drinking water supply by about 2 times the active storage of the reservoir (about 4% of the total annual demand).

Obesity-related costs and the economic impact of laparoscopic adjustable gastric banding procedures: benefits in the Texas Employees Retirement System.

PubMed

Perryman, M Ray; Gleghorn, Virginia

2010-01-01

To assess the return on investment (ROI) and economic impact of providing insurance coverage for the laparoscopic adjustable gastric banding (LAGB) procedure in classes II and III obese members of the Texas Employees Retirement System (ERS) and their dependents from payer, employer, and societal perspectives. Classes II and III obese employee members and their adult dependents were identified in a Texas ERS database using self-reported health risk assessment (HRA) data. Direct health costs and related absenteeism and mortality losses were estimated using data from previous research. A dynamic input-output model was then used to calculate overall economic effects by incorporating direct, indirect, and induced impacts. Direct health costs were inflation-adjusted to 2008 US dollars using the Consumer Price Index for Medical Care and other spending categories were similarly adjusted using relevant consumer and industrial indices. The future cost savings and other monetary benefits were discounted to present value using a real rate of 4.00%. From the payer perspective (ERS), the payback period for direct health costs associated with the LAGB procedure was 23-24 months and the annual return (over 5 years) was 28.8%. From the employer perspective (State of Texas), the costs associated with the LAGB procedure were recouped within 17-19 months (in terms of direct, indirect, and induced gains as they translated into State revenue) and the annual return (over 5 years) was 45.5%. From a societal perspective, the impact on total business activity for Texas (over 5 years) included gains of $195.3 million in total expenditures, $93.8 million in gross product, and 1354 person-years of employment. The analysis was limited by the following: reliance on other studies for methodology and use of a control sample; restriction of cost savings to 2.5 years which required out-of-sample forecasting; conservative assumptions related to the cost of the procedure; exclusion of presenteeism; and no sensitivity analyses performed. This analysis indicates that providing benefits for the LAGB procedure to eligible members of the Texas ERS and their dependents is worthy of support from payer, employer, and societal perspectives.

20 CFR 422.135 - Reports by beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-04-01

....135 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ORGANIZATION AND PROCEDURES General Procedures... of disability has been established are obligated to report to the Social Security Administration the... after the close of a taxable year, submit to the Social Security Administration and annual report of his...

Proceedings of a Symposium on the Use of Group Procedures in the Prevention and Treatment of Drug and Alcohol Addiction.

ERIC Educational Resources Information Center

Gazda, George M., Ed.

The theme of the fifth annual Symposium on Group Procedures was "The Use of Group Procedures in the Prevention and Treatment of Drug and Alcohol Addiction." Symposium participants included professionals in counseling; clinical, school, and educational psychology, psychiatry, and social work. In addition, invitations were sent to members of…

75 FR 38837 - Amendment to Prohibited Transaction Exemption (PTE) 84-14 for Plan Asset Transactions Determined...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-06

... compliance with the conditions of the exemptions and have an independent auditor conduct an annual exemption... contingent upon an ``independent auditor'' conducting an annual ``exemption audit'' to determine whether the... written policies and procedures and a representative sample of plan transactions by an independent auditor...

76 FR 37285 - Fisheries in the Western Pacific; Mechanism for Specifying Annual Catch Limits and Accountability...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-27

... Limits and Accountability Measures AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and... procedures and timing for specifying annual catch limits (ACLs) and accountability measures (AMs) for western... accountability measures to ensure that the ACL is not exceeded. Restrictions may include, but are not limited to...

Annual Report: 2011-2012 Storm Season Sampling, Non-Dry Dock Stormwater Monitoring for Puget Sound Naval Shipyard, Bremerton, WA

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

Brandenberger, Jill M.; Metallo, David; Rupert, Brian

2013-07-03

Annual PSNS non-dry dock storm water monitoring results for 2011-2012 storm season. Included are a brief description of the sampling procedures, storm event information, laboratory methods and data collection, a results and discussion section, and the conclusions and recommendations.

20 CFR 632.22 - Modification of a Comprehensive Annual Plan (CAP) and/or Master Plan.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (CAP) and/or Master Plan. 632.22 Section 632.22 Employees' Benefits EMPLOYMENT AND TRAINING..., Application and Modification Procedures § 632.22 Modification of a Comprehensive Annual Plan (CAP) and/or Master Plan. (a) The requirements for modifying a Master Plan and/or CAP will be included in...

Foundation for Child Development Annual Report, 2001-2002.

ERIC Educational Resources Information Center

Foundation for Child Development, New York, NY.

This annual report details the activities of the Foundation for Child Development (FCD) for 2001-2002. Beginning the report is a brief description of the Foundations mission, its funding priorities, and application procedures. The report then presents the joint statement of the chair, Karen Gerard, and the president, Ruby Takanishi, focusing on…

Foundation for Child Development Annual Report, 1998/1999.

ERIC Educational Resources Information Center

Foundation for Child Development, New York, NY.

This annual report details the activities of the Foundation for Child Development (FCD) for 1998-99. Beginning the report is a discussion of the history and mission of the foundation, its funding priorities, and application procedures. The report lists the members of the Council, Board of Directors, Officers, and staff. The joint statement of the…

Estimating Uncertainty in Annual Forest Inventory Estimates

Treesearch

Ronald E. McRoberts; Veronica C. Lessard

1999-01-01

The precision of annual forest inventory estimates may be negatively affected by uncertainty from a variety of sources including: (1) sampling error; (2) procedures for updating plots not measured in the current year; and (3) measurement errors. The impact of these sources of uncertainty on final inventory estimates is investigated using Monte Carlo simulation...

National Council on Disability Annual Report Volume 19, Fiscal Year 1998.

ERIC Educational Resources Information Center

National Council on Disability, Washington, DC.

The annual report of the National Council on Disability (NCD) describes major activities of 1998 to promote policies, programs, practices, and procedures that guarantee equal opportunity for all individuals with disabilities, regardless of the nature or severity of the disability. NCD's major activities for 1998 are grouped into four areas: (1)…

40 CFR 98.423 - Calculating CO2 supply.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) Calculate the annual mass of CO2 captured, extracted, imported, or exported through each flow meter in... flow meters are used, you shall calculate the annual mass of CO2 for all flow meters according to the procedures specified in paragraph (a)(3) of this section. (1) For each mass flow meter, you shall calculate...

Hybrid balloon valvuloplasty through the ascending aorta via median sternotomy in infants with severe congenital valvular aortic stenosis: feasibility of a new method†.

PubMed

Pan, Xiang-Bin; Zhang, Feng-Wen; Hu, Sheng-Shou; Liu, Zhen-Guo; Ma, Kai; Pang, Kun-Jing; Yan, Fu-Xia; Wang, Xu; Ou-Yang, Wen-Bin; Wang, Yang; Li, Shou-Jun

2015-06-01

To evaluate a novel hybrid balloon valvuloplasty procedure for severe congenital valvular aortic stenosis in low-weight infants, performed through the ascending aorta via median sternotomy. Eighteen infants (<90 days of age) with severe congenital aortic stenosis were included in this study. Hybrid balloon valvuloplasty procedures were performed in a hybrid operating room. Patients were followed up at 3 months, 6 months, 1 year and then annually following the procedure. The hybrid balloon valvuloplasty procedure was successful in all patients. Eight patients were successfully rescued from left ventricular systolic dysfunction by cardiac compression under direct vision. The aortic valve pressure gradient decreased from 80.3 ± 20.8 mmHg preoperatively to 16.0 ± 3.6 mmHg immediately postoperatively (P < 0.001). None of the patients developed significant aortic insufficiency. The fluoroscopy time was 6.2 ± 2.9 min. Intraoperative blood transfusions and pacing were not required. The patients were all alive and healthy at the end of the follow-up period (mean 21.3 months; range 3-41 months), and the aortic valve pressure gradient remained low (21.7 ± 5.3 mmHg). Reintervention was not required in any of the patients. Hybrid balloon valvuloplasty through the ascending aorta via median sternotomy is an effective and safe procedure for infants with severe congenital aortic stenosis. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

The role of transvaginal ultrasonography for detecting ovarian cancer in an asymptomatic screening population: a systematic review.

PubMed

Buhling, Kai J; Lezon, S; Eulenburg, C; Schmalfeldt, B

2017-05-01

The purpose of this study was to systematically analyze the effect of transvaginal ultrasonography in an asymptomatic female population as an annual screening procedure with regard to mortality data. Studies were evaluated descriptively on their strengths and weaknesses considering the methods and results. We evaluated 632 international studies by selecting only randomized controlled trials (RCTs). Three RCTs concerning transvaginal ultrasonography were found, performed in Japan, the USA, and Great Britain. Currently, no clear recommendation for the screening for ovarian cancer in an asymptomatic population can be given based on these three studies. The authors could not show a change in mortality using transvaginal ultrasonography for annual screening. An annual palpation does not offer a beneficial effect. The development of new ultrasound machines with higher image resolution in combination with a well-standardized algorithm for ovarian cancer in upcoming years might provide an improvement regarding mortality. The current studies do not show a benefit in screening an asymptomatic population annually with transvaginal ultrasonography, but the most recent publication showed a trend toward lower mortality in patients who underwent screening after 7-14 years of follow-up. Nevertheless, all three heterogeneous RCTs had weaknesses in their methods and therefore they neither contradict the general recommendation for screening in an asymptomatic population nor do they support it.

76 FR 26302 - Submission for OMB Review; Comment Request; Reunification Procedures for Unaccompanied Alien...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-06

...-0278] Submission for OMB Review; Comment Request; Reunification Procedures for Unaccompanied Alien... and placement of unaccompanied alien children in Federal custody, and implementing a policy for the... Release of Information. Respondents: Sponsors requesting release of unaccompanied alien. Annual Burden...

40 CFR 91.316 - Hydrocarbon analyzer calibration.

Code of Federal Regulations, 2011 CFR

2011-07-01

... periodic optimization of detector response. Prior to introduction into service and at least annually... nitrogen. (2) One of the following procedures is required for FID or HFID optimization: (i) The procedure outlined in Society of Automotive Engineers (SAE) paper No. 770141, “Optimization of Flame Ionization...

40 CFR 98.185 - Procedures for estimating missing data.

Code of Federal Regulations, 2010 CFR

2010-07-01

... facility that estimate annual process CO2 emissions using the carbon mass balance procedure in § 98.183(b... best available estimate of the mass of the material from all available process data or data used for accounting purposes (such as purchase records). ...

8 CFR 286.5 - Remittance and statement procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Financial Management, INS. (e) Annually, each U.S. based remitter, which retains an independent accountant... Commissioner, Financial Management a report from the independent accountant in accordance with the Statement on... Procedures established by the American Institute of Certified Public Accountants and the Service, to the...

Advances in Liposuction: Five Key Principles with Emphasis on Patient Safety and Outcomes

PubMed Central

Tabbal, Geo N.; Ahmad, Jamil; Lista, Frank

2013-01-01

Summary: Since Illouz’s presentation of a technique for lipoplasty at the 1982 Annual Meeting of the American Society of Plastic and Reconstructive Surgeons, liposuction has become one of the most commonly performed aesthetic surgery procedures. The evolution of liposuction has seen refinements in technique and improvement of patient safety-related standards of care. Based on long-term experience with body contouring surgery, 5 principles of advanced liposuction are presented: preoperative evaluation and planning, intraoperative monitoring—safety measures, the role of wetting solutions and fluid resuscitation, circumferential contouring and complication prevention, and outcomes measurement. PMID:25289270

The cost of atrial fibrillation in Italy: a five-year analysis of healthcare expenditure in the general population. From the Italian Survey of Atrial Fibrillation Management (ISAF) study.

PubMed

Zoni Berisso, M; Landolina, M; Ermini, G; Parretti, D; Zingarini, G L; Degli Esposti, L; Cricelli, C; Boriani, G

2017-01-01

Atrial fibrillation (AF) is a relevant item of expenditure for the National Healthcare systems. The aim of the study was to estimate the annual costs of AF in Italy. The Italian Survey of Atrial Fibrillation Management Study enrolled 6.036 patients with AF among 295.906 subjects representative of the Italian population. Data were collected by 233 General Practitioners (GPs) distributed across Italy. Quantities of resources used during the 5 years preceding the ISAF screening were inferred from the survey data and multiplied by the current Italian unit costs of 2015 in order to estimate the mean per patient annual cumulative cost of AF. Patients were subdivided on the basis of the number of hospitalizations, invasive/non-invasive diagnostic tests and invasive therapeutic procedures in 3 different clinical subsets: "low cost", " medium cost" and "high cost clinical scenario". The estimated mean costs per patient per year were 613 €, 891 € and 1213 € for the "Low cost", "Medium cost" and "High Cost Clinical Scenario" respectively. Hospitalizations and inpatient interventional procedures accounted for more than 80% of the cumulative annual costs. The mean annual costs among patients pursuing "Rhythm control" strategy was 956 €. In Italy, the estimated costs of AF per patient per year are lower than those reported in other developed countries and vary widely related to the different characteristics of AF patients. Hospitalizations and interventional procedures are the main drivers of costs. The mean annual cost of AF is mainly influenced by the duration of the period of observation and the patients' characteristics. Measures to reduce hospitalizations are needed.

28 CFR 33.70 - Annual performance report.

Code of Federal Regulations, 2012 CFR

2012-07-01

... provide the basis for the annual report from the Bureau to the President and the Congress as required by... 28 Judicial Administration 1 2012-07-01 2012-07-01 false Annual performance report. 33.70 Section... Criminal Justice Block Grants Reports § 33.70 Annual performance report. (a) Section 405 of the Justice...

28 CFR 33.70 - Annual performance report.

Code of Federal Regulations, 2013 CFR

2013-07-01

... provide the basis for the annual report from the Bureau to the President and the Congress as required by... 28 Judicial Administration 1 2013-07-01 2013-07-01 false Annual performance report. 33.70 Section... Criminal Justice Block Grants Reports § 33.70 Annual performance report. (a) Section 405 of the Justice...

28 CFR 33.70 - Annual performance report.

Code of Federal Regulations, 2010 CFR

2010-07-01

... provide the basis for the annual report from the Bureau to the President and the Congress as required by... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Annual performance report. 33.70 Section... Criminal Justice Block Grants Reports § 33.70 Annual performance report. (a) Section 405 of the Justice...

28 CFR 33.70 - Annual performance report.

Code of Federal Regulations, 2011 CFR

2011-07-01

... provide the basis for the annual report from the Bureau to the President and the Congress as required by... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Annual performance report. 33.70 Section... Criminal Justice Block Grants Reports § 33.70 Annual performance report. (a) Section 405 of the Justice...

28 CFR 33.70 - Annual performance report.

Code of Federal Regulations, 2014 CFR

2014-07-01

... provide the basis for the annual report from the Bureau to the President and the Congress as required by... 28 Judicial Administration 1 2014-07-01 2014-07-01 false Annual performance report. 33.70 Section... Criminal Justice Block Grants Reports § 33.70 Annual performance report. (a) Section 405 of the Justice...

NASA - easyJet Collaboration on the Human Factors Monitoring Program (HFMP) Study

NASA Technical Reports Server (NTRS)

Srivistava, Ashok N.; Barton, Phil

2012-01-01

This is the first annual report jointly prepared by NASA and easyJet on the work performed under the agreement to collaborate on a study of the many factors entailed in flight - and cabin-crew fatigue and documenting the decreases in performance associated with fatigue. The objective of this Agreement is to generate reliable, automated procedures that improve understanding of the levels and characteristics of flight - and cabin-crew fatigue factors, both latent and proximate, whose confluence will likely result in unacceptable flight crew performance. This study entails the analyses of numerical and textual data collected during operational flights. NASA and easyJet are both interested in assessing and testing NASA s automated capabilities for extracting operationally significant information from very large, diverse (textual and numerical) databases, much larger than can be handled practically by human experts.

[Environmental hygiene of the surgery suites for the control of surgical wound infection: Italian legislation and international guidelines].

PubMed

Charrier, L; Castella, A; Di Legami, V; Pastorino, F; Farina, E C; Argentero, P A; Zotti, C M

2006-01-01

Aim of the study is to describe the application of surgical site infection (SSI) control procedures in general surgery operating rooms of Piedmont region hospitals. A specific data collection form was designed to record information. 54 questionnaires were compiled. Piedmont legislation related to operating rooms' equipment is obeyed in more than 90% of hospitals. Nevertheless, there are some critical aspects than could be risk factors for SSI or that are not useful in order to prevent them: use of UV radiation (11.3%), use of tacky mats at the entrance of the operating room (5.7%), special cleaning of operating rooms after contaminated or dirty operations (73.6%) and routine environmental sampling (10%) that is strongly recommended by ISPESL guideline in disagreement with international recommendations. Steam autoclave is used for surgical instruments sterilization by 100% of hospitals, but only 50% of them performs an annual validation of both autoclave performance and sterilization procedures. The study gave useful information in order to promote some structural modifications and personnel education for efficacious SSI prevention and control.

Diagnostic needle arthroscopy and the economics of improved diagnostic accuracy: a cost analysis.

PubMed

Voigt, Jeffrey D; Mosier, Michael; Huber, Bryan

2014-10-01

Hundreds of thousands of surgical arthroscopy procedures are performed annually in the United States (US) based on MRI findings. There are situations where these MRI findings are equivocal or indeterminate and because of this clinicians commonly perform the arthroscopy in order not to miss pathology. Recently, a less invasive needle arthroscopy system has been introduced that is commonly performed in the physician office setting and that may help improve the accuracy of diagnostic findings. This in turn may prevent unnecessary follow-on arthroscopy procedures from being performed. The purpose of this analysis is to determine whether the in-office diagnostic needle arthroscopy system can provide cost savings by reducing unnecessary follow on arthroscopy procedures. Data obtained from a recent trial and from a systematic review were used in comparing the accuracy of MRI and VisionScope needle arthroscopy (VSI) with standard arthroscopy (gold standard). The resultant false positive and false negative findings were then used to evaluate the costs of follow-on procedures. These differences were then modeled for the US patient population diagnosed and treated for meniscal knee pathology (most common disorder) to determine if a technology such as VSI could save the US healthcare system money. Data on surgical arthroscopy procedures in the US for meniscal knee pathology were used (calendar year [CY] 2010). The costs of performing diagnostic and surgical arthroscopy procedures (using CY 2013 Medicare reimbursement amounts), costs associated with false negative findings, and the costs for treating associated complications arising from diagnostic and therapeutic arthroscopy procedures were assessed. In patients presenting with medial meniscal pathology (International Classification of Diseases, 9th edition, Clinical Modification [ICD9CM] diagnosis 836.0), VSI in place of MRI (standard of care) resulted in a net cost savings to the US system of US$115-US$177 million (CY 2013) (use of systematic review and study data, respectively). In patients presenting with lateral meniscus pathology (ICD9CM 836.1), VSI in place of MRI cost the healthcare system an additional US$14-US$97 million (CY 2013). Overall aggregate savings for meniscal (lateral plus medial) pathology were identified in representative care models along with more appropriate care as fewer patients were exposed to higher risk surgical procedures. Since in-office arthroscopy is significantly more accurate, patients can be treated more appropriately and the US healthcare system can save money, most especially in medial meniscal pathology.

50 CFR 300.152 - Procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... Nationals Fishing in Russian Fisheries § 300.152 Procedures. (a) Application for annual permits. U.S. vessel owners and operators must have a valid permit issued by the Russian Federation obtained pursuant to a complete application submitted through NMFS before fishing in the Russian EZ or for Russian fishery...

50 CFR 300.152 - Procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... Nationals Fishing in Russian Fisheries § 300.152 Procedures. (a) Application for annual permits. U.S. vessel owners and operators must have a valid permit issued by the Russian Federation obtained pursuant to a complete application submitted through NMFS before fishing in the Russian EZ or for Russian fishery...

50 CFR 300.152 - Procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

.... Nationals Fishing in Russian Fisheries § 300.152 Procedures. (a) Application for annual permits. U.S. vessel owners and operators must have a valid permit issued by the Russian Federation obtained pursuant to a complete application submitted through NMFS before fishing in the Russian EZ or for Russian fishery...

50 CFR 300.152 - Procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... Nationals Fishing in Russian Fisheries § 300.152 Procedures. (a) Application for annual permits. U.S. vessel owners and operators must have a valid permit issued by the Russian Federation obtained pursuant to a complete application submitted through NMFS before fishing in the Russian EZ or for Russian fishery...

50 CFR 300.152 - Procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... Nationals Fishing in Russian Fisheries § 300.152 Procedures. (a) Application for annual permits. U.S. vessel owners and operators must have a valid permit issued by the Russian Federation obtained pursuant to a complete application submitted through NMFS before fishing in the Russian EZ or for Russian fishery...

Specialization and the Current Practices of General Surgeons

PubMed Central

Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

2014-01-01

Background The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons’ operative practices to inform surgical education and workforce planning. Study Design We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project (HCUP) for three US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and the percentage of practice comprised of their most common operation were calculated. Correlation was measured between general surgeons’ case volume and the number of other specialists in a health service area. Results There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure comprised no more than 30% of total practice. The most common operations, ranked by the frequency that they appeared as general surgeons’ top procedure, included: cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice comprised of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (Rho = - 0.50, p = 0.005). Conclusions Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. PMID:24210145

National practice patterns for management of adult congenital heart disease: operation by pediatric heart surgeons decreases in-hospital death.

PubMed

Karamlou, Tara; Diggs, Brian S; Person, Thomas; Ungerleider, Ross M; Welke, Karl F

2008-12-02

Surgery for grown-up (age > or = 18 years) patients with congenital heart disease (GUCH) is frequently performed by surgeons without specialization in pediatric heart surgery. We sought to define national practice patterns and to determine whether outcomes for GUCH patients are improved if they are treated by specialized pediatric heart surgeons (PHSs) compared with non-PHSs. We identified index cardiac procedures in patients with 12 congenital heart disease diagnostic groups using the Nationwide Inpatient Sample 1988 to 2003. PHSs were defined as surgeons whose annual practice volumes were made of >75% annual pediatric heart cases. GUCH operations were defined as operations within these 12 diagnoses occurring in patients > or =18 years of age. We identified 30,250 operations, yielding a national estimate of 152,277 +/- 7,875 operations. Of these, 111,816 +/- 7,456 (73%) were pediatric operations, and 40,461 +/- 1,365 (27%) were GUCH operations. PHSs performed 68% of pediatric operations in all diagnostic groups, whereas non-PHSs performed 95% of GUCH operations within the same diagnostic groups (P<0.0001). In-hospital death rates for GUCH patients operated on by PHSs were lower than death rates for GUCH patients operated on by non-PHSs (1.87% [95% CI, 0.62 to 3.13] versus 4.84% [95% CI, 4.30 to 5.38%]; P<0.0001). Survival advantage increased with increasing surgeon annual pediatric volume (P=0.0031). Pediatric patients within specific diagnostic groups are more likely to undergo operation by PHSs, whereas GUCH patients within the same diagnostic groups are more likely to undergo operation by non-PHSs. In-hospital death rates are lower for GUCH patients operated on by PHSs. GUCH patients should be encouraged to obtain surgical operation by PHS.

Estimating annual growth losses from drought in loblolly pine plantations

Treesearch

Ralph L. Amateis; Harold E. Burkhart; Daniel Waiswa

2013-01-01

Growth data over the past 10 years from loblolly pine (Pinus taeda L.) plantations established across the natural range of the species were linked with annual rainfall data over the same period to evaluate the impact of drought on stand growth. Regression procedures were used to determine (1) whether dominant height growth or basal area growth or...

16 CFR 305.5 - Determinations of estimated annual energy consumption, estimated annual operating cost, and...

Code of Federal Regulations, 2012 CFR

2012-01-01

... procedures contained in the EnergyStar Version 4.2 test, which is comprised of the ENERGY STAR Program... and 19 hours in sleep (standby) mode per day. These ENERGY STAR requirements are incorporated by... inspected or obtained at the United States Environmental Protection Agency, ENERGY STAR Hotline (6202J...

16 CFR 305.5 - Determinations of estimated annual energy consumption, estimated annual operating cost, and...

Code of Federal Regulations, 2013 CFR

2013-01-01

... procedures contained in the EnergyStar Version 4.2 test, which is comprised of the ENERGY STAR Program... and 19 hours in sleep (standby) mode per day. These ENERGY STAR requirements are incorporated by... inspected or obtained at the United States Environmental Protection Agency, ENERGY STAR Hotline (6202J...

16 CFR 305.5 - Determinations of estimated annual energy consumption, estimated annual operating cost, and...

Code of Federal Regulations, 2014 CFR

2014-01-01

... procedures contained in the ENERGY STAR Version 4.2 test, which is comprised of the ENERGY STAR Program... and 19 hours in sleep (standby) mode per day. These ENERGY STAR requirements are incorporated by... inspected or obtained at the United States Environmental Protection Agency, ENERGY STAR Hotline (6202J...

47 CFR 1.1152 - Schedule of annual regulatory fees and filing locations for wireless radio services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... locations for wireless radio services. 1.1152 Section 1.1152 Telecommunication FEDERAL COMMUNICATIONS... Procedures for Payment § 1.1152 Schedule of annual regulatory fees and filing locations for wireless radio..., St. Louis, MO 63197-9000. General Mobile Radio Service (a) New, Renew/Mod (FCC 605 & 159) 5.00 FCC, P...

47 CFR 1.1152 - Schedule of annual regulatory fees and filing locations for wireless radio services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... locations for wireless radio services. 1.1152 Section 1.1152 Telecommunication FEDERAL COMMUNICATIONS... Procedures for Payment § 1.1152 Schedule of annual regulatory fees and filing locations for wireless radio..., P.O. Box 979097, St. Louis, MO 63197-9000. General Mobile Radio Service: (a) New, Renew/Mod (FCC 605...

47 CFR 1.1152 - Schedule of annual regulatory fees and filing locations for wireless radio services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... locations for wireless radio services. 1.1152 Section 1.1152 Telecommunication FEDERAL COMMUNICATIONS... Procedures for Payment § 1.1152 Schedule of annual regulatory fees and filing locations for wireless radio..., P.O. Box 979097, St. Louis, MO 63197-9000. General Mobile Radio Service (a) New, Renew/Mod (FCC 605...

30 CFR 48.28 - Annual refresher training of miners; minimum courses of instruction; hours of instruction.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Retraining of Miners Working at Surface Mines and Surface Areas of Underground Mines § 48.28 Annual refresher...) Ground control; working in areas of highwalls, water hazards, pits, and spoil banks; illumination and... ground control plans in effect at the mine; procedures for working safely in areas of highwalls, water...

NOTES performed using multiple ports of entry: Current experience and potential implications for urologic applications.

PubMed

Lima, Estevao; Rolanda, Carla; Correia-Pinto, Jorge

2009-05-01

An isolated transgastric port raises serious limitations in performing natural orifice translumenal endoscopic surgery (NOTES) complex procedures in the urology field. In an attempt to overcome these limitations, several solutions has been advanced, such as the hybrid approach (adding a single abdominal port access) or the pure NOTES combined approach (joining multiple natural orifice ports). To review the current state of experimental and clinical results of multiple ports in NOTES, a literature search of PubMed was performed, seeking publications from January 2002 to 2008 on NOTES. In addition, we looked at pertinent abstracts of annual meetings of the American Urological Association, the European Association of Urology, and the World Congress of Endourology from 2007. Multiple ports of entry seem to be necessary, mainly for moderately complex procedures. Thus, we could find studies using the hybrid approach (combination of transgastric or transvaginal access with a single transabdominal port), or using the pure NOTES combined approach (transgastric and transvesical, transvaginal and transcolonic, or transgastric and transvaginal). There is still limited experience in humans using these approaches, and no comparative studies exist to date. It is predictable that for moderately complex procedures, we will need multiple ports, so the transvaginal-transabdominal (hybrid) approach is the most appealing, whereas in a pure NOTES perspective, the transgastric-transvesical approach seems to be the preferred approach. We are waiting for new equipment and instruments that are more appropriate for these novel techniques.

Differences in utilization of dental procedures by children enrolled in Wisconsin Medicaid and Delta Dental insurance plans.

PubMed

Bhagavatula, Pradeep; Xiang, Qun; Szabo, Aniko; Eichmiller, Fredrick; Okunseri, Christopher

2017-12-01

Few studies have directly compared dental procedures provided in public and private insurance plans for enrollees living in dental health professional shortage areas (DHPSAs). We examined the rates for the different types of dental procedures received by 0-18-year-old children living in DHPSAs and non-DHPSAs who were enrolled in Medicaid and those enrolled under Delta Dental of Wisconsin (DDW) for years 2002 to 2008. Medicaid and DDW dental claims data for 2002 to 2008 was analyzed. Enrollees were divided into DDW-DHPSA and non-DHPSA and Medicaid-DHPSA and non-DHPSA groups. Descriptive and multivariable analyses using over-dispersed Poisson regression were performed to examine the effect of living in DHPSAs and insurance type in relation to the number of procedures received. Approximately 49 and 65 percent of children living in non-DHPSAs that were enrolled in Medicaid and DDW received at least one preventive dental procedure annually, respectively. Children in DDW non-DHPSA group had 1.79 times as many preventive, 0.27 times fewer complex restorative and 0.51 times fewer endodontic procedures respectively, compared to those in Medicaid non-DHPSA group. Children enrolled in DDW-DHPSA group had 1.53 times as many preventive and 0.25 times fewer complex restorative procedures, compared to children in Medicaid-DHPSA group. DDW enrollees had significantly higher utilization rates for preventive procedures than children in Medicaid. There were significant differences across Medicaid and DDW between non-DHPSA and DHPSA for most dental procedures received by enrollees. © 2016 American Association of Public Health Dentistry.

Title VI-B, Education of the Handicapped Act Annual Program Plan Fiscal Year 1979-Kansas State Department of Education.

ERIC Educational Resources Information Center

Kansas State Dept. of Education, Topeka.

The Kansas state plan for FY 1979 includes information on the following topics: full educational opportunities goal, policy on priorities, child identification, personnel development, individualized education program, procedural safeguards, least restrictive environment, protection in evaluation procedures, participation of private school…

42 CFR 431.814 - Sampling plan and procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Sampling plan and procedures. 431.814 Section 431.814 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... annual expenditures for services for active cases, and on the total number of negative case actions in...

42 CFR 431.814 - Sampling plan and procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Sampling plan and procedures. 431.814 Section 431.814 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... annual expenditures for services for active cases, and on the total number of negative case actions in...

42 CFR 431.814 - Sampling plan and procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Sampling plan and procedures. 431.814 Section 431.814 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... annual expenditures for services for active cases, and on the total number of negative case actions in...

42 CFR 431.814 - Sampling plan and procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Sampling plan and procedures. 431.814 Section 431.814 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... annual expenditures for services for active cases, and on the total number of negative case actions in...

42 CFR 431.814 - Sampling plan and procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Sampling plan and procedures. 431.814 Section 431.814 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... annual expenditures for services for active cases, and on the total number of negative case actions in...

48 CFR 13.303-6 - Review procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Review procedures. (a) The contracting officer placing orders under a BPA, or the designated representative of the contracting officer, shall review a sufficient random sample of the BPA files at least... into the BPA shall— (1) Ensure that each BPA is reviewed at least annually and, if necessary, updated...

48 CFR 13.303-6 - Review procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Review procedures. (a) The contracting officer placing orders under a BPA, or the designated representative of the contracting officer, shall review a sufficient random sample of the BPA files at least... into the BPA shall— (1) Ensure that each BPA is reviewed at least annually and, if necessary, updated...

48 CFR 13.303-6 - Review procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Review procedures. (a) The contracting officer placing orders under a BPA, or the designated representative of the contracting officer, shall review a sufficient random sample of the BPA files at least... into the BPA shall— (1) Ensure that each BPA is reviewed at least annually and, if necessary, updated...

48 CFR 13.303-6 - Review procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Review procedures. (a) The contracting officer placing orders under a BPA, or the designated representative of the contracting officer, shall review a sufficient random sample of the BPA files at least... into the BPA shall— (1) Ensure that each BPA is reviewed at least annually and, if necessary, updated...

48 CFR 13.303-6 - Review procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Review procedures. (a) The contracting officer placing orders under a BPA, or the designated representative of the contracting officer, shall review a sufficient random sample of the BPA files at least... into the BPA shall— (1) Ensure that each BPA is reviewed at least annually and, if necessary, updated...

Home, Division of Administrative Services, Department of Administration,

Science.gov Websites

and fiscal management support to divisions. Information Technology (DOA-IT) Provides overall planning departmental programs. Policies and Procedures Establish business management policies and procedures for the Department of Administration (DOA). Budget Develop DOA's annual budget, liaison with the Office of Management

40 CFR 90.316 - Hydrocarbon analyzer calibration.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) Initial and periodic optimization of detector response. Prior to initial use and at least annually... nitrogen. (2) Use of one of the following procedures is required for FID or HFID optimization: (i) The procedure outlined in Society of Automotive Engineers (SAE) paper No. 770141, “Optimization of a Flame...

75 FR 28550 - Proposed Information Collection; Comment Request; Delivery Verification Procedure

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-21

... the commodities shipped to the U.S. were in fact received. This procedure increases the effectiveness... Review: Regular submission. Affected Public: Business or other for-profit organizations. Estimated Number.... Estimated Total Annual Cost to Public: $0. IV. Request for Comments Comments are invited on: (a) Whether the...

78 FR 23743 - Proposed Information Collection; Comment Request; Delivery Verification Procedure for Imports

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-22

..., received. This procedure increases the effectiveness of controls on the international trade of strategic... collection). Affected Public: Business or other for-profit organizations. Estimated Number of Respondents... Annual Cost to Public: $0. IV. Request for Comments Comments are invited on: (a) Whether the proposed...

Office Organization and Procedures in the Office--Calendar; Commencement Procedure; Publications; Records; Registration; Reports; Scheduling; Staffing; Testing; Transcripts

ERIC Educational Resources Information Center

College and University, 1977

1977-01-01

Proceedings of AACRAO's 63rd annual meeting cover: calendar conversion; publications economy; class schedules; fraudulent transcripts; student retention; student ID numbers; veteran student reporting; financial aid reporting; faculty activity analyses; time management; registration; and transcript forms for nontraditional programs. (LBH)

40 CFR 98.63 - Calculating GHG emissions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... baking of prebake cells using either the procedures in paragraph (d) of this section or the procedures in.../metric tons Al). MP = Annual metal production (metric tons Al). Sa = Sulfur content in baked anode (percent weight). Asha = Ash content in baked anode (percent weight). 44/12 = Ratio of molecular weights...

40 CFR 205.54-1 - Low speed sound emission test procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Low speed sound emission test....54-1 Low speed sound emission test procedures. (a) Instrumentation. The following instrumentation... checked annually to verify that its output has not changed. (3) An engine-speed tachometer which is...

75 FR 78707 - Medicare Program; First Semi-Annual Meeting of the Advisory Panel on Ambulatory Payment...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-16

... hospital payment systems; hospital medical care delivery systems; provider billing and accounting systems; APC groups; Current Procedural Terminology codes; Health Care Common Procedure Coding System (HCPCS) codes; the use of, and payment for, drugs, medical devices, and other services in the outpatient setting...

The influenza vaccine licensing process.

PubMed

Wood, J M; Levandowski, R A

2003-05-01

Influenza vaccines are unique because they require a licensing process which includes a procedure for rapid annual updates to vaccine strains. The licensing procedures in the European Union and the USA are described as examples. In the event of an influenza pandemic, vaccines will be required urgently and licensing process should reflect such needs.

Low rates of complications for carotid artery stenting are associated with a high clinician volume of carotid artery stenting and aortic endografting but not with a high volume of percutaneous coronary interventions.

PubMed

Modrall, J Gregory; Chung, Jayer; Kirkwood, Melissa L; Baig, M Shadman; Tsai, Shirling X; Timaran, Carlos H; Valentine, R James; Rosero, Eric B

2014-07-01

Prior studies have demonstrated improved clinical outcomes for surgeons with a high-volume experience with certain open vascular operations. A high-volume experience with carotid artery stenting (CAS) improves clinical outcomes. Moreover, it is not known whether experience with other endovascular procedures, including percutaneous coronary interventions (PCIs), is an adequate substitute for experience with CAS. The goal of this study was to quantify the effect of increasing clinician volume of CAS, endovascular aneurysm repair (EVAR), and thoracic endovascular aortic aneurysm repair (TEVAR), and PCI on the outcomes for CAS. The Nationwide Inpatient Sample was analyzed to identify patients undergoing CAS for the years 2005 to 2009. Clinicians were stratified into tertiles of low-volume, medium-volume, and high-volume groups by annual volume of CAS, EVAR/TEVAR, and PCI. Multiple logistic regression analyses were used to examine the relationship between clinician volume and a composite outcome of the in-hospital stroke and death rate after CAS. Between 2005 and 2009, 56,374 elective CAS procedures were performed nationwide, with a crude in-hospital stroke and death rate of 3.22%. A median of nine CAS procedures (interquartile range, 3-20) were performed annually per clinician. As expected, stroke and death rates for CAS decreased with increasing volume of CAS performed by a clinician (low-volume vs medium-volume vs high-volume: 4.43% vs 2.89% vs 2.27%; P = .0001). Similar patterns were noted between clinicians' volume of EVAR/TEVAR (low-volume vs medium-volume vs high-volume: 4.58% vs 3.18% vs 2.16%; P = .0023). In contrast, increasing PCI volume was not associated with decreased stroke and death rates after CAS (low-volume vs medium-volume vs high-volume: 2.99% vs 3.18% vs 3.55%; P = .35). After adjusting for patient and hospital characteristics, clinician volume of CAS (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.74-0.94; P = .003) and EVAR/TEVAR (OR, 0.85; 95% CI, 0.75-0.97; P = .020) remained significant predictors of stroke and death after CAS, whereas increasing clinician volume of PCI was associated with significantly increasing likelihood of stroke or death after CAS (OR, 1.025; 95% CI, 1.004-1.047; P = .019). The stroke and death rate for CAS to treat carotid stenosis is inversely affected by the number of CAS and EVAR/TEVAR procedures performed by a clinician. In contrast, a high-volume experience with PCI is not associated with improved outcomes after CAS. Copyright © 2014 Society for Vascular Surgery. All rights reserved.

Survival and re-operation rates after neurosurgical procedures in Scotland: implications for targeted surveillance of sub-clinical variant Creutzfeldt-Jakob disease.

PubMed

Bird, Sheila M; Merrall, Elizabeth L C; Ward, Hester J T; Will, Robert G

2009-01-01

To assess the feasibility of post-mortem surveillance for subclinical variant Creutzfeldt-Jakob disease (vCJD) at least 5 years after neurosurgical procedures. Using Scottish record linkage, we estimated 5-year survival and re-operation rates after 4 neurosurgical procedures performed during 1993-2001 and identified as high or medium risk for transmitting vCJD: [B] drainage of extra- or subdural haematoma, [E] primary or revisional decompression operations and [H] creation of other ventricular shunts were classified as high risk; [C] operations on cerebral aneurysm (clipping) were classified as medium risk. Fatality rate at 1 year depended strongly on procedure, weakly or not at all on sex and era, and increased with age. Procedure rates differed by sex. The rate of subsequent neurosurgical operations was highest for procedure [H] (sole: 21%; multiple: 28%). Each year, the UK has a new cohort of some 5,000 5-year survivors after a high- or medium-risk neurosurgical procedure, whose subsequent annual mortality is at least 3%. Even if half the surviving 5-year survivors of neurosurgery since 1996 gave consent-in-life for vCJD-informative testing at post-mortem, there would be too few relevant post-mortems in 2008-2010 (around 1,600) for 'nil detections' to exclude a 1 in 1,000 subclinical vCJD rate. Autopsy surveillance beyond 2010, or among 5-year survivors of non-neurosurgical at-risk operations, would be needed. (c) 2009 S. Karger AG, Basel.

Development of a CSP plant energy yield calculation tool applying predictive models to analyze plant performance sensitivities

NASA Astrophysics Data System (ADS)

Haack, Lukas; Peniche, Ricardo; Sommer, Lutz; Kather, Alfons

2017-06-01

At early project stages, the main CSP plant design parameters such as turbine capacity, solar field size, and thermal storage capacity are varied during the techno-economic optimization to determine most suitable plant configurations. In general, a typical meteorological year with at least hourly time resolution is used to analyze each plant configuration. Different software tools are available to simulate the annual energy yield. Software tools offering a thermodynamic modeling approach of the power block and the CSP thermal cycle, such as EBSILONProfessional®, allow a flexible definition of plant topologies. In EBSILON, the thermodynamic equilibrium for each time step is calculated iteratively (quasi steady state), which requires approximately 45 minutes to process one year with hourly time resolution. For better presentation of gradients, 10 min time resolution is recommended, which increases processing time by a factor of 5. Therefore, analyzing a large number of plant sensitivities, as required during the techno-economic optimization procedure, the detailed thermodynamic simulation approach becomes impracticable. Suntrace has developed an in-house CSP-Simulation tool (CSPsim), based on EBSILON and applying predictive models, to approximate the CSP plant performance for central receiver and parabolic trough technology. CSPsim significantly increases the speed of energy yield calculations by factor ≥ 35 and has automated the simulation run of all predefined design configurations in sequential order during the optimization procedure. To develop the predictive models, multiple linear regression techniques and Design of Experiment methods are applied. The annual energy yield and derived LCOE calculated by the predictive model deviates less than ±1.5 % from the thermodynamic simulation in EBSILON and effectively identifies the optimal range of main design parameters for further, more specific analysis.

Growth of Nonoperating Room Anesthesia Care in the United States: A Contemporary Trends Analysis.

PubMed

Nagrebetsky, Alexander; Gabriel, Rodney A; Dutton, Richard P; Urman, Richard D

2017-04-01

Although previous publications suggest an increasing demand and volume of nonoperating room anesthesia (NORA) cases in the United States, there is little factual information on either volume or characteristics of NORA cases at a national level. Our goal was to assess the available data using the National Anesthesia Clinical Outcomes Registry (NACOR). We performed a retrospective analysis of NORA volume and case characteristics using NACOR data for the period 2010-2014. Operating room (OR) and NORA cases were assessed for patient, provider, procedural, and facility characteristics. NACOR may indicate general trends, since it collects data on about 25% of all anesthetics in the United States each year. We examined trends in the annual proportion of NORA cases, the annual mean age of patients, the annual proportions of American Society of Anesthesiologists physical status (ASA PS) III-V patients, and outpatient cases. Regression analyses for trends included facility type and urban/rural location as covariables. The most frequently reported procedures were identified. The proportion of NORA cases overall increased from 28.3% in 2010 to 35.9% in 2014 (P < .001). The mean age of NORA patients was 3.5 years higher compared with OR patients (95% CI 3.5-3.5, P < .001). The proportion of patients with ASA PS class III-V was higher in the NORA group compared with OR group, 37.6% and 33.0%, respectively (P < .001). The median (quartile 1, 3) duration of NORA cases was 40 (25, 70) minutes compared with 86 (52, 141) minutes for OR cases (P < .001). In comparison to OR cases, more NORA cases were started after normal working hours (9.9% vs 16.7%, P < .001). Colonoscopy was the most common procedure that required NORA. There was a significant upward trend in the mean age of NORA patients in the multivariable analysis-the estimated increase in mean age was 1.06 years of age per year of study period (slope 1.06; 95% confidence interval [CI] 1.05-1.07, P < .001). Multivariable analysis demonstrated that the mean age of NORA patients increased significantly faster compared with OR patients (difference in slopes 0.39; 95% CI 0.38-0.41, P < .001). The annual increase in ordinal ASA PS of NORA patients was small in magnitude, but statistically significant (odds ratio 1.03; 95% CI 1.03-1.03, P < .001). The proportion of outpatient NORA cases increased from 69.7% in 2010 to 73.3% in 2014 (P < .001). Our results demonstrate that NORA is a growing component of anesthesiology practice. The proportion of cases performed outside of the OR increased during the study period. In addition, we identified an upward trend in the age of patients receiving NORA care. NORA cases were different from OR cases in a number of aspects. Data collected by NACOR in the coming years will further characterize the trends identified in this study.

Rates of strabismus surgery in the United States: implications for manpower needs in pediatric ophthalmology.

PubMed

Dombrow, Matthew; Engel, Harry M

2007-08-01

To investigate rates of strabismus surgery and population projections in the United States and to consider whether a sufficient number of pediatric ophthalmologists are being trained to meet future needs. Review of online data from Series 13 reports from the National Center for Health Statistics for the period 1965 to 1996, including reports from the National Hospital Discharge Survey and the National Survey of Ambulatory Surgery. Population data were obtained from the U.S. Census Bureau. The current rate of strabismus surgery for children under 15 years of age is 80 per 100,000 persons in the United States. This rate would generate an additional 389 strabismus cases annually, based on the predicted growth of the pediatric population. On average, today's pediatric ophthalmologist performs about 114 strabismus procedures annually. If the current rates and trends remain stable over the coming years, it is not likely that there will be a shortage of pediatric ophthalmologists in the United States.

Defensive Medicine in U.S. Spine Neurosurgery.

PubMed

Din, Ryan S; Yan, Sandra C; Cote, David J; Acosta, Michael A; Smith, Timothy R

2017-02-01

Observational cross-sectional survey. To compare defensive practices of U.S. spine and nonspine neurosurgeons in the context of state medical liability risk. Defensive medicine is a commonly reported and costly phenomenon in neurosurgery. Although state liability risk is thought to contribute greatly to defensive practice, variation within neurosurgical specialties has not been well explored. A validated, online survey was sent via email to 3344 members of the American Board of Neurological Surgeons. The instrument contained eight question domains: surgeon characteristics, patient characteristics, practice type, insurance type, surgeon liability profile, basic surgeon reimbursement, surgeon perceptions of medical legal environment, and the practice of defensive medicine. The overall response rate was 30.6% (n = 1026), including 499 neurosurgeons performing mainly spine procedures (48.6%). Spine neurosurgeons had a similar average practice duration as nonspine neurosurgeons (16.6 vs 16.9 years, P = 0.64) and comparable lifetime case volume (4767 vs 4,703, P = 0.71). The average annual malpractice premium for spine neurosurgeons was similar to nonspine neurosurgeons ($104,480.52 vs $101,721.76, P = 0.60). On average, spine neurosurgeons had a significantly higher rate of ordering labs, medications, referrals, procedures, and imaging solely for liability concerns compared with nonspine neurosurgeons (89.2% vs 84.6%, P = 0.031). Multivariate analysis revealed that spine neurosurgeons were roughly 3 times more likely to practice defensively compared with nonspine neurosurgeons (odds ratio, OR = 2.9, P = 0.001) when controlling for high-risk procedures (OR = 7.8, P < 0.001), annual malpractice premium (OR = 3.3, P = 0.01), percentage of patients publicly insured (OR = 1.1, P = 0.80), malpractice claims in the last 3 years (OR = 1.13, P = 0.71), and state medical-legal environment (OR = 1.3, P = 0.37). State-based medical legal environment is not a significant driver of increased defensive medicine associated with neurosurgical spine procedures. 3.

Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population.

PubMed

Jensen, Andrew R; Cha, Peter S; Devana, Sai K; Ishmael, Chad; Di Pauli von Treuheim, Theo; D'Oro, Anthony; Wang, Jeffrey C; McAllister, David R; Petrigliano, Frank A

2017-10-01

Medicare insures the largest population of patients at risk for rotator cuff tears in the United States. To evaluate the trends in incidence, concomitant procedures, and complications with open and arthroscopic rotator cuff repairs in Medicare patients. Cohort study; Level of evidence, 3. All Medicare patients who had undergone open or arthroscopic rotator cuff repair from 2005 through 2011 were identified with a claims database. Annual incidence, concomitant procedures, and postoperative complications were compared between these 2 groups. In total, 372,109 rotator cuff repairs were analyzed. The incidence of open repairs decreased (from 6.0 to 4.3 per 10,000 patients, P < .001) while the incidence of arthroscopic repairs increased (from 4.5 to 7.8 per 10,000 patients, P < .001) during the study period. Patients in the arthroscopic group were more likely to have undergone concomitant subacromial decompression than those in the open group (87% vs 35%, P < .001), and the annual incidence of concomitant biceps tenodesis increased for both groups (from 3.8% to 11% for open and 2.2% to 16% for arthroscopic, P < .001). While postoperative complications were infrequent, patients in the open group were more likely to be diagnosed with infection within 6 months (0.86% vs 0.37%, P < .001) but no more likely to undergo operative debridement (0.43% vs 0.26%, P = .08). Additionally, patients in the open group were more likely to undergo intervention for shoulder stiffness within 1 year (1.4% vs 1.1%, P = .01). In the Medicare population, arthroscopic rotator cuff repairs have increased in incidence and now represent the majority of rotator cuff repair surgery. Among concomitant procedures, subacromial decompression was most commonly performed despite evidence suggesting a lack of efficacy. Infections and stiffness were rare complications that were slightly but significantly more frequent in open rotator cuff repairs.

Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population

PubMed Central

Jensen, Andrew R.; Cha, Peter S.; Devana, Sai K.; Ishmael, Chad; Di Pauli von Treuheim, Theo; D’Oro, Anthony; Wang, Jeffrey C.; McAllister, David R.; Petrigliano, Frank A.

2017-01-01

Background: Medicare insures the largest population of patients at risk for rotator cuff tears in the United States. Purpose: To evaluate the trends in incidence, concomitant procedures, and complications with open and arthroscopic rotator cuff repairs in Medicare patients. Study Design: Cohort study; Level of evidence, 3. Methods: All Medicare patients who had undergone open or arthroscopic rotator cuff repair from 2005 through 2011 were identified with a claims database. Annual incidence, concomitant procedures, and postoperative complications were compared between these 2 groups. Results: In total, 372,109 rotator cuff repairs were analyzed. The incidence of open repairs decreased (from 6.0 to 4.3 per 10,000 patients, P < .001) while the incidence of arthroscopic repairs increased (from 4.5 to 7.8 per 10,000 patients, P < .001) during the study period. Patients in the arthroscopic group were more likely to have undergone concomitant subacromial decompression than those in the open group (87% vs 35%, P < .001), and the annual incidence of concomitant biceps tenodesis increased for both groups (from 3.8% to 11% for open and 2.2% to 16% for arthroscopic, P < .001). While postoperative complications were infrequent, patients in the open group were more likely to be diagnosed with infection within 6 months (0.86% vs 0.37%, P < .001) but no more likely to undergo operative debridement (0.43% vs 0.26%, P = .08). Additionally, patients in the open group were more likely to undergo intervention for shoulder stiffness within 1 year (1.4% vs 1.1%, P = .01). Conclusion: In the Medicare population, arthroscopic rotator cuff repairs have increased in incidence and now represent the majority of rotator cuff repair surgery. Among concomitant procedures, subacromial decompression was most commonly performed despite evidence suggesting a lack of efficacy. Infections and stiffness were rare complications that were slightly but significantly more frequent in open rotator cuff repairs. PMID:29051905

[Regional anaesthesia as advantage in competition between hospitals. Strategic market analysis].

PubMed

Heller, A R; Bauer, K R; Eberlein-Gonska, M; Albrecht, D M; Koch, T

2009-05-01

The German Social Act V section sign 12 is aimed towards competition, efficiency and quality in healthcare. Because surgical departments are billing standard diagnosis-related group (DRG) case costs to health insurance companies, they claim best value for money for internal services. Thus, anaesthesia concepts are being closely scrutinized. The present analysis was performed to gain economic arguments for the strategic positioning of regional anaesthesia procedures into clinical pathways. Surgical procedures, which in 2005 had a relevant caseload in Germany, were chosen in which regional anaesthesia procedures (alone or in combination with general anaesthesia) could routinely be used. The structure of costs and earnings for hospital services, split by types and centres of cost, as well as by underlying procedures are contained in the annually updated public accessible dataset (DRG browser) of the German Hospital Reimbursement Institute (InEK). For the year 2005 besides own data, national anaesthesia staffing costs are available from the German Society of Anaesthesiology (DGAI). The curve of earnings per DRG can be calculated from the 2005 InEK browser. This curve intersects by the cost curve at the point of national mean length of stay. The cost curve was calculated by process-oriented distribution of cost centres over the length of stay and allows benchmarking within the national competitive environment. For comparison of process times data from our local database were used. While the InEK browser lacks process times, the cost positions 5.1-5.3 (staffing costs anaesthesia) and the national structure adjusted anaesthesia staffing costs 2005 as published by the DGAI, were used to calculate nationwide mean available anaesthesia times which were compared with own process times. Within the portfolio diagram of lengths of stay for each DRG and process times most procedures are located in the economic lower left, in particular those with high case mix (length of stay and anaesthesia times below reimbursement relevant national mean). The driver of increased earnings is shortening length of stay. Our use of regional anaesthesia is 5 to 10-fold higher than national benchmarks and may contribute to our advantageous position in national competition. The annual increases in profit per DRG range between EUR 1,706 and EUR 467,359 and compensate by far the investment of regional anaesthesia derived pain management, besides the advantage of increased patient satisfaction and avoidance of complications. Regional anaesthesia is a considerable value driver in clinical pathways by shortening length of stay. The present analysis further demonstrates that time for regional block performance is covered by anaesthesia reimbursement within the DRG costing schedule.

40 CFR 98.473 - Calculating CO2 received.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... (a) You must calculate and report the annual mass of CO2 received by pipeline using the procedures in... applicable. (1) For a mass flow meter, you must calculate the total annual mass of CO2 in a CO2 stream received in metric tons by multiplying the mass flow by the CO2 concentration in the flow, according to...

40 CFR 98.473 - Calculating CO2 received.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... (a) You must calculate and report the annual mass of CO2 received by pipeline using the procedures in... applicable. (1) For a mass flow meter, you must calculate the total annual mass of CO2 in a CO2 stream received in metric tons by multiplying the mass flow by the CO2 concentration in the flow, according to...

40 CFR 98.473 - Calculating CO2 received.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... (a) You must calculate and report the annual mass of CO2 received by pipeline using the procedures in... applicable. (1) For a mass flow meter, you must calculate the total annual mass of CO2 in a CO2 stream received in metric tons by multiplying the mass flow by the CO2 concentration in the flow, according to...

40 CFR 98.473 - Calculating CO2 received.

Code of Federal Regulations, 2012 CFR

2012-07-01

.... (a) You must calculate and report the annual mass of CO2 received by pipeline using the procedures in... applicable. (1) For a mass flow meter, you must calculate the total annual mass of CO2 in a CO2 stream received in metric tons by multiplying the mass flow by the CO2 concentration in the flow, according to...

Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry.

PubMed

Lenguerrand, E; Whitehouse, M R; Beswick, A D; Jones, S A; Porter, M L; Blom, A W

2017-06-01

We used the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to investigate the risk of revision due to prosthetic joint infection (PJI) for patients undergoing primary and revision hip arthroplasty, the changes in risk over time, and the overall burden created by PJI. We analysed revision total hip arthroplasties (THAs) performed due to a diagnosis of PJI and the linked index procedures recorded in the NJR between 2003 and 2014. The cohort analysed consisted of 623 253 index primary hip arthroplasties, 63 222 index revision hip arthroplasties and 7585 revision THAs performed due to a diagnosis of PJI. The prevalence, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression. We demonstrated a prevalence of revision THA due to prosthetic joint infection of 0.4/100 procedures following primary and 1.6/100 procedures following revision hip arthroplasty. The prevalence of revision due to PJI in the three months following primary hip arthroplasty has risen 2.3-fold (95% confidence interval (CI) 1.3 to 4.1) between 2005 and 2013, and 3.0-fold (95% CI 1.1 to 8.5) following revision hip arthroplasty. Over 1000 procedures are performed annually as a consequence of hip PJI, an increase of 2.6-fold between 2005 and 2013. Although the risk of revision due to PJI following hip arthroplasty is low, it is rising and, coupled with the established and further predicted increased incidence of both primary and revision hip arthroplasty, this represents a growing and substantial treatment burden. Cite this article : E. Lenguerrand, M. R. Whitehouse, A. D. Beswick, S. A. Jones, M. L. Porter, A. W. Blom. Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry. Bone Joint Res 2017;6:391-398. DOI: 10.1302/2046-3758.66.BJR-2017-0003.R1. © 2017 Lenguerrand et al.

The Korean Spinal Neurosurgery Society ; Are We Reimbursed Properly for Spinal Neurosurgical Practices under the Korean Resource Based Relative Value Scale Service?

PubMed Central

Kwon, Woo-Keun; Kim, Joo Han; Moon, Hong Joo; Park, Youn-Kwan

2017-01-01

Objectives The Korean Resource Based Relative Value Scale (K-RBRVS) was introduced in 2001 as an alternative of the previous medical fee schedule. Unfortunately, most neurosurgeons are unfamiliar with the details of the K-RBRVS and how it affects the reimbursement rates for the surgical procedures we perform. We summarize the K-RBRVS in brief, and discuss on how the relative value (RV) of the spinal neurosurgical procedures have changed since the introduction in 2001. Methods We analyzed the change of spinal procedure RVs since 2001, and compared it with the change of values in the brain neurosurgical procedures. RVs of 88 neurospinal procedures on the list of K-RBRVS were analyzed, while 24 procedures added during annual revisions were excluded. Results During the past 15 years, RVs for spinal procedures have increased 62.8%, which is not so different with the cumulative increase of consumer prices during this time period or the increase rate of 92.3% for brain surgeries. When comparing the change of RVs in more complex procedures between spinal and brain neurosurgery, the increase rate was 125.3% and 133%, respectively. Conclusion More effort of the society of spinal surgeons seems to be needed to get adequate reimbursement, as there have been some discrimination compared to brain surgeons in the increase of RVs. And considering the relative underestimation of spinal neurosurgeons’ labor, more objective measures of neurospinal surgeons’ work and productivity should be developed for impartial reimbursement. PMID:28061492

The importance of protection glasses during neuroangiographies: A study on radiation exposure at the lens of the primary operator.

PubMed

Tavares, J B; Sacadura-Leite, E; Matoso, T; Neto, L L; Biscoito, L; Campos, J; Sousa-Uva, A

2016-06-01

In interventional neuroradiology, few operators routinely use radiation protection glasses. Moreover, in most centers, radiation dose data only accounts for whole body dose without specific information on lens dose. In 2012, the International Commission on Radiological Protection advised that the threshold limit value for the lens should be 20 mSv/year instead of the previous 150 mSv/year limit. The purpose of this study was to compare the radiation dose in the operator's lens during real diagnostic and interventional neuroangiographies, either using or without lead protection glasses. Using the Educational Direct Dosimeter (EDD30 dosimeter), accumulated radiation dose in the lens was measured in 13 neuroangiographies: seven diagnostic and six interventional. Operators with and without radiation protection glasses were included and the sensor was placed near their left eye, closest to the radiation beam. Without glasses, the corrected mean dose of radiation in the lens was 8.02 µSv for diagnostic procedures and 168.57 µSv for interventional procedures. Using glasses, these values were reduced to 1.74 µSv and 33.24 µSv, respectively. Considering 20 mSv as the suggested annual limit of equivalent dose in the lens, neuroradiologists may perform up to 2,494 diagnostic procedures per year without protecting glasses, a number that increases to 11,494 when glasses are used consistently. Regarding intervention, a maximum of 119 procedures per year is advised if glasses are not used, whereas up to 602 procedures/year may be performed using this protection. Therefore, neuroradiologists should always wear radiation protection glasses. © The Author(s) 2016.

Volume changes of autogenous bone after sinus lifting and grafting procedures: a 6-year computerized tomographic follow-up.

PubMed

Sbordone, Carolina; Toti, Paolo; Guidetti, Franco; Califano, Luigi; Bufo, Pantaleo; Sbordone, Ludovico

2013-04-01

To evaluate long-term bone remodelling of autografts over time (annually, for 6 years), comparing the block and particulate bone procedures for sinus floor elevation, as well as to evaluate the survival of positioned dental implants. Twenty-three sinus lift procedures with autogenous bone were performed: seven sinus lift procedures using particulate graft and 10 with block autogenous bone were performed in 17 patients. Employing a software program, pre- and post-surgical computerized tomography (CT) scans were used to compare the volume (V) and density (D) of inlay grafts over time (up to 6 years), and to determine the percentage of remaining bone (%R). All variable (V, D and %R) measurements were then compared statistically. At the 6-year survey for block form, a resorption of 21.5% was seen, whereas for particulate grafts there was a resorption of 39.2%. Both groups exhibited bone remodelling between the first and second follow-up which was significant regarding volume for the block form and regarding density for the particulate group. During the initial period of healing, the cortico-cancellous block bone grafted into the maxillary sinus underwent a negative remodelling of the volume, which is most probably due to graft cortex resorption, coupled with, primarily, an increase in density in the spongious area; for the particulate grafts, significant augmentations in density were obtained. The lack of significant differences among volumes was due to the wide degree of dispersion of the data. The rough data presented in this paper seem to support the use of a bone-block grafting procedure in maxillary sinus augmentation. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

[IMSS in numbers. Surgeries].

PubMed

2005-01-01

Surgery occupies a priority place within the organization of health services. In the IMSS around 1.4 million surgeries are performed annually and 3934 take place each day. A great part of the resources goes to obstetric interventions, since 222,928 caesarean sections were performed in 2004, and along with curettages, tubal occlusions and hysterectomies, they sum 37.6% of the surgeries performed in 2004. Abdominal deliveries (caesarean sections) were done in 39% of the pregnancies delivered in the IMSS and 8.3% were done in adolescents. Simple surgical interventions were also important. Cholecystectomies were 6 times more frequent in women aged 20 to 59 years old than in men the same age. Among the main interventions we also describe hernioplasty, appendicectomies, amygdalectomies, rhinoplasties, biopsies and circumcisions. Scarce data on complications are registered and no data is available for infections of surgical wounds. Surgical procedures are more frequent in women and in certain specialities.

10 CFR 765.12 - Inflation index adjustment procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Inflation index adjustment procedures. 765.12 Section 765.12 Energy DEPARTMENT OF ENERGY REIMBURSEMENT FOR COSTS OF REMEDIAL ACTION AT ACTIVE URANIUM AND... Department shall adjust annually, using the CPI-U as defined in this part, amounts paid to an active uranium...

10 CFR 765.12 - Inflation index adjustment procedures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Inflation index adjustment procedures. 765.12 Section 765.12 Energy DEPARTMENT OF ENERGY REIMBURSEMENT FOR COSTS OF REMEDIAL ACTION AT ACTIVE URANIUM AND... Department shall adjust annually, using the CPI-U as defined in this part, amounts paid to an active uranium...

10 CFR 765.12 - Inflation index adjustment procedures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Inflation index adjustment procedures. 765.12 Section 765.12 Energy DEPARTMENT OF ENERGY REIMBURSEMENT FOR COSTS OF REMEDIAL ACTION AT ACTIVE URANIUM AND... Department shall adjust annually, using the CPI-U as defined in this part, amounts paid to an active uranium...

10 CFR 765.12 - Inflation index adjustment procedures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Inflation index adjustment procedures. 765.12 Section 765.12 Energy DEPARTMENT OF ENERGY REIMBURSEMENT FOR COSTS OF REMEDIAL ACTION AT ACTIVE URANIUM AND... Department shall adjust annually, using the CPI-U as defined in this part, amounts paid to an active uranium...

EVALUATION OF ENVIRONMENTAL HAZARD ASSESSMENT PROCEDURES FOR NEAR-COASTAL AREAS OF THE GULF OF MEXICO

EPA Science Inventory

Lewis, Michael A. In press. Evaluation of Environmental Hazard Assessment Procedures for Near-Coastal Areas of the Gulf of Mexico (Abstract). To be presented at the Annual Meeting of the the Australasian Society of Ecotoxicology, July 2004, Gold Coast, Australia. 1 p. (ERL,GB R98...

Patient or visitor, mentally disturbed individuals may pose a safety threat.

PubMed

2004-09-01

As the hospital point of entry, EDs often are the first place unstable individuals can threaten others. Have specific procedures outlined for visitors and for mentally unstable patients. Cooperate closely with your security department, but always retain clinical control. Periodically review and update your procedures, and have staff re-educated annually.

Annual Vehicle Miles of Travel and Related Data : Procedures Used to Derive the Data Elements of the 1994 Table VM-1

DOT National Transportation Integrated Search

1996-06-01

The purpose of this report is to document the preparation of the 1994 Table VM-1, including data sources, assumptions, and estimating procedures. Table VM-1 describes vehicle distance traveled in miles, by highway category and vehicle type. VM-1 depi...

10 CFR 765.12 - Inflation index adjustment procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Inflation index adjustment procedures. 765.12 Section 765.12 Energy DEPARTMENT OF ENERGY REIMBURSEMENT FOR COSTS OF REMEDIAL ACTION AT ACTIVE URANIUM AND... Department shall adjust annually, using the CPI-U as defined in this part, amounts paid to an active uranium...

12 CFR 326.4 - Reports.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 4 2011-01-01 2011-01-01 false Reports. 326.4 Section 326.4 Banks and Banking... DEVICES AND PROCEDURES AND BANK SECRECY ACT 1 COMPLIANCE Minimum Security Procedures § 326.4 Reports. The security officer for each insured nonmember bank shall report at least annually to the bank's board of...

12 CFR 326.4 - Reports.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 5 2012-01-01 2012-01-01 false Reports. 326.4 Section 326.4 Banks and Banking... DEVICES AND PROCEDURES AND BANK SECRECY ACT 1 COMPLIANCE Minimum Security Procedures § 326.4 Reports. The security officer for each insured nonmember bank shall report at least annually to the bank's board of...

12 CFR 326.4 - Reports.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 5 2013-01-01 2013-01-01 false Reports. 326.4 Section 326.4 Banks and Banking... DEVICES AND PROCEDURES AND BANK SECRECY ACT 1 COMPLIANCE Minimum Security Procedures § 326.4 Reports. The security officer for each insured nonmember bank shall report at least annually to the bank's board of...

12 CFR 326.4 - Reports.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 5 2014-01-01 2014-01-01 false Reports. 326.4 Section 326.4 Banks and Banking... DEVICES AND PROCEDURES AND BANK SECRECY ACT 1 COMPLIANCE Minimum Security Procedures § 326.4 Reports. The security officer for each insured nonmember bank shall report at least annually to the bank's board of...

No-migration variance petition. Appendices C--J: Volume 5, Revision 1

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

Not Available

1990-03-01

Volume V contains the appendices for: closure and post-closure plans; RCRA ground water monitoring waver; Waste Isolation Division Quality Program Manual; water quality sampling plan; WIPP Environmental Procedures Manual; sample handling and laboratory procedures; data analysis; and Annual Site Environmental Monitoring Report for the Waste Isolation Pilot Plant.

Each procedure matters: threshold for surgeon volume to minimize complications and decrease cost associated with adrenalectomy.

PubMed

Anderson, Kevin L; Thomas, Samantha M; Adam, Mohamed A; Pontius, Lauren N; Stang, Michael T; Scheri, Randall P; Roman, Sanziana A; Sosa, Julie A

2018-01-01

An association has been suggested between increasing surgeon volume and improved patient outcomes, but a threshold has not been defined for what constitutes a "high-volume" adrenal surgeon. Adult patients who underwent adrenalectomy by an identifiable surgeon between 1998-2009 were selected from the Healthcare Cost and Utilization Project National Inpatient Sample. Logistic regression modeling with restricted cubic splines was utilized to estimate the association between annual surgeon volume and complication rates in order to identify a volume threshold. A total of 3,496 surgeons performed adrenalectomies on 6,712 patients; median annual surgeon volume was 1 case. After adjustment, the likelihood of experiencing a complication decreased with increasing annual surgeon volume up to 5.6 cases (95% confidence interval, 3.27-5.96). After adjustment, patients undergoing resection by low-volume surgeons (<6 cases/year) were more likely to experience complications (odds ratio 1.71, 95% confidence interval, 1.27-2.31, P = .005), have a greater hospital stay (relative risk 1.46, 95% confidence interval, 1.25-1.70, P = .003), and at increased cost (+26.2%, 95% confidence interval, 12.6-39.9, P = .02). This study suggests that an annual threshold of surgeon volume (≥6 cases/year) that is associated with improved patient outcomes and decreased hospital cost. This volume threshold has implications for quality improvement, surgical referral and reimbursement, and surgical training. Copyright © 2017 Elsevier Inc. All rights reserved.

We still need to operate at night!

PubMed Central

Faiz, Omar; Banerjee, Saswata; Tekkis, Paris; Papagrigoriadis, Savvas; Rennie, John; Leather, Andrew

2007-01-01

Introduction In the past the National Confidential Enquiry into Peri-operative deaths (NCEPOD) have advocated a reduction in non-essential night-time operating in NHS hospitals. In this study a retrospective analysis of the emergency general surgical operative workload at a London Teaching centre was performed. Methods All general surgical and vascular emergency operations recorded prospectively on the theatre database between 1997 and 2004 were included in the study. Operations were categorised according to whether they commenced during the daytime(08:01–18:00 hours), evening(18:01–00:00 hours) or night-time(00:01–08:00 hours). The procedure type and grade of the participating surgical personnel were also recorded. Bivariate correlation was used to analyse changing trends in the emergency workload. Results In total 5,316 emergency operations were performed over the study period. The numbers of daytime, evening and night-time emergency procedures performed were 2,963(55.7%), 1,832(34.5%), and 521(9.8%) respectively. Laparotomies and complex vascular procedures collectively accounted for half of all cases performed after midnight whereas they represented only 30% of the combined daytime and evening emergency workload. Thirty-two percent (n = 166) of all night-time operations were supervised or performed by a consultant surgeon. The annual volume of emergency cases performed increased significantly throughout the study period. Enhanced daytime (r = 0.741, p < 0.01) and evening (r = 0.548, p < 0.01) operating absorbed this increase in workload. There was no significant change in the absolute number of cases performed at night but the proportion of the emergency workload that took place after midnight decreased significantly throughout the study (r = -0.742, p < 0.01). Conclusion A small but consistent volume of complex cases require emergency surgery after midnight. Provision of an emergency general surgical service must incorporate this need. PMID:17973987

Provincial Variation of Cochlear Implantation Surgical Volumes and Cost in Canada.

PubMed

Crowson, Matthew G; Chen, Joseph M; Tucci, Debara

2017-01-01

Objectives To investigate provincial cochlear implantation (CI) annual volume and cost trends. Study Design Database analysis. Setting National surgical volume and cost database. Subjects and Methods Aggregate-level provincial CI volumes and cost data for adult and pediatric CI surgery from 2005 to 2014 were obtained from the Canadian Institute for Health Information. Population-level aging forecast estimates were obtained from the Ontario Ministry of Finance and Statistics Canada. Linear fit, analysis of variance, and Tukey's analyses were utilized to compare variances and means. Results The national volume of annual CI procedures is forecasted to increase by <30 per year ( R 2 = 0.88). Ontario has the highest mean annual CI volume (282; 95% confidence interval, 258-308), followed by Alberta (92.0; 95% confidence interval, 66.3-118), which are significantly higher than all other provinces ( P < .05 for each). Ontario's annual CI procedure volume is forecasted to increase by <11 per year ( R 2 = 0.62). Newfoundland and Nova Scotia have the highest CI procedures per 100,000 residents as compared with all other provinces ( P < .05). Alberta, Newfoundland, and Manitoba have the highest estimated implantation cost of all provinces ( P < .05). Conclusions Historical trends of CI forecast modest national volume growth. Potential bottlenecks include provincial funding and access to surgical expertise. The proportion of older adult patients who may benefit from a CI will rise, and there may be insufficient capacity to meet this need. Delayed access to CI for pediatric patients is also a concern, given recent reports of long wait times for CI surgery.

Knowledge and opinions on oncoplastic surgery among breast and plastic surgeons.

PubMed

Carstensen, Lena; Rose, Michael; Bentzon, Niels; Kroman, Niels Thorndal

2015-04-01

More than 4,000 Danish women are diagnosed with operable breast cancer annually, and 70% receive breast conserving surgery. Without the use of oncoplastic surgery (OPS), 20-30% will get an unsatisfactory cosmetic result. The aim of this study was to illustrate the level of implementation of OPS in Denmark. An electronic questionnaire was sent to breast and plastic surgeons performing breast cancer treatment. The questionnaire included demographics, education, experience with operative procedures and opinions on OPS. The questionnaire was sent to 50 breast surgeons and 22 plastic surgeons; the response rate was 67%. All breast surgery units had an established cooperation with plastic surgeons. Most breast surgeons used unilateral displacement techniques; plastic surgeons also included breast reduction techniques and replacement with local flaps. Almost all symmetrisation procedures were performed by plastic surgeons. Breast surgeons had sought more specific education, both international observerships and specific courses. In both groups of surgeons, the majority expressed that both tumour removal and reconstruction should be performed by doctors of their own specialty. OPS has become integrated in all breast centres, but has not yet been fully implemented. For optimal results in all patients, this study underlines the importance of the inclusion of a dedicated plastic surgeon within the multidisciplinary team for optimal initial evaluation of all breast cancer patients. not relevant. not relevant.

Effect of Hospital Volume on Prosthesis Use and Mortality in Aortic Valve Operations in the Elderly.

PubMed

McNeely, Christian; Markwell, Stephen; Filson, Kathryn; Hazelrigg, Stephen; Vassileva, Christina

2016-02-01

This study was designed to examine the effect of hospital procedural volume on outcomes in aortic valve replacement (AVR) in the elderly. The study included 277,928 Medicare beneficiaries who underwent AVR from 2000 through 2009 at one of 1,255 participating hospitals. Operative mortality and the use of mechanical prostheses were analyzed according to hospital annual procedural volume. Annual AVR volume was divided into 5 different categories: the smallest volume group with less than 10 AVRs per year to the largest group averaging more than 70 AVRs per year. The overall observed operative mortality rate was 7.3%; for isolated AVR it was 5.5%. Lower-volume hospitals exhibited increased adjusted operative mortality: 10 cases or fewer per year--odds ratio (OR), 1.55; 95% confidence interval (CI), 1.39 to 1.72; 11 to 20 cases per year--OR, 1.35; 95% CI, 1.23 to 1.47; 21 to 40 cases per year--OR, 1.15; 95% CI, 1.06 to 1.25; 41 to 70 cases per year--OR, 1.10; 95% CI, 1.01 to 1.20 relative to those hospitals performing more than 70 cases per year. The discrepancy in operative mortality between low- and high-volume hospitals diverged during the study. Mechanical valve use decreased with increasing hospital volume (p = 0.0001). Mechanical valves were used in 64.5% of AVRs in hospitals with an annual AVR volume less than 10 in contrast to only 25.4% in hospitals with an annual AVR volume more than 70. After adjustment, the use of mechanical valves was independently associated with increased operative mortality (OR, 1.15; 95% CI, 1.11-1.19). Low-volume centers were characterized by increased adjusted operative mortality and greater use of mechanical prostheses, a trend that persisted during the 10-year course of the study. These data would support the center-of-excellence concept for AVR and may be particularly relevant in the elderly population. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Statistical analysis of global horizontal solar irradiation GHI in Fez city, Morocco

NASA Astrophysics Data System (ADS)

Bounoua, Z.; Mechaqrane, A.

2018-05-01

An accurate knowledge of the solar energy reaching the ground is necessary for sizing and optimizing the performances of solar installations. This paper describes a statistical analysis of the global horizontal solar irradiation (GHI) at Fez city, Morocco. For better reliability, we have first applied a set of check procedures to test the quality of hourly GHI measurements. We then eliminate the erroneous values which are generally due to measurement or the cosine effect errors. Statistical analysis show that the annual mean daily values of GHI is of approximately 5 kWh/m²/day. Daily monthly mean values and other parameter are also calculated.

Evolution of treatment of fistula in ano.

PubMed

Blumetti, J; Abcarian, A; Quinteros, F; Chaudhry, V; Prasad, L; Abcarian, H

2012-05-01

Fistula-in-ano is a common medical problem affecting thousands of patients annually. In the past, the options for treatment of fistula-in-ano were limited to fistulotomy and/or seton placement. Current treatment options also include muscle-sparing techniques such as a dermal island flap, endorectal advancement flap, fibrin sealent injection, anal fistula plug, and most recently ligation of the intersphincteric fistula tract (procedure). This study seeks to evaluate types and time trends for treatment of fistula-in-ano. A retrospective review from 1975 to 2009 was performed. Data were collected and sorted into 5-year increments for type and time trends of treatment. Fistulotomy and partial fistulotomy were grouped as cutting procedures. Seton placement, fibrin sealant, dermal flap, endorectal flap, and fistula plug were grouped as noncutting procedures. Statistical analysis was performed for each time period to determine trends. With institutional review board approval, the records of 2,267 fistula operations available for analysis were included. Most of the patients were men (74 vs. 26%). Cutting procedures comprised 66.6% (n = 1510) of all procedures. Noncutting procedures were utilized in 33.4% (n = 757), including Seton placement alone 370 (16.3%), fibrin sealant 168 (7.4%), dermal or endorectal flap 147 (6.5%), and fistula plug 72 (3.2%). The distribution of operations grouped in 5-year intervals is as follows: 1975-1979, 78 cutting and one noncutting; 1980-1984, 170 cutting and 10 noncutting; 1985-1989, 54 cutting and five noncutting; 1990-1994, 37 cutting and six noncutting; 1995-1999, 367 cutting and 167 noncutting; 2000-2004, 514 cutting and 283 noncutting; 2005-2009, 290 cutting and 285 noncutting. The percentage of cutting and noncutting procedures significantly differed over time, with cutting procedures decreasing and noncutting procedures increasing proportionally (χ(2) linear-by-linear association, p < 0.05). Fistula-in-ano remains a common complex disease process. Its treatment has evolved to include a variety of noncutting techniques in addition to traditional fistulotomy. With the advent of more sphincter-sparing techniques, the number of patients undergoing fistulotomy should continue to decrease over time. Surgeons should become familiar with various surgical techniques so the treatment can be tailored to the patient.

The Zond Victory Garden Phase 4 windfarm: A planning, installation, and performance case study. Final report

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

Chapman, J.

1994-07-01

This is one of a series of reports that document the steps taken to plan and install a utility-scale windfarm and follow its energy production performance. The reports are intended to help utility planners and others better understand the issues involved in installing and operating a windfarm. This report describes the Zond Victory Garden Phase IV (VGIV) windfarm in the Tehachapi mountain region, 100 miles north of Los Angeles. The Victory Garden series of windfarms were planned and installed and are operated by Zond Systems, Inc. of Tehachapi, California. The VGIV installation, which became operational in stages from January throughmore » June 1990, consists of 98 Vestas V27--225 wind turbines. The total rated capacity is 22 MW with a projected annual average net energy production of 54.3 million kWh/yr, equivalent to an annual capacity factor of 0.28. This energy projection, based on extensive wind resource measurements and an average wind turbine availability of 97%, includes the effects of a number of operational loss factors. The report includes descriptions of the windfarm layout, the wind turbine component, and the electrical layout. Particular attention is paid to one of the most important issues in implementing a windfarm, namely, the wind resource assessment and its use in projecting and updating the expected annual-average energy production of the facility. Also included are details of the planning, construction, and commissioning of the windfarm along with a description of the operations and maintenance procedures employed.« less

Transport modeling and multivariate adaptive regression splines for evaluating performance of ASR systems in freshwater aquifers

NASA Astrophysics Data System (ADS)

Forghani, Ali; Peralta, Richard C.

2017-10-01

The study presents a procedure using solute transport and statistical models to evaluate the performance of aquifer storage and recovery (ASR) systems designed to earn additional water rights in freshwater aquifers. The recovery effectiveness (REN) index quantifies the performance of these ASR systems. REN is the proportion of the injected water that the same ASR well can recapture during subsequent extraction periods. To estimate REN for individual ASR wells, the presented procedure uses finely discretized groundwater flow and contaminant transport modeling. Then, the procedure uses multivariate adaptive regression splines (MARS) analysis to identify the significant variables affecting REN, and to identify the most recovery-effective wells. Achieving REN values close to 100% is the desire of the studied 14-well ASR system operator. This recovery is feasible for most of the ASR wells by extracting three times the injectate volume during the same year as injection. Most of the wells would achieve RENs below 75% if extracting merely the same volume as they injected. In other words, recovering almost all the same water molecules that are injected requires having a pre-existing water right to extract groundwater annually. MARS shows that REN most significantly correlates with groundwater flow velocity, or hydraulic conductivity and hydraulic gradient. MARS results also demonstrate that maximizing REN requires utilizing the wells located in areas with background Darcian groundwater velocities less than 0.03 m/d. The study also highlights the superiority of MARS over regular multiple linear regressions to identify the wells that can provide the maximum REN. This is the first reported application of MARS for evaluating performance of an ASR system in fresh water aquifers.

Method of estimating natural recharge to the Edwards Aquifer in the San Antonio area, Texas

USGS Publications Warehouse

Puente, Celso

1978-01-01

The principal errors in the estimates of annual recharge are related to errors in estimating runoff in ungaged areas, which represent about 30 percent of the infiltration area. The estimated long-term average annual recharge in each basin, however, is probably representative of the actual recharge because the averaging procedure tends to cancel out the major errors.

New Mexico State Annual Evaluation Report, Fiscal Year Ending June 30, 1970. P. L. 89-10, Title 1 ESEA Projects.

ERIC Educational Resources Information Center

Legant, Jean; Eakens, Doyle R.

Contents of the New Mexico State Annual Evaluation Report for ESEA Title I Projects, for fiscal year ending June 30, 1970, include: New Mexico allocations for 1969-70; school districts allocations for 1969-70--basic statistics, state education agency staff visits to local education agencies, changes in the effect of state agency procedures, effect…

History of the Voluntary Intermodal Sealift Agreement

DTIC Science & Technology

2002-06-01

reflect executed Voluntary Enrollment Contracts (VEC) for VISA Stages I, II, and III to include basic activation procedures; DOD annual minimums for...provisions; and on-the-shelf basic agreements (such as VISA Intermodal Contingency Contracts (VICC) for Stages I, II, and III). The anticipated...insufficient Program incentives are revised annually, but the basic tenets remain in place. Activation, capacity required to commit and carrier risk clauses

Occupational Radiation Exposure to the Extremities of Medical Staff during Hysterosalpingography and Radionuclide Bone Scan Procedures in Several Nigerian Hospitals.

PubMed

Jibiri, Nnamdi Norbert; Akintunde, Tawakalitu Oluwatoyin; Dambele, Musa Yusuf; Olowookere, Christopher Jimoh

2016-10-05

The practice of regular dose measurement helps to ascertain the level of occupational dose delivered to the staff involved in diagnostic procedures. This study was carried out to evaluate the dose exposed to the hands of radiologists and a radiologic technologist carrying out HSG and radionuclide bone scan examinations in several hospitals in Nigeria. Radiation doses exposed to the hands of radiologists and a technician carrying out hysterosalpingography (HSG) and bone scan procedures were measured using calibrated thermo-luminescent dosimeters. Five radiologists and a radiologic technologist were included in the study for dose measurement. The study indicates that each radiologist carried out approximately 2 examinations per week with the mean dose ranging between 0.49-0.62 mSv per week, resulting in an annual dose of 191 mSv. Similarly, the occupational dose delivered to both the left and right hands of a radiologic technologist administering 99mTc-methylene diphosphonate (MDP) without cannula and with cannula were 10.68 (720.2) and 13.82 (556.4) mSv per week (and per annum), respectively. It was determined that the left hand of the personnel received higher doses than their right hand. The estimated annual dose during HSG is far below the annual dose limit for deterministic effects, however, it is greater than 10% of the applicable annual dose limit. Hence, routine monitoring is required to ensure adequate protection of the personnel. The total annual dose received during the bone scan exceeds the annual dose limit for both hands, and the dose to either left or right hand is greater than the dose limit of 500 mSv/yr. The radiologists monitored are not expected to incur any deterministic effects during HSG examinations, however, accumulated doses arising from the scattered radiation to the eyes, legs, and neck could be substantial and might lead to certain effects. More staff are required to administer 99mTc-MDP in Nigerian institutions to prevent excessive doses to personnel.

Occupational Radiation Exposure to the Extremities of Medical Staff during Hysterosalpingography and Radionuclide Bone Scan Procedures in Several Nigerian Hospitals

PubMed Central

Jibiri, Nnamdi Norbert; Akintunde, Tawakalitu Oluwatoyin; Dambele, Musa Yusuf; Olowookere, Christopher Jimoh

2016-01-01

Objective: The practice of regular dose measurement helps to ascertain the level of occupational dose delivered to the staff involved in diagnostic procedures. This study was carried out to evaluate the dose exposed to the hands of radiologists and a radiologic technologist carrying out HSG and radionuclide bone scan examinations in several hospitals in Nigeria. Methods: Radiation doses exposed to the hands of radiologists and a technician carrying out hysterosalpingography (HSG) and bone scan procedures were measured using calibrated thermo-luminescent dosimeters. Five radiologists and a radiologic technologist were included in the study for dose measurement. Results: The study indicates that each radiologist carried out approximately 2 examinations per week with the mean dose ranging between 0.49-0.62 mSv per week, resulting in an annual dose of 191 mSv. Similarly, the occupational dose delivered to both the left and right hands of a radiologic technologist administering 99mTc-methylene diphosphonate (MDP) without cannula and with cannula were 10.68 (720.2) and 13.82 (556.4) mSv per week (and per annum), respectively. It was determined that the left hand of the personnel received higher doses than their right hand. Conclusion: The estimated annual dose during HSG is far below the annual dose limit for deterministic effects, however, it is greater than 10% of the applicable annual dose limit. Hence, routine monitoring is required to ensure adequate protection of the personnel. The total annual dose received during the bone scan exceeds the annual dose limit for both hands, and the dose to either left or right hand is greater than the dose limit of 500 mSv/yr. The radiologists monitored are not expected to incur any deterministic effects during HSG examinations, however, accumulated doses arising from the scattered radiation to the eyes, legs, and neck could be substantial and might lead to certain effects. More staff are required to administer 99mTc-MDP in Nigerian institutions to prevent excessive doses to personnel. PMID:27751973

Review of Methods for Buildings Energy Performance Modelling

NASA Astrophysics Data System (ADS)

Krstić, Hrvoje; Teni, Mihaela

2017-10-01

Research presented in this paper gives a brief review of methods used for buildings energy performance modelling. This paper gives also a comprehensive review of the advantages and disadvantages of available methods as well as the input parameters used for modelling buildings energy performance. European Directive EPBD obliges the implementation of energy certification procedure which gives an insight on buildings energy performance via exiting energy certificate databases. Some of the methods for buildings energy performance modelling mentioned in this paper are developed by employing data sets of buildings which have already undergone an energy certification procedure. Such database is used in this paper where the majority of buildings in the database have already gone under some form of partial retrofitting - replacement of windows or installation of thermal insulation but still have poor energy performance. The case study presented in this paper utilizes energy certificates database obtained from residential units in Croatia (over 400 buildings) in order to determine the dependence between buildings energy performance and variables from database by using statistical dependencies tests. Building energy performance in database is presented with building energy efficiency rate (from A+ to G) which is based on specific annual energy needs for heating for referential climatic data [kWh/(m2a)]. Independent variables in database are surfaces and volume of the conditioned part of the building, building shape factor, energy used for heating, CO2 emission, building age and year of reconstruction. Research results presented in this paper give an insight in possibilities of methods used for buildings energy performance modelling. Further on it gives an analysis of dependencies between buildings energy performance as a dependent variable and independent variables from the database. Presented results could be used for development of new building energy performance predictive model.

Cost Minimization Analysis of Precut Cornea Grafts in Descemet Stripping Automated Endothelial Keratoplasty

PubMed Central

Yong, Kai-Ling; Nguyen, Hai V.; Cajucom-Uy, Howard Y.; Foo, Valencia; Tan, Donald; Finkelstein, Eric A.; Mehta, Jodhbir S.

2016-01-01

Abstract Descemet stripping automated endothelial keratoplasty (DSAEK) is the most common corneal transplant procedure. A key step in the procedure is preparing the donor cornea for transplantation. This can be accomplished via 1 of 3 alternatives: surgeon cuts the cornea on the day of surgery, the cornea is precut ahead of time in an offsite facility by a trained technician, or a precut cornea is purchased from an eye bank. Currently, there is little evidence on the costs and effectiveness of these 3 strategies to allow healthcare providers decide upon the preferred method to prepare grafts. The aim of this study was to compare the costs and relative effectiveness of each strategy. The Singapore National Eye Centre and Singapore Eye Bank performed both precut cornea and surgeon-cut cornea transplant services between 2009 and 2013. This study included 110 subjects who received precut cornea and 140 who received surgeon-cut cornea. Clinical outcomes and surgical duration were compared across the strategies using the propensity score matching. The cost of each strategy was estimated using the microcosting and consisted of facility costs and procedural costs including surgical duration. One-way sensitivity analysis and threshold analysis were performed. The cost for DSAEK was highest for the surgeon-cut approach ($13,965 per procedure), followed by purchasing precut corneas ($12,659) and then setting up precutting ($12,421). The higher procedural cost of the surgeon-cut approach was largely due to the longer duration of the procedure (surgeon-cut = 72.54 minutes, precut = 59.45 minutes, P < 0.001) and the higher surgeon fees. There was no evidence of differences in clinical outcomes between grafts that were precut or surgeon-cut. Threshold analysis demonstrated that if the number of cases was below 31 a year, the strategy that yielded the lowest cost was purchasing precut cornea from eye bank. If there were more than 290 cases annually, the cheapest option would be to setup precutting facility. Our findings suggest that it is more efficient for centers that are performing a large number of cornea transplants (more than 290 cases) to set up their own facility to conduct precutting. PMID:26937927

National Trends in Surgery for Rotator Cuff Disease in Korea

PubMed Central

2017-01-01

The objective of this study was to investigate the national trends in rotator cuff surgery in Korea and analyze hospital type-specific trends. We analyzed a nationwide database acquired from the Korean Health Insurance Review and Assessment Service (HIRA) from 2007 to 2015. International Classification of Diseases, 10th revision (ICD-10) codes, procedure codes, and arthroscopic device code were used to identify patients who underwent surgical treatment for rotator cuff disease. A total of 383,719 cases of rotator cuff surgeries were performed from 2007 to 2015. The mean annual percentage change in the age-adjusted rate of rotator cuff surgery per population of 100,000 persons rapidly increased from 2007 to 2012 (53.3%, P < 0.001), while that between 2012 to 2015 remained steady (2.3%, P = 0.34). The proportion of arthroscopic surgery among all rotator cuff surgeries steadily rose from 89.9% in 2007 to 96.8% in 2015 (P < 0.001). In terms of hospital types, the rate of rotator cuff surgery increased to the greatest degree in hospitals with 30–100 inpatient beds, and isolated acromioplasty procedure accounted for a larger proportion of the rotator cuff surgeries in small hospitals and clinics compared to large hospitals. Overall, our findings indicate that cases of rotator cuff surgery have increased rapidly recently in Korea, of which arthroscopic surgeries account for the greatest proportion. While rotator cuff surgery is a popular procedure that is commonly performed even in small hospitals, there was a difference in the component ratio of the procedure code in accordance with hospital type. PMID:28049250

Specialization and the current practices of general surgeons.

PubMed

Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

2014-01-01

The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons' operative practices to inform surgical education and workforce planning. We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project for 3 US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and percentage of practice that made up their most common operation were calculated. Correlation was measured between general surgeons' case volume and the number of other specialists in a health service area. There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure constituted no more than 30% of total practice. The most common operations, ranked by the frequency they appeared as general surgeons' top procedure, included cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice composed of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (rho = -0.50; p = 0.005). Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Temporal variations in the potential hydrological performance of extensive green roof systems

NASA Astrophysics Data System (ADS)

De-Ville, Simon; Menon, Manoj; Stovin, Virginia

2018-03-01

Existing literature provides contradictory information about variation in potential green roof hydrological performance over time. This study has evaluated a long-term hydrological monitoring record from a series of extensive green roof test beds to identify long-term evolutions and sub-annual (seasonal) variations in potential hydrological performance. Monitoring of nine differently-configured extensive green roof test beds took place over a period of 6 years in Sheffield, UK. Long-term evolutions and sub-annual trends in maximum potential retention performance were identified through physical monitoring of substrate field capacity over time. An independent evaluation of temporal variations in detention performance was undertaken through the fitting of reservoir-routing model parameters. Aggregation of the resulting retention and detention variations permitted the prediction of extensive green roof hydrological performance in response to a 1-in-30-year 1-h summer design storm for Sheffield, UK, which facilitated the comparison of multi and sub-annual hydrological performance variations. Sub-annual (seasonal) variation was found to be significantly greater than long-term evolution. Potential retention performance increased by up to 12% after 5-years, whilst the maximum sub-annual variation in potential retention was 27%. For vegetated roof configurations, a 4% long-term improvement was observed for detention performance, compared to a maximum 63% sub-annual variation. Consistent long-term reductions in detention performance were observed in unvegetated roof configurations, with a non-standard expanded-clay substrate experiencing a 45% reduction in peak attenuation over 5-years. Conventional roof configurations exhibit stable long-term hydrological performance, but are nonetheless subject to sub-annual variation.

The State of Anesthetic Services in Korea: A National Survey of the Status of Anesthesia Provider in the 2011-2013 Period

PubMed Central

2016-01-01

Active involvement of anesthesiologists in perioperative management is important to ensure the patients' safety. This study aimed to investigate the state of anesthetic services in Korea by identifying anesthetic service providers. From the insurance claims data of National Health Insurance for 3 yr, the Korean state of anesthetic services was analyzed. The claims for anesthesia from the medical institutions which hire their own anesthesiologist or with an anesthesiologist invitation fee are assumed to be the anesthesia performed by anesthesiologists. The annual anesthetic data were similar during the study period. In 2013, total counts of 2,129,871 were composed with general anesthesia (55%), regional anesthesia (36%) and procedural sedation with intravenous anesthetics (9%). About 80% of total cases of general anesthesia were performed in general hospitals, while more than 60% of the regional anesthesia and sedation were performed in the clinics and hospitals under 100 beds. Non-anesthesiologists performed 273,006 cases of anesthesia (13% of total) including 36,008 of general anesthesia, 143,134 of regional anesthesia, and 93,864 of sedation, mainly in the clinics and hospitals under 100 beds. All procedural sedations in the institutions without direct employed anesthesiologist were performed by non-anesthesiologists. Significant numbers of anesthesia are performed by non-anesthesiologist in Korea. To promote anesthetic services that prioritize the safety of patients, the standard to qualify anesthetic service is required. Surgeons and patients need to enhance their perception of anesthesia, and the payment system should be revised in a way that advocates anesthesiologist-performed anesthetic services. PMID:26770049

Restructuring, Reallocation and Retrenchment at the Same Time: The Dutch Universities. AIR 1983 Annual Forum Paper.

ERIC Educational Resources Information Center

Dijkman, Frank G.; Savenije, Bas S.

Conditions and management procedures used in Dutch universities are discussed. Attention is directed to: (1) the structure of higher education in the Netherlands -- especially the University of Utrecht, its administrative procedures, and decision-making process; (2) the nature of the problems the university faced and the ineffective way in which…

Streamflow responses to road building and harvesting: A comparison with the equivalent clearcut area procedure

Treesearch

John G. King

1989-01-01

lncreases in annual streamflow and peak streamflows were determined on four small watersheds following timber harvesting and road building. The measured hydrologic changes are compared to those predicted by a methodology commonly used in the Forest Service's Northern Region, the equivalent clearcut area procedure. lncreases in peak streamflows are discussed with...

40 CFR Appendix B to Part 434 - Baseline Determination and Compliance Monitoring for Pre-existing Discharges at Remining Operations

Code of Federal Regulations, 2014 CFR

2014-07-01

... Monitoring for Pre-existing Discharges at Remining Operations B Appendix B to Part 434 Protection of.... B Appendix B to Part 434—Baseline Determination and Compliance Monitoring for Pre-existing... monthly (single-observation) procedure and an annual procedure shall be applied, as described below. b. In...

The Assessment Supplement: A Faculty-Designed Addition to NCC's Manual, "Concepts & Procedures for Academic Assessment." First Edition.

ERIC Educational Resources Information Center

Nassau Community Coll., Garden City, NY.

This document is the first in a series of annual, faculty-designed supplements to Nassau Community College's (NCC's) (New York) manual, "Concepts & Procedures for Academic Assessment." The supplements are intended to provide faculty a forum through which they can communicate assessment designs and the impacts of those designs on…

1 CFR 425.2 - Procedures for notification of existence of records pertaining to individuals.

Code of Federal Regulations, 2010 CFR

2010-01-01

...'S COMMISSION ON WHITE HOUSE FELLOWSHIPS § 425.2 Procedures for notification of existence of records... the President's Commission on White House Fellowships is listed annually in the Federal Register as... the hours of 8:30 a.m. and 5 p.m. or may write to the President's Commission on White House...

1 CFR 425.2 - Procedures for notification of existence of records pertaining to individuals.

Code of Federal Regulations, 2011 CFR

2011-01-01

...'S COMMISSION ON WHITE HOUSE FELLOWSHIPS § 425.2 Procedures for notification of existence of records... the President's Commission on White House Fellowships is listed annually in the Federal Register as... the hours of 8:30 a.m. and 5 p.m. or may write to the President's Commission on White House...

33 CFR 155.1070 - Procedures for plan review, revision, amendment, and appeal.

Code of Federal Regulations, 2010 CFR

2010-07-01

... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1070 Procedures for plan review, revision, amendment, and appeal. (a) A vessel response plan must be reviewed annually by the owner or operator. (1... of this part must be submitted. (c) Revisions or amendments to an approved response plan must be...

33 CFR 155.1070 - Procedures for plan review, revision, amendment, and appeal.

Code of Federal Regulations, 2014 CFR

2014-07-01

... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1070 Procedures for plan review, revision, amendment, and appeal. (a) A vessel response plan must be reviewed annually by the owner or operator. (1... “Application for Approval/Revision of Vessel Pollution Response Plans” (CG-6083) located at: http://www.uscg...

33 CFR 155.1070 - Procedures for plan review, revision, amendment, and appeal.

Code of Federal Regulations, 2011 CFR

2011-07-01

... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1070 Procedures for plan review, revision, amendment, and appeal. (a) A vessel response plan must be reviewed annually by the owner or operator. (1... of this part must be submitted. (c) Revisions or amendments to an approved response plan must be...

33 CFR 155.1070 - Procedures for plan review, revision, amendment, and appeal.

Code of Federal Regulations, 2012 CFR

2012-07-01

... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1070 Procedures for plan review, revision, amendment, and appeal. (a) A vessel response plan must be reviewed annually by the owner or operator. (1... of this part must be submitted. (c) Revisions or amendments to an approved response plan must be...

33 CFR 155.1070 - Procedures for plan review, revision, amendment, and appeal.

Code of Federal Regulations, 2013 CFR

2013-07-01

... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1070 Procedures for plan review, revision, amendment, and appeal. (a) A vessel response plan must be reviewed annually by the owner or operator. (1... of this part must be submitted. (c) Revisions or amendments to an approved response plan must be...

Annual Research Progress Report, FY 1980.

DTIC Science & Technology

1980-10-01

surgical procedure was documented on video tape for future reference. CONCLUSIONS A surgical procedure was developed to expose the dorsal spinal...cACicor M uW o , nbeloI *mpo,8 nnl PoRN 1AQQ PREVIOUS EDIOTIONS OF THIS FORM ARE ORSOLYTE DO FORMS 1498A. I NOV GO ABSTRACT PROJECT NO. 3S162772A814

78 FR 64929 - Agency Information Collection Activities; Comment Request; Annual Performance Reports for Title...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-30

...; Comment Request; Annual Performance Reports for Title III and Title V Grantees AGENCY: Office of... notice will be considered public records. Title of Collection: Annual Performance Reports for Title III and Title V Grantees. OMB Control Number: 1840-0766. Type of Review: Extension without change of an...

Tri-Service Disability Evaluation Systems Database Analysis and Research. Annual Report 2011

DTIC Science & Technology

2011-12-28

aftercare 501 2.6 682: Other cellulitis and abscess 104 2.9 682: Other cellulitis and abscess 463 2.4 300: Anxiety, dissociative and somatoform...procedures 25 3.9 295: Schizophrenic disorders 165 3.6 682: Other cellulitis and abscess 24 3.7 998: Other complications of procedures 164 3.6... cellulitis and abscess 135 3.0 722: Intervertebral disc disorders 17 2.6 996: Complications peculiar to certain specified procedures 134 3.0 738

Reflections on a Heart Surgery Career with Insights for Western-Trained Medical Specialists in Developing Countries

PubMed Central

Kabbani, Sami S.

2011-01-01

Herein, I describe my experience (spanning 40 years) in helping to develop the specialty of cardiovascular surgery in Syria. Especially in the early years, the challenges were daunting. We initially performed thoracic, vascular, and closed-heart operations while dealing with inadequate facilities, bureaucratic delays, and poorly qualified personnel. After our independent surgical center was established in early 1976, we performed 1 open-heart and 1 closed-heart procedure per day. Open-heart procedures evolved from the few and simple to the multiple and complex, and we solved difficulties as they arose. Today, our cardiac surgical center occupies an entire 6-floor building. We have 12 cardiac surgeons, 10 surgical residents, a formal 6-year surgical residency program, a pediatric cardiac unit, an annual caseload of 1,600, and plans to double our productivity in 2 years. The tribulations of establishing sophisticated surgical programs in a developing country are offset by the variety of clinicopathologic conditions that are encountered, and even more so by the psychological rewards of overcoming adversity and serving a population in need. This account may prove to be insightful for Western-trained physicians who seek to develop specialized medical care in emerging societies. PMID:21841854

Does Demand for Breast Augmentation Reflect National Financial Trends?

PubMed

Kearney, L; Dolan, R T; Clover, A J; Kelly, E J; O'Broin, E; O'Shaughnessy, M; O'Sullivan, S T

2017-04-01

Aesthetic plastic surgery is a consumer-driven industry, subject to influence by financial forces. A changing economic environment may thus impact on the demand for surgery. The aim of this study was to explore trends in demand for bilateral breast augmentation (BBA) in consecutively presenting patients over an 11-year period and to examine if a correlation exists between these trends and changes in Gross Domestic Product (GDP), a key economic indicator. This study revealed a correlation between annual number of breast augmentation procedures performed and GDP values (r 2  = 0.34, p value = 0.059). Additionally, predicted number of BBA procedures, based on predicted GDP growth in Ireland, strongly correlated with actual number of BBA performed (r 2  = 0.93, p value = 0.000001). Predicted GDP growth can potentially forecast future demand for BBA in our cohort allowing plastic surgeons to modify their practice accordingly. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Reflections on a heart surgery career with insights for Western-trained medical specialists in developing countries.

PubMed

Kabbani, Sami S

2011-01-01

Herein, I describe my experience (spanning 40 years) in helping to develop the specialty of cardiovascular surgery in Syria. Especially in the early years, the challenges were daunting. We initially performed thoracic, vascular, and closed-heart operations while dealing with inadequate facilities, bureaucratic delays, and poorly qualified personnel. After our independent surgical center was established in early 1976, we performed 1 open-heart and 1 closed-heart procedure per day. Open-heart procedures evolved from the few and simple to the multiple and complex, and we solved difficulties as they arose. Today, our cardiac surgical center occupies an entire 6-floor building. We have 12 cardiac surgeons, 10 surgical residents, a formal 6-year surgical residency program, a pediatric cardiac unit, an annual caseload of 1,600, and plans to double our productivity in 2 years. The tribulations of establishing sophisticated surgical programs in a developing country are offset by the variety of clinicopathologic conditions that are encountered, and even more so by the psychological rewards of overcoming adversity and serving a population in need. This account may prove to be insightful for Western-trained physicians who seek to develop specialized medical care in emerging societies.

48 CFR 3.502-2 - Subcontractor kickbacks.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the consequences of detection; procurement procedures to minimize the opportunity for kickbacks; audit... gifts or gratuities received from subcontractors; annual employee declarations that they have violated...

Analysis of GaAs and Si solar energy hybrid systems

NASA Technical Reports Server (NTRS)

Heinbockel, J. H.; Roberts, A. S., Jr.

1977-01-01

Various silicon hybrid systems are modeled and compared with a gallium arsenide hybrid system. The hybrid systems modeled produce electric power and also thermal power which can be used for heating or air conditioning. Various performance indices are defined and used to compare the system performance: capital cost per electric power out; capital cost per total power out; capital cost per electric power plus mechanical power; annual cost per annual electric energy; and annual cost per annual electric energy plus annual mechanical work. These performance indices indicate that concentrator hybrid systems can be cost effective when compared with present day energy costs.

The horror of unsafe abortion: case report of a life threatening complication in a 29-year old woman.

PubMed

Naqvi, Kaniz Zehra; Edhi, Muhammad Muzzammil

2013-10-16

Every year 42 million women with unintended pregnancies choose abortion, and fifty percent of these procedures, 20 million are unsafe. An unsafe abortion is defined as a procedure for terminating an unintended pregnancy carried out either by person lacking the necessary skills or in an environment that does not conform to minimal medical standards or both.Pakistan is the one of the six countries where more than 50% of the world's all maternal deaths occur. It is estimated that 890,000 induced abortions are performed annually in Pakistan, and estimate an annual abortion rate of 29 per 1000 women aged 15-49. Here we present a case report of a 29-year old woman who underwent an unsafe abortion for unintended pregnancy resulting in uterine perforation. The unskilled provider pulled out her bowel through vagina after perforating the uterus, as a result she lost major portion of her small intestine resulting in short bowel syndrome. The law of Pakistan only allows abortion during early stages of pregnancy for purpose of saving the life of a mother but does not cater for cases of rape, incest and fetal abnormalities or social reasons.Only legalization of abortion is not sufficient, preventing unintended pregnancy should be the priority of all the nations and for this reason contraception should be widely accessible.Practitioners need to become better trained in safer abortion methods and be to able transfer the patient to health facility when complications occur.

36 CFR 51.46 - May the Director determine that a concessioner has not operated satisfactorily after a prospectus...

Code of Federal Regulations, 2010 CFR

2010-07-01

... of an annual evaluation of a concessioner's performance may not occur until after the selection of the best proposal submitted in response to a prospectus, the Director will make an annual performance... performance evaluation. In the event the concessioner receives a second less than satisfactory annual...

Annual Performance Report - FY 2011

EPA Pesticide Factsheets

This report summarizes OIG activity, performance, results, and challenges, and provides a financial accounting of resources for fiscal year (FY) 2011 compared to our FY 2011 annual performance targets.

75 FR 31699 - Indian Self-Determination Act Contracts and Annual Funding Agreements-Appeal Procedures

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-04

... to Justice Act Additional technical changes are being made to the regulations in Parts 900 and 1000 dealing with the Equal Access to Justice Act (EAJA), 5 U.S.C. 504. First, section 900.177 currently... post-award disputes, the CBCA procedural regulations at 48 CFR 6101.30 and 6101.31 will apply. But...

A STATE PLAN FOR COMMUNITY SERVICE AND CONTINUING EDUCATION PROGRAMS UNDER TITLE I OF THE HIGHER EDUCATION ACT OF 1965 SUBMITTED BY THE STATE OF LOUISIANA.

ERIC Educational Resources Information Center

DAVIDSON, JOHN W.; PELLEGRIN, LIONEL O.

THE LOUISIANA STATE PLAN INCLUDES ADMINISTRATIVE INFORMATION, PROCEDURES FOR SELECTING COMMUNITY PROBLEMS, INSTITUTIONS, AND REVIEWING APPLICATIONS, FISCAL AND INSTITUTIONAL ASSURANCES, ACCOUNTING PROCEDURES, REVIEW AND EVALUATION OF PROGRAMS, TRANSFER OF FUNDS, REPORTS, DETAILS OF THE ANNUAL PROGRAM, AND ELIGIBILITY OF PROGRAMS. GENERAL PROBLEM…

Diagnostic strategies for urinary tract infections in French general practice.

PubMed

Kinouani, S; de Lary de Latour, H; Joseph, J-P; Letrilliart, L

2017-10-01

We aimed to describe the diagnostic management procedures for detection of urinary tract infections in general practice and their correlated factors. We analyzed data from the ECOGEN study on urinary tract infections, collected in France between November 2011 and April 2012. This national cross-sectional study was carried out in general practices. Data was coded according to the International Classification of Primary Care. A total of 340 consultations or home visits were held for urinary tract infections. The five most frequent diagnostic procedures were (in descending order) clinical examination (67.6%), urine cytobacteriological examination (UCBE) (47.9%), urine dipstick test (15.6%), blood test (8.5%), and imaging (6.5%). No urine dipstick test or UCBE was performed in 43% of cases. Factors correlated with diagnostic procedures were age and gender of patients, annual number of consultations held by family physicians, and duration of consultation. Family physicians did not comply with guidelines on diagnostic management for detection of urinary tract infections. We hypothesized that this non-compliance could be due to the family physicians' environment and characteristics, and to clinical practice guidelines. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Attitudes and preferences of parents about being present in the dental operatory.

PubMed

Shroff, Sulabh; Hughes, Cody; Mobley, Connie

2015-01-01

To determine if there was an association between the type of dental procedure being performed on children and parental desire to be present in the operatory. Parents (N=339) whose children had dental appointments at a university pediatric dental clinic or affiliated practices in Southern Nevada completed a survey. Parents identified attitudes/preferences associated with five commonly conducted pediatric dental procedural scenarios. Data were analyzed using chi-square tests (P=.05). Most respondents (N=339) were female (N=248) and/or Hispanic (N=204), had a household income of less than $50,000 annually (N=251), and a high school education. The primary reason (78 percent) parents wanted to be present during their child's dental treatment was comfort. Most parents wanted to observe exams/X-rays (70 percent), sedation procedures (69 percent), fillings and crowns (66 percent), extractions (64 percent), and physical restraint (61 percent). Only 38 percent of parents would be content with the dentist unilaterally deciding about their presence in the operatory. Parents in this study expressed a preference to remain with their child during any dental treatment. Practitioners are encouraged to consider their presence customary and establish office policies and protocols that beneficially involve parents in the pediatric patient's care.

Colorectal cancer screening: Estimated future colonoscopy need and current volume and capacity.

PubMed

Joseph, Djenaba A; Meester, Reinier G S; Zauber, Ann G; Manninen, Diane L; Winges, Linda; Dong, Fred B; Peaker, Brandy; van Ballegooijen, Marjolein

2016-08-15

In 2014, a national campaign was launched to increase colorectal cancer (CRC) screening rates in the United States to 80% by 2018; it is unknown whether there is sufficient colonoscopy capacity to reach this goal. This study estimated the number of colonoscopies needed to screen 80% of the eligible population with fecal immunochemical testing (FIT) or colonoscopy and determined whether there was sufficient colonoscopy capacity to meet the need. The Microsimulation Screening Analysis-Colon model was used to simulate CRC screening test use in the United States (2014-2040); the implementation of a national screening program in 2014 with FIT or colonoscopy with 80% participation was assumed. The 2012 Survey of Endoscopic Capacity (SECAP) estimated the number of colonoscopies that were performed and the number that could be performed. If a national screening program started in 2014, by 2024, approximately 47 million FIT procedures and 5.1 million colonoscopies would be needed annually to screen the eligible population with a program using FIT as the primary screening test; approximately 11 to 13 million colonoscopies would be needed annually to screen the eligible population with a colonoscopy-only screening program. According to the SECAP survey, an estimated 15 million colonoscopies were performed in 2012, and an additional 10.5 million colonoscopies could be performed. The estimated colonoscopy capacity is sufficient to screen 80% of the eligible US population with FIT, colonoscopy, or a mix of tests. Future analyses should take into account the geographic distribution of colonoscopy capacity. Cancer 2016;122:2479-86. © 2016 American Cancer Society. © 2016 American Cancer Society.

Patient doses in the healing arts

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

NONE

Determinations of radiation doses to patients from x-ray procedures and radiopharmaceuticals are detailed in this chapter. Instructions are given for estimating doses from x-ray procedures. For selected pediatric procedures, the methodology developed by the Food and Drug Administration is presented. The effect of testicular and ovarian shielding is illustrated in tabular form. Estimates of the Genetically Significant Dose (GSD) and mean annual bone marrow dose from diagnostic x-ray examinations are presented for the US populations (1990). This chapter also provides tables of patient doses from selected nuclear medicine procedures and estimates of fetal doses from {sup 131}I.

Assessment of interspecific interactions in plant communities: an illustration from the cold desert saltbush grasslands of North America

USGS Publications Warehouse

Freeman, Carl D.; Emlen, John M.

1995-01-01

Interspecific interactions influence both the productivity and composition of plant communities. Here, we propose new field procedures and analytical approaches for assessing interspecific interactions in nature and apply these procedures to the salt desert shrub grasslands of western Utah. Data were collected from two grazing treatments over a period of 2 years. The proposed equations were fairly consistent across both treatments and years. In addition to illustrating how to assess interspecific interactions within a community, we also develop a new approach for projecting the community composition as a result of some alteration, i.e. increase or decrease in the abundance of one or more species. Results demonstrate competition both within and between plant life-form groups. While introduced annuals were found to depress profoundly the likelihood of perennial plants replacing themselves, perennials had little influence on annuals. Thus, as native perennials die, they are more likely to be replaced by perennials than for the reverse to occur. Our results suggest that unless conditions change, these communities will become increasingly dominated by introduced annuals.

50 CFR 20.152 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PLANTS (CONTINUED) MIGRATORY BIRD HUNTING Special Procedures for Issuance of Annual Hunting Regulations... Committee of the Fish and Wildlife Service; and (c) Significant, as used in reference to a communication or...

50 CFR 20.152 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... PLANTS (CONTINUED) MIGRATORY BIRD HUNTING Special Procedures for Issuance of Annual Hunting Regulations... Committee of the Fish and Wildlife Service; and (c) Significant, as used in reference to a communication or...

The Internet and Global Telecommunications: Exploring the Boundaries of International Coordination. A Report of the Annual Aspen Institute Roundtable on International Telecommunications (4th, Shonan Village Center, Japan, September 21-24, 1998).

ERIC Educational Resources Information Center

Kleeman, Michael J.

The goals of the Fourth Annual Aspen Institute Roundtable on International Telecommunications were: to address procedural and substantive solutions for international coordination of Internet policy issues; to suggest different models for dispute resolution and policy coordination that might be employed in the various contexts of Internet usage;…

Vocational Education--A Decade of Progress. 10th Annual Report of the Advisory Council for Technical-Vocational Education in Texas to the State Board for Vocational Education.

ERIC Educational Resources Information Center

Texas Advisory Council for Technical - Vocational Education, Austin.

Assessment of the present status of vocational education in Texas and recommended priorities for the future constitute this annual report. Part 1 documents the progress of the 1970s and lists 15 challenges for vocational education in the 1980s, including application of meaningful evaluation procedures and careful program planning to maximize cost…

Trends and weekly and seasonal cycles in the rate of errors in the clinical management of hospitalized patients.

PubMed

Buckley, David; Bulger, David

2012-08-01

Studies on the rate of adverse events in hospitalized patients seldom examine temporal patterns. This study presents evidence of both weekly and annual cycles. The study is based on a large and diverse data set, with nearly 5 yrs of data from a voluntary staff-incident reporting system of a large public health care provider in rural southeastern Australia. The data of 63 health care facilities were included, ranging from large non-metropolitan hospitals to small community and aged health care facilities. Poisson regression incorporating an observation-driven autoregressive effect using the GLARMA framework was used to explain daily error counts with respect to long-term trend and weekly and annual effects, with procedural volume as an offset. The annual pattern was modeled using a first-order sinusoidal effect. The rate of errors reported demonstrated an increasing annual trend of 13.4% (95% confidence interval [CI] 10.6% to 16.3%); however, this trend was only significant for errors of minor or no harm to the patient. A strong "weekend effect" was observed. The incident rate ratio for the weekend versus weekdays was 2.74 (95% CI 2.55 to 2.93). The weekly pattern was consistent for incidents of all levels of severity, but it was more pronounced for less severe incidents. There was an annual cycle in the rate of incidents, the number of incidents peaking in October, on the 282 nd day of the year (spring in Australia), with an incident rate ratio 1.09 (95% CI 1.05 to 1.14) compared to the annual mean. There was no so-called "killing season" or "July effect," as the peak in incident rate was not related to the commencement of work by new medical school graduates. The major finding of this study is the rate of adverse events is greater on weekends and during spring. The annual pattern appears to be unrelated to the commencement of new graduates and potentially results from seasonal variation in the case mix of patients or the health of the medical workforce that alters health care performance. These mechanisms will need to be elucidated with further research.

Provision of gastrointestinal endoscopy and related services for a district general hospital. Working Party of the Clinical Services Committee of the British Society of Gastroenterology.

PubMed

1991-01-01

(1) The number of endoscopic examinations performed is rising. Epidemiological data and the workload of well developed units show that annual requirements per head of population are approaching: Upper gastrointestinal 1 in 100 Flexible sigmoidoscopy 1 in 500 Colonoscopy 1 in 500 ERCP 1 in 2000 (2) Open access endoscopy to general practitioners is desirable and increasingly sought. For a district general hospital serving a population of 250,000, this workload entails about 3500 procedures annually, performed during 10 half day routine sessions plus emergency work. (3) High standards of training and experience are needed by all staff, who must work in purpose built accommodation designed to promote efficient and safe practice. (4) The endoscopy unit should be adjacent to day care facilities and near the x ray department. There should be easy access to wards. (5) An endoscopy unit needs at least two endoscopy rooms; a fully ventilated cleaning/disinfection area; rooms for patient reception, preparation, and recovery; and accommodation for administration, storage, and staff amenities. (6) The service should be consultant based. At least 10 clinical sessions are required, made up of six or more consultant sessions and two to four clinical assistant, hospital practitioner, or staff specialist sessions. Each consultant should be expected to commit at least two sessions weekly to endoscopy. Extra consultant sessions may be needed to provide an efficient service. (7) A specially trained nursing sister (grade G or H) and five other endoscopy nurses are needed to care for the patients; their work may be supplemented by care assistants. (8) A new post of endoscopy department assistant (analogous to an operating department assistant) is proposed to maintain and prepare instruments, and to give technical assistance during procedures. (9) A full time secretary should be employed. Records, appointments, and audit should be computer based. (10) ERCP needs the collaboration of an interventional radiologist working with high quality x ray equipment in a specially prepared radiology screening room. This facility may need to serve more than one hospital. (11) A gastrointestinal measurement laboratory can conveniently be combined with the endoscopy unit. In some hospitals one or more gastrointestinal measurement technicians may staff this laboratory. (12) An endoscopy unit is a service department analogous to a radiology department. It needs an annual budget.

1990-2016 surface solar radiation variability and trend over the Piedmont region (northwest Italy)

NASA Astrophysics Data System (ADS)

Manara, Veronica; Bassi, Manuela; Brunetti, Michele; Cagnazzi, Barbara; Maugeri, Maurizio

2018-05-01

A new surface solar radiation database of 74 daily series is set up for the Piedmont region (northwest Italy) for the 1990-2016 period. All the series are subjected to a detailed quality control, homogenization and gap-filling procedure and are transformed into relative annual/seasonal anomaly series. Finally, a gridded version (0.5°×0.5°) of the database is generated. The resulting series show an increasing tendency of about + 2.5% per decade at annual scale, with strongest trend in autumn (+ 4% per decade). The only exception is winter, showing a negative but not significant trend. Considering the plain and mountain mean series, the trends are more intense for low than for high elevations with a negative vertical gradient of about - 0.03% per decade per 100 m at annual scale and values up to - 0.07% per decade per 100 m in spring. Focusing on clear days only (selected by CM SAF ClOud fractional cover dataset from METeosat first and second generation—Edition 1 satellite data over the 1991-2015 period), trend significance strongly increases and both low and high elevation records exhibit a positive trend in all seasons. However, the trends result slightly lower than for all-sky days (with the only exception of winter). The differences observed under clear-sky conditions between low and high elevations are more pronounced in winter, where the trend shows a negative vertical gradient of about - 0.1% per decade every 100 m. Overall, this paper shows how a high station density allows performing a more detailed quality control thanks to the higher performances in detecting the inhomogeneities with higher data availability and capturing regional peculiarities otherwise impossible to observe.

Newborn drug testing practices in Iowa birthing hospitals.

PubMed

Wood, K E; Smith, P; Krasowski, M D

2017-01-01

Federal law mandates states to have policies and procedures to identify newborns exposed to maternal substance use during pregnancy. National guidelines for newborn drug testing are lacking; therefore, procedures are variable and determined by state law and local practices. In Iowa, maternal substance use during pregnancy is considered child abuse and must be reported.The objective of this study was to identify newborn drug testing policies and procedures among birthing hospitals in Iowa. This was a cross sectional survey of all birthing hospitals in Iowa identified via the Statewide Perinatal Care Program. An electronic survey was sent to the representative at each affiliated hospital. Sixty-nine of 76 hospitals completed the survey for a 90.8% response rate. Newborn drug testing is ordered in 97.1% of responding hospitals with most testing 25% or less of newborns annually. The majority utilized a risk assessment tool (89.6%), although many (62.7%) also allowed for provider discretion. No hospital performed universal testing of all newborns. 86.6% of hospitals reported all positive newborn drug test results including illicit and/or prescription drugs to child protective services. 35.0% of hospitals notified mothers of the report and 45.5% offered substance abuse services and/or treatment to the mothers. Most Iowa birthing hospitals perform newborn drug testing and report all positive test results to child protective services. The majority use risk assessment tools. Maternal notification practices and referral for substance use disorder treatment are suboptimal and represent an area for future improvement.

A Cohort Analysis of Postbariatric Panniculectomy--Current Trends in Surgeon Reimbursement.

PubMed

Aherrera, Andrew S; Pandya, Sonal N

2016-01-01

The overall number of patients undergoing body contouring procedures after massive weight loss (MWL) has progressively increased over the past decade. The purpose of this study was to evaluate the charges and reimbursements for panniculectomy after MWL at a large academic institution in Massachusetts. A retrospective review was performed and included all identifiable panniculectomy procedures performed at our institution between January 2008 and January 2014. The annual number of patients undergoing panniculectomy, the type of insurance coverage and reimbursement method of each patient, and the amounts billed and reimbursed were evaluated. During our study period, 114 patients underwent a medically necessary panniculectomy as a result of MWL. The average surgeon fee billed was $3496 ± $704 and the average amount reimbursed was $1271 ± $589. Ten cases (8.8%) had no reimbursements, 31 cases (21.8%) reimbursed less than $1000, 66 cases (57.9%) reimbursed between $1000 and $2000, and no cases reimbursed the full amount billed. When evaluated by type of insurance coverage, collection ratios were 37.4% ± 17.4% overall, 41.7% ± 16.4% for private insurance, and 24.0% ± 13.0% for Medicare/Medicaid insurance (P < 0.001). Reimbursements for panniculectomy are remarkably low, and in many instances, absent, despite obtaining previous preauthorization of medical necessity. Although panniculectomy is associated with improvements in quality of life and high levels of patient satisfaction, poor physician reimbursement for this labor intensive procedure may preclude access to appropriate care required by the MWL patient population.

Annual and Semi-Annual Temperature Oscillations in the Upper Mesosphere

NASA Technical Reports Server (NTRS)

Niciejewski, R. J.; Killeen, T. L.

1995-01-01

Fourier transform spectrometer observations of the mesosphere have been performed at the University of Michigan (latitude: 42.5 N) on a long term basis. A database of near infrared Meinel hydroxyl spectra has been accumulated from which rotational temperatures have been determined. Harmonic analysis of one-day averaged temperatures for the period 1992.0 to 1994.5 has shown a distinct annual and semi-annual variation. Subsequent fitting of a five term periodic function characterizing the annual and semi-annual temperature oscillations to the daily averaged temperatures was performed. The resultant mean temperature and the amplitudes and phases of the annual and semi-annual variations are shown to coincide with an emission height slightly above 85 km which is consistent with the mean rocket derived altitude for peak nocturnal hydroxyl emission.

40 CFR 52.320 - Identification of plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) regulations to incorporate the nitrogen dioxide (NO2) increments. (i) Incorporation by reference. (A... Gasoline Transfer at Bulk Plants-Vapor Balance System), and D (Test Procedures for Annual Pressure/Vacuum...

50 CFR 20.154 - Flyway Councils.

Code of Federal Regulations, 2011 CFR

2011-10-01

... PLANTS (CONTINUED) MIGRATORY BIRD HUNTING Special Procedures for Issuance of Annual Hunting Regulations... before the meeting or as soon as practicable after the Department learns of the meeting. The notice will...

50 CFR 20.154 - Flyway Councils.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PLANTS (CONTINUED) MIGRATORY BIRD HUNTING Special Procedures for Issuance of Annual Hunting Regulations... before the meeting or as soon as practicable after the Department learns of the meeting. The notice will...

Declining rates of sterilisation reversal procedures in western Australian women from 1990 to 2008: the relationship with age, hospital type and government policy changes.

PubMed

Jama-Alol, Khadra A; Bremner, Alexandra P; Pereira, Gavin; Stewart, Louise M; Malacova, Eva; Moorin, Rachael; Preen, David B

2017-11-25

Female sterilisation is usually performed on an elective basis at perceived family completion, however, around 1-3% of women who have undergone sterilisation elect to undergo sterilisation reversal (SR) at a later stage. The trends in SR rates in Western Australia (WA), proportions of SR procedures between hospital types (public and private), and the effects of Federal Government policies on these trends are unknown. Using records from statutory state-wide data collections of hospital separations and births, we conducted a retrospective descriptive study of all women aged 15-49 years who underwent a SR procedure during the period 1st January 1990 to 31st December 2008 (n = 1868 procedures). From 1991 to 2007 the annual incidence rate of SR procedures per 10,000 women declined from 47.0 to 3.6. Logistic regression modelling showed that from 1997 to 2001 the odds of women undergoing SR in a private hospital as opposed to all other hospitals were 1.39 times higher (95% CI 1.07-1.81) and 7.51 times higher (95% CI 5.46-10.31) from 2002 to 2008. There were significant decreases in SR rates overall and among different age groups after the Federal Government interventions. Rates of SR procedures in WA have declined from 1990 to 2008, particularly following policy changes such as the introduction of private health insurance (PHI) policies. This suggests decisions to undergo SR may be influenced by Federal Government interventions.

Trends in surgical treatment of Chiari malformation Type I in the United States.

PubMed

Wilkinson, D Andrew; Johnson, Kyle; Garton, Hugh J L; Muraszko, Karin M; Maher, Cormac O

2017-02-01

OBJECTIVE The goal of this analysis was to define temporal and geographic trends in the surgical treatment of Chiari malformation Type I (CM-I) in a large, privately insured health care network. METHODS The authors examined de-identified insurance claims data from a large, privately insured health care network of over 58 million beneficiaries throughout the United States for the period between 2001 and 2014 for all patients undergoing surgical treatment of CM-I. Using a combination of International Classification of Diseases (ICD) diagnosis codes and Current Procedural Terminology (CPT) codes, the authors identified CM-I and associated diagnoses and procedures over a 14-year period, highlighting temporal and geographic trends in the performance of CM-I decompression (CMD) surgery as well as commonly associated procedures. RESULTS There were 2434 surgical procedures performed for CMD among the beneficiaries during the 14-year interval; 34% were performed in patients younger than 20 years of age. The rate of CMD increased 51% from the first half to the second half of the study period among younger patients (p < 0.001) and increased 28% among adult patients between 20 and 65 years of age (p < 0.001). A large sex difference was noted among adult patients; 78% of adult patients undergoing CMD were female compared with only 53% of the children. Pediatric patients undergoing CMD were more likely to be white with a higher household net worth. Regional variability was identified among rates of CMD as well. The average annual rate of surgery ranged from 0.8 surgeries per 100,000 insured person-years in the Pacific census division to 2.0 surgeries per 100,000 insured person-years in the East South Central census division. CONCLUSIONS Analysis of a large nationwide health care network showed recently increasing rates of CMD in children and adults over the past 14 years.

77 FR 64111 - Notice of Proposed Information Collection Requests; Office of Postsecondary Education; Annual...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-18

... DEPARTMENT OF EDUCATION Notice of Proposed Information Collection Requests; Office of Postsecondary Education; Annual Performance Report for the Gaining Early Awareness for Undergraduate Programs SUMMARY: The GEAR UP annual performance report asks for information specific to the budget year for which...

A Survey of Endodontic Practices among Dentists in Burkina Faso.

PubMed

Kaboré, Wendpoulomdé Ad; Chevalier, Valérie; Gnagne-Koffi, Yolande; Ouédraogo, Carole Dw; Ndiaye, Diouma; Faye, Babacar

2017-08-01

Dental surgeons must be aware of the most appropriate endodontic treatments and how to properly conduct them. The aim of this study was to evaluate the knowledge of dental surgeons in Burkina Faso in terms of endodontic treatment procedures. This descriptive, cross-sectional study was performed during the regular annual conference of the National Board of Dental Surgeons of Burkina Faso, held on February 27 and 28, 2015 in Ouagadougou, through a questionnaire. A total of 33 practitioners took part (52.4% of the dental surgeons of Burkina Faso) in the study. The majority of them (90.9%) used sodium hypochlorite as their preferred irrigation solution. Nearly half of the dental surgeons (48.5%) did not know how to use a permeabilization file, and most did not make use of nickel-titanium (NiTi) mechanized instruments (78.8%) or rubber dams (93.9%). Approximately two-thirds of participants did not perform file-in-place radiography (66.7%) or control radiography of the canal obturation (63.6%). The adjusted single-cone technique was the most commonly used (87.9%). This study highlights that the majority of dental surgeons in Burkina Faso are not using the currently recommended endodontic procedures to perform obturations. Dental surgeons in Burkina Faso must commit to regularly upgrading their knowledge and techniques. Key words: Burkina faso, Cross-sectional study, Dental surgeons, Endodontic treatments, Protocol adherence.

Variable surgical outcomes after hospital consolidation: Implications for local health care delivery.

PubMed

Chang, Victor; Blackwell, Robert H; Yau, Ryan M; Besser, Stephanie; Albright, Joslyn M; Gupta, Gopal N; Kuo, Paul C; Kothari, Anai N

2016-11-01

With more hospital consolidations as an inevitable part of our future health care ecosystem, we investigated the relationship between hospital consolidations and operative outcomes. Using the Health Care Cost and Utilization Project State Inpatient Database (Florida and California), the American Hospital Association Annual Survey Database, and Medicare's Case Mix Index data, we identified 19 hospitals that consolidated between 2007 and 2013 and propensity matched them with 19 independent hospitals, using patient and hospital characteristics. One year before consolidation and again 1 year after, we used difference-in-differences analysis to compare changes in the risk-adjusted complication rate of 7 elective operations performed in the consolidated hospitals and in the matched control group. Of the 7 procedures studied, 2 procedures saw a decrease in complication rate (lumbar and lumbosacral fusion of the posterior column posterior technique, difference-in-differences = -0.6%, P < .01; total hip replacement, difference-in-differences = -0.6%, P < .01); 3 procedures saw an increase in complication rate (transurethral prostatectomy, difference-in-differences = 4.1%, P < .01; cervical fusion of the anterior column anterior technique, difference-in-differences = 1.5%, P < .01; total knee replacement, difference-in-differences = 0.3%, P < .01); and 2 procedures saw no change in complication rate (laparoscopic cholecystectomy, lumbar and lumbosacral fusion of the anterior column posterior technique, both P > .05) after hospital consolidation. Arguments have been made that consolidated health care systems can share high-performing clinical services and infrastructure resources, such as electronic medical records, to improve quality. Our results indicate that hospital consolidation does not uniformly improve postoperative complication rates. Copyright © 2016 Elsevier Inc. All rights reserved.

Laparoscopic Colorectal Surgery in the Emergency Setting: Trends in the Province of Ontario.

PubMed

Musselman, Reilly P; Gomes, Tara; Chan, Beverley P; Auer, Rebecca C; Moloo, Husein; Mamdani, Muhammad; Al-Omran, Mohammed; Al-Obeed, Omar; Boushey, Robin P

2015-10-01

The purpose of this study was to examine the adoption trends of emergency laparoscopic colorectal surgery in the province of Ontario. We conducted a retrospective time-series analysis examining rates of emergency colorectal surgery among 10.5 million adults in Ontario, Canada from April 1, 2002 to December 31, 2009. We linked administrative claims databases and the Ontario Cancer Registry to assess procedure rates over time. Procedure trends were assessed using time-series analysis. Over the 8-year period, 29,676 emergency colorectal procedures were identified. A total of 2582 (8.7%) were performed laparoscopically and 27,094 (91.3%) were open. Open and laparoscopic patients were similar with respect age, sex, and Charlson Comorbidity Index. The proportion of surgery for benign (63.8% of open cases vs. 65.6% laparoscopic, standardized difference=0.04) and malignant disease (36.2% open vs. 34.4% laparoscopic, standardized difference=0.04) was equal between groups. The percentage of emergency colorectal surgery performed laparoscopically increased from 5.7% in 2002 to 12.0% in 2009 (P<0.01). The use of laparoscopy increased for both benign and malignant disease. Statistically significant upward trends in laparoscopic surgery were seen for inflammatory bowel disease (P<0.01), obstruction (P<0.01), and colon cancer (P<0.01). From 2002 to 2009, annual procedure rates increased at a greater rate in nonacademic centers (P<0.01). Laparoscopic emergency colorectal surgery has increased significantly between 2002 and 2009 for both benign and malignant disease and for a wide range of diagnoses. This was driven in part by steadily rising usage of laparoscopy in nonacademic centers.

Perioperative patient radiation exposure in the endoscopic removal of upper urinary tract calculi.

PubMed

Jamal, Joseph E; Armenakas, Noel A; Sosa, R Ernest; Fracchia, John A

2011-11-01

The efficacy of computed tomography (CT) in detailing upper urinary tract calculi is well established. There is no established acceptable annual recommended limit for medical exposure, yet the global accepted upper limit for occupational radiation exposure is <50 millisieverts (mSv) in any one year. We sought to appreciate the CT and fluoroscopic radiation exposure to our patients undergoing endoscopic removal of upper tract calculi during the periprocedure period. All patients undergoing upper urinary endoscopic stone removal between 2005 and 2009 were identified. To calculate the cumulative radiation exposure, we included all ionizing radiation imaging performed during a periprocedure period, which we defined as ≤90 days pre- and post-therapeutic procedure. A total of 233 upper urinary tract therapeutic patient stone procedures were identified; 127 patients underwent ureteroscopy (URS) and 106 patients underwent percutaneous nephrolithotomy (PCNL). A mean 1.58 CTs were performed per patient. Ninety (38.6%) patients underwent ≥2 CTs in the periprocedure period, with an average number in this group of 2.49 CT/patient, resulting in approximately 49.8 mSv of CT radiation exposure. Patients who were undergoing URS were significantly more likely to have multiple CTs (P=0.003) than those undergoing PCNL. Median fluoroscopic procedure exposures were 43.3 mGy for patients who were undergoing PCNL and 27.6 mGy for those patients undergoing URS. CT radiation exposure in the periprocedure period for patients who were undergoing endoscopic upper tract stone removal is considerable. Added to this is the procedure-related fluoroscopic radiation exposure. Urologic surgeons should be aware of the cumulative amount of ionizing radiation received by their patients from multiple sources.

Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States.

PubMed

Raymond, Elizabeth G; Grossman, Daniel; Weaver, Mark A; Toti, Stephanie; Winikoff, Beverly

2014-11-01

The recent surge of new legislation regulating induced abortion in the United States is ostensibly motivated by the desire to protect women's health. To provide context for interpreting the risk of abortion, we compared abortion-related mortality to mortality associated with other outpatient surgical procedures and selected nonmedical activities. We calculated the abortion-related mortality rate during 2000-2009 using national data. We searched PubMed and other sources for contemporaneous data on mortality associated with other outpatient procedures commonly performed on healthy young women, marathon running, bicycling and driving. The abortion-related mortality rate in 2000-2009 in the United States was 0.7 per 100,000 abortions. Studies in approximately the same years found mortality rates of 0.8-1.7 deaths per 100,000 plastic surgery procedures, 0-1.7deaths per 100,000 dental procedures, 0.6-1.2 deaths per 100,000 marathons run and at least 4 deaths among 100,000 cyclists in a large annual bicycling event. The traffic fatality rate per 758 vehicle miles traveled by passenger cars in the United States in 2007-2011 was about equal to the abortion-related mortality rate. The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities. The new legislation restricting abortion is unnecessary; indeed, by reducing the geographic distribution of abortion providers and requiring women to travel farther for the procedure, these laws are potentially detrimental to women's health. Copyright © 2014 Elsevier Inc. All rights reserved.

76 FR 34138 - Proposed Agency Information Collection Activities; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-10

... safety manual; a clear delineation of employers' responsibilities, as well as employees' rights and responsibilities thereto; well-defined procedures for communication and protection; and annual on-track safety...

50 CFR 300.97 - Inseason orders.

Code of Federal Regulations, 2013 CFR

2013-10-01

...: the hotline telephone number is published in the inseason notice procedures section of the annual... fisheries hotline: 1-800-562-6142. (2) Notice of inseason orders of the Secretary and other applicable...

50 CFR 300.97 - Inseason orders.

Code of Federal Regulations, 2012 CFR

2012-10-01

...: the hotline telephone number is published in the inseason notice procedures section of the annual... fisheries hotline: 1-800-562-6142. (2) Notice of inseason orders of the Secretary and other applicable...

50 CFR 300.97 - Inseason orders.

Code of Federal Regulations, 2014 CFR

2014-10-01

...: the hotline telephone number is published in the inseason notice procedures section of the annual... fisheries hotline: 1-800-562-6142. (2) Notice of inseason orders of the Secretary and other applicable...

FY 2016 Annual Performance Report

EPA Pesticide Factsheets

Presents detailed performance results, as measured against the targets established in EPA’s FY 2016 Annual Plan and Budget. The Executive Overview section analyzes key performance outcomes and links to FY 2016 program evaluations.

FY 2017 Annual Performance Report (APR)

EPA Pesticide Factsheets

Presents detailed performance results, as measured against the targets established in EPA’s FY 2017 Annual Plan and Budget. The Executive Overview section analyzes key performance outcomes and links to FY 2017 program evaluations.

FY 2015 Annual Performance Report

EPA Pesticide Factsheets

Presents detailed performance results, as measured against the targets established in EPA’s FY 2015 Annual Plan and Budget. The Executive Overview section analyzes key performance outcomes and links to FY 2015 program evaluations.

Developing Policy and Practice for Implementation of the Individuals with Disabilities Education Act--Innovative Approaches to State and National Issues: Invasive Procedures. Final Report.

ERIC Educational Resources Information Center

Krajicek, Marilyn J.

This final report discusses the activities and outcomes of a federally funded project designed to address the safe and legal implementation of the Individuals with Disabilities Education Act for young children who required invasive health care procedures. To accomplish the project objectives three annual, interdisciplinary conferences were held to…

Estimating equations estimates of trends

USGS Publications Warehouse

Link, W.A.; Sauer, J.R.

1994-01-01

The North American Breeding Bird Survey monitors changes in bird populations through time using annual counts at fixed survey sites. The usual method of estimating trends has been to use the logarithm of the counts in a regression analysis. It is contended that this procedure is reasonably satisfactory for more abundant species, but produces biased estimates for less abundant species. An alternative estimation procedure based on estimating equations is presented.

77 FR 43817 - Notice of Submission for OMB Review; Office of Postsecondary Education; Talent Search (TS) Annual...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-26

...; Talent Search (TS) Annual Performance Report SUMMARY: The Talent Search program provides Federal... Records Management Services, Office of Management, publishes this notice containing proposed information... records. Title of Collection: Talent Search (TS) Annual Performance Report. OMB Control Number: Pending...

Iowa's Community College Adult Literacy Annual Report. Program Year 2007, July 1, 2006-June 30, 2007

ERIC Educational Resources Information Center

Division of Community Colleges and Workforce Preparation, Iowa Department of Education, 2007

2007-01-01

This comprehensive document replaces the previously published Benchmark Report, Benchmark Report Executive Summary, Iowa's Community College Basic Literacy Skills Credential Report, Iowa GED Statistical Report, GED Annual Performance Report and Iowa's Adult Literacy Program National Reporting System Annual Performance Report (Graphic…

Cost of neurocysticercosis patients treated in two referral hospitals in Mexico City, Mexico.

PubMed

Bhattarai, Rachana; Carabin, Hélène; Proaño, Jefferson V; Flores-Rivera, Jose; Corona, Teresa; Flisser, Ana; Budke, Christine M

2015-08-01

To estimate annual costs related to the diagnosis, treatment and productivity losses among patients with neurocysticercosis (NCC) receiving treatment at two referral hospitals, the Instituto Nacional de Neurologia y Neurocirugia (INNN) and the Hospital de Especialidades of the Instituto Mexicano del Seguro Social (HE-IMSS), in Mexico City from July 2007 to August 2008. Information on presenting clinical manifestations, diagnostic tests, hospitalisations, surgical procedures and other treatments received by NCC outpatients was collected from medical charts, and supplemented by an individual questionnaire regarding productivity losses and out-of-pocket expenses related to NCC. The annual average per-patient direct costs were US$ 503 (95% CI: 414-592) and US$ 438 (95% CI: 322-571) for patients without a history of hospitalisation and/or surgery seen at the INNN and the HE-IMSS, respectively. These costs increased to US$ 2506 (95% CI: 1797-3215) and US$ 2170 (95% CI: 1303-3037), respectively, for patients with a history of hospitalisation and/or surgery. The average annual per-patient indirect costs were US$ 246 (95% CI: 165-324) and US$ 114 (95% CI: 51-178), respectively, using minimum salary wages for individuals not officially employed. The total annual cost for patients who had and had not been hospitalised and/or undergone a surgical procedure for the diagnosis or treatment of NCC corresponded to 212% and 41% of an annual minimum wage salary, respectively. The disease tends to affect rural socioeconomically disadvantaged populations and creates health disparities and significant economic losses in Mexico. © 2015 John Wiley & Sons Ltd.

U.S. Department of Transportation performance report fiscal year 2000 and performance plan fiscal year 2002

DOT National Transportation Integrated Search

2001-04-01

This document affirms the U.S. Department of Transportation's (DOT) commitment to managing for results. It is DOT's second annual performance report and fourth annual performance plan. By combining the DOT performance report on 2000 results with the ...

Field Test Evaluation of Conservation Retrofits of Low-Income, Single-Family Buildings in Wisconsin: Blower-Door-Directed Infiltration Reduction Procedure, Field Test Implementation and Results

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

Gettings, M.B.

A blower-door-directed infiltration retrofit procedure was field tested on 18 homes in south central Wisconsin. The procedure, developed by the Wisconsin Energy Conservation Corporation, includes recommended retrofit techniques as well as criteria for estimating the amount of cost-effective work to be performed on a house. A recommended expenditure level and target air leakage reduction, in air changes per hour at 50 Pascal (ACH50), are determined from the initial leakage rate measured. The procedure produced an average 16% reduction in air leakage rate. For the 7 houses recommended for retrofit, 89% of the targeted reductions were accomplished with 76% of themore » recommended expenditures. The average cost of retrofits per house was reduced by a factor of four compared with previous programs. The average payback period for recommended retrofits was 4.4 years, based on predicted energy savings computed from achieved air leakage reductions. Although exceptions occurred, the procedure's 8 ACH50 minimum initial leakage rate for advising retrofits to be performed appeared a good choice, based on cost-effective air leakage reduction. Houses with initial rates of 7 ACH50 or below consistently required substantially higher costs to achieve significant air leakage reductions. No statistically significant average annual energy savings was detected as a result of the infiltration retrofits. Average measured savings were -27 therm per year, indicating an increase in energy use, with a 90% confidence interval of 36 therm. Measured savings for individual houses varied widely in both positive and negative directions, indicating that factors not considered affected the results. Large individual confidence intervals indicate a need to increase the accuracy of such measurements as well as understand the factors which may cause such disparity. Recommendations for the procedure include more extensive training of retrofit crews, checks for minimum air exchange rates to insure air quality, and addition of the basic cost of determining the initial leakage rate to the recommended expenditure level. Recommendations for the field test of the procedure include increasing the number of houses in the sample, more timely examination of metered data to detect anomalies, and the monitoring of indoor air temperature. Though not appropriate in a field test of a procedure, further investigation into the effects of air leakage rate reductions on heating loads needs to be performed.« less

A prospective comparison of procedural sedation and ultrasound-guided interscalene nerve block for shoulder reduction in the emergency department.

PubMed

Blaivas, Michael; Adhikari, Srikar; Lander, Lina

2011-09-01

Emergency physicians (EPs) are beginning to use ultrasound (US) guidance to perform regional nerve blocks. The primary objective of this study was to compare length of stay (LOS) in patients randomized to US-guided interscalene block or procedural sedation to facilitate reduction of shoulder dislocation in the emergency department (ED). The secondary objectives were to compare one-on-one health care provider time, pain experienced by the patient during reduction, and patient satisfaction between the two groups. This was a prospective, randomized study of patients presenting to the ED with shoulder dislocation. The study was conducted at an academic Level I trauma center ED with an annual census of approximately 80,000. Patients were eligible for the study if they were at least 18 years of age and required reduction of a shoulder dislocation. A convenience sample of patients was randomized to either traditional procedural sedation or US-guided interscalene nerve block. Procedural sedation was performed with etomidate as the sole agent. Interscalene blocks were performed by hospital-credentialed EPs using sterile technique and a SonoSite MicroMaxx US machine with a high-frequency linear array transducer. Categorical variables were evaluated using Fisher's exact test, and continuous variables were analyzed using the Wilcoxon rank sum test. Forty-two patients were enrolled, with 21 patients randomized to each group. The groups were not significantly different with respect to sex or age. The mean (±SD) LOS in the ED was significantly higher in the procedural sedation group (177.3 ± 37.9 min) than in the US-guided interscalene block group (100.3 ± 28.2 minutes; p < 0.0001). The mean (±SD) one-on-one health care provider time was 47.1 (±9.8) minutes for the sedation group and 5 (±0.7) minutes for the US-guided interscalene block group (p < 0.0001). There was no statistically significant difference between the two groups in patient satisfaction or pain experienced during the procedure. There were no significant differences between groups with respect to complications such as hypoxia or hypotension (p = 0.49). In this study, patients undergoing shoulder dislocation reduction using US-guided interscalene block spent less time in the ED and required less one-on-one health care provider time compared to those receiving procedural sedation. There was no difference in pain level or satisfaction when compared to procedural sedation patients. © 2011 by the Society for Academic Emergency Medicine.

Döderlein-Krönig vaginal hysterectomy: an alternative to the traditional Heaney hysterectomy.

PubMed

Stone, Daniel E; Malik, Shazia A; Doerhman, Pooja; Videla, Felipe L

2015-05-01

The aim of this study was to demonstrate the surgical steps of performing the Döderlein-Krönig hysterectomy. A video recording was made of the hysterectomy using an alternative technique described by Drs. Döderlein and Krönig in 1906. The patient in the video had stage 3 prolapse and desired surgical correction. The video demonstrates an exam under anesthesia, an anterior colpotomy, delivery of the uterine fundus through the colpotomy, and completion of the hysterectomy. The surgery was performed by a urogynecologist and a resident physician. The patient tolerated the procedure well and had no symptom recurrence at her 1-year follow-up visit. This video was presented at the 2014 International Urogynecological Association Annual Meeting in Washington, DC, as a nondiscussed video poster. This video can assist and educate others in using this technique for performing a hysterectomy. Possible benefits of this approach include decreased blood loss and improved visualization, especially in women with pelvic organ prolapse.

Radiation exposure and safety practices during pediatric central line placement

PubMed Central

Saeman, Melody R.; Burkhalter, Lorrie S.; Blackburn, Timothy J.; Murphy, Joseph T.

2015-01-01

Purpose Pediatric surgeons routinely use fluoroscopy for central venous line (CVL) placement. We examined radiation safety practices and patient/surgeon exposure during fluoroscopic CVL. Methods Fluoroscopic CVL procedures performed by 11 pediatric surgeons in 2012 were reviewed. Fluoroscopic time (FT), patient exposure (mGy), and procedural data were collected. Anthropomorphic phantom simulations were used to calculate scatter and dose (mSv). Surgeons were surveyed regarding safety practices. Results 386 procedures were reviewed. Median FT was 12.8 seconds. Median patient estimated effective dose was 0.13 mSv. Median annual FT per surgeon was 15.4 minutes. Simulations showed no significant difference (p = 0.14) between reported exposures (median 3.5 mGy/min) and the modeled regression exposures from the C-arm default mode (median 3.4 mGy/min). Median calculated surgeon exposure was 1.5 mGy/year. Eight of 11 surgeons responded to the survey. Only three reported 100% lead protection and frequent dosimeter use. Conclusion We found non-standard radiation training, safety practices, and dose monitoring for the 11 surgeons. Based on simulations, the C-arm default setting was typically used instead of low dose. While most CVL procedures have low patient/surgeon doses, every effort should be used to minimize patient and occupational exposure, suggesting the need for formal hands-on training for non-radiologist providers using fluoroscopy. PMID:25837269

National Economic Development Procedures Manual. Coastal Storm Damage and Erosion

DTIC Science & Technology

1991-09-01

study area is temperate with warm summers and moderate winters. The annual temperature averages approximately 53 degrees Fahrenheit (*F). On average ...January is the coolest month with a mean temperature of 32°F and July is the warmest month. The average annual precipitation is about 45 inches with...0704.0188 Public rooing burden for rhr$ LoIlecton of ,nformaton .s estma eO to average I hour oer resiorse including the time for resrewing inttuctiOn

B-1 Systems Approach to Training. Volume 3. Appendix B. Bibliography and Data Collection Trips

DTIC Science & Technology

1975-07-01

the Fourth Annual Symposium on Psychology in the Air Force, 1974, ~ •—- ~ - --- - Creelman , J.A., Evaluation of Approach Training Procedures...of Engineering Psychology , American Psychologist, 1972, 27 (7), 615-622. Adams, J.A., and Hufford, I.E., Effects of Programmed Perceptual Training on...Control, Wright-Patterson Air Force Base, Ohio, April 7-9, 1970. Aldrich, T.B., Proceedings of the Annual Symposium on Psychology in the Air Force (2nd

Antibiotic prophylaxis in open inguinal hernia repair: a literature review and summary of current knowledge

PubMed Central

Makarewicz, Wojciech; Ropel, Jerzy; Bobowicz, Maciej; Kąkol, Michał; Śmietański, Maciej

2016-01-01

More than 1 million inguinal hernia repairs are performed in Europe and the US annually. Although antibiotic prophylaxis is not required in clean, elective procedures, the routine use of implants (90% of inguinal hernia repairs are performed with mesh) makes the topic controversial. The European Hernia Society does not recommend routine antibiotic prophylaxis for elective inguinal hernia repairs. However, the latest randomized controlled trial, published by Mazaki et al., indicates that the use of prophylaxis is effective for the prevention of surgical site infection. Unnecessary prophylaxis contributes to the development of bacterial resistance and significantly increases healthcare costs. This review documents clinical trials on inguinal hernia repairs with mesh and summarizes the current knowledge. It also tries to solve certain problems, namely: what constitutes a real risk factor, late-onset infection, and how the “surgical environment” impacts on the need to use antibiotic prophylaxis. PMID:27829934

The relationship between perceptions of organizational functioning and voluntary counselor turnover: A four-wave longitudinal study

PubMed Central

Eby, Lillian T.; Rothrauff-Laschober, Tanja C.

2011-01-01

Using data from a nationwide study, we annually track a cohort of 598 substance use disorder counselors over a 4-wave period to (1) document the cumulative rates of voluntary turnover and (2) examine how counselor perceptions of the organizational environment (procedural justice, distributive justice, perceived organizational support, job satisfaction) and clinical supervisor leadership effectiveness (relationship quality, in-role performance, extra-role performance) predict voluntary turnover over time. Survey data were collected from counselors in year 1 and actual turnover data were collected from organizational records in year 2, 3, and 4. Findings reveal that 25% of the original counselors turned over by year 2, 39% by year 3, and 47% by year 4. Counselors with more favorable perceptions of the organizational environment are between 13.8% – 22.8% less likely to turn over than those with less favorable perceptions. None of the leadership effectiveness variables are significant. PMID:22116013

48 CFR 419.201-71 - Small business coordinators.

Code of Federal Regulations, 2011 CFR

2011-10-01

... available SDB, WOB, and VOSB to be solicited by competitive procedures. Coordinators shall document the... planning activities and establishing aggressive SDB, WOB, and SDVOSB goals based on the annual review of...

48 CFR 419.201-71 - Small business coordinators.

Code of Federal Regulations, 2014 CFR

2014-10-01

... available SDB, WOB, and VOSB to be solicited by competitive procedures. Coordinators shall document the... planning activities and establishing aggressive SDB, WOB, and SDVOSB goals based on the annual review of...

48 CFR 419.201-71 - Small business coordinators.

Code of Federal Regulations, 2013 CFR

2013-10-01

... available SDB, WOB, and VOSB to be solicited by competitive procedures. Coordinators shall document the... planning activities and establishing aggressive SDB, WOB, and SDVOSB goals based on the annual review of...

48 CFR 419.201-71 - Small business coordinators.

Code of Federal Regulations, 2012 CFR

2012-10-01

... available SDB, WOB, and VOSB to be solicited by competitive procedures. Coordinators shall document the... planning activities and establishing aggressive SDB, WOB, and SDVOSB goals based on the annual review of...

50 CFR 300.182 - HMS international trade permit.

Code of Federal Regulations, 2010 CFR

2010-10-01

... those entities authorized under 19 CFR 141.18. A resident agent or resident corporate surety provider..., at least annually, in accordance with the procedures of the NOAA Finance Handbook, available from...

36 CFR 230.3 - National program administration.

Code of Federal Regulations, 2011 CFR

2011-07-01

... implementation of such policy and procedure over the life of the Program. (b) The Chief shall annually distribute... State foresters. (c) Tree planting, tree maintenance, and tree improvement are national priorities for...

36 CFR 230.3 - National program administration.

Code of Federal Regulations, 2010 CFR

2010-07-01

... implementation of such policy and procedure over the life of the Program. (b) The Chief shall annually distribute... State foresters. (c) Tree planting, tree maintenance, and tree improvement are national priorities for...

50 CFR 648.21 - Procedures for determining initial annual amounts.

Code of Federal Regulations, 2010 CFR

2010-10-01

...; virtual population analysis results; levels of noncompliance by harvesters or individual states; impact of...: (A) Total world export potential of mackerel producing countries. (B) Total world import demand of...

Trends in Penile Prosthetics: Influence of Patient Demographics, Surgeon Volume, and Hospital Volume on Type of Penile Prosthesis Inserted in New York State.

PubMed

Kashanian, James A; Golan, Ron; Sun, Tianyi; Patel, Neal A; Lipsky, Michael J; Stahl, Peter J; Sedrakyan, Art

2018-02-01

Penile prostheses (PPs) are a discrete, well-tolerated treatment option for men with medical refractory erectile dysfunction. Despite the increasing prevalence of erectile dysfunction, multiple series evaluating inpatient data have found a decrease in the frequency of PP surgery during the past decade. To investigate trends in PP surgery and factors affecting the choice of different PPs in New York State. This study used the New York State Department of Health Statewide Planning and Research Cooperative (SPARCS) data cohort that includes longitudinal information on hospital discharges, ambulatory surgery, emergency department visits, and outpatient services. Patients older than 18 years who underwent inflatable or non-inflatable PP insertion from 2000 to 2014 were included in the study. Influence of patient demographics, surgeon volume, and hospital volume on type of PP inserted. Since 2000, 14,114 patients received PP surgery in New York State; 12,352 PPs (88%) were inflatable and 1,762 (12%) were non-inflatable, with facility-level variation from 0% to 100%. There was an increasing trend in the number of annual procedures performed, with rates of non-inflatable PP insertion decreasing annually (P < .01). More procedures were performed in the ambulatory setting over time (P < .01). Important predictors of device choice were insurance type, year of insertion, hospital and surgeon volume, and the presence of comorbidities. Major influences in choice of PP inserted include racial and socioeconomic factors and surgeon and hospital surgical volume. Use of the SPARCS database, which captures inpatient and outpatient services, allows for more accurate insight into trends in contrast to inpatient sampling alone. However, SPARCS is limited to patients within New York State and the results might not be generalizable to men in other states. Also, patient preference was not accounted for in these analyses, which can play a role in PP selection. During the past 14 years, there has been an increasing trend in inflatable PP surgery for the management of erectile dysfunction. Most procedures are performed in the ambulatory setting and not previously captured by prior studies using inpatient data. Kashanian JA, Golan R, Sun T, et al. Trends in Penile Prosthetics: Influence of Patient Demographics, Surgeon Volume, and Hospital Volume on Type of Penile Prosthesis Inserted in New York State. J Sex Med 2018;15:245-250. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Auditing the Records of Student-Athletes.

ERIC Educational Resources Information Center

Riggs, Robert O.; Hedden, Carole R.

1985-01-01

A 1985 survey showed that NCAA members favored mandating annual audits of athletics budgets by institutional or independent auditors. Development of Tennessee's internal audit system is described, and its internal audit procedures is outlined. (MLW)

Statewide Trends in Utilization and Outcomes of Endovascular Treatment of Acute Ischemic Stroke: Analysis of Minnesota Hospital Association Data (2014 and 2015).

PubMed

Hussein, Haitham M; Saleem, Muhammad A; Qureshi, Adnan I

2018-03-01

The study aims at examining the changes in endovascular procedures utilization after the publication of the clinical trials showing their benefit in patients with acute ischemic stroke (AIS). Minnesota Hospital Association database from 137 member hospitals was used to calculate the statewide utilization rates for 2 periods: prior to (calendar year 2014) and after (calendar year 2015) the publication of multiple randomized clinical trials showing the efficacy of endovascular therapy. Patients were identified using International Classification of Disease, Clinical Modification, 9th revision (ICD-9) or ICD-10 codes (ICD-10 started October 2015). Utilization rates for endovascular treatment were calculated monthly, quarterly, and annually. Of the 13,043 patients admitted with AIS, 434 patients (mean age 68.5 ± 15.5 years; 51.2% women) received endovascular treatment. The number of procedures increased from 194 in 2014 to 240 in 2015. Utilization rate was 3.4% in the first quarter of 2014, gradually declined to reach its lowest value (2.6%) the last quarter of 2014, then steadily increased to reach its peak (4%) in the last quarter of 2015. Procedures performed at comprehensive stroke centers increased from 52% of total procedures in 2014 to 57.5% in 2015, whereas those performed at primary stroke centers decreased from 22.6% to 19.5%. In 2015, fewer patients had hypertension (50.4% versus 60.3%; P = .039) and more patients had chronic kidney disease (28.3% versus 15.5%; P = .001) compared with 2014. Intracranial hemorrhage, mortality rate, and rate of home discharge were similar between the 2 years. Utilization of endovascular procedures for treatment of AIS has been rapidly influenced by medical literature. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Implementation of a national external quality assessment program for medical laboratories in Burkina Faso: challenges, lessons learned, and perspectives.

PubMed

Sakandé, Jean; Nikièma, Abdoulaye; Kabré, Elie; Sawadogo, Charles; Nacoulma, Eric W; Sanou, Mamadou; Sangaré, Lassana; Traoré-Ouédraogo, Rasmata; Sawadogo, Mamadou; Gershy-Damet, Guy Michel

2014-02-01

The National External Quality Assessment (NEQA) program of Burkina Faso is a proficiency testing program mandatory for all laboratories in the country since 2006. The program runs two cycles per year and covers all areas of laboratories. All panels were validated by the expert committee before dispatch under optimal storage and transport conditions to participating laboratories along with report forms. Performance in the last 5 years varied by panel, with average annual performance of bacteriology panels for all laboratories rising from 75% in 2006 to 81% in 2010 and with a best average performance of 87% in 2007 and 2008. During the same period, malaria microscopy performance varied from 85% to 94%, with a best average performance of 94% in 2010; chemistry performance increased from 87% to 94%, with a best average annual performance of 97% in 2009. Hematology showed more variation in performance, ranging from 61% to 86%, with a best annual average performance of 90% in 2008. Average annual performance for immunology varied less between 2006 and 2010, recording 97%, 90%, and 95%. Except for malaria microscopy, annual performances for enrolled panels varied substantially from year to year, indicating some difficulty in maintaining consistency in quality. The main challenges of the NEQA program observed between 2006 to 2010 were funding, sourcing, and safe transportation of quality panels to all laboratories countrywide.

The national cost burden of bronchial foreign body aspiration in children.

PubMed

Kim, Irene A; Shapiro, Nina; Bhattacharyya, Neil

2015-05-01

Foreign body aspiration (FBA) continues to be a concerning pediatric problem, accounting for thousands of emergency room visits and more than 100 deaths each year in the United States. The costs incurred with hospitalizations and procedures following these events are the focus of this study. Retrospective review. The Nationwide Inpatient Sample from 2009 to 2011 was analyzed, and all cases with pediatric bronchial foreign body aspirations (International Classification of Diseases-9 codes: 934.0, 934.1, 934.8, and 934.9) were reviewed. Cases were analyzed to determine type of foreign body aspiration, procedural interventions performed, duration of inpatient stay, mortality rate, complications, and posthospitalization disposition. The median length of hospital stay and total costs associated with aspiration events were determined. An estimated 1,908 ± 273 pediatric bronchial FBA patients were admitted annually over the 3-year period (mean age, 3.6 ± 0.3 years; 61.3% ± 1.9% male). The ratio of foreign object aspiration to food aspiration was 5:3. Overall, 56%.0 ± 3.6% of the patients underwent a bronchoscopic procedure for foreign body removal; of those, 41.5% ± 2.5% had a foreign body removed at the time of the endoscopy. The hospital mortality rate associated with bronchial aspiration was 1.8% ± 0.4%; and 2.2% ± 0.5% of patients were diagnosed with anoxic brain injury. The median length of stay was 3 days (25th-75th interquartile range, 1-7 days).The median charges and actual costs per case were $20,820 ($10,800-$53,453) and $6,720 ($3,628-$16,723), respectively. The annual overall inpatient cost associated with pediatric bronchial foreign-body aspiration is approximately $12.8 million. Combined, the rate of death or anoxic brain injury associated with pediatric foreign body is approximately 4%. 2C. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

National hospital discharge survey: 2004 annual summary with detailed diagnosis and procedure data.

PubMed

Kozak, Lola Jean; DeFrances, Carol Jean; Hall, Margaret Jean

2006-10-01

This report presents 2004 national estimates and selected trend data on the use of nonfederal short-stay hospitals in the United States. Estimates are provided by selected patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Estimates of diagnoses and procedures are presented according to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually since 1965. In 2004, data were collected for approximately 371,000 discharges. Of the 476 eligible nonfederal short-stay hospitals in the sample, 439 (92 percent) responded to the survey. An estimated 34.9 million inpatients were discharged from nonfederal short-stay hospitals in 2004. They used 167.9 million days of care and had an average length of stay of 4.8 days. Hospital use by age ranged from 4.3 million days of care for patients 5-14 years of age to 31.8 million days of care for 75-84 year olds. Almost a third of patients 85 years and over were discharged from hospitals to long-term care institutions. Diseases of the circulatory system was the leading diagnostic category for males. Childbirth was the leading category for females, followed by circulatory diseases. The proportion of HIV discharges who were 40 years of age and over increased from 40 percent in 1995 to 67 percent in 2004. The rate of cardiac catheterizations was higher for males than for females and higher for patients 65-74 and 75-84 years of age than for older or younger groups. The average length of stay for both vaginal and cesarean deliveries decreased from 1980 through 1995 but stays for vaginal deliveries increased 24 percent during the period from 1995 to 2004.

The horror of unsafe abortion: case report of a life threatening complication in a 29-year old woman

PubMed Central

2013-01-01

Background Every year 42 million women with unintended pregnancies choose abortion, and fifty percent of these procedures, 20 million are unsafe. An unsafe abortion is defined as a procedure for terminating an unintended pregnancy carried out either by person lacking the necessary skills or in an environment that does not conform to minimal medical standards or both. Pakistan is the one of the six countries where more than 50% of the world’s all maternal deaths occur. It is estimated that 890,000 induced abortions are performed annually in Pakistan, and estimate an annual abortion rate of 29 per 1000 women aged 15-49. Case presentation Here we present a case report of a 29-year old woman who underwent an unsafe abortion for unintended pregnancy resulting in uterine perforation. The unskilled provider pulled out her bowel through vagina after perforating the uterus, as a result she lost major portion of her small intestine resulting in short bowel syndrome. Conclusion The law of Pakistan only allows abortion during early stages of pregnancy for purpose of saving the life of a mother but does not cater for cases of rape, incest and fetal abnormalities or social reasons. Only legalization of abortion is not sufficient, preventing unintended pregnancy should be the priority of all the nations and for this reason contraception should be widely accessible. Practitioners need to become better trained in safer abortion methods and be to able transfer the patient to health facility when complications occur. PMID:24131627

Simulation-based otolaryngology - head and neck surgery boot camp: 'how I do it'.

PubMed

Chin, C J; Chin, C A; Roth, K; Rotenberg, B W; Fung, K

2016-03-01

In otolaryngology, surgical emergencies can occur at any time. An annual surgical training camp (or 'boot camp') offers junior residents from across North America the opportunity to learn and practice these skills in a safe environment. The goals of this study were to describe the set-up and execution of a simulation-based otolaryngology boot camp and to determine participants' confidence in performing routine and emergency on-call procedures in stressful situations before and after the boot camp. There were three main components of the boot camp: task trainers, simulations and an interactive panel discussion. Surveys were given to participants before and after the boot camp, and their confidence in performing the different tasks was assessed via multiple t-tests. Participants comprised 22 residents from 12 different universities; 10 of these completed both boot camp surveys. Of the nine tasks, the residents reported a significant improvement in confidence levels for six, including surgical airway and orbital haematoma management. An otolaryngology boot camp gives residents the chance to learn and practice emergency skills before encountering the emergencies in everyday practice. Their confidence in multiple skillsets was significantly improved after the boot camp. Given the shift towards competency-based learning in medical training, this study has implications for all surgical and procedural specialties.

Effectiveness of two conventional methods for seismic retrofit of steel and RC moment resisting frames based on damage control criteria

NASA Astrophysics Data System (ADS)

Beheshti Aval, Seyed Bahram; Kouhestani, Hamed Sadegh; Mottaghi, Lida

2017-07-01

This study investigates the efficiency of two types of rehabilitation methods based on economic justification that can lead to logical decision making between the retrofitting schemes. Among various rehabilitation methods, concentric chevron bracing (CCB) and cylindrical friction damper (CFD) were selected. The performance assessment procedure of the frames is divided into two distinct phases. First, the limit state probabilities of the structures before and after rehabilitation are investigated. In the second phase, the seismic risk of structures in terms of life safety and financial losses (decision variables) using the recently published FEMA P58 methodology is evaluated. The results show that the proposed retrofitting methods improve the serviceability and life safety performance levels of steel and RC structures at different rates when subjected to earthquake loads. Moreover, these procedures reveal that financial losses are greatly decreased, and were more tangible by the application of CFD rather than using CCB. Although using both retrofitting methods reduced damage state probabilities, incorporation of a site-specific seismic hazard curve to evaluate mean annual occurrence frequency at the collapse prevention limit state caused unexpected results to be obtained. Contrary to CFD, the collapse probability of the structures retrofitted with CCB increased when compared with the primary structures.

Committee Representation and Medicare Reimbursements-An Examination of the Resource-Based Relative Value Scale.

PubMed

Gao, Y Nina

2018-04-06

The Resource-Based Relative Value Scale Update Committee (RUC) submits recommended reimbursement values for physician work (wRVUs) under Medicare Part B. The RUC includes rotating representatives from medical specialties. To identify changes in physician reimbursements associated with RUC rotating seat representation. Relative Value Scale Update Committee members 1994-2013; Medicare Part B Relative Value Scale 1994-2013; Physician/Supplier Procedure Summary Master File 2007; Part B National Summary Data File 2000-2011. I match service and procedure codes to specialties using 2007 Medicare billing data. Subsequently, I model wRVUs as a function of RUC rotating committee representation and level of code specialization. An annual RUC rotating seat membership is associated with a statistically significant 3-5 percent increase in Medicare expenditures for codes billed to that specialty. For codes that are performed by a small number of physicians, the association between reimbursement and rotating subspecialty representation is positive, 0.177 (SE = 0.024). For codes that are performed by a large number of physicians, the association is negative, -0.183 (SE = 0.026). Rotating representation on the RUC is correlated with overall reimbursement rates. The resulting differential changes may exacerbate existing reimbursement discrepancies between generalist and specialist practitioners. © Health Research and Educational Trust.

Epidermal Growth Factor (EGF) Receptor Intron 1 CA Repeat Polymorphisms in African-American and Caucasian Males: Influence on Prostate Cancer Risk or Disease Progression and Interaction with Androgen Receptor CAG Repeat Polymorphisms

DTIC Science & Technology

2003-09-01

Adipose Stromal Cells from Tumescent Liposuction Procedures. American Society for Dermatologic Surgery, $15,000 direct, 11/01/01 -10/31/02. 1999...stromal cells from tumescent liposuction procedures" ASDS Annual Meeting, Chicago, IL, November 1,2002."Adult Multipotent Stem Cells", Coriell

Statistics of Scientific Procedures on Living Animals Great Britain 2015 - highlighting an ongoing upward trend in animal use and missed opportunities.

PubMed

Hudson-Shore, Michelle

2016-12-01

The Annual Statistics of Scientific Procedures on Living Animals Great Britain 2015 indicate that the Home Office were correct in recommending that caution should be exercised when interpreting the 2014 data as an apparent decline in animal experiments. The 2015 report shows that, as the changes to the format of the annual statistics have become more familiar and less problematic, there has been a re-emergence of the upward trend in animal research and testing in Great Britain. The 2015 statistics report an increase in animal procedures (up to 4,142,631) and in the number of animals used (up to 4,069,349). This represents 1% more than the totals in 2013, and a 7% increase on the procedures reported in 2014. This paper details an analysis of these most recent statistics, providing information on overall animal use and highlighting specific issues associated with genetically-altered animals, dogs and primates. It also reflects on areas of the new format that have previously been highlighted as being problematic, and concludes with a discussion about the use of animals in regulatory research and testing, and how there are significant missed opportunities for replacing some of the animal-based tests in this area. 2016 FRAME.

Resident and young physician experience with complex cataract surgery and new cataract and refractive technology: Results of the ASCRS 2016 Young Eye Surgeons survey.

PubMed

Schallhorn, Julie M; Ciralsky, Jessica B; Yeu, Elizabeth

2017-05-01

A survey was offered to attendees of the 2016 annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS) as well as online to ASCRS members. Of the 429 self-identified surgeons in training or those with fewer than 5 years in practice, 83% had performed complex cataract surgery using iris expansion devices or capsular tension rings (63%) and 70% had implanted a toric intraocular lens (IOL). A minority of respondents had performed laser-assisted cataract surgery (27%) or implanted presbyopia-correcting IOLs (39%), and only half (50%) had performed laser vision correction (LVC). Comfort with complex cataract and IOL procedures improved with increasing number of cases performed until greater than 10 cases. From this we can conclude that young surgeons have adequate exposure to complex cataracts but lack experience in refractive surgery and new IOL technology. Reported surgeon confidence improved with increased experience and exposure. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Annual research briefs, 1993. [Center for Turbulence Research

NASA Technical Reports Server (NTRS)

1993-01-01

The 1993 annual progress reports of the Research Fellow and students of the Center for Turbulence Research are included. The first group of reports are directed towards the theory and application of active control in turbulent flows including the development of a systematic mathematical procedure based on the Navier Stokes equations for flow control. The second group of reports are concerned with the prediction of turbulent flows. The remaining articles are devoted to turbulent reacting flows, turbulence physics, experiments, and simulations.

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

Nephew, E.A.; Abbatiello, L.A.; Ballou, M.L.

The basic concept of the Annual Cycle Energy System (ACES) - an integrated system for supplying space heating, hot water, and air conditioning to a building - and the theory underlying its design and operation are described. Practical procedures for designing an ACES for a single-family residence, together with recommended guidelines for the construction and installation of system components, are presented. Methods are discussed for estimating the life-cycle cost, component sizes, and annual energy consumption of the system for residential applications in different climatic regions of the US.

Titanium Dioxide Nanoparticle Integrated Concrete: An Assessment of Nanoparticle Release When Exposed to UV Radiation and Wet Weather Conditions

DTIC Science & Technology

2016-03-23

polystyrene tubes . This procedure was repeated 30 times to simulate an annual exposure to acidic precipitation weathering. The average annual number...with diluted nitric acid in a 10 mL test tube . This sample was used for the ICP-AES analysis. The remainder of the sample solution was acid...Water at a Semiconducter Electrode. Nature 238 9. Gamer AO, Leibold E, van Ravenzwaay B. 2006. The in vitro absorption of microfine zinc oxide and

Prospective Evaluation of Operating Room Inefficiency.

PubMed

Madni, Tarik D; Imran, Jonathan B; Clark, Audra T; Cunningham, Holly B; Taveras, Luis; Arnoldo, Brett D; Phelan, Herb A; Wolf, Steven E

2018-04-06

Previously, we identified that 60% of our facility's total operative time is nonoperative. We performed a review of our operating room to determine where inefficiencies exist in nonoperative time. Live video of operations performed in a burn operating room from 6/23/17 to 8/16/17 were prospectively reviewed. Preparation (end of induction to procedure start) and turnover (patient out of room to next patient in room) were divided into the following activities: 1) Preparation: remove dressing, position patient, clean patient, drape patient, and 2) Turnover: clean operating room, scrub tray set-up, anesthesia set-up. Ideal preparation time was calculated as the sum of time needed to perform preparation activities consecutively. Ideal turnover time was calculated as the sum of time needed to clean the operating room and to set up either the scrub tray or anesthesia (the larger of the two times as these can be done in parallel). We reviewed 101 consecutive operations. An average of 2.4±0.8 cases/day were performed. Ideal preparation and turnover time were 16.6 and 30.1 minutes, a 38.3% and 32.5% reduction compared to actual times. Attending surgeon presence in the operating room within 10 minutes of a patient's arrival was found to significantly decrease time to incision by 33% (52.7±14.3 minutes down to 35.7±20.4, p<0.0001). A reduction in preparation and turnover time could save $1.02 million and generate $1.76 million in additional revenue annually. Reducing preparation and turnover to ideal times could increase caseload to 4/day, leading to millions of dollars of savings annually.

40 CFR 98.114 - Monitoring and QA/QC requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... requirements. If you determine annual process CO2 emissions using the carbon mass balance procedure in § 98.113... D5373-08 Standard Test Methods for Instrumental Determination of Carbon, Hydrogen, and Nitrogen in...

40 CFR 98.114 - Monitoring and QA/QC requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... requirements. If you determine annual process CO2 emissions using the carbon mass balance procedure in § 98.113... D5373-08 Standard Test Methods for Instrumental Determination of Carbon, Hydrogen, and Nitrogen in...

40 CFR 98.114 - Monitoring and QA/QC requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... requirements. If you determine annual process CO2 emissions using the carbon mass balance procedure in § 98.113... D5373-08 Standard Test Methods for Instrumental Determination of Carbon, Hydrogen, and Nitrogen in...

40 CFR 98.114 - Monitoring and QA/QC requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... requirements. If you determine annual process CO2 emissions using the carbon mass balance procedure in § 98.113... D5373-08 Standard Test Methods for Instrumental Determination of Carbon, Hydrogen, and Nitrogen in...

76 FR 59190 - Voluntary Service National Advisory Committee; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-23

...). On October 14, agenda topics will include: Subcommittee reports; review of standard operating procedure revisions; 2013 NAC annual meeting plans; and any new business. No time will be allocated at this...

Optimizing traffic counting procedures.

DOT National Transportation Integrated Search

1986-01-01

Estimates of annual average daily traffic volumes are important in the planning and operations of state highway departments. These estimates are used in the planning of new construction and improvement of existing facilities, and, in some cases, in t...

Seasonal and annual precipitation time series trend analysis in North Carolina, United States

NASA Astrophysics Data System (ADS)

Sayemuzzaman, Mohammad; Jha, Manoj K.

2014-02-01

The present study performs the spatial and temporal trend analysis of the annual and seasonal time-series of a set of uniformly distributed 249 stations precipitation data across the state of North Carolina, United States over the period of 1950-2009. The Mann-Kendall (MK) test, the Theil-Sen approach (TSA) and the Sequential Mann-Kendall (SQMK) test were applied to quantify the significance of trend, magnitude of trend, and the trend shift, respectively. Regional (mountain, piedmont and coastal) precipitation trends were also analyzed using the above-mentioned tests. Prior to the application of statistical tests, the pre-whitening technique was used to eliminate the effect of autocorrelation of precipitation data series. The application of the above-mentioned procedures has shown very notable statewide increasing trend for winter and decreasing trend for fall precipitation. Statewide mixed (increasing/decreasing) trend has been detected in annual, spring, and summer precipitation time series. Significant trends (confidence level ≥ 95%) were detected only in 8, 7, 4 and 10 nos. of stations (out of 249 stations) in winter, spring, summer, and fall, respectively. Magnitude of the highest increasing (decreasing) precipitation trend was found about 4 mm/season (- 4.50 mm/season) in fall (summer) season. Annual precipitation trend magnitude varied between - 5.50 mm/year and 9 mm/year. Regional trend analysis found increasing precipitation in mountain and coastal regions in general except during the winter. Piedmont region was found to have increasing trends in summer and fall, but decreasing trend in winter, spring and on an annual basis. The SQMK test on "trend shift analysis" identified a significant shift during 1960 - 70 in most parts of the state. Finally, the comparison between winter (summer) precipitations with the North Atlantic Oscillation (Southern Oscillation) indices concluded that the variability and trend of precipitation can be explained by the Oscillation indices for North Carolina.

U.S. Department of Education FY 2009 Annual Performance Report

ERIC Educational Resources Information Center

US Department of Education, 2010

2010-01-01

The United States Department of Education's "Annual Performance Report" (APR) for fiscal year (FY) 2009 provides detailed information on how the outcomes of the strategic performance measures identified in its "FY 2007-2012 Strategic Plan" and updated in the "Fiscal Year 2008 Performance and Accountability Report"…

The Bottom Line: Performance Measurement in a Corporate Library.

ERIC Educational Resources Information Center

McAllister, Moyra

This paper discusses performance measurement in the Blake Dawson Waldron (BDW) law firm, a partnership with five offices in Australia, as well as a number overseas. Three levels of performance measurement are described: (1) personal level--through annual performance appraisals; (2) team level--the annual team meeting; and (3) service…

An indicator device for monitoring of room illuminance level in the radiological image viewing environment.

PubMed

Azlan, C A; Ng, K H; Anandan, S; Nizam, M S

2006-09-01

Illuminance level in the softcopy image viewing room is a very important factor to optimize productivity in radiological diagnosis. In today's radiological environment, the illuminance measurements are normally done during the quality control procedure and performed annually. Although the room is equipped with dimmer switches, radiologists are not able to decide the level of illuminance according to the standards. The aim of this study is to develop a simple real-time illuminance detector system to assist the radiologists in deciding an adequate illuminance level during radiological image viewing. The system indicates illuminance in a very simple visual form by using light emitting diodes. By employing the device in the viewing room, illuminance level can be monitored and adjusted effectively.

Delayed hypersensitivity reaction of the knee after injection of arthroscopy portals with bupivacaine (marcaine)

PubMed

Craft, D V; Good, R P

1994-06-01

The number of arthroscopic procedures performed annually for the management of intraarticular injuries has grown at an exponential rate. Whether done with the patient under general anesthesia or local anesthesia supplemented with intravenous sedation, it is common practice to postoperatively inject each portal as well as the joint with a local anesthetic to provide pain relief in the transition to the recovery room and discharge after outpatient surgery. To our knowledge, no previous reports of localized urticaria and delayed hypersensitivity reaction have been reported in the postarthroscopy setting. We are reporting a case of delayed hypersensitivity reaction and urticaria of the knee that presented after bupivacaine (Marcaine) injection of arthroscopic portals after routine meniscectomy.

2013 Annual Site Inspection and Monitoring Report for Uranium Mill Tailings Radiation Control Act Title II Disposal Sites

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

None

This report, in fulfillment of a license requirement, presents the results of long-term surveillance and maintenance activities conducted by the U.S. Department of Energy (DOE) Office of Legacy Management in 2013 at six uranium mill tailings disposal sites reclaimed under Title II of the Uranium Mill Tailings Radiation Control Act (UMTRCA) of 1978. These activities verified that the UMTRCA Title II disposal sites remain in compliance with license requirements. DOE manages six UMTRCA Title II disposal sites under a general license granted by the U.S. Nuclear Regulatory Commission (NRC) established at Title 10 Code of Federal Regulations Part 40.28. Reclamationmore » and site transition activities continue at other sites, and DOE ultimately expects to manage approximately 27 Title II disposal sites. Long-term surveillance and maintenance activities and services for these disposal sites include inspecting and maintaining the sites; monitoring environmental media and institutional controls; conducting any necessary corrective action; and performing administrative, records, stakeholder services, and other regulatory functions. Annual site inspections and monitoring are conducted in accordance with site-specific long-term surveillance plans (LTSPs) and procedures established by DOE to comply with license requirements. Each site inspection is performed to verify the integrity of visible features at the site; to identify changes or new conditions that may affect the long-term performance of the site; and to determine the need, if any, for maintenance, follow-up inspections, or corrective action. LTSPs and site compliance reports are available online at http://www.lm.doe.gov« less

Government Performance and Results Act: Annual Report to the President and Congress. Fiscal Year 2008

ERIC Educational Resources Information Center

National Council on Disability, 2009

2009-01-01

This report compares actual performance with the projected levels of performance set out in the National Council on Disability's annual performance plan. The findings of this report show a positive link between the allocated resources and NCD's performance. NCD's assessment review showed that it was successful in meeting its goals and achieving…

Utilization and growth patterns of sacroiliac joint injections from 2000 to 2011 in the medicare population.

PubMed

Manchikanti, Laxmaiah; Hansen, Hans; Pampati, Vidyasagar; Falco, Frank J E

2013-01-01

  The high prevalence of persistent low back pain and growing number of diagnostic and therapeutic modalities employed to manage chronic low back pain and the subsequent impact on society and the economy continue to hold sway over health care policy. Among the multiple causes responsible for chronic low back pain, the contributions of the sacroiliac joint have been a subject of debate albeit a paucity of research. At present, there are no definitive conservative, interventional or surgical management options for managing sacroiliac joint pain. It has been shown that the increases were highest for facet joint interventions and sacroiliac joint blocks with an increase of 310% per 100,000 Medicare beneficiaries from 2000 to 2011. There has not been a systematic assessment of the utilization and growth patterns of sacroiliac joint injections. Analysis of the growth patterns of sacroiliac joint injections in Medicare beneficiaries from 2000 to 2011. To evaluate the utilization and growth patterns of sacroiliac joint injections. This assessment was performed utilizing Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master data from 2000 to 2011. The findings of this assessment in Medicare beneficiaries from 2000 to 2011 showed a 331% increase per 100,000 Medicare beneficiaries with an annual increase of 14.2%, compared to an increase in the Medicare population of 23% or annual increase of 1.9%. The number of procedures increased from 49,554 in 2000 to 252,654 in 2011, or a rate of 125 to 539 per 100,000 Medicare beneficiaries. Among the various specialists performing sacroiliac joint injections, physicians specializing in physical medicine and rehabilitation have shown the most increase, followed by neurology with 1,568% and 698%, even though many physicians from both specialties have been enrolling in interventional pain management and pain management. Even though the numbers were small for nonphysician providers including certified registered nurse anesthetists, nurse practitioners, and physician assistants, these numbers increased substantially at a rate of 4,526% per 100,000 Medicare beneficiaries with 21 procedures performed in 2000 increasing to 4,953 procedures in 2011. The, majority of sacroiliac joint injections were performed in an office setting. The utilization of sacroiliac joint injections by state from 2008 to 2010 showed increases of more than 20% in New Hampshire, Alabama, Minnesota, Vermont, Oregon, Utah, Massachusetts, Kansas, and Maine. Similarly, some states showed significant decreases of 20% or more, including Oklahoma, Louisiana, Maryland, Arkansas, New York, and Hawaii. Overall, there was a 1% increase per 100,000 Medicare population from 2008 to 2010. However, 2011 showed significant increases from 2010. The limitations of this study included a lack of inclusion of Medicare participants in Medicare Advantage plans, the availability of an identifiable code for only sacroiliac joint injections, and the possibility that state claims data may include claims from other states. . This study illustrates the explosive growth of sacroiliac joint injections even more than facet joint interventions. Furthermore, certain groups of providers showed substantial increases. Overall, increases from 2008 to 2010 were nominal with 1%, but some states showed over 20% increases whereas some others showed over 20% decreases.

Current UK practice in emergency laparotomy

PubMed Central

Barrow, E; Varley, S; Pichel, AC; Peden, CJ; Saunders, DI; Murray, D

2013-01-01

Introduction Emergency laparotomy is a common procedure, with 30,000–50,000 performed annually in the UK. This large scale study reports the current spectrum of emergency laparotomies, and the influence of the surgical procedure, underlying pathology and subspecialty of the operating surgeon on mortality. Methods Anonymised data on consecutive patients undergoing an emergency laparotomy were submitted for a three-month period. The primary outcome measure was unadjusted 30-day mortality. Appendicectomy and cholecystectomy were among the procedures excluded. Results Data from 1,708 patients from 35 National Health Service hospitals were analysed. The overall 30-day mortality rate was 14.8%. ‘True’ emergency laparotomies (ie those classified by the National Confidential Enquiry into Patient Outcome and Death as immediate or urgent) comprised 86.5% of cases. The mortality rate rose from 8.0% among expedited cases to 14.3% among urgent cases and to 25.7% among laparotomies termed immediate. Among the most common index procedures, small bowel resection exhibited the highest 30-day mortality rate of 21.1%. The presence of abdominal sepsis was associated with raised 30-day mortality (17.5% in the presence of sepsis vs 12.6%, p=0.027). Colorectal procedures comprised 44.3% and within this group, data suggest that mortality from laparotomy may be influenced by surgical subspecialisation. Conclusions This report of a large number of patients undergoing emergency laparotomy in the UK confirms a remarkably high mortality by modern standards across the range. Very few pathologies or procedures can be considered anything other than high risk. The need for routine consultant involvement and critical care is evident, and the case distribution helps define the surgical skill set needed for a modern emergency laparotomy service. Preliminary data relating outcomes from emergency colonic surgery to surgical subspecialty require urgent further study. PMID:24165345

Current UK practice in emergency laparotomy.

PubMed

Barrow, E; Anderson, I D; Varley, S; Pichel, A C; Peden, C J; Saunders, D I; Murray, D

2013-11-01

Emergency laparotomy is a common procedure, with 30,000-50,000 performed annually in the UK. This large scale study reports the current spectrum of emergency laparotomies, and the influence of the surgical procedure, underlying pathology and subspecialty of the operating surgeon on mortality. Anonymised data on consecutive patients undergoing an emergency laparotomy were submitted for a three-month period. The primary outcome measure was unadjusted 30-day mortality. Appendicectomy and cholecystectomy were among the procedures excluded. Data from 1,708 patients from 35 National Health Service hospitals were analysed. The overall 30-day mortality rate was 14.8%. 'True' emergency laparotomies (ie those classified by the National Confidential Enquiry into Patient Outcome and Death as immediate or urgent) comprised 86.5% of cases. The mortality rate rose from 8.0% among expedited cases to 14.3% among urgent cases and to 25.7% among laparotomies termed immediate. Among the most common index procedures, small bowel resection exhibited the highest 30-day mortality rate of 21.1%. The presence of abdominal sepsis was associated with raised 30-day mortality (17.5% in the presence of sepsis vs 12.6%, p=0.027). Colorectal procedures comprised 44.3% and within this group, data suggest that mortality from laparotomy may be influenced by surgical subspecialisation. This report of a large number of patients undergoing emergency laparotomy in the UK confirms a remarkably high mortality by modern standards across the range. Very few pathologies or procedures can be considered anything other than high risk. The need for routine consultant involvement and critical care is evident, and the case distribution helps define the surgical skill set needed for a modern emergency laparotomy service. Preliminary data relating outcomes from emergency colonic surgery to surgical subspecialty require urgent further study.

Higher revision risk for unicompartmental knee arthroplasty in low-volume hospitals

PubMed Central

Espehaug, Birgitte; Indrekvam, Kari; Havelin, Leif I; Furnes, Ove

2014-01-01

Background and purpose Some studies have found high complication rates and others have found low complication rates after unicompartmental knee arthroplasty (UKA). We evaluated whether hospital procedure volume influences the risk of revision using data from the Norwegian Arthroplasty Register (NAR). Materials and methods 5,791 UKAs have been registered in the Norwegian Arthroplasty Register. We analyzed the 4,460 cemented medial Oxford III implants that were used from 1999 to 2012; this is the most commonly used UKA implant in Norway. Cox regression (adjusted for age, sex, and diagnosis) was used to estimate risk ratios (RRs) for revision. 4 different volume groups were compared: 1–10, 11–20, 21–40, and > 40 UKA procedures annually per hospital. We also analyzed the reasons for revision. Results and interpretation We found a lower risk of revision in hospitals performing more than 40 procedures a year than in those with less than 10 UKAs a year, with an unadjusted RR of 0.53 (95% CI: 0.35–0.81) and adjusted RR of 0.59 (95% CI: 0.39–0.90). Low-volume hospitals appeared to have a higher risk of revision due to dislocation, instability, malalignment, and fracture than high-volume hospitals. PMID:24847789

Intracranial Procedures and Expected Frequency of Creutzfeldt-Jakob Disease.

PubMed

Abrams, Joseph Y; Maddox, Ryan A; Schonberger, Lawrence B; Belay, Ermias D

2016-01-01

To assess the frequency and characteristics of intracranial procedures (ICPs) performed and the number of U.S. residents living with a history of ICP. These data are used to calculate the expected annual number of sporadic Creutzfeldt-Jakob disease (CJD) cases among U.S. residents with a history of ICP. The Nationwide Inpatient Sample provided data on the frequency and types of ICPs, and data from the National Center for Health Statistics was used to produce age-adjusted mortality rates. A model was constructed, which estimated long-term survival and sporadic CJD rates among ICP patients based on procedure type and age. There were an estimated 2,070,488 ICPs in the United States from 1998 to 2007, an average of over 200,000 per year. There were an estimated 2,023,726 U.S. residents in 2013 with a history of ICP in the previous 30 years. In 2013, there was expected to be 4.1 sporadic CJD cases (95% CI 1-8) among people with a history of ICP in the past 30 years. The considerable proportion of U.S. residents living with a history of ICP is important information for retrospective assessments of CJD or any other suspected long-term outcome of ICPs. © 2015 S. Karger AG, Basel.

Who's minding the charge description master?

PubMed

Schaum, Kathleen D

2011-11-01

Just as it takes a team to manage chronic wounds, it takes a team to maintain the CDM. The technical staff from the wound care department should be represented on this team and should share the appropriate HCPCS codes and CPT codes, product descriptions, and costs for all procedures, services, supplies, drugs, and biologics used in their department. The billing department should ensure that the appropriate revenue codes for each payer are listed for each item on the CDM. Based on costs supplied by the wound care department, the finance department should consistently assign hospital charges to each line item on the CDM. The information technology department is responsible for making the specific changes to the CDM in the computer system. Most hospitals have a CDM coordinator. The technical staff from the wound care department should work closely with the CDM coordinator and should obtain from him/her the policies and procedures for maintaining the wound care department CDM. Most CDM coordinators will also provide a CDM Change Request Form. Use that form each year when the hospital is performing its annual CDM maintenance and throughout the year to add procedures, services, supplies, drugs, or biologics to your wound care offerings and/or when the cost for these offerings change.

Advanced Imaging Catheter: Final Project Report

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

Krulevitch, P; Colston, B; DaSilva, L

2001-07-20

Minimally invasive surgery (MIS) is an approach whereby procedures conventionally performed with large and potentially traumatic incisions are replaced by several tiny incisions through which specialized instruments are inserted. Early MIS, often called laparoscopic surgery, used video cameras and laparoscopes to visualize and control the medical devices, which were typically cutting or stapling tools. More recently, catheter-based procedures have become a fast growing sector of all surgeries. In these procedures, small incisions are made into one of the main arteries (e.g. femoral artery in the thigh), and a long thin hollow tube is inserted and positioned near the target area.more » The key advantage of this technique is that recovery time can be reduced from months to a matter of days. In the United States, over 700,000 catheter procedures are performed annually representing a market of over $350 million. Further growth in this area will require significant improvements in the current catheter technology. In order to effectively navigate a catheter through the tortuous vessels of the body, two capabilities must exist: imaging and positioning. In most cases, catheter procedures rely on radiography for visualization and manual manipulation for positioning of the device. Radiography provides two-dimensional, global images of the vasculature and cannot be used continuously due to radiation exposure to both the patient and physician. Intravascular ultrasound devices are available for continuous local imaging at the catheter tip, but these devices cannot be used simultaneously with therapeutic devices. Catheters are highly compliant devices, and manipulating the catheter is similar to pushing on a string. Often, a guide wire is used to help position the catheter, but this procedure has its own set of problems. Three characteristics are used to describe catheter maneuverability: (1) pushability -- the amount of linear displacement of the distal end (inside body) relative to an applied displacement of the proximal end (outside body); (2) torquability -- the amount of rotation of the distal end relative to an applied rotation of the proximal end; and (3) trackability -- the extent to which the catheter tracks along the guide wire without displacing it.« less

How often are x-rays used as diagnostic tool by healthcare providers in the Mazovian province of Poland.

PubMed

Bekas, Marcin; Gajewski, Antoni K; Pachocki, Krzysztof

2013-01-01

Within the medical facilities provided by state healthcare services, a universally applied technique for patient diagnosis and treatment relies on ionising radiation; for example in radiotherapy and X-ray (ie. examination). Human exposure to such radiation is not however entirely free of associated health risks. To determine and estimate the numbers and types of X-ray based medical procedures that are performed in general and dental radiography, mammography and computer tomography on patients from the Mazovian province in Poland, which included children, women and men subjects. The numbers of patient subjects undergoing X-rays was estimated by surveying the patient intake in X-ray testing rooms within the healthcare facilities of the Mazovian province. Questionnaires were either dispatched by mail to such healthcare centres or were completed by the X-ray operating staff during the testing of quality control. Results so obtained from the latter, were compared to entries from the X-ray rooms' register During 2009, the number of X-rays performed were 7612046 equivalent to 1460 examinations per 1000 inhabitants. The majority were done on women ie. 3847961 (50.55%), followed by 3193781 (41.96%) on men and 570 304 (7.49%) for children. Results indicated that the predominating medical procedure used of this type, was for making general diagnoses; especially through using chest radiography. Others included, in descending order; dental X-ray (mainly intra-oral examination), computer tomography (mainly CT head examinations) and mammography procedures. It was also found that the annual numbers of having X-rays has increased compared to previous years.

Alignment of training curriculum and surgical practice: implications for competency, manpower, and practice modeling.

PubMed

Sømme, S; Bronsert, M; Kempe, A; Morrato, E H; Ziegler, M

2012-02-01

The attractiveness of pediatric surgery (PS) as a specialty includes its primary role in the care of multisystemic disease. We were interested in identifying changes in operative case quality and quantity when comparing PS residents to PS practitioners. The 2006 Accreditation Council for Graduate Medical Education PS resident current procedural terminology (CPT) code database (26,077 resident cases) was merged with the 2006 Kids' Inpatient Database of International Classification of Diseases (ICD)-9 procedure codes (230,504 practitioner cases) and categorized by case type and volumes according to a resident CPT reference file. Cases were categorized into 84 procedure types. A recent estimate of 691 practicing pediatric surgeons was used as denominator to calculate case volume per surgeon. Our analysis focused on the PS index cases and we compared PS residents to subspecialty board certified general pediatric surgeons in practice. We excluded cases that may be performed by general surgeons without PS training. Our data indicate that, on average, 501 cases are performed annually by each PS resident. We identified significant differences in case volume per surgeon between training and practice for most PS index cases.CONCLUSIONS The PS index case quantity declined significantly from training to practice. If a volume to outcome relationship applies to these complex and infrequent PS cases, then to sustain and improve clinical quality post-training will require a new paradigm of continued learning. Additionally, a relook at the optimal manpower and more focused regionalization is warranted. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fiber optic D dimer biosensor

DOEpatents

Glass, Robert S.; Grant, Sheila A.

1999-01-01

A fiber optic sensor for D dimer (a fibrinolytic product) can be used in vivo (e.g., in catheter-based procedures) for the diagnosis and treatment of stroke-related conditions in humans. Stroke is the third leading cause of death in the United States. It has been estimated that strokes and stroke-related disorders cost Americans between $15-30 billion annually. Relatively recently, new medical procedures have been developed for the treatment of stroke. These endovascular procedures rely upon the use of microcatheters. These procedures could be facilitated with this sensor for D dimer integrated with a microcatheter for the diagnosis of clot type, and as an indicator of the effectiveness, or end-point of thrombolytic therapy.

Fiber optic D dimer biosensor

DOEpatents

Glass, R.S.; Grant, S.A.

1999-08-17

A fiber optic sensor for D dimer (a fibrinolytic product) can be used in vivo (e.g., in catheter-based procedures) for the diagnosis and treatment of stroke-related conditions in humans. Stroke is the third leading cause of death in the United States. It has been estimated that strokes and stroke-related disorders cost Americans between $15-30 billion annually. Relatively recently, new medical procedures have been developed for the treatment of stroke. These endovascular procedures rely upon the use of microcatheters. These procedures could be facilitated with this sensor for D dimer integrated with a microcatheter for the diagnosis of clot type, and as an indicator of the effectiveness, or end-point of thrombolytic therapy. 4 figs.

The Utility, Reliability, and Validity of Holistic Scoring for Writing Assessment Samples. Symposium Presented at the Annual Meeting of the Mid-South Educational Research Association (Knoxville, Tennessee, November 11-13, 1992).

ERIC Educational Resources Information Center

McLean, James E., Comp.

Four papers describe a study of the use of holistic writing assessment procedures in a pretest and posttest manner to determine improvement of 10th graders' writing skills. "Problem and Context" (James E. McLean) briefly describes the project and introduces the other three papers. "Holistic Scoring Procedures for Scoring Writing…