The economic impact of chronic prostatitis.

PubMed

Calhoun, Elizabeth A; McNaughton Collins, Mary; Pontari, Michel A; O'Leary, Michael; Leiby, Benjamin E; Landis, J Richard; Kusek, John W; Litwin, Mark S

2004-06-14

Little information exists on the economic impact of chronic prostatitis. The objective of this study was to determine the direct and indirect costs associated with chronic prostatitis. Outcomes were assessed using a questionnaire designed to capture health care resource utilization. Resource estimates were converted into unit costs with direct medical cost estimates based on hospital cost-accounting data and indirect costs based on modified labor force, employment, and earnings data from the US Census Bureau. The total direct costs for the 3 months prior to entry into the cohort, excluding hospitalization, were $126 915 for the 167 study participants for an average of $954 per person among the 133 consumers. Of the men, 26% reported work loss valued at an average of $551. The average total costs (direct and indirect) for the 3 months was $1099 per person for those 137 men who had resource consumption with an expected annual total cost per person of $4397. For those study participants with any incurred costs, tests for association revealed that the National Institutes of Health Chronic Prostatitis Symptom Index (P<.001) and each of the 3 subcategories of pain (P =.003), urinary function (P =.03), and quality-of-life (P =.002) were significantly associated with resource use, although the quality-of-life subscale score from the National Institutes of Health Chronic Prostatitis Symptom Index was the only predictor of resource consumption. Chronic prostatitis is associated with substantial costs and lower quality-of-life scores, which predicted resource consumption. The economic impact of chronic prostatitis warrants increased medical attention and resources to identify and test effective treatment strategies.

Correlates of African-American Undergraduate Student Achievement: Implications for the Prize Initiative

ERIC Educational Resources Information Center

Newton, Brian C.; Ghee, Kenneth L.; Langmeyer, Daniel

2014-01-01

Male and female African-American college students (n = 131) at a large urban predominately White publicly funded institution participated in a survey measuring the effect of a multitude of psychosocial constructs and factors on grade point average (GPA). Part One of the study's analysis focused on three of the six total constructs examined within…

Profix cemented total knee replacement: a 5-year outcome review from Lagos, Nigeria.

PubMed

Ugbeye, M E; Odunubi, O O; Dim, E M; Ekundayo, O O

2012-01-01

Total knee replacement is a standard treatment for severe osteoarthritis of the knees. It is however, still a novel procedure in Nigeria. Literature on the procedure and outcome of management are sparse in Nigeria. This study aimed at describing Total Knee prosthetic Replacement as it is practiced in National Orthopaedic Hospital, Lagos. Data on patients treated with Total knee replacement between 2006 and 2010 were analyzed retrospectively. The standard anterior approach, with a medial parapatellar incision under pneumatic tourniquet was used in all cases. There were a total of 59 knees in 48 patients operated, with a female: male ratio of 5:1. Patients were in the sixth to ninth decades of life. There was a statistically significant relationship between duration of symptoms and severity of angular deformity. The average pre-operative Knee score (KS) was 27 and average function score (FS) was 43. Average duration of surgery was 126.38 minutes. Tourniquet removal after wound closure was associated with reduced intra-operative blood loss (p < 0.05). Post-operative complications included peri-prosthetic fracture (1.69%), post-operative anaemia (8.47%), superficial wound dehiscence (3.39%) and foot drop (3.39%). The mean post-operative KS and FS increased to 80 and 75 respectively. Total knee replacement, though a novel procedure in our institution is beneficial to patients with severe osteoarthritis. A long term outcome study is being planned.

Patellofemoral arthroplasty conversion to total knee arthroplasty: Retrieval analysis and clinical correlation.

PubMed

Christ, Alexander B; Baral, Elexis; Koch, Chelsea; Shubin Stein, Beth E; Gonzalez Della Valle, Alejandro; Strickland, Sabrina M

2017-10-01

Patellofemoral arthroplasty (PFA) can be a successful, bone-sparing treatment for isolated patellofemoral arthritis. However, progression of tibio-femoral arthritis or incorrect indications may predispose patients to early conversion to total knee arthroplasty (TKA). The purpose of this study was to review the clinical cases and perform retrieval analysis of PFA conversions to TKA at our institution. Twenty one patellofemoral arthroplasties in 18 patients that were converted to TKA were identified through our implant retrieval registry. Sixteen implants were available for review by biomechanical engineers, who recorded surface markings, wear patterns, and integrity of fixation. Patient charts were reviewed and time to conversion, tourniquet time, conversion implant, additional surgeries, infections, and Kellgren & Lawrence grade of the tibio-femoral joint on pre-operative radiographs were recorded. PFAs converted to TKAs at our institution were implanted for an average of 2.7years. The most common reason for conversion was pain, but most patients had significant tibio-femoral arthritis, as indicated by an average Kellgren & Lawrence grade of 2.6. The average tourniquet time for these conversions was 67min. These patients underwent an average of one additional surgery per PFA converted, and the infection rate of these conversions was approximately 14%. Success of PFA depends upon correct patient selection rather than implant failure or wear. Conversion of PFA to TKA is technically similar to primary TKA, with similar post-operative pain relief and range of motion. However, infection rates and complications requiring further surgery are more consistent with results seen in revision TKA. IV. Copyright © 2017 Elsevier B.V. All rights reserved.

Modeling the oxidative capacity of the atmosphere of the south coast air basin of California. 1. Ozone formation metrics.

PubMed

Griffin, Robert J; Revelle, Meghan K; Dabdub, Donald

2004-02-01

Metrics associated with ozone (O3) formation are investigated using the California Institute of Technology (CIT) three-dimensional air-quality model. Variables investigated include the O3 production rate (P(O3)), O3 production efficiency (OPE), and total reactivity (the sum of the reactivity of carbon monoxide (CO) and all organic gases that react with the hydroxyl radical). Calculations are spatially and temporally resolved; surface-level and vertically averaged results are shown for September 9, 1993 for three Southern California locations: Central Los Angeles, Azusa, and Riverside. Predictions indicate increasing surface-level O3 concentrations with distance downwind, in line with observations. Surface-level and vertically averaged P(O3) values peak during midday and are highest downwind; surface P(O3) values are greater than vertically averaged values. Surface OPEs generally are highest downwind and peak during midday in downwind locations. In contrast, peaks occur in early morning and late afternoon in the vertically averaged case. Vertically averaged OPEs tend to be greater than those for the surface. Total reactivities are highest in upwind surface locations and peak during rush hours; vertically averaged reactivities are smaller and tend to be more uniform temporally and spatially. Total reactivity has large contributions from CO, alkanes, alkenes, aldehydes, unsubstituted monoaromatics, and secondary organics. Calculations using estimated emissions for 2010 result in decreases in P(O3) values and reactivities but increases in OPEs.

Differences between recalculated and original Dobson total ozone data from Hradec Kralove, Czechoslovakia, 1962-1990

NASA Technical Reports Server (NTRS)

Vanicek, Karel

1994-01-01

Backward reevaluation of long-term total ozone measurements from the Solar and Ozone Observatory of Czech Hydrometeorological Institute at Hradec Kralove, Czechoslovakia, was performed for the period 1962-1990. The homogenization was carried out with respect to the calibration level of the World Primary Standard Spectrophotometer No. 83 - WPSS by means of day-by-day recalculations of more than 25,000 individual measurements using the R-N tables reconstructed after international comparisons and regular standard lamp tests of the Dobson spectrophotometer No. 74. The results showed significant differences among the recalculated data and those original ones published in the bulletins Ozone Data for the World. In the period 1962-1979 they reached 10-19 D.U. (3.0-5.5%) for annual averages and even 26 D.U. (7.0%) for monthly averages of total ozone. Such differences exceed several times accuracy of measuring and can significantly influence character of trends of total ozone in Central Europe. Therefore the results from Hradec Kralove support the calls for reevaluation of all historical Dobson total ozone data sets at individual stations of Global Ozone Observing System.

Assessing the evolution of scientific publications in orthopedics journals from mainland China, Hong Kong, and Taiwan: a 12-year survey of the literature.

PubMed

Jiang, Hua; Nong, Bingjin; Yang, Lijing; Zong, Shaohui; Zhan, Xinli; Wei, Qingjun; Xiao, Zengming

2016-06-17

In China, the field of orthopedics has experienced significant growth over the past 12 years. However, the recent status of research on orthopedics among individuals in mainland China, Hong Kong, and Taiwan is unknown. In this study, we investigated characteristics and trends of orthopedics publications from these three regions. Between 2003 and 2014, all articles published in 63 orthopedics journals originating from mainland China, Hong Kong, and Taiwan were identified via Science Citation Index Expanded (SCIE) database. A survey was conducted to systematically analyze the published orthopedics articles from the three regions according to the numbers of articles, study design, impact factors (IFs), citations, most prolific authors, and institutions. Additionally, we evaluated global trends in orthopedics publications, and ranked top 10 countries in terms of the total number of published articles over 12 years and the number of published articles per year. A total number of 123,317 articles were published in the 63 orthopedics journals between 2003 and 2014. The worldwide number of annually published orthopedics articles tended to increase during the study period. The total number of orthopedics publications from the three regions, especially in mainland China, increased markedly from 2003 to 2014. The annual number of orthopedics articles from mainland China increased from 6 in 2003 to 813 in 2014, Hong Kong increased from 32 in 2003 to 71 in 2014, and Taiwan increased from 68 in 2003 to 168 in 2014. For accumulated IFs and total citations of articles, mainland China ranked the first place, followed by Taiwan and Hong Kong. However, publications from Taiwan had the highest average citations per article, and publications from Hong Kong had the highest average IFs. Among the top 10 most prolific authors and institutions, 4 authors and 4 institutions were from Taiwan, 3 authors and 4 institutions were from mainland China, and 3 authors and 2 institutions were from Hong Kong. The quantity of articles published in international orthopedics journals from mainland China presented a remarkable upward trend during the past 12 years. Given the relative size of the populations, it should be emphasized that mainland China still has a long way to go to achieve the academic performance of Hong Kong and Taiwan.

The Effects of Television on Institutionalized Children.

ERIC Educational Resources Information Center

Sprafkin, Joyce N.; And Others

The extent to which television can be used to promote prosocial behavior is examined in this study. A total of 132 boys and girls (age range 8 to 18 years) with behavior problems serious enough to require institutional care participated in the study. The average IQ (WISC) was approximately 88. In the course of a year each of four treatments was…

Interpreting the Relationships between TOEFL iBT Scores and GPA: Language Proficiency, Policy, and Profiles

ERIC Educational Resources Information Center

Ginther, April; Yan, Xun

2018-01-01

This study examines the predictive validity of the TOEFL iBT with respect to academic achievement as measured by the first-year grade point average (GPA) of Chinese students at Purdue University, a large, public, Research I institution in Indiana, USA. Correlations between GPA, TOEFL iBT total and subsection scores were examined on 1990 mainland…

[Direct costs of medical care for patients with type 2 diabetes mellitus in Mexico micro-costing analysis].

PubMed

Rodríguez Bolaños, Rosibel de Los Ángeles; Reynales Shigematsu, Luz Myriam; Jiménez Ruíz, Jorge Alberto; Juárez Márquezy, Sergio Arturo; Hernández Ávila, Mauricio

2010-12-01

Estimate the direct cost of medical care incurred by the Mexican Social Security Institute (IMSS, Instituto Mexicano del Seguro Social) for patients with type 2 diabetes mellitus (DM2). The clinical files of 497 patients who were treated in secondary and tertiary medical care units in 2002-2004 were reviewed. Costs were quantified using a disease costing approach (DCA) from the provider's perspective, a micro-costing technique, and a bottom-up methodology. Average annual costs by diagnosis, complication, and total cost were estimated. Total IMSS DM2 annual costs were US$452 064 988, or 3.1% of operating expenses. The annual average cost per patient was US$3 193.75, with US$2 740.34 per patient without complications and US$3 550.17 per patient with complications. Hospitalization and intensive care bed-days generated the greatest expenses. The high cost of providing medical care to patients with DM2 and its complications represents an economic burden that health institutions should consider in their budgets to enable them to offer quality service that is both adequate and timely. Using the micro-costing methodology allows an approximation to real data on utilization and management of the disease.

Patients speak out: development of an evidence-based model for managing orthopaedic postoperative pain.

PubMed

Pulido, Pamela; Hardwick, Mary E; Munro, Michelle; May, Laura; Dupies-Rosa, Denise

2010-01-01

Perioperative pain management after total joint replacement continues to be a concern for orthopaedic nurses. In our institution, the results of routine post-hospital stay surveys had shown below average scores in the area of pain management. This began as a quality management issue, became a pain subcommittee issue, and drew in the research nurses to ask what we can learn from this process. Changing the method of handling pain management is not easy, but it makes a difference in patients' hospital experiences. We learned that cooperation and expertise from multiple departments within the institution and some organizations outside the institution is needed to bring about change. We learned that education of not just staff members but also patients on pain management affected the outcome. This article describes our journey to enhance pain management in our institution.

Factors affecting local recurrence and distant metastases of invasive breast cancer after breast-conserving surgery in Chiang Mai University Hospital.

PubMed

Ditsatham, Chagkrit; Somwangprasert, Areewan; Watcharachan, Kirati; Wongmaneerung, Phanchaporn; Khorana, Jiraporn

2016-01-01

The purpose of this study was to collect data regarding breast cancer profiles and factors that affect local recurrence and distant metastasis after breast-conserving surgery (BCS) in Chiang Mai University Hospital. This study was a retrospective review in a single institution of newly diagnosed invasive breast cancer patients who were treated with BCS between April 9, 2001 and December 25, 2011. A total of 185 patients treated with BCS were included in this study, with an average age of 46.83 years. The average recurrence age was 41.1 years and the average nonrecurrence age was 47.48 years, with a recurrence rate of 10.27%. Premenopause was significant in recurrence (P=0.047), as well as non-estrogen-expression patients (P=0.001) and patients who did not receive antihormonal treatment (P=0.011). The recurrence rate in our institute was 10.27%. Factors affecting recurrence after BCS included young age, premenopausal status, nonexpression of the estrogen receptor, and patients who had not received antihormonal treatment. The recurrence rate was higher in the first 90 postoperative months.

National Institutes of Health Funding in Plastic Surgery: A Crisis?

PubMed

Silvestre, Jason; Abbatematteo, Joseph M; Serletti, Joseph M; Chang, Benjamin

2016-09-01

Decreasing funding rates and increasing competition for National Institutes of Health research grants have prompted diverse interventions in various fields of biomedicine. Currently, the state of National Institutes of Health funding for plastic surgery research is poorly understood. The purpose of this study was to describe the portfolio of National Institutes of Health grants in academic plastic surgery. Plastic surgery faculty at integrated and independent programs were queried individually in the National Institutes of Health RePORTER database for grants awarded in 2014. Funding totals, mechanisms, and institutes were calculated. Abstracts were categorized by research type and field of interest. Characteristics of National Institutes of Health-funded principal investigators were elucidated. Eight hundred sixty-one academic plastic surgeons at 94 programs were queried, and only 18 investigators (2.1 percent) were funded at 12 programs (12.8 percent). National Institutes of Health-funded investigators were predominately male (72 percent), fellowship-trained (61 percent), and aged 49.3 ± 7.8 years. A total of 20 awards amounted to $6,916,886, with an average award of $345,844 ± $222,909. Costs were primarily awarded through the R01 mechanism (77.2 percent). The top three National Institutes of Health institutes awarded 72.9 percent of the entire portfolio. Funding supported clinical (41.1 percent), translational (36.9 percent), and basic science (22.0 percent) research. Craniofacial (20.5 percent), hand (18.7 percent), and breast (16.2 percent) had the greatest funding. Few programs and faculty drive the National Institutes of Health portfolio of plastic surgery research. These data suggest a tenuous funding situation that may be susceptible to future spending cuts. Future research is needed to identify barriers to National Institutes of Health funding procurement in academic plastic surgery.

CDRH RF phantom for hyperthermia systems evaluations.

PubMed

Allen, S; Kantor, G; Bassen, H; Ruggera, P

1988-01-01

The National Cancer Institute (NCI) sponsored clinical evaluations of investigational 'regional' hyperthermia systems at four clinical institutions. To support this project, the Center for Devices and Radiological Health (CDRH) developed a series of test instruments to evaluate the magnitude and repeatability of the induced heating by radiofrequency (RF) systems. Data from three institutions using the same model hyperthermia system have been analyzed. After heating, the average temperature from measurements taken at several points in the test phantom at each institution agree within +/- 0.002 degrees C. These differences are about equal to the measurement uncertainty. Thus, this technique can be used for preclinical evaluation and quality control of the total system operation. After one of the institutions relocated its hyperthermia system, a subsequent set of data showed inconsistencies compared to their earlier data. Investigation traced this to cable loss and power meter interference. From the analysis of the data from the three institutions, the utility of the CDRH RF phantom for hyperthermia systems evaluation is demonstrated.

[Analysis of academic impact of publications from National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention based on SCIE database in recent five years].

PubMed

Zhen, Li; Bin, Zheng

2017-03-02

To describe the academic impact of publications from National Institute of Parasitic Diseases (NIPD), Chinese Center for Disease Control and Prevention, so as to give the quantity evidence for scientific research decision making. The SCIE papers of NIPD published from 2011-2015 were searched and statistically analyzed. The number of published papers, citation frequencies, h-index, and funding resources were analyzed. The academic impact of the institute was assessed according to these data. A total of 361 papers were published by NIPD, and the quantity increased year by year. The majority type is original articles. The total citations were 1 641 times, the average citation per paper was 5.19 and h-index was 17. The majority of these papers were published in foreign professional periodicals, whose impact factors were between 1.194 and 6.751. The major resources of NIPD were from China, and NIPD also had good collaborations with institutions in US and Switzerland. In China and Asia, NIPD led the research in the field of parasitology and tropical medicine. The quantity and quality of annual published papers of NIPD are on the rise. However, NIPD lagged behind the leading institutions in the world.

A single-institution experience: the integrated vascular surgery residency's effect on fellowship and general surgery resident case volume and diversity.

PubMed

Carroll, Megan I; Downes, Kathryne; Miladinovic, Branko; Illig, Karl A; Armstrong, Paul A; Back, Martin R; Johnson, Brad L; Shames, Murray L

2014-01-01

To determine whether the formation of an integrated vascular surgery residency (0 + 5) has negatively impacted the case volume and diversity of the vascular surgery fellows (5 + 2) and chief general surgeons at the same institution. Operative data from the vascular integrated (0 + 5), independent (5 + 2), and general surgery residencies at a single institution were retrospectively reviewed and analyzed to determine vascular surgery case volumes from 2006-2012. National operative data (Residency Review Committee) were used for comparison of diversity and volume. Standard statistical methods were applied. During this period, the 5 + 2 fellows at our institution performed on average 741 (range, 554-1002) primary cases and 1091 (range, 844-1479) combined primary and secondary cases for the 2-year fellowship. Our integrated residency began in July 2007. Our fellows' primary case volumes remained relatively stable between 2006 and 2011, with a 4% increase in the number of cases, although their total (primary and secondary) case volumes fell 15%; by comparison, the equivalent national 50th percentile rates rose 16% during this time frame. Our institution's general surgery residents performed an average of 116 (range, 56-221) vascular cases individually during their 5-year residency from 2005-2011. From 2006-2011, the total case volume fell only 5%, while the national 50th percentile rate fell 24%. Across all years, however, resident and fellow volumes both continue to be above Accreditation Council for Graduate Medical Education minimum requirements, and the major vascular case volume at our institution in all groups studied remained statistically greater than or equal to the national 50th percentile of cases. Our first integrated resident to graduate finished in June 2012 with 931 total vascular cases and 249 general surgery cases for a total operative experience of 1180 cases during the 5-year residency. Finally, after an 8-year period (2003-2010) in which none of our general surgery residents pursued vascular training, 1 resident in each of the 2011, 2012, and 2013 graduating years has now done so. At our institution, the introduction of a 0 + 5 vascular residency has correlated with a modest drop (15%) in overall case volume for the 5 + 2 fellows, but the number of primary cases have actually increased slightly and they continue to meet or exceed Accreditation Council for Graduate Medical Education requirements and national 50th percentile rates. General surgery residents' vascular volumes, by contrast, have remained stable, and interest in vascular surgery by residents has increased. Our integrated vascular residents are projected to exceed the fellows' 50th percentile case volume and diversity targets during their residency experience. Copyright © 2014 Elsevier Inc. All rights reserved.

The Effect of Applicant Publication Volume on the Orthopaedic Residency Match.

PubMed

Campbell, Sean T; Gupta, Ryan; Avedian, Raffi S

2016-01-01

Research is an important factor used in evaluating applicants to orthopaedic training programs. Current reports regarding the publication rate among prospective residents are likely inaccurate. It is unknown whether research productivity is weighted more heavily at programs affiliated with research-driven institutions. To establish accurate baseline data on publication rate among matched applicants to orthopaedic residency programs and to compare publication rates between applicants who matched at research-focused institutions and those who matched elsewhere. We performed a literature search for each U.S. resident in the 2013-2014 intern class. Number of publications: (1) in total, (2) in orthopaedic journals, and (3) as first/last author were recorded. Publication rate at the top 25 programs (according to medical school and departmental National Institutes of Health [NIH] funding and U.S. News ranking) was compared statistically against all others. Average number of publications per intern for all programs was 1.28 ± 0.15. Number of total and first/last author publications was significantly greater for programs affiliated with medical schools and departments in the top 25 for NIH funding, and at schools in the top 25 U.S. News rankings. Publication rate in orthopaedic journals was significantly higher for programs affiliated with departments in the top 25 for NIH funding and at top 25 U.S. News medical schools. The average matched applicant to an orthopaedic residency program publishes in the peer-reviewed literature less frequently than previously reported. Matched applicants at research-focused institutions tended to have more publications than those who matched at other programs. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

[A cross analysis on the capability of examining helminths: national technique competition for parasitic disease diagnosis in 2011].

PubMed

Zhang, Li; Li, Shi-Zhu; Li, Yu; Wang, Qiang; Fu, Qing; Liu, Wei; Zhu, Hong-Qing; Xu, Jing; Chen, Ying-Dan; Chen, Shao-Hong; Chen, Jia-Xu; Chen, Zhao; Wang, Li-Ying; Zhou, Xiao-Nong

2012-08-30

To understand the comprehensive capability of helminth detection among professionals at different level of parasitic disease control institutions and promote the overall strength of diagnosis. Four professionals from each parasitic diseases control institutions were selected as contestant (age < 45 and at least two contestant from county-level institution). The content of contest included making stool slides with Kato-Katz method (five slides in thirty minutes, a total score of 15 and 9 as passing score) and identification of eleven common helminth eggs with microscopy (ten slides, five minutes per slide, a total score of 60, 36 as passing score). The average score of making slides in 119 contestants from 30 provinces was 11.4, and 119 contestants passed accounted for 93.3%. The average score of film-reading was 22.0, and 20 contestants passed accounted for 16.8%. There were no statistically significant differences between the results in different gender, age (< or = 30, 31-40, > 40), job title (the junior, intermediate, and senior), institution level (provincial, municipal, and county level) (P > 0.05). By Kato-Katz slide-making and film-reading, the scores in contestants from provinces with schistosomiasis control task (12.1 +/- 1.7, 32.1 +/- 11.5, respectively) were better than contestants from other provinces (11.1 +/- 1.8, 18.1 +/- 10.5, respectively). The scores in contestants from western (18.4 +/- 11.4) were lower than those from eastern (25.2 +/- 12.4) and central (24.1 +/- 13.1) for film-reading. The overall capability of parasitic disease examination is unbalanced among regions, and evidently there is a need to strengthen the capacity of pathogen detection in the disease control programs.

Evaluation of the effects of comprehensive reform on primary healthcare institutions in Anhui Province

PubMed Central

2014-01-01

Background In 2009, the Chinese Central Communist Party and the China State Council started to implement comprehensive healthcare reforms. The first round of reforms, involving Anhui province, was from 2009 to 2011, and focused on primary healthcare institutions. This study conducts an initial assessment of the effects of specific parts of the reforms in Anhui. Methods Mixed quantitative and qualitative methods were adopted for data collection. Seven hundred and three health institutions from 15 counties were randomly chosen. The practices, development, effects, problems, and other relevant information related to the reform were classified into four aspects: medicine management; personnel systems and income distribution mechanisms; compensation mechanisms for primary healthcare institutions; and strengthening the primary healthcare system. The effects of reform were analyzed by evaluating changes in compensation channels, visit costs, diagnosis and treatment structure, hardware, structures, efficiency, and behavior. Results A new system for authorizing drugs resulted in a total of 857 new drugs being accessible at agreed prices through primary healthcare institutions in Anhui. The cost of the average outpatient visit decreased from 35.29 RMB to 31.64 RMB, although for inpatients, the average cost increased from 799.05 RMB to 992.60 RMB. The number of healthcare personnel decreased, but their workloads increased. The total revenue from government sources increased by 41.09%, and the proportion of revenue from drugs decreased by 25.19%. The rate of diagnosis and treatment visits and outpatient visits to primary healthcare institutions increased. Finally, between 2008 and 2010, 1,195 standardized township hospitals, 14,134 village clinics, and 1,234 community health service institutions were constructed. Conclusion The reform of primary healthcare institutions in Anhui has improved the personnel structures surrounding frontline healthcare workers, increased their incomes, improved work efficiency, and changed the compensation patterns of primary healthcare institutions, improved hardware, reduced drug prices, and, to some extent, improved the diagnosis and treatment structure. However, the reforms have not radically changed the behavior of medical workers or the visit patterns of patients. Approaches such as strengthening performance evaluation, and carrying out initiatives to further mobilize frontline healthcare workers, enhance rational drug use through improved training and educate patients, should be undertaken in the future. PMID:24942901

26 CFR 1.585-5 - Denial of bad debt reserves for large banks.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., exceeded $500 million. Example 3. Bank P, a calendar year taxpayer, is an institution described in § 1.585-1(b)(1)(i). P has average total assets of $300 million for its taxable year beginning on January 1... section and §§ 1.585-6, 1.585-7 and 1.585-8: (1) Disqualification year. A bank's disqualification year is...

26 CFR 1.585-5 - Denial of bad debt reserves for large banks.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., exceeded $500 million. Example 3. Bank P, a calendar year taxpayer, is an institution described in § 1.585-1(b)(1)(i). P has average total assets of $300 million for its taxable year beginning on January 1... section and §§ 1.585-6, 1.585-7 and 1.585-8: (1) Disqualification year. A bank's disqualification year is...

26 CFR 1.585-5 - Denial of bad debt reserves for large banks.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., exceeded $500 million. Example 3. Bank P, a calendar year taxpayer, is an institution described in § 1.585-1(b)(1)(i). P has average total assets of $300 million for its taxable year beginning on January 1... section and §§ 1.585-6, 1.585-7 and 1.585-8: (1) Disqualification year. A bank's disqualification year is...

26 CFR 1.585-5 - Denial of bad debt reserves for large banks.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., exceeded $500 million. Example 3. Bank P, a calendar year taxpayer, is an institution described in § 1.585-1(b)(1)(i). P has average total assets of $300 million for its taxable year beginning on January 1... section and §§ 1.585-6, 1.585-7 and 1.585-8: (1) Disqualification year. A bank's disqualification year is...

The Debt Burden of Bachelor's Degree Recipients. Stats in Brief. NCES 2017-436

ERIC Educational Resources Information Center

Velez, Erin Dunlop; Woo, Jennie H.

2017-01-01

As of May 2013, total outstanding student loan debt in the United States had reached $1.2 trillion, up from $1 trillion fewer than 18 months before. The growth in debt is due primarily to increases in both the rate of borrowing and the average amount borrowed, especially among graduates of 4-year institutions. In 1989-90, about half (51 percent)…

The highly-cited Electrocardiogram-related articles in science citation index expanded: characteristics and hotspots.

PubMed

Yang, Xianglin; Gu, Jiaojiao; Yan, Hong; Xu, Zhi; Ren, Bing; Yang, Yaming; Yang, Xiaodong; Chen, Qi; Tan, Shaohua

2014-01-01

We used bibliometric analysis methodology in the expanded Science Citation Index to identify highly-cited electrocardiogram (ECG)-related articles with total citations (TC2012) exceeding 100 from the publication year to 2012. Web of Science search tools were used to identify the highly-cited articles. The aspects analyzed for highly cited publications included effect of time on citation analysis, journals and Web of Science categories, number of authors per publication, originating institutions and countries, total citation and total citation per year life cycles of articles (C2012) and research hotspots. Results showed that a total of 467 electrocardiogram-related publications were regarded as the highly-cited publications. TC2012 ranged from 101 to 2879, with 215 as the average number of citations. No highly-cited publications have emerged yet during the first two years of the present 2010 Decade. All 11 countries and institutions originating highly-cited ECG-related publications were developed countries, USA in 9 of them. Four subject categories were identified as hotspots by total citations TC2012 and C2012: atrial fibrillation, long QT syndrome, angina and myocardial infarction, and risk factor analysis and health evaluation. Copyright © 2014 Elsevier Inc. All rights reserved.

Advanced Satellite-Based Frequency Transfer at the 10-16 Level.

PubMed

Fujieda, Miho; Yang, Sung-Hoon; Gotoh, Tadahiro; Hwang, Sang-Wook; Hachisu, Hidekazu; Kim, Huidong; Lee, Young Kyu; Tabuchi, Ryo; Ido, Tetsuya; Lee, Won-Kyu; Heo, Myoung-Sun; Park, Chang Yong; Yu, Dai-Hyuk; Petit, Gerard

2018-06-01

Advanced satellite-based frequency transfers by two-way carrier-phase (TWCP) and integer precise point positioning have been performed between the National Institute of Information and Communications Technology and Korea Research Institute of Standards and Science. We confirm that the disagreement between them is less than at an averaging time of several days. In addition, an overseas frequency ratio measurement of Sr and Yb optical lattice clocks was directly performed by TWCP. We achieved an uncertainty at the mid-10 -16 level after a total measurement time of 12 h. The frequency ratio was consistent with the recently reported values within the uncertainty.

The cost of hospitalization in Crohn's disease.

PubMed

Cohen, R D; Larson, L R; Roth, J M; Becker, R V; Mummert, L L

2000-02-01

The aim of this study was to evaluate the demographics, resource use, and costs associated with hospitalization of Crohn's disease patients. All patients hospitalized at our institution from 7/1/96 to 6/30/97 with a primary diagnosis of "Crohn's Disease" were analyzed using a computerized database. Data are presented "per hospitalization." A total of 175 hospitalizations (147 patients) were identified. Mean patient age was 36.5 yr; 61% were female; 82% Caucasian. Payer mix was most commonly contracted (57%), commercial (21%), or Medicare (13%). 57% of hospitalizations had a primary surgical procedure; the remainder were medical. Average length of stay was 8.7 days (surgical, 9.6 days; medical, 7.5 days). The average cost of hospitalization, excluding physician fees, was $12,528 (surgical, $14,409; medical, $10,020), whereas average charges were $35,378 (surgical, $46,354; medical, $20,744), including physician fees, which averaged $7,249 (surgical, $11,217; medical, $1,959). Mean reimbursements were $21,968 (surgical, $28,946; medical, $12,666) with average weighted reimbursement rates of 60.17% of hospital charges, 69.57% of physician fees. The distribution of costs across subcategories was: Surgery (39.6%), Pharmacy (18.6%), Laboratory (3.8%), Radiology (2.1%), Pathology (0.8%), Endoscopy (0.3%), and Other Hospital Costs (34.9%). Of the hospitalizations, 87% included treatment with steroids, 23% with immunomodulators, and 14% with aminosalicylates; 27% included the administration of total parenteral nutrition, which accounted for 63% of the total pharmacy costs. Surgery accounts for the majority of hospitalizations, nearly 40% of their total costs, and 75% of overall charges and reimbursements. Therapy that decreases the number of surgical hospitalizations should substantially reduce inpatient Crohn's disease costs, as well as overall costs.

Estimating Gestational Age With Sonography: Regression-Derived Formula Versus the Fetal Biometric Average.

PubMed

Cawyer, Chase R; Anderson, Sarah B; Szychowski, Jeff M; Neely, Cherry; Owen, John

2018-03-01

To compare the accuracy of a new regression-derived formula developed from the National Fetal Growth Studies data to the common alternative method that uses the average of the gestational ages (GAs) calculated for each fetal biometric measurement (biparietal diameter, head circumference, abdominal circumference, and femur length). This retrospective cross-sectional study identified nonanomalous singleton pregnancies that had a crown-rump length plus at least 1 additional sonographic examination with complete fetal biometric measurements. With the use of the crown-rump length to establish the referent estimated date of delivery, each method's (National Institute of Child Health and Human Development regression versus Hadlock average [Radiology 1984; 152:497-501]), error at every examination was computed. Error, defined as the difference between the crown-rump length-derived GA and each method's predicted GA (weeks), was compared in 3 GA intervals: 1 (14 weeks-20 weeks 6 days), 2 (21 weeks-28 weeks 6 days), and 3 (≥29 weeks). In addition, the proportion of each method's examinations that had errors outside prespecified (±) day ranges was computed by using odds ratios. A total of 16,904 sonograms were identified. The overall and prespecified GA range subset mean errors were significantly smaller for the regression compared to the average (P < .01), and the regression had significantly lower odds of observing examinations outside the specified range of error in GA intervals 2 (odds ratio, 1.15; 95% confidence interval, 1.01-1.31) and 3 (odds ratio, 1.24; 95% confidence interval, 1.17-1.32) than the average method. In a contemporary unselected population of women dated by a crown-rump length-derived GA, the National Institute of Child Health and Human Development regression formula produced fewer estimates outside a prespecified margin of error than the commonly used Hadlock average; the differences were most pronounced for GA estimates at 29 weeks and later. © 2017 by the American Institute of Ultrasound in Medicine.

Operative Cost Comparison: Plating Versus Intramedullary Fixation for Clavicle Fractures.

PubMed

Hanselman, Andrew E; Murphy, Timothy R; Bal, George K; McDonough, E Barry

2016-09-01

Although clavicle fractures often heal well with nonoperative management, current literature has shown improved outcomes with operative intervention for specific fracture patterns in specific patient types. The 2 most common methods of midshaft clavicle fracture fixation are intramedullary and plate devices. Through retrospective analysis, this study performed a direct cost comparison of these 2 types of fixation at a single institution over a 5-year period. Outcome measures included operative costs for initial surgery and any hardware removal surgeries. This study reviewed 154 patients (157 fractures), and of these, 99 had intramedullary fixation and 58 had plate fixation. A total of 80% (79 of 99) of intramedullary devices and 3% (2 of 58) of plates were removed. Average cost for initial intramedullary placement was $2955 (US dollars) less than that for initial plate placement (P<.001); average cost for removal was $1874 less than that for plate removal surgery (P=.2). Average total cost for all intramedullary surgeries was $1392 less than the average cost for all plating surgeries (P<.001). Average cost for all intramedullary surgeries requiring plate placement and removal was $653 less than the average cost for all plating surgeries that involved only placement (P=.04). Intramedullary fixation of clavicle fractures resulted in a statistically significant cost reduction compared with plate fixation, despite the incidence of more frequent removal surgeries. [Orthopedics.2016; 39(5):e877-e882.]. Copyright 2016, SLACK Incorporated.

Survey of Medical Oncology Status in Korea (SOMOS-K): A National Survey of Medical Oncologists in the Korean Association for Clinical Oncology (KACO).

PubMed

Kim, Do Yeun; Lee, Yun Gyoo; Kim, Bong-Seog

2017-07-01

This study was conducted to investigate the current role of medical oncologists in cancer care with a focus on increasing the recognition of medical oncology as an independent specialty. Questionnaires modified from the Medical Oncology Status in Europe Survey dealing with oncology structure, resources, research, and patterns of care given by medical oncologists were selected. Several modifications were made to the questionnaire after feedback from the insurance and policy committee of the Korean Association for Clinical Oncology (KACO). The online survey was then sent to KACO members. A total of 214 medical oncologists (45.8% of the total inquiries), including 71 directors of medical oncology institutions, took the survey. Most institutions had various resources, including a medical oncology department (94.1%) and a department of radiation oncology (82.4%). There was an average of four medical oncologists at each institution. Medical oncologists were involved in various treatments from diagnosis to end-of-life care. They were also chemotherapy providers from a wide range of institutions that treated many types of solid cancers. In addition, 86.2% of the institutions conducted research. This is the first national survey in Korea to show that medical oncologists are involved in a wide range of cancer treatments and care. This survey emphasizes the contributions and proper roles of medical oncologists in the evolving health care environment in Korea.

Credit allocation for research institutes

NASA Astrophysics Data System (ADS)

Wang, J.-P.; Guo, Q.; Yang, K.; Han, J.-T.; Liu, J.-G.

2017-05-01

It is a challenging work to assess research performance of multiple institutes. Considering that it is unfair to average the credit to the institutes which is in the different order from a paper, in this paper, we present a credit allocation method (CAM) with a weighted order coefficient for multiple institutes. The results for the APS dataset with 18987 institutes show that top-ranked institutes obtained by the CAM method correspond to well-known universities or research labs with high reputation in physics. Moreover, we evaluate the performance of the CAM method when citation links are added or rewired randomly quantified by the Kendall's Tau and Jaccard index. The experimental results indicate that the CAM method has better performance in robustness compared with the total number of citations (TC) method and Shen's method. Finally, we give the first 20 Chinese universities in physics obtained by the CAM method. However, this method is valid for any other branch of sciences, not just for physics. The proposed method also provides universities and policy makers an effective tool to quantify and balance the academic performance of university.

[Research on competency building standards of institutions of schistosomiasis prevention and control in Hubei Province I Investigation of institution management].

PubMed

Liu, Han-cheng; Zhong, Chen-hui; Liao, Si-qi; He, Hui

2014-08-01

To investigate the current situation of management of institutions of schistosomiasis prevention and control in Hubei Province, so as to explore the probable competency building standards for these institutions at the county and township levels. By using a combination of quantitative and qualitative methods, the institutions of schistosomiasis prevention and control at county and township levels were investigated for the institutional setup, staffing and fulfillment functions since the reform of 2004. Among 63 schistosomiasis endemic counties (cities, districts) of Hubei Province, there were 26 independent schistosomiasis control institutions (41.27%), there were 24 institutions which were incorporated into CDC (38.10%), and there were no institutions in 13 counties (20.63%). Among 518 endemic towns, there were 299 institutions (57.72%). The total staffing size were 1 932, but there were 1 586 (82.09%) people actually working in the post, and therefore there were 346 (17.91%) empty positions. The average rates of carrying out the six functions were 91.48%-71.19%, but only 19.23% of the institutions participated in the comprehensive schistosomiasis control management project and its effect assessment. According to the management model for schistosomiasis control institutions under the current institutional mechanisms, we need a rigorous industry standard to constrain, guide and standardize the management and capacity-building of the institutions in different historical periods.

The 100 Most-Cited Human Cleft Lip and Palate-Related Articles Published in Dentistry, Oral Surgery, and Medicine Journals.

PubMed

Christou, Panagiotis; Antonarakis, Gregory S

2015-07-01

To identify the 100 most-cited articles pertaining to human cleft lip and palate research published in dentistry, oral surgery, and medicine journals and to identify their principal bibliometric characteristics. Web-based bibliometric analysis. The Web of Science was searched to identify the 100 most-cited clinical articles related to cleft lip and/or palate. Information was extracted with regard to total number of citations, number of authors, affiliations, year, and journal of publication, Medical Subject Headings, type of study, specific area of study. Trends in citations were assessed. The 100 most-cited articles identified received between 437 and 58 citations. The oldest was published in 1954 and the most recent in 2008. The number of authors ranged from 1 to 12, with an average of three authors per article. Most of the first authors were affiliated with institutions in the United States, with the most prolific institution being the University of Iowa. More than 70% of the studies appeared in The Cleft Palate-Craniofacial Journal. There was a significant negative correlation between average citations per year and time since publication (P < .001); whereas, a significant positive correlation was observed between average citations per year and number of total citations (P < .001). The 100 most-cited articles in human cleft lip and palate research published in dentistry, oral surgery, and medicine journals are listed and characterized. This can be used as a potential knowledge base for specialists in training or to produce relevant knowledge defining the direction of future research.

Impact of trained oncology financial navigators on patient out-of-pocket spending.

PubMed

Yezefski, Todd; Steelquist, Jordan; Watabayashi, Kate; Sherman, Dan; Shankaran, Veena

2018-03-01

Patients with cancer often face financial hardships, including loss of productivity, high out-of-pocket (OOP) costs, depletion of savings, and bankruptcy. By providing financial guidance and assistance through specially trained navigators, hospitals and cancer care clinics may be able mitigate the financial burdens to patients and also minimize financial losses for the treating institutions. Financial navigators at 4 hospitals were trained through The NaVectis Group, an organization that provides training to healthcare staff to increase patient access to care and assist with OOP expenses. Data regarding financial assistance and hospital revenue were collected after instituting these programs. Amount and type of assistance (free medication, new insurance enrollment, premium/co-pay assistance) were determined annually for all qualifying patients at the participating hospitals. Of 11,186 new patients with cancer seen across the 4 participating hospitals between 2012 and 2016, 3572 (32%) qualified for financial assistance. They obtained $39 million in total financial assistance, averaging $3.5 million per year in the 11 years under observation. Patients saved an average of $33,265 annually on medication, $12,256 through enrollment in insurance plans, $35,294 with premium assistance, and $3076 with co-pay assistance. The 4 hospitals were able to avoid write-offs and save on charity care by an average of $2.1 million per year. Providing financial navigation training to staff at hospitals and cancer centers can significantly benefit patients through decreased OOP expenditures and also mitigate financial losses for healthcare institutions.

Resource utilization in primary repair of cleft palate.

PubMed

Owusu, James A; Liu, Meixia; Sidman, James D; Scott, Andrew R

2013-03-01

To estimate the current incidence of cleft palate in the United States and to determine national variations in resource utilization for primary repair of cleft palate. Retrospective analysis of a national, pediatric database (2009 Kids Inpatient Database). Patients aged 3 and below admitted for cleft palate repair were selected, using ICD-9 codes for cleft palate and procedure code for primary (initial) repair of cleft palate. A number of demographic variables were analyzed, and hospital charges were considered as a measure of resource utilization. Primary repair of cleft palate was performed on 1,943 patients. The estimated incidence was 0.11% with male to female ratio of 1.2:1. Regional incidence ranged from 0.09% (Northeast) to 0.12% (Midwest). The mean age at surgery was 13.4 months. The average length of stay was 1.9 days. The average total charge nationwide was $22,982, ranging from $17,972 (South) to $25,671 (Northeast). Average charge in a teaching institution was $4,925 higher than for nonteaching institutions. The strongest predictor of charge was length of stay, increasing charge by $7,663 for every additional hospital day (P < 0.01). National variations exist in resource utilization for primary repair of cleft palate, with higher charges in Northeastern states and teaching hospitals. The strongest predictor of increased resource use was length of stay, which was significantly higher at teaching institutions. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Average Tuition and Fees at Colleges Rose Less Than 5% This Year.

ERIC Educational Resources Information Center

Reisberg, Leo

1999-01-01

Summarizes College Board data indicating that college tuition and fees rose this year an average of 3.4% at four-year public institutions and 4.7% at four-year private institutions, a decline from previous rates of increase but still greater than the inflation rate. Average tuition and fees ranged from $15,380 at four-year private institutions to…

Pennsylvania Higher Education Assistance Agency. State Higher Education Grant Program. Comparative Summary Statistics. 1972-73 (June 30, 1973) vs. 1973-74 (June 30, 1974).

ERIC Educational Resources Information Center

Pennsylvania Higher Education Assistance Agency, Harrisburg.

This document deals with the grants awarded in Pennsylvania during 1973-74. There were 149,247 applicants for grants in Pennsylvania that year, of which 106,474 were awarded grants totaling $63,639,614. The full-year average award was $662. (Of those awarded grants, 88.6 percent attended institutions of higher learning in Pennsylvania. The total…

Student Financing of Undergraduate Education: 2003-04. With a Special Analysis of the Net Price of Attendance and Federal Education Tax Benefits. Statistical Analysis Report. NCES 2006-186

ERIC Educational Resources Information Center

Berkner, Lutz; Wei, Christina Chang

2006-01-01

This report, based on data from the 2003-04 National Postsecondary Student Aid Study (NASAS:04), provides detailed information about undergraduate tuition and total price of attendance at various types of institutions, the percentage of students receiving various types of financial aid, and the average amounts that they received. In 2003-04,…

The bias in current measures of gestational weight gain

PubMed Central

Hutcheon, Jennifer A; Bodnar, Lisa M; Joseph, KS; Abrams, Barbara; Simhan, Hyagriv N; Platt, Robert W

2014-01-01

Summary Conventional measures of gestational weight gain (GWG), such as average rate of weight gain, are likely correlated with gestational duration. Such correlation could introduce bias to epidemiologic studies of GWG and adverse perinatal outcomes because many perinatal outcomes are also correlated with gestational duration. This study aimed to quantify the extent to which currently-used GWG measures may bias the apparent relation between maternal weight gain and risk of preterm birth. For each woman in a provincial perinatal database registry (British Columbia, Canada, 2000–2009), a total GWG was simulated such that it was uncorrelated with risk of preterm birth. The simulation was based on serial antenatal GWG measurements from a sample of term pregnancies. Simulated GWGs were classified using 3 approaches: total weight gain (kg), average rate of weight gain (kg/week) or adequacy of gestational weight gain in relation to Institute of Medicine recommendations, and their association with preterm birth ≤ 32 weeks was explored using logistic regression. All measures of GWG induced an apparent association between GWG and preterm birth ≤32 weeks even when, by design, none existed. Odds ratios in the lowest fifths of each GWG measure compared with the middle fifths ranged from 4.4 [95% CI 3.6, 5.4] (total weight gain) to 1.6 [95% CI 1.3, 2.0] (Institute of Medicine adequacy ratio). Conventional measures of GWG introduce serious bias to the study of maternal weight gain and preterm birth. A new measure of GWG that is uncorrelated with gestational duration is needed. PMID:22324496

Forecasting Strategies for Predicting Peak Electric Load Days

NASA Astrophysics Data System (ADS)

Saxena, Harshit

Academic institutions spend thousands of dollars every month on their electric power consumption. Some of these institutions follow a demand charges pricing structure; here the amount a customer pays to the utility is decided based on the total energy consumed during the month, with an additional charge based on the highest average power load required by the customer over a moving window of time as decided by the utility. Therefore, it is crucial for these institutions to minimize the time periods where a high amount of electric load is demanded over a short duration of time. In order to reduce the peak loads and have more uniform energy consumption, it is imperative to predict when these peaks occur, so that appropriate mitigation strategies can be developed. The research work presented in this thesis has been conducted for Rochester Institute of Technology (RIT), where the demand charges are decided based on a 15 minute sliding window panned over the entire month. This case study makes use of different statistical and machine learning algorithms to develop a forecasting strategy for predicting the peak electric load days of the month. The proposed strategy was tested for a whole year starting May 2015 to April 2016 during which a total of 57 peak days were observed. The model predicted a total of 74 peak days during this period, 40 of these cases were true positives, hence achieving an accuracy level of 70 percent. The results obtained with the proposed forecasting strategy are promising and demonstrate an annual savings potential worth about $80,000 for a single submeter of RIT.

The financial impact of heparin-induced thrombocytopenia.

PubMed

Smythe, Maureen A; Koerber, John M; Fitzgerald, Maureen; Mattson, Joan C

2008-09-01

Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction that increases patient morbidity and mortality. The financial impact of HIT to an institution is thought to be significant. The objective of this study was to evaluate the financial impact of HIT. A case-control study was employed. Case patients were identified as newly diagnosed HIT patients. Control subjects were matched by diagnosis-related group, primary diagnosis code, primary procedure code, and hospital admission date. The financial/decision support database of the hospital was queried to identify the matched control subjects, total cost, and reimbursement. The determination of financial impact included the total profit or (total loss) and the backfill effect (ie, the lost operating margin resulting from increased length of stay). Length of stay and mortality were compared. Data from 22 case patients and 255 control subjects were analyzed. On average, HIT case patients incurred a financial loss of $14,387 per patient and an increase in length of stay of 14.5 days. When confining the analysis to only Medicare case patients (n = 17) and Medicare control subjects, case patients incurred a financial loss of $20,170 per case and an increase in length of stay of 15.8 days. Depending on the occupancy rate of the institution, additional financial loss could result from the backfill effect. Mortality was not significantly affected. For an institution that sees 50 new cases of HIT per year, the projected annual financial impact ranges from approximately $700,000 to $1 million. Institutions with high bed occupancy rates may see an additional loss from the backfill effect.

Local and national trends in general surgery residents' operative experience: do work hour limitations negatively affect case volume in small community-based programs?

PubMed

Markelov, Alexey; Sakharpe, Aniket; Kohli, Harjeet; Livert, David

2011-12-01

The goals of this study were to analyze the impact of work hour restrictions on the operative case volume at a small community-based general surgery residency training program and compare changes with the national level. Annual national resident case log data from Accreditation Council for Graduate Medical Education (ACGME) website and case logs of graduating Easton Hospital residents (years 2002-2009) were used for analysis. Weighted average change in total number of cases in our institution was -1.20 (P = 0.52) vs 1.78 (P = 0.07) for the national program average with statistically significant difference on comparison (P = 0.027). We also found significant difference in case volume changes at the national level compared with our institution for the following ACGME defined subcategories: alimentary tract [8.19 (P < 0.01) vs -1.08 (P = 0.54)], abdomen [8.48 (P < 0.01) vs -6.29 (P < 0.01)], breast [1.91 (P = 0.89) vs -3.6 (P = 0.02)], and vascular [4.03 (P = 0.02) vs -3.98 (P = 0.01)]. Comparing the national trend to the community hospital we see that there is total increase in cases at the national level whereas there is a decrease in case volume at the community hospital. These trends can also be followed in ACGME defined subcategories which form the major case load for a general surgical training such as alimentary tract, abdominal, breast, and vascular procedures. We hypothesize that work hour restrictions have been favorable for the larger programs, as these programs were able to better integrate the night float system, restructure their call schedule, and implement institutional modifications which are too resource demanding for smaller training programs.

Impact of advanced pharmacy practice experience placement changes in colleges and schools of pharmacy.

PubMed

Duke, Lori J; Staton, April G; McCullough, Elizabeth S; Jain, Rahul; Miller, Mindi S; Lynn Stevenson, T; Fetterman, James W; Lynn Parham, R; Sheffield, Melody C; Unterwagner, Whitney L; McDuffie, Charles H

2012-04-10

To document the annual number of advanced pharmacy practice experience (APPE) placement changes for students across 5 colleges and schools of pharmacy, identify and compare initiating reasons, and estimate the associated administrative workload. Data collection occurred from finalization of the 2008-2009 APPE assignments throughout the last date of the APPE schedule. Internet-based customized tracking forms were used to categorize the initiating reason for the placement change and the administrative time required per change (0 to 120 minutes). APPE placement changes per institution varied from 14% to 53% of total assignments. Reasons for changes were: administrator initiated (20%), student initiated (23%), and site/preceptor initiated (57%) Total administrative time required per change varied across institutions from 3,130 to 22,750 minutes, while the average time per reassignment was 42.5 minutes. APPE placements are subject to high instability. Significant differences exist between public and private colleges and schools of pharmacy as to the number and type of APPE reassignments made and associated workload estimates.

Study of a wind energy conversion system in New Hampshire

NASA Astrophysics Data System (ADS)

Lockwood, J.; Kraft, G.; Pregent, G.; Smukler, L.

1981-08-01

Concern over conventional energy costs and supplies is currently strong, particularly in New England region where eighty percent of the total energy is oil based; furthermore, forty percent of this region's total energy is OPEC oil. These figures contrast with national averages of forty-seven and thirteen percent, respectively (1). The quest to develop alternative and renewable energy sources indigenous to New England is understandable in light of these figures. The wind is one such source. The study of wind energy can be divided into three basic areas; these are technical, legal-institutional, and financial. The technical area encompasses collection and analysis of wind data, selection and installation of wind turbines and peripheral equipment, and operation and maintenance. The legal-institutional area encompasses the resolution of such issues as land use policies, power contracts, and state and federal regulations. The financial area encompasses the examination of investment opportunities made available by various site-machine combinations and the selling of such opportunities to the investment community.

Using standard and institutional mentorship models to implement SLMTA in Kenya

PubMed Central

Mwalili, Samuel; Basiye, Frank L.; Zeh, Clement; Emonyi, Wilfred I.; Langat, Raphael; Luman, Elizabeth T.; Mwangi, Jane

2014-01-01

Background Kenya is home to several high-performing internationally-accredited research laboratories, whilst most public sector laboratories have historically lacked functioning quality management systems. In 2010, Kenya enrolled an initial eight regional and four national laboratories into the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. To address the challenge of a lack of mentors for the regional laboratories, three were paired, or ‘twinned’, with nearby accredited research laboratories to provide institutional mentorship, whilst the other five received standard mentorship. Objectives This study examines results from the eight regional laboratories in the initial SLMTA group, with a focus on mentorship models. Methods Three SLMTA workshops were interspersed with three-month periods of improvement project implementation and mentorship. Progress was evaluated at baseline, mid-term, and exit using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) audit checklist and scores were converted into a zero- to five-star scale. Results At baseline, the mean score for the eight laboratories was 32%; all laboratories were below the one-star level. At mid-term, all laboratories had measured improvements. However, the three twinned laboratories had increased an average of 32 percentage points and reached one to three stars; whilst the five non-twinned laboratories increased an average of 10 percentage points and remained at zero stars. At exit, twinned laboratories had increased an average 12 additional percentage points (44 total), reaching two to four stars; non-twinned laboratories increased an average of 28 additional percentage points (38 total), reaching one to three stars. Conclusion The partnership used by the twinning model holds promise for future collaborations between ministries of health and state-of-the-art research laboratories in their regions for laboratory quality improvement. Where they exist, such laboratories may be valuable resources to be used judiciously so as to accelerate sustainable quality improvement initiated through SLMTA. PMID:29043191

The "Big Bang" in Public and Private Faculty Salaries

ERIC Educational Resources Information Center

Rippner, Jennifer A.; Toutkoushian, Robert K.

2015-01-01

The gap between average faculty salaries at public and private institutions has been growing wider over the past 40 years, yet little is known about the nature and causes of the gap. This study uses data on more than 1,000 institutions to examine institutional average faculty salaries and how they have changed for public and private institutions.…

Multifaceted Comparison of Two Cryotherapy Devices Used After Total Knee Arthroplasty: Cryotherapy Device Comparison.

PubMed

Schinsky, Mark F; McCune, Christine; Bonomi, Judith

2016-01-01

Some form of cryotherapy used after total knee arthroplasty is commonplace. However, various factors determine the specific device deployed. This study aimed to answer the following questions: : A group of 100 patients undergoing primary total knee arthroplasty by a single surgeon were enrolled in an institutional review board-approved, prospective study and randomized to receive either a circulating cold water or ice/gel pack cryotherapy device postoperatively. Demographic, pain, swelling, blood loss, range of motion, compliance, satisfaction, and adverse event outcomes were recorded until 6 weeks after surgery. Hospital staff satisfaction and economic variables were examined. The ice/gel pack cryotherapy wrap was noninferior to the cold water cryotherapy device for any patient outcome measured. Average pain level at 6 weeks postoperative was significantly less in the ice/gel pack cryotherapy wrap group. Hospital staff satisfaction was higher with the ice/gel pack cryotherapy wrap.Substantial economic savings can be realized at our institution by switching to the lower cost cryotherapy device. In this study, the lower cost ice/gel pack cryotherapy wrap was noninferior to the circulating ice water cryotherapy device with respect to objective patient outcomes and subjective patient satisfaction after total knee arthroplasty. Hospital staff satisfaction and economic considerations also favor the ice/gel pack compression cryotherapy wraps.

Multi-faceted case management: reducing compensation costs of musculoskeletal work injuries in Australia.

PubMed

Iles, Ross Anthony; Wyatt, M; Pransky, G

2012-12-01

This study aimed to determine whether a multi-faceted model of management of work related musculoskeletal disorders reduced compensation claim costs and days of compensation for injured workers. An intervention including early reporting, employee centred case management and removal of barriers to return to work was instituted in 16 selected companies with a combined remuneration over $337 million. Outcomes were evaluated by an administrative dataset from the Victorian WorkCover Authority database. A 'quasi experimental' pre-post design was employed with 492 matched companies without the intervention used as a control group and an average of 21 months of post-intervention follow-up. Primary outcomes were average number of days of compensation and average cost of claims. Secondary outcomes were total medical costs and weekly benefits paid. Information on 3,312 claims was analysed. In companies where the intervention was introduced the average cost of claims was reduced from $6,019 to $3,913 (estimated difference $2,329, 95 % CI $1,318-$3,340) and the number of days of compensation decreased from 33.5 to 14.1 (HR 0.77, 95 % CI 0.67-0.88). Medical costs and weekly benefits costs were also lower after the intervention (p < 0.05). Reduction in claims costs were noted across industry types, injury location and most employer sizes. The model of claims management investigated was effective in reducing the number of days of compensation, total claim costs, total medical costs and the amount paid in weekly benefits. Further research should investigate whether the intervention improves non-financial outcomes in the return to work process.

TU-G-BRD-05: Results From Multi-Institutional Measurements with An Anthropomorphic Spine Phantom

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

Molineu, A; Hernandez, N; Alvarez, P

Purpose: To analyze the results from an anthropomorphic spine phantom used for credentialing institutions for National Cancer Institute (NCI) sponsored clinical trial. Methods: An anthropomorphic phantom that contains left and right lungs, a heart, an esophagus, spinal cord, bony material and a PTV was sent to institutions wishing to be credentialed for NCI trials. The PTV holds 4 TLD and radiochromic film in the axial and sagittal planes. The heart holds one TLD. Institutions created IMRT plans to cover ≥90% of the PTV with 6 Gy and limit the cord dose to <0.35cc receiving 3.75 Gy and <1.2cc receiving 2.63more » Gy. They were instructed to treat the phantom as they would a patient, including making plan specific IMRT/SBRT QA measurements before treatment. The TLD results in the PTV were required to be within ±7% of the plan dose. A gamma calculation was performed using the film results and the submitted DICOM plan. ≥85% of the analyzed region was required to pass a 5%/3 mm criteria. Results: 176 institutions irradiated the spine phantom for a total of 255 results. The pass rate was 73% (187 irradiations) overall. 44 irradiations failed only the gamma criteria, 2 failed only the dose criteria and 22 failed both. The most used planning systems were Eclipse (116) and Pinnacle (52) and they had pass rates of 76% and 71%, respectively. The AAA algorithm had a pass rate of 77% while superposition type algorithms had a 71% pass rate. The average TLD measurement to institution calculation ratio was 0.99 (0.04 std dev.). The average percent pixels passing the gamma criteria for films was 89% (12% std dev.) Conclusion: Results show that this phantom is an important part of credentialing and that we have room for improvement in IMRT/SBRT spine treatments. This work was supported by PHS CA180803 and CA037422 awarded by NCI, DHHS.« less

The Cost and Burden of the Residency Match in Emergency Medicine.

PubMed

Blackshaw, Aaron M; Watson, Simon C; Bush, Jeffrey S

2017-01-01

To obtain a residency match, medical students entering emergency medicine (EM) must complete away rotations, submit a number of lengthy applications, and travel to multiple programs to interview. The expenses incurred acquiring this residency position are burdensome, but there is little specialty-specific data estimating it. We sought to quantify the actual cost spent by medical students applying to EM residency programs by surveying students as they attended a residency interview. Researchers created a 16-item survey, which asked about the time and monetary costs associated with the entire EM residency application process. Applicants chosen to interview for an EM residency position at our institution were invited to complete the survey during their interview day. In total, 66 out of a possible 81 residency applicants (an 81% response rate) completed our survey. The "average applicant" who interviewed at our residency program for the 2015-16 cycle completed 1.6 away, or "audition," rotations, each costing an average of $1,065 to complete. This "average applicant" applied to 42.8 programs, and then attended 13.7 interviews. The cost of interviewing at our program averaged $342 and in total , an average of $8,312 would be spent in the pursuit of an EM residency. Due to multiple factors, the costs of securing an EM residency spot can be expensive. By understanding the components that are driving this trend, we hope that the academic EM community can explore avenues to help curtail these costs.

Six-year follow-up on work force and finances of the United States anesthesiology training programs: 2000 to 2006.

PubMed

Kheterpal, Sachin; Tremper, Kevin K; Shanks, Amy; Morris, Michelle

2009-01-01

In the mid 1990s, interest in the field of anesthesiology decreased significantly among medical students, resulting in a decreasing resident class size and, subsequently, fewer anesthesiologists entering the United States workforce. This apparent practitioner shortage was associated with increased salary demands, which placed anesthesiology training departments in financial jeopardy. Starting in 1999, a survey was sent to the department chairs of the United States anesthesiology training programs to assess the status of faculty and finances of their departments. Follow-up surveys have been conducted each year thereafter. We present the results of the 2006 survey and 7 yr trend data. Surveys were distributed by e-mail in September 2006 to anesthesiology department chairs of the United States training programs. The responses were received by e-mail. Descriptive statistics were performed on responder data. In addition, a linear regression model to predict institutional support was developed. One-hundred-eighteen departments were surveyed with a response rate of 61%. There were an average of 4 open faculty positions in the 71% of the departments reporting open faculty positions. This would imply an overall 5% open position rate, down from 10% in 2000. Of the 96% of departments who employ certified registered nurse anesthetists, 70% had an average of 4 open positions, or approximately 11% shortage. The average department received $5,500,000 in total institutional support annually ($120,000/faculty). When the portion of this support provided for certified registered nurse anesthetists was removed, the average amount received was $4,600,000 or $100,000/faculty. This is a 10% increase over the previous year and an approximate 300% increase over the year 2000. Faculty academic time averaged 18% (where 20% is 1 day per week). The departments billed an average of 12,200 U/faculty/year. The average anesthesia unit value collected was $31/unit, while departments would require $46/unit to meet expenses. In a linear regression model, clinical revenue per unit billed minus expenses per unit billed predicted faculty support per full-time equivalent. This current survey reveals a continuing need for institutional support to keep anesthesiology training departments financially solvent. The amount of support is associated with the reimbursement for anesthesia work. There is also a continuing, but decreasing, number of open faculty anesthesiologist positions nationwide.

Stone Attenuation Values Measured by Average Hounsfield Units and Stone Volume as Predictors of Total Laser Energy Required During Ureteroscopic Lithotripsy Using Holmium:Yttrium-Aluminum-Garnet Lasers.

PubMed

Ofude, Mitsuo; Shima, Takashi; Yotsuyanagi, Satoshi; Ikeda, Daisuke

2017-04-01

To evaluate the predictors of the total laser energy (TLE) required during ureteroscopic lithotripsy (URS) using the holmium:yttrium-aluminum-garnet (Ho:YAG) laser for a single ureteral stone. We retrospectively analyzed the data of 93 URS procedures performed for a single ureteral stone in our institution from November 2011 to September 2015. We evaluated the association between TLE and preoperative clinical data, such as age, sex, body mass index, and noncontrast computed tomographic findings, including stone laterality, location, maximum diameter, volume, stone attenuation values measured using average Hounsfield units (HUs), and presence of secondary signs (severe hydronephrosis, tissue rim sign, and perinephric stranding). The mean maximum stone diameter, volume, and average HUs were 9.2 ± 3.8 mm, 283.2 ± 341.4 mm 3 , and 863 ± 297, respectively. The mean TLE and operative time were 2.93 ± 3.27 kJ and 59.1 ± 28.1 minutes, respectively. Maximum stone diameter, volume, average HUs, severe hydronephrosis, and tissue rim sign were significantly correlated with TLE (Spearman's rho analysis). Stepwise multiple linear regression analysis defining stone volume, average HUs, severe hydronephrosis, and tissue rim sign as explanatory variables showed that stone volume and average HUs were significant predictors of TLE (standardized coefficients of 0.565 and 0.320, respectively; adjusted R 2  = 0.55, F = 54.7, P <.001). Stone attenuation values measured by average HUs and stone volume were strong predictors of TLE during URS using Ho:YAG laser procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

Assessing National Institutes of Health funding and scholarly impact in neurological surgery.

PubMed

Svider, Peter F; Husain, Qasim; Folbe, Adam J; Couldwell, William T; Liu, James K; Eloy, Jean Anderson

2014-01-01

Research productivity is increasingly important in academic neurological surgery and can be measured through a variety of methods, such as publications, objective bibliometrics, and securing external grant support. The authors' objectives were to determine whether there is an association between scholarly impact, as measured by the h index, and successful National Institutes of Health (NIH) grant funding awarded to faculty in neurological surgery departments. Primary investigators receiving National Institutes of Health (NIH) awards from Fiscal Years 2011-2013 were organized by academic rank, terminal degree, and their h index, as calculated from the Scopus database. These data were also obtained for nonfunded faculty from 15 randomly selected departments for comparison, and the average h index for each group was calculated. National Institutes of Health-funded faculty had higher average h indices than their nonfunded colleagues (23.6 vs 10.8, p < 0.0001), a finding that persisted upon controlling for academic rank. The mean h index increased with successive academic rank in both cohorts; greater funding totals were seen with successive academic position (Kruskal-Wallis, p < 0.05). National Institutes of Health-funded MDs had higher h indices than their PhD colleagues (p = 0.04), although funding levels did not differ significantly. There was a trend of increasing h index with higher NIH-funding ranges (p < 0.05). The authors' findings demonstrate a strong relationship between scholarly impact and securing NIH funding among faculty in academic neurosurgical departments. Faculty receiving a greater amount of funding tended to have a higher h index. Mean scholarly impact, as measured by the h index, increased with successive academic rank among both NIH-funded and nonfunded faculty, suggesting that this bibliometric may have utility as an adjunct in the academic appointment and promotion process in academic neurological surgery.

Patient-oriented Functional Results of Total Femoral Endoprosthetic Reconstruction Following Oncologic Resection

PubMed Central

Jones, Kevin B.; Griffin, Anthony M.; Chandrasekar, Coonoor R.; Biau, David; Babinet, Antoine; Deheshi, Benjamin; Bell, Robert S.; Grimer, Robert J.; Wunder, Jay S.; Ferguson, Peter C.

2011-01-01

Background and Objectives Functional outcomes following oncologic total femoral endoprosthetic reconstruction (TFR) are lacking. We compared patient-oriented functional results of TFRs to proximal femur and distal femur reconstructions (PFR and DFR). We also compared function and complications with regard to knee and hip componentry. Methods 54 TFR patients were identified from 3 institutional prospective databases. 41 had fixed- and 13 had rotating-hinge knees, 37 hemiarthroplasty and 17 total hip arthroplasty componentry. Toronto Extremity Salvage Scores (TESS) for n=27 were compared between groups and to cohorts of PFR (n=31) and DFR (n=85) patients using the Mann-Whitney U test. Results Follow-up averaged 4 years. Mechanical complications included 5 hip dislocations and 1 femoral malrotation. Four dislocations were in fixed-hinge implants, all in those lacking abductor reattachment. TESS averaged 69.3±17.8, statistically decreased from DFR (p=0.002) and PFR patients (p=0.036). No significant differences were detected between patients in the fixed-hinge (n=18) and rotating-hinge (n=9) groups (p = 0.944), or total hip (n=8) and hemiarthroplasty (n=19) groups (p=0.633). Conclusions TFR is reserved for extreme cases of limb salvage, portending a poor prognosis overall. Function reflects additive impairments from PFR and DFR. TFR outcomes differ little with rotating- or fixed-hinge, total hip or hemiarthroplasty implants. PMID:21695701

A financial analysis of maxillomandibular fixation versus rigid internal fixation for treatment of mandibular fractures.

PubMed

Schmidt, B L; Kearns, G; Gordon, N; Kaban, L B

2000-11-01

The aim of this study was to compare the cost-effectiveness of mandibular fracture treatment by closed reduction with maxillomandibular fixation (CRF) with open reduction and rigid internal fixation (ORIF). This was a retrospective study of 85 patients admitted to the Oral and Maxillofacial Surgery Service at San Francisco General Hospital and treated for mandibular fractures from January 1 to December 31, 1993. The patients were divided into 2 groups: 1) those treated with CRF and 2) those treated with ORIF. The outcome variables were length of hospital stay, duration of anesthesia, and time in operating room. The charge for primary fracture treatment included the fees for the operation and hospitalization without any complications. Within the group of 85 patients treated for mandibular fractures in 1993, 10 patients treated with CRF and 10 patients treated with ORIF were randomly selected, and hospital billing statements were used to estimate the average charge of primary treatment. The average charge to manage a major postoperative infection also was estimated based on the billing statements of 10 randomly selected patients treated in 1992 (5 treated with CRF, 5 with ORIF) who required hospital admission for the management of a complication. The average total charge was computed by using the average charge for primary treatment plus the incidence of postoperative infection multiplied by the average charge for management of that complication. Eighty-five patients were included in the study. The average charge for primary treatment was $10,100 for the CRF group and $28,362 for the ORIF group. The average charge for the inpatient management of a major postoperative infection was $26,671 for the CRF group and $39,213 for the ORIF group. The average total charge for management of a mandible fracture with CRF was $10,927; the total charge for the ORIF group was $34,636. The results of this retrospective study suggest that the use of CRF in the management of mandibular fractures at our institution provides considerable savings over treatment by using ORIF. The use of ORIF should be reserved for patients and fracture types with specific indications.

Inpatient versus outpatient cleft lip repair and alveolar bone grafting: a cost analysis.

PubMed

Albert, Mark Graham; Babchenko, Oksana Olegovna; Lalikos, Janice Fay; Rothkopf, Douglas Miller

2014-12-01

The lifetime cost of a child with an orofacial cleft is estimated at $101,000, which amounts to $697 million total for those born each year with orofacial clefts. There has been a trend toward outpatient procedures for cleft lip repair (CLR) and alveolar bone grafting (ABG), and studies have shown no disparities in safety or outcome between inpatient and ambulatory treatment. The financial implications of outpatient versus inpatient procedures have not been compared. Financial data were collected for outpatient (n = 33) and inpatient (n = 2) CLR, as well as outpatient (n = 7) and inpatient (n = 5) ABG during a 5-year period at our institution. We examined hospital charges and reimbursement for these procedures by private insurance plans and Medicaid Managed Care (MMC) plans. The average total reimbursements for inpatient and outpatient CLR were similar at $6848 and $5557, respectively. Average facility reimbursement for CLR was greater for inpatient ($5344) than outpatient ($4291) procedures. Average professional reimbursement was similar between inpatient ($1504) and outpatient ($1266) CLR.For ABG, the average total inpatient reimbursement was $14,573, whereas outpatient was $8877. Average facility reimbursements were greater for inpatient ($12,398) than outpatient ($7183) ABG. Average professional reimbursement was similar between inpatient ($2175) and outpatient ($1693) ABG, with 35% and 31% of charges reimbursed, respectively.A substantial difference existed between reimbursements based on insurance types for both outpatient CLR and outpatient ABG. On average for CLR, commercial payers reimbursed 52% ($7344) of overall charges, whereas Medicaid and MMC reimbursed 9% ($1447). For ABG, commercial payers reimbursed an average of 78% ($11,950) of overall charges, whereas Medicaid and MMC reimbursed 10% ($1192). Fewer patients' insurance companies are reimbursing for inpatient stays; in many cases, even patients who remain hospitalized up to 48 hours are treated as "day surgery" from a reimbursement perspective. For outpatient surgery, a greater percentage of CLR and ABG charges were successfully recouped compared to inpatient surgery. Awareness of higher payment for inpatient surgery and potential savings through use of the outpatient setting is crucial for hospitals and the US health care system as a whole.

Implementation of Preoperative Screening Criteria Lowers Infection and Complication Rates Following Elective Total Hip Arthroplasty and Total Knee Arthroplasty in a Veteran Population.

PubMed

Nussenbaum, Fernando D; Rodriguez-Quintana, David; Fish, Sara M; Green, David M; Cahill, Catherine W

2018-01-01

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common procedures with a risk of complications. Attempting to minimize complications, our institution implemented preoperative screening criteria for patients undergoing elective total joint replacement. Our study aimed to determine if screening criteria lowered total complications and/or surgical site infections (SSI). Two groups of consecutive patients undergoing TKA and THA at a single Veterans Affairs facility were evaluated prior to and after implementation of screening criteria, 520 and 475 respectively. Screening criteria included hemoglobin A1c ≤7, hemoglobin ≥11, body mass index ≤35, and albumin ≥3.5. Groups were analyzed for demographics, preoperative comorbidities, and postoperative complications. Rates of total complications and SSI were compared. Average follow-up was at least 2 years with minimum of 1 year. Demographics and comorbidities outside the screening criteria were similar. Total complication rate was reduced from 35.4% to 14.8% (P < .01) after implementation of screening criteria. For TKA, total complications were reduced from 33.1% to 15.0% (P < .01) and for THA they were reduced from 42.4% to 14.2% (P < .01). SSI rates for combined TKA and THA were reduced from 4.4% to 1.3% (P < .01). For knees, SSI was reduced from 4.6% to 1.3% (P = .01) and was statistically significant. For THA, SSI decreased from 3.8% to 1.2% (P < .05). Our institution saw a statistically significant decrease in both SSI and total complications following implementation of preoperative screening criteria for elective TKA and THA. Published by Elsevier Inc.

Predictors for Perioperative Outcomes following Total Laryngectomy: A University HealthSystem Consortium Discharge Database Study.

PubMed

Rutledge, Jonathan W; Spencer, Horace; Moreno, Mauricio A

2014-07-01

The University HealthSystem Consortium (UHC) database collects discharge information on patients treated at academic health centers throughout the United States. We sought to use this database to identify outcome predictors for patients undergoing total laryngectomy. A secondary end point was to assess the validity of the UHC's predictive risk mortality model in this cohort of patients. Retrospective review. Academic medical centers (tertiary referral centers) and their affiliate hospitals in the United States. Using the UHC discharge database, we retrieved and analyzed data for 4648 patients undergoing total laryngectomy who were discharged between October 2007 and January 2011 from all of the member institutions. Demographics, comorbidities, institutional data, and outcomes were retrieved. The length of stay and overall costs were significantly higher among female patients (P < .0001), while age was a predictor of intensive care unit stay (P = .014). The overall complication rate was higher among Asians (P = .019) and in patients with anemia and diabetes compared with other comorbidities. The average institutional case load was 1.92 cases/mo; we found an inverse correlation (R = -0.47) between the institutional case load and length of stay (P < .0001). The UHC admit mortality risk estimator was found to be an accurate predictor not only of mortality (P < .0002) but also of intensive care unit admission and complication rate (P < .0001). This study provides an overview of laryngectomy outcomes in a contemporary cohort of patients treated at academic health centers. UHC admit mortality risk is an excellent outcome predictor and a valuable tool for risk stratification in these patients. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

Research output of health research institutions and its use in 42 sub-Saharan African countries: results of a questionnaire-based survey.

PubMed

Kebede, Derege; Zielinski, Chris; Mbondji, Peter Ebongue; Sanou, Issa; Kouvividila, Wenceslas; Lusamba-Dikassa, Paul-Samson

2014-05-01

To describe and analyse research output from surveyed national health research institutions in Africa. The survey used a structured questionnaire to solicit information from 847 health research institutions in 42 countries of the World Health Organization African Region. Eight hundred and forty-seven health research institutions in 42 sub-Saharan African countries. Key informants from the health research institutions. Volume, type and medium of publications, and distribution of research outputs. Books or chapters for books accounted for the highest number of information products published (on average 16.7 per respondent institution), followed by patents registered in country (8.2), discussion or working papers (6.5) and conference proceedings (6.4). Publication in a peer-reviewed journal constituted only a minor part of research output (on average about 1 paper per institution). Radio and TV broadcasts on health research accounted for the highest number of products issued by institution staff (on average 5.5 per institution), followed by peer-reviewed journals indexed internationally (3.8) or nationally (3.1). There were, on average, 1.5 press releases, 1.5 newspaper or magazine articles, and 1.4 policy briefs per institution. Over half of respondent institutions (52%) developed briefs and summaries of articles to share with their target audiences, 43% developed briefs for possible actions and 37% provided articles and reports upon request. Only a small proportion of information products produced were available in institutional databases. The research output of health research institutions in the Region is significant, but more effort is needed to strengthen research capacity, including human and financial resources. © The Royal Society of Medicine.

The Regional Autopsy Center: The University of Alabama at Birmingham Experience.

PubMed

Atherton, Daniel Stephen; Reilly, Stephanie

2017-09-01

Rates of autopsied deaths have decreased significantly for the last several decades. It may not be practical for some institutions to maintain the facilities and staffing required to perform autopsies. In recent years, the University of Alabama at Birmingham (UAB) has established contracts to perform autopsies for several regional institutions including the Alabama Department of Forensic Sciences (ADFS), the United States Veterans Affairs, the local prison system, local community hospitals, and with families for private autopsy services. Contracts and autopsy data from 2004 to 2015 were obtained and reviewed. Since 2004, the number of UAB hospital autopsies trended slightly downward. On average, UAB hospital cases comprised most yearly cases, and the ADFS was the second largest contributor of cases. Income generated from outside autopsies performed from 2006 to 2015 totaled just more than 2 million dollars, and most of the income was generated from referred ADFS cases. This study provides evidence that a centralized institution (regional autopsy center [RAC]) can provide regional autopsy service in a practical, feasible, and economically viable manner, and a RAC can benefit both the referring institutions as well as the RAC itself.

Perioperative comorbidities and complications among patients undergoing primary total knee arthroplasty: a retrospective analysis and prospective survey.

PubMed

Oviedo Baena, Ana M; Moeschler, Susan M; Smith, Hugh M; Duncan, Christopher M; Schroeder, Darrell R; Kopp, Sandra L

2015-11-01

To determine the demographic characteristics of patients undergoing primary total knee arthroplasty during the years 1989, 1999, and 2009 at our institution and determine whether their characteristics mirror the changing US demographic characteristics. Retrospective chart review of patients and prospective survey of experienced anesthesia providers in total knee arthroplasty. Tertiary care academic medical center. All patients 18 years and older who underwent unilateral primary total knee arthroplasty in 1989, 1999, and 2009 were identified through the Mayo Clinic Total Joint Registry. For each year, 200 patients were randomly selected. The demographic characteristics, comorbidities, perioperative care, and postoperative outcomes of patients, as well as survey responses from experienced anesthesia providers. During the 3 study years, a total of 591 patients were included for analysis. A statistically significant increase in body mass index (BMI) was observed over time in patients undergoing primary total knee arthroplasty (average BMI, 29.01 in 1989, 31.32 in 1999, and 32.32 in 2009 [P < .001]). Despite the increase in patient comorbidities, the percentage of patients who had postoperative complications decreased over time (P = .003), and postoperative disposition (general medicine ward vs intensive care unit) did not change. Our provider survey received a 76% response rate. In total, 82% of anesthesia providers who responded to the survey perceived that both BMI and the number of comorbidities had increased. Of survey respondents, 67% state that they have modified their perioperative anesthesia care because of changes in body habitus and patient comorbidities. The number of obese patients with comorbidities who present for total knee arthroplasty at our institution has increased over the past 20 years. Despite this fact, a reduction was detected in postoperative complications. Copyright © 2015 Elsevier Inc. All rights reserved.

Estimating the Direct Costs of Outpatient Opioid Prescriptions: A Retrospective Analysis of Data from the Rhode Island Prescription Drug Monitoring Program.

PubMed

Aroke, Hilary; Buchanan, Ashley; Wen, Xuerong; Ragosta, Peter; Koziol, Jennifer; Kogut, Stephen

2018-03-01

Overuse and misuse of prescription opioids is associated with increased morbidity and mortality and places a significant cost burden on health systems. To estimate annual statewide spending for prescription opioids in Rhode Island. A cross-sectional study of opioids dispensed from retail pharmacies using data from the Rhode Island Prescription Drug Monitoring Program (PDMP) was performed. The study sample consisted of 651,227 opioid prescriptions dispensed to 197,062 patients between January 1, 2015, and December 31, 2015. The mean, median, and total cost of opioid use was estimated using prescription dispensings and patients as units of analysis. A generalized linear model with gamma distribution with an identity link function, and separately with a log link function, was used to estimate the absolute and relative differences in per-patient annual adjusted average opioid prescription cost, respectively, by potential predictors. The estimated 2015 annual expenditure for opioid prescriptions in Rhode Island was $44,271,827. The average and median costs of an opioid prescription were $67.98 (SD $210.91) and $21.08 (quartile 1 to quartile 3 = $7.65-$47.51), respectively. Prescriptions for branded opioid products accounted for $17,380,279.05, which was approximately 39.3% of overall spending, although only 6% of all opioids dispensed were for branded drugs. On average, patients aged 45-54 years and 55-64 years had overall adjusted spending for opioids that were 1.53 (95% CI = 1.49-1.57) and 1.75 (95% CI = 1.71-1.80) times higher than patients aged 65 years and older, respectively. Per patient Medicaid and Medicare average annual spending for opioid prescriptions were 1.19 (95% CI = 1.16-1.22) and 2.01 (95% CI = 1.96-2.06) times higher than commercial insurance spending, respectively. Annual opioid prescription spending was 2.01 (95% CI = 1.98-2.04) and 1.50 (95% CI = 1.45-1.55) times higher among patients who also had at least 1 dispensing of a benzodiazepine or sympathomimetic stimulant, respectively. Average total spending for prescription opioids per patient increased with the average daily dosage: from 3-fold for patients using 50-90 morphine milligrams equivalent (MME) daily to 22-fold for those receiving 90 or more MME daily compared with those receiving less than 50 MME daily. This study provides the first estimate of the statewide direct cost burden of prescription opioid use using PDMP data and standardized pricing benchmarks. Total annual cost increased with age up to 65 years, mean daily dose, and concurrent use of benzodiazepines or stimulants. Commercial insurance bore the majority of the cost of prescription opioid use, but cost per patient was highest among Medicare beneficiaries. In addition to reducing harms associated with opioid overuse and misuse, substantial cost savings could be realized by reducing unnecessary opioid use, especially among middle-aged adults. This study was funded by the Rhode Island Department of Health. Aroke and Kogut report grants from the Rhode Island Department of Health during this study. Kogut is partially supported by Institutional Development Award Number U54GM115677 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds Advance Clinical and Translational Research (Advance-CTR). Koziol reports grants from the Centers for Disease Control and Prevention during this study. The other authors have nothing to disclose. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Study concept and design were contributed by Koziol, Ragosta, and Kogut, along with Aroke. Koziol, Ragosta, Aroke, and Kogut collected the data, and data interpretation was performed by Aroke, Buchanan, Wen, and Kogut. The manuscript was primarily written by Aroke, along with Buchanan and Kogut, and revised by Aroke, Buchanan, Wen, and Kogut.

Patient dose estimation from CT scans at the Mexican National Neurology and Neurosurgery Institute

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

Alva-Sánchez, Héctor, E-mail: halva@ciencias.unam.mx; Reynoso-Mejía, Alberto; Casares-Cruz, Katiuzka

In the radiology department of the Mexican National Institute of Neurology and Neurosurgery, a dedicated institute in Mexico City, on average 19.3 computed tomography (CT) examinations are performed daily on hospitalized patients for neurological disease diagnosis, control scans and follow-up imaging. The purpose of this work was to estimate the effective dose received by hospitalized patients who underwent a diagnostic CT scan using typical effective dose values for all CT types and to obtain the estimated effective dose distributions received by surgical and non-surgical patients. Effective patient doses were estimated from values per study type reported in the applications guidemore » provided by the scanner manufacturer. This retrospective study included all hospitalized patients who underwent a diagnostic CT scan between 1 January 2011 and 31 December 2012. A total of 8777 CT scans were performed in this two-year period. Simple brain scan was the CT type performed the most (74.3%) followed by contrasted brain scan (6.1%) and head angiotomography (5.7%). The average number of CT scans per patient was 2.83; the average effective dose per patient was 7.9 mSv; the mean estimated radiation dose was significantly higher for surgical (9.1 mSv) than non-surgical patients (6.0 mSv). Three percent of the patients had 10 or more brain CT scans and exceeded the organ radiation dose threshold set by the International Commission on Radiological Protection for deterministic effects of the eye-lens. Although radiation patient doses from CT scans were in general relatively low, 187 patients received a high effective dose (>20 mSv) and 3% might develop cataract from cumulative doses to the eye lens.« less

Patient dose estimation from CT scans at the Mexican National Neurology and Neurosurgery Institute

NASA Astrophysics Data System (ADS)

Alva-Sánchez, Héctor; Reynoso-Mejía, Alberto; Casares-Cruz, Katiuzka; Taboada-Barajas, Jesús

2014-11-01

In the radiology department of the Mexican National Institute of Neurology and Neurosurgery, a dedicated institute in Mexico City, on average 19.3 computed tomography (CT) examinations are performed daily on hospitalized patients for neurological disease diagnosis, control scans and follow-up imaging. The purpose of this work was to estimate the effective dose received by hospitalized patients who underwent a diagnostic CT scan using typical effective dose values for all CT types and to obtain the estimated effective dose distributions received by surgical and non-surgical patients. Effective patient doses were estimated from values per study type reported in the applications guide provided by the scanner manufacturer. This retrospective study included all hospitalized patients who underwent a diagnostic CT scan between 1 January 2011 and 31 December 2012. A total of 8777 CT scans were performed in this two-year period. Simple brain scan was the CT type performed the most (74.3%) followed by contrasted brain scan (6.1%) and head angiotomography (5.7%). The average number of CT scans per patient was 2.83; the average effective dose per patient was 7.9 mSv; the mean estimated radiation dose was significantly higher for surgical (9.1 mSv) than non-surgical patients (6.0 mSv). Three percent of the patients had 10 or more brain CT scans and exceeded the organ radiation dose threshold set by the International Commission on Radiological Protection for deterministic effects of the eye-lens. Although radiation patient doses from CT scans were in general relatively low, 187 patients received a high effective dose (>20 mSv) and 3% might develop cataract from cumulative doses to the eye lens.

Bibliometric analysis of the orthopedic literature.

PubMed

Hui, Zhaoyang; Yi, Zhongmei; Peng, Jun

2013-10-01

Bibliometric indicators are used to assess research performance. The goal of this study was to explore publication output to construct a picture of orthopedics that may be beneficial to researchers and orthopedic specialists. All orthopedics articles published in 61 journals from 2000 to 2011 were retrieved from the Science Citation Index Expanded database. The numbers of articles, citations, authors, institutions, and journals were analyzed and subjected to quantitative and qualitative comparisons. The number of published orthopedics articles increased between 2000 and 2011. Articles published by authors from the United States always ranked first in number, although the United States' share is decreasing in the world literature. Authors from the United States published the most-cited articles and the most articles in journals with top-10 impact factors; moreover, the United States also had the greatest share of experts and highly ranked institutions. The United Kingdom, Germany, and Japan were always within the world's top 4 in terms of numbers of articles and citations. The shares of Germany, South Korea, and China among total orthopedics articles increased, especially that of China. In 2011, China ranked the fifth in the world, with its world share increasing from 0.64% in 2000 to 5.05% in 2011. However, China lags behind in average citations per article, top research institutions, and most prolific authors. According to the total citations per article, the University of Pittsburgh, Harvard University, and the Hospital for Special Surgery were the most prolific institutions. Copyright 2013, SLACK Incorporated.

Should money follow the patient: Financial implication for being the National Centre for the Treatment and Management of Pelvic and Acetabular Fractures in Ireland.

PubMed

Kelly, M E; Leonard, M; Green, C; Beggs, R; Cheung, C; McElwain, J; Morris, S

2013-12-01

Pelvic and acetabular fractures are complex injuries requiring specialist treatment. Our institution is the National Centre for Treatment and Management of these injuries. To audit all referrals to our institution over a 6-month period and calculate the cost incurred by being the national referral centre. Retrospective review of database, and subsequent allocation of Casemix points to assess total cost of treatment for each patient referred to our institution. 103 patients referred with pelvic or acetabular fracture for operative management. The furthest referral distance was 181miles. Over-all, the length of stay was 15.4 days. The average inclusive cost for a referral to our unit for operative management was €16,302. Pelvic and acetabular fractures are complex injuries that require specialist referral unit management. However for these units to remain sustainable money needs to "follow the patient". Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

[Comparison of survival under domestic or institutional care: the Hannover morbidity and mortality long-term care study].

PubMed

Seger, W; Sittaro, N-A; Lohse, R; Rabba, J

2011-07-01

Empirical data, representative of the total population are necessary for medico-actuarial risk calculations. Our study compares mortalities of long-term care (LTC) patients with regard to age, gender and distribution of care levels when in home or institutional care. The data of 88.575 long-term care patients were analysed longitudinally for ten years, using routine data on the files of the German Federal Health Insurance fund (average observation period 2.5 years, a total of 221.625 observation years). The numbers of LTC patients and their care levels while remaining in home or institutional care were calculated, as were any changes to another care level or discontinuation of long-term care benefits (as a result of the need for care falling below the eligibility criteria for care level I or to death) during 1 - 10 years after the onset of long-term care. Total mortality was found to increase with age and care level in homecare as well as in institutional settings for both sexes. It is greatly influenced by the first year mortality, which for both genders was lower for care level 1 in home care settings but higher for care level 2 and much higher for care level 3 than in institutional care settings. Follow-up mortality (second to tenth year after the start of LTC) was lower for care level 1 and 2 in home care settings than for institutional care. But for care level 3 the follow-up mortality was conversely higher in home care settings than in institutional care (for both genders). The number of patients returning to an active life after rehabilitation is much higher for home care patients than those who had been in institutional care. The transfer rate from homecare to institutional care increased during the first three years after onset of care, descending thereafter, and was much higher than conversely. The slogan "outpatient care before inpatient care" must be differentiated and considered carefully with regard to the character and constellation of diseases, age attained, length of time after onset of care, care level, potential for resuming an active life, as well as level of compensation and number and nature of activities of daily life together with being given the necessary help when choosing between homecare or institutional care. Differentiation between first year and follow-up mortalities is recommended when undertaking medico-actuarial calculations. Georg Thieme Verlag KG Stuttgart · New York.

Impact of Advanced Pharmacy Practice Experience Placement Changes in Colleges and Schools of Pharmacy

PubMed Central

Staton, April G.; McCullough, Elizabeth S.; Jain, Rahul; Miller, Mindi S.; Lynn Stevenson, T.; Fetterman, James W.; Lynn Parham, R.; Sheffield, Melody C.; Unterwagner, Whitney L.; McDuffie, Charles H.

2012-01-01

Objective. To document the annual number of advanced pharmacy practice experience (APPE) placement changes for students across 5 colleges and schools of pharmacy, identify and compare initiating reasons, and estimate the associated administrative workload. Methods. Data collection occurred from finalization of the 2008-2009 APPE assignments throughout the last date of the APPE schedule. Internet-based customized tracking forms were used to categorize the initiating reason for the placement change and the administrative time required per change (0 to 120 minutes). Results. APPE placement changes per institution varied from 14% to 53% of total assignments. Reasons for changes were: administrator initiated (20%), student initiated (23%), and site/preceptor initiated (57%) Total administrative time required per change varied across institutions from 3,130 to 22,750 minutes, while the average time per reassignment was 42.5 minutes. Conclusion. APPE placements are subject to high instability. Significant differences exist between public and private colleges and schools of pharmacy as to the number and type of APPE reassignments made and associated workload estimates. PMID:22544966

Application of total care time and payment per unit time model for physician reimbursement for common general surgery operations.

PubMed

Chatterjee, Abhishek; Holubar, Stefan D; Figy, Sean; Chen, Lilian; Montagne, Shirley A; Rosen, Joseph M; Desimone, Joseph P

2012-06-01

The relative value unit system relies on subjective measures of physician input in the care of patients. A payment per unit time model incorporates surgeon reimbursement to the total care time spent in the operating room, postoperative in-house, and clinic time to define payment per unit time. We aimed to compare common general surgery operations by using the total care time and payment per unit time method in order to demonstrate a more objective measurement for physician reimbursement. Average total physician payment per case was obtained for 5 outpatient operations and 4 inpatient operations in general surgery. Total care time was defined as the sum of operative time, 30 minutes per hospital day, and 30 minutes per office visit for each operation. Payment per unit time was calculated by dividing the physician reimbursement per case by the total care time. Total care time, physician payment per case, and payment per unit time for each type of operation demonstrated that an average payment per time spent for inpatient operations was $455.73 and slightly more at $467.51 for outpatient operations. Partial colectomy with primary anastomosis had the longest total care time (8.98 hours) and the least payment per unit time ($188.52). Laparoscopic gastric bypass had the highest payment per time ($707.30). The total care time and payment per unit time method can be used as an adjunct to compare reimbursement among different operations on an institutional level as well as on a national level. Although many operations have similar payment trends based on time spent by the surgeon, payment differences using this methodology are seen and may be in need of further review. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Relationship between nurses' organizational trust levels and their organizational citizenship behaviors.

PubMed

Altuntas, Serap; Baykal, Ulku

2010-06-01

This research used a descriptive and explorative design to determine the levels of nurses' organizational trust and organizational citizenship and to investigate relationships between the levels of organizational trust and organizational citizenship behaviors. Nurses who had completed their orientation from a total of 11 hospitals with bed capacities of 100 and located in the European district of Istanbul were included in the sample for this study. Formal, written applications and approval of the ethical committee were obtained from concerned institutions before proceeding with the data collection step. The Organizational Trust Inventory and the Organizational Citizenship Level Scale, a questionnaire form including five questions regarding nurses' personal characteristics, were used in data collection. Data collection tools were distributed to 900 nurses in total, and usable data were obtained from 482 nurses. Number and percentage calculations and Pearson correlation analysis were used to assess research data. The results of the present research showed that nurses had a higher than average level of trust in their managers and coworkers and they trusted more in their managers and coworkers than their institutions. The Organizational Citizenship Level Scale indicated that the behavior most frequently demonstrated by the nurses was conscientiousness, followed by courtesy and civic virtue, whereas sportsmanship was displayed to an average extent. An analysis of relationships between nurses' level of organizational trust and their organizational citizenship behaviors revealed that nurses who trust in their managers, institutions, and coworkers demonstrated the organizational citizenship behaviors of conscientiousness, civic virtue, courtesy, and altruism more frequently. The findings attained in this study indicated that the organizational trust the staff had in their institutions, managers, and coworkers influenced the organizational citizenship behaviors of conscientiousness, civic virtue, altruism, and courtesy, whereas it had no effect on sportsmanship behavior. Nurse managers should introduce studies to improve their subordinates' organizational trust to ensure that they develop organizational citizenship behaviors, and they should support them in this process. These topics for nursing services will provide guidance to managers, particularly to managers of nursing services, in establishing processes to predict nurses' organizational commitment, job satisfaction, performance, intention to leave, and other relevant issues.

Preoperative predictors of increased hospital costs in elective anterior cervical fusions: a single-institution analysis of 1,082 patients.

PubMed

Minhas, Shobhit V; Chow, Ian; Jenkins, Tyler J; Dhingra, Brian; Patel, Alpesh A

2015-05-01

The frequency of anterior cervical fusion (ACF) surgery and total hospital costs in spine surgery have substantially increased in the last several years. To determine which patient comorbidities are associated with increased total hospital costs after elective one- or two-level ACFs. Retrospective cohort analysis. Individuals who have undergone elective one- or two-level ACFs at our single institution. The total number of patients amounted to 1,082. Total hospital costs during single admission. Multivariate linear regression models were used to analyze independent effects of preoperative patient characteristics on total hospital costs. Univariate analysis was used to examine association of these characteristics on operative time, length of hospital stay (LOS), and complications. Age, obesity, and diabetes were independently associated with increased average hospital costs of $1,404 (95% confidence interval [CI], $857-$1,951; p<.001), $681 (95% CI, $285-$1,076; p=.001), and $1,877 (95% CI, $726-$3,072; p=.001), respectively. Age was associated with increased LOS (p<.001) and complications (p<.001) but not operative time (p=.431). Diabetes was associated with increased LOS (p<.001) and complications (p=.042) but not operative time (p=.234). Obesity was not associated with increased LOS (p=.164), complications (p=.890), or operative time (p=.067). This study highlights the patient comorbidities associated with increased hospital costs after one- or two-level ACFs and the potential drivers of these costs. Copyright © 2015 Elsevier Inc. All rights reserved.

[Economic evaluation of the demand of medical care for mental health in Mexico: schizophrenia and depression, 1996-2000].

PubMed

Arredondo, Armando; Ramos, René; Zúñiga, Alexis

2003-01-01

Financing protection for both, users and providers of health care services is one of the main objectives of National Program of Health in Mexico, 2001-2006. In fact one of the elements of the present health care reform initiatives is need for the efficient allocation of financial resources, using resource allocation schemes by specific health care demands that combine both the economic, clinical and the epidemiological perspectives. The evaluation of such schemes has been approached in several ways; however, in the case of mental health services, there is dearth of studies that use economic assessment methods. Moreover, such studies are of limited scope, often a response to unmated health needs, disregarding the economic implication for health services production and financing and ensuing medical care market imbalances. This paper presents the results of an evaluative research work aimed to assess the average cost of depression and schizophrenia case management, the financial resources required to meet the health care demands by type of institution, period 1996-2000, in Mexico by type of health care provider. The case management average cost for schizophrenia was $211.00 US, and that for depression was $221.00 US. The demand of services for both conditions in each type of institution showed that the greatest relative demands (96% of the national total for depression and 94% of the national total for schizophrenia) occur in three institutions: IMSS, SSA and ISSSTE. The greatest demand of the health services for the two study condition corresponded to those insured by the IMSS, followed by those uninsured who use the SSA services, and those insured by the ISSSTE. The case management costs for mental conditions are in the middle range between hypertension and diabetes in the upper end, pneumonia and diarrhea in the lower end. The case managment costs of health care demands for the selected tracer conditions differ considerably among institutions for insure populations and those for uninsured populations, with a greater economic impact on-the former. Independent from differences found, these results allow the identification of economic evaluation indicators that could be used to design resource allocation schemes for each of the institutions included in this study.

The Cost and Burden of the Residency Match in Emergency Medicine

PubMed Central

Blackshaw, Aaron M.; Watson, Simon C.; Bush, Jeffrey S.

2017-01-01

Introduction To obtain a residency match, medical students entering emergency medicine (EM) must complete away rotations, submit a number of lengthy applications, and travel to multiple programs to interview. The expenses incurred acquiring this residency position are burdensome, but there is little specialty-specific data estimating it. We sought to quantify the actual cost spent by medical students applying to EM residency programs by surveying students as they attended a residency interview. Methods Researchers created a 16-item survey, which asked about the time and monetary costs associated with the entire EM residency application process. Applicants chosen to interview for an EM residency position at our institution were invited to complete the survey during their interview day. Results In total, 66 out of a possible 81 residency applicants (an 81% response rate) completed our survey. The “average applicant” who interviewed at our residency program for the 2015–16 cycle completed 1.6 away, or “audition,” rotations, each costing an average of $1,065 to complete. This “average applicant” applied to 42.8 programs, and then attended 13.7 interviews. The cost of interviewing at our program averaged $342 and in total, an average of $8,312 would be spent in the pursuit of an EM residency. Conclusion Due to multiple factors, the costs of securing an EM residency spot can be expensive. By understanding the components that are driving this trend, we hope that the academic EM community can explore avenues to help curtail these costs. PMID:28116032

An Analysis of Leading Undergraduate Sources of Ph.D.s, Adjusted for Institutional Size. Revised and Expanded.

ERIC Educational Resources Information Center

Fuller, Carol H.

Data on Ph.D. productivity during 1951-1980 for all accredited institutions are presented, along with a narrative summary. Productivity ratios were computed by dividing the average number of Ph.D.s conferred per year (1951-1980) by the average number of bachelor's degrees conferred per year (1946-1976) for each institution. Liberal arts colleges…

The Age and Related Demographic Characteristics of Students Attending Community Colleges and Four-Year Institutions. Working Papers in Education Finance.

ERIC Educational Resources Information Center

Hyde, William

Information is presented on demographic and socioeconomic characteristics of students attending community colleges and four-year institutions in the United States, based on data from the Current Population Survey. It was found that the community college student, on the average, is older than the average student attending a four-year institution.…

Strategic behaviour of institutional providers in mental handicapped care in the Netherlands.

PubMed

Van Harten, Willem H; Veldhuis, Marleen J M; Hoeksma, Bernhard H; Krabbendam, Koos J

2007-01-01

The purpose of this paper is to describe an inventory of the strategic responses of institutional providers of mental handicapped care to the strengthening of consumer choice through a personal care budget (PCB). Semi structured interviews were conducted among 26 providers covering 52 per cent of the total market volume of about 100,000 clients annually. A representative number of providers was included; on average a percentage below the national average of PCB users was found to be served. Of the 26 providers, 16 indicated adaption to their strategy in response to expected consumer empowerment The actual deployment of this response in the organisations seemed not to be very thorough or explicit. Surprisingly, as a growing part of PCB-clients choose alternative providers, no concerns were raised concerning the possible emergence of new service providers. Although the market share of PCB users is growing fast and existing providers do not seem to absorb this accordingly, a lack of market analysis and strategic behaviour of the traditional providers in response to this development was found. Based on this research growth of market shares of disruptive service providers can very well be anticipated.

Prescribing Practices of Physicians at Different Health Care Institutions

PubMed Central

Mollahaliloglu, Salih; Alkan, Ali; Donertas, Basak; Ozgulcu, Senay; Akici, Ahmet

2013-01-01

Objective: Irrational pharmacotherapy is a widespread health care problem, and knowing the prescription practices of physicians at an institutional level can present solutions. This study aimed to investigate whether physicians’ prescribing patterns showed differences at the level of the health care institution. Materials and Methods: Photocopies of 3201 prescriptions written at primary health care centers (PHCs), public hospitals, private hospitals, and university hospitals (UHs) were collected from 10 provinces in Turkey. The prescriptions were evaluated according to prescribing indicators, and the details of drug utilization were compared for different health care institutions. Results: The average number of medicines per prescription was 2.83, and the highest average was noted in PHCs (2.96). The average cost per prescription was US $51.57, and the highest average cost was found in UHs (US $166.10). The most frequently prescribed drug group was different among health care institutions. With the exception of UHs, the “cold-cough medicines” were the most frequently prescribed medicines at all of the institutions. Thirty-nine percent of the prescriptions included antibiotics. Conclusion: Despite the similarities between the distributions of diagnoses on prescriptions by health care institutions, the contents of the prescriptions showed differences. The high levels of prescriptions for “cold-cough medicines,” whose use is widely debated, and the widespread tendency of physicians to prescribe antibiotics suggest that there is a growing need for disseminating the principles of rational pharmacotherapy. Furthermore, institutional differences must be considered when conducting rational pharmacotherapy programs. PMID:25610260

Characteristics of the Surface Turbulent Flux and the Components of Radiation Balance over the Grasslands in the Southeastern Tibetan Plateau

NASA Astrophysics Data System (ADS)

Li, H.; Xiao, Z.; Wei, J.

2016-12-01

Characteristics of the Surface Turbulent Flux and the Components of Radiation Balance over the Grasslands in the Southeastern Tibetan PlateauHongyi Li 1, Ziniu Xiao 2 and Junhong Wei31 China Meteorological Administration Training Centre, Beijing, China2 State Key Laboratory of Numerical Modeling for Atmospheric Sciences and Geophysical Fluid Dynamics, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing, China 3Theory of Atmospheric Dynamics and Climate, Institute for Atmospheric and Environmental Sciences, Goethe University of Frankfurt, Campus Riedberg, GermanyAbstract:Based on the field observation data over the grasslands in the southeastern Tibetan Plateau and the observational datasets in Nyingchi weather station for the period from May 20 to July 9, 2013, the variation characteristics of the basic meteorological elements in Nyingchi weather station, the surface turbulent fluxes and the components of radiation balance over the grasslands, as well as their relationships, are analyzed in this paper. The results show that in Nyingchi weather station, the daily variations of relative humidity and average total cloud cover are consistent with that of precipitation, but that those of daily average air temperature, daily average ground temperature, daily average wind speed and daily sunshine duration have an opposite change to that of precipitation. During the observation period, latent heat exchange is greater than sensible heat exchange, and latent heat flux is significantly higher when there is rainfall, but sensible heat flux and soil heat flux are lower. The daily variation of the total solar radiation (DR) is synchronous with that of sensible heat flux, and the daily variations of reflective solar radiation (UR), long wave radiation by earth (ULR), net radiation (Rn) and surface albedo are consistent with DR, but that of the long wave radiation by atmosphere (DLR) has an opposite change. The diurnal variations of sensible heat flux, latent heat flux, soil heat flux and the components of surface radiation balance over the grasslands are characterized by higher values at noon and lower values in the morning and evening. Keywords: surface turbulent flux, components of radiation balance, grasslands, southeastern Tibetan Plateau

Patient-oriented functional results of total femoral endoprosthetic reconstruction following oncologic resection.

PubMed

Jones, Kevin B; Griffin, Anthony M; Chandrasekar, Coonoor R; Biau, David; Babinet, Antoine; Deheshi, Benjamin; Bell, Robert S; Grimer, Robert J; Wunder, Jay S; Ferguson, Peter C

2011-11-01

Functional outcomes following oncologic total femoral endoprosthetic reconstruction (TFR) are lacking. We compared patient-oriented functional results of TFRs to proximal femur and distal femur reconstructions (PFR and DFR). We also compared function and complications with regard to knee and hip componentry. Fifty-four TFR patients were identified from three institutional prospective databases. Forty-one had fixed- and 13 had rotating-hinge knees, 37 hemiarthroplasty and 17 total hip arthroplasty componentry. Toronto Extremity Salvage Scores (TESS) for n = 27 were compared between groups and to cohorts of PFR (n = 31) and DFR (n = 85) patients using the Mann-Whitney U-test. Follow-up averaged 4 years. Mechanical complications included five hip dislocations and one femoral malrotation. Four dislocations were in fixed-hinge implants, all in those lacking abductor reattachment. TESS averaged 69.3 ± 17.8, statistically decreased from DFR (P = 0.002) and PFR patients (P = 0.036). No significant differences were detected between patients in the fixed-hinge (n = 18) and rotating-hinge (n = 9) groups (P = 0.944), or total hip (n = 8) and hemiarthroplasty (n = 19) groups (P = 0.633). TFR is reserved for extreme cases of limb salvage, portending a poor prognosis overall. Function reflects additive impairments from PFR and DFR. TFR outcomes differ little with rotating- or fixed-hinge, total hip or hemiarthroplasty implants. Copyright © 2011 Wiley Periodicals, Inc.

Team-based learning on a third-year pediatric clerkship improves NBME subject exam blood disorder scores.

PubMed

Saudek, Kris; Treat, Robert

2015-01-01

Purpose At our institution, speculation amongst medical students and faculty exists as to whether team-based learning (TBL) can improve scores on high-stakes examinations over traditional didactic lectures. Faculty with experience using TBL developed and piloted a required TBL blood disorders (BD) module for third-year medical students on their pediatric clerkship. The purpose of this study is to analyze the BD scores from the NBME subject exams before and after the introduction of the module. Methods We analyzed institutional and national item difficulties for BD items from the NBME pediatrics content area item analysis reports from 2011 to 2014 before (pre) and after (post) the pilot (October 2012). Total scores of 590 NBME subject examination students from examinee performance profiles were analyzed pre/post. t-Tests and Cohen's d effect sizes were used to analyze item difficulties for institutional versus national scores and pre/post comparisons of item difficulties and total scores. Results BD scores for our institution were 0.65 (±0.19) compared to 0.62 (±0.15) nationally (P=0.346; Cohen's d=0.15). The average of post-consecutive BD scores for our students was 0.70(±0.21) compared to examinees nationally [0.64 (±0.15)] with a significant mean difference (P=0.031; Cohen's d=0.43). The difference in our institutions pre [0.65 (±0.19)] and post [0.70 (±0.21)] BD scores trended higher (P=0.391; Cohen's d=0.27). Institutional BD scores were higher than national BD scores for both pre and post, with an effect size that tripled from pre to post scores. Institutional BD scores increased after the use of the TBL module, while overall exam scores remained steadily above national norms. Conclusions Institutional BD scores were higher than national BD scores for both pre and post, with an effect size that tripled from pre to post scores. Institutional BD scores increased after the use of the TBL module, while overall exam scores remained steadily above national norms.

Federal Bureau of Prisons clinical pharmacy program improves patient A1C.

PubMed

Bingham, J Tyler; Mallette, Jeff J

2016-01-01

The Federal Bureau of Prisons (BOP) currently has over 13,000 patients with diabetes and has placed an emphasis on preventing and delaying the onset or progression of diabetes-related complications. In an ongoing effort to improve patient outcomes, BOP has implemented a nationwide, dynamic system of pharmacist-delivered patient care services via pharmacist clinicians working under the auspices of a physician-pharmacist collaborative practice agreement (CPA). The BOP Clinical Pharmacy Workgroup targets improved patient outcomes via oversight and support of institution pharmacist clinicians and physicians in establishing and maintaining physician-pharmacist CPAs. A primary emphasis is diabetes and the pharmacist-run clinic clinical outcomes data are presented. Seventy (nearly one-half) of eligible BOP pharmacists at 37 institutions offer pharmacist-delivered patient care services via an approved CPA. In total, BOP has 111 active physician-pharmacist CPAs. Pharmacist-run diabetes clinic outcomes from 5 institutions have been reported to date. A total of 126 patients were enrolled. Patient's hemoglobin A1C, blood pressure, and LDL cholesterol level are measured before (i.e., when accepted in the diabetes clinic) and after pharmacist-delivered care has been provided. The pharmacist-run diabetes clinics reported an average baseline A1C of 10.6% and produced an average outcome decrease in A1C of 2.3% from baseline. Specific pharmacist clinic interventions found to have the greatest impact are: 1) timely medication adjustment when indicated to help patients meet outcome goals; and 2) timely follow-up after a change in therapy is made (often within 1-2 weeks) with continued medication adjustment when indicated until outcome goal is achieved. BOP pharmacists have become respected and trusted clinicians within the team medicine model. As demonstrated by the pharmacist-run diabetes clinic outcomes, pharmacist clinicians are a valued link to the improvement of patient outcomes in BOP. Copyright © 2016. Published by Elsevier Inc.

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

Nyflot, MJ; Kusano, AS; Zeng, J

Purpose: Interest in incident learning systems (ILS) for improving safety and quality in radiation oncology is growing, as evidenced by the upcoming release of the national ILS. However, an institution implementing such a system would benefit from quantitative metrics to evaluate performance and impact. We developed metrics to measure volume of reporting, severity of reported incidents, and changes in staff attitudes over time from implementation of our institutional ILS. Methods: We analyzed 2023 incidents from our departmental ILS from 2/2012–2/2014. Incidents were prospectively assigned a near-miss severity index (NMSI) at multidisciplinary review to evaluate the potential for error ranging frommore » 0 to 4 (no harm to critical). Total incidents reported, unique users reporting, and average NMSI were evaluated over time. Additionally, departmental safety attitudes were assessed through a 26 point survey adapted from the AHRQ Hospital Survey on Patient Safety Culture before, 12 months, and 24 months after implementation of the incident learning system. Results: Participation in the ILS increased as demonstrated by total reports (approximately 2.12 additional reports/month) and unique users reporting (0.51 additional users reporting/month). Also, the average NMSI of reports trended lower over time, significantly decreasing after 12 months of reporting (p<0.001) but with no significant change at months 18 or 24. In survey data significant improvements were noted in many dimensions, including perceived barriers to reporting incidents such as concern of embarrassment (37% to 18%; p=0.02) as well as knowledge of what incidents to report, how to report them, and confidence that these reports were used to improve safety processes. Conclusion: Over a two-year period, our departmental ILS was used more frequently, incidents became less severe, and staff confidence in the system improved. The metrics used here may be useful for other institutions seeking to create or evaluate their own incident learning systems.« less

Estimation of annual occupational effective doses from external ionizing radiation at medical institutions in Kenya

NASA Astrophysics Data System (ADS)

Korir, Geoffrey; Wambani, Jeska; Korir, Ian

2011-04-01

This study details the distribution and trends of doses due to occupational radiation exposure among radiation workers from participating medical institutions in Kenya, where monthly dose measurements were collected for a period of one year ranging from January to December in 2007. A total of 367 medical radiation workers were monitored using thermoluminescent dosemeters. They included radiologists (27%), oncologists (2%), dentists (4%), Physicists (5%), technologists (45%), nurses (4%), film processor technicians (3%), auxiliary staff (4%), and radiology office staff (5%). The average annual effective dose of all categories of staff was found to range from 1.19 to 2.52 mSv. This study formed the initiation stage of wider, comprehensive and more frequent monitoring of occupational radiation exposures and long-term investigations into its accumulation patterns in our country.

A cost-effective method for femoral head allograft procurement for spinal arthrodesis: an alternative to commercially available allograft.

PubMed

Brown, Desmond A; Mallory, Grant W; Higgins, Dominique M; Abdulaziz, Mohammed; Huddleston, Paul M; Nassr, Ahmad; Fogelson, Jeremy L; Clarke, Michelle J

2014-07-01

A cost-effective procurement process for harvesting, storing, and using femoral head allografts is described. A brief review of the literature on the use of these allografts and a discussion of costs are provided. To describe a cost-effective method for the harvesting, storage, and use of femoral heads from patients undergoing total hip arthroplasty at our institution as a source of allograft bone. Spine fusion surgery uses a large proportion of commercially available bone grafts and bone substitutes. As the number of such surgical procedures performed in the United States continues to rise, these materials are at a historically high level of demand, which is projected to continue. Iliac crest bone autograft has historically been the standard of care, although this may be losing favor due to potential donor site morbidity. Although many substitutes are effective in promoting arthrodesis, their use is limited because of cost. Femoral heads are harvested under sterile conditions during total hip arthroplasty. The patient is tested per Food and Drug Administration regulations, and the tissue sample is cultured. The tissue is frozen and quarantined for a 6-month minimum pending repeat testing of donors and subsequently released for use. The relative cost-effectiveness of this tissue as a source of allograft bone is discussed. The average femoral head allograft is 54 to 56 mm in diameter and yields 50 cm of bone graft, with an average cost of US $435 for processing of the tissue resulting in a cost of US $8.70 per cm of allograft produced. Average production costs are significantly lower than those for other commonly available commercial bone grafts and substitutes. Femoral head allograft is a cost-effective alternative to commercially available allografts and bone substitutes. The method of procurement, storage, and use described could be adopted by other institutions in an effort to mitigate cost and increase supply. N/A.

The travel-related carbon dioxide emissions of atmospheric researchers

NASA Astrophysics Data System (ADS)

Stohl, A.

2008-11-01

Most atmospheric scientists agree that greenhouse gas emissions have already caused significant changes to the global climate system and that these changes will accelerate in the near future. At the same time, atmospheric scientists who like other scientists rely on international collaboration and information exchange travel a lot and, thereby, cause substantial emissions of CO2. In this paper, the CO2 emissions of the employees working at an atmospheric research institute (the Norwegian Institute for Air Research, NILU) caused by all types of business travel (conference visits, workshops, field campaigns, instrument maintainance, etc.) were calculated for the years 2005 2007. It is estimated that more than 90% of the emissions were caused by air travel, 3% by ground travel and 5% by hotel usage. The travel-related annual emissions were between 1.9 and 2.4 t CO2 per employee or between 3.9 and 5.5 t CO2 per scientist. For comparison, the total annual per capita CO2 emissions are 4.5 t worldwide, 1.2 t for India, 3.8 t for China, 5.9 t for Sweden and 19.1 t for Norway. The travel-related CO2 emissions of a NILU scientist, occurring in 24 days of a year on average, exceed the global average annual per capita emission. Norway's per-capita CO2 emissions are among the highest in the world, mostly because of the emissions from the oil industry. If the emissions per NILU scientist derived in this paper are taken as representative for the average Norwegian researcher, travel by Norwegian scientists would nevertheless account for a substantial 0.2% of Norway's total CO2 emissions. Since most of the travel-related emissions are due to air travel, water vapor emissions, ozone production and contrail formation further increase the relative importance of NILU's travel in terms of radiative forcing.

The travel-related carbon dioxide emissions of atmospheric researchers

NASA Astrophysics Data System (ADS)

Stohl, A.

2008-04-01

Most atmospheric scientists agree that greenhouse gas emissions have already caused significant changes to the global climate system and that these changes will accelerate in the near future. At the same time, atmospheric scientists who - like other scientists - rely on international collaboration and information exchange travel a lot and, thereby, cause substantial emissions of carbon dioxide (CO2). In this paper, the CO2 emissions of the employees working at an atmospheric research institute (the Norwegian Institute for Air Research, NILU) caused by all types of business travel (conference visits, workshops, field campaigns, instrument maintainance, etc.) were calculated for the years 2005-2007. It is estimated that more than 90% of the emissions were caused by air travel, 3% by ground travel and 5% by hotel usage. The travel-related annual emissions were between 1.9 and 2.4 t CO2 per employee or between 3.9 and 5.5 t CO2 per scientist. For comparison, the total annual per capita CO2 emissions are 4.5 t worldwide, 1.2 t for India, 3.8 t for China, 5.9 t for Sweden and 19.1 t for Norway. The travel-related CO2 emissions of a NILU scientist, occurring in 24 days of a year on average, exceed the global average annual per capita emission. Norway's per-capita CO2 emissions are among the highest in the world, mostly because of the emissions from the oil industry. If the emissions per NILU scientist derived in this paper are taken as representative for the average Norwegian researcher, travel by Norwegian scientists would nevertheless account for a substantial 0.2% of Norway's total CO2 emissions. Since most of the travel-related emissions are due to air travel, water vapor emissions, ozone production and contrail formation further increase the relative importance of NILU's travel in terms of radiative forcing.

Public reporting influences antibiotic and injection prescription in primary care: a segmented regression analysis.

PubMed

Liu, Chenxi; Zhang, Xinping; Wan, Jie

2015-08-01

Inappropriate use and overuse of antibiotics and injections are serious threats to the global population, particularly in developing countries. In recent decades, public reporting of health care performance (PRHCP) has been an instrument to improve the quality of care. However, existing evidence shows a mixed effect of PRHCP. This study evaluated the effect of PRHCP on physicians' prescribing practices in a sample of primary care institutions in China. Segmented regression analysis was used to produce convincing evidence for health policy and reform. The PRHCP intervention was implemented in Qian City that started on 1 October 2013. Performance data on prescription statistics were disclosed to patients and health workers monthly in 10 primary care institutions. A total of 326 655 valid outpatient prescriptions were collected. Monthly effective prescriptions were calculated as analytical units in the research (1st to 31st every month). This study involved multiple assessments of outcomes 13 months before and 11 months after PRHCP intervention (a total of 24 data points). Segmented regression models showed downward trends from baseline on antibiotics (coefficient = -0.64, P = 0.004), combined use of antibiotics (coefficient = -0.41, P < 0.001) and injections (coefficient = -0.5957, P = 0.001) after PRHCP intervention. The average expenditure of patients slightly increased monthly before the intervention (coefficient = 0.8643, P < 0.001); PRHCP intervention also led to a temporary increase in average expenditure of patients (coefficient = 2.20, P = 0.307) but slowed down the ascending trend (coefficient = -0.45, P = 0.033). The prescription rate of antibiotics and injections after intervention (about 50%) remained high. PRHCP showed positive effects on physicians' prescribing behaviour, considering the downward trends on the use of antibiotics and injections and average expenditure through the intervention. However, the effect was not immediately observed; a lag time existed before public reporting intervention worked. © 2015 John Wiley & Sons, Ltd.

Institutional Variation in Traumatic Brain Injury Acute Rehabilitation Practice.

PubMed

Seel, Ronald T; Barrett, Ryan S; Beaulieu, Cynthia L; Ryser, David K; Hammond, Flora M; Cullen, Nora; Garmoe, William; Sommerfeld, Teri; Corrigan, John D; Horn, Susan D

2015-08-01

To describe institutional variation in traumatic brain injury (TBI) inpatient rehabilitation program characteristics and evaluate to what extent patient factors and center effects explain how TBI inpatient rehabilitation services are delivered. Secondary analysis of a prospective, multicenter, cohort database. TBI inpatient rehabilitation programs. Patients with complicated mild, moderate, or severe TBI (N=2130). Not applicable. Mean minutes; number of treatment activities; use of groups in occupational therapy, physical therapy, speech therapy, therapeutic recreation, and psychology inpatient rehabilitation sessions; and weekly hours of treatment. A wide variation was observed between the 10 TBI programs, including census size, referral flow, payer mix, number of dedicated beds, clinician experience, and patient characteristics. At the centers with the longest weekday therapy sessions, the average session durations were 41.5 to 52.2 minutes. At centers with the shortest weekday sessions, the average session durations were approximately 30 minutes. The centers with the highest mean total weekday hours of occupational, physical, and speech therapies delivered twice as much therapy as the lowest center. Ordinary least-squares regression modeling found that center effects explained substantially more variance than patient factors for duration of therapy sessions, number of activities administered per session, use of group therapy, and amount of psychological services provided. This study provides preliminary evidence that there is significant institutional variation in rehabilitation practice and that center effects play a stronger role than patient factors in determining how TBI inpatient rehabilitation is delivered. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Initial experience at a university teaching hospital from using telemedicine to promote education through video conferencing.

PubMed

Pereira, Bruno Monteiro Tavares; Calderan, Thiago Rodrigues Araújo; Silva, Marcos Tadeu Nolasco da; Silva, Antonio Carlos da; Marttos, Antonio Carlos; Fraga, Gustavo Pereira

2012-01-01

Telehealth and telemedicine services are advancing rapidly, with an increasing spectrum of information and communication technologies that can be applied broadly to the population's health, and to medical education. The aim here was to report our institution's experience from 100 videoconferencing meetings between five different countries in the Americas over a one-year period. Retrospective study at Universidade Estadual de Campinas. Through a Microsoft Excel database, all conferences in all specialties held at our institution from September 2009 to August 2010 were analyzed retrospectively. A total of 647 students, physicians and professors participated in telemedicine meetings. A monthly mean of 8.3 (± 4.3) teleconferences were held over the analysis period. Excluding holidays and the month of inaugurating the telemedicine theatre, our teleconference rate reached a mean of 10.3 (± 2.7), or two teleconferences a week, on average. Trauma surgery and meetings on patient safety were by far the most common subjects discussed in our teleconference meetings, accounting for 22% and 21% of the total calls. Our experience with telemedicine meetings has increased students' interest; helped our institution to follow and discuss protocols that are already accepted worldwide; and stimulated professors to promote telemedicine-related research in their own specialties and keep up-to-date. These high-technology meetings have shortened distances in our vast country, and to other reference centers abroad. This virtual proximity has enabled discussion of international training with students and residents, to increase their overall knowledge and improve their education within this institution.

Financial Implications of Intravenous Anesthetic Drug Wastage in Operation Room

PubMed Central

Kaniyil, Suvarna; Krishnadas, A.; Parathody, Arun Kumar; Ramadas, K. T.

2017-01-01

Background and Objectives: Anesthetic drugs and material wastage are common in operation rooms (ORs). In this era of escalating health-care expenditure, cost reduction strategies are highly relevant. The aim of this study was to assess the amount of daily intravenous anesthetic drug wastage from major ORs and to estimate its financial burden. Any preventive measures to minimize drug wastage are also looked for. Methods: It was a prospective study conducted at the major ORs of a tertiary care hospital after getting the Institutional Research Committee approval. The total amount of all drugs wasted at the end of a surgical day from each major OR was audited for five nonconsecutive weeks. Drug wasted includes the drugs leftover in the syringes unutilized and opened vials/ampoules. The total cost of the wasted drugs and average daily loss were estimated. Results: The drugs wasted in large quantities included propofol, thiopentone sodium, vecuronium, mephentermine, lignocaine, midazolam, atropine, succinylcholine, and atracurium in that order. The total cost of the wasted drugs during the study period was Rs. 59,631.49, and the average daily loss was Rs. 1987.67. The average daily cost of wasted drug was maximum for vecuronium (Rs. 699.93) followed by propofol (Rs. 662.26). Interpretation and Conclusions: Financial implications of anesthetic drug wastage can be significant. Propofol and vecuronium contributed maximum to the financial burden. Suggestions for preventive measures to minimize the wastage include education of staff and residents about the cost of drugs, emphasizing on the judicial use of costly drugs. PMID:28663611

Computer-aided detection of colorectal polyps: can it improve sensitivity of less-experienced readers? Preliminary findings.

PubMed

Baker, Mark E; Bogoni, Luca; Obuchowski, Nancy A; Dass, Chandra; Kendzierski, Renee M; Remer, Erick M; Einstein, David M; Cathier, Pascal; Jerebko, Anna; Lakare, Sarang; Blum, Andrew; Caroline, Dina F; Macari, Michael

2007-10-01

To determine whether computer-aided detection (CAD) applied to computed tomographic (CT) colonography can help improve sensitivity of polyp detection by less-experienced radiologist readers, with colonoscopy or consensus used as the reference standard. The release of the CT colonographic studies was approved by the individual institutional review boards of each institution. Institutions from the United States were HIPAA compliant. Written informed consent was waived at all institutions. The CT colonographic studies in 30 patients from six institutions were collected; 24 images depicted at least one confirmed polyp 6 mm or larger (39 total polyps) and six depicted no polyps. By using an investigational software package, seven less-experienced readers from two institutions evaluated the CT colonographic images and marked or scored polyps by using a five-point scale before and after CAD. The time needed to interpret the CT colonographic findings without CAD and then to re-evaluate them with CAD was recorded. For each reader, the McNemar test, adjusted for clustered data, was used to compare sensitivities for readers without and with CAD; a Wilcoxon signed-rank test was used to analyze the number of false-positive results per patient. The average sensitivity of the seven readers for polyp detection was significantly improved with CAD-from 0.810 to 0.908 (P=.0152). The number of false-positive results per patient without and with CAD increased from 0.70 to 0.96 (95% confidence interval for the increase: -0.39, 0.91). The mean total time for the readings was 17 minutes 54 seconds; for interpretation of CT colonographic findings alone, the mean time was 14 minutes 16 seconds; and for review of CAD findings, the mean time was 3 minutes 38 seconds. Results of this feasibility study suggest that CAD for CT colonography significantly improves per-polyp detection for less-experienced readers. Copyright (c) RSNA, 2007.

Acute hospital costs after minimally invasive versus open lumbar interbody fusion: data from a US national database with 6106 patients.

PubMed

Wang, Michael Y; Lerner, Jason; Lesko, James; McGirt, Matthew J

2012-08-01

Retrospective multi-institutional database review. To determine if minimally invasive interbody fusion is associated with cost savings when compared with open surgery. Minimally invasive spine (MIS) surgeries are increasingly recognized as equivalent to open procedures. Although these techniques have been advocated for reducing pain, disability, and length of hospitalization, to date there has been little data demonstrating these benefits. This study analyzed inpatient hospital records from the Premier Perspective database (2002 to 2009), including patients who underwent a posterior lumbar fusion with interbody cage placement by ICD-9 code, and had implant charge codes that allowed determination if MIS pedicle screws were utilized. Exclusion criteria included a refusion surgery, deformity, >2 levels, and anterior fusion. Total costs were adjusted for covariates (age, sex, race, hospital geography and setting, payor, and comorbidities) using an analysis of covariance model. A total of 6106 patients were identified (1667 MIS and 4439 open). Length of stay (LOS) for 1-level MIS surgery averaged of 3.35 days versus 3.6 days for open surgery (P≤0.006). For 2-level MIS surgery LOS averaged of 3.4 days versus 4.03 days for open surgery (P≤0.001). Total inflation-adjusted acute hospitalization cost averaged $29,187 for 1-level MIS procedures versus $29,947 for open surgery, a nonsignificant difference (P=0.55). Total inflation-adjusted acute hospitalization cost averaged $2106 lower for 2-level MIS surgery (total costs of $33,879 for MIS vs. $35,984 for open surgery, P=0.0023). Cost savings were attributable primarily to lower room and board ($857), operating room ($359), pharmacy ($304), and laboratory ($166) costs in the MIS group. High variances in the 2-level open surgery with prolonged hospital stay also accounted for overall cost differences. This data from a large nationwide sample of hospitalizations demonstrates that MIS lumbar interbody fusion results in a statistically significant reduction in hospital LOS and a reduction in total hospital costs with 2-level surgery after adjusting for significant covariates. The majority of cost savings from MIS surgery were due to more rapid mobilization and discharge, as well as a reduction in outliers with extended hospitalizations.

Cost-effectiveness of cervical total disc replacement vs fusion for the treatment of 2-level symptomatic degenerative disc disease.

PubMed

Ament, Jared D; Yang, Zhuo; Nunley, Pierce; Stone, Marcus B; Kim, Kee D

2014-12-01

Cervical total disc replacement (CTDR) was developed to treat cervical spondylosis, while preserving motion. While anterior cervical discectomy and fusion (ACDF) has been the standard of care for 2-level disease, a randomized clinical trial (RCT) suggested similar outcomes. Cost-effectiveness of this intervention has never been elucidated. To determine the cost-effectiveness of CTDR compared with ACDF. Data were derived from an RCT that followed up 330 patients over 24 months. The original RCT consisted of multi-institutional data including private and academic institutions. Using linear regression for the current study, health states were constructed based on the stratification of the Neck Disability Index and a visual analog scale. Data from the 12-item Short-Form Health Survey questionnaires were transformed into utilities values using the SF-6D mapping algorithm. Costs were calculated by extracting Diagnosis-Related Group codes from institutional billing data and then applying 2012 Medicare reimbursement rates. The costs of complications and return-to-work data were also calculated. A Markov model was built to evaluate quality-adjusted life-years (QALYs) for both treatment groups. The model adopted a third-party payer perspective and applied a 3% annual discount rate. Patients included in the original RCT had to be diagnosed as having radiculopathy or myeloradiculopathy at 2 contiguous levels from C3-C7 that was unresponsive to conservative treatment for at least 6 weeks or demonstrated progressive symptoms. Incremental cost-effectiveness ratio of CTDR compared with ACDF. A strong correlation (R2 = 0.6864; P < .001) was found by projecting a visual analog scale onto the Neck Disability Index. Cervical total disc replacement had an average of 1.58 QALYs after 24 months compared with 1.50 QALYs for ACDF recipients. Cervical total disc replacement was associated with $2139 greater average cost. The incremental cost-effectiveness ratio of CTDR compared with ACDF was $24,594 per QALY at 2 years. Despite varying input parameters in the sensitivity analysis, the incremental cost-effectiveness ratio value stays below the threshold of $50,000 per QALY in most scenarios (range, -$58,194 to $147,862 per QALY). The incremental cost-effectiveness ratio of CTDR compared with traditional ACDF is lower than the commonly accepted threshold of $50,000 per QALY. This remains true with varying input parameters in a robust sensitivity analysis, reaffirming the stability of the model and the sustainability of this intervention.

Analysis of Management Practices in Lagos State Tertiary Institutions through Total Quality Management Structural Framework

ERIC Educational Resources Information Center

AbdulAzeez, Abbas Tunde

2016-01-01

This research investigated total quality management practices and quality teacher education in public tertiary institutions in Lagos State. The study was therefore designed to analyse management practices in Lagos state tertiary institutions through total quality management structural framework. The selected public tertiary institutions in Lagos…

To flap or not to flap: a discussion between a fish and a jellyfish

NASA Astrophysics Data System (ADS)

Martin, Nathan; Roh, Chris; Idrees, Suhail; Gharib, Morteza

2016-11-01

Fish and jellyfish are known to swim by flapping and by periodically contracting respectively, but which is the more effective propulsion mechanism? In an attempt to answer this question, an experimental comparison is made between simplified versions of these motions to determine which generates the greatest thrust for the least power. The flapping motion is approximated by pitching plates while periodic contractions are approximated by clapping plates. A machine is constructed to operate in either a flapping or a clapping mode between Reynolds numbers 1,880 and 11,260 based on the average plate tip velocity and span. The effect of the total sweep angle, total sweep time, plate flexibility, and duty cycle are investigated. The average thrust generated and power required per cycle are compared between the two modes when their total sweep angle and total sweep time are identical. In general, operating in the clapping mode required significantly more power to generate a similar thrust compared to the flapping mode. However, modifying the duty cycle for clapping caused the effectiveness to approach that of flapping with an unmodified duty cycle. These results suggest that flapping is the more effective propulsion mechanism within the range of Reynolds numbers tested. This work was supported by the Charyk Bio-inspired Laboratory at the California Institute of Technology, the National Science Foundation Graduate Research Fellowship under Grant No. DGE-1144469, and the Summer Undergraduate Research Fellowships program.

[A quantitative analysis of information-seeking behaviors regarding medical institutions with Spanish language support among South American Spanish-speaking migrants in Aichi Prefecture, Japan].

PubMed

Takaku, Michiko; Ichikawa, Seiichi; Kaneko, Noriyo

2015-01-01

This study aimed to explore the factors associated with information-seeking behaviors regarding medical institutions with Spanish language support among South American Spanish-speaking migrants living in Aichi Prefecture, Japan. The survey targeted South American Spanish-speaking migrants aged 18 years and older currently residing in Aichi Prefecture who had lived in Japan for at least three months and who had previously seen a doctor in Japan. The questionnaire was written in Spanish and the survey was conducted from April to July, 2010. Wilson's information behavior model was used to study information-seeking behavior regarding medical institutions with Spanish language support among 245 respondents who completed the questionnaires (response rate: 58.9%). Experience seeking medical institutions with Spanish language support in the Tokai area was set as the dependent variable and a chi-square test was conducted to examine relationships with language support needs, recognition of and access to medical institutions with Spanish language support, living situation in Japan, and Japanese language skills. Among the 245 respondents, 106 were male (43.3%) and 139 were female (56.7%). The average age was 39.6±11.2 years old and 84.5% were Peruvian. The average length of residency in Japan was 11.0±5.7 years, and 34.3% of respondents had lived in Aichi for 5-9 years. A total of 165 respondents (67.3%) had searched for medical institutions with Spanish language support, while 80 (32.7%) had not. Information-seeking behavior regarding medical institutions with Spanish language support was associated with having previously experienced a need for Spanish language support when seeing doctors in Japan, finding and attending medical institutions with Spanish language support in the Tokai area, length of residency in Japan, Japanese language skills, and the language used in daily life. Experience in requiring Spanish support when sick or injured in Japan motivated respondents to seek medical institutions with Spanish language support. Communication difficulties in Japanese, speaking Spanish in daily life, and length of residency in Japan were relevant factors in their information-seeking behaviors. Respondents were likely to obtain information from family, friends, co-workers, and Spanish media, but not from public institutions that distribute Spanish material. Finding an effective way to disseminate health-related information was a fundamental health issue for South American Spanish-speaking migrants.

Comparative hospital cost-analysis of open and robotic-assisted radical prostatectomy.

PubMed

Tomaszewski, Jeffrey J; Matchett, Jarred C; Davies, Benjamin J; Jackman, Stephen V; Hrebinko, Ronald L; Nelson, Joel B

2012-07-01

To perform a contemporary comparative cost-analysis of robotic-assisted laparoscopic radical prostatectomy (RARP) and open radical retropubic prostatectomy (RRP). All patients undergoing RARP (n = 115) or RRP (n = 358) by 1 of 4 surgeons at a single institution during a 15-month period were retrospectively reviewed. The hospital length of stay (LOS), operative time, hospital charges, reimbursement, and direct and indirect hospital costs were analyzed and compared. The mean LOS between patients undergoing RARP (1.2 ± 0.6 days) and RRP (1.4 ± 0.8 days) was not significantly different. The operating room supply costs per case were almost 7 times greater for RARP ($2852 ± $528) than for RRP ($417 ± $59; P < .05). The ancillary, cardiology, imaging, administrative, laboratory, and pharmacy costs were not significantly different between the 2 approaches. The mean total costs per case for RARP exceeded the total costs for RRP by 62% ($14 006 ± $1641 vs $8686 ± $1989; P < .05). Payment to the hospital from all sources was nearly equivalent: $10 011 for RRP and $9993 for RARP. Therefore, the average profit for each RRP was $1325 and each RARP lost $4013. In the present single-institution analysis, the total actual costs associated with RARP were significantly greater than those for RRP and were attributable to the robotic equipment and supplies. Copyright © 2012 Elsevier Inc. All rights reserved.

Variability of thermal and precipitation conditions in the growing season in Poland in the years 1966-2015

NASA Astrophysics Data System (ADS)

Tomczyk, Arkadiusz M.; Szyga-Pluta, Katarzyna

2018-03-01

The aim of the study was to identify the thermal and precipitation conditions and their changes in the growing season in Poland in the years 1966-2015. Data on average daily air temperature and daily precipitation totals for 30 stations from the period of 1966-2015 were used. The data were obtained from the collections of the Institute of Meteorology and Water Management—National Research Institute. The growing season was defined as the period of average daily air temperature ≥ 5 °C. The mathematical formulas proposed by Gumiński (1948) were used to determine its start and end dates. In the growing season in Poland in the years 1966-2015, there were more significant changes in the thermal conditions than there were in the precipitation conditions. In terms of long-term trends over the study period, thermal conditions during the growing season are characterised by an increase in mean air temperature, an increase in the sum of air temperatures and an increasing occurrence of seasons classified as above-normal seasons. Precipitation conditions of the growing season show large temporal and spatial variations in precipitation and a predominance of normal conditions. The changes in precipitation were not statistically significant, except for Świnoujście.

Breast cancer and screening in persons with an intellectual disability living in institutions in France.

PubMed

Trétarre, B; Bourgarel, S; Stoebner-Delbarre, A; Jacot, W; Bessaoud, F; Satge, D

2017-03-01

We aimed to describe, among a population of women with intellectual disabilities (ID) living in institutions in France, the characteristics in whom breast cancer (BC) was diagnosed and of those who participated in BC screening. Study was performed in 2009 among a random, representative sample of women with ID living in institutions in France. Participants answered a questionnaire either directly by themselves, or with the help of an intermediary. In total, 978 women with ID aged over 18 years were included, and 14 were diagnosed with BC. The incidence observed in this sample of women with ID is similar to that of the general population (standardised incidence ratio, SIR 0.857, 95% confidence interval (CI) 0.42-1.53). Average age at diagnosis was 47.8 years, and the risk of developing BC before the age of 50 was 2.03% (0.4-3.66). This risk was not significantly different from that of the general population (2.4%, 1.0-3.78). Obesity was almost twice as frequent in women who had BC as compared to those without BC (43% vs. 22.5%, P = 0.0196). Among the 310 women aged >50 years and eligible for the national BC screening programme, 238 (77%) had already had at least one mammogram, and 199 had had it within the previous 2 years. Adherence to the screening programme was 64.2% (199/310) in the participating institutions. This rate was slightly higher than the national average of 62% for the same period. The results of this study show that BC is equally as frequent among women with ID living in institutions as in the general population, and occurs at around the same age. Obesity was significantly more frequent among women in whom BC was diagnosed in our study. Participation in BC screening is slightly higher among women with ID living in institutions than among the general population. © 2016 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Operating efficiency of an emergency Burns theatre: An eight month analysis.

PubMed

Mohan, Arvind; Lutterodt, Christopher; Leon-Villapalos, Jorge

2017-11-01

The efficient use of operating theatres is important to insure optimum cost-benefit for the hospital. We used the emergency Burns theatre as a model to assess theatre efficiency at our institution. Data was collected retrospectively on every operation performed in the Burns theatre between 01/04/15 and 30/11/15. Each component of the operating theatre process was considered and integrated to calculate values for surgical/anaesthetic time, changeover time and ultimately theatre efficiency. A total of 426 operations were carried out over 887h of allocated theatre time (ATT). Actual operating time represented 67.7%, anaesthetic time 8.8% and changeover time 14.2% of ATT. The average changeover time between patients was 30.1min. Lists started on average 27.7min late each day. There were a total of 5.8h of overruns and 9.6h of no useful activity. Operating theatre efficiency was 69.3% for the 8 month period. Our study highlights areas where theatre efficiency can be improved. We suggest various strategies to improve this that may be applied universally. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Design and implementation of an institutional case report form library.

PubMed

Nahm, Meredith; Shepherd, John; Buzenberg, Ann; Rostami, Reza; Corcoran, Andrew; McCall, Jonathan; Pietrobon, Ricardo

2011-02-01

Case report forms (CRFs) are used to collect data in clinical research. Case report form development represents a significant part of the clinical trial process and can affect study success. Libraries of CRFs can preserve the organizational knowledge and expertise invested in CRF development and expedite the sharing of such knowledge. Although CRF libraries have been advocated, there have been no published accounts reporting institutional experiences with creating and using them. We sought to enhance an existing institutional CRF library by improving information indexing and accessibility. We describe this CRF library and discuss challenges encountered in its development and implementation, as well as future directions for continued work in this area. We transformed an existing but underused and poorly accessible CRF library into a resource capable of supporting and expediting clinical and translational investigation at our institution by (1) expanding access to the entire institution; (2) adding more form attributes for improved information retrieval; and (3) creating a formal information curation and maintenance process. An open-source content management system, Plone (Plone.org), served as the platform for our CRF library. We report results from these three processes. Over the course of this project, the size of the CRF library increased from 160 CRFs comprising an estimated total of 17,000 pages, to 177 CRFs totaling 1.5 gigabytes. Eighty-two of these CRFs are now available to researchers across our institution; 95 CRFs remain within a contractual confidentiality window (usually 5 years from database lock) and are not available to users outside of the Duke Clinical Research Institute (DCRI). Conservative estimates suggest that the library supports an average of 37 investigators per month. The resources needed to curate and maintain the CRF library require less than 10% of the effort of one full-time equivalent employee. Although we succeeded in expanding use of the CRF library, creating awareness of such institutional resources among investigators and research teams remains challenging and requires additional efforts to overcome. Institutions that have not achieved a critical mass of attractive research resources or effective dissemination mechanisms may encounter persistent difficulty attracting researchers to use institutional resources. Further, a useful CRF library requires both an initial investment of resources for development, as well as ongoing maintenance once it is established. CRF libraries can be established and made broadly available to institutional researchers. Curation - that is, indexing newly added forms - is required. Such a resource provides knowledge management capacity for institutions until standards and software are available to support widespread exchange of data and form definitions.

A study of institutional spending on open access publication fees in Germany.

PubMed

Jahn, Najko; Tullney, Marco

2016-01-01

Publication fees as a revenue source for open access publishing hold a prominent place on the agendas of researchers, policy makers, and academic publishers. This study contributes to the evolving empirical basis for funding these charges and examines how much German universities and research organisations spent on open access publication fees. Using self-reported cost data from the Open APC initiative, the analysis focused on the amount that was being spent on publication fees, and compared these expenditure with data from related Austrian (FWF) and UK (Wellcome Trust, Jisc) initiatives, in terms of both size and the proportion of articles being published in fully and hybrid open access journals. We also investigated how thoroughly self-reported articles were indexed in Crossref, a DOI minting agency for scholarly literature, and analysed how the institutional spending was distributed across publishers and journal titles. According to self-reported data from 30 German universities and research organisations between 2005 and 2015, expenditures on open access publication fees increased over the years in Germany and amounted to € 9,627,537 for 7,417 open access journal articles. The average payment was € 1,298, and the median was € 1,231. A total of 94% of the total article volume included in the study was supported in accordance with the price cap of € 2,000, a limit imposed by the Deutsche Forschungsgemeinschaft (DFG) as part of its funding activities for open access funding at German universities. Expenditures varied considerably at the institutional level. There were also differences in how much the institutions spent per journal and publisher. These differences reflect, at least in part, the varying pricing schemes in place including discounted publication fees. With an indexing coverage of 99%, Crossref thoroughly indexed the open access journals articles included in the study. A comparison with the related openly available cost data from Austria and the UK revealed that German universities and research organisations primarily funded articles in fully open access journals. By contrast, articles in hybrid journal accounted for the largest share of spending according to the Austrian and UK data. Fees paid for hybrid journals were on average more expensive than those paid for fully open access journals.

A study of institutional spending on open access publication fees in Germany

PubMed Central

Tullney, Marco

2016-01-01

Publication fees as a revenue source for open access publishing hold a prominent place on the agendas of researchers, policy makers, and academic publishers. This study contributes to the evolving empirical basis for funding these charges and examines how much German universities and research organisations spent on open access publication fees. Using self-reported cost data from the Open APC initiative, the analysis focused on the amount that was being spent on publication fees, and compared these expenditure with data from related Austrian (FWF) and UK (Wellcome Trust, Jisc) initiatives, in terms of both size and the proportion of articles being published in fully and hybrid open access journals. We also investigated how thoroughly self-reported articles were indexed in Crossref, a DOI minting agency for scholarly literature, and analysed how the institutional spending was distributed across publishers and journal titles. According to self-reported data from 30 German universities and research organisations between 2005 and 2015, expenditures on open access publication fees increased over the years in Germany and amounted to € 9,627,537 for 7,417 open access journal articles. The average payment was € 1,298, and the median was € 1,231. A total of 94% of the total article volume included in the study was supported in accordance with the price cap of € 2,000, a limit imposed by the Deutsche Forschungsgemeinschaft (DFG) as part of its funding activities for open access funding at German universities. Expenditures varied considerably at the institutional level. There were also differences in how much the institutions spent per journal and publisher. These differences reflect, at least in part, the varying pricing schemes in place including discounted publication fees. With an indexing coverage of 99%, Crossref thoroughly indexed the open access journals articles included in the study. A comparison with the related openly available cost data from Austria and the UK revealed that German universities and research organisations primarily funded articles in fully open access journals. By contrast, articles in hybrid journal accounted for the largest share of spending according to the Austrian and UK data. Fees paid for hybrid journals were on average more expensive than those paid for fully open access journals. PMID:27602289

Physician Education on Controllable Costs Significantly Reduces Cost of Laparoscopic Hysterectomy.

PubMed

Croft, Katherine; Mattingly, Patricia J; Bosse, Patrick; Naumann, R Wendel

2017-01-01

To determine whether educating surgeons about their controllable instrumentation costs by providing cost data on total laparoscopic hysterectomy (LH) would reduce the cost of this procedure. Prospective cohort study (Canadian Task Force classification III). Academic-affiliated community hospital. Patients who underwent LH between April 2014 and March 2015 with surgeons who performed at least 10 LHs during that time period, along with a second group who underwent LH with the same cohort of surgeons between July 2015 and September 2015. The cost of LH was calculated for all surgeons who performed more than 10 LHs between April 2014 and March 2015. Itemized cost data were collected. The individual costs, as well as a summary of the data, were shared with all of the physicians to highlight areas of potential cost savings. The costs were then measured for 3 months after the educational intervention (July-September 2015) to gauge the impact of physician cost education. Thirteen surgeons met the criteria for inclusion in this analysis. Together, they performed 271 hysterectomies, with an average instrumentation cost of $1539.47 ± $294.16 and an average operating room time of 178 ± 26 minutes. Bipolar instrument choice represented 37% of the baseline costs, followed by 10% for trocar, 9% for cuff closure, and 8% for uterine manipulator. This same group of surgeons performed a total of 69 hysterectomies in the 3-month follow-up period of July-September 2015, with an average instrumentation cost of $1282.62 ± $235.03 and an average operating room time of 163 ± 50 minutes. There was statistically significant cost reduction of $256.85 ± $190.69 (p = .022), with no significant change in operating room time. Bipolar instrument cost decreased significantly, by $130.02 ± $125.02 (p = .021), representing 51% of the total cost savings. Trocar, cuff closure, and uterine manipulator costs were not significant sources of cost savings on average, but did represent sources of cost savings for some surgeons individually. Given adequate education about the products available for use in their institution, surgeons make informed decisions regarding the choice of instrumentation, allowing them to directly impact the cost of total LH, resulting in cost savings. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical care pathway after elective colon resection.

PubMed

Stephen, Antonia E; Berger, David L

2003-03-01

Patient care pathways have been developed for operative procedures with documented improvements in length of stay and cost without compromising outcome. The average hospital stay after colonic resection is 5 to 10 days. This study describes a clinical pathway for colon resections and examines patient outcome before and after institution of the pathway. One hundred thirty-eight patients underwent elective colon resections at our institution by a single surgeon before (n = 52) and after (n = 86) introduction of a clinical pathway. Length of stay, postoperative complications, readmissions, and cost per patient were compared between the 2 groups. Mean total length of stay (+/- standard deviation [SD]) was less in the postclinical pathway patients (3.7 +/- 1.5 days) compared to preclinical pathway patients (6.6 +/- 3.3 days) (P <.001). When adjusted for age, sex, diagnosis, and type of operation, the difference in length of stay remains statistically significant (P <.001). There was 1 readmission in the prepathway group and 8 readmissions in the postpathway group. When the readmissions were added to the original admissions, the mean length of stay in the postpathway patients was 4.2 +/- 2.8 days and in the prepathway patients was 6.9 +/- 4.1 days (P <.001). The average cost per patient (+/- standard error of the mean), with readmission costs added, was 9310 +/- 5170 US dollars in the prepathway group and 7070 +/- 3670 US dollars in the postpathway group (P =.002). The institution of a clinical pathway for elective, open colon resections can be done safely with improvements in cost and length of stay.

Intravenous Lipid Emulsion as an Antidote for the Treatment of Acute Poisoning: A Bibliometric Analysis of Human and Animal Studies.

PubMed

Zyoud, Sa'ed H; Waring, W Stephen; Al-Jabi, Samah W; Sweileh, Waleed M; Rahhal, Belal; Awang, Rahmat

2016-11-01

In recent years, there has been increasing interest in the role of intravenous lipid formulations as potential antidotes in patients with severe cardiotoxicity caused by drug toxicity. The aim of this study was to conduct a comprehensive bibliometric analysis of all human and animal studies featuring lipid emulsion as an antidote for the treatment of acute poisoning. The Scopus database search was performed on 5 February 2016 to analyse the research output related to intravenous lipid emulsion as an antidote for the treatment of acute poisoning. Research indicators used for analysis included total number of articles, date (year) of publication, total citations, value of the h-index, document types, countries of publication, journal names, collaboration patterns and institutions. A total of 594 articles were retrieved from Scopus database for the period of 1955-2015. The percentage share of global intravenous lipid emulsion research output showed that research output was 85.86% in 2006-2015 with yearly average growth in this field of 51 articles per year. The USA, United Kingdom (UK), France, Canada, New Zealand, Germany, Australia, China, Turkey and Japan accounted for 449 (75.6%) of all the publications. The total number of citations for all documents was 9,333, with an average of 15.7 citations per document. The h-index of the retrieved documents for lipid emulsion research as antidote for the treatment of acute poisoning was 49. The USA and the UK achieved the highest h-indices, 34 and 14, respectively. New Zealand produced the greatest number of documents with international collaboration (51.9%) followed by Australia (50%) and Canada (41.4%) out of the total number of publications for each country. In summary, we found an increase in the number of publications in the field of lipid emulsion after 2006. The results of this study demonstrate that the majority of publications in the field of lipid emulsion were published by high-income countries. Researchers from institutions in the USA led scientific production on lipid emulsion research. There is an obvious need to promote a deeper engagement through international collaborative research projects and funding mechanisms. © 2016 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

Estimation of health-care costs for work-related injuries in the Mexican Institute of Social Security.

PubMed

Carlos-Rivera, Fernando; Aguilar-Madrid, Guadalupe; Gómez-Montenegro, Pablo Anaya; Juárez-Pérez, Cuauhtémoc A; Sánchez-Román, Francisco Raúl; Durcudoy Montandon, Jaqueline E A; Borja-Aburto, Víctor Hugo

2009-03-01

Data on the economic consequences of occupational injuries is scarce in developing countries which prevents the recognition of their economic and social consequences. This study assess the direct heath care costs of work-related accidents in the Mexican Institute of Social Security, the largest health care institution in Latin America, which covered 12,735,856 workers and their families in 2005. We estimated the cost of treatment for 295,594 officially reported occupational injuries nation wide. A group of medical experts devised treatment algorithms to quantify resource utilization for occupational injuries to which unit costs were applied. Total costs were estimated as the product of the cost per illness and the severity weighted incidence of occupational accidents. Occupational injury rate was 2.9 per 100 workers. Average medical care cost per case was $2,059 USD. The total cost of the health care of officially recognized injured workers was $753,420,222 USD. If injury rate is corrected for underreporting, the cost for formal injured workers is 791,216,460. If the same costs are applied for informal workers, approximately half of the working population in Mexico, the cost of healthcare for occupational injuries is about 1% of the gross domestic product. Health care costs of occupational accidents are similar to the economic direct expenditures to compensate death and disability in the social security system in Mexico. However, indirect costs might be as important as direct costs.

Reduced-dose C-arm computed tomography applications at a pediatric institution.

PubMed

Acord, Michael; Shellikeri, Sphoorti; Vatsky, Seth; Srinivasan, Abhay; Krishnamurthy, Ganesh; Keller, Marc S; Cahill, Anne Marie

2017-12-01

Reduced-dose C-arm computed tomography (CT) uses flat-panel detectors to acquire real-time 3-D images in the interventional radiology suite to assist with anatomical localization and procedure planning. To describe dose-reduction techniques for C-arm CT at a pediatric institution and to provide guidance for implementation. We conducted a 5-year retrospective study on procedures using an institution-specific reduced-dose protocol: 5 or 8 s Dyna Rotation, 248/396 projection images/acquisition and 0.1-0.17 μGy/projection dose at the detector with 0.3/0.6/0.9-mm copper (Cu) filtration. We categorized cases by procedure type and average patient age and calculated C-arm CT and total dose area product (DAP). Two hundred twenty-two C-arm CT-guided procedures were performed with a dose-reduction protocol. The most common procedures were temporomandibular and sacroiliac joint injections (48.6%) and sclerotherapy (34.2%). C-arm CT was utilized in cases of difficult percutaneous access in less common applications such as cecostomy and gastrostomy placement, foreign body retrieval and thoracentesis. C-arm CT accounted for between 9.9% and 80.7% of the total procedural DAP. Dose-reducing techniques can preserve image quality for intervention while reducing radiation exposure to the child. This technology has multiple applications within pediatric interventional radiology and can be considered as an adjunctive imaging tool in a variety of procedures, particularly when percutaneous access is challenging despite routine fluoroscopic or ultrasound guidance.

Rising to the Challenge of promoting research in primary care and nursing: Research productivity and professional view.

PubMed

Giménez, Nuria; Caro, Conxi; Ponsa, Ester; Perez Ortiz, Ángel Mauricio; Navazo, Inma; Gavagnach, Montse

To analyze the evolution of scientific production in a privately managed public institution, and to explore the perceptions of primary healthcare professionals with regard to research. The institution includes a university hospital and 10 primary health centres, 673 physicians, and 747 nurses. A bibliometric analysis on scientific production was performed. A questionnaire was designed, with 5 sections (sociodemographic data, competences, needs, motivation and satisfaction s with research) and 40 items (scale of 1-10). Its understanding, pertinence and validity of content were analyzed. In 2014, the contribution of primary care to research accounted for 2.8% of the total impact factor of publications, and 4.8% of clinical trials. Nurses accounted for 0.6% of the impact factor, having published articles in first quartile journals. A total of 110(51%) primary care professionals participated in the survey. The average motivation for research was 7.85 points and satisfaction with research 4.37 points. The interest in receiving training in research (8.46 points) was highlighted as well as the lack of leadership in research (2.93 points). Regarding competences, research in teams was highlighted (6.87 points), and obtaining funding was noted as a negative (3.44 points). Research is experiencing a surge in all institutions, especially in hospitals. The primary care professionals expressed their motivation towards research and their dissatisfaction with the difficulties encountered, especially in obtaining funds. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

[Survey of silicone oil for ocular diseases in Japan].

PubMed

Sakamoto, Taiji; Hida, Tetsuo; Tano, Yasuo; Negi, Akira; Takeuchi, Shinobu; Ishibashi, Tatsuro; Inoue, Yoshitsugu; Ohguro, Nobuyuki; Okada, Annabelle Ayame

2008-09-01

To survey the use of silicone oil in clinical ophthalmology in Japan. Questionnaires were sent to 1,240 hospitals registered as being ophthalmology residency training institutions with the Japanese Ophthalmological Society as of September 2007. Responses were collected via the Internet and results totaled. The use of silicone oil at each institution for the 2006 one-year period was assessed, included queries regarding type of silicone oil, indication for use, results and complications. Hospitals were divided into non-specialty institutions, intermediate-specialty institutions and specialty institutions based on number of vitrectomy procedures performed in the one-year period, and trends were analyzed based on these divisions. Responses were received from 272 institutions (21.9% response rate). Of a total of 36,104 vitrectomy procedures, silicone oil was used in 2,170 cases (6.0%). The diagnosis was proliferative vitreoretinopathy in the majority of cases, followed by proliferative diabetic retinopathy and rhegmatogenous retinal detachment. The majority of institutions replied that the indication for use was complicated case. The type of silicone oil used was ophthalmic formulation in 120 institutions (54.1%) and industrial formulation in 73 institutions (32.9%). Specialty institutions had a higher rate of use of the industrial formulation. The average volume used at one time was 6.4 ml. The majority of institutions responded that silicone oil removal was performed at 3 months after the initial vitrectomy. Silicone oil was not removed in 530 cases in which continued tamponade was judged to be appropriate; this comprised 53.3% of cases at non-specialty institutions. The overall evaluation for silicone oil use was good; silicone oil was rated as being indispensable in 72 cases (31.2%) and effective in 130 cases (56.3%). Responses stating a high need for silicone oil were most frequent for proliferative vitreoretinopathy and proliferative diabetic retinopathy. Complications related to silicone oil use were glaucoma in 125 cases (5.6%), intraocular pressure elevation in 411 cases (18.4%), hypotony in 28 cases (1.3%), endophthalmitis in 5 cases (0.22%), retinal detachment in 13 cases (0.58%), corneal opacification in 105 cases (4.7%), inadvertant subretinal infusion in 31 cases (1.4%) and silicone oil emulsification in 82 cases (3.7%). It was the opinion of many institutions that, in cases where silicone oil could not be used, the number of necessary surgical procedures increased, with lower rates of cure and greater burden on the patient. Silicone oil was utilized in approximately 1 in every 17 vitrectomy procedures performed in 2006 by the Japanese institutions surveyed. Complications were observed, however overall the indications were appropriate and the use of silicone oil was judged to be necessary by nearly 90% of institutions surveyed.

12 CFR 303.207 - Restricted activities for critically undercapitalized institutions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... institution is required to provide notice to the appropriate federal banking agency. Materiality will be... liabilities at a rate that would increase the institution's weighted average cost of funds to a level...

Nutritional quality of lunches consumed by Korean workers: Comparison between institutional and commercial lunches

PubMed Central

Kim, Won Gyoung; Choi, Injoo

2016-01-01

BACKGROUND/OBJECTIVES The nutritional quality of lunches is an important factor related to workers' health. This study examined the nutritional quality of Korean workers' lunches with a focus on comparing institutional and commercial lunches. SUBJECTS/METHODS The data from a 1-day, 24-hour dietary recall from the 5th Korea National Health and Nutrition Examination Survey (2010-2012) were analyzed. A total of 2,192 subjects aged 19 to 64 years, who had consumed lunches served by institutional or commercial food service vendors, were included for analysis. The nutritional quality of the lunches of the institutional lunch group (n=626) and the commercial lunch group (n=1,566) was compared in terms of the number of servings, food groups, nutrient intake, Nutrient Adequacy Ratio (NAR), and Mean Adequacy Ratio (MAR). RESULTS The NAR and MAR were significantly higher in the institutional lunches than in the commercial lunches, but more than half of workers in both groups obtained over 65% of their energy from carbohydrate. The average sodium intake from the lunches exceeded the daily intake goal (2,000 mg) in both groups. More than half of workers in both groups presented less than one-third of their respective recommended daily intake of riboflavin and calcium. With the exception of riboflavin, the nutrient intake from lunches accounted for more than 35% of the daily nutrient intake. CONCLUSIONS The overall nutritional quality of institutional lunches was higher than that of commercial lunches. However, institutional lunches had room for improvement in terms of nutritional quality. PMID:27909558

Will Medicare Readmission Penalties Motivate Hospitals to Reduce Arthroplasty Readmissions?

PubMed

Clement, R Carter; Gray, Caitlin M; Kheir, Michael M; Derman, Peter B; Speck, Rebecca M; Levin, L Scott; Fleisher, Lee A

2017-03-01

The Centers for Medicare & Medicaid Services (CMS) recently imposed penalties against hospitals with above-average 30-day readmission rates following total joint arthroplasty (TJA). Hospitals must decide whether investments in readmission prevention are worthwhile. This study examines the financial incentives associated with unplanned readmissions before and after invocation of these penalties. Financial data were reviewed for 2028 consecutive primary TJAs performed on Medicare beneficiaries over a 2-year period at an urban academic health system. Readmission penalties were estimated in accordance with CMS policies. Unplanned readmissions generated a $4416 median contribution margin. The initial hospitalizations (when the TJA was performed) were financially unfavorable for patients subsequently readmitted relative to those not readmitted due to increased costs of care (P = .002), but these costs were more than outweighed by the increased reimbursement earned during the readmission (P < .001), ultimately making readmitted patients financially preferable (P < .001). Going forward, penalties will be levied for risk-adjusted readmission rates above the national rate of 4.8%. For the institution under review, the penalty per readmission outweighs the financial gains earned through readmission by $12,184, resulting in a net loss from readmissions if the rate exceeds 6.5%. It will be financially optimal to maintain a readmission rate (after risk adjustment) equal to the national average but exceeding that rate will be $7768 more expensive per readmission than undershooting that target. If our results are generalizable, unplanned Medicare readmissions have traditionally been financially beneficial, but CMS penalties outweigh this benefit. Thus, penalties should incentivize institutions to maintain below-average arthroplasty readmissions rates. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of Body Mass Index on Complications and Reoperations After Total Hip Arthroplasty.

PubMed

Wagner, Eric R; Kamath, Atul F; Fruth, Kristin M; Harmsen, William S; Berry, Daniel J

2016-02-03

High body mass index (BMI) is associated with increased rates of complications after total hip arthroplasty. Studies to date have evaluated risk mainly as a dichotomous variable according to BMI thresholds. The purpose of this paper was to characterize the risk of complications and implant survival according to BMI as a continuous variable. Using prospectively collected data from our institutional total joint registry, we analyzed 21,361 consecutive hips (17,774 patients) treated with primary total hip arthroplasty between 1985 and 2012 at a single institution. The average BMI at the time of surgery was 28.7 kg/m(2) (range, 15 to 69 kg/m(2)). Estimates of revision surgery and common complications associated with BMI were analyzed using the Kaplan-Meier method of assessing survivorship, with associations of outcomes assessed using a Cox model. Utilizing smoothing spline parameterization, we found that reoperation (p < 0.001) and implant revision or removal rates (p = 0.002) increased with increasing BMI. Increasing BMI was associated with increased rates of early hip dislocation (p = 0.02), wound infection, and, most strikingly, deep periprosthetic infection (a hazard ratio of 1.09 per unit of BMI >25 kg/m(2); p < 0.001). However, we found no association between increasing BMI and any revision for mechanical failure of the implant or between increasing BMI and revision for aseptic implant loosening. There was an inverse correlation between increasing BMI and risk of revision for bearing wear. The rates of reoperation, implant revision or removal, and common complications after total hip arthroplasty were strongly associated with BMI. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Pharmacy student debt and return on investment of a pharmacy education.

PubMed

Cain, Jeff; Campbell, Tom; Congdon, Heather Brennan; Hancock, Kim; Kaun, Megan; Lockman, Paul R; Evans, R Lee

2014-02-12

To describe the current landscape within the profession of pharmacy regarding student tuition, indebtedness, salaries, and job potential. Pharmacy tuition and student debt data were obtained through the American Association of Colleges of Pharmacy Institutional Research website. Tuition was defined as average first-year tuition and fees for accredited schools. Debt was defined as the total average amount borrowed. Median salaries and numbers of jobs were obtained from the United States Department of Labor. In-state tuition at public schools rose an average of $1,211 ± 31 (r2 = 0.996), whereas out-of-state tuition at public schools rose significantly faster at $1,838 ± 80 per year (r2 = 0.988). The average tuition cost for pharmacy school has increased 54% in the last 8 years. The average pharmacist salary has risen from $75,000 to over $112,000 since 2002. The increase in salary has been nearly linear (r2 = 0.988) rising $4,409 ± $170 dollars per year. However, average salary in 2011 was $3,064 below the predicted value based upon a linear regression of salaries over 10 years. The number of pharmacist jobs in the United States has risen from 215,000 jobs in 2003 to 275,000 in 2010. However, there were 3,000 fewer positions in 2012 than in 2011. In 2011, average indebtedness for pharmacy students ($114,422) was greater than average first-year salary ($112,160). Rising tuition and student indebtedness is a multifaceted problem requiring attention from a number of parties including students, faculty members, universities, and accreditation and government entities.

Workplace Determinants of Endotoxin Exposure in Dental Healthcare Facilities in South Africa

PubMed Central

Singh, Tanusha S.; Bello, Braimoh; Mabe, Onnicah D.; Renton, Kevin; Jeebhay, Mohamed F.

2010-01-01

Objectives: Aerosols generated during dental procedures have been reported to contain endotoxin as a result of bacterial contamination of dental unit water lines. This study investigated the determinants of airborne endotoxin exposure in dental healthcare settings. Methods: The study population included dental personnel (n = 454) from five academic dental institutions in South Africa. Personal air samples (n = 413) in various dental jobs and water samples (n = 403) from dental handpieces and basin taps were collected. The chromogenic-1000 limulus amebocyte lysate assay was used to determine endotoxin levels. Exposure metrics were developed on the basis of individually measured exposures and average levels within each job category. Analysis of variance and multivariate linear regression models were constructed to ascertain the determinants of exposure in the dental group. Results: There was a 2-fold variation in personal airborne endotoxin from the least exposed (administration) to the most exposed (laboratory) jobs (geometric mean levels: 2.38 versus 5.63 EU m−3). Three percent of personal samples were above DECOS recommended exposure limit (50 EU m−3). In the univariate linear models, the age of the dental units explained the most variability observed in the personal air samples (R2 = 0.20, P < 0.001), followed by the season of the year (R2 = 0.11, P < 0.001). Other variables such as institution and total number of dental units per institution also explained a modest degree of variability. A multivariate model explaining the greatest variability (adjusted R2 = 0.40, P < 0.001) included: the age of institution buildings, total number of dental units per institution, ambient temperature, ambient air velocity, endotoxin levels in water, job category (staff versus students), dental unit model type and age of dental unit. Conclusions: Apart from job type, dental unit characteristics are important predictors of airborne endotoxin levels in this setting. PMID:20044586

The Elementary School as a Total Institution.

ERIC Educational Resources Information Center

Wiggins, Thomas; Langenbach, Michael

The proliferation of additional responsibilities in health, welfare, and recreation suggests the justification of the conceptualization of the elementary school as a total institution. This research was undertaken to investigate the application of Goffman's concept of total institution to the public elementary school. An exploratory field study…

Selected Cardiovascular Risk Markers in Vegetarians and Subjects of General Population.

PubMed

Valachovičová, Martina; Príbojová, Jana; Urbánek, Vladimír; Bírošová, Lucia

2017-12-01

Besides genetic factors there are environmental effects including nutritional habits which can influence the risk of age-related diseases. The aim of the study was to assess the age dependence of selected cardiovascular risk markers in two groups of subjects with different nutritional pattern. In 470 long-term vegetarians and 478 subjects of general population the following indicators were measured: total cholesterol, HDL-cholesterol, triacylglycerol, glucose, insulin concentrations, LDL-cholesterol, atherogenic index and insulin resistance IR(HOMA) were also calculated in studied subjects. Obtained data were evaluated according to age decades. Vegetarian vs. non-vegetarian concentrations of total cholesterol, LDL-cholesterol, insulin, and values of atherogenic index and IR(HOMA) were significantly reduced in all age decades. Vegetarian vs. non-vegetarian triacalglycerol concentrations were significantly reduced from 4th–7th decade. Vegetarian average decade values of all lipid parameters were in reference range. In non-vegetarian group, the risk average values of total cholesterol (>5.2 mmol/l) were found from 5th–7th decade, LDL-cholesterol (>3.3 mmol/l) in 7th decade and atherogenic index (>4) in 6th–7th decade. In vegetarians vs. non-vegetarians were noted the average decade values for total cholesterol ranging from 4.01–4.59 vs. 4.48–5.67 mmol/l, for triacylglycerols 1.00–1.33 vs. 1.13–1.74 mmol/l, for LDL-cholesterol 2.03–2.58 vs. 2.43–3.49 mmol/l, for atherogenic index 2.72–3.31 vs. 3.05–4.21 and for IR(HOMA) 0.99–1.15 vs. 1.15–1.84. Our data show significantly reduced mean age decade values of lipid and non-lipid cardiovascular risk markers in all adult vegetarians. Smaller changes of markers between decades compared to non-vegetarians document a protective effect of vegetarian nutrition in prevention of cardiovascular disease. Copyright© by the National Institute of Public Health, Prague 2017

Changing costs of metastatic non small cell lung cancer in the Netherlands.

PubMed

Keusters, W R; de Weger, V A; Hövels, A; Schellens, J H M; Frederix, G W J

2017-12-01

The primary objective of this study was to identify the total intramural cost of illness of metastatic non-small cell lung cancer (NSCLC) in the Netherlands between 2006-2012. Secondary objective was to identify whether changes in cost patterns of metastatic NSCLC have occurred over the last years. Patients diagnosed with metastatic NSCLC between 1-1-2006 and 31-12-2012, who had follow-up to death or the date of data cut-off and no trial participation were included. A structured chart review was performed using a case report form. Data collection started after diagnosis of metastatic NSCLC and ended at death or April first, 2015. Data regarding outpatient visits, clinical attendance, oncolytic drug use, imaging, lab tests, radiotherapy and surgery were collected. Sixty-seven patients were included with a median age of 67 years. The median follow-up was 234days. On average patients had 28 outpatient visits and 11 inpatient days. Oncolytic drugs were administered to 76% of the patients. Mean per patient expenditures amounted up to €17,463, with oncolytic drugs (€6,390) as the main cost driver. In comparison with the time-period of 2003-2005 total per patient per year expenses decreased by 44%. The contribution to total yearly costs of oncolytic drugs increased from 18% to 35%, while costs for inpatient stay decreased from 52% to 28% of total expenditures. Outcomes in this study demonstrate that average treatment costs for metastatic NSCLC in the Netherlands Cancer Institute amount to €17,463. Compared to a prior study the average cost for metastatic NSCLC over time in the Netherlands has decreased. A shift of main cost drivers seems to have occurred from inpatient stay, to oncolytic drugs as main contributor. The shift towards treatment cost might become more visible with the introduction of immunotherapy. These results mark the importance of up-to-date cost of illness studies. Copyright © 2017 Elsevier B.V. All rights reserved.

Costs and benefits to industry of online literature searches

NASA Technical Reports Server (NTRS)

Jensen, R. J.; Asbury, H. O.; King, R. G.

1980-01-01

A description is given of a client survey conducted by the NASA Industrial Application Center, U.S.C., examining user-identified dollar costs and benefits of an online computerized literature search. Telephone interviews were conducted on a random sample of clients using a Denver Research Institute questionnaire. Of the total 159 clients surveyed, over 53% identified dollar benefits. A direct relationship between client dollars invested and benefits derived from the search was shown. The ratio of dollar benefit to investment dollar averaged 2.9 to 1. Precise data on the end user's evaluation of the dollar value of an information search are presented.

Trends in Authorship Characteristics in The American Journal of Sports Medicine, 1994 to 2014.

PubMed

Schrock, John B; Kraeutler, Matthew J; McCarty, Eric C

2016-07-01

Trends in author qualifications, the number of authors per article, and the internationalization of author groups in sports medicine journals have not been widely investigated. To examine trends in authorship characteristics in a single prominent sports medicine journal. Systematic review. Articles published in The American Journal of Sports Medicine (AJSM) in 1994, 2004, and 2014 were reviewed. For each article, the academic degree(s) of the first and last author, the total number of authors, the country of the author group, and academic institution status were recorded. A total of 708 articles met the inclusion criteria: 129 in 1994, 244 in 2004, and 335 in 2014. There were significant differences in the proportion of first authors with an MD degree (80% in 1994, 75% in 2004, 67% in 2014; P = .01), a dual MD/PhD degree (4.7% in 1994, 6.2% in 2004, 9.3% in 2014; P < .001), and a bachelor's degree (0% in 1994, 0% in 2004, 3.9% in 2014; P < .001). The proportion of last authors with an MD/PhD significantly increased over the 2 decades studied (7% in 1994, 13% in 2004, 17% in 2014; P = .01). The mean number of authors per article also significantly increased (3.8 in 1994, 4.3 in 2004, 5.8 in 2014; P < .0001). The proportion of articles published by an international group and the proportion of articles published by an academic institution increased over the 20-year span as well (both P < .0001). Within the past 2 decades, there has been a significant increase in the average number of authors per article in AJSM, as well as a higher proportion of international groups and academic institutions publishing in the journal. More nonphysicians are publishing in AJSM, with a significantly higher percentage of first authors with a bachelor's degree as their highest degree. This is likely due to a combination of a general increased interest in research as well as increased competition among medical students. These factors have likely led to larger research groups and thus a significantly higher average number of authors per article. © 2016 The Author(s).

Solar and Space Physics PhD Production and Job Availability: Implications for the Future of the Space Weather Research Workforce

NASA Astrophysics Data System (ADS)

Moldwin, M.; Morrow, C. A.; Moldwin, L. A.; Torrence, J.

2012-12-01

To assess the state-of-health of the field of Solar and Space Physics an analysis of the number of Ph.D.s produced and number of Job Postings each year was done for the decade 2001-2010. To determine the number of Ph.D's produced in the field, the University of Michigan Ph.D. Dissertation Archive (Proquest) was queried for Solar and Space Physics dissertations produced in North America. The field generated about 30 Ph.D. per year from 2001 to 2006, but then saw the number increase to 50 to 70 per year for the rest of the decade. Only 14 institutions account for the majority of Solar and Space Physics PhDs. To estimate the number of jobs available each year in the field, a compilation of the job advertisements listed in the American Astronomical Society's Solar Physics Division (SPD) and the American Geophysical Union's Space Physics and Aeronomy (SPA) electronic newsletters was done. The positions were sorted into four types (Faculty, Post-doctoral Researcher, and Scientist/Researcher or Staff), institution type (academic, government lab, or industry) and if the position was located inside or outside the United States. Overall worldwide, 943 Solar and Space Physics positions were advertised over the decade. Of this total, 52% were for positions outside the US. Within Solar Physics, 44% of the positions were in the US, while in Space Physics 57% of the positions were for US institutions. The annual average for positions in the US were 26.9 for Solar Physics and 31.5 for Space Physics though there is much variability year-to-year particularly in Solar Physics positions outside the US. A disconcerting trend is a decline in job advertisements in the last two years for Solar Physics positions and between 2009 and 2010 for Space Physics positions. For both communities within the US in 2010, the total job ads reached their lowest levels in the decade (14), approximately half the decadal average number of job advertisements.

Health Care Expenditures After Initiating Long-term Services and Supports in the Community Versus in a Nursing Facility.

PubMed

Newcomer, Robert J; Ko, Michelle; Kang, Taewoon; Harrington, Charlene; Hulett, Denis; Bindman, Andrew B

2016-03-01

Individuals who receive long-term services and supports (LTSS) are among the most costly participants in the Medicare and Medicaid programs. To compare health care expenditures among users of Medicaid home and community-based services (HCBS) versus those using extended nursing facility care. Retrospective cohort analysis of California dually eligible adult Medicaid and Medicare beneficiaries who initiated Medicaid LTSS, identified as HCBS or extended nursing facility care, in 2006 or 2007. Propensity score matching for demographic, health, and functional characteristics resulted in a subsample of 34,660 users who initiated Medicaid HCBS versus extended nursing facility use. Those with developmental disabilities or in managed care plans were excluded. Average monthly adjusted acute, postacute, long-term, and total Medicare and Medicaid expenditures for the 12 months following initiation of either HCBS or extended nursing facility care. Those initiating extended nursing facility care had, on average, $2919 higher adjusted total health care expenditures per month compared with those who initiated HCBS. The difference was primarily attributable to spending on LTSS $2855. On average, the monthly LTSS expenditures were higher for Medicare $1501 and for Medicaid $1344 when LTSS was provided in a nursing facility rather than in the community. The higher cost of delivering LTSS in a nursing facility rather than in the community was not offset by lower acute and postacute spending. Medicare and Medicaid contribute similar amounts to the LTSS cost difference and both could benefit financially by redirecting care from institutions to the community.

Evaluation of Glaucoma Progression in Large-Scale Clinical Data: The Japanese Archive of Multicentral Databases in Glaucoma (JAMDIG).

PubMed

Fujino, Yuri; Asaoka, Ryo; Murata, Hiroshi; Miki, Atsuya; Tanito, Masaki; Mizoue, Shiro; Mori, Kazuhiko; Suzuki, Katsuyoshi; Yamashita, Takehiro; Kashiwagi, Kenji; Shoji, Nobuyuki

2016-04-01

To develop a large-scale real clinical database of glaucoma (Japanese Archive of Multicentral Databases in Glaucoma: JAMDIG) and to investigate the effect of treatment. The study included a total of 1348 eyes of 805 primary open-angle glaucoma patients with 10 visual fields (VFs) measured with 24-2 or 30-2 Humphrey Field Analyzer (HFA) and intraocular pressure (IOP) records in 10 institutes in Japan. Those with 10 reliable VFs were further identified (638 eyes of 417 patients). Mean total deviation (mTD) of the 52 test points in the 24-2 HFA VF was calculated, and the relationship between mTD progression rate and seven variables (age, mTD of baseline VF, average IOP, standard deviation (SD) of IOP, previous argon/selective laser trabeculoplasties (ALT/SLT), previous trabeculectomy, and previous trabeculotomy) was analyzed. The mTD in the initial VF was -6.9 ± 6.2 dB and the mTD progression rate was -0.26 ± 0.46 dB/year. Mean IOP during the follow-up period was 13.5 ± 2.2 mm Hg. Age and SD of IOP were related to mTD progression rate. However, in eyes with average IOP below 15 and also 13 mm Hg, only age and baseline VF mTD were related to mTD progression rate. Age and the degree of VF damage were related to future progression. Average IOP was not related to the progression rate; however, fluctuation of IOP was associated with faster progression, although this was not the case when average IOP was below 15 mm Hg.

A behavioral weight-loss intervention for persons with serious mental illness in psychiatric rehabilitation centers.

PubMed

Daumit, G L; Dalcin, A T; Jerome, G J; Young, D R; Charleston, J; Crum, R M; Anthony, C; Hayes, J H; McCarron, P B; Khaykin, E; Appel, L J

2011-08-01

Overweight and obesity are epidemic in populations with serious mental illnesses. We developed and pilot-tested a behavioral weight-loss intervention appropriately tailored for persons with serious mental disorders. We conducted a single-arm pilot study in two psychiatric rehabilitation day programs in Maryland, and enrolled 63 overweight or obese adults. The 6-month intervention provided group and individual weight management and group physical activity classes. The primary outcome was weight change from baseline to 6 months. A total of 64% of those potentially eligible enrolled at the centers. The mean age was 43.7 years; 56% were women; 49% were white; and over half had schizophrenia or a schizoaffective disorder. One-third had hypertension and one-fifth had diabetes. In total, 52 (82%) completed the study; others were discharged from psychiatric centers before completion of the study. Average attendance across all weight management sessions was 70% (87% on days participants attended the center) and 59% for physical activity classes (74% on days participants attended the center). From a baseline mean of 210.9 lbs (s.d. 43.9), average weight loss for 52 participants was 4.5 lb (s.d. 12.8) (P<0.014). On average, participants lost 1.9% of body weight. Mean waist circumference change was 3.1 cm (s.d. 5.6). Participants on average increased the distance on the 6-minute walk test by 8%. This pilot study documents the feasibility and preliminary efficacy of a behavioral weight-loss intervention in adults with serious mental illness who were attendees at psychiatric rehabilitation centers. The results may have implications for developing weight-loss interventions in other institutional settings such as schools or nursing homes.

SU-G-JeP1-06: Correlation of Lung Tumor Motion with Tumor Location Using Electromagnetic Tracking

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

Muccigrosso, D; Maughan, N; Parikh, P

Purpose: It is well known that lung tumors move with respiration. However, most measurements of lung tumor motion have studied long treatment times with intermittent imaging; those populations may not necessarily represent conventional LINAC patients. We summarized the correlation between tumor motion and location in a multi-institutional trial with electromagnetic tracking, and identified the patient cohort that would most benefit from respiratory gating. Methods: Continuous electromagnetic transponder data (Varian Medical, Seattle, WA) of lung tumor motion was collected from 14 patients (214 total fractions) across 3 institutions during external beam radiation therapy in a prospective clinical trial (NCT01396551). External interventionmore » from the clinician, such as couch shifts, instructed breath-holds, and acquisition pauses, were manually removed from the 10 Hz tracking data according to recorded notes. The average three-dimensional displacement from the breathing cycle’s end-expiratory to end-inhalation phases (peak-to-peak distance) of the transponders’ isocenter was calculated for each patient’s treatment. A weighted average of each isocenter was used to assess the effects of location on motion. A total of 14 patients were included in this analysis, grouped by their transponders’ location in the lung: upper, medial, and lower. Results: 8 patients had transponders in the upper lung, and 3 patients each in the medial lobe and lower lung. The weighted average ± standard deviation of all peak-to-peak distances for each group was: 1.04 ± 0.39 cm in the lower lung, 0.56 ± 0.14 cm in the medial lung, and 0.30 ± 0.06 cm in the upper lung. Conclusion: Tumors in the lower lung are most susceptible to excessive motion and daily variation, and would benefit most from continuous motion tracking and gating. Those in the medial lobe might be at moderate risk. The upper lobes have limited motion. These results can guide different motion management strategies between lung tumor locations. This is part of an NIH-funded prospective clinical trial (NCT01396551), using an electromagnetic transponder tracking system and additional funding from Varian Medical (Seattle, WA).« less

SU-F-P-13: NRG Oncology Medical Physics Manpower Survey Quantifying Support Demands for Multi Institutional Clinical Trials

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

Monroe, J; Case Western Reserve University; Boparai, K

Purpose: A survey was taken by NRG Oncology to assess Full Time Equivalent (FTE) contributions to multi institutional clinical trials by medical physicists.No current quantification of physicists’ efforts in FTE units associated with clinical trials is available. The complexity of multi-institutional trials increases with new technologies and techniques. Proper staffing may directly impact the quality of trial data and outcomes. The demands on physics time supporting clinical trials needs to be assessed. Methods: The NRG Oncology Medical Physicist Subcommittee created a sixteen question survey to obtain this FTE data. IROC Houston distributed the survey to their list of 1802 contactmore » physicists. Results: After three weeks, 363 responded (20.1% response). 187 (51.5%) institutions reporting external beam participation were processed. There was a wide range in number of protocols active and supported at each institution. Of the 187 clinics, 134 (71.7%) participate in 0 to 10 trials, 28 (15%) in 11 to 20 trials, 10 (5.3%) in 21 to 30 trials, 9 (4.8%) had 40 to 75 trials. On average, physicist spent 2.7 hours (SD: 6.0) per week supervising or interacting with clinical trial staff. 1.25 hours (SD: 3.37), 1.83 hours (SD: 4.13), and 0.64 hours(SD: 1.13) per week were spent on patient simulation, reviewing treatment plans, and maintaining a DICOM server, respectively. For all protocol credentialing activities, physicist spent an average of 37.05 hours (SD: 96.94) yearly. To support dosimetrists, clinicians, and therapists, physicist spend on average 2.07 hours (SD: 3.52) per week just reading protocols. Physicist attended clinical trial meetings for on average 1.13 hours (SD: 1.85) per month. Conclusion: Responding physicists spend a nontrivial amount of time: 8.8 hours per week (0.22 FTE) supporting, on average, 9 active multi-institutional clinical trials.« less

How much do persons with Alzheimer's disease cost Medicare?

PubMed

Taylor, D H; Sloan, F A

2000-06-01

Medicare claims are increasingly being used to identify persons with chronic diseases such as Alzheimer's disease (AD) for the purpose of determining the cost to Medicare of caring for such persons. Past work has been limited by the use of only 1 or 2 years of claims data to identify cases, leading to worries that this might lead to an undercount of prevalent cases and bias cost findings. To analyze the average total cost to the Medicare program in 1994 of persons with a claims-based diagnosis of AD, using a 12-year period of claims history to identify prevalent cases, and to investigate the effect on cost of time since diagnosis. A cross-sectional design with a 12-year retrospective period to identify persons with AD. Medical care practices, hospitals, and other providers of services to Medicare beneficiaries in the US in 1994. Respondents to the screener (n = 10,858) and community (5429) and institutional (n = 1341) questionnaire of the 1994 National Long Term Care Survey, with and without a claims-based diagnosis of AD. Average total cost to Medicare in 1994, measured as the actual amount Medicare paid for inpatient, outpatient, home health, skilled nursing facility, hospice, and Part B services, including payments to physicians, and other items such as durable medical equipment. We also measured disability in a variety of ways, including cognition, activity limitations, and residence in a nursing home. The average total cost to Medicare of persons with a claims-based diagnosis of AD was $6021 versus $2310 (P < .001) for persons without a diagnosis. When adjusting for patient characteristics, the ratio of cost between persons with AD and those without was reduced to about 1.6 to 1. Time since diagnosis was an important predictor of average total cost in 1994, with each additional year since diagnosis resulting in a $248 (P = .04) decrease in total cost (about 10% of the total sample mean cost of $2426). There was mixed evidence that persons with a diagnosis of AD incurred less cost than otherwise similarly disabled Medicare beneficiaries. Time since diagnosis with AD is an important predictor of cost and one that should be explicitly included in any rate-setting formula. Expanding the period used to identify cases resulted in an increase in the unadjusted ratio of cost of a Medicare beneficiary with AD relative to one without primarily because our control group costs are lower compared with those of past work.

Analysis of Variability in Intraoperative Fluid Administration for Colorectal Surgery: An Argument for Goal-Directed Fluid Therapy.

PubMed

Quinn, Timothy D; Brovman, Ethan Y; Urman, Richard D

2017-09-01

Fluid therapy in the perioperative period varies greatly between anesthesia providers and may have a negative impact on surgical outcomes. We conducted a retrospective analysis of 705 elective colorectal cases consisting of colectomies, ileocolic resections, and low anterior resections at an academic institution from January 1, 2010 to May 29, 2015, collected by our electronic medical record before implementation of Enhanced Recovery After Surgery (ERAS ® ) pathways. The mean for total crystalloid administration was 2578 mL with a standard deviation (SD) that was approximately 50% of the mean value. A combination of both normal saline and lactated Ringer's solution was used in almost all cases without a clear rationale for fluid choice. Fluid administered to patients was disproportional to measured intraoperative fluid losses (estimated blood loss and urine output) by a factor of 10. The average rate of fluid given was 1050 mL/h with an SD of nearly the same amount (951 mL). There was a variability of over 67% in total crystalloid administered based on both ideal body weight and total body weight. We found that a wide variability in the amount and type of fluid therapy administered existed at our institution before implementation of a colorectal ERAS pathway or routine use of goal-directed fluid therapy (GDFT). ERAS pathways with GDFT protocols could lead to more rational and consistent fluid therapy leading to improved outcomes.

Therapeutic communication training in long-term care institutions: recommendations for future research.

PubMed

Levy-Storms, Lené

2008-10-01

The purpose of this review is to critique contemporary experimental research and to recommend future directions for research interventions on nursing aides' therapeutic communication with older adults who have cognitive impairment and/or dementia in institutional long-term care settings. This literature review covers 13 journal articles (1999-2006) and focuses on the strengths and weaknesses of experimental research interventions to improve nursing aides' therapeutic communication with older adults who have cognitive impairment and/or dementia in long-term care settings. Based on this review, recommendations for improved experimental designs include a minimum of two groups with one being a control and randomization of subjects at the care unit level, an average 3-5h of total training, a minimum of a 6-month total evaluation period, and objective outcomes relevant to both nursing aides and residents. Findings from studies in this review indicate that the following therapeutic communication techniques can be taught and can benefit staffs and older adults' quality of life: verbal and non-verbal communication behaviors including open-ended questions, positive statements, eye contact, affective touch, and smiling. Some evidence exists to support that nursing aides can improve their therapeutic communication during care. Nursing aides need not only more training in therapeutic communication but also ongoing, dedicated supervision in psychosocial aspects of care.

Changes in average length of stay and average charges generated following institution of PSRO review.

PubMed Central

Westphal, M; Frazier, E; Miller, M C

1979-01-01

A five-year review of accounting data at a university hospital shows that immediately following institution of concurrent PSRO admission and length of stay review of Medicare-Medicaid patients, there was a significant decrease in length of stay and a fall in average charges generated per patient against the inflationary trend. Similar changes did not occur for the non-Medicare-Medicaid patients who were not reviewed. The observed changes occurred even though the review procedure rarely resulted in the denial of services to patients, suggesting an indirect effect of review. PMID:393658

The Impact of the National Essential Medicines Policy on Rational Drug Use in Primary Care Institutions in Jiangsu Province of China

PubMed Central

CHAO, Jianqian; GU, Jiangyi; ZHANG, Hua; CHEN, Huanghui; WU, Zhenchun

2018-01-01

Background: Essential medicine policy is a successful global health policy to promote rational drug use. The aim of this study was to evaluate the impact of the National Essential Medicines Policy (NEMP) on the rational drug use in primary care institutions in Jiangsu Province of China. Methods: In this exploratory study, a multistage, stratified, random sampling was used to select 3400 prescriptions from 17 primary care institutions who implemented the NEMP before (Jan 2010) and after the implementation of the NEMP (Jan 2014). The analyses were performed in SPSS 18.0 and SPSS Clementine client. Results: After the implementation of the NEMP, the percentage of prescribed EML (Essential Medicines List) drugs rose significantly, the average number of drugs per prescription and average cost per prescription were declined significantly, while the differences of the prescription proportion of antibiotics and injection were not statistically significant. BP (Back Propagation) neural network analysis showed that the average number of drugs per prescription, the number of using antibiotics and hormone, regional differences, size of institutions, sponsorship, financial income of institutions, doctor degree, outpatient and emergency visits person times were important factors affecting the prescription costs, among these the average number of drugs per prescription has the greatest effect. Conclusion: The NEMP can promote the rational use of drugs in some degree, but its role is limited. We should not focus only on the EML but also make comprehensive NEMP. PMID:29318114

The Impact of the National Essential Medicines Policy on Rational Drug Use in Primary Care Institutions in Jiangsu Province of China.

PubMed

Chao, Jianqian; Gu, Jiangyi; Zhang, Hua; Chen, Huanghui; Wu, Zhenchun

2018-01-01

Essential medicine policy is a successful global health policy to promote rational drug use. The aim of this study was to evaluate the impact of the National Essential Medicines Policy (NEMP) on the rational drug use in primary care institutions in Jiangsu Province of China. In this exploratory study, a multistage, stratified, random sampling was used to select 3400 prescriptions from 17 primary care institutions who implemented the NEMP before (Jan 2010) and after the implementation of the NEMP (Jan 2014). The analyses were performed in SPSS 18.0 and SPSS Clementine client. After the implementation of the NEMP, the percentage of prescribed EML (Essential Medicines List) drugs rose significantly, the average number of drugs per prescription and average cost per prescription were declined significantly, while the differences of the prescription proportion of antibiotics and injection were not statistically significant. BP (Back Propagation) neural network analysis showed that the average number of drugs per prescription, the number of using antibiotics and hormone, regional differences, size of institutions, sponsorship, financial income of institutions, doctor degree, outpatient and emergency visits person times were important factors affecting the prescription costs, among these the average number of drugs per prescription has the greatest effect. The NEMP can promote the rational use of drugs in some degree, but its role is limited. We should not focus only on the EML but also make comprehensive NEMP.

75 FR 45632 - Proposed Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-03

... into agreements with financial institutions doing business in States for the purpose of securing...: Financial institutions doing business in two or more States. Annual Burden Estimates Number of Average... Information Collection Activity; Comment Request Proposed Projects: Title: Financial Institution Data Match...

Survey of Stereotactic Body Radiation Therapy in Japan by the Japan 3-D Conformal External Beam Radiotherapy Group

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

Nagata, Yasushi; Hiraoka, Masahiro; Mizowaki, Takashi

2009-10-01

Purpose: To recognize the current status of stereotactic body radiotherapy (SBRT) in Japan, using a nationwide survey conducted by the Japan 3-D Conformal External Beam Radiotherapy Group. Methods and Materials: The questionnaire was sent by mail to 117 institutions. Ninety-four institutions (80%) responded by the end of November 2005. Fifty-three institutions indicated that they have already started SBRT, and 38 institutions had been reimbursed by insurance. Results: A total of 1111 patients with histologically confirmed lung cancer were treated. Among these patients, 637 had T1N0M0 and 272 had T2N0M0 lung cancer. Metastatic lung cancer was found in 702 and histologicallymore » unconfirmed lung tumor in 291 patients. Primary liver cancer was found in 207 and metastatic liver cancer in 76 patients. The most frequent schedule used for primary lung cancer was 48Gy in 4 fractions at 22 institutions (52%), followed by 50Gy in 5 fractions at 11 institutions (26%) and 60Gy in 8 fractions at 4 institutions (10%). The tendency was the same for metastatic lung cancer. The average number of personnel involved in SBRT was 1.8 radiation oncologists, including 1.1 certified radiation oncologists, 2.8 technologists, 0.7 nurses, and 0.6 certified quality assurance personnel and 0.3 physicists. The most frequent amount of time for treatment planning was 61-120min, for quality assurance was 50-60min, and for treatment was 30min. There were 14 (0.6% of all cases) reported Grade 5 complications: 11 cases of radiation pneumonitis, 2 cases of hemoptysis, and 1 case of radiation esophagitis. Conclusion: The current status of SBRT in Japan was surveyed.« less

[Mobile geriatric rehabilitation in statutory health insurance: Conceptual strategy and results of a nationwide treatment documentation (Part 1)].

PubMed

Meinck, Matthias; Pippel, K; Lübke, N

2017-04-01

Insurants have a statutory right to mobile rehabilitation in which a multidisciplinary team carries out treatment in the familiar home environment. Framework recommendations in geriatric medicine were presented by the statutory health insurance (SHI) and a standardized treatment documentation was implemented nationwide. This article presents the conceptual design and selected results from this treatment documentation and reports on the established practice. A total of 1879 anonymized cases of mobile geriatric rehabilitation carried out between 2011 and 2014 from 11 participating institutions were analyzed with respect to patient and process-related features. The patients were on average 81 years old and 61 % were female. The mobile rehabilitation was provided on average over 22 treatment days over a period of 8 weeks and in 84 % of cases following hospital treatment. Of the rehabilitation patients 27 % lived in a care home prior to treatment and 73 % were already allocated to a care level. The statistically significant gain in capacity for self-sufficiency was 18 points on the Barthel index at the end of the rehabilitation. The majority of treatment was provided by physiotherapists and occupational therapists followed by speech therapists and nursing personnel. Relevant differences were detected between the institutions regarding the indications, access route, therapy combinations, treatment frequency, scope and duration. At the same time individual requirements from the framework recommendations were sometimes not met. Even though the treatment documentation does not replace any external mobile rehabilitation quality assurance, it provides transparency in a still very limited range of services that are sometimes differently implemented at institutions. It therefore provides the basis for further development of mobile out-patient rehabilitation in SHI.

The Challenges for Persistence with Two-Year College Student Transfers and How One Survey Attempts to Identify Pathways of Success for Geoscience Students

NASA Astrophysics Data System (ADS)

Wilson, C. E.; Van Der Hoeven Kraft, K.; Wolfe, B.

2014-12-01

With the rapid growth in enrollments at two-year colleges (2YCs), these institutions provide a rich talent pool for future science, technology, engineering, and math (STEM) graduates at four-year universities, particularly students from underrepresented groups (American Geosciences Institute [AGI], 2014). This is particularly true for the geosciences because over 25% of recent geoscience graduates with a bachelor's degree attended a 2YC for at least one semester (AGI, 2013). However, it is difficult to successfully track 2YC transfers because many 2YC students do not complete an associate's degree and very few institutions offer a geoscience-specific associate's degree. In order to recruit future geoscientists from this pool of students, researchers need to better understand the barriers these students face when trying to transfer and how they are able to successfully navigate these barriers. During spring 2014 graduation, AGI surveyed students completing their bachelor's, master's, and doctoral degrees about their educational background, experiences and future plans after graduation. Those graduates who attended a 2YC for at least one semester provided insight into their enrollment decisions as they transferred into a four-year university. The sample from this survey represents 154 responses from a total of 596 responses. General demographics reveal an older population (average age: 30, median: 27), a higher percent of male students (54% male, 40% female) and Caucasians (76%, 10% non Caucasian) than a traditional 2YC student. Students attending 2YC nationally are on average 28 years old (median: 24), are 57% women, and are 51% Caucasian (AACC Fast Facts, 2014). In addition, responses indicated some of the factors that influenced their ability to successfully transfer into 4-year geoscience programs including personal motivation and successful transfer of credits.

Financial Impact of the Robotic Approach in Liver Surgery: A Comparative Study of Clinical Outcomes and Costs Between the Robotic and Open Technique in a Single Institution.

PubMed

Daskalaki, Despoina; Gonzalez-Heredia, Raquel; Brown, Marc; Bianco, Francesco M; Tzvetanov, Ivo; Davis, Myriam; Kim, Jihun; Benedetti, Enrico; Giulianotti, Pier C

2017-04-01

One of the perceived major drawbacks of minimally invasive techniques has always been its cost. This is especially true for the robotic approach and is one of the main reasons that has prevented its wider acceptance among hospitals and surgeons. The aim of our study was to evaluate the clinical outcomes and economic impact of robotic and open liver surgery in a single institution. Sixty-eight robotic and 55 open hepatectomies were performed at our institution between January 1, 2009 and December 31, 2013. Demographics, perioperative data, and postoperative outcomes were collected and compared between the two groups. An independent company performed the financial analysis. The economic parameters comprised direct variable costs, direct fixed costs, and indirect costs. Mean estimated blood loss was significantly less in the robotic group (438 versus 727.8 mL; P = .038). Overall morbidity was significantly lower in the robotic group (22% versus 40%; P = .047). Clavien III/IV complications were also lower, with 4.4% in the robotic versus 16.3% in the open group (P = .043). The length of stay in the intensive care unit (ICU) was shorter for patients who underwent a robotic procedure (2.1 versus 3.3 days; P = .004). The average total cost, including readmissions, was $37,518 for robotic surgery and $41,948 for open technique. Robotic liver resections had less overall morbidity, ICU, and hospital stay. This translates into decreased average costs for robotic surgery. These procedures are financially comparable to open resections and do not represent a financial burden to the hospital.

Financial Impact of the Robotic Approach in Liver Surgery: A Comparative Study of Clinical Outcomes and Costs Between the Robotic and Open Technique in a Single Institution

PubMed Central

Daskalaki, Despoina; Brown, Marc; Bianco, Francesco M.; Tzvetanov, Ivo; Davis, Myriam; Kim, Jihun; Benedetti, Enrico; Giulianotti, Pier C.

2017-01-01

Abstract Background: One of the perceived major drawbacks of minimally invasive techniques has always been its cost. This is especially true for the robotic approach and is one of the main reasons that has prevented its wider acceptance among hospitals and surgeons. The aim of our study was to evaluate the clinical outcomes and economic impact of robotic and open liver surgery in a single institution. Methods: Sixty-eight robotic and 55 open hepatectomies were performed at our institution between January 1, 2009 and December 31, 2013. Demographics, perioperative data, and postoperative outcomes were collected and compared between the two groups. An independent company performed the financial analysis. The economic parameters comprised direct variable costs, direct fixed costs, and indirect costs. Results: Mean estimated blood loss was significantly less in the robotic group (438 versus 727.8 mL; P = .038). Overall morbidity was significantly lower in the robotic group (22% versus 40%; P = .047). Clavien III/IV complications were also lower, with 4.4% in the robotic versus 16.3% in the open group (P = .043). The length of stay in the intensive care unit (ICU) was shorter for patients who underwent a robotic procedure (2.1 versus 3.3 days; P = .004). The average total cost, including readmissions, was $37,518 for robotic surgery and $41,948 for open technique. Conclusions: Robotic liver resections had less overall morbidity, ICU, and hospital stay. This translates into decreased average costs for robotic surgery. These procedures are financially comparable to open resections and do not represent a financial burden to the hospital. PMID:28186429

Gender Differences in Physicians' Financial Ties to Industry: A Study of National Disclosure Data.

PubMed

Rose, Susannah L; Sanghani, Ruchi M; Schmidt, Cory; Karafa, Matthew T; Kodish, Eric; Chisolm, Guy M

2015-01-01

Academic literature extensively documents gender disparities in the medical profession with regard to salary, promotion, and government funded research. However, gender differences in the value of financial ties to industry have not been adequately studied despite industry's increasing contribution to income and research funding to physicians in the U.S. We analyzed publicly reported financial relationships among 747,603 physicians and 432 pharmaceutical, device and biomaterials companies. Demographic and payment information were analyzed using hierarchical regression models to determine if statistically significant gender differences exist in physician-industry interactions regarding financial ties, controlling for key covariates. In 2011, 432 biomedical companies made an excess of $17,991,000 in payments to 220,908 physicians. Of these physicians, 75.1% were male. Female physicians, on average, received fewer total dollars (-$3,598.63, p<0.001) per person than men. Additionally, female physicians received significantly lower amounts for meals (-$41.80, p<0.001), education (-$1,893.14, p<0.001), speaker fees (-$2,898.44, p<0.001), and sponsored research (-$15,049.62, p=0.05). For total dollars, an interaction between gender and institutional reputation was statistically significant, implying that the differences between women and men differed based on industry's preference for an institution, with larger differences at higher reputation institutions. Female physicians receive significantly lower compensation for similarly described activities than their male counterparts after controlling for key covariates. As regulations lead to increased transparency regarding these relationships, efforts to standardize compensation should be considered to promote equitable opportunities for all physicians.

Gender Differences in Physicians’ Financial Ties to Industry: A Study of National Disclosure Data

PubMed Central

Rose, Susannah L.; Sanghani, Ruchi M.; Schmidt, Cory; Karafa, Matthew T.; Kodish, Eric; Chisolm, Guy M.

2015-01-01

Background Academic literature extensively documents gender disparities in the medical profession with regard to salary, promotion, and government funded research. However, gender differences in the value of financial ties to industry have not been adequately studied despite industry’s increasing contribution to income and research funding to physicians in the U.S. Methods & Findings We analyzed publicly reported financial relationships among 747,603 physicians and 432 pharmaceutical, device and biomaterials companies. Demographic and payment information were analyzed using hierarchical regression models to determine if statistically significant gender differences exist in physician-industry interactions regarding financial ties, controlling for key covariates. In 2011, 432 biomedical companies made an excess of $17,991,000 in payments to 220,908 physicians. Of these physicians, 75.1% were male. Female physicians, on average, received fewer total dollars (-$3,598.63, p<0.001) per person than men. Additionally, female physicians received significantly lower amounts for meals (-$41.80, p<0.001), education (-$1,893.14, p<0.001), speaker fees (-$2,898.44, p<0.001), and sponsored research (-$15,049.62, p=0.05). For total dollars, an interaction between gender and institutional reputation was statistically significant, implying that the differences between women and men differed based on industry’s preference for an institution, with larger differences at higher reputation institutions. Conclusions Female physicians receive significantly lower compensation for similarly described activities than their male counterparts after controlling for key covariates. As regulations lead to increased transparency regarding these relationships, efforts to standardize compensation should be considered to promote equitable opportunities for all physicians. PMID:26067810

Predictive factors of premedical student retention and degree completion within a private undergraduate university

NASA Astrophysics Data System (ADS)

Carter, Frances E.

Undergraduate retention and eventual graduation is of paramount importance to universities globally. Approximately 58% of students who began their college career at a four-year institution with the intention of receiving a bachelor's degree actually received that degree in a 6-year timeframe, according to the National Center for Education Statistics (NCES) annual report The Condition of Education 2009 (Planty, 2009). In certain subgroups of the undergraduate population, this graduation rate is even lower. This dissertation presents research into the academic integration of students in premedical programs subgroup based on Vincent Tinto's Integrationist Model of Student Departure. Pre-entry factors of interest for this study included incoming high school grade point average (GPA), incoming SAT total test scores, while post-matriculation factors included grade in organic chemistry, and the initial calculus course taken. A sample of 519 students from a private coeducational institution in the southeastern United States was examined. A logistic regression was performed to determine the effect of high school GPA, SAT total scores, organic chemistry grades, and calculus-readiness on graduation. A significant regression equation was found. The findings suggest that of the four predictor variables, high school GPA and organic chemistry grade were the only variables that showed significant predictive ability based on a significance level of p < .05. Further research should involve the examination of additional indicators of academic integration as well as information on the social integration of the student. Additionally, institutional leaders should continue to evaluate the premedical curriculum based on potential changes in medical school requirements.

Vocal fold hypomobility secondary to elective endotracheal intubation: a general surgeon's perspective.

PubMed

Sariego, Jack

2010-01-01

This study was performed retrospectively to evaluate the incidence of documented vocal fold injury as a result of elective endotracheal intubation during general surgical procedures. Medical record review was performed at a single institution and all surgical cases reviewed which required endotracheal intubation in the nonemergent setting between April 1, 2003 and August, 31, 2007. Cases with unexpected and documented vocal fold immobility postoperatively formed the study cohort, and data were gathered regarding diagnosis and procedures performed. Of 23,010 general surgery cases performed during the study period, only seven documented cases of vocal fold paralysis were discovered (0.03%). There were five women and two men in the group; all were adults. Only one patient had a primary diagnosis related to the head and neck. Comorbidities were recorded as well, but there were no statistically significant patterns discerned. Furthermore, during the study period, a total of 31 patients overall (both surgical and nonsurgical) were admitted who carried a primary diagnosis of vocal fold paralysis. Therefore, the study cohort therefore constituted 22.6% of this total. Finally, cohort patients spent a total of 150 days in hospital during the study period; this length of stay (an average of 16.7 hospital days per patient) was significantly longer than the average of 5.1 days, presumably at least in part related to the vocal paralysis. Copyright 2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Cost-Effectiveness Analysis of Total Hip Arthroplasty Performed by a Canadian Short-Stay Surgical Team in Ecuador.

PubMed

Schlegelmilch, Michael; Rashiq, Saifee; Moreau, Barbara; Jarrín, Patricia; Tran, Bach; Chuck, Anderson

2017-01-01

Few charitable overseas surgical missions produce cost-effectiveness analyses of their work. We compared the pre- and postoperative health status for 157 total hip arthroplasty (THA) patients operated on from 2007 to 2011 attended by an annual Canadian orthopedic mission to Ecuador to determine the quality-adjusted life years (QALYs) gained. The costs of each mission are known. The cost per surgery was divided by the average lifetime QALYs gained to estimate an incremental cost-effectiveness ratio (ICER) in Canadian dollars per QALY. The average lifetime QALYs (95% CI) gained were 1.46 (1.4-1.5), 2.5 (2.4-2.6), and 2.9 (2.7-3.1) for unilateral, bilateral, and staged (two THAs in different years) operations, respectively. The ICERs were $4,442 for unilateral, $2,939 for bilateral, and $4392 for staged procedures. Seventy percent of the mission budget was spent on the transport and accommodation of volunteers. THA by a Canadian short-stay surgical team was highly cost-effective, according to criteria from the National Institute for Health and Care Excellence and the World Health Organization. We encourage other international missions to provide similar cost-effectiveness data to enable better comparison between mission types and between mission and nonmission care.

Pharmacy Student Debt and Return on Investment of a Pharmacy Education

PubMed Central

Campbell, Tom; Congdon, Heather Brennan; Hancock, Kim; Kaun, Megan; Lockman, Paul R.; Evans, R. Lee

2014-01-01

Objective. To describe the current landscape within the profession of pharmacy regarding student tuition, indebtedness, salaries, and job potential. Methods. Pharmacy tuition and student debt data were obtained through the American Association of Colleges of Pharmacy Institutional Research website. Tuition was defined as average first-year tuition and fees for accredited schools. Debt was defined as the total average amount borrowed. Median salaries and numbers of jobs were obtained from the United States Department of Labor. Results. In-state tuition at public schools rose an average of $1,211 ± 31 (r2 = 0.996), whereas out-of-state tuition at public schools rose significantly faster at $1,838 ± 80 per year (r2 = 0.988). The average tuition cost for pharmacy school has increased 54% in the last 8 years. The average pharmacist salary has risen from $75,000 to over $112,000 since 2002. The increase in salary has been nearly linear (r2 = 0.988) rising $4,409 ± $170 dollars per year. However, average salary in 2011 was $3,064 below the predicted value based upon a linear regression of salaries over 10 years. The number of pharmacist jobs in the United States has risen from 215,000 jobs in 2003 to 275,000 in 2010. However, there were 3,000 fewer positions in 2012 than in 2011. In 2011, average indebtedness for pharmacy students ($114,422) was greater than average first-year salary ($112,160). Conclusion. Rising tuition and student indebtedness is a multifaceted problem requiring attention from a number of parties including students, faculty members, universities, and accreditation and government entities. PMID:24558273

An external dosimetry audit programme to credential static and rotational IMRT delivery for clinical trials quality assurance.

PubMed

Eaton, David J; Tyler, Justine; Backshall, Alex; Bernstein, David; Carver, Antony; Gasnier, Anne; Henderson, Julia; Lee, Jonathan; Patel, Rushil; Tsang, Yatman; Yang, Huiqi; Zotova, Rada; Wells, Emma

2017-03-01

External dosimetry audits give confidence in the safe and accurate delivery of radiotherapy. The RTTQA group have performed an on-site audit programme for trial recruiting centres, who have recently implemented static or rotational IMRT, and those with major changes to planning or delivery systems. Measurements of reference beam output were performed by the host centre, and by the auditor using independent equipment. Verification of clinical plans was performed using the ArcCheck helical diode array. A total of 54 measurement sessions were performed between May 2014 and June 2016 at 28 UK institutions, reflecting the different combinations of planning and delivery systems used at each institution. Average ratio of measured output between auditor and host was 1.002±0.006. Average point dose agreement for clinical plans was -0.3±1.8%. Average (and 95% lower confidence intervals) of gamma pass rates at 2%/2mm, 3%/2mm and 3%/3mm respectively were: 92% (80%), 96% (90%) and 98% (94%). Moderately significant differences were seen between fixed gantry angle and rotational IMRT, and between combination of planning systems and linac manufacturer, but not between anatomical treatment site or beam energy. An external audit programme has been implemented for universal and efficient credentialing of IMRT treatments in clinical trials. Good agreement was found between measured and expected doses, with few outliers, leading to a simple table of optimal and mandatory tolerances for approval of dosimetry audit results. Feedback was given to some centres leading to improved clinical practice. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Nonmyeloablative allogeneic stem cell transplantation for chronic lymphocytic leukaemia offers the possibility of disease control with minimal morbidity and mortality--a single institution experience.

PubMed

Chakupurakal, G; Leitzke, S; Langerbeins, P; Schiller, J; Schneider, P M; Holtick, U; Shimabukuro-Vornhagen, A; Theurich, S; Chemnitz, J; Hallek, M; von Bergwelt-Baildon, M; Scheid, C

2015-10-01

Allogeneic stem cell transplantation is a treatment option for patients with poor risk CLL. We conducted a retrospective analysis of all CLL patients allografted at our institution, the University Hospital of Cologne, Germany. Data was collected on 40 patients from 2004 to 2012. The mean age was 54, and the majority were male (75 %). On average, the patients were diagnosed 6 years (range 2-12) prior to transplant with an average of 4 years (range 1-8) from time of first-line therapy to transplant. The remission states at the time of transplant were complete remission (CR) (n = 4), stable disease (n = 10), partial remission (n = 20) and progressive disease (n = 6). Only reduced intensity conditioning regimens were employed. The average CD34(+) cell dose was 4.16 × 10(6)/kg. Neutrophil engraftment was seen by day +17 (range 10-23) post-transplant, and 88 % achieved 95-100 % donor chimerism by day 100. Overall survival, progression-free survival and non-relapse mortality at 2 years post-transplant were 65, 52.5 and 27.5 %, respectively. A total of 51 % of patients were found to be minimal residual disease (MRD)-negative at 1 year post-transplant. Our single-centre experience confirms the valuable role of allogeneic stem cell transplantation (allo-SCT) in the treatment of poor risk CLL patients with promising long-term survival and acceptable transplant-related mortality. The advent of newer therapeutic agents should not hinder the consideration of allo-SCT for this patient cohort as it remains the only curative option for these patients.

Is Postoperative Intensive Care Unit Care Necessary following Cranial Vault Remodeling for Sagittal Synostosis?

PubMed

Wolfswinkel, Erik M; Howell, Lori K; Fahradyan, Artur; Azadgoli, Beina; McComb, J Gordon; Urata, Mark M

2017-12-01

Of U.S. craniofacial and neurosurgeons, 94 percent routinely admit patients to the intensive care unit following cranial vault remodeling for correction of sagittal synostosis. This study aims to examine the outcomes and cost of direct ward admission following primary cranial vault remodeling for sagittal synostosis. An institutional review board-approved retrospective review was undertaken of the records of all patients who underwent primary cranial vault remodeling for isolated sagittal craniosynostosis from 2009 to 2015 at a single pediatric hospital. Patient demographics, perioperative course, and outcomes were recorded. One hundred ten patients met inclusion criteria with absence of other major medical problems. Average age at operation was 6.7 months, with a mean follow-up of 19.8 months. Ninety-eight patients (89 percent) were admitted to a general ward for postoperative care, whereas the remaining 12 (11 percent) were admitted to the intensive care unit for preoperative or perioperative concerns. Among ward-admitted patients, there were four (3.6 percent) minor complications; however, there were no major adverse events, with none necessitating intensive care unit transfers from the ward and no mortalities. Average hospital stay was 3.7 days. The institution's financial difference in cost of intensive care unit stay versus ward bed was $5520 on average per bed per day. Omitting just one intensive care unit postoperative day stay for this patient cohort would reduce projected health care costs by a total of $540,960 for the study period. Despite the common practice of postoperative admission to the intensive care unit following cranial vault remodeling for sagittal craniosynostosis, the authors suggest that postoperative care be considered on an individual basis, with only a small percentage requiring a higher level of care. Therapeutic, III.

Influence of urbanization level and gross domestic product of counties in Croatia on access to health care.

PubMed

Bagat, Mario; Drakulić, Velibor; Sekelj Kauzlarić, Katarina; Vlahusić, Andro; Bilić, Ivica; Matanić, Dubravka

2008-06-01

To examine the association of counties' urbanization level and gross domestic product (GDP) per capita on the access to health care. Counties were divided in two groups according to the urbanization level and GDP per capita in purchasing power standards. The number of physicians per 100,000 inhabitants, the number of physicians in hospitals in four basic specialties, physicians' workload, average duration of working week, the average number of insurants per general practice (GP) team, and the number of inhabitants covered by one internal medicine outpatient clinic were compared between predominantly urban and predominantly rural counties and between richer and poorer counties. Our study included only GP teams and outpatient clinics under the contract with the Croatian Institute for Health Insurance. Data on physicians were collected from the Ministry of Health and Social Welfare, the Croatian Institute for Health Insurance, the Croatian Institute for Public Health, and the Croatian Medical Chamber. Data on the contracts with the Croatian Institute for Health Insurance and health care services provided under these contracts were obtained from the database of the Institute, while population and gross domestic product data were obtained from the Database of the Croatian Institute for Statistics. World Health Organization Health for All Database was used for the international comparison of physician's data. There was no significant difference in the total number of physicians per 100,000 inhabitants between predominantly urban and predominantly rural counties (206.9+/-41.0 vs 175.4+/-30.3; P=0.067, t test) nor between richer and poorer counties (194.5+/-49.8 vs 187.7+/-25.3; P=0.703, t test). However, there were significantly fewer GPs per 100,000 inhabitants in rural than urban counties (49.0+/-5.5 vs 56.7+/-4.6; P=0.003, t test). GPs in rural counties had more insurants than those working in urban counties (1.749.8+/-172.8 vs 1.540.7+/-106.3; P=0.004, t test). The working week of specialists in the four observed specialties in hospitals was longer than the recommended 48 hours a week. The lack of physicians, especially in primary health care can lead to a reduced access to health care and increased workload of physicians, predominantly in rural counties, regardless of the counties' GDP.

[Descriptive epidemiology of children with acute myeloid leukemia residing in Mexico City: a report from the Mexican Inter-Institutional Group for Identifying Childhood Leukemia Causes].

PubMed

Mejía-Aranguré, Juan Manuel; Núñez-Enríquez, Juan Carlos; Fajardo-Gutiérrez, Arturo; Rodríguez-Zepeda, María Del Carmen; Martín-Trejo, Jorge Alfonso; Duarte-Rodríguez, David Aldebarán; Medina-Sansón, Aurora; Flores-Lujano, Janet; Jiménez-Hernández, Elva; Núñez-Villegas, Nora Nancy; Pérez-Saldívar, María Luisa; Paredes-Aguilera, Rogelio; Cárdenas-Cardós, Rocío; Flores-Chapa, José de Diego; Reyes-Zepeda, Nancy Carolina; Flores-Villegas, Luz Victoria; Amador-Sánchez, Raquel; Torres-Nava, José Refugio; Bolea-Murga, Victoria; Espinosa-Elizondo, Rosa Martha; Peñaloza-González, José Gabriel; Velázquez-Aviña, Martha Margarita; González-Bonilla, César; Békker-Méndez, Vilma Carolina; Jiménez-Morales, Silvia; Martínez-Morales, Gabriela Bibiana; Vargas, Haydeé Rosas; Rangel-López, Angélica

2016-10-01

Acute myeloid leukemias represent the second most common childhood leukemia subtype. In Mexico, there are few studies on descriptive epidemiology for this disease. To report acute myeloid leukemia incidence for children less than 15 years of age in the Metropolitan Area of the Valley of Mexico for a period of five years (2010-2014) and to analyze whether there are differences in the incidence of acute myeloid leukemia by regions. A descriptive study was conducted in nine public hospitals in Mexico City. The crude annual average incidence rate and adjusted average annual incidence rate were calculated. A total of 190 patients with diagnosis of de novo acute myeloid leukemia were analyzed. Male sex (57.2%) and acute myeloid leukemia-M3 subtype (25.3%) were more frequent. The adjusted average annual incidence rates for Mexico City and for the Metropolitan Area of the Valley of Mexico were 8.18 and 7.74 per million children under 15 years old, respectively. It seems that childhood acute myeloid leukemia incidence is increasing in Mexico City, which makes the identification of associated risk factors imperative.

The development of postinstitutionalized versus parent-reared Russian children as a function of age at placement and family type.

PubMed

McCall, Robert B; Muhamedrahimov, Rifkat J; Groark, Christina J; Palmov, Oleg I; Nikiforova, Natalia V; Salaway, Jennifer; Julian, Megan M

2016-02-01

A total of 149 children, who spent an average of 13.8 months in Russian institutions, were transferred to Russian families of relatives and nonrelatives at an average age of 24.7 months. After residing in these families for at least 1 year (average = 43.2 months), parents reported on their attachment, indiscriminately friendly behavior, social-emotional competencies, problem behaviors, and effortful control when they were 1.5-10.7 years of age. They were compared to a sample of 83 Russian parents of noninstitutionalized children, whom they had reared from birth. Generally, institutionalized children were rated similarly to parent-reared children on most measures, consistent with substantial catch-up growth typically displayed by children after transitioning to families. However, institutionalized children were rated more poorly than parent-reared children on certain competencies in early childhood and some attentional skills. There were relatively few systematic differences associated with age at family placement or whether the families were relatives or nonrelatives. Russian parent-reared children were rated as having more problem behaviors than the US standardization sample, which raises cautions about using standards cross-culturally.

Educational Impact of Trainee-Facilitated Head and Neck Radiology-Pathology Correlation Conferences.

PubMed

Ginat, Daniel Thomas; Cipriani, Nicole A; Christoforidis, Gregory

2018-05-17

The goal of this study was to evaluate the benefits of resident and fellow-facilitated radiology-pathology head and neck conferences. A total of seven resident-facilitated and six fellow-facilitated head and neck radiology-pathology cases were presented as part of the radiology department conference series. The radiology residents were surveyed regarding the perceived quality and effectiveness of the fellow-facilitated sessions. The number of publications yielded from all the cases presented was tracked. Overall, the residents assessed the quality of the fellow-facilitated conferences with an average score of 3.9 out of 5 and the overall helpfulness with an average of 3.5 out of 5. The overall average level of resident understanding among the residents for the topics presented to them by the fellows at baseline was 2.5 out of 5 and 3.4 out of 5 after the presentations, which was a significant increase (p-value < 0.01). There were three peer-reviewed publications generated from the resident presentations and four peer-reviewed publications generated from the fellow presentations, which represents a 54% publication rate collectively. Therefore, trainee-facilitated head and neck radiology-pathology conferences at our institution provide added learning and scholarly activity opportunities.

University Students With Poor Reading Comprehension: The Hidden Cognitive Processing Deficit.

PubMed

Georgiou, George K; Das, J P

2015-01-01

The present study aimed to examine the nature of the working memory and general cognitive ability deficits experienced by university students with a specific reading comprehension deficit. A total of 32 university students with poor reading comprehension but average word-reading skills and 60 age-matched controls with no comprehension difficulties participated in the study. The participants were assessed on three verbal working memory tasks that varied in terms of their processing demands and on the Das-Naglieri Cognitive Assessment System, which was used to operationalize intelligence. The results indicated first that the differences between poor and skilled comprehenders on working memory were amplified as the processing demands of the tasks increased. In addition, although poor comprehenders as a group had average intelligence, they experienced significant difficulties in simultaneous and successive processing. Considering that working memory and general cognitive ability are highly correlated processes, these findings suggest that the observed differences between poor and skilled comprehenders are likely a result of a deficient information processing system. © Hammill Institute on Disabilities 2013.

Hidden costs associated with venous thromboembolism: impact of lost productivity on employers and employees.

PubMed

Page, Robert L; Ghushchyan, Vahram; Gifford, Brian; Read, Richard Allen; Raut, Monika; Bookhart, Brahim K; Naim, Ahmad B; Damaraju, C V; Nair, Kavita V

2014-09-01

To determine productivity loss and indirect costs with deep vein thrombosis (DVT) and pulmonary embolism (PE). Medical and pharmacy claims with short-term disability (STD) and long-term disability (LTD) claims from 2007 to 2010 were analyzed from the Integrated Benefits Institute's Health and Productivity Benchmarking (IBI-HPB) database (STD and LTD claims) and IMS LifeLink™ data (medical and pharmacy claims), which were indirectly linked using a weighting approach matching from IBI-HPB patients' demographic distribution. A total of 5442 DVT and 6199 PE claims were identified. Employees with DVT lost 57 STD and 440 LTD days per disability incident. The average per claim productivity loss from STD and LTD was $7414 and $58181, respectively. Employees with PE lost 56 STD and 364 LTD days per disability incident. The average per claim productivity loss from STD and LTD was $7605 and $48,751, respectively. Deep vein thrombosis and PE impose substantial economic burdens.

Institutional Delivery Service Utilization among Women from Rural Districts of Wolaita and Dawro Zones, Southern Ethiopia; a Community Based Cross-Sectional Study

PubMed Central

Arba, Mihiretu Alemayehu; Darebo, Tadele Dana; Koyira, Mengistu Meskele

2016-01-01

Introduction The highest number of maternal deaths occur during labour, delivery and the first day after delivery highlighting the critical need for good quality care during this period. Therefore, for the strategies of institutional delivery to be effective, it is essential to understand the factors that influence individual and household factors to utilize skilled birth attendance and institutions for delivery. This study was aimed to assess factors affecting the utilization of institutional delivery service of women in rural districts of Wolaita and Dawro Zones. Methods A community based cross-sectional study was done among mothers who gave birth within the past one year preceding the survey in Wolaita and Dawro Zones, from February 01 –April 30, 2015 by using a three stage sampling technique. Initially, 6 districts were selected randomly from the total of 17 eligible districts. Then, 2 kebele from each district was selected randomly cumulating a total of 12 clusters. Finally, study participants were selected from each cluster by using systematic sampling technique. Accordingly, 957 mothers were included in the survey. Data was collected by using a pretested interviewer administered structured questionnaire. The questionnaire was prepared by including socio-demographic variables and variables of maternal health service utilization factors. Data was entered using Epi-data version 1.4.4.0 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were applied to identify candidate and predictor variables respectively. Result Only 38% of study participants delivered the index child at health facility. Husband’s educational status, wealth index, average distance from nearest health facility, wanted pregnancy, agreement to follow post-natal care, problem faced during delivery, birth order, preference of health professional for ante-natal care and maternity care were predictors of institutional delivery. Conclusion The use of institutional delivery service is low in the study community. Eventhough antenatal care service is high; nearly two in every three mothers delivered their index child out of health facility. Improving socio-economic status of mothers as well as availing modern health facilities to the nearest locality will have a good impact to improve institutional delivery service utilization. Similarly, education is also a tool to improve awareness of mothers and their husbands for the improvement of health care service utilization. PMID:26986563

Institutional Delivery Service Utilization among Women from Rural Districts of Wolaita and Dawro Zones, Southern Ethiopia; a Community Based Cross-Sectional Study.

PubMed

Arba, Mihiretu Alemayehu; Darebo, Tadele Dana; Koyira, Mengistu Meskele

2016-01-01

The highest number of maternal deaths occur during labour, delivery and the first day after delivery highlighting the critical need for good quality care during this period. Therefore, for the strategies of institutional delivery to be effective, it is essential to understand the factors that influence individual and household factors to utilize skilled birth attendance and institutions for delivery. This study was aimed to assess factors affecting the utilization of institutional delivery service of women in rural districts of Wolaita and Dawro Zones. A community based cross-sectional study was done among mothers who gave birth within the past one year preceding the survey in Wolaita and Dawro Zones, from February 01 -April 30, 2015 by using a three stage sampling technique. Initially, 6 districts were selected randomly from the total of 17 eligible districts. Then, 2 kebele from each district was selected randomly cumulating a total of 12 clusters. Finally, study participants were selected from each cluster by using systematic sampling technique. Accordingly, 957 mothers were included in the survey. Data was collected by using a pretested interviewer administered structured questionnaire. The questionnaire was prepared by including socio-demographic variables and variables of maternal health service utilization factors. Data was entered using Epi-data version 1.4.4.0 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were applied to identify candidate and predictor variables respectively. Only 38% of study participants delivered the index child at health facility. Husband's educational status, wealth index, average distance from nearest health facility, wanted pregnancy, agreement to follow post-natal care, problem faced during delivery, birth order, preference of health professional for ante-natal care and maternity care were predictors of institutional delivery. The use of institutional delivery service is low in the study community. Eventhough antenatal care service is high; nearly two in every three mothers delivered their index child out of health facility. Improving socio-economic status of mothers as well as availing modern health facilities to the nearest locality will have a good impact to improve institutional delivery service utilization. Similarly, education is also a tool to improve awareness of mothers and their husbands for the improvement of health care service utilization.

Total and methyl mercury contents and distribution characteristics in cicada, Cryptotympana atrata (Fabricius).

PubMed

Zheng, Dongmei; Zhang, Zhongsheng; Wang, Qichao

2010-06-01

Total and methyl mercury concentrations of cicada bodies, wings, and exuviae were investigated to study the mercury distribution characteristics. Results indicated that total and methyl mercury concentrations of cicada bodies were 2.64 mg/kg and 123.93 ng/g on average, respectively. In cicada tissues, total mercury concentrations were found to increase in the order of exuviae (0.50 mg/kg on average) < wings (0.98 mg/kg on average) < cicada bodies (2.64 mg/kg on average) and methyl mercury concentrations of cicada bodies were 123.93 ng/g on average and were the highest. Methyl mercury concentrations accounted for about 4.69% of total mercury in cicada bodies and most mercury was in inorganic forms in cicada. Sex differences of total mercury concentrations were significantly great (F = 8.433, p < 0.01) and total mercury concentrations of the males, which were 3.38 mg/kg on average, were much higher. Correlation analysis showed that neither total nor methyl mercury concentrations of cicada bodies was significantly related to the corresponding contents of soil (r = 0.0598, p > 0.05).

The Invisible Wall: Exploring the Experiences of African-American Students at CCCU Institutions

ERIC Educational Resources Information Center

Young, Timothy Perry

2013-01-01

African-American students who attend a CCCU institution do not complete their degrees as frequently as other student groups. The average gap at CCCU institutions between "overall and Black graduation rates is more than 19%. This is greater than the gap at other private institutions" (Smith, 2009, p.80). While the six-year graduation rate…

Ground-water resources of Cumberland County, New Jersey

USGS Publications Warehouse

Rooney, James G.

1971-01-01

Water use in Cumberland County varies and is highly seasonal, mainly because of increasing requirements for irrigation and the food processing industries in the county. In 1964 seasonal use ranged from 27 mgd in March to 145 mgd in August. This is much higher than withdrawals in neighboring Salem and Cape May Counties. In 1964 withdrawals in Cumberland County averaged about 51 mgd; almost all of this, 49.4 mgd, was from ground-water supplies. The total annual water use in 1964 according to type of use was: for public supply, 10.6 mgd; for industrial uses, 19.0 mgd; irrigation, 15.4 mgd; suburban, rural, residential, institutional, farm, and commercial, 5.9 mgd. 

An Analysis of Costs in Institutions of Higher Education in England

ERIC Educational Resources Information Center

Johnes, Geraint; Johnes, Jill; Thanassoulis, Emmanuel

2008-01-01

Cost functions are estimated, using random effects and stochastic frontier methods, for English higher education institutions. The article advances on existing literature by employing finer disaggregation by subject, institution type and location, and by introducing consideration of quality effects. Estimates are provided of average incremental…

Class of 1994, Annual Report: NH Technical Colleges and Institute and NH Police Standards and Training.

ERIC Educational Resources Information Center

New Hampshire State Dept. of Postsecondary Technical Education, Concord.

This 1994 annual report for the New Hampshire Technical Colleges and Institute System (NHTC&IS) includes information on enrollments, outcomes, job placement, average salaries, transfer institutions, work force training, the Police Academy, finances, future directions, and governance. Introductory material highlights the following…

Capturing a Different Picture

ERIC Educational Resources Information Center

Nealy, Michelle J.

2008-01-01

This article describes how the New York Times Student Journalism Institute helps train a new generation of minority newsroom professionals. The New York Times Student Journalism Institute offers an intensive two-week internship every summer for students. Averaging about 30 students a year, the institute has graduated nearly 150 Black students,…

Institutions in Modern Society: Caretakers and Subjects

ERIC Educational Resources Information Center

Romano-V, Octavio I.

1974-01-01

Examines some of the problems associated with the training, retraining, and rehabilitation of people in urban, industrial California. Indicates that on an average day in 1969, over seven million people in California were under institutional care or in some institutional program related to law enforcement, social welfare, hospitals, and schools.…

Gender Differences in Academic Rank of Radiologists in U.S. Medical Schools.

PubMed

Kapoor, Neena; Blumenthal, Daniel M; Smith, Stacy E; Ip, Ivan K; Khorasani, Ramin

2017-04-01

Purpose To determine whether there were gender differences in full professorship after accounting for factors known to influence academic advancement. Materials and Methods Institutional review board approval was obtained for this HIPAA-compliant study, with waiver of informed consent. In this cross-sectional study, the authors used a comprehensive 2014 physician database (5089 academic radiologists, inclusive of all U.S. academic radiologists in 2014; 11.3% of all U.S. radiologists) containing information on physician age, years since residency, National Institutes of Health funding, scientific publications (first or last author and total), clinical trial investigation, and clinical volume measured according to 2013 Medicare reimbursement. Primary outcome of gender differences in full professorship was estimated by using a multilevel logistic regression model adjusting for these factors. Results Among 5089 academic radiologists, 3638 (71.5%) were men. The average age for male and female radiologists was 52 and 49 years, respectively. Overall, 239 women (16.5%) and 948 (26.1%) men were full professors (P < .001). Women had fewer total and first or last author publications than men (total, 12.2 vs 17.6; first or last, 6.8 vs 10.7; P < .001 for both comparisons). Women were less likely than men to have National Institutes of Health funding (2.0% vs 3.6%; P = .004) and generated less annual Medicare revenue ($63 346 vs $75 854; P = .001). After multivariate adjustment, rates of full professorship among female and male radiologists were not significantly different (absolute adjusted difference for female vs male radiologists, -1.5%; 95% confidence interval: -3.8%, 0.9%). Conclusion Among radiologists with U.S. medical school faculty appointments in 2014, men and women were similarly likely to be full professor after several factors known to influence promotion were taken into account. However, unadjusted differences in promotion and research productivity were present, which suggests that female radiologists may lack equal research opportunities. © RSNA, 2016.

A partial economic evaluation of blended learning in teaching health research methods: a three-university collaboration in South Africa, Sweden, and Uganda

PubMed Central

Kumpu, Minna; Atkins, Salla; Zwarenstein, Merrick; Nkonki, Lungiswa

2016-01-01

Background Novel research training approaches are needed in global health, particularly in sub-Saharan African universities, to support strengthening of health systems and services. Blended learning (BL), combining face-to-face teaching with computer-based technologies, is also an accessible and flexible education method for teaching global health and related topics. When organised as inter-institutional collaboration, BL also has potential for sharing teaching resources. However, there is insufficient data on the costs of BL in higher education. Objective Our goal was to evaluate the total provider costs of BL in teaching health research methods in a three-university collaboration. Design A retrospective evaluation was performed on a BL course on randomised controlled trials, which was led by Stellenbosch University (SU) in South Africa and joined by Swedish and Ugandan universities. For all three universities, the costs of the BL course were evaluated using activity-based costing with an ingredients approach. For SU, the costs of the same course delivered with a classroom learning (CL) approach were also estimated. The learning outcomes of both approaches were explored using course grades as an intermediate outcome measure. Results In this contextually bound pilot evaluation, BL had substantially higher costs than the traditional CL approach in South Africa, even when average per-site or per-student costs were considered. Staff costs were the major cost driver in both approaches, but total staff costs were three times higher for the BL course at SU. This implies that inter-institutional BL can be more time consuming, for example, due to use of new technologies. Explorative findings indicated that there was little difference in students’ learning outcomes. Conclusions The total provider costs of the inter-institutional BL course were higher than the CL course at SU. Long-term economic evaluations of BL with societal perspective are warranted before conclusions on full costs and consequences of BL in teaching global health topics can be made. PMID:27725076

A partial economic evaluation of blended learning in teaching health research methods: a three-university collaboration in South Africa, Sweden, and Uganda.

PubMed

Kumpu, Minna; Atkins, Salla; Zwarenstein, Merrick; Nkonki, Lungiswa

2016-01-01

Novel research training approaches are needed in global health, particularly in sub-Saharan African universities, to support strengthening of health systems and services. Blended learning (BL), combining face-to-face teaching with computer-based technologies, is also an accessible and flexible education method for teaching global health and related topics. When organised as inter-institutional collaboration, BL also has potential for sharing teaching resources. However, there is insufficient data on the costs of BL in higher education. Our goal was to evaluate the total provider costs of BL in teaching health research methods in a three-university collaboration. A retrospective evaluation was performed on a BL course on randomised controlled trials, which was led by Stellenbosch University (SU) in South Africa and joined by Swedish and Ugandan universities. For all three universities, the costs of the BL course were evaluated using activity-based costing with an ingredients approach. For SU, the costs of the same course delivered with a classroom learning (CL) approach were also estimated. The learning outcomes of both approaches were explored using course grades as an intermediate outcome measure. In this contextually bound pilot evaluation, BL had substantially higher costs than the traditional CL approach in South Africa, even when average per-site or per-student costs were considered. Staff costs were the major cost driver in both approaches, but total staff costs were three times higher for the BL course at SU. This implies that inter-institutional BL can be more time consuming, for example, due to use of new technologies. Explorative findings indicated that there was little difference in students' learning outcomes. The total provider costs of the inter-institutional BL course were higher than the CL course at SU. Long-term economic evaluations of BL with societal perspective are warranted before conclusions on full costs and consequences of BL in teaching global health topics can be made.

78 FR 19262 - Notice of Annual Adjustment of the Cap on Average Total Assets That Defines Community Financial...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-29

... FEDERAL HOUSING FINANCE AGENCY [No. 2013-N-04] Notice of Annual Adjustment of the Cap on Average.... ACTION: Notice. SUMMARY: The Federal Housing Finance Agency (FHFA) has adjusted the cap on average total... Federal Deposit Insurance Corporation and that has average total assets below a statutory cap.\\2\\ The Bank...

75 FR 9601 - Notice of Annual Adjustment of the Cap on Average Total Assets That Defines Community Financial...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-03

... FEDERAL HOUSING FINANCE AGENCY [No. 2010-N-01] Notice of Annual Adjustment of the Cap on Average.... ACTION: Notice. SUMMARY: The Federal Housing Finance Agency (FHFA) has adjusted the cap on average total... Deposit Insurance Corporation and that has average total assets below a statutory cap. See 12 U.S.C. 1422...

Risk for Sleep Disorder Measured during Students' First College Semester May Predict Institutional Retention and Grade Point Average over a 3-Year Period, with Indirect Effects through Self-Efficacy

ERIC Educational Resources Information Center

Gaultney, Jane F.

2016-01-01

The present study used a validated survey to assess freshmen college students' sleep patterns and risk for sleep disorders and then examined associations with retention and grade point average (GPA) over a 3-year period. Students at risk for a sleep disorder were more likely to leave the institution over the 3-year period, although this…

Total ozone column derived from GOME and SCIAMACHY using KNMI retrieval algorithms: Validation against Brewer measurements at the Iberian Peninsula

NASA Astrophysics Data System (ADS)

Antón, M.; Kroon, M.; López, M.; Vilaplana, J. M.; Bañón, M.; van der A, R.; Veefkind, J. P.; Stammes, P.; Alados-Arboledas, L.

2011-11-01

This article focuses on the validation of the total ozone column (TOC) data set acquired by the Global Ozone Monitoring Experiment (GOME) and the Scanning Imaging Absorption Spectrometer for Atmospheric Chartography (SCIAMACHY) satellite remote sensing instruments using the Total Ozone Retrieval Scheme for the GOME Instrument Based on the Ozone Monitoring Instrument (TOGOMI) and Total Ozone Retrieval Scheme for the SCIAMACHY Instrument Based on the Ozone Monitoring Instrument (TOSOMI) retrieval algorithms developed by the Royal Netherlands Meteorological Institute. In this analysis, spatially colocated, daily averaged ground-based observations performed by five well-calibrated Brewer spectrophotometers at the Iberian Peninsula are used. The period of study runs from January 2004 to December 2009. The agreement between satellite and ground-based TOC data is excellent (R2 higher than 0.94). Nevertheless, the TOC data derived from both satellite instruments underestimate the ground-based data. On average, this underestimation is 1.1% for GOME and 1.3% for SCIAMACHY. The SCIAMACHY-Brewer TOC differences show a significant solar zenith angle (SZA) dependence which causes a systematic seasonal dependence. By contrast, GOME-Brewer TOC differences show no significant SZA dependence and hence no seasonality although processed with exactly the same algorithm. The satellite-Brewer TOC differences for the two satellite instruments show a clear and similar dependence on the viewing zenith angle under cloudy conditions. In addition, both the GOME-Brewer and SCIAMACHY-Brewer TOC differences reveal a very similar behavior with respect to the satellite cloud properties, being cloud fraction and cloud top pressure, which originate from the same cloud algorithm (Fast Retrieval Scheme for Clouds from the Oxygen A-Band (FRESCO+)) in both the TOSOMI and TOGOMI retrieval algorithms.

Treatment of Ruptured Vertebral Artery Dissecting Aneurysms Distal to the Posterior Inferior Cerebellar Artery: Stenting or Trapping?

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

Fang, Yi-Bin, E-mail: fangyibin@163.com; Zhao, Kai-Jun, E-mail: zkjwcfzwh@163.com; Wu, Yi-Na, E-mail: wuyina0923@163.com

2015-06-15

PurposeThe treatment of ruptured vertebral artery dissecting aneurysms (VADAs) continues to be controversial. Our goal was to evaluate the safety, efficacy, and long-term outcomes of internal trapping and stent-assisted coiling (SAC) for ruptured VADAs distal to the posterior inferior cerebellar artery (supra-PICA VADAs), which is the most common subset.MethodsA retrospective review was conducted of 39 consecutive ruptured supra-PICA VADAs treated with internal trapping (n = 20) or with SAC (n = 19) at our institution. The clinical and angiographic data were retrospectively compared.ResultsThe immediate total occlusion rate of the VADAs was 80 % in the trapping group, which improved to 88.9 % at the follow-ups (45 monthsmore » on average). Unwanted occlusions of the posterior inferior cerebellar artery (PICA) were detected in three trapped cases. Incomplete obliteration of the VADA or unwanted occlusions of the PICA were detected primarily in the VADAs closest to the PICA. In the stenting group, the immediate total occlusion rate was 47.4 %, which improved to 100 % at the follow-ups (39 months on average). The immediate total occlusion rate of the VADAs was higher in the trapping group (p < 0.05), but the later total occlusion was slightly higher in the stenting group (p > 0.05).ConclusionsOur preliminary results showed that internal trapping and stent-assisted coiling are both technically feasible for treating ruptured supra-PICA VADAs. Although not statistically significant, procedural related complications occurred more frequently in the trapping group. When the VADAs are close to the PICA, we suggest that the lesions should be treated using SAC.« less

Poor knowledge about osteoporosis in learned Indian women.

PubMed

Pande, K; Pande, Sonali; Tripathi, S; Kanoi, R; Thakur, A; Patle, S

2005-05-01

The present study was done to assess knowledge about osteoporosis in learned Indian women, identify their source of knowledge and to study the correlation of level of knowledge with other variables. A total of 73 female staff members (average age 44.7 years) of a teaching institute completed the Osteoporosis Questionnaire (OPQ). The mean +/- SD of total score for the sample was 4.1 +/- 4.1 (range -8 to 15; maximum possible score 20). The correct definition of osteoporosis was given by 74%, but there was general lack of awareness in all the areas assessed. There was statistically significant difference in the total score depending on the faculty of education, with staff members from the science faculty having the maximum mean score (p < 0.05). We found no influence of age, menopausal status, previous history of fracture and family history of osteoporosis on the level of knowledge. Media (74%) was the commonest source of knowledge followed by friends (49%) and doctors (25%). This study highlights the general lack of knowledge about osteoporosis in learned Indian women and also the need for increased involvement of medical professionals in patient education.

76 FR 3142 - Notice of Annual Adjustment of the Cap on Average Total Assets That Defines Community Financial...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-19

... FEDERAL HOUSING FINANCE AGENCY [No. 2011-N-01] Notice of Annual Adjustment of the Cap on Average.... ACTION: Notice. SUMMARY: The Federal Housing Finance Agency (FHFA) has adjusted the cap on average total... average total assets below a statutory cap. See 12 U.S.C. 1422(10)(A); 12 CFR 1263.1. The Bank Act was...

Five-year follow-up on the work force and finances of United States anesthesiology training programs: 2000 to 2005.

PubMed

Tremper, Kevin K; Shanks, Amy; Morris, Michelle

2007-04-01

In the middle 1990s, there was a decrease in anesthesiology residency class sizes, which contributed to a nationwide shortage of anesthesiologists, resulting in a competitive market with increased salary demands. In 1999, a nationwide survey of the financial status of United States anesthesiology training programs was conducted. Follow-up surveys have been conducted each year thereafter. We present the results of the sixth survey in this series. Surveys were distributed by e-mail to the anesthesiology department chairs of the United States Training Programs. Responses were also received by e-mail. One hundred twenty-one departments were surveyed with a response rate of 60%. The 87% of departments seeking at least one additional faculty had an average of 2.8 faculty open positions (5.5% open positions overall which is down from 9.7% in 2000). Of the 96% of departments that employ certified registered nurse anesthetists (CRNAs) 89% were seeking additional CRNAs, averaging 3.6 open positions. The average department received $4.9 million (or $116,000/faculty) in institutional support. When the portion of this support allocated for CRNA salaries was removed, the average department received $4.1 million (or $95,000/faculty) in institutional support. This is a 16% increase over the previous year. Faculty academic time averaged 17% (where 20% is 1 d/wk). Departments billed an average of 11,320 anesthesia units/faculty/yr. Although the average anesthesia unit value collected was $31, departments required approximately $40/U to meet expenses. Medicaid payments averaged $15, ranging from $5 to $30/U. These results demonstrate the continuing need for institutional support to keep anesthesiology training departments financially stable.

Towards the design of an optimal strategy for the production of ergosterol from Saccharomyces cerevisiae yeasts.

PubMed

Náhlík, Jan; Hrnčiřík, Pavel; Mareš, Jan; Rychtera, Mojmír; Kent, Christopher A

2017-05-01

The total yield of ergosterol produced by the fermentation of the yeast Saccharomyces cerevisiae depends on the final amount of yeast biomass and the ergosterol content in the cells. At the same time ergosterol purity-defined as percentage of ergosterol in the total sterols in the yeast-is equally important for efficient downstream processing. This study investigated the development of both the ergosterol content and ergosterol purity in different physiological (metabolic) states of the microorganism S. cerevisiae with the aim of reaching maximal ergosterol productivity. To expose the yeast culture to different physiological states during fermentation an on-line inference of the current physiological state of the culture was used. The results achieved made it possible to design a new production strategy, which consists of two preferable metabolic states, oxidative-fermentative growth on glucose followed by oxidative growth on glucose and ethanol simultaneously. Experimental application of this strategy achieved a value of the total efficiency of ergosterol production (defined as product of ergosterol yield coefficient and volumetric productivity), 103.84 × 10 -6 g L -1 h -1 , more than three times higher than with standard baker's yeast fed-batch cultivations, which attained in average 32.14 × 10 -6 g L -1 h -1 . At the same time the final content of ergosterol in dry biomass was 2.43%, with a purity 86%. These results make the product obtained by the proposed control strategy suitable for effective down-stream processing. © 2017 American Institute of Chemical Engineers Biotechnol. Prog., 33:838-848, 2017. © 2017 American Institute of Chemical Engineers.

Modes of failure of Osteonics constrained tripolar implants: a retrospective analysis of forty-three failed implants.

PubMed

Guyen, Olivier; Lewallen, David G; Cabanela, Miguel E

2008-07-01

The Osteonics constrained tripolar implant has been one of the most commonly used options to manage recurrent instability after total hip arthroplasty. Mechanical failures were expected and have been reported. The purpose of this retrospective review was to identify the observed modes of failure of this device. Forty-three failed Osteonics constrained tripolar implants were revised at our institution between September 1997 and April 2005. All revisions related to the constrained acetabular component only were considered as failures. All of the devices had been inserted for recurrent or intraoperative instability during revision procedures. Seven different methods of implantation were used. Operative reports and radiographs were reviewed to identify the modes of failure. The average time to failure of the forty-three implants was 28.4 months. A total of five modes of failure were observed: failure at the bone-implant interface (type I), which occurred in eleven hips; failure at the mechanisms holding the constrained liner to the metal shell (type II), in six hips; failure of the retaining mechanism of the bipolar component (type III), in ten hips; dislocation of the prosthetic head at the inner bearing of the bipolar component (type IV), in three hips; and infection (type V), in twelve hips. The mode of failure remained unknown in one hip that had been revised at another institution. The Osteonics constrained tripolar total hip arthroplasty implant is a complex device involving many parts. We showed that failure of this device can occur at most of its interfaces. It would therefore appear logical to limit its application to salvage situations.

Pricing and Enrollment Planning.

ERIC Educational Resources Information Center

Martin, Robert E.

2003-01-01

Presents a management model for pricing and enrollment planning that yields optimal pricing decisions relative to student fees and average scholarship, the institution's financial ability to support students, and an average cost-pricing rule. (SLD)

38 CFR 21.9640 - Rates of payment of educational assistance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the institution of higher learning (converted into United States dollars); or (2) The average (i.e... percent) and who— (1) Is enrolled at an institution of higher learning located in the United States, or at... amount for established charges paid directly to the institution of higher learning for the entire quarter...

Salaries of Head Coaches Are Rising, Survey Shows.

ERIC Educational Resources Information Center

Naughton, Jim

1998-01-01

Salaries of head coaches in college sports are rising, but a large salary gap remains between coaches of men's and women's teams. In a national ranking of institutions by salary averages, men's coaches at the median institution made 43% more than women's coaches. Some institutions provide more salary equity than others. The Justice Department is…

WE-G-BRA-04: Common Errors and Deficiencies in Radiation Oncology Practice

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

Kry, S; Dromgoole, L; Alvarez, P

Purpose: Dosimetric errors in radiotherapy dose delivery lead to suboptimal treatments and outcomes. This work reviews the frequency and severity of dosimetric and programmatic errors identified by on-site audits performed by the IROC Houston QA center. Methods: IROC Houston on-site audits evaluate absolute beam calibration, relative dosimetry data compared to the treatment planning system data, and processes such as machine QA. Audits conducted from 2000-present were abstracted for recommendations, including type of recommendation and magnitude of error when applicable. Dosimetric recommendations corresponded to absolute dose errors >3% and relative dosimetry errors >2%. On-site audits of 1020 accelerators at 409 institutionsmore » were reviewed. Results: A total of 1280 recommendations were made (average 3.1/institution). The most common recommendation was for inadequate QA procedures per TG-40 and/or TG-142 (82% of institutions) with the most commonly noted deficiency being x-ray and electron off-axis constancy versus gantry angle. Dosimetrically, the most common errors in relative dosimetry were in small-field output factors (59% of institutions), wedge factors (33% of institutions), off-axis factors (21% of institutions), and photon PDD (18% of institutions). Errors in calibration were also problematic: 20% of institutions had an error in electron beam calibration, 8% had an error in photon beam calibration, and 7% had an error in brachytherapy source calibration. Almost all types of data reviewed included errors up to 7% although 20 institutions had errors in excess of 10%, and 5 had errors in excess of 20%. The frequency of electron calibration errors decreased significantly with time, but all other errors show non-significant changes. Conclusion: There are many common and often serious errors made during the establishment and maintenance of a radiotherapy program that can be identified through independent peer review. Physicists should be cautious, particularly in areas highlighted herein that show a tendency for errors.« less

Reduced pleural drainage, length of stay, and readmissions using a modified Fontan management protocol.

PubMed

Pike, Nancy A; Okuhara, Carol A; Toyama, Joy; Gross, Barbara P; Wells, Winfield J; Starnes, Vaughn A

2015-09-01

Persistent pleural effusions after the Fontan procedure contribute to prolonged hospitalization and increased costs. We report our experience using a modified Wisconsin Fontan protocol to reduce chest tube drainage and hospital length of stay (LOS). Single institutional retrospective chart review of 120 consecutive patients (60 before and 60 after initiation of our protocol) undergoing an extracardiac Fontan procedure from January 2004 to February 2007. Protocol influence was assessed by comparing group differences on duration of pleural drainage, requirement for nothing by mouth/total parenteral nutrition, hospital LOS, readmission for pleural effusion, and total hospital costs. Groups were similar in demographic characteristics, single ventricle morphology, preoperative hemodynamic parameters, and operative and immediate postoperative management. Median duration of pleural drainage and hospital LOS was reduced in the post- versus preprotocol groups: 4 days (interquartile range [IQR], 4-5 days) pre versus 6 days (IQR, 5-10 days) (P < .0001) and 6 days (IQR, 5-9 days) versus 8 days (IQR, 6-13 days) (P = .005), respectively. Pleural drainage lasting >1 week was also less common postprotocol: 23 (38%) before versus 7 (12%) after (P = .001). Fewer postprotocol patients required nothing by mouth/total parenteral nutrition to control effusions: 5 pre versus 0 post (P = .06), and fewer readmissions for effusions (14 before vs 7 after [P = .1]). An average total cost savings of 22% and readmissions savings of 29% resulted in nearly $500,000 in institutional savings over the study period. A modified Fontan protocol resulted in reduced time to chest tube removal, hospital LOS, and chest tube drainage lasting >1 week. There was a strong trend toward avoiding nothing by mouth/total parenteral nutrition to control pleural effusion and lower hospital costs. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

[Analysis on 2011 quality control results on aerobic plate count of microbiology laboratories in China].

PubMed

Han, Haihong; Li, Ning; Li, Yepeng; Fu, Ping; Yu, Dongmin; Li Zhigang; Du, Chunming; Guo, Yunchang

2015-01-01

To test the aerobic plate count examining capability of microbiology laboratories, to ensure the accuracy and comparability of quantitative bacteria examination results, and to improve the quality of monitoring. The 4 different concentration aerobic plate count piece samples were prepared and noted as I, II, III and IV. After homogeneity and stability tests, the samples were delivered to monitoring institutions. The results of I, II, III samples were logarithmic transformed, and evaluated with Z-score method using the robust average and standard deviation. The results of IV samples were evaluated as "satisfactory" when reported as < 10 CFU/piece or as "not satisfactory" otherwise. Pearson χ2 test was used to analyze the ratio results. 309 monitoring institutions, which was 99.04% of the total number, reported their results. 271 institutions reported a satisfactory result, and the satisfactory rate was 87.70%. There was no statistical difference in satisfactory rates of I, II and III samples which were 81.52%, 88.30% and 91.40% respectively. The satisfactory rate of IV samples was 93.33%. There was no statistical difference in satisfactory rates between provincial and municipal CDC. The quality control program has provided scientific data that the aerobic plate count capability of the laboratories meets the requirements of monitoring tasks.

Failure analysis of knee arthrodesis with the WichitaFusion Nail.

PubMed

Parcel, Ted W; Levering, Melissa; Polikandriotis, John A; Gustke, Kenneth A; Bernasek, Thomas L

2013-11-01

Arthrodesis is a salvage procedure for failed total knee arthroplasty with the intent to create a stable, pain-free limb on which to ambulate or transfer. For many patients, the alternative to arthrodesis may be an above-knee amputation. Available techniques for knee arthrodesis include compression plating, external fixators, and intramedullary fixation. The purpose of this study was to report the knee fusion rate of consecutive patients at 1 institution using an intramedullary fusion nail and to identify patient risk factors for fusion failure. Between November 1998 and November 2008, twenty-eight patients undergoing knee arthrodesis with an average follow-up of 18 months (range, 3-64 months) were retrospectively studied. Demographic information, presence of fusion, clinical function, pain level, and bone defect data were collected and analyzed. Eighty-two percent (23/28) of patients had radiographic evidence of successful fusion with an average time to fusion of 21 weeks (range, 10-58 weeks). When examining patient variables that could correlate with fusion rates, patients with an Anderson Orthopaedic Research Institute type 3 femoral or type 3 tibial defect had a statistically significant lower fusion rate. The intramedullary fusion nail is an effective device for knee arthrodesis that offers ease of insertion through the knee wound with the advantages of initial bone compression and rigid fixation. Although the use of intramedullary fusion nails leads to a high fusion rate, significant bone deficiency limits successful fusion. Copyright 2013, SLACK Incorporated.

Malignant tumors associated with ovarian mature teratoma: A single institution experience.

PubMed

Trabzonlu, Levent; Durmaz, Guray; Vural, Cigdem; Muezzinoglu, Bahar; Corakci, Aydin

2017-05-01

The aims of this study are to present demographical features of cases diagnosed with malignant tumor associated with ovarian mature teratoma and to analyze histopathological features and clinical follow up of these tumors. Single-institution retrospective charts were reviewed to identify all cases of ovarian mature teratoma diagnosed from 1998 to 2015. Clinicopathological parameters that were analyzed include age, tumor size, tumor stage, histological type, laterality, IOC diagnosis and whether or not patient has received adjuvant chemotherapy. A total of 218 ovarian mature teratoma cases were identified during the study period. Of the 218 ovarian mature teratoma specimens, eight (3.7%) exhibited malignant tumors. The average age for cases of malignancy associated with ovarian mature teratoma was 44.6 years. The average size of tumors was 10.36cm. On final pathology, histological types of tumors were as follows: two cases each of squamous cell carcinoma and papillary thyroid carcinoma; one case each of mucinous adenocarcinoma, metastatic adenocarcinoma, sebaceous carcinoma and oligodendroglioma. Only one patient with Stage IIB tumor died of disease. One patient was alive with metastatic disease two months after initial diagnosis. Mean and median follow-up times were 64.1 and 49 months, respectively. An ovarian mass that has characteristics of a teratoma in a postmenopausal patient should alert for malignancy -regardless of tumor size. IOC is a valuable tool for the detection of malignancy and should be requested to determine the modality of surgical approach. Copyright © 2017 Elsevier GmbH. All rights reserved.

Trends in funding for research on pain: a report on the National Institutes Of Health grant awards over the years 2003 to 2007.

PubMed

Bradshaw, David H; Empy, Court; Davis, Phillip; Lipschitz, David; Dalton, Peter; Nakamura, Yoshio; Chapman, C Richard

2008-12-01

In recent years, the National Institutes of Health (NIH) has experienced unprecedented reductions in its customary annual budget increases. Consequently, researchers, health care policy planners and others have a pressing need for accurate information on NIH funding patterns. We created a unique and objective system for compiling, classifying, and analyzing data on NIH grant awards and funding for research on pain, nausea, and dyspnea using naïve observers, cross-validation by multiple raters, and face validation by experts. We present results of our method and analyses for the period from 2003 to 2007. Following a 12% increase from 2003 to 2004, funding for pain research fell by 9.4% per year on average over the next 3 years. The percent of the total NIH budget going to support pain research increased to 0.78% in 2004 but fell to 0.61% in 2007. A piecewise regression model confirmed the declining trend represented a significant fit to the data (R(2)=0.98, p=0.024). Separate breakdowns by Institutes showed similar patterns. Analyses of nausea and dyspnea research support revealed small but steady increases over the same period. Declining support for pain research disproportionate to decreases in the NIH budget signals a need for measures to promote funding for meritorious applications. Results of 5 year trends in numbers of grants and funding for research in pain, nausea, and dyspnea by the NIH show overall declines for pain but slight increases for nausea and dyspnea. Declining support for pain research that exceeds the reductions in the total NIH budget signals a need for measures to increase pain research funding.

MO-FG-202-05: Identifying Treatment Planning System Errors in IROC-H Phantom Irradiations

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

Kerns, J; Followill, D; Howell, R

Purpose: Treatment Planning System (TPS) errors can affect large numbers of cancer patients receiving radiation therapy. Using an independent recalculation system, the Imaging and Radiation Oncology Core-Houston (IROC-H) can identify institutions that have not sufficiently modelled their linear accelerators in their TPS model. Methods: Linear accelerator point measurement data from IROC-H’s site visits was aggregated and analyzed from over 30 linear accelerator models. Dosimetrically similar models were combined to create “classes”. The class data was used to construct customized beam models in an independent treatment dose verification system (TVS). Approximately 200 head and neck phantom plans from 2012 to 2015more » were recalculated using this TVS. Comparison of plan accuracy was evaluated by comparing the measured dose to the institution’s TPS dose as well as the TVS dose. In cases where the TVS was more accurate than the institution by an average of >2%, the institution was identified as having a non-negligible TPS error. Results: Of the ∼200 recalculated plans, the average improvement using the TVS was ∼0.1%; i.e. the recalculation, on average, slightly outperformed the institution’s TPS. Of all the recalculated phantoms, 20% were identified as having a non-negligible TPS error. Fourteen plans failed current IROC-H criteria; the average TVS improvement of the failing plans was ∼3% and 57% were found to have non-negligible TPS errors. Conclusion: IROC-H has developed an independent recalculation system to identify institutions that have considerable TPS errors. A large number of institutions were found to have non-negligible TPS errors. Even institutions that passed IROC-H criteria could be identified as having a TPS error. Resolution of such errors would improve dose delivery for a large number of IROC-H phantoms and ultimately, patients.« less

Incidence and Demographics of Post-Operative Naloxone Administration: A 13-Year Experience at a Major Tertiary Teaching Institution.

PubMed

Khelemsky, Yury; Kothari, Rishi; Campbell, Neville; Farnad, Shahbaz

2015-01-01

Perioperative use of opioids is associated with the risk of opioid-induced respiratory depression. Naloxone is a competitive opioid antagonist typically administered to reverse opioid-induced respiratory depression. Postoperative administration of naloxone may be considered a proxy for significant postoperative opioid-induced respiratory depression and data regarding its use may be utilized as a quality measure. Few large studies have been done to characterize the population and define an incidence of naloxone recipients in the postoperative inpatient setting. We aimed to characterize the demographics of patients receiving postoperative naloxone, as well as the incidence of administration in the first 72 post-operative hours at a large urban academic medical center in the United States. This is a retrospective cohort study. Major urban tertiary teaching institution. The robust electronic record database of The Department of Anesthesiology at The Icahn School of Medicine at Mount Sinai, as well as the institution's data warehouse were instrumental in allowing almost 450,000 surgical cases performed between 2001 and 2014 to be screened for naloxone administration within the first 72 postoperative hours. Organ harvests, outside of OR intubations, cancelled cases, and patients age less than or equal to 18 were excluded from the total case count. Naloxone was administered 433 times in a total of 442,699 postoperative cases. This yielded an incidence of 0.1%. Additionally, the demographics of the group receiving naloxone were described. The mean age was 60, mean body mass index (BMI) was 27, 60% were women, and the mean American Society of Anesthesiologists (ASA) status was 3. Average time to naloxone administration was 21 hours (standard deviation 7) after surgery. Thirteen percent of the cases were emergent. Breakdown of anesthetic technique revealed that 81% of the cases were performed under general anesthesia, 7% with monitored anesthesia care (MAC), and 12% under neuraxial anesthesia. This study lays the groundwork for further elucidating risk factors for postoperative administration of naloxone. This is a retrospective study. The overall incidence of postoperative naloxone administration over a 13 year period in approximately 450,000 patients was 0.1%. Demographics of this group were older, ASA 3 women, qualifying as overweight, but not obese, undergoing elective surgery with a general anesthetic technique. Average time to administration was 21 hours postoperatively.

ON-Q infusion pump linked to increased hospital stay after total knee arthroplasty.

PubMed

O'Neil, Stephen; Danielson, Kristopher; Johnson, Kory; Matelic, Thomas

2018-06-01

The purpose of this study was to evaluate immediate postoperative pain control modalities after total knee arthroplasty at the author's specific institution and compare those modalities with patient satisfaction, rehabilitation status, and length of hospital stay. A retrospective chart review of 101 patients who underwent total knee arthroplasty from 2013 to 2016 was performed. Data was collected including the pain control modality, total pain medication consumption, physical therapy progress, length of hospital stay and Visual Analog Scores. Analysis was then performed using SAS proprietary software. Results were reported as statistically significant if p value was less than 0.05. Multiple variables proved to be statistically significant (p value <0.05) in this particular study. Patients who received Valium required more morphine equivalents on average and reported higher Visual Analog Scores (VAS). For those patients who received a lower extremity nerve block pre operatively, there was a decrease in morphine equivalents on postoperative day one and lower VAS. For those patients who received the continuous pain pump, ON-Q postoperatively, there was an average increase in length of hospital stay by one day and a decrease in ambulation on postoperative day one. Also, females required less overall pain medication on postoperative days two and three compared to their male counterparts. Finally, there was no statistically significant difference for those patients who received Lyrica (pregabalin) or NSAIDS for the parameters that were measured in this study. Postoperative pain control modalities after total knee arthroplasty are highly variable among physicians. This variability has allowed researchers to review each modality and compare and contrast the benefits with the potential adverse effects of these medications on total knee replacement outcomes. The data in this study suggests that the use of Valium is correlated with increased pain medication consumption and decreased patient satisfaction. Data from this study also reveals that patients who underwent preoperative nerve blocks experienced decreased pain on postoperative day one and greater patient satisfaction. The most notable contribution of this study was the discovery of the adverse effects of the continuous pain pump, ON-Q. Patients treated with this modality had decreased ambulation on postoperative day one and on average remained in the hospital one extra day, a variable that significantly increases the cost of a total knee arthroplasty for the hospital, the surgeon and the patient. Even though this data is significant, further studies should be performed to enhance our knowledge of postoperative pain control for these patients.

T700 Blisk and Impeller Manufacturing Process Development Program.

DTIC Science & Technology

1979-11-01

700(40) Reworked Media Temperature - 790 F Average Media Pressure - 200 psi Total Cycles (Test No. 1) - 40 Total Cycles (Test No. 2) - 20 Total Time...36A(73), - 700(40" Media Temperature - 80F Average Media Pressure - 150 psi Total Cycles - 52 Total Time - 95 Minutes Some difficulty was...61)-36A(73)-700( 4O)Media Temperature - 79OF average Media Pressure - 200 psi Time - 40 cycles - 72 minutes Time - 60 cycles - 109 minutes Time - 80

Total control: a critical analysis of mandatory HIV testing in U.S. prisons.

PubMed

Gagnon, Marilou; Jacob, Jean Daniel; Cormier, Luc

2013-01-01

The aim of this paper is to explore the relationship between mandatory HIV testing and the institutional management of inmates in U.S. prisons. Mandatory HIV testing has been largely overlooked by the nursing community even though it has important human rights and ethical implications. Drawing on the work of Goffman (1990) on the inner workings of total institutions, the present article critically examines the deployment of mandatory HIV testing in U.S. prisons. To set the stage, we define mandatory HIV testing and describe the methods of HIV testing currently used in U.S. prison settings. Then, we provide a brief overview of the concept of total institution and the mortification process. Finally, we expand on the relationship between mandatory HIV testing and much larger institutional objectives of total control, total structuring, total isolation, and separation of inmates from society (as summarized by Farrington, 1992). And lastly, we provide a brief discussion on the implications of mandatory HIV testing (as a method of HIV testing) from a nursing perspective.

Linking Student Retention Model with Institutional Planning: The Benefits and Limitations of a Student Matrix Model.

ERIC Educational Resources Information Center

Schartman, Laura; Rhee, Byung-Shik

This study explored the possibility of linking the Luna (1999) student flow matrix model with institutional planning at a comprehensive state institution, investigating how student flow environments were associated with student characteristics such as race, gender, citizenship, class level, entry type, and cumulative grade point average. The study…

Predicting Sex Offender Institutional Adjustment and Treatment Compliance Using the Personality Assessment Inventory

ERIC Educational Resources Information Center

Caperton, Jennifer D.; Edens, John F.; Johnson, Judy K.

2004-01-01

This study examined the utility of the Personality Assessment Inventory (PAI) to identify prison inmates in a mandatory sex offender treatment program prone to engage in institutional misconduct. Archival PAI and institutional disciplinary data were coded for 137 inmates in treatment for an average of 1.59 years. The Antisocial Features scale…

Naive vs. Sophisticated Methods of Forecasting Public Library Circulations.

ERIC Educational Resources Information Center

Brooks, Terrence A.

1984-01-01

Two sophisticated--autoregressive integrated moving average (ARIMA), straight-line regression--and two naive--simple average, monthly average--forecasting techniques were used to forecast monthly circulation totals of 34 public libraries. Comparisons of forecasts and actual totals revealed that ARIMA and monthly average methods had smallest mean…

Cost-Effectiveness Analysis of Total Hip Arthroplasty Performed by a Canadian Short-Stay Surgical Team in Ecuador

PubMed Central

Schlegelmilch, Michael; Moreau, Barbara; Jarrín, Patricia; Tran, Bach; Chuck, Anderson

2017-01-01

Background Few charitable overseas surgical missions produce cost-effectiveness analyses of their work. Methods We compared the pre- and postoperative health status for 157 total hip arthroplasty (THA) patients operated on from 2007 to 2011 attended by an annual Canadian orthopedic mission to Ecuador to determine the quality-adjusted life years (QALYs) gained. The costs of each mission are known. The cost per surgery was divided by the average lifetime QALYs gained to estimate an incremental cost-effectiveness ratio (ICER) in Canadian dollars per QALY. Results The average lifetime QALYs (95% CI) gained were 1.46 (1.4–1.5), 2.5 (2.4–2.6), and 2.9 (2.7–3.1) for unilateral, bilateral, and staged (two THAs in different years) operations, respectively. The ICERs were $4,442 for unilateral, $2,939 for bilateral, and $4392 for staged procedures. Seventy percent of the mission budget was spent on the transport and accommodation of volunteers. Conclusion THA by a Canadian short-stay surgical team was highly cost-effective, according to criteria from the National Institute for Health and Care Excellence and the World Health Organization. We encourage other international missions to provide similar cost-effectiveness data to enable better comparison between mission types and between mission and nonmission care. PMID:29403664

Changes in Soil Carbon and Moisture over the Six Year after Thinning of a Natural Oak Forest

NASA Astrophysics Data System (ADS)

Kim, S.; Han, S. H.; Li, G.; Chang, H.; Kim, H. J.; Son, Y.

2017-12-01

The objective of this study was to assess the effects of thinning on soil carbon (C) in a natural oak forest in central Korea. The study forest received three different thinning treatments consisting of un-thinned control (UTC) and two thinning intensities (15% and 30% basal area reductions) in March in 2010. Precipitation near the study forest maintained the normal level from 2010 to 2013 (average 1,400 mm year-1), but abnormally decreased from 2014 to 2016 (average 800 mm year-1). To measure total soil C stock and soil moisture conditions, soils were collected from 0-10, 10-20, and 20-30 cm depths in June, 2010, 2013, and 2016, respectively. Soil microbial biomass C and C-cycling enzymes (β-glucosidase, cellobiohydrolase, β-xylosidase, phenol oxidase, and peroxidase) at 0-10 cm depth were determined in June, 2016. Total soil C stock at 0-30 cm depth increased throughout the study period, whereas soil moisture decreased at all depths from 2013 to 2016. Both thinning treatments had higher total soil C stock at 0-30 cm depth and moisture at 10-20 and 20-30 cm depths than the UTC in 2013 and 2016, whereas the treatments showed no effects in 2010. Microbial biomass C at 0-10 cm depth in 2016 also increased because of the thinning treatments, which was positively correlated to total soil C stock. However, any effects of thinning on C-cycling enzymes were not significant. Our results indicate that thinning could contribute to relieving the impacts of decreasing precipitation by enhancing the storage of soil moisture. Furthermore, the change in total soil C stock under thinning might result from the stimulation of microbial potential for retaining organic C as a form of biomass. This study was supported by the Ministry of Environment (2014001810002) and the National Institute of Forest Science of Korea (FM0101-2009-01).

On-site audits to investigate the quality of radiation physics of radiation therapy institutions in the Republic of Korea.

PubMed

Park, Jong Min; Park, So-Yeon; Chun, Minsoo; Kim, Sang-Tae

2017-08-01

To investigate and improve the domestic standard of radiation therapy in the Republic of Korea. On-site audits were performed for 13 institutions in the Republic of Korea. Six items were investigated by on-site visits of each radiation therapy institution, including collimator, gantry, and couch rotation isocenter check; coincidence between light and radiation fields; photon beam flatness and symmetry; electron beam flatness and symmetry; physical wedge transmission factors; and photon beam and electron beam outputs. The average deviations of mechanical collimator, gantry, and couch rotation isocenter were less than 1mm. Those of radiation isocenter were also less than 1mm. The average difference between light and radiation fields was 0.9±0.6mm for the field size of 20cm×20cm. The average values of flatness and symmetry of the photon beams were 2.9%±0.6% and 1.1%±0.7%, respectively. Those of electron beams were 2.5%±0.7% and 0.6%±1.0%, respectively. Every institutions showed wedge transmission factor deviations less than 2% except one institution. The output deviations of both photon and electron beams were less than ±3% for every institution. Through the on-site audit program, we could effectively detect an inappropriately operating linacs and provide some recommendations. The standard of radiation therapy in Korea is expected to improve through such on-site audits. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

A single center analysis of factors influencing study start-up timeline in clinical trials.

PubMed

Krafcik, Brianna M; Doros, Gheorghe; Malikova, Marina A

2017-11-01

Efficient start-up phase in clinical trials is crucial to execution. The goal was to determine factors contributing to delays. The start-up milestones were assessed for 38 studies and analyzed. Total start-up time was shorter for following studies: device trials, no outsourcing, fewer ancillary services used and in interventional versus observational designs. The use of a centralized Institutional Review Board (IRB) versus a local IRB reduced time to approval. Studies that never enrolled took longer on average to finalize their budget/contract, and obtain IRB than ones that did enroll. Different features of clinical trials can affect timeline of start-up process. An understanding of the impact of each feature allows for optimization.

A Model to Improve Detection of Nonaccidental Pediatric Burns.

PubMed

Nigro, Lauren C; Feldman, Michael J; Foster, Robin L; Pozez, Andrea L

2018-06-01

Pediatric burn patients warrant thorough evaluation because a sizeable proportion of pediatric burns are nonaccidental. A multidisciplinary method involving an internal child protection team (CPT) was developed and used to identify suspected nonaccidental pediatric burns in all pediatric burn patients 5 years of age or younger who were evaluated by the CPT and social workers at our institution over a 55-month period. We identified 343 cases for review that fit our age criteria, 6 of which we identified as cases of suspected abuse or neglect. On average, these patients were younger, suffered greater total body surface area burns (TBSA), and required a longer length of stay in the hospital than the total population. We have not had readmissions for repeat nonaccidental pediatric burn injuries in this group of patients since this model was implemented. Our multidisciplinary method might provide a more consistent and reliable method for identifying cases of suspected abuse. © 2018 American Medical Association. All Rights Reserved.

Therapeutic effect of lipoprostaglandin E1 on sudden hearing loss.

PubMed

Ahn, Joong Ho; Kim, Mi Ra; Kim, Hyang Cho

2005-01-01

The authors conducted a prospective, comparative clinical trial for the purpose of additional effect of lipoprostaglandin E 1 (lipo-PGE 1 ) on sudden hearing loss. With the approval of the institute ethics committee, a total of 128 consecutive patients with diagnoses of sudden hearing loss were included in the study. The patients in the lipo-PGE 1 group received continuous infusion of 10 microL lipo-PGE 1 and 48 mg methylprednisolone for 5 days, and the patient in the control group were treated with only 48 mg methylprednisolone. The total recovery rate after the treatment was 67.2%. There were 70.5% recovery rate in lipo-PGE 1 group and 60.5% recovery rate in control group. However, no significant differences were observed in the improvements of pure tone average and subjective symptoms between the lipo-PGE 1 and control groups. The results failed to prove a beneficial effect of lipo-PGE 1 in the treatment of sudden hearing loss in spite of its higher cure rate.

[Comparison of development and mortality under domestic or institutional care with and without medical rehabilitation : The Hannover morbidity and mortality long-term care study].

PubMed

Seger, W; Sittaro, N-A; Lohse, R; Rabba, J

2013-12-01

Empirical data, representative of the total population, are necessary for medico-actuarial risk calculations. Our study compares mortalities of long-term care (LTC) patients who are covered by statutory health insurance with regard to age and distribution of care levels when in home or institutional care with a special focus on whether rehabilitative care was performed. The data of 88,575 LTC patients were analyzed longitudinally for 10 years, using routine data analyses on the files of the German Federal Health Insurance fund (average observation period 2.5 years, a total of 221,625 observation years). The numbers of LTC patients and their care levels while in home or institutional care were calculated, as were any changes to another care level or discontinuation of LTC benefits (as a result of the need for care falling below the eligibility criteria for care leveI or to death) during 1-10 years after the onset of LTC, always with respect to whether rehabilitative care had taken place or not. For the evaluation of care factors an indicator was developed. Total mortality was found to decline and reactivation to increase considerably for LTC patients after rehabilitation, basically irrespective of their age or care level and in home or institutional care settings as well. Ten years after the onset of care, 30.7 % of the patients with rehabilitation were still in nursing care, 9.8 % were reactivated and 59.5 % deceased. In contrast, only 9.2 % were still in nursing care, 3.7 % reactivated and 87.1 % deceased without rehabilitation. These results are irrespective of age distribution, care level, and residence in home or institutional care settings. The care status of patients, measured by the percentage in reactivation, care level I-III, and death, substantially depends on age at onset and care level and in addition on rehabilitative procedures. Hypotheses for further research are outlined. Rehabilitation has a clear-cut potential for life extension as well as reducing or detaining long-term care if applied to (LTC) patients. The group of rehabilitated LTC patients has a comparatively higher degree of reducing or resolving LTC up to a complete reactivation or prolonging of life in spite of care needed. A successful rehabilitative effect occurs over all age groups and all care levels during home care considerably as well as during institutional care to a lower extent. Differentiation between the age at onset of LTC, care level, and first year and follow-up mortalities is recommended as well as between rehabilitated and nonrehabilitated care patients when undertaking medico-actuarial calculations.

Outcomes of laparoscopic adrenalectomy. Clinical experience with 68 patients.

PubMed

Pugliese, Raffaele; Boniardi, Marco; Sansonna, Fabio; Maggioni, Dario; De Carli, Stefano; Costanzi, Andrea; Scandroglio, Ildo; Ferrari, Giovanni Carlo; Di Lernia, Stefano; Magistro, Carmelo; Loli, Paola; Grossrubatscher, Erika

2008-07-01

The aim of this study was to analyze feasibility and outcomes of laparoscopic adrenalectomy (LA). Pathology, size and bilateral site of lesions were considered. Between December 1998 and May 2007 in our institution a total of 68 patients of mean age of 53 years underwent unilateral (n=57) or bilateral (n=11) LA. Adrenal masses averaged 5.4cm in size (range 1.2-13cm) and 56.7g in weight (range 10-265) including 71 benign and 8 malignant lesions. A total of 79 adrenal glands were resected, 44 right sided and 35 left sided. Removal was complete in 77 cases and partial (sparing adrenalectomy) in 1 patient affected by bilateral pheochomocytoma. Three left adrenalectomies for pheochromocytoma were robot-assisted. The transperitoneal lateral approach was preferred and the posterior retroperitoneal approach was adopted in 5 patients. The mean duration of surgery for each LA was 138+/-90min and 3.8 trocar were used on average (range 3-6). Conversion was needed in 3 cases owing to difficult dissection of large masses. Estimated mean blood loss for each LA was 95+/-30ml and it was greater for bilateral LA. Mortality was nil and morbidity was 5.8%. The average length of hospital stay (LOS) in surgical unit was 4+/-2.4 days (range 2-8). Patients affected by hormone secreting or bilateral lesions, by unilateral or bilateral pheochromocytoma and by bilateral Cushing's disease were transferred to the endocrinological ward so that their overall hospital stay was prolonged to 9+/-2.8 days on average (range 7-17). Mean duration of follow-up of patients was 38 months (range 2-100) and demonstrated acceptable endocrine results. Three primary cortical carcinomas were discovered as chance findings on histologic examination. While long-term results after LA for cortical carcinomas were poor and LA is not recommended in such cases, long-term results after LA for adrenal metastases were encouraging.

Geographic trends of scientific output and citation practices in psychiatry.

PubMed

Igoumenou, Artemis; Ebmeier, Klaus; Roberts, Nia; Fazel, Seena

2014-12-06

Measures of research productivity are increasingly used to determine how research should be evaluated and funding decisions made. In psychiatry, citation patterns within and between countries are not known, and whether these differ by choice of citation metric. In this study, we examined publication characteristics and citation practices in articles published in 50 Web of Science indexed psychiatric and relevant clinical neurosciences journals, between January 2004 and December 2009 comprising 51,072 records that produced 375,962 citations. We compared citation patterns, including self-citations, between countries using standard x(2) tests. We found that most publications came from the USA, with Germany being second and UK third in productivity. USA articles received most citations and the highest citation rate with an average 11.5 citations per article. The UK received the second highest absolute number of citations, but came fourth by citation rate (9.7 citations/article), after the Netherlands (11.4 citations/article) and Canada (9.8 citations/article). Within the USA, Harvard University published most articles and these articles were the most cited, on average 20.0 citations per paper. In Europe, UK institutions published and were cited most often. The Institute of Psychiatry/Kings College London was the leading institution in terms of number of published records and overall citations, while Oxford University had the highest citation rate (18.5 citations/record). There were no differences between the self-citation practices of American and European researchers. Articles that examined some aspect of treatment in psychiatry were the most published. In terms of diagnosis, papers about schizophrenia-spectrum disorders were the most published and the most cited. We found large differences between and within countries in terms of their research productivity in psychiatry and clinical neuroscience. In addition, the ranking of countries and institutions differed widely by whether productivity was assessed by total research records published, overall citations these received, or citations per paper. The choice of measures of scientific output could be important in determining how research output translates into decisions about resource allocation.

Of duty hour violations and shift work: changing the educational paradigm.

PubMed

Kohlbrenner, Amanda; Dirks, Rachel; Davis, James; Wolfe, Mary; Maser, Christina

2016-06-01

Successful surgical education balances learning opportunities with Accreditation Council on Graduate Medical Education (ACGME) duty hour requirements. We instituted a night shift system and hypothesized that implementation would decrease duty hour violations while maintaining quality education. A system of alternating teams working 12-hour shifts was instituted and was assessed via an electronic survey distributed at 2, 6, and 12 months after implementation. Resident duty hour violations and resident case volume were evaluated for 1 year before and 2 years after implementation of the night shift system. Survey data revealed a decrease in the perception that residents had problems meeting duty hour restrictions from 44% to 14% at 12 months (P = .012). Total violations increased 26% in the 1st year, subsequently decreasing by 62%, with shift length violations decreasing by 90%. Resident availability for didactics was improved, and average operative cases per academic year increased by 65%. Night shift systems are feasible and help meet duty hour requirements. Our program decreased violations while increasing operative volume and didactic time. Copyright © 2015 Elsevier Inc. All rights reserved.

The validity of ACT-PEP test scores for predicting academic performance of registered nurses in BSN programs.

PubMed

Yang, J C; Noble, J

1990-01-01

This study investigated the validity of three American College Testing-Proficiency Examination Program (ACT-PEP) tests (Maternal and Child Nursing, Psychiatric/Mental Health Nursing, Adult Nursing) for predicting the academic performance of registered nurses (RNs) enrolled in bachelor's degree BSN programs nationwide. This study also examined RN students' performance on the ACT-PEP tests by their demographic characteristics: student's age, sex, race, student status (full- or part-time), and employment status (full- or part-time). The total sample for the three tests comprised 2,600 students from eight institutions nationwide. The median correlation coefficients between the three ACT-PEP tests and the semester grade point averages ranged from .36 to .56. Median correlation coefficients increased over time, supporting the stability of ACT-PEP test scores for predicting academic performance over time. The relative importance of selected independent variables for predicting academic performance was also examined; the most important variable for predicting academic performance was typically the ACT-PEP test score. Across the institutions, student demographic characteristics did not contribute significantly to explaining academic performance, over and above ACT-PEP scores.

Final progress report, Construction of a genome-wide highly characterized clone resource for genome sequencing

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

Nierman, William C.

At TIGR, the human Bacterial Artificial Chromosome (BAC) end sequencing and trimming were with an overall sequencing success rate of 65%. CalTech human BAC libraries A, B, C and D as well as Roswell Park Cancer Institute's library RPCI-11 were used. To date, we have generated >300,000 end sequences from >186,000 human BAC clones with an average read length {approx}460 bp for a total of 141 Mb covering {approx}4.7% of the genome. Over sixty percent of the clones have BAC end sequences (BESs) from both ends representing over five-fold coverage of the genome by the paired-end clones. The average phredmore » Q20 length is {approx}400 bp. This high accuracy makes our BESs match the human finished sequences with an average identity of 99% and a match length of 450 bp, and a frequency of one match per 12.8 kb contig sequence. Our sample tracking has ensured a clone tracking accuracy of >90%, which gives researchers a high confidence in (1) retrieving the right clone from the BA C libraries based on the sequence matches; and (2) building a minimum tiling path of sequence-ready clones across the genome and genome assembly scaffolds.« less

Using dew points to estimate savings during a planned cooling shutdown

NASA Astrophysics Data System (ADS)

Friedlein, Matthew T.; Changnon, David; Musselman, Eric; Zielinski, Jeff

2005-12-01

In an effort to save money during the summer of 2003, Northern Illinois University (NIU) administrators instituted a four-day working week and stopped air conditioning buildings for the three-day weekends (Friday through Sunday). Shutting down the air conditioning systems caused a noticeable drop in electricity usage for that part of the campus that features in our study, with estimated total electricity savings of 1,268,492 kilowatt-hours or 17% of the average usage during that eight-week period. NIU's air conditioning systems, which relied on evaporative cooling to function, were sensitive to dew point levels. Greatest savings during the shutdown period occurred on days with higher dew points. An examination of the regional dew point climatology (1959 2003) indicated that the average summer daily dew point for 2003 was 14.9°C (58.8°F), which fell in the lowest 20% of the distribution. Based on the relationship between daily average dew points and electrical usage, a predictive model that could estimate electrical daily savings was created. This model suggests that electrical savings related to any future three-day shutdowns over summer could be much greater in more humid summers. Studies like this demonstrate the potential value of applying climatological information and of integrating this information into practical decision-making.

The effect of TISSEEL fibrin sealant on seroma formation following complex abdominal wall hernia repair: a single institutional review and derived cost analysis.

PubMed

Azoury, S C; Rodriguez-Unda, N; Soares, K C; Hicks, C W; Baltodano, P A; Poruk, K E; Hu, Q L; Cooney, C M; Cornell, P; Burce, K; Eckhauser, F E

2015-12-01

The authors evaluated the ability of a fibrin sealant (TISSEEL™: Baxter Healthcare Corp, Deerfield, IL, USA) to reduce the incidence of post-operative seroma following abdominal wall hernia repair. We performed a 4-year retrospective review of patients undergoing abdominal wall hernia repair, with and without TISSEEL, by a single surgeon (FEE) at The Johns Hopkins Hospital. Demographics, surgical risk factors, operative data and 30-day outcomes, including wound complications and related interventions, were compared. The quantity and cost of Tisseel per case was reviewed. A total of 250 patients were evaluated: 127 in the TISSEEL group and 123 in the non-TISSEEL control group. The average age for both groups was 56.6 years (P = 0.97). The majority of patients were female (TISSEEL 52.8%, non-TISSEEL 56.1%, P = 0.59) and ASA Class III (TISSEEL 56.7%, non-TISSEEL 58.5%, P = 0.40). There was no difference in the average defect size for both groups (TISSEEL 217 ± 187.6 cm(2), non-TISSEEL 161.3 ± 141.5 cm(2), P = 0.36). Surgical site occurrences occurred in 18.1% of the TISSEEL and 13% of the non-TISSEEL group (P = 0.27). There was a trend towards an increased incidence of seroma in the TISSEEL group (TISSEEL 11%, non-TISSEEL 4.9%, P = 0.07). A total of $124,472.50 was spent on TISSEEL, at an average cost of $995.78 per case. In the largest study to date, TISSEEL™ application offered no advantage for the reduction of post-operative seroma formation following complex abdominal hernia repair. Moreover, the use of this sealant was associated with significant costs.

Arthrodesis of the knee: experience with intramedullary nailing.

PubMed

Incavo, S J; Lilly, J W; Bartlett, C S; Churchill, D L

2000-10-01

Knee arthrodesis using an intramedullary nail has gained acceptance as treatment in difficult cases such as infection after total knee arthroplasty (TKA), neuropathic joint, and obesity. A retrospective review of 22 cases treated at our institution using an intramedullary nail for knee arthrodesis was performed. Deep infection after primary (11) or revision (6) TKA was the most common indication for this procedure. A long intramedullary nail was used in 3 cases, a long nail with a proximal interlocking screw was used in 6 cases, and a customized nail with a valgus bend and a proximal interlocking screw was used in 11 cases. A modular knee fusion nail was used in 1 case. Successful fusion occurred in all cases, although 4 patients required additional surgery. Average operative blood loss was 748 mL, and average time to union was 7 months. Shortening of the extremity averaged 3.2 cm. Tibiofemoral alignment was improved by using a customized valgus nail (average, 3.1 valgus; range, 1-5) when compared with a straight nail (average, 0.2 valgus; range, 3 varus to 3 valgus). No patient developed infection in the hip or ankle region as a result of the long intramedullary nail. Intramedullary nailing is an excellent technique for knee arthrodesis in difficult cases. A customized proximal interlocking nail with 5 degrees to 7 degrees of valgus and 5 degrees of anterior angulation improves tibiofemoral alignment and is straightforward to insert or extract should it be necessary. Stability and pain relief are rapid, and the fusion rate is maximized.

Influence of Urbanization Level and Gross Domestic Product of Counties in Croatia on Access to Health Care

PubMed Central

Bagat, Mario; Drakulić, Velibor; Sekelj Kauzlarić, Katarina; Vlahušić, Andro; Bilić, Ivica; Matanić, Dubravka

2008-01-01

Aim To examine the association of counties’ urbanization level and gross domestic product (GDP) per capita on the access to health care. Methods Counties were divided in two groups according to the urbanization level and GDP per capita in purchasing power standards. The number of physicians per 100 000 inhabitants, the number of physicians in hospitals in four basic specialties, physicians’ workload, average duration of working week, the average number of insurants per general practice (GP) team, and the number of inhabitants covered by one internal medicine outpatient clinic were compared between predominantly urban and predominantly rural counties, and between richer and poorer counties. Our study included only GP teams and outpatients’ clinics under the contract with the Croatian Institute for Health Insurance. Data on physicians were collected from the Ministry of Health and Social Welfare, the Croatian Institute for Health Insurance, the Croatian Institute for Public Health, and the Croatian Medical Chamber. Data on the contracts with the Croatian Institute for Health Insurance and health care services provided under these contracts were obtained from the database of the Institute, while population and gross domestic product data were obtained from the Database of the Croatian Institute for Statistics. World Health Organization Health for All Database was used for the international comparison of physician’s data. Results There was no significant difference in the total number of physicians per 100 000 inhabitants between predominantly urban and predominantly rural counties (206.9 ± 41.0 vs 175.4 ± 30.3; P = 0.067, t test) nor between richer and poorer counties (194.5 ± 49.8 vs 187.7 ± 25.3; P = 0.703, t test). However, there were significantly fewer GPs per 100 000 inhabitants in rural than urban counties (49.0 ± 5.5 vs 56.7 ± 4.6; P = 0.003, t test). GPs in rural counties had more insurants than those working in urban counties (1.749.8 ± 172.8 vs 1.540.7 ± 106.3; P = 0.004, t test). The working week of specialists in the four observed specialties in hospitals was longer than the recommended 48 hours a week. Conclusion The lack of physicians, especially in primary health care can lead to a reduced access to health care and increased workload of physicians, predominantly in rural counties, regardless of the counties’ GDP. PMID:18581617

An institutional postdoctoral research training program: predictors of publication rate and federal funding success of its graduates.

PubMed

Ross, Randal G; Greco-Sanders, Linda; Laudenslager, Mark; Reite, Martin

2009-01-01

The National Institute of Mental Health funds institutional National Research Service Awards (NRSA) to provide postdoctoral research training. While peer-reviewed publications are the most common outcome measure utilized, there has been little discussion of how publications should be counted or what factors impact the long-term publication rates of trainees in these programs. The authors reviewed current curricula vitae from 92 graduates of an institutional NRSA and from the faculty mentors of that program to assess publications through 2005. Publications were weighted based on peer versus non-peer-reviewed and authorship position. Trainee and mentor factors were assessed for their impact on publication rates and on becoming principal investigators of larger scale federal grants such as a National Institutes of Health (NIH) R01. Weighted publication scores correlate with total publication rates at such a high rate that the two scores can be used interchangeably. Forty-three percent of graduates average at least one publication per year after completing the postdoctoral program; 20% were listed as an independent investigator on a larger federal grant. The number of publications published during postdoctoral training and additional funded training beyond that provided by the institutional NRSA are correlated with increased posttraining program publication rates; other factors including gender, terminal degree, number of publications prior to postdoctoral training, and mentor variables had no significant impact. Additional funded training, male gender, and increased time since completion of the training are associated with increased likelihood of larger grant federal funding. Weighting publications by whether they were peer-reviewed and by authorship position appears to have little benefit over a simple counting of the number of publications. Publication during research training and the pursuit of funding for additional individual research training may be appropriate short-term goals within an institutional research training program.

Institutional capacity for health systems research in East and Central African schools of public health: knowledge translation and effective communication.

PubMed

Ayah, Richard; Jessani, Nasreen; Mafuta, Eric M

2014-06-02

Local health systems research (HSR) provides policymakers and practitioners with contextual, evidence-based solutions to health problems. However, producers and users of HSR rarely understand the complexities of the context within which each operates, leading to the "know-do" gap. Universities are well placed to conduct knowledge translation (KT) integrating research production with uptake. The HEALTH Alliance Africa Hub, a consortium of seven schools of public health (SPHs) in East and Central Africa, was formed to build capacity in HSR. This paper presents information on the capacity of the various SPHs to conduct KT activities. In 2011, each member of the Africa Hub undertook an institutional HSR capacity assessment using a context-adapted and modified self-assessment tool. KT capacity was measured by several indicators including the presence of a KT strategy, an organizational structure to support KT activities, KT skills, and institutional links with stakeholders and media. Respondents rated their opinions on the various indicators using a 5-point Likert scale. Averages across all respondents for each school were calculated. Thereafter, each school held a results validation workshop. A total of 123 respondents from all seven SPHs participated. Only one school had a clear KT strategy; more commonly, research was disseminated at scientific conferences and workshops. While most respondents perceived their SPH as having strong institutional ties with organizations interested in HSR as well as strong institutional leadership, the organizational structures required to support KT activities were absent. Furthermore, individual researchers indicated that they had little time or skills to conduct KT. Additionally, institutional and individual links with policymakers and media were reported as weak. Few SPHs in Africa have a clear KT strategy. Strengthening the weak KT capacity of the SPHs requires working with institutional leadership to develop KT strategies designed to guide organizational structure and development of networks with both the media and policymakers to improve research uptake.

Institutional capacity for health systems research in East and Central African schools of public health: knowledge translation and effective communication

PubMed Central

2014-01-01

Background Local health systems research (HSR) provides policymakers and practitioners with contextual, evidence-based solutions to health problems. However, producers and users of HSR rarely understand the complexities of the context within which each operates, leading to the “know–do” gap. Universities are well placed to conduct knowledge translation (KT) integrating research production with uptake. The HEALTH Alliance Africa Hub, a consortium of seven schools of public health (SPHs) in East and Central Africa, was formed to build capacity in HSR. This paper presents information on the capacity of the various SPHs to conduct KT activities. Methods In 2011, each member of the Africa Hub undertook an institutional HSR capacity assessment using a context-adapted and modified self-assessment tool. KT capacity was measured by several indicators including the presence of a KT strategy, an organizational structure to support KT activities, KT skills, and institutional links with stakeholders and media. Respondents rated their opinions on the various indicators using a 5-point Likert scale. Averages across all respondents for each school were calculated. Thereafter, each school held a results validation workshop. Results A total of 123 respondents from all seven SPHs participated. Only one school had a clear KT strategy; more commonly, research was disseminated at scientific conferences and workshops. While most respondents perceived their SPH as having strong institutional ties with organizations interested in HSR as well as strong institutional leadership, the organizational structures required to support KT activities were absent. Furthermore, individual researchers indicated that they had little time or skills to conduct KT. Additionally, institutional and individual links with policymakers and media were reported as weak. Conclusions Few SPHs in Africa have a clear KT strategy. Strengthening the weak KT capacity of the SPHs requires working with institutional leadership to develop KT strategies designed to guide organizational structure and development of networks with both the media and policymakers to improve research uptake. PMID:24890939

De-institutionalisation and trans-institutionalisation - changing trends of inpatient care in Norwegian mental health institutions 1950-2007

PubMed Central

2009-01-01

Background Over the last decades mental health services in most industrialised countries have been characterised by de-institutionalisation and different kinds of redistribution of patients. This article will examine the historical trends in Norway over the period 1950-2007, identify the patterns of change in service settings and discuss why the mental health services have been dramatically transformed in less than sixty years. Methods The presentation of the trends in the Norwegian mental health services and the outline of the major changes in the patterns of inpatient care over the period 1950-2007 is founded on five indicators: The average inpatient population, the number of discharges during a year, the average length of stay, the number of beds or places, and the occupancy rate (average inpatient population/beds). Data are reported by institutional setting. Multiple sources of data are used. In some cases it has been necessary to interpolate data due to missing data. Results New categories of institutions were established and closed during the 57 years period. De-hospitalisation started in Norway in the early 1970s, de-institutionalisation in general 15 years later. Six distinct periods are identified: The asylum period (-1955), institutionalisation and trans-institutionalisation (1955-65), stabilisation and onset of de-hospitalisation (1965-75), de-hospitalisation (1975-87), from nursing homes to community-based services (1988-98), and the national mental health program (1999-2007). There has been a significant reduction in the number of beds and in the average in-patient population. The average length of stay in institutions has been continuously reduced since 1955. The number of patients actually treated in psychiatric institutions has increased significantly. Accessibility, quality of care and treatment for most patients has improved during the period. The mental health system in Norway has recently been evaluated as better than the systems in USA, England and Canada. Conclusions De-institutionalisation means fewer beds but not fewer patients treated, neither in institutions in general nor in psychiatric hospitals. The periods represent different kinds of de-, trans-, and even re-institutionalisation. Expansion of the welfare state, increased professional focus on active treatment and increased focus on patients' preferences are the factors that best explain de-institutionalisation in Norway. PMID:20035623

Calculating High Speed Centrifugal Compressor Performance from Averaged Measurements

NASA Astrophysics Data System (ADS)

Lou, Fangyuan; Fleming, Ryan; Key, Nicole L.

2012-12-01

To improve the understanding of high performance centrifugal compressors found in modern aircraft engines, the aerodynamics through these machines must be experimentally studied. To accurately capture the complex flow phenomena through these devices, research facilities that can accurately simulate these flows are necessary. One such facility has been recently developed, and it is used in this paper to explore the effects of averaging total pressure and total temperature measurements to calculate compressor performance. Different averaging techniques (including area averaging, mass averaging, and work averaging) have been applied to the data. Results show that there is a negligible difference in both the calculated total pressure ratio and efficiency for the different techniques employed. However, the uncertainty in the performance parameters calculated with the different averaging techniques is significantly different, with area averaging providing the least uncertainty.

14 CFR Appendix F to Part 25

Code of Federal Regulations, 2012 CFR

2012-01-01

... not exceed 6 inches and the average flame time after removal of the flame source may not exceed 15... means. The average burn length may not exceed 8 inches, and the average flame time after removal of the... Standards Institute, 1430 Broadway, New York, NY 10018). If the film travels through ducts, the ducts must...

14 CFR Appendix F to Part 25

Code of Federal Regulations, 2011 CFR

2011-01-01

... not exceed 6 inches and the average flame time after removal of the flame source may not exceed 15... means. The average burn length may not exceed 8 inches, and the average flame time after removal of the... Standards Institute, 1430 Broadway, New York, NY 10018). If the film travels through ducts, the ducts must...

14 CFR Appendix F to Part 25

Code of Federal Regulations, 2010 CFR

2010-01-01

... not exceed 6 inches and the average flame time after removal of the flame source may not exceed 15... means. The average burn length may not exceed 8 inches, and the average flame time after removal of the... Standards Institute, 1430 Broadway, New York, NY 10018). If the film travels through ducts, the ducts must...

14 CFR Appendix F to Part 25

Code of Federal Regulations, 2013 CFR

2013-01-01

... not exceed 6 inches and the average flame time after removal of the flame source may not exceed 15... means. The average burn length may not exceed 8 inches, and the average flame time after removal of the... Standards Institute, 1430 Broadway, New York, NY 10018). If the film travels through ducts, the ducts must...

Planning and Management of Faculty Resources. AIR Forum 1981 Paper.

ERIC Educational Resources Information Center

Montgomery, James R.; And Others

A computerized faculty allocation and reallocation model is presented to aid the decision maker in evaluating the outcomes of various strategies. A unique goal can be computed for each department based on the average index of the institution, the average of the college, the preceding average of the department, and a goal established by management…

Tuition and Fees in Public Higher Education in the West, 2007-2008: Detailed Tuition and Fees Tables

ERIC Educational Resources Information Center

Western Interstate Commission for Higher Education, 2007

2007-01-01

This annual report provides detailed information concerning tuition and mandatory fees at public higher institutions in the Western Interstate Commission for Higher Education's (WICHE's) 15-state region, including an institution-by-institution historical review of tuition changes from year to year as well as a 10-year average. Also included are…

Demographic Characteristics of Ghanaian Optometry Students and Factors Influencing Their Career Choice and Institution of Learning

ERIC Educational Resources Information Center

Boadi-Kusi, Samuel Bert; Kyei, Samuel; Mashige, Khathutshelo Percy; Abu, Emmanuel Kwasi; Antwi-Boasiako, Daniel; Halladay, Abraham Carl

2015-01-01

Optometry is only provided at tertiary level in two institutions in Ghana, with an average of 50 students graduating each year for a population of approximately 24.6 million. No information on the demography of optometry students and factors that influence their choice of optometry as a career and institution of learning is available. This…

[Research on competency building standards of institutions of schistosomiasis prevention and control in Hubei Province. II. Investigation of human resources].

PubMed

Liu, Han-Cheng; Liao, Si-Qi; Zhong, Chen-Hui; He, Hui

2014-12-01

To understand the human resources of the grassroots institutions of schistosomiasis control and prevention, so as to provide the evidence for formulating the standards of institutional capacity-building. By using the combination of quantitative and qualitative methods, the hierarchy of schistosomiasis control institution workers, structural features of workers, and benefits of workers were investigated and the results were analyzed statistically after the 2004 reform. The constituent ratios of personnel ≤ 30 years old, 30 to 45 years old, and ≥ 45 years old were 6.8%, 64.0% and 29.2% respectively, with an average age of 43.1 years. For education levels, 61.35% of the personnel had secondary or high school levels. At the city level, the structural proportion of the senior professional; medium professional and primary professional titles was 1.4 : 5.6 : 3.0, and at the county level, the proportion was 0.5 : 6.1 : 3.4. There was 14 200 yuan per capita at the township schistosomiasis control institutions. The technology of the personnel in schistosomiasis institutions of Hubei Province is weak, the average age of personnel is old, and the salary is low.

Global collaborative healthcare: assessing the resource requirements at a leading Academic Medical Center.

PubMed

Rosson, Nicole J; Hassoun, Heitham T

2017-09-20

Academic Medical Centers ("AMCs") have served as a hub of the United States ("US") health system and represented the state-of-the art in American health care for well over a century. Currently, the global healthcare market is both massive and expanding and is being altered by the unprecedented impact of technological advances and globalization. This provides AMCs a platform to enter into trans-national collaborative partnerships with healthcare organizations around the world, thus providing a means to deliver on its promise globally while also expanding and diversifying its resources. A number of leading US AMCs have engaged in global collaborative healthcare, employing different models based on services offered, global distribution, and inclination to assume risk. Engaging in these collaborations requires significant effort from across the health system, and an understanding of the resources required is paramount for effective delivery and to avoid overextension and diversion from the primary mission of these organizations. The goal of this paper is to discuss the role of US AMCs in this current global healthcare landscape and to also investigate our institutional faculty and staff resource requirements to support the operating model. We extracted and retrospectively analyzed data from the JHI Global Services database for a 3-year period (Jan, 2013-Dec, 2015) to determine total utilization (hours and full time equivalent (FTE)), utilization by profession, and clinical and non-clinical areas of expertise. JHI utilized on average 21,940 h annually, or 10.55 FTEs of faculty and staff subject matter experts. The majority of the hours are for work performed by physician faculty members from 23 departments within the School of Medicine, representing 77% percent or on average 16,894 h annually. Clinical and allied health departments had an average annual utilization of 17,642 h or 7.8 FTEs, while non-clinical departments, schools and institutes averaged 4298 h or 1.9 FTEs, representing 80.4% and 19.6% respectively. We found that significant human resources are required within a broad range of AMC subject matter expertise across multiple disciplines, and that with adequate forecasting AMCs can successfully engage in these collaborations while continuing to fulfill their core mission.

Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of a matched case-control study.

PubMed

Sarlos, Dimitri; Kots, Lavonne; Stevanovic, Nebojsa; Schaer, Gabriel

2010-05-01

Robotic surgery, with its technical advances, promises to open a new window to minimally invasive surgery in gynaecology. Feasibility and safety of this surgical innovation have been demonstrated in several studies, and now a critical analysis of these new developments regarding outcome and costs is in place. So far only a few studies compare robotic with conventional laparoscopic surgery in gynaecology. Our objective was to evaluate our initial experience performing total robot-assisted hysterectomy with the da Vinci surgical system and compare peri-operative outcome and costs with total laparoscopic hysterectomy. For this prospective matched case-control study at our institution, peri-operative data from our first 40 consecutive total robot-assisted hysterectomies for benign indications were recorded and matched 1:1 with total laparoscopic hysterectomies according to age, BMI and uterus weight. Surgical costs were calculated for both procedures. Surgeons' subjective impressions of robotics were evaluated with a self-developed questionnaire. No conversions to laparotomy or severe peri-operative complications occurred. Mean operating time was 109 (113; 50-170) min for the robotic group and 83 (80; 55-165) min for the conventional laparoscopic group. Mean postoperative hospitalisation for robotic surgery was 3.3 (3; 2-6) days versus 3.9 (4; 2-7) days for the conventional laparoscopic group. Average surgical cost of a robot-assisted laparoscopic hysterectomy was 4067 euros compared to 2151 euros for the conventional laparoscopic procedure at our institution. For the robotic group wider range of motion of the instruments and better ergonomics were considered to be an advantage, and lack of direct access to the patient was stated as a disadvantage. Robot-assited hysterectomy is a feasible and interesting new technique with comparable outcome to total laparoscopic hysterectomy. Operating times of total laparoscopic hysterectomy seem to be achieved quickly especially for experienced laparoscopic surgeons. However, costs of robotic surgery are still higher than for conventional laparoscopy. Randomised clinical trials need to be conducted to further evaluate benefits of this new technology for patients and surgeons and analyse its cost-effectiveness in gynaecology. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Comparison of a direct-reading device to gravimetric methods for evaluating organic dust aerosols in an enclosed swine production environment.

PubMed

Taylor, C D; Reynolds, S J

2001-01-01

The production of livestock in enclosed facilities has become an accepted practice, driven by the need for increased efficiency. Exposure to organic dusts, containing various bioactive components, has been identified an important risk factor for the high rate of lung disease found among workers in these environments. Assessment of organic dust exposure requires technical skills and instrumentation not readily available to most agricultural enterprises. Development of a simple, cost-effective method for measuring organic dust levels would be useful in evaluating and controlling exposures in these environments. The objective of this study was to evaluate the usefulness of the direct reading MIE PDM-3 Miniram for estimating organic dust concentrations in enclosed swine production facilities. Responses from the MIE PDM-3 Miniram were compared to gravimetric methods for total and inhalable dust. Total dust determinations were conducted in accordance with the National Institute for Occupational Safety and Health (NIOSH) method 0500. Inhalable particulate mass (IPM) sampling was conducted using SKC brand IOM (Institute of Occupational Medicine) sampling cassettes, which meet the American Conference of Governmental Industrial Hygienists ACGIH criteria for inhalable dust sampling. This study design also allowed for the comparison of traditional total dust method to the IPM method, in collecting organic dusts in an agricultural setting. Fifteen sets of side-by-side samples (Miniram, total dust, and IPM) were collected over a period of six months in a swine confinement building. There were statistically significant differences in the results provided by the three sampling methods. Measurements for inhalable dust exceeded those for total dust in eleven of fifteen samples. The Miniram time-weighted average (TWA) response to the organic dust was always the lower of the three methods. A high degree of correlation was found among all three methods. The Miniram performed well under field conditions of varying temperature and humidity. The Miniram has the potential to predict the inhalable and total dust concentrations, assuming a correction factor for the organic dust being measured is applied.

Evaluation of the Environmental Bias on Accelerometer-Measured Total Daily Activity Counts and Owner Survey Responses in Dogs with Osteoarthritis.

PubMed

Katz, Erin M; Scott, Ruth M; Thomson, Christopher B; Mesa, Eileen; Evans, Richard; Conzemius, Michael G

2017-11-01

Objective  To determine if environmental variables affect the average daily activity counts (AC) of dogs with osteoarthritis (OA) and/or owners' perception of their dog's clinical signs or quality of life. Methods  The AC and Canine Brief Pain Inventory (CBPI) owner questionnaires of 62 dogs with OA were compared with daily environmental variables including the following: average temperature (°C), high temperature (°C), low temperature (°C), relative humidity (%), total precipitation (mm), average barometric pressure (hPa) and total daylight hours. Results  Daily AC significantly correlated with average temperature and total daylight hours, but average temperature and total daylight hours accounted for less than 1% of variation in AC. No other significant relationships were found between daily AC and daily high temperature, low temperature, relative humidity, total precipitation or average barometric pressure. No statistical relationship was found between daily AC and the CBPI, nor between environmental variables and the CBPI. Canine Brief Pain Inventory scores for pain severity and pain interference decreased significantly over the test period. Clinical Significance  The relationship between daily AC and average temperature and total daylight hours was significant, but unlikely to be clinically significant. Thus, environmental variables do not appear to have a clinically relevant bias on AC or owner CBPI questionnaires. The decrease over time in CBPI pain severity and pain interference values suggests owners completing the CBPI in this study were influenced by a caregiver placebo effect. Schattauer GmbH Stuttgart.

[An analysis on papers published by the National Institute of Parasitic Diseases in 2002-2006].

PubMed

Zhang, Min-qi

2007-06-01

To partially evaluate the scientific and technological activities of the Institute of Parasitic Diseases, China CDC, through publication analysis. Information on the papers published in the last 5 years was collected since the renaming of the Institute in 2002. Number, category and being cited frequency of the publications were analyzed using the data of 2002 as baseline. 272 papers were published at 48 national and international periodicals during 2002-2006. The total number, the number of papers published at the core journals and at the SCI journals all increased in the year 2003-2006. Publications on research, review and report occupied 54.8%, 36.0% and 15.4% respectively, covered schistosomiasis, malaria, echinococcosis, filariasis, visceral leishmaniasis, food-borne and soil-transmitted parasitic infections, and newly emerging parasites with 44.5% and 15.4% on schistosomiasis and malaria respectively. 87.9%, 11.0% and 1.1% of the articles were published at the national, international and local journals respectively. The balance rate for the trends of papers submitted in 2002 was 6.5%, and 10.2%-15.4% in 2003-2006. 34 of the 272 papers were included in SCI journals. Retrieval through the web of knowledge revealed that 187 citations were found in the SCI papers with an average of 5.5; 6 papers were cited for more than 9 times each, occupying 27.3% of the overall citations, the highest being 84 citations. There was an unbalanced distribution of the publications among the departments of the Institute. The results indicate that the research direction and content are in line with the tasks of the Institute and with the scientific merits of disease control; the level of research is increasing and some of the publications exert certain impact at home and abroad.

Development and reproducibility evaluation of a Monte Carlo-based standard LINAC model for quality assurance of multi-institutional clinical trials.

PubMed

Usmani, Muhammad Nauman; Takegawa, Hideki; Takashina, Masaaki; Numasaki, Hodaka; Suga, Masaki; Anetai, Yusuke; Kurosu, Keita; Koizumi, Masahiko; Teshima, Teruki

2014-11-01

Technical developments in radiotherapy (RT) have created a need for systematic quality assurance (QA) to ensure that clinical institutions deliver prescribed radiation doses consistent with the requirements of clinical protocols. For QA, an ideal dose verification system should be independent of the treatment-planning system (TPS). This paper describes the development and reproducibility evaluation of a Monte Carlo (MC)-based standard LINAC model as a preliminary requirement for independent verification of dose distributions. The BEAMnrc MC code is used for characterization of the 6-, 10- and 15-MV photon beams for a wide range of field sizes. The modeling of the LINAC head components is based on the specifications provided by the manufacturer. MC dose distributions are tuned to match Varian Golden Beam Data (GBD). For reproducibility evaluation, calculated beam data is compared with beam data measured at individual institutions. For all energies and field sizes, the MC and GBD agreed to within 1.0% for percentage depth doses (PDDs), 1.5% for beam profiles and 1.2% for total scatter factors (Scps.). Reproducibility evaluation showed that the maximum average local differences were 1.3% and 2.5% for PDDs and beam profiles, respectively. MC and institutions' mean Scps agreed to within 2.0%. An MC-based standard LINAC model developed to independently verify dose distributions for QA of multi-institutional clinical trials and routine clinical practice has proven to be highly accurate and reproducible and can thus help ensure that prescribed doses delivered are consistent with the requirements of clinical protocols. © The Author 2014. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

Comparison of Domiciliary and Institutional Delivery-care Practices in Rural Rajasthan, India

PubMed Central

Iyengar, Kirti; Suhalka, Virendra; Agarwal, Kumaril

2009-01-01

A retrospective cross-sectional survey was conducted to assess key practices and costs relating to home- and institutional delivery care in rural Rajasthan, India. One block from each of two sample districts was covered (estimated population–279,132). Field investigators listed women who had delivered in the past three months and contacted them for structured case interview. In total, 1,947 (96%) of 2,031 listed women were successfully interviewed. An average of 2.4 and 1.7 care providers attended each home- and institutional delivery respectively. While 34% of the women delivered in health facilities, modern care providers attended half of all the deliveries. Intramuscular injections, intravenous drips, and abdominal fundal pressure were widely used for hastening delivery in both homes and facilities while post-delivery injections for active management of the third stage were administered to a minority of women in both the venues. Most women were discharged prematurely after institutional delivery, especially by smaller health facilities. The cost of accessing home-delivery care was Rs 379 (US$ 8) while the mean costs in facilities for elective, difficult vaginal deliveries and for caesarean sections were Rs 1,336 (US$ 30), Rs 2,419 (US$ 54), and Rs 11,146 (US$ 248) respectively. Most families took loans at high interest rates to meet these costs. It is concluded that widespread irrational practices by a range of care providers in both homes and facilities can adversely affect women and newborns while inadequate observance of beneficial practices and high costs are likely to reduce the benefits of institutional delivery, especially for the poor. Government health agencies need to strengthen regulation of delivery care and, especially, monitor perinatal outcomes. Family preference for hastening delivery and early discharge also require educational efforts. PMID:19489423

An assessment of radiation doses at an educational institution 57.8 km away from the Fukushima Daiichi nuclear power plant 1 month after the nuclear accident.

PubMed

Tsuji, Masayoshi; Kanda, Hideyuki; Kakamu, Takeyasu; Kobayashi, Daisuke; Miyake, Masao; Hayakawa, Takehito; Mori, Yayoi; Okochi, Toshiyasu; Hazama, Akihiro; Fukushima, Tetsuhito

2012-03-01

On 11 March 2011, the Great East Japan Earthquake occurred. Due to this earthquake and subsequent tsunami, malfunctions occurred at the Fukushima Daiichi nuclear power plant. Radioactive material even reached the investigated educational institution despite being 57.8 km away from the power station. With the goal of ensuring the safety of our students, we decided to carry out a risk assessment of the premises of this educational institution by measuring radiation doses at certain locations, making it possible to calculate estimated radiation accumulation. Systematic sampling was carried out at measurement points spaced at regular intervals for a total of 24 indoor and outdoor areas, with 137 measurements at heights of 1 cm and 100 cm above the ground surface. Radiation survey meters were used to measure environmental radiation doses. Radiation dose rates and count rates were higher outdoors than indoors, and higher 1 cm above the ground surface than at 100 cm. Radiation doses 1 cm above the ground surface were higher on grass and moss than on asphalt and soil. The estimated radiation exposure for a student spending an average of 11 h on site at this educational institution was 9.80 μSv. Environmental radiation doses at our educational institution 57.8 km away from the Fukushima Daiichi nuclear power plant 1 month after the accident were lower than the national regulation dose for schools (3.8 μSv/h) at most points. Differences in radiation doses depending on outdoor surface properties are important to note for risk reduction.

Cost awareness decreases total percutaneous coronary intervention procedural cost: The SHOPPING (Show How Options in Price for Procedures Can Be Influenced Greatly) trial.

PubMed

Asher, Elad; Mansour, John; Wheeler, Adam; Kendrick, Daniel; Cunningham, Michael; Parikh, Sahil; Zidar, David; Harford, Todd; Simon, Daniel I; Kashyap, Vikram S

2017-06-01

We initiated the SHOPPING Trial (Show How Options in Price for Procedures can be InflueNced Greatly) to see if percutaneous coronary intervention (PCI) procedures can be performed at a lower cost in a single institution. Procedural practice variability is associated with inefficiency and increased cost. We hypothesized that announcing costs for all supplies during a catheterization procedure and reporting individual operator cost relative to peers would spur cost reduction without affecting clinical outcomes. Baseline costs of 10 consecutive PCI procedures performed by 9 interventional cardiologists were documented during a 90-day interval. Costs were reassessed after instituting cost announcing and peer reporting the next quarter. The intervention involved labeling of all endovascular supplies, equipment, devices, and disposables in the catheterization laboratory and announcement of the unit price for each piece when requested. For each interventionalist, procedure time and costs were measured and analyzed prior to and after the intervention. We found that total PCI procedural cost was significantly reduced by an average of $234.77 (P = 0.01), equating to a total savings of $21,129.30 over the course of 90 PCI procedures. Major Adverse Cardiac and Cerebrovascular Event (MACCE) rates were similar during both periods (2.3% vs. 3.5%, P = NS). Announcing costs in the catheterization laboratory during single vessel PCI and peer reporting leads to cost reduction without affecting clinical outcomes. This intervention may have a role in more complex coronary and peripheral interventional procedures, and in other procedural areas where multiple equipment and device alternatives with variable costs are available. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Who will cover the cost of undocumented immigrant trauma care?

PubMed

Mitchell, Christopher D; Truitt, Michael S; Shifflette, Vanessa K; Johnson, Van; Mangram, Alicia J; Dunn, Ernest L

2012-03-01

Health care reform under the "Patient Protection and Affordable Care Act" (PPACA) will lead to changes in reimbursement. Although this legislation provides a mechanism for uninsured Americans to obtain coverage, it excludes undocumented immigrants (UDI). Reimbursement for UDIs comes from the disproportionate share hospital (DSH) program and was previously supported by Section-1011 of the 2003 Medicare Modernization Act (S1011). The PPACA details a cut of DSH funds starting in 2014. This could impose a significant financial burden on trauma centers. From May 2005 to May 2008, we retrospectively reviewed all trauma-related emergency room visits by UDIs. We quantified charges for three entities: emergency department physicians, trauma surgeons, and the hospital. We applied our average institutional collection rate to these charges and compared these projected collections with the actual collections. Over a three-year period, we identified 1,325 trauma UDIs. The financial records revealed a projected emergency department physicians collection of $452,686, a projected trauma surgeons collection of $1.2 million, and a projected hospital collection of $6.9 million (total $8.6 million). Actual funding from S1011 provided $1.7 million and DSH provided $1.9 million (total $3.6 million). Texas State Funding and UDI self-payment contributed $611,082. Overall, our institution had a reimbursement discrepancy of $4.3 million with DSH/S1011 assistance. This increased to $6.0 million after the termination of S1011 and may increase to $7.9 million under PPACA. These figures underestimate the total cost of UDI trauma care as it only includes three entities. Our data represent a fraction of national figures. Failure to address these issues could result in ongoing financial problems for trauma centers. II, economic and decision analysis.

Failure at the Tibial Cement-Implant Interface With the Use of High-Viscosity Cement in Total Knee Arthroplasty.

PubMed

Kopinski, Judith E; Aggarwal, Ajay; Nunley, Ryan M; Barrack, Robert L; Nam, Denis

2016-11-01

Recent literature has shown debonding of the tibial implant-cement interface as a potential cause for implant loosening. The purpose of this case series is to report this phenomenon in a historically well-performing implant when used with high-viscosity cement (HVC). Thirteen primary cemented Biomet Vanguard total knee arthroplasties were referred to 1 of 2 institutions with complaints of persistent pain after their index procedure. A radiographic and infectious work-up was completed for each patient. All 13 patients underwent a revision of the index surgery with intraoperative diagnosis of tibial component debonding at the implant-cement interface. HVC (Cobalt, DJO Surgical, Vista, CA and Depuy HVC; Depuy Inc, Warsaw, IN) was used in all index cases. The average time to revision surgery for the 13 patients was 2.7 ± 1.9 years from the index surgery. Laboratory infectious markers were within normal in most cases, and all intra-articular aspirations showed no bacterial, fungal, or anaerobic growth. Eleven of 13 patients showed no radiographic evidence of loosening; however, all cases demonstrated tibial component debonding intraoperatively. Given our institution's experience and previously reported data demonstrating excellent survivorship with this total knee arthroplasty prosthesis, we propose that the early failures seen in this case series may be associated with the use of HVC cement. In the setting of a negative infectious work-up and no radiographic evidence to suggest loosening, the surgeon should consider debonding of the tibial component as a potential cause for persistent pain if HVC cement was used with this prosthetic design. Copyright © 2016 Elsevier Inc. All rights reserved.

The 100 most influential papers about cataract surgery: a bibliometric analysis.

PubMed

Lin, Ze-Nan; Chen, Jie; Zhang, Qi; Li, Qian; Cai, Min-Yun; Yang, Hai; Cui, Hong-Ping

2017-01-01

To identify the 100 most cited papers in cataract surgery, we performed a comprehensive bibliometric analysis basing on the literature search on the Thomson Reuters Web of Knowledge. The number of citations, including the total citations, latest 5y citations and average citation number per year (ACY), authorship, year of publication, major topics, journal of publication, country and institution of origin of each paper were recorded and then analyzed. Pearson's correlation analysis was conducted to evaluate the correlation between the published year and the number of citations. The correlation between journal's impact factor (IF) and number of citations was assessed as well. The most cited paper was the classic paper done by the European Society of Cataract & Refractive Surgeons (ESCRS) group. This paper focused on the topic of endophthalmitis. Not only the most cited papers originated from the USA, but also some American institutions like Johns Hopkins University, Harvard Medical School, etc. had the most citations. Pearson's correlation analysis indicated that the latest 5y citations and ACY were significantly related with the published year (5y citations: r =0.615, P <0.001; ACY: r =0.657, P <0.001), whereas no association between the total number of citations and published year was found ( r =0.045). Moreover, the IFs of journals were found to have no significant effect on the number of total citations. To our knowledge, this is the first study on the most influential papers in cataract surgery after a comprehensive research of relevant literatures. The present work may provide us concise information concerning the development history of cataract surgery over the past 66y.

Total body surface area overestimation at referring institutions in children transferred to a burn center.

PubMed

Swords, Douglas S; Hadley, Edmund D; Swett, Katrina R; Pranikoff, Thomas

2015-01-01

Total body surface area (TBSA) burned is a powerful descriptor of burn severity and influences the volume of resuscitation required in burn patients. The incidence and severity of TBSA overestimation by referring institutions (RIs) in children transferred to a burn center (BC) are unclear. The association between TBSA overestimation and overresuscitation is unknown as is that between TBSA overestimation and outcome. The trauma registry at a BC was queried over 7.25 years for children presenting with burns. TBSA estimate at RIs and BC, total fluid volume given before arrival at a BC, demographic variables, and clinical variables were reviewed. Nearly 20 per cent of children arrived from RIs without TBSA estimation. Nearly 50 per cent were overestimated by 5 per cent or greater TBSA and burn sizes were overestimated by up to 44 per cent TBSA. Average TBSA measured at BC was 9.5 ± 8.3 per cent compared with 15.5 ± 11.8 per cent as measured at RIs (P < 0.0001). Burns between 10 and 19.9 per cent TBSA were overestimated most often and by the greatest amounts. There was a statistically significant relationship between overestimation of TBSA by 5 per cent or greater and overresuscitation by 10 mL/kg or greater (P = 0.02). No patient demographic or clinical factors were associated with TBSA overestimation. Education efforts aimed at emergency department physicians regarding the importance of always calculating TBSA as well as the mechanics of TBSA estimation and calculating resuscitation volume are needed. Further studies should evaluate the association of TBSA overestimation by RIs with adverse outcomes and complications in the burned child.

Cost of Surgery for Symptomatic Spinal Metastases in the United Kingdom.

PubMed

Turner, Isobel; Minhas, Zulfiqar; Kennedy, Joanne; Morris, Stephen; Crockard, Alan; Choi, David

2015-11-01

Spinal metastases represent a significant health and economic burden. The average cost of surgical management varies between institutions and countries, partially a result of differences in health care system billing. This study assessed hospital costs from a single institute in the United Kingdom National Healthcare Service and identified patient factors associated with these costs. This prospective study recruited patients with confirmed symptomatic spinal metastases who presented for surgical treatment. The primary outcome was cost of inpatient treatment collected using the Patient Level Costing and Information System; preoperative details collected included patient demographics, primary tumor type, Tomita and Tokuhashi scores, pain level, EuroQol 5 dimension score, Frankel, Karnofsky, and American Society of Anesthesiologists' physical status classification system scores, and operative details. Costs were analyzed for 74 patients. The mean cost of treatment (standard deviation, SD) per patient was £ 16,885 (£ 10,687); which was mainly comprised of operating theater (25% of the total) and ward costs (27%). Better health status at presentation significantly increased total and ward costs (Frankel score P = 0.006, and EuroQol 5 dimension index P = 0.014 respectively); male sex also increased total and ward costs (P < 0.01 and P = 0.06). Operation cost showed a trend to increased costs with less impairment on American Society of Anesthesiologists' physical status classification system scores. The cost of surgical management of spinal metastases is associated with several factors but is greater in patients presenting with better health status, probably because of their suitability for larger operations, whereas those with poor health status undergo smaller, palliative operations, resulting in shorter inpatient postoperative recovery. Copyright © 2015 Elsevier Inc. All rights reserved.

The 100 most influential papers about cataract surgery: a bibliometric analysis

PubMed Central

Lin, Ze-Nan; Chen, Jie; Zhang, Qi; Li, Qian; Cai, Min-Yun; Yang, Hai; Cui, Hong-Ping

2017-01-01

AIM To identify the 100 most cited papers in cataract surgery, we performed a comprehensive bibliometric analysis basing on the literature search on the Thomson Reuters Web of Knowledge. METHODS The number of citations, including the total citations, latest 5y citations and average citation number per year (ACY), authorship, year of publication, major topics, journal of publication, country and institution of origin of each paper were recorded and then analyzed. Pearson's correlation analysis was conducted to evaluate the correlation between the published year and the number of citations. The correlation between journal's impact factor (IF) and number of citations was assessed as well. RESULTS The most cited paper was the classic paper done by the European Society of Cataract & Refractive Surgeons (ESCRS) group. This paper focused on the topic of endophthalmitis. Not only the most cited papers originated from the USA, but also some American institutions like Johns Hopkins University, Harvard Medical School, etc. had the most citations. Pearson's correlation analysis indicated that the latest 5y citations and ACY were significantly related with the published year (5y citations: r=0.615, P<0.001; ACY: r=0.657, P<0.001), whereas no association between the total number of citations and published year was found (r=0.045). Moreover, the IFs of journals were found to have no significant effect on the number of total citations. CONCLUSION To our knowledge, this is the first study on the most influential papers in cataract surgery after a comprehensive research of relevant literatures. The present work may provide us concise information concerning the development history of cataract surgery over the past 66y. PMID:29062780

Clinical experience with image-guided radiotherapy in an accelerated partial breast intensity-modulated radiotherapy protocol.

PubMed

Leonard, Charles E; Tallhamer, Michael; Johnson, Tim; Hunter, Kari; Howell, Kathryn; Kercher, Jane; Widener, Jodi; Kaske, Terese; Paul, Devchand; Sedlacek, Scot; Carter, Dennis L

2010-02-01

To explore the feasibility of fiducial markers for the use of image-guided radiotherapy (IGRT) in an accelerated partial breast intensity modulated radiotherapy protocol. Nineteen patients consented to an institutional review board approved protocol of accelerated partial breast intensity-modulated radiotherapy with fiducial marker placement and treatment with IGRT. Patients (1 patient with bilateral breast cancer; 20 total breasts) underwent ultrasound guided implantation of three 1.2- x 3-mm gold markers placed around the surgical cavity. For each patient, table shifts (inferior/superior, right/left lateral, and anterior/posterior) and minimum, maximum, mean error with standard deviation were recorded for each of the 10 BID treatments. The dose contribution of daily orthogonal films was also examined. All IGRT patients underwent successful marker placement. In all, 200 IGRT treatment sessions were performed. The average vector displacement was 4 mm (range, 2-7 mm). The average superior/inferior shift was 2 mm (range, 0-5 mm), the average lateral shift was 2 mm (range, 1-4 mm), and the average anterior/posterior shift was 3 mm (range, 1 5 mm). This study shows that the use of IGRT can be successfully used in an accelerated partial breast intensity-modulated radiotherapy protocol. The authors believe that this technique has increased daily treatment accuracy and permitted reduction in the margin added to the clinical target volume to form the planning target volume. Copyright 2010 Elsevier Inc. All rights reserved.

Spending on medicines in Israel in an international context.

PubMed

Sax, Philip

2005-05-01

Like most developed countries, in the last decade Israel's healthcare system has been subject to cost-containing measures in the drug sector. To provide comparative information in an international context on the level of outpatient drug expenditures in Israel, both total and those publicly financed, and to analyze how these have changed with time during the last decade. Using definitions of the OECD (Organization of Economic Cooperation and Development), internationally comparable data on total expenditure and public expenditure on medicines in Israel are provided. The Israeli estimates are based on data from the Ministry of Health audited reports of financial activities of the health management organizations and from the family expenditure surveys carried out by the Central Bureau of Statistics. Per capita total and public expenditures in Israel are analyzed over time, as are their share of national expenditure on health and of gross domestic product. Israel expenditures are then compared with those for individual member countries of the OECD, as well as a 21 country average, from 1992 to 2002. Analysis of the Israeli expenditure data shows a considerable reduction in growth of per capita total and public expenditures on medicines since 1997. Growth in the share of total drug expenditure of NEH and of GDP has also been constrained since 1997. In an international context, per capita expenditure on medicines in Israel, particularly what is publicly financed, is one of the lowest. Furthermore, its share of NEH and GDP is also very low compared to other countries. This substantive gap in spending on medicines between Israel and other countries has increased since 1997. Israel, a medium-income country with a lower than average level of expenditure on health compared to OECD countries, has a particularly low level of expenditure on medicines. Whereas the share of health expenditure of GDP in Israel is similar to the international average, the share of drug expenditure of GDP is well below the average. In addition to structural and longer-term factors contributing to Israel's low per capita spending on medicines, such as the young population and the apparently low level of actual prices paid by most institutional purchasers, recent years are witness to the growing impact of National Health Insurance budgetary pressures on HMOs as well as continual increases in prescription cost sharing by patients. The impact is felt both on the demand side (higher copayments, administrative and prescribing restrictions) and perhaps more crucially on the supply side (price competition, mainly from generics). Substantial extra public funding for the addition of new drugs to the NHI basket in recent years has had no overall impact on these longer-term spending patterns.

Oxygenation of the Intraportally Transplanted Pancreatic Islet

PubMed Central

2016-01-01

Intraportal islet transplantation (IT) is not widely utilized as a treatment for type 1 diabetes. Oxygenation of the intraportally transplanted islet has not been studied extensively. We present a diffusion-reaction model that predicts the presence of an anoxic core and a larger partly functional core within intraportally transplanted islets. Four variables were studied: islet diameter, islet fractional viability, external oxygen partial pressure (P) (in surrounding portal blood), and presence or absence of a thrombus on the islet surface. Results indicate that an islet with average size and fractional viability exhibits an anoxic volume fraction (AVF) of 14% and a function loss of 72% at a low external P. Thrombus formation increased AVF to 30% and function loss to 92%, suggesting that the effect of thrombosis may be substantial. External P and islet diameter accounted for the greatest overall impact on AVF and loss of function. At our institutions, large human alloislets (>200 μm diameter) account for ~20% of total islet number but ~70% of total islet volume; since most of the total transplanted islet volume is accounted for by large islets, most of the intraportal islet cells are likely to be anoxic and not fully functional. PMID:27872862

Oxygenation of the Intraportally Transplanted Pancreatic Islet.

PubMed

Suszynski, Thomas M; Avgoustiniatos, Efstathios S; Papas, Klearchos K

2016-01-01

Intraportal islet transplantation (IT) is not widely utilized as a treatment for type 1 diabetes. Oxygenation of the intraportally transplanted islet has not been studied extensively. We present a diffusion-reaction model that predicts the presence of an anoxic core and a larger partly functional core within intraportally transplanted islets. Four variables were studied: islet diameter, islet fractional viability, external oxygen partial pressure ( P ) (in surrounding portal blood), and presence or absence of a thrombus on the islet surface. Results indicate that an islet with average size and fractional viability exhibits an anoxic volume fraction (AVF) of 14% and a function loss of 72% at a low external P . Thrombus formation increased AVF to 30% and function loss to 92%, suggesting that the effect of thrombosis may be substantial. External P and islet diameter accounted for the greatest overall impact on AVF and loss of function. At our institutions, large human alloislets (>200 μ m diameter) account for ~20% of total islet number but ~70% of total islet volume; since most of the total transplanted islet volume is accounted for by large islets, most of the intraportal islet cells are likely to be anoxic and not fully functional.

The impact of patient volume on surgical trauma training in a Scandinavian trauma centre.

PubMed

Gaarder, Christine; Skaga, Nils Oddvar; Eken, Torsten; Pillgram-Larsen, Johan; Buanes, Trond; Naess, Paal Aksel

2005-11-01

Some of the problems faced in trauma surgery are increasing non-operative management of abdominal injuries, decreasing work hours and increasing sub-specialisation. We wanted to document the experience of trauma team leaders at the largest trauma centre in Norway, hypothesising that the patient volume would be inadequate to secure optimal trauma care. Patients registered in the hospital based Trauma Registry during the 2-year period from 1 August 2000 to 31 July 2002 were included. Of a total of 1667 patients registered, 645 patients (39%) had an Injury Severity Score (ISS)>15. Abdominal injuries were diagnosed in 205 patients with a median ISS of 30. An average trauma team leader assessed a total of 119 trauma cases a year (46 patients with ISS>15) and participated in 10 trauma laparotomies. Although the total number of trauma cases seems adequate, the experience of the trauma team leaders with challenging abdominal injuries is limited. With increasing sub-specialisation and general surgery vanishing, fewer surgical specialties provide operative competence in dealing with complicated torso trauma. A system of additional education and quality assurance measures is a prerequisite of high quality, and has consequently been introduced in our institution.

The Chicken Soup Effect: The Role of Recreation and Intramural Participation in Boosting Freshman Grade Point Average

ERIC Educational Resources Information Center

Gibbison, Godfrey A.; Henry, Tracyann L.; Perkins-Brown, Jayne

2011-01-01

Freshman grade point average, in particular first semester grade point average, is an important predictor of survival and eventual student success in college. As many institutions of higher learning are searching for ways to improve student success, one would hope that policies geared towards the success of freshmen have long term benefits…

Human resources in health research institutions in sub-Saharan African countries: results of a questionnaire-based survey.

PubMed

Kebede, Derege; Zielinski, Chris; Mbondji, Peter Ebongue; Sanou, Issa; Kouvividila, Wenceslas; Lusamba-Dikassa, Paul-Samson

2014-05-01

To describe human capacity and staff movement in national health research institutions in 42 sub-Saharan African countries. A structured questionnaire was used to solicit information on governance and stewardship from health research institutions. Eight hundred and forty-seven health research institutions in 42 sub-Saharan African countries. Key informants from 847 health research institutions. The availability, mix and quality of human resources in health research institutions. On average, there were 122 females employed per respondent health research institution, compared with 159 males. For researchers, the equivalent figures were nine females to 17 males. The average annual gross salary of researchers varied between US$ 12,260 for staff with 5-10 years of experience and US$ 14,772 for the institution head. Of those researchers who had joined the institution in the previous 12 months, 55% were employed on a full-time basis. Of the researchers who left the institutions in the same period, 71% had a full-time contract. Among all those who left, those who left to a non-research sector and to another country accounted for two-thirds. The study revealed significant gaps in the area of human capacity development for research in Africa. The results showed a serious shortage of qualified staff engaged in health research, with a dearth of staff that held at least a master's degree or doctoral degree. Major efforts will be required to strengthen human resource capacity, including addressing the lack of motivation or time for research on the part of existing capable staff. © The Royal Society of Medicine.

Intraoperative vancomycin use in spinal surgery: single institution experience and microbial trends.

PubMed

Ghobrial, George M; Thakkar, Vismay; Andrews, Edward; Lang, Michael; Chitale, Ameet; Oppenlander, Mark E; Maulucci, Christopher M; Sharan, Ashwini D; Heller, Joshua; Harrop, James S; Jallo, Jack; Prasad, Srinivas

2014-04-01

Retrospective case series. To demonstrate the microbial trends of spinal surgical site infections in patients who had previously received crystallized vancomycin in the operative bed. Prior large, case control series demonstrate the significant decrease in surgical site infection with the administration of vancomycin in the wound bed. A single institution, electronic database search was conducted for all patients who underwent spinal surgery who had received prophylactic crystalline vancomycin powder in the wound bed. Patients with a prior history of wound infection, intrathecal pumps, or spinal stimulators were excluded. A total of 981 consecutive patients (494 males, 487 females; mean age, 59.4 yr; range, 16-95 yr) were identified from January 2011 to June 2013. The average dose of vancomycin powder was 1.13 g (range, 1-6 g). Sixty-six patients (6.71%) were diagnosed with a surgical site infection, of which 51 patients had positive wound cultures (5.2%). Of the 51 positive cultures, the most common organism was Staphylococcus aureus. The average dose of vancomycin was 1.3 g in the 38 cases where a gram-positive organism was cultured. A number of gram-negative infections were encountered such as Serratia marcescens, Enterobacter aerogenes, Bacteroides fragilis, Enterobacter cloacae, Citrobacter koseri, and Pseudomonas aeruginosa. The average dose of vancomycin was 1.2 g in 23 cases where a gram-negative infection was cultured. Fifteen of the 51 positive cultures (29.4%) were polymicrobial. Eight (53%) of these 15 polymicrobial cultures contained 3 or more distinct organisms. Prophylactic intraoperative vancomycin use in the wound bed in spinal surgery may increase the incidence of gram-negative or polymicrobial spinal infections. The use of intraoperative vancomycin may correlate with postoperative seromas, due to the high incidence of nonpositive cultures. Large, randomized, prospective trials are needed to demonstrate causation and dose-response relationship.

Institutional Conflict of Interest Policies at U.S. Academic Research Institutions.

PubMed

Resnik, David B; Ariansen, J L; Jamal, Jaweria; Kissling, Grace E

2016-02-01

Institutional conflicts of interest (ICOIs) occur when the institution or leaders with authority to act on behalf of the institution have conflicts of interest (COIs) that may threaten the objectivity, integrity, or trustworthiness of research because they could impact institutional decision making. The purpose of this study was to gather and analyze information about the ICOI policies of the top 100 U.S. academic research institutions, ranked according to total research funding. From May-June 2014, the authors attempted to obtain ICOI policy information for the top 100 U.S. academic research institutions from publicly available Web sites or via e-mail inquiry. If an ICOI policy was not found, the institutions' online COI policies were examined. Data on each institution's total research funding, national funding rank, public versus private status, and involvement in clinical research were collected. The authors developed a coding system for categorizing the ICOI policies and used it to code the policies for nine items. Interrater agreement and P values were assessed. Only 28/100 (28.0%) institutions had an ICOI policy. ICOI policies varied among the 28 institutions. Having an ICOI policy was positively associated with total research funding and national funding ranking but not with public versus private status or involvement in clinical research. Although most U.S. medical schools have policies that address ICOIs, most of the top academic research institutions do not. Federal regulation and guidance may be necessary to encourage institutions to adopt ICOI policies and establish a standard form of ICOI review.

WE-FG-207B-04: Noise Suppression for Energy-Resolved CT Via Variance Weighted Non-Local Filtration

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

Harms, J; Zhu, L

Purpose: The photon starvation problem is exacerbated in energy-resolved CT, since the detected photons are shared by multiple energy channels. Using pixel similarity-based non-local filtration, we aim to produce accurate and high-resolution energy-resolved CT images with significantly reduced noise. Methods: Averaging CT images reconstructed from different energy channels reduces noise at the price of losing spectral information, while conventional denoising techniques inevitably degrade image resolution. Inspired by the fact that CT images of the same object at different energies share the same structures, we aim to reduce noise of energy-resolved CT by averaging only pixels of similar materials - amore » non-local filtration technique. For each CT image, an empirical exponential model is used to calculate the material similarity between two pixels based on their CT values and the similarity values are organized in a matrix form. A final similarity matrix is generated by averaging these similarity matrices, with weights inversely proportional to the estimated total noise variance in the sinogram of different energy channels. Noise suppression is achieved for each energy channel via multiplying the image vector by the similarity matrix. Results: Multiple scans on a tabletop CT system are used to simulate 6-channel energy-resolved CT, with energies ranging from 75 to 125 kVp. On a low-dose acquisition at 15 mA of the Catphan©600 phantom, our method achieves the same image spatial resolution as a high-dose scan at 80 mA with a noise standard deviation (STD) lower by a factor of >2. Compared with another non-local noise suppression algorithm (ndiNLM), the proposed algorithms obtains images with substantially improved resolution at the same level of noise reduction. Conclusion: We propose a noise-suppression method for energy-resolved CT. Our method takes full advantage of the additional structural information provided by energy-resolved CT and preserves image values at each energy level. Research reported in this publication was supported by the National Institute Of Biomedical Imaging And Bioengineering of the National Institutes of Health under Award Number R21EB019597. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.« less

Annual Survey of Optometric Educational Institutions, 1984-85.

ERIC Educational Resources Information Center

Journal of Optometric Education, 1986

1986-01-01

Tabulations include entering class grade point averages and educational backgrounds, loan and non-loan student financial aid granted by the institutions, resident and nonresident student expenses, full-time male and female enrollment in each class, and minority student enrollment in colleges of optometry. (MSE)

The University of Santo Tomas Viewed from the Lens of Total Quality Management: Implications to Total Quality Education

ERIC Educational Resources Information Center

de Guzman, Allan B.; Torres, Josefina R.

2004-01-01

Considered as a major management approach for improving organizational performance and competitive advantage, Total Quality Management (TQM) poses a challenge to dynamic institutions to adopt a systemic philosophy that places emphasis on customer needs and a commitment to a culture of excellence. Higher education institutions (HEIs) as learning…

Resource allocation in academic health centers: creating common metrics.

PubMed

Joiner, Keith A; Castellanos, Nathan; Wartman, Steven A

2011-09-01

Optimizing resource allocation is essential for effective academic health center (AHC) management, yet guidelines and principles for doing so in the research and educational arenas remain limited. To address this issue, the authors analyzed responses to the 2007-2008 Association of Academic Health Centers census using ratio analysis. The concept was to normalize data from an individual institution to that same institution, by creating a ratio of two separate values from the institution (e.g., total faculty FTEs/total FTEs). The ratios were then compared across institutions. Generally, this strategy minimizes the effect of institution size on the responses, size being the predominant limitation of using absolute values for developing meaningful metrics. In so doing, ratio analysis provides a range of responses that can be displayed in graphical form to determine the range and distribution of values. The data can then be readily scrutinized to determine where any given institution falls within the distribution. Staffing ratios and operating ratios from up to 54 institutions are reported. For ratios including faculty numbers in the numerator or denominator, the range of values is wide and minimally discriminatory, reflecting heterogeneity across institutions in faculty definitions. Values for financial ratios, in particular total payroll expense/total operating expense, are more tightly clustered, reflecting in part the use of units with a uniform definition (i.e., dollars), and emphasizing the utility of such ratios in decision guidelines. The authors describe how to apply these insights to develop metrics for resource allocation in the research and educational arenas.

Management of foreign bodies obstructing the airway in children.

PubMed

Shah, Rahul K; Patel, Anju; Lander, Lina; Choi, Sukgi S

2010-04-01

To review national trends in the management of pediatric airway foreign bodies (A-FBs) and esophageal foreign bodies (E-FBs) that obstruct the airway. Retrospective review using a national pediatric data set (Kids' Inpatient Database). Pediatric patients admitted across the United States during 2003. The Kids' Inpatient Database 2003 samples 2 984 129 pediatric discharges from 3438 hospitals in 36 states. The Kids' Inpatient Database 2003 was analyzed for A-FBs and E-FBs (International Classification of Diseases, Ninth Revision, Clinical Modification codes E911 and E912) in patients 20 years or younger, and weighted data are presented to facilitate national estimates. A total of 2771 patients (59% male) were admitted for an A-FB or an E-FB that was obstructing the airway. The mean (SE) age of the patients was 3.5 (0.17) years; 55% were younger than 2 years. The foreign bodies were classified as food (42%; mean age, 2.5 years) or other (58%; mean age, 4.3 years). The average length of stay was 6.4 days (median [SE], 1.5 [0.6] days), and the average number of procedures was 2.4 (median [SE], 1.3 [0.1] procedures). Seventy-one percent of the patients were treated at teaching hospitals. The mean (SD) total charges were $34 652 ($3543), with regional variation (P < .001). Children's hospitals (28%) had higher mean total charges than nonchildren's hospitals (P = .03); 3.4% of admissions died in the hospital (mean [SE] age, 4.6 [0.9] years), with an average length of stay of 11.7 (SE, 2.7) days and an average of 6.2 (SE, 0.7) procedures. Bronchoscopy (52%), esophagoscopy (28%), and tracheotomy (1.7%) were the primary procedures performed. The rates of positive FB findings for bronchoscopy and esophagoscopy were 37% and 46%, respectively. Pediatric A-FBs and E-FBs that obstruct the airway occur infrequently. Most of the patients are referred to teaching institutions. Among patients who were admitted with a diagnosis of airway obstruction from an A-FB or an E-FB, the rates of positive findings at surgery were 37% and 46%, respectively. A surprisingly high mortality rate was noted. Alternative education measures should be considered to train physicians in the management of this infrequent, potentially lethal condition.

Full robot-assisted gastrectomy with intracorporeal robot-sewn anastomosis produces satisfying outcomes

PubMed Central

Liu, Xin-Xin; Jiang, Zhi-Wei; Chen, Ping; Zhao, Yan; Pan, Hua-Feng; Li, Jie-Shou

2013-01-01

AIM: To evaluate the feasibility and safety of full robot-assisted gastrectomy with intracorporeal robot hand-sewn anastomosis in the treatment of gastric cancer. METHODS: From September 2011 to March 2013, 110 consecutive patients with gastric cancer at the authors’ institution were enrolled for robotic gastrectomies. According to tumor location, total gastrectomy, distal or proximal subtotal gastrectomy with D2 lymphadenectomy was fully performed by the da Vinci Robotic Surgical System. All construction, including Roux-en-Y jejunal limb, esophagojejunal, gastroduodenal and gastrojejunal anastomoses were fully carried out by the intracorporeal robot-sewn method. At the end of surgery, the specimen was removed through a 3-4 cm incision at the umbilicus trocar point. The details of the surgical technique are well illustrated. The benefits in terms of surgical and oncologic outcomes are well documented, as well as the failure rate and postoperative complications. RESULTS: From a total of 110 enrolled patients, radical gastrectomy could not be performed in 2 patients due to late stage disease; 1 patient was converted to laparotomy because of uncontrollable hemorrhage, and 1 obese patient was converted due to difficult exposure; 2 patients underwent extra-corporeal anastomosis by minilaparotomy to ensure adequate tumor margin. Robot-sewn anastomoses were successfully performed for 12 proximal, 38 distal and 54 total gastrectomies. The average surgical time was 272.52 ± 53.91 min and the average amount of bleeding was 80.78 ± 32.37 mL. The average number of harvested lymph nodes was 23.1 ± 5.3. All specimens showed adequate surgical margin. With regard to tumor staging, 26, 32 and 46 patients were staged as I, II and III, respectively. The average hospitalization time after surgery was 6.2 d. One patient experienced a duodenal stump anastomotic leak, which was mild and treated conservatively. One patient was readmitted for intra-abdominal infection and was treated conservatively. Jejunal afferent loop obstruction occurred in 1 patient, who underwent re-operation and recovered quickly. CONCLUSION: This technique is feasible and can produce satisfying postoperative outcomes. It is also convenience and reliable for anastomoses in gastrectomy. Full robotic hand-sewn anastomosis may be a minimally invasive technique for gastrectomy surgery. PMID:24151361

What Factors Drive Inpatient Satisfaction After Knee Arthroplasty?

PubMed

Peres-da-Silva, Ashwin; Kleeman, Lindsay T; Wellman, Samuel S; Green, Cynthia L; Attarian, David E; Bolognesi, Michael P; Seyler, Thorsten M

2017-06-01

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, developed by the Centers for Medicare & Medicaid Services, is directly tied to hospital reimbursement. The purpose of this study is to analyze survey responses from patients who underwent primary knee arthroplasty in order to identify factors that drive patient dissatisfaction in the inpatient setting. HCAHPS responses received from patients undergoing elective total and unicompartmental knee arthroplasty at our institution between January 1, 2013 and January 1, 2016 were obtained and expressed as a percentage of overall satisfaction. Satisfaction scores were correlated to patient demographics. Overall, responses from 580 patients were obtained (554 total knee arthroplasties, 26 unicompartmental knee arthroplasties). There was a statistically significant difference in overall satisfaction when comparing sex (P = .034), race (P = .030), and socioeconomic status (P = .001). Men reported a higher average satisfaction score than women (77.8% vs 74.2%). Patients in the 1st quartile of socioeconomic status reported a higher average satisfaction than those in the 4th quartile (81.3% vs 71.3%). African American patients reported a higher satisfaction than Caucasian and other races (81.6% vs 75.3% vs 66.3%, respectively). There was an inverse relationship between increased length of stay and reported satisfaction (r = -0.113, P = .006). Our data indicate that patients who are likely to report higher levels of inpatient satisfaction after knee arthroplasty are male, African American, of lower socioeconomic status, and with shorter length of stay. To our knowledge, this is the first reported analysis of the HCAHPS survey in relation to total joint arthroplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

Use of the UPOINT Classification in Turkish Chronic Prostatitis or Chronic Pelvic Pain Syndrome Patients.

PubMed

Arda, Ersan; Cakiroglu, Basri; Tas, Tuncay; Ekici, Sinan; Uyanik, Bekir Sami

2016-11-01

To determine the positive subdomain numbers and distribution of the UPOINT classification in chronic prostatitis and to compare the erectile dysfunction (ED) pattern. From 2008 to 2013, 839 patients with symptomatic chronic prostatitis or chronic pelvic pain syndrome were included in this study. The correlation between UPOINT domains and National Institutes of Health chronic prostatitis symptom index (NIH-CPSI) total score, subscores, and the 5-item International Index of Erectile Function scores were evaluated retrospectively. The mean patient age was calculated as 37.7 ± 7.4 (range 21-65). The average total NIH-CPSI score was determined as 9.07 (range 1-40) and the average positive UPOINT subdomain number was determined as 2.87 ± 0.32 (range 1-6). Subdomain patient numbers and rates were calculated as 529 urinary (63%), 462 psychosocial (55%), 382 organ specific (45%), 290 infection (34%), 288 neurological or systemic (34%), and 418 tenderness (skeletal muscle) (50%), respectively. It was determined that ED, determining the subdomain of sexual dysfunction in patients, was positive in a total of 326 (39.9%) patients, with 220 patients having mild (26.2%), 76 mild to moderate (9.1%), 19 moderate (2.3%), and 5 with severe (0.6%) ED. A statistically significant correlation was not determined between the 5-item International Index of Erectile Function score and UPOINT subdomain number and NIH-CPSI score. It has been determined that although there is a strong and significant correlation between UPOINT classification and NIH-CPSI score in Turkish patients with chronic prostatitis or chronic pelvic pain syndrome, the inclusion of ED as an independent subdomain to the UPOINT classification is not statistically significant. Copyright © 2016 Elsevier Inc. All rights reserved.

The validation of peer review through research impact measures and the implications for funding strategies.

PubMed

Gallo, Stephen A; Carpenter, Afton S; Irwin, David; McPartland, Caitlin D; Travis, Joseph; Reynders, Sofie; Thompson, Lisa A; Glisson, Scott R

2014-01-01

There is a paucity of data in the literature concerning the validation of the grant application peer review process, which is used to help direct billions of dollars in research funds. Ultimately, this validation will hinge upon empirical data relating the output of funded projects to the predictions implicit in the overall scientific merit scores from the peer review of submitted applications. In an effort to address this need, the American Institute of Biological Sciences (AIBS) conducted a retrospective analysis of peer review data of 2,063 applications submitted to a particular research program and the bibliometric output of the resultant 227 funded projects over an 8-year period. Peer review scores associated with applications were found to be moderately correlated with the total time-adjusted citation output of funded projects, although a high degree of variability existed in the data. Analysis over time revealed that as average annual scores of all applications (both funded and unfunded) submitted to this program improved with time, the average annual citation output per application increased. Citation impact did not correlate with the amount of funds awarded per application or with the total annual programmatic budget. However, the number of funded applications per year was found to correlate well with total annual citation impact, suggesting that improving funding success rates by reducing the size of awards may be an efficient strategy to optimize the scientific impact of research program portfolios. This strategy must be weighed against the need for a balanced research portfolio and the inherent high costs of some areas of research. The relationship observed between peer review scores and bibliometric output lays the groundwork for establishing a model system for future prospective testing of the validity of peer review formats and procedures.

Epidemiology of pediatric burns in southwest China from 2011 to 2015.

PubMed

Li, Haisheng; Wang, Song; Tan, Jianglin; Zhou, Junyi; Wu, Jun; Luo, Gaoxing

2017-09-01

Burns are a major form of injury in children worldwide. This study aimed to investigate the epidemiology, outcome, cost and risk factors of pediatric burns in southwest China. This retrospective study was performed at the Institute of Burn Research of the Third Military Medical University from 2011 to 2015. Data, including demographic, injury-related, and clinical data and patient outcome, were collected from medical records. A total of 2478 children with burns (58.03% boys), accounting for 39.2% of total burn patients, were included. The average age of the burn patients was 2.86±2.86years, and most patients (85.55%) were under five years old. The incidence of burns peaked in January, February and May. Scald burns were the most frequent (79.06%), followed by flame burns (14.0%) and electrical burns (3.35%). Limbs were the most common burn sites (69.73%), and the average total body surface area (TBSA) was 11.57±11.61%. The percentage of children who underwent operations and the number of operations were significantly increased in cases of electrical burns, the older-age group, a larger TBSA and full-thickness burns. Six deaths were recorded, yielding a mortality of 0.24%. The median length of stay and cost were 14days and 9541 CNY, respectively, and the major risk factors for length of stay and cost were the TBSA, number of operations, full-thickness burns and outcome. In southwest China, among children under five years old, scald and flame burns should become the key prevention target, and future prevention strategies should be based on related risk factors. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Accident risk associated with smartphone addiction: A study on university students in Korea.

PubMed

Kim, Hye-Jin; Min, Jin-Young; Kim, Hyun-Jin; Min, Kyoung-Bok

2017-12-01

Background and aims The smartphone is one of the most popular devices, with the average smartphone usage at 162 min/day and the average length of phone usage at 15.79 hr/week. Although significant concerns have been made about the health effects of smartphone addiction, the relationship between smartphone addiction and accidents has rarely been studied. We examined the association between smartphone addiction and accidents among South Korean university students. Methods A total of 608 college students completed an online survey that included their experience of accidents (total number; traffic accidents; falls/slips; bumps/collisions; being trapped in the subway, impalement, cuts, and exit wounds; and burns or electric shocks), their use of smartphone, the type of smartphone content they most frequently used, and other variables of interests. Smartphone addiction was estimated using Smartphone Addiction Proneness Scale, a standardized measure developed by the National Institution in Korea. Results Compared with normal users, participants who were addicted to smartphones were more likely to have experienced any accidents (OR = 1.90, 95% CI: 1.26-2.86), falling from height/slipping (OR = 2.08, 95% CI: 1.10-3.91), and bumps/collisions (OR = 1.83, 95% CI: 1.16-2.87). The proportion of participants who used their smartphones mainly for entertainment was significantly high in both the accident (38.76%) and smartphone addiction (36.40%) groups. Discussion and conclusions We suggest that smartphone addiction was significantly associated with total accident, falling/slipping, and bumps/collisions. This finding highlighted the need for increased awareness of the risk of accidents with smartphone addiction.

The Validation of Peer Review through Research Impact Measures and the Implications for Funding Strategies

PubMed Central

Gallo, Stephen A.; Carpenter, Afton S.; Irwin, David; McPartland, Caitlin D.; Travis, Joseph; Reynders, Sofie; Thompson, Lisa A.; Glisson, Scott R.

2014-01-01

There is a paucity of data in the literature concerning the validation of the grant application peer review process, which is used to help direct billions of dollars in research funds. Ultimately, this validation will hinge upon empirical data relating the output of funded projects to the predictions implicit in the overall scientific merit scores from the peer review of submitted applications. In an effort to address this need, the American Institute of Biological Sciences (AIBS) conducted a retrospective analysis of peer review data of 2,063 applications submitted to a particular research program and the bibliometric output of the resultant 227 funded projects over an 8-year period. Peer review scores associated with applications were found to be moderately correlated with the total time-adjusted citation output of funded projects, although a high degree of variability existed in the data. Analysis over time revealed that as average annual scores of all applications (both funded and unfunded) submitted to this program improved with time, the average annual citation output per application increased. Citation impact did not correlate with the amount of funds awarded per application or with the total annual programmatic budget. However, the number of funded applications per year was found to correlate well with total annual citation impact, suggesting that improving funding success rates by reducing the size of awards may be an efficient strategy to optimize the scientific impact of research program portfolios. This strategy must be weighed against the need for a balanced research portfolio and the inherent high costs of some areas of research. The relationship observed between peer review scores and bibliometric output lays the groundwork for establishing a model system for future prospective testing of the validity of peer review formats and procedures. PMID:25184367

The evaluation of NIMROD, a community-based service for people with mental handicap: revenue costs.

PubMed

Davies, L; Felce, D; Lowe, K; de Paiva, S

1991-11-01

The cost implications of moving from a system of services for people with mental handicaps centred on large institutions to a network of community-based services are not precisely known. The provision of the NIMROD service in a part of Cardiff, with its aim not only to meet the residential needs of adults comprehensively by providing a number of houses in the community but also to develop a support service to people living in their family home, gave an opportunity to investigate and report the revenue costs of a number of service elements with respect to a defined total population. The residential costs of intensively staffed houses in 1986-87, varying in size from two to six places, were found to range between pounds 16,473 and pounds 23,319 per person per year. With the addition of community support costs, such as the provision of day services, the total costs of care per resident averaged pounds 21,708; range, pounds 18,883-pounds 26,009. These compared to the total costs in a minimally staffed house of pounds 9,678 per resident. The costs of community support services for people living in their family homes averaged pounds 5,614 inclusive of DSS benefits, of which pounds 1,743 was accounted for by the NIMROD domiciliary support service, office base and administrative overheads. The residential costs reported were compared to other cost data in the literature. The study supports previous conclusions that there is little evidence of diseconomy attached to small scale per se but that the way staffing levels and therefore staff costs are determined is critical. No evidence was found in this study to link greater cost to better quality.

Perioperative strategies and technical modifications to the Nuss repair for pectus excavatum in pediatric patients: a large volume, single institution experience.

PubMed

Sacco Casamassima, Maria Grazia; Goldstein, Seth D; Salazar, Jose H; McIltrot, Kimberly H; Abdullah, Fizan; Colombani, Paul M

2014-04-01

The safety and efficacy of minimally invasive pectus excavatum repair have been demonstrated over the last twenty years. However, technical details and perioperative management strategies continue to be debated. The aim of the present study is to review a large single-institution experience with the modified Nuss procedure. A retrospective review was performed of patients who underwent primary pectus excavatum repair at a single tertiary hospital via a modified Nuss procedure that included: no thoracoscopy, retrosternal dissection achieved via a left-to-right thoracic approach, four-point stabilization of the bar, and no routine epidural analgesia. Data collected included demographics, preoperative symptoms, operative characteristics, hospital charges and postoperative outcomes. A total of 336 pediatric patients were identified. No cardiac perforations occurred and the rate of pericarditis was 0.6%. Contemporary rates of bar displacement have fallen to 1.2%. Routine use of chlorhexidine scrub reduced superficial site infections to 0.7%. Two patients (0.6%) with severe recurrence required reoperation. Bars were removed after an average period of 31.7(SD 13.2) months, with satisfactory cosmetic and functional results in 94.9% of cases. We report here a single-institution large volume experience, including modifications to the Nuss procedure that make the technique simpler and safer, improve results, and minimize hospital charges. Copyright © 2014 Elsevier Inc. All rights reserved.

20 CFR 617.3 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... (e) Average weekly hours means a figure obtained by dividing: (1) Total hours worked (excluding... employment. (f) Average weekly wage means one-thirteenth of the total wages paid to an individual in the... preceding the individual's appropriate week. (g) Average weekly wage in adversely affected employment means...

Minority Male Mentoring: A Program Evaluation

ERIC Educational Resources Information Center

Deas, Antoine T.

2017-01-01

This study analyzed the effectiveness of a minority male mentoring program at a public two-year institution of higher education in South Carolina. To assist in investigating the successfulness of African American males at the institution, data regarding graduation rates, grade point averages, developmental course completion, and campus involvement…

Impact of field of study, college and year on calculation of cumulative grade point average.

PubMed

Trail, Carla; Reiter, Harold I; Bridge, Michelle; Stefanowska, Patricia; Schmuck, Marylou; Norman, Geoff

2008-08-01

A consistent finding from many reviews is that undergraduate Grade Point Average (uGPA) is a key predictor of academic success in medical school. Curiously, while uGPA has established predictive validity, little is known about its reliability. For a variety of reasons, medical schools use different weighting schemas to combine years of study. Additional concerns relate to the equivalence of grades obtained from different fields of study and institutions, with little hard data to guide conclusions. At the Michael G. DeGroote School of Medicine Class of 2007 at McMaster University, every undergraduate grade of 2,138 applicants, along with field of study and post-secondary educational institution, was analyzed. Individual grades were aggregated into an overall uGPA using published algorithms from several medical school, and correlated with a non-weighted sum. Correlations of the different schemas with equal weights ranged from 0.973 to 0.990. The extent of the difference between fields of study was small, accounting for only 1.5% of the variance. However, differences among 16 Ontario universities were larger, and accounted for 9.3% of the variance. The results of this study suggest that all weighting schemas are virtually equivalent, making any formulation reasonable. Differences by field of study are small, but do not show any bias against non-science students. Differences by institution are larger, amounting to a range in average score from 78.7 to 84.6; however it is not clear whether this reflects candidate ability or institutional policy, so attempts to correct for institution may be difficult.

Normoxia vs. Hyperoxia: Impact of Oxygen Tension Strategies on Outcomes for Patients Receiving Cardiopulmonary Bypass for Routine Cardiac Surgical Repair

PubMed Central

Brown, D. Mark; Holt, David W.; Edwards, Jeff T.; Burnett, Robert J.

2006-01-01

Abstract: Oxygen pressure field theory (OPFT) was originally described in the early 1900s by Danish physiologist, Dr. August Krogh. This revolutionary theory described microcirculation of blood gases at the capillary level using a theoretical cylindrical tissue model commonly referred to as the Krogh cylinder. In recent years, the principles and benefits of OPFT in long-term extracorporeal circulatory support (ECMO) have been realized. Cardiac clinicians have successfully mastered OPFT fundamentals and incorporated them into their clinical practice. These clinicians have experienced significantly improved survival rates as a result of OPFT strategies. The objective of this study was to determine if a hyperoxic strategy can lead to equally beneficial outcomes for short-term support as measured by total ventilator time and total length of stay in intensive care unit (ICU) in the cardiopulmonary bypass (CPB) patient at a private institution. Patients receiving traditional blood gas management while on CPB (group B, n = 17) were retrospectively compared with hyperoxic patients (group A, n = 19). Hyperoxic/OPFT management was defined as paO2 values of 300–350 mmHg and average VSAT > 75%. Traditional blood gas management was defined as paO2 values of 150–250 mmHg and average VSAT < 75%. No significant differences between treatment groups were found for patient weight, CPB/AXC times, BSA, pre/post Hgb, pre/post-platelet (PLT) counts, pre/post-creatinine levels, pre/post-BUN, UF volumes, or CPB urine output. Additionally, no significant statistical differences were found between treatment groups for total time in ICU (T-ICU) or total time on ventilator (TOV). Hyperoxic management strategies provided no conclusive evidence of outcome improvement for patients receiving CPB for routine cardiac surgical repair. Additional studies into the impact of hyperoxia in short-term extracorporeal circulatory support are needed. PMID:17089511

A Prospective Multicenter Evaluation of the Value of the On-Call Orthopedic Resident.

PubMed

Jackson, J Benjamin; Vincent, Scott; Davies, James; Phelps, Kevin; Cornett, Chris; Grabowski, Greg; Scannell, Brian; Stotts, Alan; Bice, Miranda

2018-02-01

Funding for graduate medical education is at risk despite the services provided by residents. We quantified the potential monetary value of services provided by on-call orthopedic surgery residents. We conducted a prospective, cross-sectional, multicenter cohort study design. Over a 90-day period in 2014, we collected data on consults by on-call orthopedic surgery residents at 4 tertiary academic medical centers in the United States. All inpatient and emergency department consults evaluated by first-call residents during the study period were eligible for inclusion. Based on their current procedural terminology codes, procedures and evaluations for each consult were assigned a relative value unit and converted into a monetary value to determine the value of services provided by residents. The primary outcome measures were the total dollar value of each consult and the percentage of resident salaries that could be funded by the generated value of the resident consult services. In total, 2644 consults seen by 33 residents from the 4 institutions were included for analysis. These yielded an average value of $81,868 per center for the 90-day study period, that is, $327,471 annually. With a median resident stipend of $53,992, the extrapolated average percentage of resident stipends that could be funded by these consult revenues was 73% of the stipends of the residents who took call or 36% of the stipends of the overall resident cohort. The potential monetary value generated by on-call orthopedic surgery residents is substantial.

Cost Analysis of an Intervention to Prevent Methicillin-Resistant Staphylococcus Aureus (MRSA) Transmission.

PubMed

Chowers, Michal; Carmeli, Yehuda; Shitrit, Pnina; Elhayany, Asher; Geffen, Keren

2015-01-01

Our objective was to assess the cost implications of a vertical MRSA prevention program that led to a reduction in MRSA bacteremia. We performed a matched historical cohort study and cost analysis in a single hospital in Israel for the years 2005-2011. The cost of MRSA bacteremia was calculated as total hospital cost for patients admitted with bacteremia and for patients with hospital-acquired bacteremia, the difference in cost compared to matched controls. The cost of prevention was calculated as the sum of the cost of microbiology tests, single-use equipment used for patients in isolation, and infection control personnel. An average of 20,000 patients were screened yearly. The cost of prevention was $208,100 per year, with the major contributor being laboratory cost. We calculated that our intervention averted 34 cases of bacteremia yearly: 17 presenting on admission and 17 acquired in the hospital. The average cost of a case admitted with bacteremia was $14,500, and the net cost attributable to nosocomial bacteremia was $9,400. Antibiotics contributed only 0.4% of the total disease management cost. When the annual cost of averted cases of bacteremia and that of prevention were compared, the intervention resulted in annual cost savings of $199,600. A vertical MRSA prevention program targeted at high-risk patients, which was highly effective in preventing bacteremia, is cost saving. These results suggest that allocating resources to targeted prevention efforts might be beneficial even in a single institution in a high incidence country.

Extraosseous Primary Intracranial Ewing Sarcoma/peripheral Primitive Neuroectodermal Tumor: Series of Seven Cases and Review of Literature

PubMed Central

Singh, Amit Kumar; Srivastava, Arun Kumar; Pal, Lily; Sardhara, Jayesh; Yadav, Rajan; Singh, Shalini; Bhaisora, Kamlesh Singh; Das, Kuntal Kanti; Mehrotra, Anant; Sahu, Rabi Narayan; Jaiswal, Awadhesh Kumar; Behari, Sanjay

2018-01-01

Background: The Ewing sarcoma peripheral PNET (ES-pPNET) is very rare small round cell tumour that involves the CNS as either a primary dural neoplasm or by direct extension from contiguous bone or soft tissue. Materials and Methods: Biopsy proven cases of intracranial ES/pPNET with orbital involvement operated during Jan 2010-Jan 2014 were retrospectively included and their clinical data, operative and histological findings were reviewed from institutional oncology register. Results: seven patients (4 males; 3 female) were studied with mean age at presentation of 13 years. Six patients had orbital involvement in one or other form. Surgical excision was gross total in five, near total in one, and subtotal in one patient. All patients received adjuvant therapy, only chemotherapy in 2, only Radiotherapy in four, both in one. MRI characteristics were studied in six patients. Four patients died with average survival of 33.2 months and three patients are having Progression free survival of average 23.3 months. Conclusions: The EWS-pPNET is very rare tumour and very poorly described in literature. These tumours are showing special predilection for the frontotemporal dura and erode through the flat bone of cranium like orbital roof and lateral wall of the orbit. These tumours are aggressive, multi compartmental, vascular and very rapidly growing, so missing or overlooking the primary symptoms of dural stretching/bony involvement leads to delay in management and poor outcome. PMID:29682023

The NIH's Funding to US Dental Institutions from 2005 to 2014.

PubMed

Ferland, C L; O'Hayre, M; Knosp, W M; Fox, C H; Horsford, D J

2017-01-01

This study examines funding from the National Institutes of Health (NIH) to US dental institutions between 2005 and 2014 based on publicly available data from the NIH Research Portfolio Online Reporting Tools. Over the 10-y span, 56 US dental institutions received approximately $2.2 billion from 20 Institutes, Centers, and Offices at the NIH. The National Institute of Dental and Craniofacial Research (NIDCR) is the largest NIH supporter of dental institutions, having invested 70% of the NIH total, about $1.5 billion. The NIDCR is also the primary supporter of research training and career development, as it has invested $177 million, which represents 92% of the total NIH investment of $192 million. Over the past 10 y, about half of the NIDCR's extramural award dollars have gone to dental schools, while the NIH has invested about 1%. There has been an approximately 10% net decrease in extramural dollars awarded to dental institutions over the past decade; however, given the year-to-year variability in support to dental institutions, it is unclear if this net decline reflects a long-term trend. In addition, there was an overall reduction in the extramural dollars awarded by the NIDCR and by the NIH. For example, from 2005 to 2014, the total NIDCR budget for extramural research decreased by roughly 4%, which represents a decrease of $20 million to dental institutions. After adjusting for inflation, the decline in funding to dental institutions from the NIDCR and NIH was approximately 30%. Although the NIDCR and NIH continue to invest in dental institutions, if the current decline were to continue, it could negatively affect the research conducted at dental institutions. Therefore, we discuss opportunities for dental institutions to increase NIDCR and NIH support and improve their capacity for research, research training, and career development.

12 CFR 1070.22 - Fees for processing requests for CFPB records.

Code of Federal Regulations, 2012 CFR

2012-01-01

... of grades typically involved may be established. This charge shall include transportation of...), an average rate for the range of grades typically involved may be established. Fees shall be charged... research. (iii) Non-commercial scientific institution refers to an institution that is not operated on a...

Grades as Predictors of College and Career Success: The Case of a Health-Related Institution.

ERIC Educational Resources Information Center

Tan, David L.

1991-01-01

Examined relationship between grades, academic performance, and career success in case of nontraditional, health-related educational institution (Palmer College of Chiropractic). Found direct relationship between entering grade point average and subsequent college performance. Relationship between good grades in professional schools and career…

12 CFR 615.5200 - Capital planning.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the capital adequacy plan: (1) Capability of management and the board of directors; (2) Quality of... of Directors of each Farm Credit System institution shall determine the amount of total capital, core surplus, total surplus, and unallocated surplus needed to assure the institution's continued financial...

12 CFR 615.5200 - Capital planning.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the capital adequacy plan: (1) Capability of management and the board of directors; (2) Quality of... of Directors of each Farm Credit System institution shall determine the amount of total capital, core surplus, total surplus, and unallocated surplus needed to assure the institution's continued financial...

[Medico-economic analysis of a neurosurgery department at a university hospital].

PubMed

Lemaire, J-J; Delom, C; Coste, A; Khalil, T; Jourdy, J-C; Pontier, B; Gabrillargues, J; Sinardet, D; Chabanne, A; Achim, V; Sakka, L; Coste, J; Chazal, J; Salagnac, A; Coll, G; Irthum, B

2015-02-01

Economic and societal constraints require to take into account the economic dimension and medical performance of hospital departments. We carried out a self-assessment study, which we thought could be useful to share with the neurosurgical community. Care and research activities were assessed from 2009 to 2013. We used institutional and assessment-body parameters in order to describe activities and perform a financial evaluation. It was a retrospective descriptive study based on the guidelines of the DHOS/O4 circular No. 2007/390 of October 29, 2007. The average annual, analytic income statement was +1.39 millions euros, for 63 beds with a 92% occupancy rate, including 6.7 full-time equivalent neurosurgeons (and assistants), for 2553 patients and 1975 surgeries. The average mortality rate was 2.74%. The annual mean length of stay was 6.82 days. Per year, on average 15.6% of patients were admitted in emergency and 76.9% returned home. The annual, act-related-pricing and publication-related incomes represented 77% and 0.6%, respectively of the total funding. Difficulties to find downstream beds for the most severe patients induced 1401 "waiting days" in 2012. Medico-economic analysis of a neurosurgery department at a university hospital was useful in order to take into account the care, teaching and research activities, as well as its related financial value. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Assessing the Library Homepages of COPLAC Institutions for Section 508 Accessibility Errors: Who's Accessible, Who's Not, and How the Online WebXACT Assessment Tool Can Help

ERIC Educational Resources Information Center

Huprich, Julia; Green, Ravonne

2007-01-01

The Council on Public Liberal Arts Colleges (COPLAC) libraries websites were assessed for Section 508 errors using the online WebXACT tool. Only three of the twenty-one institutions (14%) had zero accessibility errors. Eighty-six percent of the COPLAC institutions had an average of 1.24 errors. Section 508 compliance is required for institutions…

Costs for Breast Cancer Care in the Military Health System: An Analysis by Benefit Type and Care Source.

PubMed

Eaglehouse, Yvonne L; Manjelievskaia, Janna; Shao, Stephanie; Brown, Derek; Hofmann, Keith; Richard, Patrick; Shriver, Craig D; Zhu, Kangmin

2018-04-11

Breast cancer care imposes a significant financial burden to U.S. healthcare systems. Health services factors, such as insurance benefit type and care source, may impact costs to the health system. Beneficiaries in the U.S. Military Health System (MHS) have universal healthcare coverage and access to a network of military facilities (direct care) and private practices (purchased care). This study aims to quantify and compare breast cancer care costs to the MHS by insurance benefit type and care source. We conducted a retrospective analysis of data linked between the MHS data repository administrative claims and central cancer registry databases. The institutional review boards of the Walter Reed National Military Medical Center, the Defense Health Agency, and the National Institutes of Health Office of Human Subjects Research reviewed and approved the data linkage. We used the linked data to identify records for women aged 40-64 yr who were diagnosed with breast cancer between 2003 and 2007 and to extract information on insurance benefit type, care source, and cost to the MHS for breast cancer treatment. We estimated per capita costs for breast cancer care by benefit type and care source in 2008 USD using generalized linear models, adjusted for demographic, pathologic, and treatment characteristics. The average per capita (n = 2,666) total cost for breast cancer care was $66,300 [standard error (SE) $9,200] over 3.31 (1.48) years of follow-up. Total costs were similar between benefit types, but varied by care source. The average per capita cost was $34,500 ($3,000) for direct care (n = 924), $96,800 ($4,800) for purchased care (n = 622), and $60,700 ($3,900) for both care sources (n = 1,120), respectively. Care source differences remained by tumor stage and for chemotherapy, radiation, and hormone therapy treatment types. Per capita costs to the MHS for breast cancer care were similar by benefit type and lower for direct care compared with purchased care. Further research is needed in breast and other tumor sites to determine patterns and determinants of cancer care costs between benefit types and care sources within the MHS.

40 CFR 80.305 - How are credits generated during the time period 2000 through 2003?

Code of Federal Regulations, 2011 CFR

2011-07-01

... AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Sulfur Abt... averaging period. Va = Total volume of gasoline produced during the averaging period at the refinery (or for a foreign refinery, the total volume of gasoline produced during the averaging period at the...

40 CFR 80.305 - How are credits generated during the time period 2000 through 2003?

Code of Federal Regulations, 2010 CFR

2010-07-01

... AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Sulfur Abt... averaging period. Va = Total volume of gasoline produced during the averaging period at the refinery (or for a foreign refinery, the total volume of gasoline produced during the averaging period at the...

Impact of business infrastructure on financial metrics in departments of surgery.

PubMed

Wai, Philip Y; O'Hern, Tim; Andersen, Dave O; Kuo, Marissa C; Weber, Cynthia E; Talbot, Lindsay J; Kuo, Paul C

2012-10-01

In the current environment, pressure is ever increasing to maximize financial performance in surgery departments. Factors such as physician extenders, billing and collection, payor mix, contracting, incentives from the Centers for Medicare and Medicaid Services, and administrative incentives may greatly influence financial performance. However, despite a plethora of information from the University HealthSystem Consortium and the Association of American Medical Colleges, best-practice information for business infrastructure is lacking. To obtain a sampling of current practices, we conducted a survey of departments of surgery. An anonymous 30-question survey addressing demographics, productivity, revenue and expense profile, payor mix, physician extender and staff personnel, billing and collections methodology, and financial performance was distributed among members of the Society of Surgical Chairs via SurveyMonkey. This was approved by the Loyola Institutional Research Board. Multivariate linear regression analyses and t tests/rank-sum tests were performed, as appropriate. Data are presented as mean ± SEM. A total of 25 (19%) departments responded; 14 were integrated with the hospital/health system, and 11 were integrated with the medical school. In 60% (n = 15), the main hospital had 500 to 1,000 beds; 48% (n = 12) had >4 hospitals in their system. For FY10, MD clinical full-time equivalents (FTEs) were 49 ± 10; total work relative value units (wRVUs) were 320 ± 8 k; and total billed cases were 43 ± 16 k. A total of 23 of 25 used physician-extenders with an average of 18 ± 5 per department and in 22 of 23, the physician extenders billed. On average, there were 18 ± 6 clinical-support staff, 25 ± 11 front-office staff, and 13 ± 3 back-office support staff FTEs. Among these FTEs, there were 16 ± 5 devoted to business operations (billing, coding, denial/claims management, financial oversight). Collections/wRVUs were $60 ± 3 (range, 39-80). Regression modeling demonstrated that total wRVUs were determined by the number of MD FTEs (P = .01), number of physician extenders (P = .01), number of front-office staff (P = .01), number of back-office staff (P = .02), and number of total business staff (P = .01). Collections/wRVUs were predicted by number of hospitals (P = .04), number of MD FTEs (P = .03), number of physician extenders (P = .01), and number of cases/total business staff (P = .02). Interestingly, wRVUs/MD was predicted by number of MD FTEs (P = .01) but were not greatly impacted by numbers of clinical or business support staff. In 4 of 25, the billing and coding staff were incentivized and had a Collections/wRVU = 64 ± 5 whereas nonincentivized staff had collections/wRVU = 59 ± 3. (P = NS) Also, %Accounts receivable >90 days (15% vs 25%) were not substantially different. Only 48% (12/25) have departments have recouped Centers for Medicare and Medicaid dollars for Physician Quality Reporting Initiative, Meaningful Use, Patient-Centered Medical Homes, or other Accountable Care-like programs. One-half (13) of the departments had both an inpatient and outpatient electronic medical record. Finally, on a scale of 1-10 (10 = highest), the average level of satisfaction with billing and collections processes was 6. Our results indicate that the physician extender, clinical support staff, and business staff environment can impact surgeon productivity, and there is opportunity for improvement. Determining best practices for ratios of support staff/MD and optimizing the role of electronic medical record in workflow and billing/collections are critical in the current environment. Our pilot study requires extension across more institutions for validation. Copyright © 2012 Mosby, Inc. All rights reserved.

Email solicitation for scholarly work--a single researcher's perspective.

PubMed

Bugeja, Justine; Grech, Victor

2015-01-01

Publishing is important for career progression. The traditional journal model results in subscribers bearing publication costs. The eagerness with which researchers seek journals for the publishing of their work, along with the internet, has resulted in the creation of a new model called open access (OA). Author/s or their institution/s pay an actual publication fee. This has in turn resulted in the creation of questionable journals which charge steep publishing fees. Emails soliciting publication to one of the authors (VG) were collected for the month of March 2015. Information collected included costs of OA publishing, and whether or not this information was readily available. The appropriateness of said solicitations was also assessed with regard to topics with which the targeted author was familiar. There was a total of 44 solicitations: 3 were duplicates. Out of 41 solicitations, 20 (49%) were appropriate. The open access fee was readily available in 27 out of 41 solicitations (66%). The open access fee averaged $475, ranging from $25 to $1500. The only journal which provided true OA was Medical Principles and Practice, with no fees charged whatsoever. Potential authors should carefully investigate OA journals prior to choosing journals wherein to submit their work.

Basic life support skills: assessment and education of spouse and first degree relatives of patients with coronary disease.

PubMed

Khan, Javaid Arif; Shafquat, Azam; Kundi, Asadullah

2010-05-01

To assess the knowledge of basic cardiac life support (BCLS) before and after the institution of training among first degree relatives and spouses of patients with coronary disease. Quasi-experimental study. National Institute of Cardiovascular Diseases, Karachi, from April 2007 to May 2008. A total of 300 relatives of patients with coronary heart disease undertook a one day CPR course. Questionnaire assessing knowledge of CPR was administered before and after the course. Patients were studied in groups of 10-20 at a time. Proportion of correct knowledge was compared using chi-square test with significance at p < 0.05. Mean age of participants was 31.08+10.53 years. Two hundred and twenty (73.34%) were males. On the average for all 31 questions, 37.09% of participants had correct responses before the training and 68.16% after the training of BCLS (p < 0.001). There was statistically significant improvement across all age groups, gender and educational levels (p < 0.01). There was significant improvement in relatives' knowledge of BCLS after training. Different age groups, both genders and all educational groups showed equal learning abilities.

[Manual lifting and manual transport: risk assessment and prevalence of work-related diseases in construction companies in Basilicata].

PubMed

Nicoletti, S; Battevi, N; Colafemmina, G; Di Leone, G; Satriani, G; Ragone, P; Occhipinti, E

2013-01-01

The Basilicata Regional Headquarters of the Italian Institute for Insurance against Occupational Accidents and Disease (INAIL) and the Basilicata association of small building enterprises (Edilcassa di Basilicata) promoted a research project to assess the risk of manual lifting and manual transport in construction enterprises in the Basilicata Region and estimate the prevalence of related diseases. Manual lifting risk assessment was performed by calculating the VLI of 204 working days in as many building workers. Manual transport risk assessment was carried out comparing the weights transported (on the 204 days tested) with the reference values of the "Snoock and Ciriello" tables. Manual Ifting risk was present on 195 of the 204 days, with an average value of VLI equal to 2.1 (min 0.4, max 8.5), with higher values in the restructuring sector (VLI average of 2.3, min 0.4, max 8.5), and no significant differences between the different tasks. Manual transport risk was present on 129 of the 204 days, with average values of 1.2 (min 0.2, max 3.3), with no significant differences between the different tasks analyzed For both risks additional factors were present that were not analyzed by the methods of assessment used (for manual lifting: 8.8% of the geometries in the critical area; for manual transport: 39% of transport on shoulders, 42.5% on a route with uneven surface and 31.9% on a sloping route), so it is likely that the actual risk is greater than that indicated by the synthetic indices of exposure. The medical questionnaire showed from the case histories that 148 out of 546 subjects were positive for the threshold forpain or discomfort in the lumbosacral spine area and 99 out of 546 subjects reported suffering from an already diagnosed herniated spinal disk. Only 18% of osteoarticular diseases was reported to the Insurance Institute, al though there was widespread awareness that the diseases in question might be related to work. Diseases of the spine were responsible for 1.9% of absenteeism, equal to 30-40% of total absenteeism ofworkers enrolled in "Edilcassa di Basilicata". The method used provides a solid basis for evaluating the two risks in the construction industry, where employment is subject to extreme organizational, environmental and structural (machines, tools, operators involved) variability. Employment in the construction industry involves significant exposure to the two risks, counting for 30-40% of total absenteeism in this sector.

High precision measurements on fission-fragment de-excitation

NASA Astrophysics Data System (ADS)

Oberstedt, Stephan; Gatera, Angélique; Geerts, Wouter; Göök, Alf; Hambsch, Franz-Josef; Vidali, Marzio; Oberstedt, Andreas

2017-11-01

In recent years nuclear fission has gained renewed interest both from the nuclear energy community and in basic science. The first, represented by the OECD Nuclear Energy Agency, expressed the need for more accurate fission cross-section and fragment yield data for safety assessments of Generation IV reactor systems. In basic science modelling made much progress in describing the de-excitation mechanism of neutron-rich isotopes, e.g. produced in nuclear fission. Benchmarking the different models require a precise experimental data on prompt fission neutron and γ-ray emission, e.g. multiplicity, average energy per particle and total dissipated energy per fission, preferably as function of fission-fragment mass and total kinetic energy. A collaboration of scientists from JRC Geel (formerly known as JRC IRMM) and other institutes took the lead in establishing a dedicated measurement programme on prompt fission neutron and γ-ray characteristics, which has triggered even more measurement activities around the world. This contribution presents new advanced instrumentation and methodology we use to generate high-precision spectral data and will give a flavour of future data needs and opportunities.

Evaluation of Canadian undergraduate ophthalmology medical education at Western University.

PubMed

Li, Bo; Curts, Dustin; Iordanous, Yiannis; Proulx, Alain; Sharan, Sapna

2016-10-01

To assess and evaluate the current level of ophthalmology knowledge and teaching curriculum in undergraduate year 3 (MS-3) at Western University. The Undergraduate Medical Education Curriculum at Western University has instituted additional ophthalmology lecture series to all MS-3 students. A test on basic ophthalmic knowledge was administered to MS-3 students immediately before and after lecture series to evaluate the level of knowledge at baseline and after ophthalmology didactic teaching. An evaluation survey was also given to MS-3 students to assess students' self-perceived level of competency, exposure, and interests in ophthalmology. A total of 134 students attended the ophthalmology lecture series in the study, and 88.1% of students completed the pretest, post-test, and Ophthalmology Education Survey. The average pretest and post-test scores were 40.7% and 75.6% (p < 0.01), respectively. The average rating from MS-3 students for ophthalmology exposure during medical school education was 2.11 (1 = "very minimal" and 5 = "more than adequate"). The average rating for desire for additional didactic ophthalmology lectures was 4.02 (1 = "strongly disagree" and 5 = "strongly agree"). The average rating for interest in ophthalmology was 2.74 (1 = "very little interest" and 5 = "very strong interest"). The additional ophthalmology lecture series had a positive impact on the level of ophthalmic knowledge among MS-3 students, and a strong desire for more ophthalmology teaching during medical school education was identified, as evidenced by the survey undertaken by students after the lectures. Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Transoral robotic approach to parapharyngeal space tumors: Case series and technical limitations.

PubMed

Boyce, Brian J; Curry, Joseph M; Luginbuhl, Adam; Cognetti, David M

2016-08-01

The transoral robotic approach to parapharyngeal space (PPS) tumors is a new technique with limited data available on its feasibility, safety, and efficacy. We analyzed our experience with transoral robotic excisions of PPS tumors to evaluate the safety and efficacy of this technique. Retrospective chart analysis at tertiary academic medical center. From July 2010 to June 2014, 17 patients who had transoral robotic excision of PPS tumors were included in the study. Our cohort had an average age of 61.6 years and was 52.9% male. All patients had successful removal of their PPS tumors, and the average size of the tumors was 27.3 cm(3) (range 2-80 cm(3) ). Two cases (11.7%) required a cervical incision to assist with tumor removal. The average total operative time was 140.5 minutes. Two PPS PAs had focal areas of capsule rupture and one was fragmented. The average length of stay was 1.8 days (range 1-7 days), and all patients were discharged on an oral diet. Three patients experienced complications. There was no clinical or radiographic evidence of recurrence. This is the largest single-institution case series of transoral robotic approaches to PPS tumors. We demonstrate that this approach is feasible and safe but also note limitations of the robotic approaches for tumors on the far lateral and superior areas of the PPS, which required transcervical assistance. There were no patients who demonstrated recurrent tumor either radiographically or clinically. 4. Laryngoscope, 126:1776-1782, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Total Quality Management: Institutional Research Applications.

ERIC Educational Resources Information Center

Heverly, Mary Ann

Total Quality Management (TQM), a technique traditionally reserved for the manufacturing sector, has recently spread to service companies, government agencies, and educational institutions. TQM places responsibility for quality problems with management rather than on the workers. A principal concept of TQM is the management of Process Variation,…

Did the Decline in Social Connections Depress Americans' Happiness?

ERIC Educational Resources Information Center

Bartolini, Stefano; Bilancini, Ennio; Pugno, Maurizio

2013-01-01

During the last 30 years US citizens experienced, on average, a decline in reported happiness, social connections, and confidence in institutions. We show that a remarkable portion of the decrease in happiness is predicted by the decline in social connections and confidence in institutions. We carry out our investigation in three steps. First, we…

Firm-Provided Training in Europe and the Limits of National Skills Strategies

ERIC Educational Resources Information Center

Markowitsch, Jorg; Kapplinger, Bernd; Hefler, Gunter

2013-01-01

This article addresses cross-country and cross-period differences in average levels of training activity from an institutional perspective. Firm-provided training in Europe between 1999 and 2010 is scrutinized in order to explore whether diverse institutional arrangements that can be linked to welfare state regimes can yield discernible…

Basic Trends in the Development of Professional Higher Education in Armenia

ERIC Educational Resources Information Center

Aslanyan, Anna L.

2005-01-01

The subject of this investigation is the composition and distribution of students of Armenian educational institutions and their partition in the state and private sectors of higher education. The study examines the general rise of educational institutions, particularly private ones, where the average number of students is considerably less than…

Characterizing the Undergraduate Neuroscience Major in the U.S.: An Examination of Course Requirements and Institution-Program Associations

PubMed Central

Pinard-Welyczko, Kira M.; Garrison, Anna C. S.; Ramos, Raddy L.; Carter, Bradley S.

2017-01-01

Neuroscience is a rapidly expanding field, and many colleges and universities throughout the country are implementing new neuroscience degree programs. Despite the field’s growth and popularity, little data exists on the structural character of current undergraduate neuroscience programs. We collected and examined comprehensive data on existing undergraduate neuroscience programs, including academic major requirements and institution characteristics such as size, financial resources, and research opportunities. Thirty-one variables covering information about course requirements, department characteristics, financial resources, and institution characteristics were collected from 118 colleges and universities in the United States that offer a major titled “neuroscience” or “neural sciences.” Data was collected from publicly available sources (online databases, institutions’ neuroscience program websites) and then analyzed to define the average curriculum and identify associations between institution and program characteristics. Our results suggest that the average undergraduate neuroscience major requires 3 chemistry, 3 biology, 3 laboratory, 2–3 neuroscience, 1 physics, 1 math, and 2 psychology courses, suggesting that most neuroscience programs emphasize the natural sciences over the social sciences. Additionally, while 98% of institutions in our database offer research opportunities, only 31% required majors to perform research. Of note, 70% of institutions offering a neuroscience major do not have a neuroscience department, suggesting that most institutions offer neuroscience as an interdisciplinary major spanning several departments. Finally, smaller liberal arts colleges account for the majority of institutions offering a neuroscience major. Overall, these findings may be useful for informing groups interested in undergraduate neuroscience training, including institutions looking to improve or establish programs, students wanting to major in neuroscience and employers hiring neuroscience graduates. PMID:29371843

[Iodine supply of pregnant women in the Czech Republic].

PubMed

Bílek, Radovan; Kaňová, Nataša; Mindžáková, Veronika; Neumann, David; Jiskra, Jan; Ryšavá, Lydie; Zamrazil, Václav

Iodine deficiency is a global public health problem which is particularly noticeable in pregnant or breastfeeding women and their children. Even mild iodine deficiency during pregnancy can lead to damage to the developing brain and thus affecting the fetus intelligence, his cognitive and neurological function, embryogenesis and growth. In the period 2010-2015 was determined by spectrophotometry at the Institute of Endocrinology the basal urinary iodine in 532 pregnant women at the age of 32 ± 5 (18-44) years, which came from Prague, Hradec Kralove and Mlada Boleslav. It was located 349 women in the first trimester, 112 in the second trimester, and 71 women in the third trimester. In the monitoring of pregnant women in the first trimester 218 basal urine samples of women were determined by mass spectrometry with inductively coupled plasma (ICP MS) in The National Institute of Public Health (NIPH). Women came from the 6 areas in the Czech Republic. Development of urinary iodine in the general population in the period 1994-2015 was observed in patients who underwent Institute of Endocrinology and from population studies conducted in 7 regions of the Czech Republic. It performed 52 648 spectrophotometric analysis of urinary iodine in the general population. Urinary iodine was determined by alkali melting of urine samples, followed by spectrophotometric determination of iodine in the form of iodide using the Sandell-Kolthoff reaction in the Institute of Endocrinology or determination was performed by ICP-MS in the laboratory of NIPH. On average, only 21.8 % of pregnant women had urinary iodine values determined by spectrophotometry higher than 150 μg/L. The results of iodine nutrition of pregnant women in the first trimester analyzed using ICP-MS are better, but even so, only 50.5 % of pregnant women have urinary iodine higher than 150 μg/L. The results of iodine nutrition of pregnant women are alarming, on average, only 30 % of the total of 750 examined women have urinary iodine values greater than 150 μg/L and therefore meet the requirements of the WHO for pregnant women. Our results, however, show that iodine deficiency is not major public health problem in the general population.Key words: ICP-MS - pregnant women - Sandell-Kolthoff reaction - urinary iodine.

THE DOCTORATE IN ADULT EDUCATION, 1935-1965.

ERIC Educational Resources Information Center

BUSKEY, JOHN H.; HOULE, CYRIL O.

COMPLETED QUESTIONNAIRES SUBMITTED BY 480 HOLDERS OF AMERICAN ADULT EDUCATION DOCTORATES WERE ANALYZED, PRIMARILY BY KINDS OF WORK PERFORMED AND TYPES OF EMPLOYING INSTITUTIONS. TOTAL DOCTORATES AWARDED BY 30 INSTITUTIONS DURING 1935-65 WERE INDICATED, TOGETHER WITH TOTALS FOR SPECIFIC YEARS. DATA WERE OBTAINED ON (1) AGE DISTRIBUTION OF…

34 CFR 628.32 - What funding priorities does the Secretary use in evaluating an application for an endowment...

Code of Federal Regulations, 2013 CFR

2013-07-01

..., Special Needs, Hispanic-Serving Institutions, Strengthening Historically Black Colleges and Universities, or Strengthening Historically Black Graduate Institutions Program. (Total: 20 points) The Secretary... Institutions, Special Needs, Hispanic-Serving Institutions, Strengthening Historically Black Colleges and...

34 CFR 628.32 - What funding priorities does the Secretary use in evaluating an application for an endowment...

Code of Federal Regulations, 2014 CFR

2014-07-01

..., Special Needs, Hispanic-Serving Institutions, Strengthening Historically Black Colleges and Universities, or Strengthening Historically Black Graduate Institutions Program. (Total: 20 points) The Secretary... Institutions, Special Needs, Hispanic-Serving Institutions, Strengthening Historically Black Colleges and...

34 CFR 628.32 - What funding priorities does the Secretary use in evaluating an application for an endowment...

Code of Federal Regulations, 2011 CFR

2011-07-01

..., Special Needs, Hispanic-Serving Institutions, Strengthening Historically Black Colleges and Universities, or Strengthening Historically Black Graduate Institutions Program. (Total: 20 points) The Secretary... Institutions, Special Needs, Hispanic-Serving Institutions, Strengthening Historically Black Colleges and...

34 CFR 628.32 - What funding priorities does the Secretary use in evaluating an application for an endowment...

Code of Federal Regulations, 2010 CFR

2010-07-01

..., Special Needs, Hispanic-Serving Institutions, Strengthening Historically Black Colleges and Universities, or Strengthening Historically Black Graduate Institutions Program. (Total: 20 points) The Secretary... Institutions, Special Needs, Hispanic-Serving Institutions, Strengthening Historically Black Colleges and...

34 CFR 628.32 - What funding priorities does the Secretary use in evaluating an application for an endowment...

Code of Federal Regulations, 2012 CFR

2012-07-01

..., Special Needs, Hispanic-Serving Institutions, Strengthening Historically Black Colleges and Universities, or Strengthening Historically Black Graduate Institutions Program. (Total: 20 points) The Secretary... Institutions, Special Needs, Hispanic-Serving Institutions, Strengthening Historically Black Colleges and...

The Global Tracheostomy Collaborative: one institution's experience with a new quality improvement initiative.

PubMed

Lavin, Jennifer; Shah, Rahul; Greenlick, Hannah; Gaudreau, Philip; Bedwell, Joshua

2016-01-01

Given the low frequency of adverse events after tracheostomy, individual institutions struggle to collect outcome data to generate effective quality improvement protocols. The Global Tracheostomy Collaborative (GTC) is a multi-institutional, multi-disciplinary organization that utilizes a prospective database to collect data on patients undergoing tracheostomy. We describe our institution's preliminary experience with this collaborative. It was hypothesized that entry into the database would be non-burdensome and could be easily and accurately initiated by skilled specialists at the time of tracheostomy placement and completed at time of patient discharge. Demographic, diagnostic, and outcome data on children undergoing tracheostomy at our institution from January 2013 to June 2015 were entered into the GTC database, a database collected and managed by REDCap (Research Electronic Data Capture). All data entry was performed by pediatric otolaryngology fellows and all post-operative updates were completed by a skilled tracheostomy nurse. Tracked outcomes included accidental decannulation, failed decannulation, tracheostomy tube obstruction, bleeding/tracheoinnominate fistula, and tracheocutaneous fistula. Data from 79 patients undergoing tracheostomy at our institution were recorded. Database entry was straightforward and entry of patient demographic information, medical comorbidities, surgical indications, and date of tracheostomy placement was completed in less than 5min per patient. The most common indication for surgery was facilitation of ventilation in 65 patients (82.3%). Average time from admission to tracheostomy was 62.6 days (range 0-246). Stomal breakdown was seen in 1 patient. A total of 72 patients were tracked to hospital discharge with 53 patients surviving (88.3%). No mortalities were tracheostomy-related. The Global Tracheostomy Collaborative is a multi-institutional, multi-disciplinary collaborative that collects data on patients undergoing tracheostomy. Our experience proves proof of concept of entering demographics and outcome data into the GTC database in a manner that was both accurate and not burdensome to those participating in data entry. In our tertiary care, pediatric academic medical center, tracheostomy continues to be a safe procedure with no major tracheostomy-related morbidities occurring in this patient population involvement with the GTC has shown opportunities for improvement in communication and coordination with other tracheostomy-related disciplines. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Federal parity law associated with increased probability of using out-of-network substance use disorder treatment services.

PubMed

McGinty, Emma E; Busch, Susan H; Stuart, Elizabeth A; Huskamp, Haiden A; Gibson, Teresa B; Goldman, Howard H; Barry, Colleen L

2015-08-01

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 requires commercial insurers providing group coverage for substance use disorder services to offer benefits for those services at a level equal to those for medical or surgical benefits. Unlike previous parity policies instituted for federal employees and in individual states, the law extends parity to out-of-network services. We conducted an interrupted time-series analysis using insurance claims from large self-insured employers to evaluate whether federal parity was associated with changes in out-of-network treatment for 525,620 users of substance use disorder services. Federal parity was associated with an increased probability of using out-of-network services, an increased average number of out-of-network outpatient visits, and increased average total spending on out-of-network services among users of those services. Our findings were broadly consistent with the contention of federal parity proponents that extending parity to out-of-network services would broaden access to substance use disorder care obtained outside of plan networks. Project HOPE—The People-to-People Health Foundation, Inc.

The Readability of Online Patient Information About Mohs Micrographic Surgery.

PubMed

Vargas, Christina R; DePry, Jennifer; Lee, Bernard T; Bordeaux, Jeremy S

2016-10-01

Mohs micrographic surgery has become increasingly used in the treatment of cutaneous malignancies over the past decade. Concurrently, more patients are using the Internet as a resource for medical information than ever before. The average American adult reads at an eighth grade level. The American Medical Association and National Institutes of Health have recommended a sixth grade target reading level for patient health materials. This study evaluates the readability of currently available online information about Mohs micrographic surgery in the context of these recommendations. An Internet search for the term "Mohs surgery" was performed and the first 10 results were identified. Patient information from each primary site was downloaded and formatted into plain text. Readability was assessed using 9 established tests; text was analyzed both overall and by Web site for comparison. A total of 101 articles were collected from the first 10 Web site search results; the overall average reading level was 14.4. All articles exceeded the recommended sixth grade reading level. Online resources about Mohs micrographic surgery are too difficult for many patients to read. The paucity of appropriately written patient information available on the Internet may hinder informed decision-making, participation, and subsequent postoperative satisfaction.

A proposal for a quantitative indicator of original research output

NASA Astrophysics Data System (ADS)

Onofrio, Roberto

2017-12-01

The use of quantitative indicators of scientific productivity seems now quite widespread for assessing researchers and research institutions. There is a general perception, however, that these indicators are not necessarily representative of the originality of the research carried out, being primarily indicative of a more or less prolific scientific activity and of the size of the targeted scientific subcommunity. We first discuss some of the drawbacks of the broadly adopted h-index and of the fact that it represents, in an average sense, an indicator derivable from the total number of citations. Then we propose an indicator which, although not immune from biases, seems more in line with the general expectations for quantifying what is typically considered original work. Qualitative arguments on how different indicators may shape the future of science are finally discussed.

GISS GCMAM Modeled Climate Responses to Total and Spectral Solar Forcing on Decadal and Centennial Time Scales

NASA Astrophysics Data System (ADS)

Wen, Guoyong; Cahalan, Robert; Rind, David; Jonas, Jeffrey; Pilewskie, Peter; Harder, Jerry

2014-05-01

We examine the influence of the SORCE (Solar Radiation and Climate Experiment) SIM (Spectral Irradiance Monitor) observed spectral solar irradiance (SSI) variations on Earth's climate. We apply two reconstructed spectral solar forcing scenarios, one SIM based, the other based on the SATIRE (Spectral And Total Irradiance REconstruction) model, as inputs to the GISS (Goddard Institute for Space Studies) GCMAM (Global Climate Middle Atmosphere Model) to examine the climate responses on decadal and centennial time scales. We show that the atmosphere has different temperature, ozone, and dynamic responses to the two solar spectral forcing scenarios, even when the variations in TSI (Total Solar Irradiance) are the same. We find that solar variations under either scenario contribute a small fraction of the observed temperature increase since the industrial revolution. The trend of global averaged surface air temperature response to the SIM-based solar forcing is 0.02 °C/century, about half of the temperature trend to the SATIRE-based SSI. However the temporal variation of the surface air temperature for the SIM-based solar forcing scenario is much larger compared to its SATIRE counterpart. Further research is required to examine TSI and SSI variations in the ascending phase of solar cycle 24, to assess their implications for the solar influence on climate.

GISS GCMAM Modeled Climate Responses to Total and Spectral Solar Forcing on Decadal and Centennial Time Scales

NASA Astrophysics Data System (ADS)

Wen, G.; Cahalan, R. F.; Rind, D. H.; Jonas, J.; Pilewskie, P.; Harder, J. W.; Krivova, N.

2014-12-01

We examine the influence of the SORCE (Solar Radiation and Climate Experiment) SIM (Spectral Irradiance Monitor) observed spectral solar irradiance (SSI) variations on Earth's climate. We apply two reconstructed spectral solar forcing scenarios, one SIM based, the other based on the SATIRE (Spectral And Total Irradiance REconstruction) model, as inputs to the GISS (Goddard Institute for Space Studies) GCMAM (Global Climate Middle Atmosphere Model) to examine the climate responses on decadal and centennial time scales. We show that the atmosphere has different temperature, ozone, and dynamic responses to the two solar spectral forcing scenarios, even when the variations in TSI (Total Solar Irradiance) are the same. We find that solar variations under either scenario contribute a small fraction of the observed temperature increase since the industrial revolution. The trend of global averaged surface air temperature response to the SIM-based solar forcing is 0.02 °C/century, about half of the temperature trend to the SATIRE-based SSI. However the temporal variation of the surface air temperature for the SIM-based solar forcing scenario is much larger compared to its SATIRE counterpart. Further research is required to examine TSI and SSI variations in the ascending phase of solar cycle 24, to assess their implications for the solar influence on climate.

Postoperative Calcium Management in Same-Day Discharge Thyroid and Parathyroid Surgery.

PubMed

Nelson, Kurt L; Hinson, Andrew M; Lawson, Bradley R; Middleton, Derek; Bodenner, Donald L; Stack, Brendan C

2016-05-01

To describe a safe and effective postoperative prophylactic calcium regimen for same-day discharge thyroid and parathyroid surgery. Case series with chart review. Tertiary referral academic institution. In total, 162 adult patients who underwent total thyroidectomy, completion thyroidectomy, unilateral parathyroidectomy, parathyroidectomy with bilateral neck exploration, or revision parathyroidectomy were identified preoperatively to be candidates for same-day discharge. All patients in this study were successfully discharged the same day on our standard prophylactic calcium regimen. Less than 1% (1/162) of patients re-presented to the hospital within 30 days of surgery, and that patient was successfully discharged from the emergency department after negative workup for hypocalcemia. There was no significant difference between preoperative and postoperative calcium levels in the total/completion thyroidectomy groups (9.3 vs 9.2 mg/dL, respectively; P = .14). The average postoperative calcium level in the parathyroid group was well within normal limits (9.5 mg/dL), and the difference in postoperative calcium levels between revision and primary parathyroidectomy cases was not significantly different (P = .34). The reported calcium regimen demonstrates a safe, effective, and objective means of postoperative calcium management in outpatient thyroid and parathyroid surgery in appropriately selected patients. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Report of China's innovation increase and research growth in radiation oncology.

PubMed

Zhu, Hongcheng; Yang, Xi; Qin, Qin; Bian, Kangqi; Zhang, Chi; Liu, Jia; Cheng, Hongyan; Sun, Xinchen

2014-06-01

To investigate the research status of radiation oncology in China through survey of literature in international radiation oncology journals and retrospectively compare the outputs of radiation oncology articles of the three major regions of China-Mainland (ML), Taiwan (TW) and Hong Kong (HK). Radiation oncology journals were selected from "oncology" and "radiology, nuclear & medical image" category from Science Citation Index Expand (SCIE). Articles from the ML, TW and HK were retrieved from MEDLINE. The number of total articles, clinical trials, case reports, impact factors (IF), institutions and articles published in each journals were conducted for quantity and quality comparisons. A total 818 articles from 13 radiation oncology journals were searched, of which 427 are from ML, 259 from TW, and 132 from HK. Ninety-seven clinical trials and 5 case reports are reported in China. Accumulated IF of articles from ML (1,417.11) was much higher than that of TW (1,003.093) and HK (544.711), while the average IF of articles from ML is the lowest. The total number of articles from China especially ML increased significantly in the last decade. The number of articles published from the ML has exceeded those from TW and HK. However, the quality of articles from TW and HK is better than that from ML.

Changes in the number of resident publications after inception of the 80-hour work week.

PubMed

Namdari, Surena; Baldwin, Keith D; Weinraub, Barbara; Mehta, Samir

2010-08-01

Since the inception of resident work-hour regulations, there has been considerable concern regarding the influence of decreased work hours on graduate medical education. In particular, it is unclear whether implementation of work-hour restrictions has influenced resident academic performance as defined by quantity of peer-reviewed publications while participating in graduate medical education. We determined the impact of work-hour changes on resident involvement in the number of published clinical studies, laboratory research, case reports, and review articles. We conducted a PubMed literature search of 139 consecutive orthopaedic surgery residents (789 total resident-years) at one institution from academic years 1995-1996 to 2008-2009. This represented a continuous timeline before and after implementation of work-hour restrictions. The number of resident publications before and after implementation of work-hour changes was compared. There was a greater probability of peer review authorship in any given resident-year after work-hour changes than before. Average publications per resident-year increased for total articles, clinical articles, case reports, and reviews. There was an increased rate of publications in which the resident was the first author. Since implementation of work-hour changes, total resident publications and publications per resident-year have increased.

Medical care costs incurred by patients with smoking-related non-small cell lung cancer treated at the National Cancer Institute of Mexico.

PubMed

Arrieta, Oscar; Quintana-Carrillo, Roger Humberto; Ahumada-Curiel, Gabriel; Corona-Cruz, Jose Francisco; Correa-Acevedo, Elma; Zinser-Sierra, Juan; de la Mata-Moya, Dolores; Mohar-Betancourt, Alejandro; Morales-Oyarvide, Vicente; Reynales-Shigematsu, Luz Myriam

2014-01-01

Smoking is a public health problem in Mexico and worldwide; its economic impact on developing countries has not been well documented. The aim of this study was to assess the direct medical costs attributable to smoking incurred by lung cancer patients treated at the National Cancer Institute of Mexico (INCan). The study was conducted at INCan in 2009. We carried out a cost of illness (COI) methodology, using data derived from an expert panel consensus and from medical chart review. A panel of experts developed a diagnostic-therapeutic guide that combined the hospital patient pathways and the infrastructure, human resources, technology, and services provided by the medical units at INCan. Cost estimates in Mexican pesos were adjusted by inflation and converted into US Dollars using the 2013 FIX exchange rate for foreign transactions (1 USD = 13.06 Mexican pesos). A 297 incident cases diagnosed with any type of lung cancer were analyzed. According to clinical stage, the costs per patient were 13,456; 35,648; 106,186; and 144,555 USD, for lung cancer stages I, II, III, and IV respectively. The weighted average annual cost/patient was and 139,801 USD and the average annual cost/patient that was attributable to smoking was 92,269 USD. This cost was independent of the clinical stage, with stage IV representing 96% of the annual cost. The total annual cost of smoking-related lung cancer at INCan was 19,969,781 USD. The medical care costs of lung cancer attributable to smoking represent a high cost both for INCan and the Mexican health sector. These costs could be reduced if all provisions established in the Framework Convention of Tobacco Control of the World Health Organization were implemented in Mexico.

Statistics on China's 1996 social development.

PubMed

1997-04-01

1996 statistics released by China's State Statistical Bureau reflect the level of social development. Statistics are provided on education, health, population, income, employment, housing, social welfare, and environmental degradation. The number of higher education institutions declined slightly between 1995 and 1996. In 1996 there were 1032 universities and colleges and 1138 adult education higher learning institutions. The number of students enrolled in universities and colleges increased by 40,000 to 966,000. The total university population numbered 3.02 million in 1996. Increases in students occurred in adult education and graduate schools. Secondary vocational education expanded to 10.1 million students, or 56.8% of all senior middle school students. The 50.48 million junior middle school students represent an enrollment rate of 82.4%. The 136.15 million primary school students represent a 98.8% enrollment rate. About 4.07 million adults gained literacy. Preventive health work and rural public health work were strengthened in 1996. The birth rate in 1996 was 16.98/1000. The death rate was 6.56/1000. The 1996 end-of-the-year population was 1.22389 billion, an increase of 12.68 million over 1995. 29.4% were urban residents. The average family size was 3.70. 26.4% were children aged 0-14 years, and 9.4% were aged over 65 years. The average annual disposable income per capita was 4839 yuan for urban residents, 6235 yuan in provincial capital cities, and 1926 yuan for rural residents. Rural residents received the highest increase in income (9%) at constant prices. 688.5 million people were employed, of which 149.6 million were urban workers. The labor force increased by 9 million people during the year. 360 million sq. m of new buildings were added in urban areas in 1996; 760 million sq. m were added in rural areas.

Laparoscopic pancreaticoduodenectomy: a descriptive and comparative review.

PubMed

Merkow, Justin; Paniccia, Alessandro; Edil, Barish H

2015-08-01

Laparoscopic pancreaticoduodenectomy (LPD) is an extremely challenging surgery. First described in 1994, it has been slow to gain in popularity. Recently, however, we have seen an increase in the number of centers performing this operation, including our own institution, as well as an increase in the quantity of published data. The purpose of this review is to describe the current status of LPD as described in the literature. We performed a literature search in the PubMed database using MeSH terms "laparoscopy" and "pancreaticoduodenectomy". We then identified articles in the English language with over 20 patients that focused on LPD only. Review articles were excluded and only one article per institution was used for descriptive analysis in order to avoid overlap. There were a total of eight articles meeting review criteria, consisting of 492 patients. On descriptive analysis we found that percent of LPD due to high-grade malignancy averaged 47% over all articles. Average operative time was 452 minutes, blood loss 369 cc's, pancreatic leak rate 15%, delayed gastric emptying 8.6%, length of hospital stay 9.4 days, and short term mortality 2.3%. Comparison studies between open pancreaticoduodenectomy (OPD) and LPD suggested decreased blood loss, longer operative time, similar post-operative complication rate, decreased pain, and shorter hospital length of stay for LPD. There was also increased number of lymph nodes harvested and similar margin free resections with LPD in the majority of studies. LPD is a safe surgery, providing many of the advantages typically associated with laparoscopic procedures. We expect this operation to continue to gain in popularity as well as be offered in increasingly more complex cases. In future studies, it will be beneficial to look further at the oncologic outcome data of LPD including survival.

Laparoscopic pancreaticoduodenectomy: a descriptive and comparative review

PubMed Central

Merkow, Justin; Paniccia, Alessandro

2015-01-01

Laparoscopic pancreaticoduodenectomy (LPD) is an extremely challenging surgery. First described in 1994, it has been slow to gain in popularity. Recently, however, we have seen an increase in the number of centers performing this operation, including our own institution, as well as an increase in the quantity of published data. The purpose of this review is to describe the current status of LPD as described in the literature. We performed a literature search in the PubMed database using MeSH terms “laparoscopy” and “pancreaticoduodenectomy”. We then identified articles in the English language with over 20 patients that focused on LPD only. Review articles were excluded and only one article per institution was used for descriptive analysis in order to avoid overlap. There were a total of eight articles meeting review criteria, consisting of 492 patients. On descriptive analysis we found that percent of LPD due to high-grade malignancy averaged 47% over all articles. Average operative time was 452 minutes, blood loss 369 cc’s, pancreatic leak rate 15%, delayed gastric emptying 8.6%, length of hospital stay 9.4 days, and short term mortality 2.3%. Comparison studies between open pancreaticoduodenectomy (OPD) and LPD suggested decreased blood loss, longer operative time, similar post-operative complication rate, decreased pain, and shorter hospital length of stay for LPD. There was also increased number of lymph nodes harvested and similar margin free resections with LPD in the majority of studies. LPD is a safe surgery, providing many of the advantages typically associated with laparoscopic procedures. We expect this operation to continue to gain in popularity as well as be offered in increasingly more complex cases. In future studies, it will be beneficial to look further at the oncologic outcome data of LPD including survival. PMID:26361406

Single-Institution Experience With Component Separation for Ventral Hernia Repair: A Retrospective Review.

PubMed

Hill, Brian; Kambeyanda, Rohan; Fewell, Donna; Bryant, Stewart; Delaney, Kevin O; Herrera, Fernando A

2018-06-01

In this study, we reviewed our institution's experience using component separation for repair of ventral hernias. This was a retrospective review of all component separations for ventral hernia between July 2009 and December 2015. Recorded data included body mass index (BMI), preoperative albumin, smoking history, comorbidities, additional procedures, length of surgery, hospitalization, recurrence, and postoperative complications. One hundred ninety-six component separations were performed in the study period. The average patient age was 56 years, and 65.3% of patients were female. The average BMI was 32.6 kg/m; preoperative albumin was 3.59; 18.4% were current smokers; 28.1% were diabetic; and 14.3% had heart disease. Postoperative complications developed in 16.8% of patients. Recurrence developed in 8.7% of patients. Patients who developed a postoperative complication had a higher BMI (P = 0.025) and lower albumin (P = 0.047) compared with patients who did not develop complications. Current smokers were more likely to develop complications (P = 0.008). More than one third of patients had additional procedures at the time of the ventral hernia repair. The addition of a plastic surgery procedure was not associated with an increased risk of developing a complication (P = 0.25). Patients who developed complications had a significantly longer hospital course (P < 0.001) but no difference in total operative time (P = 0.975). Increased number of comorbidities did not statistically correlate with an increased complication rate (P = 0.65) or length of hospital stay (P = 0.43). We identified risk factors that increase the likelihood of postoperative complications and length of hospital stay. In addition, this study suggests that more comorbidities and additional procedures at the time of the hernia repair may not have as large of impact on complication risk as previously thought.

Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions.

PubMed

Isenberg, Sarina R; Lu, Chunhua; McQuade, John; Chan, Kelvin K W; Gill, Natasha; Cardamone, Michael; Torto, Deirdre; Langbaum, Terry; Razzak, Rab; Smith, Thomas J

2017-05-01

Palliative care inpatient units (PCUs) can improve symptoms, family perception of care, and lower per-diem costs compared with usual care. In March 2013, Johns Hopkins Medical Institutions (JHMI) added a PCU to the palliative care (PC) program. We studied the financial impact of the PC program on JHMI from March 2013 to March 2014. This study considered three components of the PC program: PCU, PC consultations, and professional fees. Using 13 months of admissions data, the team calculated the per-day variable cost pre-PCU (ie, in another hospital unit) and after transfer to the PCU. These fees were multiplied by the number of patients transferred to the PCU and by the average length of stay in the PCU. Consultation savings were estimated using established methods. Professional fees assumed a collection rate of 50%. The total positive financial impact of the PC program was $3,488,863.17. There were 153 transfers to the PCU, 60% with cancer, and an average length of stay of 5.11 days. The daily loss pretransfer to the PCU of $1,797.67 was reduced to $1,345.34 in the PCU (-25%). The PCU saved JHMI $353,645.17 in variable costs, or $452.33 per transfer. Cost savings for PC consultations in the hospital, 60% with cancer, were estimated at $2,765,218. $370,000 was collected in professional fees savings. The PCU and PC program had a favorable impact on JHMI while providing expert patient-centered care. As JHMI moves to an accountable care organization model, value-based patient-centered care and increased intensive care unit availability are desirable.

Direct and indirect medical costs incurred by Canadian patients with rheumatoid arthritis: a 12 year study.

PubMed

Clarke, A E; Zowall, H; Levinton, C; Assimakopoulos, H; Sibley, J T; Haga, M; Shiroky, J; Neville, C; Lubeck, D P; Grover, S A; Esdaile, J M

1997-06-01

To perform the first prospective longitudinal study of direct (health services utilized) and indirect costs (diminished productivity represented by income loss) incurred by patients with rheumatoid arthritis (RA) in Saskatoon and Montreal, followed for up to 12 and 4 years, respectively. 1063 patients reported on health status, health services utilization, and diminished productivity every 6 months. Annual direct costs were $3788 (1994 Canadian dollars) in the late 1980s and $4656 in the early 1990s. Given that the average age exceeded 60 years, few participated in labor force activities or considered themselves disabled from the labor force and their indirect costs were substantially less, $2165 in the late 1980s and $1597 in the early 1990s. Institutional stays and medications made up at least 80% of total direct costs. Lengths of stay in acute care facilities remained constant, but the rate of hospitalization increased in the early 1990s, increasing average hospital costs per patient from $1563 in the late 1980s to $2023 in the early 1990s. For nonacute care facilities, rate of admission as well as length of stay increased over time, increasing costs per patient in Saskatoon 5-fold, from $291 to $1605. Those with greater functional disability incurred substantially higher direct and those under 65 years incurred higher indirect costs. Direct costs are higher than indirect costs. The major component is due to institutional stays that, in contrast to other direct cost components, is increased in the older and more disabled. Measures to reduce longterm disability by earlier, more aggressive intervention have the potential to produce considerable cost savings. However, it is unknown which strategies will have the greatest effect on outcome and accordingly, how resources can be optimally allocated.

Patient navigation significantly reduces delays in breast cancer diagnosis in the District of Columbia.

PubMed

Hoffman, Heather J; LaVerda, Nancy L; Young, Heather A; Levine, Paul H; Alexander, Lisa M; Brem, Rachel; Caicedo, Larisa; Eng-Wong, Jennifer; Frederick, Wayne; Funderburk, William; Huerta, Elmer; Swain, Sandra; Patierno, Steven R

2012-10-01

Patient Navigation (PN) originated in Harlem as an intervention to help poor women overcome access barriers to timely breast cancer treatment. Despite rapid, nationally widespread adoption of PN, empirical evidence on its effectiveness is lacking. In 2005, National Cancer Institute initiated a multicenter PN Research Program (PNRP) to measure PN effectiveness for several cancers. The George Washington Cancer Institute, a project participant, established District of Columbia (DC)-PNRP to determine PN's ability to reduce breast cancer diagnostic time (number of days from abnormal screening to definitive diagnosis). A total of 2,601 women (1,047 navigated; 1,554 concurrent records-based nonnavigated) were examined for breast cancer from 2006 to 2010 at 9 hospitals/clinics in DC. Analyses included only women who reached complete diagnostic resolution. Differences in diagnostic time between navigation groups were tested with ANOVA models including categorical demographic and treatment variables. Log transformations normalized diagnostic time. Geometric means were estimated and compared using Tukey-Kramer P value adjustments. Average-geometric mean [95% confidence interval (CI)]-diagnostic time (days) was significantly shorter for navigated, 25.1 (21.7, 29.0), than nonnavigated women, 42.1 (35.8, 49.6). Subanalyses revealed significantly shorter average diagnostic time for biopsied navigated women, 26.6 (21.8, 32.5) than biopsied nonnavigated women, 57.5 (46.3, 71.5). Among nonbiopsied women, diagnostic time was shorter for navigated, 27.2 (22.8, 32.4), than nonnavigated women, 34.9 (29.2, 41.7), but not statistically significant. Navigated women, especially those requiring biopsy, reached their diagnostic resolution significantly faster than nonnavigated women. Results support previous findings of PN's positive influence on health care. PN should be a reimbursable expense to assure continuation of PN programs. 2012 AACR

Evaluating YouTube as a Source of Patient Education on the Role of the Hospitalist: A Cross-Sectional Study

PubMed Central

Hudali, Tamer; Bhattarai, Mukul; Deckard, Alan; Hingle, Susan

2017-01-01

Background Hospital medicine is a relatively new specialty field, dedicated to the delivery of comprehensive medical care to hospitalized patients. YouTube is one of the most frequently used websites, offering access to a gamut of videos from self-produced to professionally made. Objective The aim of our study was to determine the adequacy of YouTube as an effective means to define and depict the role of hospitalists. Methods YouTube was searched on November 17, 2014, using the following search words: “hospitalist,” “hospitalist definition,” “what is the role of a hospitalist,” “define hospitalist,” and “who is a hospitalist.” Videos found only in the first 10 pages of each search were included. Non-English, noneducational, and nonrelevant videos were excluded. A novel 7-point scoring tool was created by the authors based on the definition of a hospitalist adopted by the Society of Hospital Medicine. Three independent reviewers evaluated, scored, and classified the videos into high, intermediate, and low quality based on the average score. Results A total of 102 videos out of 855 were identified as relevant and included in the analysis. Videos uploaded by academic institutions had the highest mean score. Only 6 videos were classified as high quality, 53 as intermediate quality, and 42 as low quality, with 82.4% (84/102) of the videos scoring an average of 4 or less. Conclusions Most videos found in the search of a hospitalist definition are inadequate. Leading medical organizations and academic institutions should consider producing and uploading quality videos to YouTube to help patients and their families better understand the roles and definition of the hospitalist. PMID:28073738

40 CFR 63.7522 - Can I use emissions averaging to comply with this subpart?

Code of Federal Regulations, 2013 CFR

2013-07-01

.... (vi) Dutch ovens/pile burners designed to burn biomass/bio-based solid. (vii) Fuel Cells designed to...: Industrial, Commercial, and Institutional Boilers and Process Heaters Testing, Fuel Analyses, and Initial... allowed as follows: (i) You may average among units in any of the solid fuel subcategories. (ii) You may...

An Examination of the Relationship between Retention, Grade Point Average, and Developmental Characteristics of College Freshmen.

ERIC Educational Resources Information Center

Allbritten, Bill

Attrition, which averages 40 percent among college freshmen, has been associated with academic skills, career decision making, psychological characteristics, and institutional climate. To determine the self-perceived developmental characteristics of college freshmen and the relationship of those characteristics to retention and grade point average…

Tuition Discounting Is on the Rise: Results of a NACUBO Study of Independent Institutions.

ERIC Educational Resources Information Center

Hubbell, Loren Loomis

1995-01-01

A study by the National Association of College and University Business Officers (NACUBO) analyzed tuition discount ratios for small colleges with lower tuition, small colleges with higher tuition, and large colleges/universities. It examined average tuition discount percentages, average tuition rates and enrollments, percent of students aided, and…

Recommendation for Faculty Salaries in Washington Public Higher Education 1977-79. Report No. 77-17.

ERIC Educational Resources Information Center

Curry, Denis; Johnson, Jackie

This document provides an analysis of faculty salary structures in Washington state colleges, universities, and community colleges. Comparative analysis of national averages for faculty salaries and compensation show that Washington institutions are below the national average in terms of faculty salaries, although the amount expended for salaries…

78 FR 66798 - Self-Regulatory Organizations; International Securities Exchange, LLC; Order Instituting...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-06

... shares traded. Specifically, the Exchange states that, according to State Street Global Advisor, the... to the Exchange, for the three months ending on June 20, 2013, the average daily volume in SPY shares was 137 million, and the average value of shares traded was $22.1 billion. According to the Exchange...

Do closed-system hospitals shift care under case payment? Early experiences comparing five surgeries in Taiwan.

PubMed

Wen, Yu-Ping; Wen, Shiow-Ying

2008-01-01

Recently, Japan, Korea, and Taiwan have adopted prospective payment systems (PPS) for healthcare. Experiences of the United States Medicare show that PPS reduces length of stay but creates incentives to shift care from regulated to un-regulated settings. In this study we investigated whether closed-system hospitals in Taiwan responded to case payment (CP) - one type of PPS, and if so, how this was managed. Data were derived from three Taiwanese hospitals for five different surgical procedures (N = 22,327). The study period covered from October 1996 through August 1999, with CP commencing on October 1, 1997. Important dependent variables included inpatient medical claims, outpatient medical claims, and number of outpatient visits. Outpatient utilization from the period four weeks prior to admission and four weeks following discharge were merged for each patient. Ordinary Least Square (OLS) and Poisson regression were used to test the study's shifting hypotheses, controlling for gender, age, patient diagnoses, and institution attended. Length of hospital stay, amount of inpatient claims, and inpatient x-ray and lab-test claims were significantly reduced after CP. Corresponding OLS coefficients for the second year of implementation were, respectively, -.86, -.06, -.15, and -.04 (p < 0.01). Significant forward shifting of outpatient care, (79%), was found during the second year of CP. Despite the care-shifting effects noted herein, the average per-capita total claims reduced by 12%. Significant institutional effects were associated with the pattern of care-shifting. Our results indicate that CP reduced total claims for the selected surgical procedures, even under evident forward care-shifting.

Big Data Research in Neurosurgery: A Critical Look at this Popular New Study Design.

PubMed

Oravec, Chesney S; Motiwala, Mustafa; Reed, Kevin; Kondziolka, Douglas; Barker, Fred G; Michael, L Madison; Klimo, Paul

2018-05-01

The use of "big data" in neurosurgical research has become increasingly popular. However, using this type of data comes with limitations. This study aimed to shed light on this new approach to clinical research. We compiled a list of commonly used databases that were not specifically created to study neurosurgical procedures, conditions, or diseases. Three North American journals were manually searched for articles published since 2000 utilizing these and other non-neurosurgery-specific databases. A number of data points per article were collected, tallied, and analyzed.A total of 324 articles were identified since 2000 with an exponential increase since 2011 (257/324, 79%). The Journal of Neurosurgery Publishing Group published the greatest total number (n = 200). The National Inpatient Sample was the most commonly used database (n = 136). The average study size was 114 841 subjects (range, 30-4 146 777). The most prevalent topics were vascular (n = 77) and neuro-oncology (n = 66). When categorizing study objective (recognizing that many papers reported more than 1 type of study objective), "Outcomes" was the most common (n = 154). The top 10 institutions by primary or senior author accounted for 45%-50% of all publications. Harvard Medical School was the top institution, using this research technique with 59 representations (31 by primary author and 28 by senior).The increasing use of data from non-neurosurgery-specific databases presents a unique challenge to the interpretation and application of the study conclusions. The limitations of these studies must be more strongly considered in designing and interpreting these studies.

Anaerobic co-digestion of sewage sludge and food waste.

PubMed

Prabhu, Meghanath S; Mutnuri, Srikanth

2016-04-01

Anaerobic co-digestion of organic matter improves digester operating characteristics and its performance. In the present work, food waste was collected from the institute cafeteria. Two types of sludge (before centrifuge and after centrifuge) were collected from the fluidised bed reactor of the institute treating sewage wastewater. Food waste and sludge were studied for their physico-chemical characteristics, such as pH, chemical oxygen demand, total solids, volatile solids, ammoniacal nitrogen, and total nitrogen. A biomethane potential assay was carried out to find out the optimum mixing ratio of food waste and sludge for anaerobic co-digestion. Results indicated that food waste mixed with sludge in the ratio of 1:2 produced the maximum biogas of 823 ml gVS(-1)(21 days) with an average methane content of 60%. Batch studies were conducted in 5 L lab-glass reactors at a mesophilic temperature. The effect of different substrate loading rates on biogas production was investigated. The mixing ratio of food waste and sludge was 1:2. A loading rate of 1 gVS L d(-1)gave the maximum biogas production of 742 ml g(-1)VS L d(-1)with a methane content of 50%, followed by 2 gVS L d(-1)with biogas of 539 ml g(-1)VS L d(-1) Microbial diversity of the reactor during fed batch studies was investigated by terminal restriction fragment length polymorphism. A pilot-scale co-digestion of food waste and sludge (before centrifuge) indicated the process stability of anaerobic digestion. © The Author(s) 2016.

e-NIHSS: an Expanded National Institutes of Health Stroke Scale Weighted for Anterior and Posterior Circulation Strokes.

PubMed

Olivato, Silvia; Nizzoli, Silvia; Cavazzuti, Milena; Casoni, Federica; Nichelli, Paolo Frigio; Zini, Andrea

2016-12-01

The National Institutes of Health Stroke Scale (NIHSS) is the most widespread clinical scale used in patients presenting with acute stroke. The merits of the NIHSS include simplicity, quickness, and agreement between clinicians. The clinical evaluation on posterior circulation stroke remains still a limit of NIHSS. We assessed the application of a new version of NIHSS, the e-NIHSS (expanded NIHSS), adding specific elements in existing items to explore signs/symptoms of a posterior circulation stroke. A total of 22 consecutive patients with suspected vertebrobasilar stroke were compared with 25 patients with anterior circulation stroke using NIHSS and e-NIHSS. We compared the NIHSS and e-NIHSS scores obtained by the 2 examiners, in patients with posterior circulation infarct (POCI), using the Wilcoxon test. Patients with POCI evaluated with e-NIHSS had an average of 2 points higher than patients evaluated with classical NIHSS. The difference was statistically significant (P < .05), weighted by the new expanded items. The NIHSS is a practical scale model, with high reproducibility between trained, different examiners, focused on posterior circulation strokes, with the same total score and number of items of the existing NIHSS. The e-NHISS could improve the sensitivity of NIHSS in posterior circulation stroke and could have an impact on clinical trials, as well as on outcomes. Further studies are needed to investigate a larger number of patients and the correlation between the e-NIHSS score and neuroimaging findings. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

A robust and non-obtrusive automatic event tracking system for operating room management to improve patient care.

PubMed

Huang, Albert Y; Joerger, Guillaume; Salmon, Remi; Dunkin, Brian; Sherman, Vadim; Bass, Barbara L; Garbey, Marc

2016-08-01

Optimization of OR management is a complex problem as each OR has different procedures throughout the day inevitably resulting in scheduling delays, variations in time durations and overall suboptimal performance. There exists a need for a system that automatically tracks procedural progress in real time in the OR. This would allow for efficient monitoring of operating room states and target sources of inefficiency and points of improvement. We placed three wireless sensors (floor-mounted pressure sensor, ventilator-mounted bellows motion sensor and ambient light detector, and a general room motion detector) in two ORs at our institution and tracked cases 24 h a day for over 4 months. We collected data on 238 total cases (107 laparoscopic cases). A total of 176 turnover times were also captured, and we found that the average turnover time between cases was 35 min while the institutional goal was 30 min. Deeper examination showed that 38 % of laparoscopic cases had some aspect of suboptimal activity with the time between extubation and patient exiting the OR being the biggest contributor (16 %). Our automated system allows for robust, wireless real-time OR monitoring as well as data collection and retrospective data analyses. We plan to continue expanding our system and to project the data in real time for all OR personnel to see. At the same time, we plan on adding key pieces of technology such as RFID and other radio-frequency systems to track patients and physicians to further increase efficiency and patient safety.

The vascular surgeon-scientist: a 15-year report of the Society for Vascular Surgery Foundation/National Heart, Lung, and Blood Institute-mentored Career Development Award Program.

PubMed

Kibbe, Melina R; Dardik, Alan; Velazquez, Omaida C; Conte, Michael S

2015-04-01

The Society for Vascular Surgery (SVS) Foundation partnered with the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) in 1999 to initiate a competitive career development program that provides a financial supplement to surgeon-scientists receiving NIH K08 or K23 career development awards. Because the program has been in existence for 15 years, a review of the program's success has been performed. Between 1999 and 2013, 41 faculty members applied to the SVS Foundation program, and 29 from 21 different institutions were selected as awardees, resulting in a 71% success rate. Three women (10%) were among the 29 awardees. Nine awardees (31%) were supported by prior NIH F32 or T32 training grants. Awardees received their K award at an average of 3.5 years from the start of their faculty position, at the average age of 39.8 years. Thirteen awardees (45%) have subsequently received NIH R01 awards and five (17%) have received Veterans Affairs Merit Awards. Awardees received their first R01 at an average of 5.8 years after the start of their K award at the average age of 45.2 years. The SVS Foundation committed $9,350,000 to the Career Development Award Program. Awardees subsequently secured $45,108,174 in NIH and Veterans Affairs funds, resulting in a 4.8-fold financial return on investment for the SVS Foundation program. Overall, 23 awardees (79%) were promoted from assistant to associate professor in an average of 5.9 years, and 10 (34%) were promoted from associate professor to professor in an average of 5.2 years. Six awardees (21%) hold endowed professorships and four (14%) have secured tenure. Many of the awardees hold positions of leadership, including 12 (41%) as division chief and two (7%) as vice chair within a department of surgery. Eight (28%) awardees have served as president of a regional or national society. Lastly, 47 postdoctoral trainees have been mentored by recipients of the SVS Foundation Career Development Program on training grants or postdoctoral research fellowships. The SVS Foundation Career Development Program has been an effective vehicle to promote the development and independence of vascular surgeon-scientists in the field of academic vascular surgery. Published by Elsevier Inc.

Reasons for faculty departures from an academic medical center: a survey and comparison across faculty lines.

PubMed

Girod, Sabine C; Fassiotto, Magali; Menorca, Roseanne; Etzkowitz, Henry; Wren, Sherry M

2017-01-10

Faculty departure can present significant intellectual costs to an institution. The authors sought to identify the reasons for clinical and non-clinical faculty departures at one academic medical center (AMC). In May and June 2010, the authors surveyed 137 faculty members who left a west coast School of Medicine (SOM) between 1999 and 2009. In May and June 2015, the same survey was sent to 40 faculty members who left the SOM between 2010-2014, for a total sample size of 177 former faculty members. The survey probed work history and experience, reasons for departure, and satisfaction at the SOM versus their current workplace. Statistical analyses included Pearson's chi-square test of independence and independent sample t-tests to understand quantitative differences between clinical and non-clinical respondents, as well as coding of qualitative open-ended responses. Eighty-eight faculty members responded (50%), including three who had since returned to the SOM. Overall, professional and advancement opportunities, salary concerns, and personal/family reasons were the three most cited factors for leaving. The average length of time at this SOM was shorter for faculty in clinical roles, who expressed lower workplace satisfaction and were more likely to perceive incongruence and inaccuracy in institutional expectations for their success than those in non-clinical roles. Clinical faculty respondents noted difficulty in balancing competing demands and navigating institutional expectations for advancement as reasons for leaving. AMCs may not be meeting faculty needs, especially those in clinical roles who balance multiple missions as clinicians, researchers, and educators. Institutions should address the challenges these faculty face in order to best recruit, retain, and advance faculty.

Separating the Wheat From the Chaff: An Evaluation of Readability, Quality, and Accuracy of Online Health Information for Treatment of Peyronie Disease.

PubMed

Bompastore, Nicholas J; Cisu, Theodore; Holoch, Peter

2018-04-30

To characterize available information about Peyronie disease online and evaluate its readability, quality, accuracy, and respective associations with HONcode certification and website category. The search term "Peyronie disease" was queried on 3 major search engines (Google, Bing, and Yahoo) and the first 50 search results on each search engine were assessed. All websites were categorized as institutional or reference, commercial, charitable, personal or patient support, or alternative medicine, and cross-referenced with the Health on the Net (HON) Foundation. Websites that met the inclusion criteria were analyzed for readability using 3 validated algorithms, for quality using the DISCERN instrument, and for accuracy by a fellowship-trained urologist. On average, online health information about treatment of Peyronie disease is written at or above the 11th grade level, exceeding the current reading guidelines of 6th-8th grade. The mean total DISCERN score for all website categories was 50.44 (standard deviation [SD] 11.94), the upper range of "fair" quality. The mean accuracy score of all online Peyronie treatment information was 2.76 (SD 1.23), corresponding to only 25%-50% accurate information. Both institutional or reference and HONcode-certified websites were of "good" quality (53.44, SD 11.64 and 60.86, SD 8.74, respectively). Institutional or reference websites were 50%-75% accurate (3.13, SD 1.20). Most of the online Peyronie disease treatment information is of mediocre quality and accuracy. The information from institutional or reference websites is of better quality and accuracy, and the information from HONcode-certified websites is of better quality. The mean readability of all websites exceeds the reading ability of most US adults by several grade levels. Copyright © 2018 Elsevier Inc. All rights reserved.

Recent Trends in National Institutes of Health Funding of Surgical Research

PubMed Central

Rangel, Shawn J.; Efron, Bradley; Moss, R. Lawrence

2002-01-01

Objective To compare the amount of National Institutes of Health (NIH) funding provided to departments of surgery with that provided to other major clinical departments, to examine the relationship between peer-review activity and funding success, and to compare trends in participation in the peer-review process between surgeons and representatives from other clinical departments. Summary Background Data Surgical research has made enormous contributions to human health. This work is fundamentally dependent on fair and unbiased distribution of extramural research funds from the NIH. To date, no published report has examined the relative distribution of extramural support between departments of surgery and other major clinical departments. Methods Data regarding funding trends and peer-review activity were obtained from the NIH and compared between departments of surgery and four nonsurgical departments (medicine, psychiatry, pediatrics, neurology). Award data were examined during 1996 to 2001. Participation trends were examined during 1998 to 2000. Results Success rates of surgical proposals were significantly lower than nonsurgical proposals. Differentials in success rates were greatest for proposals assigned to the National Cancer Institute, although relative underfunding for surgical research spanned all major institutes. Awards for surgical grants averaged 5% to 27% less than nonsurgical grants). Surgeons exhibited 35% to 65% less peer-review activity relative to nonsurgeons when normalized to grant submission activity. Overall, surgeons participated on sections where they made up a relatively smaller proportion of total review members compared to nonsurgeons. Conclusions Surgical grant proposals are less likely to be funded and carry significantly smaller awards compared to nonsurgical proposals. Relatively fewer surgeons participate in the review process, and those who do are more likely to be in the minority within study sections. Multiple strategies are needed to address these trends and level the playing field for surgical research. PMID:12192314

Social media in public health: an analysis of national health authorities and leading causes of death in Spanish-speaking Latin American and Caribbean countries.

PubMed

Novillo-Ortiz, David; Hernández-Pérez, Tony

2017-02-03

Information and communications technologies, like social media, have the potential to reduce some barriers in disease prevention and control in the Americas. National health authorities can use these technologies to provide access to reliable and quality health information. A study was conducted to analyze availability of information about the leading causes of death on social media channels of national health authorities in 18 Spanish-speaking Latin American and Caribbean countries. We gathered data of national health authorities's institutional presence in social media. Exploratory-descriptive research was useful for analysis and interpretation of the data collected. An analysis was carried out for 6 months, from April 1 to September 30, 2015. Sixteen of the 18 countries studied have institutional presences on social media. National health authorities have a presence in an average of almost three platforms (2.8%). An average of 1% of the populations with Internet access across the 18 countries in this study follows national health authorities on social media (approximately, an average of 0.3% of the total population of the countries under study). On average, information on 3.2 of the 10 leading causes of death was posted on the national health authorities' Facebook pages, and information on 2.9 of the 10 leading causes of death was posted on their Twitter profiles. Additionally, regarding public health expenditures and the possibility of retrieving information on the leading causes of death, an apparent negative correlation exists in the case of Facebook, r(13) = -.54, P = .03 and a weak negative correlation in the case of Twitter, r(14) = -.26, P = .31, for the countries with presences in those networks. National health authorities can improve their role in participating in conversations on social media regarding the leading causes of death affecting their countries. Taking into account Internet accessibility levels in the countries under study and the high rates of people using social networks in even the poorest countries, further research is needed to provide evidence that more dedication to health promotion interventions through social media could significantly improve the impact and reach of public health messages and initiatives.

Do feasibility studies contribute to, or avoid, waste in research?

PubMed Central

Hejdenberg, Jennie; Hinrichs-Krapels, Saba; Armstrong, David

2018-01-01

In the context of avoiding research waste, the conduct of a feasibility study before a clinical trial should reduce the risk that further resources will be committed to a trial that is likely to ‘fail’. However, there is little evidence indicating whether feasibility studies add to or reduce waste in research. Feasibility studies funded by the National Institute for Health Research’s (NIHR) Research for Patient Benefit (RfPB) programme were examined to determine how many had published their findings, how many had applied for further funding for a full trial and the timeframe in which both of these occurred. A total of 120 feasibility studies which had closed by May 2016 were identified and each Principal Investigator (PI) was sent a questionnaire of which 89 responses were received and deemed suitable for analysis. Based on self reported answers from the PIs a total of 57 feasibility studies were judged as feasible, 20 were judged not feasible and for 12 it was judged as uncertain whether a full trial was feasible. The RfPB programme had spent approximately £19.5m on the 89 feasibility studies of which 16 further studies had been subsequently funded to a total of £16.8m. The 20 feasibility studies which were judged as not feasible potentially saved up to approximately £20m of further research funding which would likely to have not completed successfully. The average RfPB feasibility study took 31 months (range 18 to 48) to complete and cost £219,048 (range £72,031 to £326,830) and the average full trial funded from an RfPB feasibility study took 42 months (range 26 to 55) to complete and cost £1,163,996 (range £321,403 to £2,099,813). The average timeframe of feasibility study and full trial was 72 months (range 56 to 91), however in addition to this time an average of 10 months (range -7 to 29) was taken between the end of the feasibility study and the application for the full trial, and a further average of 18 months (range 13 to 28) between the application for the full trial and the start of the full trial. Approximately 58% of the 89 feasibility studies had published their findings with the majority of the remaining studies still planning to publish. Due to the long time frames involved a number of studies were still in the process of publishing the feasibility findings and/or applying for a full trial. Feasibility studies are potentially useful at avoiding waste and de-risking funding investments of more expensive full trials, however there is a clear time delay and therefore some potential waste in the existing research pathway. PMID:29684043

Do feasibility studies contribute to, or avoid, waste in research?

PubMed

Morgan, Ben; Hejdenberg, Jennie; Hinrichs-Krapels, Saba; Armstrong, David

2018-01-01

In the context of avoiding research waste, the conduct of a feasibility study before a clinical trial should reduce the risk that further resources will be committed to a trial that is likely to 'fail'. However, there is little evidence indicating whether feasibility studies add to or reduce waste in research. Feasibility studies funded by the National Institute for Health Research's (NIHR) Research for Patient Benefit (RfPB) programme were examined to determine how many had published their findings, how many had applied for further funding for a full trial and the timeframe in which both of these occurred. A total of 120 feasibility studies which had closed by May 2016 were identified and each Principal Investigator (PI) was sent a questionnaire of which 89 responses were received and deemed suitable for analysis. Based on self reported answers from the PIs a total of 57 feasibility studies were judged as feasible, 20 were judged not feasible and for 12 it was judged as uncertain whether a full trial was feasible. The RfPB programme had spent approximately £19.5m on the 89 feasibility studies of which 16 further studies had been subsequently funded to a total of £16.8m. The 20 feasibility studies which were judged as not feasible potentially saved up to approximately £20m of further research funding which would likely to have not completed successfully. The average RfPB feasibility study took 31 months (range 18 to 48) to complete and cost £219,048 (range £72,031 to £326,830) and the average full trial funded from an RfPB feasibility study took 42 months (range 26 to 55) to complete and cost £1,163,996 (range £321,403 to £2,099,813). The average timeframe of feasibility study and full trial was 72 months (range 56 to 91), however in addition to this time an average of 10 months (range -7 to 29) was taken between the end of the feasibility study and the application for the full trial, and a further average of 18 months (range 13 to 28) between the application for the full trial and the start of the full trial. Approximately 58% of the 89 feasibility studies had published their findings with the majority of the remaining studies still planning to publish. Due to the long time frames involved a number of studies were still in the process of publishing the feasibility findings and/or applying for a full trial. Feasibility studies are potentially useful at avoiding waste and de-risking funding investments of more expensive full trials, however there is a clear time delay and therefore some potential waste in the existing research pathway.

2004-05 Performance Year Ratings Impacting Fiscal Year 2005-06. Clemson University. Sector: Research Institutions

ERIC Educational Resources Information Center

South Carolina Commission on Higher Education, 2005

2005-01-01

This series of documents contains performance scoring information for 2004-2005 for individual institutions of higher education in South Carolina. This information is used in establishing 2005-2006 fiscal year allocations. Data includes: (1) Degrees Awarded; (2) Enrollment; (3) Average SAT score; (4) Faculty; (5) Tuition; and (6) Financial…

2004-05 Performance Year Ratings Impacting Fiscal Year 2005-06. University of South Carolina Columbia. Sector: Research Institutions

ERIC Educational Resources Information Center

South Carolina Commission on Higher Education, 2005

2005-01-01

This series of documents contains performance scoring information for 2004-2005 for individual institutions of higher education in South Carolina. This information is used in establishing 2005-2006 fiscal year allocations. Data includes: (1) Degrees Awarded; (2) Enrollment; (3) Average SAT score; (4) Faculty; (5) Tuition; and (6) Financial…

2004-05 Performance Year Ratings Impacting Fiscal Year 2005-06. Medical University of South Carolina. Sector: Research Institutions

ERIC Educational Resources Information Center

South Carolina Commission on Higher Education, 2005

2005-01-01

This series of documents contains performance scoring information for 2004-2005 for individual institutions of higher education in South Carolina. This information is used in establishing 2005-2006 fiscal year allocations. Data includes: (1) Degrees Awarded; (2) Enrollment; (3) Average SAT score; (4) Faculty; (5) Tuition; and (6) Financial…

Lower Costs, Higher Returns: UNCF HBCUs in a High-Priced College Environment. Financing African American College Aspirations Series

ERIC Educational Resources Information Center

Richards, David A. R.

2014-01-01

While research consistently shows the earning power of college degrees, those returns are best weighed against the cost of attending post-secondary institutions, historically black colleges and universities (HBCUs) included. This study is an update of "Affordability of UNCF-Member Institutions" (2009), and compares the average costs at…

Average Faculty Salary Reaches $41,650, Up 6.1% in a Year, AAUP Survey Finds.

ERIC Educational Resources Information Center

Evangelauf, Jean

1990-01-01

This study shows that by type of institution, salaries are highest at doctorate-granting public and private universities. By sector, faculty members at private, independent institutions continue to have the highest earnings. The salary gap between men and women persists, with women earning less than men at every rank. (MLW)

Institutional Strategies That Foster Academic Integrity: A Faculty-­Based Case Study

ERIC Educational Resources Information Center

Prins, Sebastian; Jones, Edward; Lathrop, Anna H.

2014-01-01

In recognition that student academic misconduct is a complex issue that requires a holistic and institutional approach, this case study explores the impact of an intervention strategy adopted by the Faculty of Applied Health Sciences (comprised of approximately 80 faculty and an average of 3,240 undergraduate students) at Brock University, St.…

Creating a University System for the 21st Century. Student Affordability Report

ERIC Educational Resources Information Center

North Dakota University System, 2009

2009-01-01

Historically, tuition and mandatory fee rates of all North Dakota University System (NDUS) institutions (except the 2-year campuses) have been less than their regional counterparts. Average tuition and fee increases at NDUS institutions were significantly higher than their regional counterparts in 2004-05, 2005-06 and 2006-07, as a result, the gap…

A Multi-Institution Study of Student Demographics and Outcomes in Chemical Engineering

ERIC Educational Resources Information Center

Lord, Susan M.; Layton, Richard A.; Ohland, Matthew W.; Brawner, Catherine E.; Long, Russell A.

2014-01-01

Using a large multi-institutional dataset, we describe demographics and outcomes for students starting in and transferring into chemical engineering (ChE). In this dataset, men outnumber women in ChE except among black students. While ChE starters graduate in ChE at rates comparable to or above their racial/ethnic population average for…

Tuition at PhD-Granting Institutions: A Supply and Demand Model.

ERIC Educational Resources Information Center

Koshal, Rajindar K.; And Others

1994-01-01

Builds and estimates a model that explains educational supply and demand behavior at PhD-granting institutions in the United States. The statistical analysis based on 1988-89 data suggests that student quantity, educational costs, average SAT score, class size, percentage of faculty with a PhD, graduation rate, ranking, and existence of a medical…

Predicting Graduation Rates at 4-Year Broad Access Institutions Using a Bayesian Modeling Approach

ERIC Educational Resources Information Center

Crisp, Gloria; Doran, Erin; Salis Reyes, Nicole A.

2018-01-01

This study models graduation rates at 4-year broad access institutions (BAIs). We examine the student body, structural-demographic, and financial characteristics that best predict 6-year graduation rates across two time periods (2008-2009 and 2014-2015). A Bayesian model averaging approach is utilized to account for uncertainty in variable…

Tuition and Fees in the West 2013-14. Policy Insights

ERIC Educational Resources Information Center

Bransberger, Peace

2014-01-01

Average resident undergraduate tuition and fees for the academic year 2013-14 at public two-year institutions in the Western Interstate Commission for Higher Education (WICHE) region (excluding California) increased by 3.2 percent ($106) from the previous year, while published prices at public four-year institutions grew by 3.1 percent ($231). By…

Wisdom in a Learning in Retirement Institute

ERIC Educational Resources Information Center

Farquhar, Lynn

2010-01-01

Seven men and women with an average age of 77 were interviewed regarding the role of wisdom in their experience of attending a Learning in Retirement Institute (LRI) in southern Ontario, Canada. A finding is that for wisdom gains to be an outcome of LRI education, older adult students need outward expression of their acquired learnings. A…

At Risk on the Border: Assessment of Student Learning at an Hispanic Serving Institution

ERIC Educational Resources Information Center

Davila, Mario A.; Lovett, Steve; Hartley, Deborah J.

2018-01-01

Hispanics face multiple barriers to academic achievement. This study measured learning in an undergraduate criminal justice program at an Hispanic Serving Institution bordering Mexico. We estimated the average gains students achieved across core content areas using a technique that can be used by other faculty as part of program assessment. The…

Arizona Uncertainty: Arbitrary Barriers in Accessing Institutional Need-Based Financial Aid

ERIC Educational Resources Information Center

Hill-Zuganelli, Dee; Cabrera, Nolan L.; Milem, Jeffrey F.

2017-01-01

Established in 2008, the Arizona Assurance Scholars Program (AASP) channeled institutional needbased aid to in-state, low-income students. Rapidly growing costs prompted three changes to the AASP eligibility requirements in 2011. We examined how these new requirements--a 3.0 or higher high school grade point average and the submission of the Free…

The Effect of Educational Computerized Games on Learning English Spelling among Iranian Children

ERIC Educational Resources Information Center

Mehrpour, Saeed; Ghayour, Maaedeh

2017-01-01

The present study investigated the effects of educational computerized games on learning English spelling among Iranian children. In doing so, 66 young Iranian English learners with the average age of 9.5, attending the children's branch of Iran Language Institute (ILI), the most well-established state-run language teaching institute in Iran,…

Phenolic compound concentration and antioxidant activities of edible and medicinal mushrooms from Korea.

PubMed

Kim, Min-Young; Seguin, Philippe; Ahn, Joung-Kuk; Kim, Jong-Jin; Chun, Se-Chul; Kim, Eun-Hye; Seo, Su-Hyun; Kang, Eun-Young; Kim, Sun-Lim; Park, Yool-Jin; Ro, Hee-Myong; Chung, Ill-Min

2008-08-27

A study was conducted to determine the content of phenolic compounds and the antioxidative activity of five edible and five medicinal mushrooms commonly cultivated in Korea. Phenolic compounds were analyzed using high performance liquid chromatography, and antioxidant activity was evaluated by 1,1-diphenyl-2-picrylhydrazyl radical scavenging activity and superoxide dismutase activity. A total of 28 phenolic compounds were detected in the mushrooms studied. The average total concentration of phenolic compounds was 326 microg/g, the average being of 174 microg/g in edible mushrooms and 477 microg/g in medicinal mushrooms. The average total flavonoids concentration was 49 microg/g, with averages of 22 and 76 microg/g in edible and medicinal mushrooms, respectively. The DPPH radical scavenging activities ranged between 15 (Pleurotus eryngii) and 70% (Ganoderma lucidum) when reaction time was for 1 min. When reaction time was 30 min, the values ranged between 5 (Pleurotus eryngii) and 78% (Agaricus bisporus). The SOD activity averaged 28% among the 10 mushroom species, averages for edible and medicinal mushrooms being comparable. DPPH activities was significantly correlated (p < 0.01) with total content of phenolic compounds in edible mushrooms, while in medicinal mushrooms there was a significant correlation (p < 0.01) between SOD activity and total concentration of phenolic compounds. Numerous significant positive correlations were observed between phenolic compounds detected and antioxidative potential.

12 CFR 327.11 - Special assessments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... basis points based on the institution's total assets less Tier 1 capital as reported on the report of... exceed 10 basis points times the institution's assessment base for the second quarter 2009 risk-based... or below zero at the end of a calendar quarter, a special assessment of up to 5 basis points on total...

The contribution of trees outside forests to national tree biomass and carbon stocks--a comparative study across three continents.

PubMed

Schnell, Sebastian; Altrell, Dan; Ståhl, Göran; Kleinn, Christoph

2015-01-01

In contrast to forest trees, trees outside forests (TOF) often are not included in the national monitoring of tree resources. Consequently, data about this particular resource is rare, and available information is typically fragmented across the different institutions and stakeholders that deal with one or more of the various TOF types. Thus, even if information is available, it is difficult to aggregate data into overall national statistics. However, the National Forest Monitoring and Assessment (NFMA) programme of FAO offers a unique possibility to study TOF resources because TOF are integrated by default into the NFMA inventory design. We have analysed NFMA data from 11 countries across three continents. For six countries, we found that more than 10% of the national above-ground tree biomass was actually accumulated outside forests. The highest value (73%) was observed for Bangladesh (total forest cover 8.1%, average biomass per hectare in forest 33.4 t ha(-1)) and the lowest (3%) was observed for Zambia (total forest cover 63.9%, average biomass per hectare in forest 32 t ha(-1)). Average TOF biomass stocks were estimated to be smaller than 10 t ha(-1). However, given the large extent of non-forest areas, these stocks sum up to considerable quantities in many countries. There are good reasons to overcome sectoral boundaries and to extend national forest monitoring programmes on a more systematic basis that includes TOF. Such an approach, for example, would generate a more complete picture of the national tree biomass. In the context of climate change mitigation and adaptation, international climate mitigation programmes (e.g. Clean Development Mechanism and Reduced Emission from Deforestation and Degradation) focus on forest trees without considering the impact of TOF, a consideration this study finds crucial if accurate measurements of national tree biomass and carbon pools are required.

Dosimetric considerations and early clinical experience of accelerated partial breast irradiation using multi-lumen applicators in the setting of breast augmentation.

PubMed

Akhtari, Mani; Pino, Ramiro; Scarboro, Sarah B; Bass, Barbara L; Miltenburg, Darlene M; Butler, E Brian; Teh, Bin S

2015-12-01

Accelerated partial breast irradiation (APBI) is an accepted treatment option in breast-conserving therapy for early stage breast cancer. However, data regarding outcomes of patients treated with multi-lumen catheter systems who have existing breast implants is limited. The purpose of this study was to report treatment parameters, outcomes, and possible dosimetric correlation with cosmetic outcome for this population of patients at our institution. We report the treatment and outcome of seven consecutive patients with existing breast implants and early stage breast cancer who were treated between 2009 and 2013 using APBI following lumpectomy. All patients were treated twice per day for five days to a total dose of 34 Gy using a high-dose-rate (192)Ir source. Cosmetic outcomes were evaluated using the Harvard breast cosmesis scale, and late toxicities were reported using the Radiation Therapy Oncology Group (RTOG) late radiation morbidity schema. After a mean follow-up of 32 months, all patients have remained cancer free. Six out of seven patients had an excellent or good cosmetic outcome. There were no grade 3 or 4 late toxicities. The average total breast implant volume was 279.3 cc, received an average mean dose of 12.1 Gy, and a maximum dose of 234.1 Gy. The average percentage of breast implant volume receiving 50%, 75%, 100%, 150%, and 200% of the prescribed dose was 15.6%, 7.03%, 4.6%, 1.58%, and 0.46%, respectively. Absolute volume of breast implants receiving more than 50% of prescribed dose correlated with worse cosmetic outcomes. Accelerated partial breast irradiation using a multi-lumen applicator in patients with existing breast implants can safely be performed with promising early clinical results. The presence of the implant did not compromise the ability to achieve dosimetric criteria; however, dose to the implant and the irradiated implant volume may be related with worse cosmetic outcomes.

Dosimetric considerations and early clinical experience of accelerated partial breast irradiation using multi-lumen applicators in the setting of breast augmentation

PubMed Central

Akhtari, Mani; Pino, Ramiro; Scarboro, Sarah B.; Bass, Barbara L.; Miltenburg, Darlene M.; Butler, E. Brian

2015-01-01

Purpose Accelerated partial breast irradiation (APBI) is an accepted treatment option in breast-conserving therapy for early stage breast cancer. However, data regarding outcomes of patients treated with multi-lumen catheter systems who have existing breast implants is limited. The purpose of this study was to report treatment parameters, outcomes, and possible dosimetric correlation with cosmetic outcome for this population of patients at our institution. Material and methods We report the treatment and outcome of seven consecutive patients with existing breast implants and early stage breast cancer who were treated between 2009 and 2013 using APBI following lumpectomy. All patients were treated twice per day for five days to a total dose of 34 Gy using a high-dose-rate 192Ir source. Cosmetic outcomes were evaluated using the Harvard breast cosmesis scale, and late toxicities were reported using the Radiation Therapy Oncology Group (RTOG) late radiation morbidity schema. Results After a mean follow-up of 32 months, all patients have remained cancer free. Six out of seven patients had an excellent or good cosmetic outcome. There were no grade 3 or 4 late toxicities. The average total breast implant volume was 279.3 cc, received an average mean dose of 12.1 Gy, and a maximum dose of 234.1 Gy. The average percentage of breast implant volume receiving 50%, 75%, 100%, 150%, and 200% of the prescribed dose was 15.6%, 7.03%, 4.6%, 1.58%, and 0.46%, respectively. Absolute volume of breast implants receiving more than 50% of prescribed dose correlated with worse cosmetic outcomes. Conclusions Accelerated partial breast irradiation using a multi-lumen applicator in patients with existing breast implants can safely be performed with promising early clinical results. The presence of the implant did not compromise the ability to achieve dosimetric criteria; however, dose to the implant and the irradiated implant volume may be related with worse cosmetic outcomes. PMID:26816499

Reoperations following proximal interphalangeal joint nonconstrained arthroplasties.

PubMed

Pritsch, Tamir; Rizzo, Marco

2011-09-01

To retrospectively analyze the reasons for reoperations following primary nonconstrained proximal interphalangeal (PIP) joint arthroplasty and review clinical outcomes in this group of patients with 1 or more reoperations. Between 2001 and 2009, 294 nonconstrained (203 pyrocarbon and 91 metal-plastic) PIP joint replacements were performed in our institution. A total of 76 fingers (59 patients) required reoperation (50 pyrocarbon and 26 metal-plastic). There were 40 women and 19 men with an average age of 51 years (range, 19-83 y). Primary diagnoses included osteoarthritis in 35, posttraumatic arthritis in 24, and inflammatory arthritis in 17 patients. There were 21 index, 27 middle, 18 ring, and 10 small fingers. The average number of reoperations per PIP joint was 1.6 (range, 1-4). A total of 45 joints had 1 reoperation, 19 had 2, 11 had 3, and 1 had 4. Extensor mechanism dysfunction was the most common reason for reoperation; it involved 51 of 76 fingers and was associated with Chamay or tendon-reflecting surgical approaches. Additional etiologies included component loosening in 17, collateral ligament failure in 10, and volar plate contracture in 8 cases. Inflammatory arthritis was associated with collateral ligament failure. Six fingers were eventually amputated, 9 had PIP joint arthrodeses, and 2 had resection arthroplasties. The arthrodesis and amputation rates correlated with the increased number of reoperations per finger. Clinically, most patients had no or mild pain at the most recent follow-up, and the PIP joint range-of-motion was not significantly different from preoperative values. Pain levels improved with longer follow-up. Reoperations following primary nonconstrained PIP joint arthroplasties are common. Extensor mechanism dysfunction was the most common reason for reoperation. The average reoperation rate was 1.6, and arthrodesis and amputation are associated with an increasing number of operations. Overall clinical outcomes demonstrated no significant change in range of motion, and most patients had mild or no pain. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

5 CFR 842.403 - Compution of basic annuity.

Code of Federal Regulations, 2011 CFR

2011-01-01

... annuity of an employee or Member is 1 percent of average pay multiplied by total service. (b) The annuity of an employee is 1.1 percent of average pay multiplied by total service, provided the individual— (1...

5 CFR 842.403 - Compution of basic annuity.

Code of Federal Regulations, 2010 CFR

2010-01-01

... annuity of an employee or Member is 1 percent of average pay multiplied by total service. (b) The annuity of an employee is 1.1 percent of average pay multiplied by total service, provided the individual— (1...

Use of Retrievable Compared to Permanent Inferior Vena Cava Filters: A Single-Institution Experience

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

Ha, Thuong G. Van; Chien, Andy S.; Funaki, Brian S.

The purpose of this study was to review the use, safety, and efficacy of retrievable inferior vena cava (IVC) filters in their first 5 years of availability at our institution. Comparison was made with permanent filters placed in the same period. A retrospective review of IVC filter implantations was performed from September, 1999, to September, 2004, in our department. These included both retrievable and permanent filters. The Recovery nitinol and Guenther tulip filters were used as retrievable filters. The frequency of retrievable filter used was calculated. Clinical data and technical data related to filter placement were reviewed. Outcomes, including pulmonarymore » embolism, complications associated with placement, retrieval, or indwelling, were calculated. During the study period, 604 IVC filters were placed. Of these, 97 retrievable filters (16%) were placed in 96 patients. There were 53 Recovery filter and 44 Tulip filter insertions. Subjects were 59 women and 37 men; the mean age was 52 years, with a range of from 18 to 97 years. The placement of retrievable filters increased from 2% in year 1 to 32% in year 5 of the study period. The total implantation time for the permanent group was 145,450 days, with an average of 288 days (range, 33-1811 days). For the retrievable group, the total implantation time was 21,671 days, with an average of 226 days (range, 2-1217 days). Of 29 patients who returned for filter retrieval, the filter was successfully removed in 28. There were 14 of 14 successful Tulip filter retrievals and 14 of 15 successful Recovery filter retrievals. In one patient, after an indwelling period of 39 days, a Recovery nitinol filter could not be removed secondary to a large clot burden within the filter. For the filters that were removed, the mean dwell time was 50 days for the Tulip type and 20 days for the Recovery type. Over the follow-up period there was an overall PE incidence of 1.4% for the permanent group and 1% for the retrieval group. In conclusion, there was an increase in the use of retrievable filters over the study period and an overall increase in the total number of filters implanted. The increased use of these filters appeared to be due to expanded indications predicated by their retrievability. Placement and retrieval of these filters have a low risk of complications, and retrievable filters appeared effective, as there was low rate of clinically significant pulmonary embolism associated with these filters during their indwelling time.« less

A Formula for Planning and Predicting Postoperative Mammoplasty Results.

PubMed

Smithson, Mary G; Collawn, Sherry S; Mousa, Mina S; Bramel, Carly M

2017-06-01

For women with macromastia, reduction mammoplasty is a safe and effective solution to increasing quality of life through alleviating pain and improving aesthetics. This study developed a way to combine a surgeon's view of breast measurement (volume) with a patient's view of breast measurement (distance between nipple and notch, inframammary fold, or midline) to provide patients with a better understanding of expected surgical outcomes after breast reduction with a medial superior pedicle. An institutional review board approved retrospective chart review was performed on all medial superior pedicle reduction mammoplasties performed by a single surgeon at a university medical center from 2008 to 2016, and a total of 133 patients were identified. Measurements of interest for this study were nipple to sternal notch (N-S), nipple to inframammary fold (N-I), nipple to midline (N-M), and breast diameter (BD). The average bilateral change per measurement was calculated for each patient in centimeters. Change was averaged for left and right breasts for N-S, N-I, N-M, and BD per patient. Grams removed for left and right breasts were also averaged. Each measurement of average change was divided by the gram average and multiplied by 100 to obtain centimeter change per 100 grams. Individual patient measurements per type of measurement were averaged to achieve a final improvement reported in centimeters per 100 g tissue removed per breast. The average change in the N-S distance was calculated to be a decrease of 1.5 ± 0.8 cm/100 g of breast tissue removed. The average change in N-I was calculated to be an overall decrease of 0.7 ± 0.5 cm/100 g. The average change in N-M was calculated to be a decrease of 0.1 ± 0.3 cm/100 g. Finally, the average change in BD was calculated to be 0.0 ± 0.4 cm/100 g. A surgeon's expression of breast measurements in terms of volume can be difficult for a patient to understand and visualize. This study determined the impact volume has on length of typical breast measurements to increase patients' understanding of expected outcomes. In summary, patients can be told to expect to see a nipple elevation of 1.5 cm per 100 grams of breast tissue removed using this medial superior pedicle technique.

Importance and Satisfaction of Preventive Health Strategies in Institutions for People with Intellectual Disabilities: A Perspective of Institutional Directors

ERIC Educational Resources Information Center

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

2005-01-01

Aim: To explore the perceptions of institutional directors on the preventive health strategies for people with intellectual disabilities in institutions. Methods: A structured questionnaire was conducted by a cross-sectional postal survey in all registered institutions in Taiwan in 2002. A total of 157 questionnaires were mailed, of which 121…

[Assessment of financial flow in the health system of Serbia in a period 2003-2006].

PubMed

Gajić-Stevanović, Milena; Teodorović, Nevenka; Dimitrijević, Snezana; Jovanović, Dragan

2010-05-01

The main goal of every health policy is not merely the establishment of the health system sustainability, but the accessability of health services to the whole population, as well. This objective is shared in European Union countries, and the consequence is the implementation of National Health Accounts (NHA). NHA, as a tool for evidence-based management, provides data regarding financial flow in health at national level and allows international comparability. The aim of this study was to determine Serbian overall health spending patterns by National Health Accounts, and to determine health care indices to provide policy makers with internationally comparable health indicators. A retrospective analysis of healthcare expenditures was obtained from the published final financial reports of relevant state institutions during a period of 2003 to 2006. The various sources of data on healthcare expenditures were connected according to instructions by the OECD "A System of Health Accounts (SHA)" Version 1.0. The obtained results showed: health expenditures in Serbia made up 8.6%, 8.3%, 8.7% and 9% of the GDP in 2003, 2004, 2005 and 2006, respectively; the Health Insurance Fund was a predominant financing source of the public sector with 93% in 2006; the largest part of the total health expenditures went towards hospitals and for health services; the expenditure per capita in 2006 was 365 US$; Serbian population finances the state institutions "out of pocket" with 21.28% of their sources, which was 7.3% of the total healthcare expenditures, and the private institutions with 78.72% of their financial sources, which is 27% of the total healthcare expenditures. In 2006 Serbia allocated financial resources out of GDP in the amount similar to the European Unity, while comparing to the countries of the region, these funds were less only than in Bosnia and Hertzegovina. This allocating of financial resources in total, however, was low as the consequence of relatively low level of GDP in Serbia. Establishing NHA provided a pattern of national healthcare spending and allowed a comparison of healthcare system in Serbia with the systems of other countries. Analysing a period 2003-2006 revealed a similarity between Serbia and the countries of the European Unity in regard to the level of average financial resources allocation for healthcare expressed as a percentage of GDP, as well as in regard to financiers in the system of healthcare. A high purchasing power disparity, however, in healthcare services was observed between the population of Serbia and other European countries.

Cost Analysis of an Intervention to Prevent Methicillin-Resistant Staphylococcus Aureus (MRSA) Transmission

PubMed Central

Chowers, Michal; Carmeli, Yehuda; Shitrit, Pnina; Elhayany, Asher; Geffen, Keren

2015-01-01

Introduction Our objective was to assess the cost implications of a vertical MRSA prevention program that led to a reduction in MRSA bacteremia. Methods We performed a matched historical cohort study and cost analysis in a single hospital in Israel for the years 2005-2011. The cost of MRSA bacteremia was calculated as total hospital cost for patients admitted with bacteremia and for patients with hospital-acquired bacteremia, the difference in cost compared to matched controls. The cost of prevention was calculated as the sum of the cost of microbiology tests, single-use equipment used for patients in isolation, and infection control personnel. Results An average of 20,000 patients were screened yearly. The cost of prevention was $208,100 per year, with the major contributor being laboratory cost. We calculated that our intervention averted 34 cases of bacteremia yearly: 17 presenting on admission and 17 acquired in the hospital. The average cost of a case admitted with bacteremia was $14,500, and the net cost attributable to nosocomial bacteremia was $9,400. Antibiotics contributed only 0.4% of the total disease management cost. When the annual cost of averted cases of bacteremia and that of prevention were compared, the intervention resulted in annual cost savings of $199,600. Conclusions A vertical MRSA prevention program targeted at high-risk patients, which was highly effective in preventing bacteremia, is cost saving. These results suggest that allocating resources to targeted prevention efforts might be beneficial even in a single institution in a high incidence country. PMID:26406889

Cost-Analysis of Seven Nosocomial Outbreaks in an Academic Hospital.

PubMed

Dik, Jan-Willem H; Dinkelacker, Ariane G; Vemer, Pepijn; Lo-Ten-Foe, Jerome R; Lokate, Mariëtte; Sinha, Bhanu; Friedrich, Alex W; Postma, Maarten J

2016-01-01

Nosocomial outbreaks, especially with (multi-)resistant microorganisms, are a major problem for health care institutions. They can cause morbidity and mortality for patients and controlling these costs substantial amounts of funds and resources. However, how much is unclear. This study sets out to provide a comparable overview of the costs of multiple outbreaks in a single academic hospital in the Netherlands. Based on interviews with the involved staff, multiple databases and stored records from the Infection Prevention Division all actions undertaken, extra staff employment, use of resources, bed-occupancy rates, and other miscellaneous cost drivers during different outbreaks were scored and quantified into Euros. This led to total costs per outbreak and an estimated average cost per positive patient per outbreak day. Seven outbreaks that occurred between 2012 and 2014 in the hospital were evaluated. Total costs for the hospital ranged between €10,778 and €356,754. Costs per positive patient per outbreak day, ranged between €10 and €1,369 (95% CI: €49-€1,042), with a mean of €546 and a median of €519. Majority of the costs (50%) were made because of closed beds. This analysis is the first to give a comparable overview of various outbreaks, caused by different microorganisms, in the same hospital and all analyzed with the same method. It shows a large variation within the average costs due to different factors (e.g. closure of wards, type of ward). All outbreaks however cost considerable amounts of efforts and money (up to €356,754), including missed revenue and control measures.

Bibliometry of the Revista de Biología Tropical / International Journal of Tropical Biology and Conservation: document types, languages, countries, institutions, citations and article lifespan.

PubMed

Monge-Nájera, Julián; Ho, Yuh-Shan

2016-09-01

The Revista de Biología Tropical / International Journal of Tropical Biology and Conservation, founded in 1953, publishes feature articles about tropical nature and is considered one of the leading journals in Latin America. This article analyzes document type, language, countries, institutions, citations and for the first time article lifespan, from 1976 through 2014. We analyzed 3 978 documents from the Science Citation Index Expanded. Articles comprised 88 % of the total production and had 3.7 citations on average, lower than reviews. Spanish and English articles were nearly equal in numbers and citation for English articles was only slightly higher. Costa Rica, Mexico, and the USA are the countries with more articles, and the leading institutions were Universidad de Costa Rica, Universidad Nacional, Universidad Nacional Autónoma de Mexico and Universidad de Oriente (Venezuela). The citation lifespan of articles is long, around 37 years. It is not surprising that Costa Rica, Mexico, and Venezuela lead in productivity and cooperation, because they are mostly covered by tropical ecosystems and share a common culture and a tradition of scientific cooperation. The same applies to the leading institutions, which are among the largest Spanish language universities in the neotropical region. American output can be explained by the regional presence of the Smithsonian Tropical Research Institute and the Organization for Tropical Studies. Tropical research does not have the rapid change typical of medical research, and for this reason, the impact factor misses most of citations for the Revista, which are made after the two-year window used by the Web of Science. This issue is especially damaging for the Revista because most journals that deal with tropical biology are never checked when citations are counted for by the Science Citation Index.

Benchmarks in Clinical Productivity: A National Comprehensive Cancer Network Survey

PubMed Central

Stewart, F. Marc; Wasserman, Robert L.; Bloomfield, Clara D.; Petersdorf, Stephen; Witherspoon, Robert P.; Appelbaum, Frederick R.; Ziskind, Andrew; McKenna, Brian; Dodson, Jennifer M.; Weeks, Jane; Vaughan, William P.; Storer, Barry; Perkel, Sara; Waldinger, Marcy

2007-01-01

Purpose Oncologists in academic cancer centers usually generate professional fees that are insufficient to cover salaries and other expenses, despite significant clinical activity; therefore, supplemental funding is frequently required in order to support competitive levels of physician compensation. Relative value units (RVUs) allow comparisons of productivity across institutions and practice locations and provide a reasonable point of reference on which funding decisions can be based. Methods We reviewed the clinical productivity and other characteristics of oncology physicians practicing in 13 major academic cancer institutions with membership or shared membership in the National Comprehensive Cancer Network (NCCN). The objectives of this study were to develop tools that would lead to better-informed decision making regarding practice management and physician deployment in comprehensive cancer centers and to determine benchmarks of productivity using RVUs accrued by physicians at each institution. Three hundred fifty-three individual physician practices across the 13 NCCN institutions in the survey provided data describing adult hematology/medical oncology and bone marrow/stem-cell transplantation programs. Data from the member institutions participating in the survey included all American Medical Association Current Procedural Terminology (CPT®) codes generated (billed) by each physician during each organization's fiscal year 2003 as a measure of actual clinical productivity. Physician characteristic data included specialty, clinical full-time equivalent (CFTE) status, faculty rank, faculty track, number of years of experience, and total salary by funding source. The average adult hematologist/medical oncologist in our sample would produce 3,745 RVUs if he/she worked full-time as a clinician (100% CFTE), compared with 4,506 RVUs for a 100% CFTE transplant oncologist. Results and Conclusion Our results suggest specific clinical productivity targets for academic oncologists and provide a methodology for analyzing potential factors associated with clinical productivity and developing clinical productivity targets specific for physicians with a mix of research, administrative, teaching, and clinical salary support. PMID:20859362

Benchmarks in clinical productivity: a national comprehensive cancer network survey.

PubMed

Stewart, F Marc; Wasserman, Robert L; Bloomfield, Clara D; Petersdorf, Stephen; Witherspoon, Robert P; Appelbaum, Frederick R; Ziskind, Andrew; McKenna, Brian; Dodson, Jennifer M; Weeks, Jane; Vaughan, William P; Storer, Barry; Perkel, Sara; Waldinger, Marcy

2007-01-01

Oncologists in academic cancer centers usually generate professional fees that are insufficient to cover salaries and other expenses, despite significant clinical activity; therefore, supplemental funding is frequently required in order to support competitive levels of physician compensation. Relative value units (RVUs) allow comparisons of productivity across institutions and practice locations and provide a reasonable point of reference on which funding decisions can be based. We reviewed the clinical productivity and other characteristics of oncology physicians practicing in 13 major academic cancer institutions with membership or shared membership in the National Comprehensive Cancer Network (NCCN). The objectives of this study were to develop tools that would lead to better-informed decision making regarding practice management and physician deployment in comprehensive cancer centers and to determine benchmarks of productivity using RVUs accrued by physicians at each institution. Three hundred fifty-three individual physician practices across the 13 NCCN institutions in the survey provided data describing adult hematology/medical oncology and bone marrow/stem-cell transplantation programs. Data from the member institutions participating in the survey included all American Medical Association Current Procedural Terminology (CPT®) codes generated (billed) by each physician during each organization's fiscal year 2003 as a measure of actual clinical productivity. Physician characteristic data included specialty, clinical full-time equivalent (CFTE) status, faculty rank, faculty track, number of years of experience, and total salary by funding source. The average adult hematologist/medical oncologist in our sample would produce 3,745 RVUs if he/she worked full-time as a clinician (100% CFTE), compared with 4,506 RVUs for a 100% CFTE transplant oncologist. Our results suggest specific clinical productivity targets for academic oncologists and provide a methodology for analyzing potential factors associated with clinical productivity and developing clinical productivity targets specific for physicians with a mix of research, administrative, teaching, and clinical salary support.

Metrics associated with NIH funding: a high-level view.

PubMed

Boyack, Kevin W; Jordan, Paul

2011-01-01

To introduce the availability of grant-to-article linkage data associated with National Institutes of Health (NIH) grants and to perform a high-level analysis of the publication outputs and impacts associated with those grants. Articles were linked to the grants they acknowledge using the grant acknowledgment strings in PubMed using a parsing and matching process as embodied in the NIH Scientific Publication Information Retrieval & Evaluation System system. Additional data from PubMed and citation counts from Scopus were added to the linkage data. The data comprise 2,572,576 records from 1980 to 2009. The data show that synergies between NIH institutes are increasing over time; 29% of current articles acknowledge grants from multiple institutes. The median time lag to publication for a new grant is 3 years. Each grant contributes to approximately 1.7 articles per year, averaged over all grant types. Articles acknowledging US Public Health Service (PHS, which includes NIH) funding are cited twice as much as US-authored articles acknowledging no funding source. Articles acknowledging both PHS funding and a non-US government funding source receive on average 40% more citations that those acknowledging PHS funding sources alone. The US PHS is effective at funding research with a higher-than-average impact. The data are amenable to further and much more detailed analysis.

77 FR 14366 - Notice of Annual Adjustment of the Cap on Average Total Assets That Defines Community Financial...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-09

... FEDERAL HOUSING FINANCE AGENCY [No. 2012-N-02] Notice of Annual Adjustment of the Cap on Average.... ACTION: Notice. SUMMARY: The Federal Housing Finance Agency (FHFA) has adjusted the cap on average total... statutory cap.\\2\\ The Bank Act was amended in 2008 to set the statutory cap at $1 billion and to require the...

40 CFR 421.306 - Pretreatment standards for new sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... average mg/kg (pounds per million pounds) of TiCl4 produced Chromium (total) 0.346 0.140 Lead 0.262 0.122... Maximum for monthly average mg/kg (pounds per million pounds) of TiCl4 produced Chromium (total) 0.385 0... for any 1 day Maximum for monthly average mg/kg (pounds per million pounds) of TiCl4 handled Chromium...

40 CFR 421.306 - Pretreatment standards for new sources.

Code of Federal Regulations, 2014 CFR

2014-07-01

... average mg/kg (pounds per million pounds) of TiCl4 produced Chromium (total) 0.346 0.140 Lead 0.262 0.122... Maximum for monthly average mg/kg (pounds per million pounds) of TiCl4 produced Chromium (total) 0.385 0... for any 1 day Maximum for monthly average mg/kg (pounds per million pounds) of TiCl4 handled Chromium...

40 CFR 421.306 - Pretreatment standards for new sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... average mg/kg (pounds per million pounds) of TiCl4 produced Chromium (total) 0.346 0.140 Lead 0.262 0.122... Maximum for monthly average mg/kg (pounds per million pounds) of TiCl4 produced Chromium (total) 0.385 0... for any 1 day Maximum for monthly average mg/kg (pounds per million pounds) of TiCl4 handled Chromium...

NATIONAL INSTITUTIONS AND SUBNATIONAL DEVELOPMENT IN AFRICA*

PubMed Central

Michalopoulos, Stelios; Papaioannou, Elias

2014-01-01

We investigate the role of national institutions on subnational African development in a novel framework that accounts for both local geography and cultural-genetic traits. We exploit the fact that the political boundaries on the eve of African independence partitioned more than 200 ethnic groups across adjacent countries subjecting similar cultures, residing in homogeneous geographic areas, to different formal institutions. Using both a matching type and a spatial regression discontinuity approach we show that differences in countrywide institutional structures across the national border do not explain within-ethnicity differences in economic performance, as captured by satellite images of light density. The average noneffect of national institutions on ethnic development masks considerable heterogeneity partially driven by the diminishing role of national institutions in areas further from the capital cities. PMID:25802926

Research productivity of doctor of physical therapy faculty promoted in the southeastern United States

PubMed Central

Littman, Marissa A.; Sonne, James W.; Smith, Gerald V.

2017-01-01

ABSTRACT Background: Little information exists on the research productivity of successfully promoted tenure-track Doctor of Physical Therapy (DPT) faculty. Objective: To determine the research productivity that typically results in successful promotion. Design: We collected publicly available curriculum vitae (CVs) from faculty currently in accredited DPT programs and who had been successfully promoted from an institution in the southeastern USA from 2000 through 2016. Total publication count, journal impact factor, funding, citations, and other metrics were analysed from 45 subjects of 22 of the 64 CAPTE-accredited DPT programs in the southeast. Results: None of the studied metrics were normally distributed with time to promotion as determined by a Shapiro-Wilk test. These faculty exhibited a median publication count of 4, range 0 to 43; median of average citation count of 12.4, range 0 to 87.25; median of average journal impact factor of 2.866, range 0 to 6.280; median external funding received of $9910, range $0.00 to $19 543 198; and median author h-index of 3, range 0 to 17. The median number of years before promotion was 6, ranging from 3 to 13 years. Linear regression analysis indicates a poor fit with no significant correlation between years before promotion and any of the studied metrics. No correlation between journal impact factor and number of citations was observed (m = −0.22, p = 0.728, R2 = 0.0003). Prior to promotion 31% (14 of 45) did not receive external funding and 24% (11 of 45) had a 0 h-index. The Carnegie Classification of the institution did not significantly correlate with research productivity metrics in this dataset (p = 0.213). Conclusion: While faculty unsuccessful in promotion were not identifiable using this method, this research can be used by faculty and committees to evaluate research productivity against regional data and promote competitive standards with peer institutions. Abbreviations: CAPTE: Commission on Accreditation in Physical Therapist Education; DPT: Doctor of Physical Therapy PMID:28835200

Research productivity of doctor of physical therapy faculty promoted in the southeastern United States.

PubMed

Littman, Marissa A; Sonne, James W; Smith, Gerald V

2017-01-01

Little information exists on the research productivity of successfully promoted tenure-track Doctor of Physical Therapy (DPT) faculty. To determine the research productivity that typically results in successful promotion. We collected publicly available curriculum vitae (CVs) from faculty currently in accredited DPT programs and who had been successfully promoted from an institution in the southeastern USA from 2000 through 2016. Total publication count, journal impact factor, funding, citations, and other metrics were analysed from 45 subjects of 22 of the 64 CAPTE-accredited DPT programs in the southeast. None of the studied metrics were normally distributed with time to promotion as determined by a Shapiro-Wilk test. These faculty exhibited a median publication count of 4, range 0 to 43; median of average citation count of 12.4, range 0 to 87.25; median of average journal impact factor of 2.866, range 0 to 6.280; median external funding received of $9910, range $0.00 to $19 543 198; and median author h-index of 3, range 0 to 17. The median number of years before promotion was 6, ranging from 3 to 13 years. Linear regression analysis indicates a poor fit with no significant correlation between years before promotion and any of the studied metrics. No correlation between journal impact factor and number of citations was observed (m = -0.22, p = 0.728, R 2  = 0.0003). Prior to promotion 31% (14 of 45) did not receive external funding and 24% (11 of 45) had a 0 h-index. The Carnegie Classification of the institution did not significantly correlate with research productivity metrics in this dataset (p = 0.213). While faculty unsuccessful in promotion were not identifiable using this method, this research can be used by faculty and committees to evaluate research productivity against regional data and promote competitive standards with peer institutions. CAPTE: Commission on Accreditation in Physical Therapist Education; DPT: Doctor of Physical Therapy.

78 FR 45178 - National School Lunch, Special Milk, and School Breakfast Programs, National Average Payments...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-26

... ``national average payments,'' the amount of money the Federal Government provides States for lunches... institutions with pricing programs that elect to serve milk free to eligible children continue to receive the... during the second preceding school year were served free or at a reduced price. The higher payment level...

76 FR 43256 - National School Lunch, Special Milk, and School Breakfast Programs, National Average Payments...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-20

... ``national average payments,'' the amount of money the Federal Government provides States for lunches... institutions with pricing programs that elect to serve milk free to eligible children continue to receive the... during the second preceding school year were served free or at a reduced price. The higher payment level...

Predicting Academic Success in First-Year Mathematics Courses Using ACT Mathematics Scores and High School Grade Point Average

ERIC Educational Resources Information Center

Mayo, Sandra Sims

2012-01-01

Improving college performance and retention is a daunting task for colleges and universities. Many institutions are taking action to increase retention rates by exploring their academic programs. Regression analysis was used to compare the effectiveness of ACT mathematics scores, high school grade point averages (HSGPA), and demographic factors…

The Richmond Plan: A Report of a Pre-Technology Program for the "Average Learner."

ERIC Educational Resources Information Center

Cogswell Polytechnical Coll., San Francisco, CA.

This concluding report of a project initiated by the Cogswell Polytechnical Institute entitled "The Richmond Plan," focuses on the results of a reevaluation of the principles and practices of high school programs in the Richmond City Schools in California. This project, designed to meet the specialized needs of "average" high…

[Analysis of qualifications of medical and health institutions and certified doctors for providing occupational disease diagnosis in China].

PubMed

Wang, Huan-qiang; Li, Tao; Qi, Fang; Wu, Rui; Nie, Wu; Yu, Chen

2013-10-01

To investigate the qualifications and current situations of the medical and health institutions and certified doctors for providing occupational disease diagnosis in China and to provide a reference for developing relevant policies. Work reports and questionnaires survey were used to investigate the qualifications of all medical and health institutions and certified doctors for providing occupational disease diagnosis in China and their acceptance and diagnosis of occupational disease cases from 2006 to 2010. The rate for the work reports was 100%, and the response rate for the questionnaires was 71.0%. By the end of 2010, in the 31 provincial-level regions (excluding Hong Kong, Macao, and Taiwan) in China, there had been 503 medical and health institutions which were qualified for providing occupational disease diagnosis, including 207 centers for disease control and prevention, accounting for 41.2%, 145 general hospitals, accounting for 28.8%, 69 enterprise-owned hospitals, accounting for 13.7%, and 64 institutes or centers for occupational disease prevention and control, accounting for 12.7%; 4986 certified doctors got the qualification for providing occupational disease diagnosis, with 9.4 certified doctors on average in each institution, and there was 0.65 certified doctor per 100 000 employees. In addition, 16.5% of the institutions got all the qualifications for diagnosing 9 occupational diseases, and 17.1% of the institutions got the qualification for diagnosing one occupational disease. Each certified doctor accepted diagnosis of 16.8 cases of occupational diseases on average every year. A national occupational disease diagnosis network has been established in China, but the imbalance in regional distribution and specialty programs still exists among the qualified medical and health institutions and certified doctors. It is essential to further strengthen the development of regional qualified medical and health institutions and training of qualified doctors.

Novel Measure of Opioid Dose and Costs of Care for Diabetes Mellitus: Opioid Dose and Health Care Costs.

PubMed

Gautam, Santosh; Franzini, Luisa; Mikhail, Osama I; Chan, Wenyaw; Turner, Barbara J

2016-03-01

Diabetes mellitus (DM) has well known costly complications but we hypothesized that costs of care for chronic pain treated with opioid analgesic (OA) medications would also be substantial. In a statewide, privately insured cohort of 29,033 adults aged 18 to 64 years with DM and noncancer pain who filled OA prescription(s) from 2008 to 2012, our outcomes were costs for specific health care services and total costs per 6-month intervals after the first filled OA prescription. Average daily OA dose (4 categories) and total dose (quartiles) in morphine-equivalent milligrams were calculated per 6-month interval after the first OA prescription and combined into a novel OA dose measure. Associations of OA measures with costs of care (n = 126,854 6-month intervals) were examined using generalized estimating equations adjusted for clinical conditions, psychotherapeutic drugs, and DM treatment. Incremental costs for each type of health care service and total cost of care increased progressively with average daily and total OA dose versus no OAs. The combined OA measure identified the highest incremental total costs per 6-month interval that were increased by $8,389 for 50- to 99-mg average daily dose plus >900 mg total dose and, by $9,181 and $9,958 respectively, for ≥100 mg average daily dose plus 301- to 900-mg or >900 mg total dose. In this statewide DM cohort, total health care costs per 6-month interval increased progressively with higher average daily OA dose and with total OA dose but the greatest increases of >$8,000 were distinguished by combinations of higher average daily and total OA doses. The higher costs of care for opioid-treated patients appeared for all types of services and likely reflects multiple factors including morbidity from the underlying cause of pain, care and complications related to opioid use, and poorer control of diabetes as found in other studies. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Hong Kong's domestic health spending--financial years 1989/90 through 2004/05.

PubMed

Leung, G M; Tin, K Y K; Yeung, G M K; Leung, E S K; Tsui, E L H; Lam, D W S; Tsang, C S H; Fung, A Y K; Lo, S V

2008-04-01

This report presents the latest estimates of Hong Kong's domestic health spending between fiscal years 1989/90 and 2004/05, cross-stratified and categorised by financing source, provider and function on an annual basis. Total expenditure on health was HK$67,807 million in fiscal year 2004/05. In real terms, total expenditure on health showed positive growth averaging 7% per annum throughout the period covered in this report while gross domestic product grew at 4% per annum on average, indicating a growing percentage of health spending relative to gross domestic product, from 3.5% in 1989/90 to 5.2% in 2004/05. This increase was largely driven by the rise in public spending, which rose 9% per annum on average in real terms over the period, compared with 5% for private spending. This represents a growing share of public spending from 40% to 55% of total expenditure on health during the period. While public spending was the dominant source of health financing in 2004/05, private household out-of-pocket expenditure accounted for the second largest share of total health spending (32%). The remaining sources of health finance were employer-provided group medical benefits (8%), privately purchased insurance (5%), and other private sources (1%). Of the $67,807 million total health expenditure in 2004/05, current expenditure comprised $65,429 million (96%) while $2378 million (4%) were capital expenses (ie investment in medical facilities). Services of curative care accounted for the largest share of total health spending (67%) which were made up of ambulatory services (35%), in-patient curative care (28%), day patient hospital services (3%), and home care (1%). The next largest share of total health expenditure was spent on medical goods outside the patient care setting (10%). Analysed by health care provider, hospitals accounted for the largest share (46%) and providers of ambulatory health care the second largest share (30%) of total health spending in 2004/05. We observed a system-wide trend towards service consolidation at institutions (as opposed to free-standing ambulatory clinics, most of which are staffed by solo practitioner). In 2004/05, public expenditure on health amounted to $35,247 million (53.9% of total current expenditure), which was mostly incurred at hospitals (76.5%), whilst private expenditure ($30,182 million) was mostly incurred at providers of ambulatory health care (54.6%). This reflects the mixed health care economy of Hong Kong where public hospitals generally account for about 90% of total bed-days and private doctors (including Western and Chinese medicine practitioners) provide 75% to 80% of out-patient care. While both public and private spending were mostly expended on personal health care services and goods (92.9%), the distributional patterns among functional categories differed. Public expenditure was targeted at in-patient care (54.2%) and substantially less on out-patient care (24.5%), especially low-intensity first-contact care. In comparison, private spending was mostly concentrated on out-patient care (49.6%), whereas medical goods outside the patient care setting (22.6%) and in-patient care (18.8%) comprised the majority of the remaining share. Compared to OECD countries, Hong Kong has devoted a relatively low percentage of gross domestic product to health in the last decade. As a share of total spending, public funding (either general government revenue or social security funds) was also lower than in most comparably developed economies, although commensurate with its public revenue collection base.

12 CFR 1805.700 - Evaluation and selection-general.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Section 1805.700 Banks and Banking COMMUNITY DEVELOPMENT FINANCIAL INSTITUTIONS FUND, DEPARTMENT OF THE TREASURY COMMUNITY DEVELOPMENT FINANCIAL INSTITUTIONS PROGRAM Evaluation and Selection of Applications... Applicants that vary by institution type, total asset size, stage of organizational development, markets...

Real-time colour pictorial radiation monitoring during coronary angiography: effect on patient peak skin and total dose during coronary angiography.

PubMed

Wilson, Sharon M; Prasan, Ananth M; Virdi, Amy; Lassere, Marissa; Ison, Glenn; Ramsay, David R; Weaver, James C

2016-10-10

The aim of this study was to evaluate whether a real-time (RT) colour pictorial radiation dose monitoring system reduces patient skin and total radiation dose during coronary angiography and intervention. Patient demographics, procedural variables and radiation parameters were recorded before and after institution of the RT skin dose recording system. Peak skin dose as well as traditionally available measures of procedural radiation dose were compared. A total of 1,077 consecutive patients underwent coronary angiography, of whom 460 also had PCI. Institution of the RT skin dose recording system resulted in a 22% reduction in peak skin dose after accounting for confounding variables. Radiation dose reduction was most pronounced in those having PCI but was also seen over a range of subgroups including those with prior coronary artery bypass surgery, high BMI, and with radial arterial access. This was associated with a significant reduction in the number of patients placed at risk of skin damage. Similar reductions in parameters reflective of total radiation dose were also demonstrated after institution of RT radiation monitoring. Institution of an RT skin dose recording reduced patient peak skin and total radiation dose during coronary angiography and intervention. Consideration should be given to widespread adoption of this technology.

Systematic analysis of funding awarded for norovirus research to institutions in the United Kingdom, 1997-2010.

PubMed

Head, Michael G; Fitchett, Joseph R; Atun, Rifat

2014-03-01

Norovirus infections pose great economic and disease burden to health systems around the world. This study quantifies the investments in norovirus research awarded to UK institutions over a 14-year time period. A systematic analysis of public and philanthropic infectious disease research investments awarded to UK institutions between 1997 and 2010. None UK institutions carrying out infectious disease research. Total funding for infectious disease research, total funding for norovirus research, position of norovirus research along the R&D value chain. The total dataset consisted of 6165 studies with sum funding of £2.6 billion. Twelve norovirus studies were identified with a total funding of £5.1 million, 0.2% of the total dataset. Of these, eight were categorized as pre-clinical, three as intervention studies and one as implementation research. Median funding was £200,620. Research funding for norovirus infections in the UK appears to be unacceptably low, given the burden of disease and disability produced by these infections. There is a clear need for new research initiatives along the R&D value chain: from pre-clinical through to implementation research, including trials to assess cost-effectiveness of infection control policies as well as clinical, public health and environmental interventions in hospitals, congregate settings and in the community.

High Satisfaction and Return to Sports After Total Shoulder Arthroplasty in Patients Aged 55 Years and Younger.

PubMed

Garcia, Grant H; Liu, Joseph N; Sinatro, Alec; Wu, Hao-Hua; Dines, Joshua S; Warren, Russell F; Dines, David M; Gulotta, Lawrence V

2017-06-01

Young, active candidates for total shoulder arthroplasty (TSA) are a unique group of patients. Not only do they demand longevity and improved function, but they also desire a return to physical activities. To determine the rate of return to sports in patients aged ≤55 years undergoing TSA. Case series; Level of evidence, 4. This was a retrospective review of consecutive patients who underwent anatomic TSA at a single institution. Exclusion criteria included age at the time of surgery >55 years and <2 years of follow-up. All patients had end-stage osteoarthritis with significant glenohumeral joint space narrowing. The final follow-up consisted of a patient-reported sports questionnaire, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale (VAS) score. From 70 eligible patients, 59 patients (61 shoulders) were included with an average follow-up of 61.0 months (range, 25-103 months) and average age at the time of surgery of 48.9 years (range, 25-55 years). The average VAS score improved from 5.6 to 0.9 ( P < .001), and the average ASES score improved from 39.3 to 88.4 ( P < .001). Forty-nine procedures (80.3%) were performed for a primary diagnosis of osteoarthritis. Four shoulders returned to the operating room; none were for glenoid loosening. There was a 93.2% satisfaction rate, and 67.7% of patients (n = 40) stated that they underwent their surgery to return to sports. Moreover, patients in 96.4% of shoulders (55/57) restarted at least 1 sport at an average of 6.7 months. Direct rates of return were as follows: fitness sports (97.2%), golf (93.3%), singles tennis (87.5%), swimming (77.7%), basketball (75.0%), and flag football (66.7%). Patients in 47 shoulders (82.4%) returned to a similar or higher level of sports; 90.3% returned to high-demand sports, and 83.8% returned to high upper extremity sports. There was no significant difference in rates of return to sports by body mass index, sex, age, preoperative diagnosis, revision status, and dominant extremity. In patients aged ≤55 years undergoing TSA, there was a 96.4% rate of return to ≥1 previous sports at an average of 6.7 months. Furthermore, at an average follow-up of 61.0 months, no patients needed revision of their glenoid component, despite an 83.8% rate of return to high upper extremity sports. While caution should still be advised in young, active patients undergoing TSA, these results demonstrate a high satisfaction rate and improved ability to return to most sports after surgery.

A Survey Data Quality Strategy: The Institutional Research Perspective. IR Applications, Volume 34

ERIC Educational Resources Information Center

Liu, Qin

2012-01-01

This discussion constructs a survey data quality strategy for institutional researchers in higher education in light of total survey error theory. It starts with describing the characteristics of institutional research and identifying the gaps in literature regarding survey data quality issues in institutional research and then introduces the…

A Survey Data Quality Strategy: The Institutional Research Perspective

ERIC Educational Resources Information Center

Liu, Qin

2009-01-01

This paper intends to construct a survey data quality strategy for institutional researchers in higher education in light of total survey error theory. It starts with describing the characteristics of institutional research and identifying the gaps in literature regarding survey data quality issues in institutional research. Then it is followed by…

Total Quality Management Elements and Results in Higher Education Institutions: The Greek Case

ERIC Educational Resources Information Center

Psomas, Evangelos; Antony, Jiju

2017-01-01

Purpose: The purpose of this paper is to determine the main total quality management (TQM) elements adopted and the respective results achieved by higher education institutions (HEIs) in Greece. Design/methodology/approach: A research study was designed and carried out in private sector Greek HEIs. Fifteen HEIs were approached through interviews…

Current Trends in College and University Investment Policies and Practices.

ERIC Educational Resources Information Center

Adams, Rodney H.

1972-01-01

Investment trends and the total return concept discussed at the NACUBO Regional Investment Workshop are described. A survey was made by the NACUBO Committee on Investment of 1,059 institutions, 189 of which responded. The most important finding was that 26 institutions reported the adoption of total return investing. Other findings were that about…

Contribution of Arab countries to breast cancer research: comparison with non-Arab Middle Eastern countries.

PubMed

Sweileh, Waleed M; Zyoud, Sa'ed H; Al-Jabi, Samah W; Sawalha, Ansam F

2015-01-01

Breast cancer is one of the most common types of cancers affecting women worldwide. The main objective of this study was to assess and compare research activity in breast cancer in Arab countries with non-Arab Middle Eastern countries. Publications about "breast cancer" as a research topic were retrieved using the ISI Web of Science database. Analysis was confined to original research and review articles. Research productivity was assessed by assessing number of publications and time trend of these publications, names of journals, citation analysis, top 10 active institutions as well as country contribution to breast cancer research. The quantity and quality of publications from Arab countries in addition to 3 other Middle East countries (Turkey, Iran and Israel) were assessed and compared using the h-index tool. A total of 1658 original research and review articles about "breast cancer" were published from Arab countries. Annual research productivity from Arab countries in the field of "breast cancer" was negligible but showed a significant increase in the last decade. Retrieved documents had relatively high citation parameters as measured by h-index of 61 and average citations of 17.46 per document. The highest research productivity was from Egypt with a total publication of 582 (35.10%). Cairo University with a total of 149 (8.99%) publications had the highest research productivity among institutions in Arab world. Forty four documents (2.65%) of breast cancer documents were published in Saudi Medical Journal. Arab researchers collaborated mostly with researchers from the United States of America (305; 18.40%) in breast cancer research. Compared with other non-Arab Middle Eastern countries, Arab countries had higher research productivity than some countries and lower than others, particularly Israel. The present data reveals a good contribution of some Arab countries to the field of "breast cancer" research. There is a gap between Arab countries and Israel in the quality of breast cancer research.

Consumption of trans fats and estimated effects on coronary heart disease in Iran.

PubMed

Mozaffarian, D; Abdollahi, M; Campos, H; Houshiarrad, A; Willett, W C

2007-08-01

To investigate the consumption of industrial trans-fatty acids (TFAs) in Iranian homes and the proportion of coronary heart disease (CHD) events in Iran attributable to such intake. The consumption of industrial TFAs was determined using (1) detailed in-home assessments of dietary intake among 7158 urban and rural households containing 35 924 individuals and (2) gas chromatography to determine TFA contents of the most commonly consumed partially hydrogenated oils. The population-attributable risk for CHD owing to TFA consumption was calculated on the basis of (1) documented effects of TFAs on total:high-density lipoprotein (HDL) cholesterol in randomized controlled dietary trials and (2) relationships of TFA intake with incidence of CHD in prospective observational studies. Partially hydrogenated oils were used extensively for cooking in Iranian homes with average per-person intake of 14 g/1000 kcal. TFAs accounted for 33% of fatty acids in these products, or 4.2% of all calories consumed (12.3 g/day). On the basis of total:HDL cholesterol effects alone, 9% of CHD events would be prevented by replacement of TFA in Iranian homes with cis-unsaturated fats (8% by replacement with saturated fats). On the basis of relationships of TFA intake with CHD incidence in prospective studies, 39% of CHD events would be prevented by replacement of TFA with cis-unsaturated fats (31% by replacement with saturated fats). These population-attributable risks may be overestimates owing to competing risks and because not all the fat used for cooking might actually be consumed. If actual TFA consumption were only half as large, the estimated proportion of CHD events prevented by TFA elimination would be 5% on the basis of total:HDL cholesterol effects and replacement with cis-unsaturated (4% for replacement with saturated fats), and 22% on the basis of prospective studies and replacement with cis-unsaturated fats (17% for replacement with saturated fats). These estimates do not include possible additional benefits derived from replacing TFAs with vegetable oils containing n-3 fatty acids. Intake of TFAs is high in Iranian homes and contributes to a sizeable proportion of CHD events. Replacement of partially hydrogenated oils with unhydrogenated oils would likely produce substantial reductions in CHD incidence. National Heart, Lung and Blood Institute, National Institutes of Health, USA. National Nutrition & Food Technology Research Institute, Tehran, Iran.

Large-Course Redesign via Blended Learning: A Post-Implementation Assessment across Institutions

ERIC Educational Resources Information Center

Rosenthal, David; Weitz, Rob

2012-01-01

This research reports the results of a survey administered to 25 of the 30 institutions that participated in the National Center for Academic Transformation (NCAT) large-course redesign project that took place between 1999 and 2003. According to NCAT, the benefits of these course redesign efforts included an average reduction in costs of about 40%…

Student Loan Default: Do Characteristics of Four-Year Institutions Contribute to the Puzzle?

ERIC Educational Resources Information Center

Webber, Karen L.; Rogers, Sharon L.

2010-01-01

College student debt and loan default are growing concerns in the United States. For each U.S. institution, the federal government is now reporting a cohort default rate, which is the percent of students who defaulted on their loan, averaged over a three-year period. Previous studies have amply shown that student characteristics are strongly…

1983 Home Study Survey. A Report on Current Course Structure and Educational Practices in NHSC Member Institutions.

ERIC Educational Resources Information Center

National Home Study Council, Washington, DC.

A study examined the course structure and educational practices used by National Home Study Council (NHSC) member institutions. To gather data for the study, researchers mailed questionnaires to 60 members of the NHSC. Based on data from the 51 usable responses, the researchers determined that the average age of students enrolled in programs…

The Centralization of Total Joint Arthroplasty in New York State An Analysis of 168,247 Cases.

PubMed

Adrados, Murillo; Theobald, Jason; Hutzler, Lorraine; Bosco, Joseph

2016-11-01

We identified 168,247 total hip and total knee arthroplasties performed in New York State between 2010 and 2012 to examine the evidence for increased geographical and institutional centralization of these procedures. We measured the increased growth of high volume institutions as compared to lower volume hospitals in New York State. We found a high proportion of total arthroplasties already performed in the dozen biggest hospitals in New York back in 2010 and a significant higher growth of these high volume, "centers of excellence," hospitals when compared to low volume hospitals.

Total hospital costs of surgical treatment for adult spinal deformity: an extended follow-up study.

PubMed

McCarthy, Ian M; Hostin, Richard A; Ames, Christopher P; Kim, Han J; Smith, Justin S; Boachie-Adjei, Ohenaba; Schwab, Frank J; Klineberg, Eric O; Shaffrey, Christopher I; Gupta, Munish C; Polly, David W

2014-10-01

Whereas the costs of primary surgery, revisions, and selected complications for adult spinal deformity (ASD) have been individually reported in the literature, the total costs over several years after surgery have not been assessed. The determinants of such costs are also not well understood in the literature. This study analyzes the total hospital costs and operating room (OR) costs of ASD surgery through extended follow-up. Single-center retrospective analysis of consecutive surgical patients. Four hundred eighty-four consecutive patients undergoing surgical treatment for ASD from January 2005 through January 2011 with minimum three levels fused. Costs were collected from hospital administrative data on the total hospital costs incurred for the operation and any related readmissions, expressed in 2010 dollars and discounted at 3.5% per year. Detailed data on OR costs, including implants and biologics, were also collected. We performed a series of paired t tests and Wilcoxon signed-rank tests for differences in total hospital costs over different follow-up periods. The goal of these tests was to identify a time period over which average costs plateau and remain relatively constant over time. Generalized linear model regression was used to estimate the effect of patient and surgical factors on hospital inpatient costs, with different models estimated for different follow-up periods. A similar regression analysis was performed separately for OR costs and all other hospital costs. Patients were predominantly women (n=415 or 86%) with an average age of 48 (18-82) years and an average follow-up of 4.8 (2-8) years. Total hospital costs averaged $120,394, with primary surgery averaging $103,143 and total readmission costs averaging $67,262 per patient with a readmission (n=130 or 27% of all patients). Operating room costs averaged $70,514 per patient, constituting the majority (59%) of total hospital costs. Average total hospital costs across all patients significantly increased (p<.01) after primary surgery, from $111,807 at 1-year follow-up to $126,323 at 4-year follow-up. Regression results also revealed physician preference as the largest determinant of OR costs, accounting for $14,780 of otherwise unexplained OR cost differences across patients, with no significant physician effects on all other non-OR costs (p<.05). The incidence of readmissions increased the average cost of ASD surgery by more than 70%, illustrating the financial burden of revisions/reoperations; however, the cost burden resulting from readmissions appeared to taper off within 5 years after surgery. The estimated impact of physician preference on OR costs also highlights the variation in current practice and the opportunity for large cost reductions via a more standardized approach in the use of implants and biologics. Copyright © 2014 Elsevier Inc. All rights reserved.

Clinical course in women undergoing termination of pregnancy within the legal time limit in French-speaking Switzerland.

PubMed

Perrin, Eliane; Berthoud, Marianne; Pott, Murielle; Toledo Vera, Anna G; Perrenoud, David; Bianchi-Demicheli, Francesco

2011-10-19

In 2002, Swiss citizens voted to accept new laws legalising the termination of pregnancy (TOP) up to 12th week of pregnancy. As a result the cantons formulated rules of implementation. Health institutions then had to modify their procedures and practices. One of the objectives of these changes was to simplify the clinical course for women who decide to terminate a pregnancy. Have the various health institutions in French-speaking Switzerland attained this goal? Are there differences between cantons? Are there any other differences, and if so, which ones? Comparative study of cantonal rules of implementation. Study by questionnaire of what happened to 281 women having undergone a TOP in French-speaking Switzerland. Quantitative and qualitative method. The comparative legal study of the six cantonal rules of implementation showed differences between cantons. The clinical course for women are defined by four quantifiable facts: 1) the number of days delay between the woman's decision (first step) and TOP; 2) the number of appointments attended before TOP; 3) the method of TOP; 4) the cost of TOP. On average, the waiting time was 12 days and the number of appointments was 3. The average cost of TOP was 1360 CHF. The differences, sometimes quite large, are explained by the size of the institutions (large university hospitals; average-sized, non-university hospitals; private doctors' offices). The cantonal rules of implementation and the size of the health care institutions play an important role in these courses for women in French-speaking Switzerland.

CCQM Pilot Study CCQM-P140: Quantitative surface analysis of multi-element alloy films

NASA Astrophysics Data System (ADS)

Kim, Kyung Joong; Jang, Jong Shik; Kim, An Soon; Suh, Jung Ki; Chung, Yong-Duck; Hodoroaba, Vasile-Dan; Wirth, Thomas; Unger, Wolfgang; Kang, Hee Jae; Popov, Oleg; Popov, Inna; Kuselman, Ilya; Lee, Yeon Hee; Sykes, David E.; Wang, Meiling; Wang, Hai; Ogiwara, Toshiya; Nishio, Mitsuaki; Tanuma, Shigeo; Simons, David; Szakal, Christopher; Osborn, William; Terauchi, Shinya; Ito, Mika; Kurokawa, Akira; Fujimoto, Toshiyuki; Jordaan, Werner; Jeong, Chil Seong; Havelund, Rasmus; Spencer, Steve; Shard, Alex; Streeck, Cornelia; Beckhoff, Burkhard; Eicke, Axel; Terborg, Ralf

2015-01-01

A pilot study for a quantitative surface analysis of multi-element alloy films has been performed by the Surface Analysis Working Group (SAWG) of the Consultative Committee for Amount of Substance (CCQM). The aim of this pilot study is to evaluate a protocol for a key comparison to demonstrate the equivalence of measures by National Metrology Institutes (NMIs) and Designated Institutes (DI) for the mole fractions of multi-element alloy films. A Cu(In,Ga)Se2 (CIGS) film with non-uniform depth distribution was chosen as a representative multi-element alloy film. The mole fractions of the reference and the test CIGS films were certified by isotope dilution—inductively coupled plasma/mass spectrometry. A total number counting (TNC) method was used as a method to determine the signal intensities of the constituent elements acquired in SIMS, XPS and AES depth profiling. TNC method is comparable with the certification process because the certified mole fractions are the average values of the films. The mole fractions of the CIGS films were measured by Secondary Ion Mass Spectrometry (SIMS), Auger Electron Spectroscopy (AES), X-ray Photoelectron Spectroscopy (XPS), X-Ray Fluorescence (XRF) Analysis and Electron Probe Micro Analysis (EPMA) with Energy Dispersive X-ray Spectrometry (EDX). Fifteen laboratories from eight NMIs, one DI, and six non-NMIs participated in this pilot study. The average mole fractions of the reported data showed relative standard deviations from 5.5 % to 6.8 % and average relative expanded uncertainties in the range from 4.52 % to 4.86 % for the four test CIGS specimens. These values are smaller than those in the key comparison CCQM-K67 for the measurement of mole fractions of Fe-Ni alloy films. As one result it can be stated that SIMS, XPS and AES protocols relying on the quantification of CIGS films using the TNC method are mature to be used in a CCQM key comparison. Main text. To reach the main text of this paper, click on Final Report. The final report has been peer-reviewed and approved for publication by CCQM.

Improving Anatomic Pathology in Sub-Saharan Africa to Support Cancer Care.

PubMed

Wilson, Michael L; Ayers, Stephanie; Berney, Daniel; Eslan, Alexia; Guarner, Jeannette; Lester, Susan; Masia, Ricard; Moloo, Zahir; Mutuku, Angela; Roberts, Drucilla; Stall, Jennifer; Sayed, Shahin

2018-03-07

Cancer care requires both accurate pathologic diagnosis as well as pathologic cancer staging. We evaluated three approaches to training pathologists in sub-Saharan Africa to perform pathologic cancer staging of breast, cervix, prostate, and colorectal cancers. One of three training methods was used at each workshop: didactic, case-based testing (CBT), or a blended approach. The project involved 52 participants from 16 pathology departments in 11 countries in East, Central, and Southern Africa. Evaluation of each method included pre- and postworkshop knowledge assessments, online pre- and postworkshop surveys of practice changes at the individual and institutional levels, and selected site visits. While CBT resulted in the highest overall average postassessment individual scores, both CBT and blended approaches resulted in 19% increases in average scores from pre- to postworkshop assessments. Institutions that participated in the blended workshop had increased changes in practice as indicated by the institutional survey. Both CBT and a blended approach are effective methods for training pathologists in pathologic cancer staging. Both are superior to traditional lectures alone.

An analysis of job placement patterns of black and non-black male and female undergraduates at the University of Virginia and Hampton Institute. Ph.D. Thesis - Virginia Univ.

NASA Technical Reports Server (NTRS)

Anderson, A. F.

1974-01-01

Research questions were proposed to determine the relationship between independent variables (race, sex, and institution attended) and dependent variables (number of job offers received, salary received, and willingness to recommend source of employer contact). The control variables were academic major, grade point average, placement registration, nonemployment activity, employer, and source of employer contact. An analysis of the results revealed no statistical significance of the institution attended as a predictor of job offers or salary, although significant relationships were found between race and sex and number of job offers received. It was found that academic major, grade point average, and source of employer contact were more useful than race in the prediction of salary. Sex and nonemployment activity were found to be the most important variables in the model. The analysis also indicated that Black students received more job offers than non-Black students.

Effect of air pollution on pediatric respiratory emergency room visits and hospital admissions.

PubMed

Farhat, S C L; Paulo, R L P; Shimoda, T M; Conceição, G M S; Lin, C A; Braga, A L F; Warth, M P N; Saldiva, P H N

2005-02-01

In order to assess the effect of air pollution on pediatric respiratory morbidity, we carried out a time series study using daily levels of PM10, SO2, NO2, ozone, and CO and daily numbers of pediatric respiratory emergency room visits and hospital admissions at the Children's Institute of the University of Sao Paulo Medical School, from August 1996 to August 1997. In this period there were 43,635 hospital emergency room visits, 4534 of which were due to lower respiratory tract disease. The total number of hospital admissions was 6785, 1021 of which were due to lower respiratory tract infectious and/or obstructive diseases. The three health end-points under investigation were the daily number of emergency room visits due to lower respiratory tract diseases, hospital admissions due to pneumonia, and hospital admissions due to asthma or bronchiolitis. Generalized additive Poisson regression models were fitted, controlling for smooth functions of time, temperature and humidity, and an indicator of weekdays. NO2 was positively associated with all outcomes. Interquartile range increases (65.04 microg/m3) in NO2 moving averages were associated with an 18.4% increase (95% confidence interval, 95% CI = 12.5-24.3) in emergency room visits due to lower respiratory tract diseases (4-day moving average), a 17.6% increase (95% CI = 3.3-32.7) in hospital admissions due to pneumonia or bronchopneumonia (3-day moving average), and a 31.4% increase (95% CI = 7.2-55.7) in hospital admissions due to asthma or bronchiolitis (2-day moving average). The study showed that air pollution considerably affects children's respiratory morbidity, deserving attention from the health authorities.

Admission of people with dementia to psychiatric hospitals in Japan: factors that can shorten their hospitalizations.

PubMed

Morikawa, Takako; Maeda, Kiyoshi; Osaki, Tohmi; Kajita, Hiroyuki; Yotsumoto, Kayano; Kawamata, Toshio

2017-11-01

People exhibiting serious behavioural and psychological symptoms of dementia are usually voluntarily or involuntarily committed to psychiatric hospitals for treatment. In Japan, the average hospital stay for individuals with dementia is about 2 years. Ideally, individuals should be discharged once their symptoms have subsided. However, we see cases in Japan where individuals remain institutionalized long after behavioural and psychological symptoms of dementia are no longer apparent. This study will attempt to identify factors contributing to shorter stays in psychiatric hospitals for dementia patients. Questionnaires consisting of 17 items were mailed to 121 psychiatric hospitals with dementia treatment wards in western Japan. Out of 121 hospitals that received the questionnaires, 45 hospitals returned them. The total number of new patient admissions at all 45 hospitals during the month of August 2014 was 1428, including 384 dementia patients (26.9%). The average length of stay in the dementia wards in August 2014 was 482.7 days. Our findings revealed that the rate of discharge after 2 months was 35.4% for the dementia wards. In addition, we found that the average stay in hospitals charging or planning to charge the rehabilitation fee to dementia patients was significantly shorter than in hospitals not charging the rehabilitation fee. In Japan, dementia patients account for over 25% of new admissions to psychiatric hospitals with dementia wards. The average length of stay in a psychiatric hospital dementia ward is more than 1 year. A discharge after fewer than 2 months is exceedingly rare for those in a dementia ward compared with dementia patients in other wards. If institutions focus on rehabilitation, it may be possible to shorten the stay of dementia patients in psychiatric hospitals. © 2017 Japanese Psychogeriatric Society.

Coherent fragmentation of 12C nuclei of momentum 4.5 GeV/ c per nucleon through the 8Beg.s.+4He channel in a nuclear photoemulsion containing lead nuclei

NASA Astrophysics Data System (ADS)

Belaga, V. V.; Gerasimov, S. G.; Dronov, V. A.; Peresadko, N. G.; Pisetskaya, A. V.; Rusakova, V. V.; Fetisov, V. N.; Kharlamov, S. P.; Shesterkina, L. N.

2017-07-01

A two-particle channel in which an unbound nucleus of 8Be in the ground state (8Beg.s.) was one of the fragments was selected among events where 12C nuclei of momentum 4.5 GeV/c per nucleon undergo coherent dissociation into three alpha particles. The events in question were detected in a track nuclear photoemulsion containing lead nuclei, which was irradiated at the synchrophasotron of the Laboratory of High Energies at the Joint Institute for Nuclear Research (JINR, Dubna). The average transverse momentum of alpha particles produced upon the decay of 8Beg.s. nuclei was 87±6 MeV/ c, while that for "single" alpha (αs) particles was 123±15 MeV/ c. The average value of the transverse-momentum transfer in the reaction being considered, Pt(12C), was 223 ± 20 MeV/ c. The average value of the cross section for this channel involving Ag and Br target nuclei was 13 ± 4 mb, while the cross section for the reaction on the Pb nucleus was 40 ± 15 mb. The Coulomb dissociation contribution evaluated on the basis of the number of events where the momentum P t(12C) did not exceed 0.1 GeV/c saturated about 20%. In nine events, the measured total transverse energy of the fragments in the reference frame comoving with the decaying carbon nucleus did not exceed 0.45 MeV, which did not contradict the excitation of the participant 12C nucleus to the level at 7.65 MeV. The average value of the transverse momentum in those events was 234 ± 25 MeV/ c.

Nutritional situation of Beijing residents.

PubMed

Zhao, X H

1992-01-01

Beijing is the capital of China with the population of 10.32 million in 1990 and the area of 1687.8 km2. It is the economic and cultural center of the country. Since the founding of new China, the development of Beijing city has been very fast. The gross national product (GNP) of Beijing in 1988 is 2.78 times the average GNP of the whole country. The sanitary institution has increased 71 times from 1949 to 1989. The prevalence of infectious diseases decreased significantly. The infant mortality is 11.6 per thousand approaching the figure of developed countries. The main food products increased rapidly. The grain, meat and egg increased from 100.7 kg and 0.48 kg per capita per year in 1949 to 217.1 kg and 20.17 kg in 1988 respectively. The food consumption of residents have been increasing consistently with the increasing of food production in Beijing. The food available in Beijing is well both in quantity and in quality. The results of the nutritional survey in 1985 showed that the daily average energy intake was 2549 kcal per capita. The average protein intake was 70g per person per day. The fat intake as the percentage of the total energy was 25.7. The average nutrients intake of Beijing residents meets the Chinese RDA basically. The nutritional status of people living in the city is good in general. But there are still some nutritional problem exist. Zn and Fe deficiencies anemia are common in infants and children along with the decreasing rate of breast feeding. Riboflavin, Zn and Ca intakes are inadequate in a lot of adults and the elderly.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical waste audit of 5 total knee arthroplasties.

PubMed

Stall, Nathan M; Kagoma, Yoan M; Bondy, Jennifer N; Naudie, Douglas

2013-04-01

Operating rooms (ORs) are estimated to generate up to one-third of hospital waste. At the London Health Sciences Centre, prosthetics and implants represent 17% of the institution's ecological footprint. To investigate waste production associated with total knee arthroplasties (TKAs), we performed a surgical waste audit to gauge the environmental impact of this procedure and generate strategies to improve waste management. We conducted a waste audit of 5 primary TKAs performed by a single surgeon in February 2010. Waste was categorized into 6 streams: regular solid waste, recyclable plastics, biohazard waste, laundered linens, sharps and blue sterile wrap. Volume and weight of each stream was quantified. We used Canadian Joint Replacement Registry data (2008-2009) to estimate annual weight and volume totals of waste from all TKAs performed in Canada. The average surgical waste (excluding laundered linens) per TKA was 13.3 kg, of which 8.6 kg (64.5%) was normal solid waste, 2.5 kg (19.2%) was biohazard waste, 1.6 kg (12.1%) was blue sterile wrap, 0.3 kg (2.2%) was recyclables and 0.3 kg (2.2%) was sharps. Plastic wrappers, disposable surgical linens and personal protective equipment contributed considerably to total waste. We estimated that landfill waste from all 47 429 TKAs performed in Canada in 2008-2009 was 407 889 kg by weight and 15 272 m3 by volume. Total knee arthroplasties produce substantial amounts of surgical waste. Environmentally friendly surgical products and waste management strategies may allow ORs to reduce the negative impacts of waste production without compromising patient care. Level IV, case series.

Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patients.

PubMed

Saxena, S K; Ng, T P; Yong, D; Fong, N P; Gerald, K

2006-11-01

Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care. The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings. Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants. The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index < or = 50, (ii) medical complications, (iii) first time stroke, (iv) unplanned discharges and (v) discharges to nursing homes. Of the stroke patients 19.5% had institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01-12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32-14.98). Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway/protocol for stroke care is further discussed.

Nutritional Status After Total Gastrectomy for Gastric Cancer.

PubMed

Cidon, Esther Una

2010-04-01

Gastric cancer is one of the most frequent causes of death secondary to cancer in the world. Surgery is the only potentially curative treatment but its clinical consequences are significant. The objective of this study is to evaluate the nutritional state of patients with a total gastrectomy secondary to gastric adenocarcinoma. We designed a descriptive study with a transversal cut in our institution. We included 22 patients which had a minimum evolution time of six months after total gastrectomy secondary to gastric cancer surgery was performed. Neither of them had metastasis. The nutritional analysis included only biochemical data. Descriptive statistics were used for statistical analysis. Eight females and 14 males were included in the study. Median age was 57 years (34 - 69 years). The 74% of the patients were underweight and none of them was overweight. The average body mass index (BMI) was 16.88 kg/m 2 . Eleven patients suffered from mild anemia (10.5 - 12 g/dl) and 5 from moderate anemia (9 - 10.5 g/dl). Only two patients presented severe anemia (less than 9 g/dl). The 58% presented hypoproteinaemia and hypoalbuminaemia. The main post-surgery complication was nausea (46%). Seventy-eight percent of the patients had loss of appetite. Twenty-one patients were able to walk without help and leave their homes. The incidence of anemia in these patients was very high. In most of the patients, albumin and proteins levels were affected too. So malnutrition was a relevant consequence of a total gastrectomy.

Correlation between sperm DNA fragmentation index and CMA3 positive spermatozoa in globozoospermic patients.

PubMed

Hosseinifar, H; Yazdanikhah, S; Modarresi, T; Totonchi, M; Sadighi Gilani, M A; Sabbaghian, M

2015-05-01

The absence of the acrosome causes the situation which is called globozoospermia. There are a few studies, mostly as case reports, about correlation between levels of sperm DNA damage in patients with total round-headed spermatozoa. We investigated this correlation as well as CMA3 positive spermatozoa in 20 globozoospermic men (with more than 90% round-headed spermatozoa) attending to Royan Institute. Semen samples divided into three parts to semen analysis, to measure DNA fragmentation index (DFI) using sperm chromatin structure assay (SCSA) and to detect CMA3(+) sperm cells by chromomycin A3 staining and fluorescent microscopy. Our results showed that there were significant differences in sperm concentration, total sperm motility, and normal morphology between patients and controls group (p < 0.001). Moreover, the average of DFI and CMA3 positive spermatozoa in patients group significantly increases compared with control group (p < 0.001). A significant correlation between DFI and CMA3(+) in total population was also detected in patients group (r = 0.45, p = 0.046). To our knowledge, this is the largest study about correlation between DNA damage levels and CMA3 positive spermatozoa with round head sperm cells in total globozoospermic men. It seems that the increase in DNA damage may be because of defective sperm DNA compaction, as we detected CMA3 positive sperm cells in these patients. © 2015 American Society of Andrology and European Academy of Andrology.

When Average Is Not Good Enough: Students With Learning Disabilities at Selective, Private Colleges.

PubMed

Weis, Robert; Erickson, Celeste P; Till, Christina H

Adolescents with learning disabilities disproportionately come from lower socioeconomic status backgrounds, show normative deficits in academic skills, and attend 2-year, public colleges instead of 4-year institutions. However, students with learning disabilities are well represented at the United States' most expensive and selective postsecondary institutions. We examined the psychoeducational functioning of students receiving accommodations for learning disabilities at a private, selective, liberal arts college. We also determined whether students had objective evidence supporting their disability diagnoses and academic accommodations. Most students showed above-average cognitive abilities, average academic skills, and no evidence of impairment. Although nearly all students reported academic problems, most lacked objective evidence of academic difficulties prior to college as well as relative or normative deficits in broad academic skills or fluency. Results indicate a need for greater reliance on objective, multimethod/multi-informant data in the diagnostic process. Results also highlight limitations in the current professional guidelines for documentation decision making in higher education.

Factors affecting the depth of burns occurring in medical institutions.

PubMed

Cho, Young Soon; Choi, Young Hwan; Yoon, Cheonjae; You, Je Sung

2015-05-01

Most cases of burns occurring in medical institutions are associated with activities involving heat. It is very difficult to detect these burns. To date, there are few reports on burns occurring in medical institutions. The purpose of this paper was to analyze the etiology of burns occurring in medical institutions and to elucidate the factors affecting burn depth. We conducted a retrospective analysis of the medical records of patients who visited our center from April 2008 to February 2013. This study enrolled all patients with burns occurring in the medical institution during or related to treatment. We excluded burn patients whose burns were not related to treatment (for example, we excluded patients with scalding burns that occurred in the hospital cafeteria and pediatric patients with hot water burns from the water purifier). However, patients with burns that occurred in the recovery room after general anesthesia were included. A total of 115 patients were enrolled in this study. The average patient age was 41.5 years, with more women than men (M:F=31:84). There were 29 cases (25.3%) of superficial burns (first-degree and superficial second-degree) and 86 cases (74.7%) of deep burns (deep second-degree and third-degree). Hot packs were the most common cause of burns (27 cases, 23.5%), followed by laser therapy, heating pads, and grounding pads, accounting for 15 cases each. There were 89 cases (77.4%) of contact burns and 26 cases (22.6%) of non-contact burns. The most common site of burns was the lower extremities (41 cases, 35.7%). The burn site and contact burns were both factors affecting burn depth. The rate of deep burns was higher in patients with contact burns than in those with non-contact burns (odds ratio 4.26) and was associated with lower body burns (odds ratio 2.85). In burns occurring in medical institutions, there is a high probability of a deep burn if it is a contact burn or occurs in the lower body. Therefore, safety guidelines are needed for the use of hot packs, heating pads, and grounding pads to prevent such incidents. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Subungual melanoma: Management in the modern era.

PubMed

Reilly, D J; Aksakal, G; Gilmour, R F; Gyorki, D E; Chauhan, A; Webb, A; Henderson, M A

2017-12-01

Subungual melanoma is a rare subtype of cutaneous melanoma that arises from the structures of the nail apparatus. It presents most commonly in older patients and at an advanced stage. A retrospective review of all patients with subungual melanoma in a single institution over a 15-year period was performed. In total, 54 patients were included (26 males, average age 62.9 years), of which 28 cases involved the upper limb. Median tumour thickness was 4.5 mm. Eighteen patients had lymph node metastasis at diagnosis, including 11 of 36 patients with positive sentinel lymph node biopsy. Median survival was 4.6 years. Subungual melanoma has a poor prognosis that is strongly associated with presence of nodal disease at diagnosis. Sentinel lymph node biopsy should be considered to determine stage and prognosis. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Respiratory predictors of disability days: a five year prospective study of U. S. coal miners

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

Ames, R.G.; Trent, R.B.

1985-01-01

A 5-year prospective analysis tests the hypothesis that coal miners who have impaired respiratory health also experience greater numbers of disability days due to occupational injury. Occupational and respiratory health information collected for the period 1977 through 1981 by the National Institute for Occupational Safety and Health (NIOSH) on 1,118 U.S. underground coal miners was linked to coal miner injury records collected under a mandatory reporting system by the Mine Safety and Health Administration (MSHA). Respiratory impairment, based on spirometric measures, and a questionnaire measure of chronic bronchitis symptoms, after adjustment for cigarette smoking and total years of underground mining,more » did not provide statistically significant prediction of average disability days. In addition, respiratory impairment did not predict the number of episodes of occupational injuries resulting in days lost from work.« less

Homicide-suicide in Brescia County (Northern Italy): a retrospective study from 1987 to 2012.

PubMed

Verzeletti, Andrea; Russo, Maria Cristina; De Ferrari, Francesco

2014-07-01

From January 1987 to December 2012, 19 homicide-suicide events were registered at the Brescia Institute of Forensic Medicine (Northern Italy), leading to 39 deaths (20 homicide victims and 19 suicide victims). The homicide victims were females in the total of the cases (100%), while perpetrators were exclusively males (100%). Only one event involved foreigners as both victim and perpetrator, all the other cases regarded Italian people. The average age was 37.3 years for the homicide victims and 41.57 years for the offenders. Perpetrators usually used a firearm both for murder (65%) and suicide (84%). In 66% of the cases the homicide-suicide events occurred at home; homicide victims were strictly bound to their perpetrators (husband, boyfriend or ex boyfriend, father) in all the events. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Study of Cost of Distance Education Institutes with Different Size Classes in India.

ERIC Educational Resources Information Center

Datt, Ruddar

A study of the cost of distance education institutes in India with different size classes involved nine institutions. The sample included 47 percent of total enrollment in distance education institutions in India. The study was restricted to recurring costs and examined the shares of different components of costs and the sources of funding. It…

76 FR 51011 - Applications for New Awards; Predominantly Black Institutions Formula Grant Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

... ability of the institutions to serve the academic needs of these students. Program Authority: Title III... such institution at the end of the academic year preceding the beginning of that fiscal year, bears to the total number of Federal Pell Grant recipients at all such institutions at the end of such academic...

75 FR 22679 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-29

... before June 1, 2010 to be assured of consideration. Community Development Financial Institutions (CDFI... institutions. Estimated Total Burden Hours: 5,940 hours. OMB Number: 1559-0034. Type of Review: Financial.... CDFI Fund Clearance Officer: Ashanti McCallum, Community Development Financial Institutions Fund...

Traditional-Age Students Becoming At-Risk: Does Working Threaten College Students' Academic Success?

ERIC Educational Resources Information Center

Torres, Vasti; Gross, Jacob P. K.; Dadashova, Afet

2011-01-01

Using survey information from undergraduate students who work while attending two urban commuter institutions in Indiana, this study explores evidence that on average undergraduates under 21 years of age worked more than 31 hours a week while also enrolled in a full course load. The findings in this study indicate that grade point average and…

The Speech Intelligibility Index and the Pure-Tone Average as Predictors of Lexical Ability in Children Fit with Hearing Aids

ERIC Educational Resources Information Center

Stiles, Derek J.; Bentler, Ruth A.; McGregor, Karla K.

2012-01-01

Purpose: To determine whether a clinically obtainable measure of audibility, the aided Speech Intelligibility Index (SII; American National Standards Institute, 2007), is more sensitive than the pure-tone average (PTA) at predicting the lexical abilities of children who wear hearing aids (CHA). Method: School-age CHA and age-matched children with…

Bull Market Helped Endowments Earn Average of 17.2% in 1996.

ERIC Educational Resources Information Center

Nicklin, Julie L.

1997-01-01

The National Association of College and University Business Officers' annual survey of 1996 college endowment performance found the rate of return up 15.5% from the previous year, the best since 1986. The average institution had 51.6% of endowment in domestic stocks, 25.5% in domestic fixed-income investments, 9.5% in foreign stock, 5.4% in cash…

Women, Men, and Academic Performance in Science and Engineering: The Gender Difference in Undergraduate Grade Point Averages

ERIC Educational Resources Information Center

Sonnert, Gerhard; Fox, Mary Frank

2012-01-01

Using longitudinal and multi-institutional data, this article takes an innovative approach in its analyses of gender differences in grade point averages (GPA) among undergraduate students in biology, the physical sciences, and engineering over a 16-year period. Assessed are hypotheses about (a) the gender ecology of science/engineering and (b) the…

Factors That Predict Marijuana Use and Grade Point Average among Undergraduate College Students

ERIC Educational Resources Information Center

Coco, Marlena B.

2017-01-01

The purpose of this study was to analyze factors that predict marijuana use and grade point average among undergraduate college students using the Core Institute national database. The Core Alcohol and Drug Survey was used to collect data on students' attitudes, beliefs, and experiences related to substance use in college. The sample used in this…

Use of Multiple Methodologies for Developing a Customer-Oriented Model of Total Quality Management in Higher Education

ERIC Educational Resources Information Center

Sahney, Sangeeta

2016-01-01

Purpose: Educational institutes must embrace the principles of total quality management (TQM) if they seek to remain competitive, and survive and succeed in the long run. An educational institution must embrace the principles of quality management and incorporate them into all of their activities. Starting with a theoretical background, the paper…

Ground-Water Occurrence and Contribution to Streamflow, Northeast Maui, Hawaii

USGS Publications Warehouse

Gingerich, Stephen B.

1999-01-01

The study area lies on the northern flank of the East Maui Volcano (Haleakala) and covers about 129 square miles between the drainage basins of Maliko Gulch to the west and Makapipi Stream to the east. About 989 million gallons per day of rainfall and 176 million gallons per day of fog drip reaches the study area and about 529 million gallons per day enters the ground-water system as recharge. Average annual ground-water withdrawal from wells totals only about 3 million gallons per day; proposed (as of 1998) additional withdrawals total about 18 million gallons per day. Additionally, tunnels and ditches of an extensive irrigation network directly intercept at least 10 million gallons per day of ground water. The total amount of average annual streamflow in gaged stream subbasins upstream of 1,300 feet altitude is about 255 million gallons per day and the total amount of average annual base flow is about 62 million gallons per day. Six major surface-water diversion systems in the study area have diverted an average of 163 million gallons per day of streamflow (including nearly all base flow of diverted streams) for irrigation and domestic supply in central Maui during 1925-97. Fresh ground water is found in two main forms. West of Keanae Valley, ground-water flow appears to be dominated by a variably saturated system. A saturated zone in the uppermost rock unit, the Kula Volcanics, is separated from a freshwater lens near sea level by an unsaturated zone in the underlying Honomanu Basalt. East of Keanae Valley, the ground-water system appears to be fully saturated above sea level to altitudes greater than 2,000 feet. The total average annual streamflow of gaged streams west of Keanae Valley is about 140 million gallons per day at 1,200 feet to 1,300 feet altitude. It is not possible to estimate the total average annual streamflow at the coast. All of the base flow measured in the study area west of Keanae Valley represents ground-water discharge from the high-elevation saturated zone. Total average daily ground-water discharge from the high-elevation saturated zone upstream of 1,200 feet altitude is greater than 38 million gallons per day, all of which is eventually removed from the streams by surface-water diversion systems. Perennial streamflow has been measured at altitudes greater than 3,000 feet in several of the streams. Discharge from the high-elevation saturated zone is persistent even during periods of little rainfall. The total average annual streamflow of the gaged streams east of Keanae Valley is about 109 million gallons per day at about 1,300 feet altitude. It is not possible to estimate the total average annual streamflow at the coast nor at higher altitudes. All of the base flow measured east of Keanae Valley represents ground-water discharge from the vertically extensive freshwater-lens system. Total average daily ground-water discharge to gaged streams upstream of 1,200 feet altitude is about 27 million gallons per day. About 19 million gallons per day of ground water discharges through the Kula and Hana Volcanics between about 500 feet and 1,300 feet altitude in the gaged stream sub-basins. About 13 million gallons per day of this discharge is in Hanawi Stream. The total ground-water discharge above 500 feet altitude in this part of the study area is greater than 56 million gallons per day.

Academic productivity among fellowship associated adult total joint reconstruction surgeons.

PubMed

Khan, Adam Z; Kelley, Benjamin V; Patel, Ankur D; McAllister, David R; Leong, Natalie L

2017-12-01

The Hirsch index (h-index) is a measure that evaluates both research volume and quality-taking into consideration both publications and citations of a single author. No prior work has evaluated academic productivity and contributions to the literature of adult total joint replacement surgeons. This study uses h-index to benchmark the academic impact and identify characteristics associated with productivity of faculty members at joint replacement fellowships. Adult reconstruction fellowship programs were obtained via the American Association of Hip and Knee Surgeons website. Via the San Francisco match and program-specific websites, program characteristics (Accreditation Council for Graduate Medical Education approval, academic affiliation, region, number of fellows, fellow research requirement), associated faculty members, and faculty-specific characteristics (gender, academic title, formal fellowship training, years in practice) were obtained. H-index and total faculty publications served as primary outcome measures. Multivariable linear regression determined statistical significance. Sixty-six adult total joint reconstruction fellowship programs were identified: 30% were Accreditation Council for Graduate Medical Education approved and 73% had an academic affiliation. At these institutions, 375 adult reconstruction surgeons were identified; 98.1% were men and 85.3% had formal arthroplasty fellowship training. Average number of publications per faculty member was 50.1 (standard deviation 76.8; range 0-588); mean h-index was 12.8 (standard deviation 13.8; range 0-67). Number of fellows, faculty academic title, years in practice, and formal fellowship training had a significant ( P < .05) positive correlation with both h-index and total publications. The statistical overview presented in this work can help total joint surgeons quantitatively benchmark their academic performance against that of their peers.

Comparison of Cocoa Beans from China, Indonesia and Papua New Guinea

PubMed Central

Gu, Fenglin; Tan, Lehe; Wu, Huasong; Fang, Yiming; Xu, Fei; Chu, Zhong; Wang, Qinghuang

2013-01-01

A survey on five kinds of cocoa beans from new cocoa planting countries was conducted to analyze each kind’s basic quality. The average bean weight and butter content of Hainan cocoa beans were the lowest, at less than 1.1 g, and 39.24% to 43.44%, respectively. Cocoa beans from Indonesia where shown to be about 8.0% and 9.0% higher in average bean weight and butter content, respectively, than that of Papua New Guinea and about 20.0% and 25.0% higher in average bean weight and butter content than Chinese dried beans, respectively. The average total polyphenolic content ranged from 81.22 mg/10 g to 301.01 mg/10 g. The Hainan 2011 sample had the highest total polyphenolic content, followed by the unfermented sample from Indonesia and the Papua New Guinea sample. The polyphenolic levels found in the Hainan 2010 sample were 123.61 mg/10 g and lower than the other three samples, but the Indonesian fermented sample had the lowest total polyphenolic content of 81.22 mg/10 g. The average total amino acid content ranged from 11.58 g/100 g to 18.17 g/100 g. The total amino acid content was the highest in the Indonesian unfermented sample, followed by the Hainan 2011 sample and the Papua New Guinea sample. The levels found in the Hainan 2010 sample were lower; the Indonesian fermented sample had the lowest total amino acid content. PMID:28239108

Career on the move: geography, stratification, and scientific impact.

PubMed

Deville, Pierre; Wang, Dashun; Sinatra, Roberta; Song, Chaoming; Blondel, Vincent D; Barabási, Albert-László

2014-04-24

Changing institutions is an integral part of an academic life. Yet little is known about the mobility patterns of scientists at an institutional level and how these career choices affect scientific outcomes. Here, we examine over 420,000 papers, to track the affiliation information of individual scientists, allowing us to reconstruct their career trajectories over decades. We find that career movements are not only temporally and spatially localized, but also characterized by a high degree of stratification in institutional ranking. When cross-group movement occurs, we find that while going from elite to lower-rank institutions on average associates with modest decrease in scientific performance, transitioning into elite institutions does not result in subsequent performance gain. These results offer empirical evidence on institutional level career choices and movements and have potential implications for science policy.

Career on the Move: Geography, Stratification, and Scientific Impact

PubMed Central

Deville, Pierre; Wang, Dashun; Sinatra, Roberta; Song, Chaoming; Blondel, Vincent D.; Barabási, Albert-László

2014-01-01

Changing institutions is an integral part of an academic life. Yet little is known about the mobility patterns of scientists at an institutional level and how these career choices affect scientific outcomes. Here, we examine over 420,000 papers, to track the affiliation information of individual scientists, allowing us to reconstruct their career trajectories over decades. We find that career movements are not only temporally and spatially localized, but also characterized by a high degree of stratification in institutional ranking. When cross-group movement occurs, we find that while going from elite to lower-rank institutions on average associates with modest decrease in scientific performance, transitioning into elite institutions does not result in subsequent performance gain. These results offer empirical evidence on institutional level career choices and movements and have potential implications for science policy. PMID:24759743

Career on the Move: Geography, Stratification, and Scientific Impact

NASA Astrophysics Data System (ADS)

Deville, Pierre; Wang, Dashun; Sinatra, Roberta; Song, Chaoming; Blondel, Vincent D.; Barabási, Albert-László

2014-04-01

Changing institutions is an integral part of an academic life. Yet little is known about the mobility patterns of scientists at an institutional level and how these career choices affect scientific outcomes. Here, we examine over 420,000 papers, to track the affiliation information of individual scientists, allowing us to reconstruct their career trajectories over decades. We find that career movements are not only temporally and spatially localized, but also characterized by a high degree of stratification in institutional ranking. When cross-group movement occurs, we find that while going from elite to lower-rank institutions on average associates with modest decrease in scientific performance, transitioning into elite institutions does not result in subsequent performance gain. These results offer empirical evidence on institutional level career choices and movements and have potential implications for science policy.

Clinical Neurophysiology Training in a Developing Country: Institutional Resources and Profiles.

PubMed

Sámano, Arturo G; Ochoa Mena, José D; Padilla, Silvana P; Acevedo, Gerardo R; Orenday Barraza, José M; San-Juan, Daniel

2018-05-01

The purpose of this study was to describe the characteristics and preferences of clinical neurophysiology (CN) fellows, as well as the resources available for their training, in a developing country such as Mexico. An online survey (25 questions) was given to Mexican CN fellows from May to June 2017, covering their reasons for choosing the CN subspecialty, their activities, future plans, institutional resources, and administrative staff. Descriptive statistics were used. Total respondents: 20/22 (90%), 65% female from 7 CN centers (80% public and 20% private hospitals) in Mexico City. Seventy-five percent chose CN out of personal interest, and all were not unsatisfied with their academic program. Most plan to work in private practice (75%) and are interested in learning EEG (85%) and intraoperative monitoring (75%-85%). The highest-reported training time by CN area allocated by the programs was as follows: EEG (27%), electromyography (22%), and evoked potentials (16%). The average number of fellows per center was 4; 75% of the centers perform epilepsy surgery, of which 60% offer invasive intracranial studies for the evaluation of surgical candidates. Mexican CN fellows are satisfied with their choice and with the academic program. They are increasingly interested in intraoperative monitoring, which is not addressed in current Mexican CN Programs.

[Nurse violence in the workplace: a study of experiences and related factors in Taiwan].

PubMed

Lee, Sheuan; Pai, Hsiang-Chu; Yen, Wen-Jiuan

2010-04-01

Workplace violence is an issue that recognizes no national boundaries. Nurses face a higher than average level of violence in the healthcare institutions in which they work. The purpose of this study was to explore the prevalence of workplace violence and its related factors amongst nurses in healthcare settings in Taiwan. A cross-sectional study using a convenience sampling technique was conducted. A total of 1,000 questionnaires were distributed, with 525 valid returns received. Results showed that 294 (56%) nurses reported having experienced physical violence. One hundred and three nurses (19.6%) reported experiencing psychological violence and 271 reported experiencing verbal abuse (51.6%). Factors found in this study to have a significant relationship with violence included age, gender, education background, job seniority and work shift status. The most significant groups of violence perpetrators were, in order of importance, patients, patient families/relatives, and co-workers. Despite the high prevalence of violence at healthcare institutions, only 198 (37.7%) participants agreed that their workplace had established violence reporting guidelines. Results provide specific data and insights into the prevalence of workplace violence faced by nurses in Taiwan. These findings may help nursing administrators, educators and healthcare managers prevent, reduce, and control such incidents in the future.

Epidemiology of pancreatic cancer in France: descriptive study from the French national hospital database.

PubMed

Maire, Frédérique; Cibot, Jean-Olivier; Compagne, Catherine; Hentic, Olivia; Hammel, Pascal; Muller, Nelly; Ponsot, Philippe; Levy, Philippe; Ruszniewski, Philippe

2017-08-01

Although indirect evidence suggests that the incidence of pancreatic adenocarcinoma has increased in the last decade, few data are available in European countries. The aim of the present study was to update the epidemiology of pancreatic cancer in France in 2014 from the French national hospital database (Programme de Médicalisation des Systèmes d'Information). All patients hospitalized for pancreatic cancer in France in 2014 in public or private institutions were included. Patient and stays (length, type of support, institutions) characteristics were studied. The results were compared with those observed in 2010. A total of 13 346 (52% men, median age 71 years) new patients were treated for pancreatic cancer in 2014, accounting for a 12.5% increase compared with 2010. Overall, 22% of patients were operated on. Liver metastases were present in 60% of cases. The disease accounted for 146 680 hospital stays (+24.8% compared with 2010), 76% of which were related to chemotherapy (+32%). The average annual number and length of stay were 7 and 2.6 days, respectively. In 2014, 11 052 deaths were reported (+15.8%). Approximately 13 350 new cases of pancreatic cancer were observed in France in 2014. The increase in incidence was associated with a marked increase in hospital stays for chemotherapy.

Cost minimization analysis of a store-and-forward teledermatology consult system.

PubMed

Pak, Hon S; Datta, Santanu K; Triplett, Crystal A; Lindquist, Jennifer H; Grambow, Steven C; Whited, John D

2009-03-01

The aim of this study was to perform a cost minimization analysis of store-and-forward teledermatology compared to a conventional dermatology referral process (usual care). In a Department of Defense (DoD) setting, subjects were randomized to either a teledermatology consult or usual care. Accrued healthcare utilization recorded over a 4-month period included clinic visits, teledermatology visits, laboratories, preparations, procedures, radiological tests, and medications. Direct medical care costs were estimated by combining utilization data with Medicare reimbursement rates and wholesale drug prices. The indirect cost of productivity loss for seeking treatment was also included in the analysis using an average labor rate. Total and average costs were compared between groups. Teledermatology patients incurred $103,043 in total direct costs ($294 average), while usual-care patients incurred $98,365 ($283 average). However, teledermatology patients only incurred $16,359 ($47 average) in lost productivity cost while usual-care patients incurred $30,768 ($89 average). In total, teledermatology patients incurred $119,402 ($340 average) and usual-care patients incurred $129,133 ($372 average) in costs. From the economic perspective of the DoD, store-and-forward teledermatology was a cost-saving strategy for delivering dermatology care compared to conventional consultation methods when productivity loss cost is taken into consideration.

Impact of the zero-markup drug policy on hospitalisation expenditure in western rural China: an interrupted time series analysis.

PubMed

Yang, Caijun; Shen, Qian; Cai, Wenfang; Zhu, Wenwen; Li, Zongjie; Wu, Lina; Fang, Yu

2017-02-01

To assess the long-term effects of the introduction of China's zero-markup drug policy on hospitalisation expenditure and hospitalisation expenditures after reimbursement. An interrupted time series was used to evaluate the impact of the zero-markup drug policy on hospitalisation expenditure and hospitalisation expenditure after reimbursement at primary health institutions in Fufeng County of Shaanxi Province, western China. Two regression models were developed. Monthly average hospitalisation expenditure and monthly average hospitalisation expenditure after reimbursement in primary health institutions were analysed covering the period 2009 through to 2013. For the monthly average hospitalisation expenditure, the increasing trend was slowed down after the introduction of the zero-markup drug policy (coefficient = -16.49, P = 0.009). For the monthly average hospitalisation expenditure after reimbursement, the increasing trend was slowed down after the introduction of the zero-markup drug policy (coefficient = -10.84, P = 0.064), and a significant decrease in the intercept was noted after the second intervention of changes in reimbursement schemes of the new rural cooperative medical insurance (coefficient = -220.64, P < 0.001). A statistically significant absolute decrease in the level or trend of monthly average hospitalisation expenditure and monthly average hospitalisation expenditure after reimbursement was detected after the introduction of the zero-markup drug policy in western China. However, hospitalisation expenditure and hospitalisation expenditure after reimbursement were still increasing. More effective policies are needed to prevent these costs from continuing to rise. © 2016 John Wiley & Sons Ltd.

Research Productivity and Rankings of Anesthesiology Departments in Canada and the United States: The Relationship Between the h-Index and Other Common Metrics [RETRACTED].

PubMed

Bunting, Alexandra C; Alavifard, Sepand; Walker, Benjamin; Miller, Donald R; Ramsay, Tim; Boet, Sylvain

2018-03-05

To evaluate the relative research productivity and ranking of anesthesiology departments in Canada and the United States, using the Hirsch index (h-index) and 4 other previously validated metrics. We identified 150 anesthesiology departments in Canada and the United States with an accredited residency program. Publications for each of the 150 departments were identified using Thomson's Institute for Scientific Information Web of Science, and the citation report for each department was exported. The bibliometric data were used to calculate publication metrics for 3 time periods: cumulative (1945-2014), 10 years (2005-2014), and 5 years (2010-2014). The following group metrics were then used to determine the publication impact and relative ranking of all 150 departments: h-index, m-index, total number of publications, sum of citations, and average number of citations per article. Ranking for each metric were also stratified by using a proxy for departmental size. The most common journals in which US and Canadian anesthesiology departments publish their work were identified. The majority (23 of the top 25) of top-ranked anesthesiology departments are in the United States, and 2 of the top 25 departments (University of Toronto; McGill University) are in Canada. There was a strong positive relationship between each of h-index, total number of publications, and the sum of citations (0.91-0.97; P < .0001). Departmental size correlates with increased academic productivity on most metrics. The most frequent journals in which US and Canadian anesthesiology departments publish are Anesthesiology, Anesthesia and Analgesia, and the Canadian Journal of Anesthesia. Our study ranked the Canadian and US anesthesiology departmental research productivity using the h-index applied to each department, total number of publications, total number of citations, and average number of citations. The strong relationship between the h-index and both the number of publications and number of citations of anesthesiology departments shows that the departments with the highest number of publications are also producing research with the most highly cited articles (ie, most impact), as demonstrated by the h-index.

2014-16 Systemwide Operating and Financial Aid Budget Amendment Recommendations for Public Higher Education in Virginia

ERIC Educational Resources Information Center

State Council of Higher Education for Virginia, 2014

2014-01-01

Fluctuations in state funding present a tremendous challenge to the well being of Virginia public higher education institutions and the state's students and families. On a per-student basis, general fund appropriations declined by 49.6% ($5,909) on average at the four year-institutions and by 46.6% ($2,550) at the Virginia Community College System…

A Successful Multi-Institutional Blog for Transferring Garden and Landscape Information to the Public

ERIC Educational Resources Information Center

Gillman, Jeffrey; Chalker-Scott, Linda; Scoggins, Holly; Cregg, Bert

2011-01-01

In July 2009 four faculty members from four different institutions created a blog to educate consumers and professionals about plant-related issues. Online resources were used to measure the number of times that the blog was viewed and its impacts. The blog averages about 200 views a day, and 80% of those responding to a survey could name specific…

"Stepping Stones": Career Paths to the SSAO for Men and Women at Four-Year Institutions

ERIC Educational Resources Information Center

Biddix, J. Patrick

2011-01-01

This study examined career paths to becoming the Senior Student Affairs Officer for men (n = 151) and women (n = 99) at 4-year institutions. Descriptive statistics and network analysis of resume data revealed that an average of 20 years and six job changes led to the position. Most started careers in residential life or student activities,…

The effect of essential medicines programme on rational use of medicines in China.

PubMed

Gong, Yanhong; Yang, Chen; Yin, Xiaoxv; Zhu, Minmin; Yang, Huajie; Wang, Yunxia; Li, Yongbin; Liu, Liqun; Dong, Xiaoxin; Cao, Shiyi; Lu, Zuxun

2016-02-01

Irrational use of medicines is a serious problem in China and has been the primary target of China's national essential medicines programme (NEMP). The aim of this study was to evaluate the effect of the NEMP on rational use of medicines in China. A nationwide sample of 3 76 700 prescriptions written by primary care providers from 2007 to 2011 was obtained following a multistage sampling process. Six prescribing indicators were measured: average number of drugs prescribed per prescription, average expenditure per prescription, percentage of prescriptions with antibiotics, with injections, with two or more antibiotics and with corticosteroids. The pre-post with control study design and the difference-in-difference (DID) methodology were employed to evaluate the effect of NEMP. Prescriptions from primary care institutions with the NEMP implementation were better than those without NEMP implementation. Adjusting for the institution's sizes, ownership, economic geographic regions and the year of NEMP implementation, the DID estimator was statistically significant in all prescribing indicators except for the percentage of prescriptions with injection. The number of drugs per prescription decreased by 0.2 per prescription [95% confidence interval (CI): -0.3, -0.1] after the NEMP was implemented; the percentages of prescriptions with antibiotics, with corticosteroids and with two or more antibiotics decreased by 7% (95% CI: -10, -4), 1% (95% CI: -2, 0) and 2% (95% CI: -3, 0), respectively; and the average expenditure per prescription decreased by eight Renminbi Yuan (95% CI: -14, -2). The effect of NEMP on reducing irrational prescribing was greater in public institutions than in private institutions (P < 0.05). China's NEMP is effective in promoting rational use of medicines, and the effect is greater in public institutions than in private institutions. However, the irrational use is still high, pointing to the need for further reforms to tackle the underlying causes, such as clinical guidelines and patient education. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

[Distributions of the numbers of monitoring stations in the surveillance of infectious diseases in Japan].

PubMed

Murakami, Y; Hashimoto, S; Taniguchi, K; Nagai, M

1999-12-01

To describe the characteristics of monitoring stations for the infectious disease surveillance system in Japan, we compared the distributions of the number of monitoring stations in terms of population, region, size of medical institution, and medical specialty. The distributions of annual number of reported cases in terms of the type of diseases, the size of medical institution, and medical specialty were also compared. We conducted a nationwide survey of the pediatrics stations (16 diseases), ophthalmology stations (3 diseases) and the stations of sexually transmitted diseases (STD) (5 diseases) in Japan. In the survey, we collected the data of monitoring stations and the annual reported cases of diseases. We also collected the data on the population, served by the health center where the monitoring stations existed, from the census. First, we compared the difference between the present number of monitoring stations and the current standard established by the Ministry of Health and Welfare (MHW). Second, we compared the distribution of all medical institutions in Japan and the monitoring stations in terms of the size of the medical institution. Third, we compared the average number of annual reported cases of diseases in terms of the size of medical institution and the medical specialty. In most health centers, the number of monitoring stations achieved the current standard of MHW, while a few health centers had no monitoring station, although they had a large population. Most prefectures also achieved the current standard of MHW, but some prefectures were well below the standard. Among pediatric stations, the sampling proportion of large hospitals was higher than other categories. Among the ophthalmology stations, the sampling proportion of hospitals was higher than other categories. Among the STD stations, the sampling proportion of clinics of obstetrics and gynecology was lower than other categories. Except for some diseases, it made little difference in the average number of annual reported cases of diseases in terms of the type of medical institution. Among STD, there was a great difference in the average number of annual reported cases of diseases in terms of medical specialty.

The increasing financial impact of chronic kidney disease in australia.

PubMed

Tucker, Patrick S; Kingsley, Michael I; Morton, R Hugh; Scanlan, Aaron T; Dalbo, Vincent J

2014-01-01

The aim of this investigation was to determine and compare current and projected expenditure associated with chronic kidney disease (CKD), renal replacement therapy (RRT), and cardiovascular disease (CVD) in Australia. Data published by Australia and New Zealand Dialysis and Transplant Registry, Australian Institute of Health and Welfare, and World Bank were used to compare CKD-, RRT-, and CVD-related expenditure and prevalence rates. Prevalence and expenditure predictions were made using a linear regression model. Direct statistical comparisons of rates of annual increase utilised indicator variables in combined regressions. Statistical significance was set at P < 0.05. Dollar amounts were adjusted for inflation prior to analysis. Between 2012 and 2020, prevalence, per-patient expenditure, and total disease expenditure associated with CKD and RRT are estimated to increase significantly more rapidly than CVD. RRT prevalence is estimated to increase by 29%, compared to 7% in CVD. Average annual RRT per-patient expenditure is estimated to increase by 16%, compared to 8% in CVD. Total CKD- and RRT-related expenditure had been estimated to increase by 37%, compared to 14% in CVD. Per-patient, CKD produces a considerably greater financial impact on Australia's healthcare system, compared to CVD. Research focusing on novel preventative/therapeutic interventions is warranted.

Boosting enrollment in neurology trials with Local Identification and Outreach Networks (LIONs)

PubMed Central

Kernan, W N.; Viscoli, C M.; DeMarco, D; Mendes, B; Shrauger, K; Schindler, J L.; McVeety, J C.; Sicklick, A; Moalli, D; Greco, P; Bravata, D M.; Eisen, S; Resor, L; Sena, K; Story, D; Brass, L M.; Furie, K L.; Gutmann, L; Hinnau, E; Gorman, M; Lovejoy, A M.; Inzucchi, S E.; Young, L H.; Horwitz, R I.

2009-01-01

Objective: Our purpose was to develop a geographically localized, multi-institution strategy for improving enrolment in a trial of secondary stroke prevention. Methods: We invited 11 Connecticut hospitals to participate in a project named the Local Identification and Outreach Network (LION). Each hospital provided the names of patients with stroke or TIA, identified from electronic admission or discharge logs, to researchers at a central coordinating center. After obtaining permission from personal physicians, researchers contacted each patient to describe the study, screen for eligibility, and set up a home visit for consent. Researchers traveled throughout the state to enroll and follow participants. Outside the LION, investigators identified trial participants using conventional recruitment strategies. We compared recruitment success for the LION and other sites using data from January 1, 2005, through June 30, 2007. Results: The average monthly randomization rate from the LION was 4.0 participants, compared with 0.46 at 104 other Insulin Resistance Intervention after Stroke (IRIS) sites. The LION randomized on average 1.52/1,000 beds/month, compared with 0.76/1,000 beds/month at other IRIS sites (p = 0.03). The average cost to randomize and follow one participant was $8,697 for the LION, compared with $7,198 for other sites. Conclusion: A geographically based network of institutions, served by a central coordinating center, randomized substantially more patients per month compared with sites outside of the network. The high enrollment rate was a result of surveillance at multiple institutions and greater productivity at each institution. Although the cost per patient was higher for the network, compared with nonnetwork sites, cost savings could result from more rapid completion of research. GLOSSARY BMI = body mass index; HIPAA = Health Insurance Portability and Accountability Act; HOMA = homeostastis model assessment of insulin resistance; ICD-9 = International Classification of Diseases, 9th Revision; IRB = institutional review board; IRIS = Insulin Resistance Intervention after Stroke; LION = Local Identification and Outreach Network. PMID:19365056

First comparison of simultaneous IRIS, BUV, and ground-based measurements of total ozone

NASA Technical Reports Server (NTRS)

Prior, E. J.; Oza, B. J.

1978-01-01

In the present paper, the zonally-averaged global distribution of total ozone obtained simultaneously from different measurements are compared with respect to differences in the measured latitudinal and seasonal variations of total ozone. Emphasis is placed on systematic discrepancies that appear to be related to differences in the sensing methodologies or instruments. While the zonal averages of the IRIS and BUV satellite techniques agree quite well at low latitudes, the results are consistently higher for IRIS than for BUV above mid-latitudes in both the Northern and Southern Hemispheres. The BUV and ground-based ultraviolet averages agree better with each other than with infrared IRIS measurements.

Surgical treatment of Lenke 1 thoracic adolescent idiopathic scoliosis with maintenance of kyphosis using the simultaneous double-rod rotation technique.

PubMed

Sudo, Hideki; Ito, Manabu; Abe, Yuichiro; Abumi, Kuniyoshi; Takahata, Masahiko; Nagahama, Ken; Hiratsuka, Shigeto; Kuroki, Kei; Iwasaki, Norimasa

2014-06-15

Retrospective analysis of a prospectively collected, consecutive, nonrandomized series of patients. To assess the surgical outcomes of the simultaneous double-rod rotation technique for treating Lenke 1 thoracic adolescent idiopathic scoliosis (AIS). With the increasing popularity of segmental pedicle screw spinal reconstruction for treating AIS, concerns regarding the limited ability to correct hypokyphosis have also increased. A consecutive series of 32 patients with Lenke 1 main thoracic AIS treated with the simultaneous double-rod rotation technique at our institution was included. Outcome measures included patient demographics, radiographical measurements, and Scoliosis Research Society questionnaire scores. All 32 patients were followed up for a minimum of 2 years (average, 3.6 yr). The average main thoracic Cobb angle correction rate and the correction loss at the final follow-up were 67.8% and 3.3°, respectively. The average preoperative thoracic kyphosis (T5-T12) was 11.9°, which improved significantly to 20.5° (P < 0.0001) at the final follow-up. An increase in thoracic kyphosis was significantly correlated with an increase in lumbar lordosis at the final follow-up (r = 0.42). The average preoperative vertebral rotation angle was 19.7°, which improved significantly after surgery to 14.9° (P = 0.0001). There was no correlation between change in thoracic kyphosis and change in apical vertebral rotation (r =-0.123). The average preoperative total Scoliosis Research Society questionnaire score was 3.0, which significantly improved to 4.4 (P < 0.0001) at the final follow-up. Throughout surgery and even after, there were no instrumentation failures, pseudarthrosis, infection of the surgical site, or clinically relevant neurovascular complications. The simultaneous double-rod rotation technique for treating Lenke 1 AIS provides significant sagittal correction of the main thoracic curve while maintaining sagittal profiles and correcting coronal and axial deformities. 4.

[Financial cost of early rheumatoid arthritis in the first year of medical attention: three clinical scenarios in a third-tier university hospital in Colombia].

PubMed

Mora, Claudia; González, Andrés; Díaz, Jorge; Quintana, Gerardo

2009-03-01

In Colombia, the cost burden of chronic diseases is not well known, either globally or in localized areas of the health system. Rheumatoid arthritis is one of most common chronic diseases, and represents a high cost for the health system. The direct medical costs were estimated for rheumatoid arthritis patients in the in the first year of diagnosis at a level 3 university hospital in Colombia. Three therapy settings for early rheumatoid arthritis patients were established in the first year of diagnosis according to national and international guidelines. Each setting included treatment with disease-modifying anti-rheumatic drugs or biologic therapy based on disease severity as measured by Disease Activity Score 28. All direct medical costs were included: specialized medical care, diagnostic tests and drugs. Cost information was obtained from the Central Military Hospital finance department in Bogotá and the national manual of drug prices based on the "Farmaprecios" 2007 guide, a reference in general use by health institutions. Results. The average of cost of medical care in patients with mild, moderate and severe disease was US $1689, $1805 and $23,441 respectively. The recommended retail prices of the medicines published in "Farmaprecios" was US $1418, $1821 and $31,931. When the charges levied by several major health institutions were compared, substantial increases were noted, US $4936, $7716 and $123,661, respectively. Drug costs represented 86% of total cost, laboratory costs were 10% and medical attention was only 4%. Drugs costs were the principal component of the total direct medical cost, and it increased 40 times when a biological therapy is used. Complete economic evaluation studies are necesary to estimate the viability and clinical relevance of biological therapy for early rheumatoid arthritis.

Robotic total pancreatectomy with or without autologous islet cell transplantation: replication of an open technique through a minimal access approach.

PubMed

Zureikat, Amer H; Nguyen, Trang; Boone, Brian A; Wijkstrom, Martin; Hogg, Melissa E; Humar, Abhinav; Zeh, Herbert

2015-01-01

Total pancreatectomy (TP) is a morbid but sometimes necessary operation. Robotic TP is not often reported but may harbor some advantages compared to the open approach. This manuscript details a single institution's outcomes and technique of robotic TP. An accompanying video demonstrates a robotic TP with auto islet cell transplantation (IAT) in which (1) the arterial blood supply and venous drainage are kept intact until the last step of the TP to minimize warm ischemia time and (2) extirpation of the entire pancreas is performed without dividing the pancreatic neck to maximize islet recovery. This study is a retrospective review of a prospective database of perioperative outcomes of all consecutive robotic TPs at a single institution. This included a single robotic TP with IAT performed on a twenty-year-old patient with chronic pancreatitis. Between 2010 and January 2014, ten robotic TPs were performed (7 males, mean age 58 years), one of which included an IAT. Median body mass index was 28. Indications were intraductal papillary mucinous neoplasms (6), pancreatic adenocarcinoma (1), and chronic pancreatitis (3). The median operative time was 560 min with a median estimated blood loss of 650 ml. One case was converted to laparotomy. Ninety days mortality and Clavien III-IV complication rate were 0 and 20 %, respectively. The average length of stay was 10 ± 3 days, with only 1 readmission within 90 days. The single TP and IAT were completed successfully without conversion, and were achieved without division of the pancreatic neck thereby maintaining vascular inflow to an entire specimen up until extraction. This represents the largest series of robotic TP, demonstrating its safety and feasibility. Additionally, TP and IAT using the technique described above can be recapitulated using the robotic approach.

Dietary intake and nutritional deficiencies in patients with diabetic or idiopathic gastroparesis.

PubMed

Parkman, Henry P; Yates, Katherine P; Hasler, William L; Nguyan, Linda; Pasricha, Pankaj J; Snape, William J; Farrugia, Gianrico; Calles, Jorge; Koch, Kenneth L; Abell, Thomas L; McCallum, Richard W; Petito, Dorothy; Parrish, Carol Rees; Duffy, Frank; Lee, Linda; Unalp-Arida, Aynur; Tonascia, James; Hamilton, Frank

2011-08-01

Gastroparesis can lead to food aversion, poor oral intake, and subsequent malnutrition. We characterized dietary intake and nutritional deficiencies in patients with diabetic and idiopathic gastroparesis. Patients with gastroparesis on oral intake (N = 305) were enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Registry and completed diet questionnaires at 7 centers. Medical history, gastroparesis symptoms, answers to the Block Food Frequency Questionnaire, and gastric emptying scintigraphy results were analyzed. Caloric intake averaged 1168 ± 801 kcal/day, amounting to 58% ± 39% of daily total energy requirements (TER). A total of 194 patients (64%) reported caloric-deficient diets, defined as <60% of estimated TER. Only 5 patients (2%) followed a diet suggested for patients with gastroparesis. Deficiencies were present in several vitamins and minerals; patients with idiopathic disorders were more likely to have diets with estimated deficiencies in vitamins A, B(6), C, K, iron, potassium, and zinc than diabetic patients. Only one-third of patients were taking multivitamin supplements. More severe symptoms (bloating and constipation) were characteristic of patients who reported an energy-deficient diet. Overall, 32% of patients had nutritional consultation after the onset of gastroparesis; consultation was more likely among patients with longer duration of symptoms and more hospitalizations and patients with diabetes. Multivariable logistic regression analysis indicated that nutritional consultation increased the chances that daily TER were met (odds ratio, 1.51; P = .08). Many patients with gastroparesis have diets deficient in calories, vitamins, and minerals. Nutritional consultation is obtained infrequently but is suggested for dietary therapy and to address nutritional deficiencies. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

The Use of Learning Strategies in Distance Learning: Comparing between Public Institutions

ERIC Educational Resources Information Center

Alliprandini, Paula Mariza Zedu

2018-01-01

The objective of this article was to examine the use of learning strategies used by students of distance learning, enrolled in courses from two public institutions. A total of 821 students took part in the research, 532 of them from the South Institution and 289 from the Midwest Institution of Brazil. Data was composed from the factors: emotion…

Transformational Leadership Characteristics of College and University Presidents of Private, Title III and Title V-Eligible Institutions

ERIC Educational Resources Information Center

Hempowicz, Christine D.

2010-01-01

The purpose of this study was to investigate the transformational leadership characteristics of college and university presidents of private Title III and Title V-eligible institutions. Private institutions of higher education comprise approximately half of the total post-secondary institutions in the U.S. However, they are at greater risk for…

Accounting for heterogeneous treatment effects in the FDA approval process.

PubMed

Malani, Anup; Bembom, Oliver; van der Laan, Mark

2012-01-01

The FDA employs an average-patient standard when reviewing drugs: it approves a drug only if is safe and effective for the average patient in a clinical trial. It is common, however, for patients to respond differently to a drug. Therefore, the average-patient standard can reject a drug that benefits certain patient subgroups (false negatives) and even approve a drug that harms other patient subgroups (false positives). These errors increase the cost of drug development - and thus health care - by wasting research on unproductive or unapproved drugs. The reason why the FDA sticks with an average patient standard is concern about opportunism by drug companies. With enough data dredging, a drug company can always find some subgroup of patients that appears to benefit from its drug, even if the subgroup truly does not. In this paper we offer alternatives to the average patient standard that reduce the risk of false negatives without increasing false positives from drug company opportunism. These proposals combine changes to institutional design - evaluation of trial data by an independent auditor - with statistical tools to reinforce the new institutional design - specifically, to ensure the auditor is truly independent of drug companies. We illustrate our proposals by applying them to the results of a recent clinical trial of a cancer drug (motexafin gadolinium). Our analysis suggests that the FDA may have made a mistake in rejecting that drug.

Biomass burning signals over the South Atlantic Ocean before and during the El Niño event of 2015/16

NASA Astrophysics Data System (ADS)

Arnold, Sabrina G.; Feist, Dietrich G.; Marshall, Julia; Guillermo Nuñez Ramirez, Tonatiuh

2017-04-01

The Max Planck Institute for Biogeochemistry (MPI-BGC) has been operating a Fourier-Transform Spectrometer (FTS) on Ascension Island (8° S, 14° W) as part of the Total Carbon Column Observation Network (TCCON). Since 2012, this instrument has been observing column-averaged dry-air mole fractions (commonly referred to as Xgas) of greenhouse gases like CO2, CH4, CO, N2O and others. Due to its location in the southern trade wind zone, the station is downwind from Africa most of the time. Different parts of the total column above the station are influenced by fluxes from different regions. Especially the lower layers of the free troposphere just above the planetary boundary layer (PBL) show strong biomass burning signals. XCH4 and especially XCO are strongly enhanced during the northern and southern African burning seasons. For XCO, enhancements of 50-100% in the total column can be observed on the time scale of days. Transport model simulations suggest that biomass burning signals from as far as the Eastern Indian Ocean may be detected over Ascension Island. Most of these effects are not visible from observations in the PBL. The 5-year time series allows a first look at the effect of the 2015/16 El Niño on the biomass burning patterns in the Southern Hemisphere.

Auxiliary total artificial heart: A compact electromechanical artificial heart working simultaneously with the natural heart.

PubMed

Andrade, A; Nicolosi, D; Lucchi, J; Biscegli, J; Arruda, A C; Ohashi, Y; Mueller, J; Tayama, E; Glueck, J; Nosé, Y

1999-09-01

Leading international institutions are designing and developing various types of ventricular assist devices (VAD) and total artificial hearts (TAH). Some of the commercially available pulsatile VADs are not readily implantable into the thoracic cavity of smaller size patients because of size limitation. The majority of the TAH dimensions requires the removal of the patients' native heart. A miniaturized artificial heart, the auxiliary total artificial heart (ATAH), is being developed in these authors' laboratories. This device is an electromechanically driven ATAH using a brushless direct current (DC) motor fixed in a center metallic piece. This pusher plate-type ATAH control is based on Frank-Starling's law. The beating frequency is regulated through the change of the left preload, assisting the native heart in obtaining adequate blood flow. With the miniaturization of this pump, the average sized patient can have the surgical implantation procedure in the right thoracic cavity without removing the native heart. The left and right stroke volumes are 35 and 32 ml, respectively. In vitro tests were conducted, and the performance curves demonstrate that the ATAH produces 5 L/min of cardiac output at 180 bpm (10 mmHg of left inlet mean pressure and 100 mm Hg of left outlet mean pressure). Taking into account that this ATAH is working along with the native heart, this output is more than satisfactory for such a device.

[Current status of costs and utilizations of hospital based home health nursing care in Korea].

PubMed

Ryu, Hosihn

2006-12-01

The purpose of this study was to describe the current status of utilization and costs of home health nursing care by the levels of medical institutes in Korea. A secondary analysis of existing data was used from the national electronic data information(EDI) of 148 home health agencies for 6 months from May to Oct 2005 in total. The 148 agencies had multiple services in cerebral infaction, essential hypertension, sequela of cerebrovascular disease, type 2 diabetes mellitus, etc.. The highest 10 rankings of 76 categories of home health nursing services were composed of 96.4% of the total services, such as simple treatment, inflammatory treatment, urethra & bladder irrigation, inserting indwelling catheter etc., in that order. The highest 20 rankings of 226 categories of home examination services were composed of 77.0% of the total home examination services. In addition, the average cost of home health care per visit was 46,088 Won ( approximately 48 $, 1 $=960 Won). The costs ranged from 74,523 Won ( approximately 78 $, loss of chronic kidney function, N18) to 32,270 Won ( approximately 34 $, other cerebrovascular diseases, I67). Results suggest that client characteristics of hospital based HHNC are not different from community based HHNC or visiting nursing services for elderly. The national results will contribute to baseline data used to establish a policy for the home health nursing care system and education.

Total Quality Management: Statistics and Graphics III - Experimental Design and Taguchi Methods. AIR 1993 Annual Forum Paper.

ERIC Educational Resources Information Center

Schwabe, Robert A.

Interest in Total Quality Management (TQM) at institutions of higher education has been stressed in recent years as an important area of activity for institutional researchers. Two previous AIR Forum papers have presented some of the statistical and graphical methods used for TQM. This paper, the third in the series, first discusses some of the…

Metrics associated with NIH funding: a high-level view

PubMed Central

Jordan, Paul

2011-01-01

Objective To introduce the availability of grant-to-article linkage data associated with National Institutes of Health (NIH) grants and to perform a high-level analysis of the publication outputs and impacts associated with those grants. Design Articles were linked to the grants they acknowledge using the grant acknowledgment strings in PubMed using a parsing and matching process as embodied in the NIH Scientific Publication Information Retrieval & Evaluation System system. Additional data from PubMed and citation counts from Scopus were added to the linkage data. The data comprise 2 572 576 records from 1980 to 2009. Results The data show that synergies between NIH institutes are increasing over time; 29% of current articles acknowledge grants from multiple institutes. The median time lag to publication for a new grant is 3 years. Each grant contributes to approximately 1.7 articles per year, averaged over all grant types. Articles acknowledging US Public Health Service (PHS, which includes NIH) funding are cited twice as much as US-authored articles acknowledging no funding source. Articles acknowledging both PHS funding and a non-US government funding source receive on average 40% more citations that those acknowledging PHS funding sources alone. Conclusion The US PHS is effective at funding research with a higher-than-average impact. The data are amenable to further and much more detailed analysis. PMID:21527408

An investigation of ADA compliance of aquatic facilities in the North Texas area.

PubMed

Pike, Hilary; Walker, Joseph; Collins, John; Hodges, Jan

2008-01-01

The study expands research on accessibility, comparing compliance scores of aquatic facilities in North Texas built before the 1991 Title III Americans with Disabilities Act Accessibility Guidelines (ADAAG) with facilities built after the 1991 ADAAG and the proposed 2002 supplement. A quasi-experimental design directed the selection of 52 facilities where measurements were taken to determine compliance with ADAAG and the supplement. A focus group provided insight into interpreting which features functioned as barriers or constraints to participation. Metropolitan statistical area in North Texas. A total of 52 aquatic facilities and 12 focus group participants (University of North Texas institutional review board 07-283). ADA aquatic facility compliance instrument. Frequency, ratios. No facilities were 100% ADA compliant overall, although some facilities were 100% compliant with specific structural domains. Women's restrooms rated lowest (average = 55%), and men's restrooms received the second lowest rating (average = 64%). Focus group results indicated that improperly designed restrooms and pool entries are primary barriers to participation. The findings support a need for stronger enforcement of policies that improve accessibility of facilities. Architectural reviews and construction practices need to be improved. The structural barriers and constraints identified can be limiting factors in efforts aimed at increasing physical activity among individuals with disabilities and individuals with physical limitations.

A Community-Driven Intervention for Improving Biospecimen Donation in African American Communities.

PubMed

Patel, Kushal; Inman, Wendelyn; Gishe, Jemal; Johnson, Owen; Brown, Elizabeth; Kanu, Mohamed; Theriot, Rosemary; Sanderson, Maureen; Hull, Pamela; Hargreaves, Margaret

2018-02-01

Human biospecimens are an invaluable resource for addressing cancers and other chronic diseases. The purpose of this study was to assess the impact of an educational intervention on biospecimen knowledge and attitudes. The participants consisted of 112 African Americans, 18 years and older, and who had not provided biospecimens for any health-related research in the past. A total of 55 participants received the educational brochure, and 57 received the educational video. The main outcomes of the study were knowledge and attitudes for biospecimen donation. This information was collected pre- and post-intervention. The average knowledge scores increased (p < 0.0001) and the average attitude scores for biospecimen donation improved (p < 0.0001) post-intervention for both the video and brochure conditions. There was an interaction between the intervention condition and knowledge where the participants who received the educational video showed a greater increase in knowledge pre-to-post compared to those who received the educational brochure (p = 0.0061). There were no significant interactions between the two intervention conditions for attitudes toward biospecimen donation. The results of this study demonstrated the feasibility and efficacy of an academic institution collaborating with the African American community in developing educational tools for biospecimen donation.

[Bronchoscopy in Germany. Cross-sectional inquiry with 681 institutions].

PubMed

Markus, A; Häussinger, K; Kohlhäufl, M; Hauck, R W

2000-11-01

Bronchoscopy represents an integral part of the diagnostic tools in pulmonary medicine. Recently, it has also gained considerable attention for its therapeutic properties. To elucidate equipment, indications and procedural techniques of bronchoscopy units, a retrospective survey of 1232 hospitals and practices is conducted. 687 questionnaires are received back (response rate 56%). 681 of which are statistically evaluated. Two thirds of the physicians in charge are internists, one third are pulmonary care specialists. A total of 200,596 endoscopic procedures is included. The majority of procedures is done with an average of 3 bronchoscopists and in over 57% (388) of cases with an average number of 100 or less procedures per year. The five main indications are tumor, hemoptysis, infection or pneumonia, drainage of secretions and suspected interstitial disease. Overall complication rate amounts to 2.7% with an incidence of 4.6% minor and 0.7% major complications and a bronchoscopy-related mortality of 0.02%. The patterns seen in premedication, intra- and post-procedural monitoring, disinfection practices as well as documentation are quite heterogeneous. It is suggested to establish revised and updated standards for bronchoscopy, which should take the data collected into particular account. Those standards should provide the basis for a high level bronchological care throughout Germany.

Do Community Characteristics Relate to Young Adult College Students' Credit Card Debt? The Hypothesized Role of Collective Institutional Efficacy.

PubMed

Friedline, Terri; West, Stacia; Rosell, Nehemiah; Serido, Joyce; Shim, Soyeon

2017-03-01

This study examines the extent of emergent, outstanding credit card debt among young adult college students and investigates whether any associations existed between this credit card debt and the characteristics of the communities in which these students grew up or lived. Using data (N = 748) from a longitudinal survey and merging community characteristics measured at the zip code level, we confirmed that a community's unemployment rate, average total debt, average credit score, and number of bank branch offices were associated with a young adult college student's acquisition and accumulation of credit card debt. For example, a community's higher unemployment rate and lower number of bank branches were associated with a young adult college student's greater accumulated debt. Community characteristics had the strongest associations with credit card debt, especially after controlling for individual characteristics (i.e., a young adult college student's race and financial independence) and familial characteristics (i.e., their parents' income and parents' discussions of financial matters while growing up at home). The findings may help to understand the unique roles that communities play in shaping children and young adults' financial capability, and how communities can be better capacitated to support the financial goals of their residents. © Society for Community Research and Action 2017.

Comparative cost analysis of housing and case management program for chronically ill homeless adults compared to usual care.

PubMed

Basu, Anirban; Kee, Romina; Buchanan, David; Sadowski, Laura S

2012-02-01

To assess the costs of a housing and case management program in a novel sample-homeless adults with chronic medical illnesses. The study used data from multiple sources: (1) electronic medical records for hospital, emergency room, and ambulatory medical and mental health visits; (2) institutional and regional databases for days in respite centers, jails, or prisons; and (3) interviews for days in nursing homes, shelters, substance abuse treatment centers, and case manager visits. Total costs were estimated using unit costs for each service. Randomized controlled trial of 407 homeless adults with chronic medical illnesses enrolled at two hospitals in Chicago, Illinois, and followed for 18 months. Compared to usual care, the intervention group generated an average annual cost savings of (-)$6,307 per person (95 percent CI: -16,616, 4,002; p = .23). Subgroup analyses of chronically homeless and those with HIV showed higher per person, annual cost savings of (-)$9,809 and (-)$6,622, respectively. Results were robust to sensitivity analysis using unit costs. The findings of this comprehensive, comparative cost analyses demonstrated an important average annual savings, though in this underpowered study these savings did not achieve statistical significance. © Health Research and Educational Trust.

The Use of Ultrasound to Improve Axillary Vein Access and Minimize Complications during Pacemaker Implantation.

PubMed

Esmaiel, Abdullah; Hassan, Jeremy; Blenkhorn, Fay; Mardigyan, Vartan

2016-05-01

The Agency for Healthcare Research and Quality in the United States recommends the use of ultrasound (US) for central venous access to improve patient outcomes. However, in a recent publication, US is still underutilized for axillary vein access during pacemaker implantation. We sought to describe a technique for US-guided axillary vein access during pacemaker implantation and to report complication rates and success rate. Retrospective data collection included success rate and complications on all pacemaker implants by one operator since implementing the systematic use of US at our institution, from November 2012 to January 2015. For the last 59 cases, data were collected prospectively to include time of venous access and number of attempts. A total of 403 consecutive patients were included in the analysis. Two leads were implanted in 255 cases and one lead was implanted in 148 cases. The rate of successful US-guided access was 99.25%. There were no access-related complications. The average number of venipuncture attempts was 1.18 per patient. The average time to obtain venous access was 2.24 minutes including the time to apply the sterile US sleeve. The described technique has the potential to improve the success rate of axillary vein access and minimize complications during pacemaker implantation. ©2016 Wiley Periodicals, Inc.

The effects of the addition of a pediatric surgery fellow on the operative experience of the general surgery resident.

PubMed

Raines, Alexander; Garwe, Tabitha; Adeseye, Ademola; Ruiz-Elizalde, Alejandro; Churchill, Warren; Tuggle, David; Mantor, Cameron; Lees, Jason

2015-06-01

Adding fellows to surgical departments with residency programs can affect resident education. Our specific aim was to evaluate the effect of adding a pediatric surgery (PS) fellow on the number of index PS cases logged by the general surgery (GS) residents. At a single institution with both PS and GS programs, we examined the number of logged cases for the fellows and residents over 10 years [5 years before (Time 1) and 5 years after (Time 2) the addition of a PS fellow]. Additionally, the procedure related relative value units (RVUs) recorded by the faculty were evaluated. The fellows averaged 752 and 703 cases during Times 1 and 2, respectively, decreasing by 49 (P = 0.2303). The residents averaged 172 and 161 cases annually during Time 1 and Time 2, respectively, decreasing by 11 (P = 0.7340). The total number of procedure related RVUs was 4627 and 6000 during Times 1 and 2, respectively. The number of cases logged by the PS fellows and GS residents decreased after the addition of a PS fellow; however, the decrease was not significant. Programs can reasonably add an additional PS fellow, but care should be taken especially in programs that are otherwise static in size.

Examining the Relationships of Component Reading Skills to Reading Comprehension in Struggling Adult Readers: A Meta-Analysis.

PubMed

Tighe, Elizabeth L; Schatschneider, Christopher

2016-07-01

The current study employed a meta-analytic approach to investigate the relative importance of component reading skills to reading comprehension in struggling adult readers. A total of 10 component skills were consistently identified across 16 independent studies and 2,707 participants. Random effects models generated 76 predictor-reading comprehension effect sizes among the 10 constructs. The results indicated that six of the component skills exhibited strong relationships with reading comprehension (average rs ≥ .50): morphological awareness, language comprehension, fluency, oral vocabulary knowledge, real word decoding, and working memory. Three of the component skills yielded moderate relationships with reading comprehension (average rs ≥ .30 and < .50): pseudoword decoding, orthographic knowledge, and phonological awareness. Rapid automatized naming (RAN) was the only component skill that was weakly related to reading comprehension (r = .15). Morphological awareness was a significantly stronger correlate of reading comprehension than phonological awareness and RAN. This study provides the first attempt at a systematic synthesis of the recent research investigating the reading skills of adults with low literacy skills, a historically understudied population. Directions for future research, the relation of our results to the children's literature, and the implications for researchers and adult basic education programs are discussed. © Hammill Institute on Disabilities 2014.

Tobacco advertising in communities: associations with race and class.

PubMed

Barbeau, Elizabeth M; Wolin, Kathleen Y; Naumova, Elena N; Balbach, Edith

2005-01-01

Individuals of lower socioeconomic position smoke at higher rates than those of higher socioeconomic position. Because of this disparity, the National Cancer Institute has called for studies of targeted tobacco marketing to clarify mechanisms contributing to higher tobacco use among low-income Americans and other high-risk populations. We observed tobacco industry marketing in six Boston area communities (two of high socioeconomic position and four of low position; total of 41 observations) and in selected print publications that circulated in those communities during a 22-month period in 2000-2002. On average, there were fewer tobacco advertisements in the higher socioeconomic communities, compared to the lower socioeconomic communities (P < 0.001). In the low socioeconomic communities, there were more than three times as many brand advertisements as youth access signs (P = 0.0012). Although brand advertisements outnumbered smoke-free signs, on average, there was no difference in the ratio of brand advertisements to smoke-free signs in low and high socioeconomic communities (P = 0.06). The tobacco industry is actively present in community settings, particularly in communities with a low socioeconomic profile (SEP). Tobacco control researchers and advocates need to continue to monitor the tobacco industry's behavior at the community level and develop strategies to counter this behavior.

Quantitative analysis of global veterinary human resources.

PubMed

Kouba, V

2003-12-01

This analysis of global veterinary personnel was based on the available quantitative data reported by individual countries to international organisations. The analysis begins with a time series of globally reported numbers of veterinarians, starting in the year 1959 (140,391). In 2000 this number reached 691,379. Of this total, 27.77% of veterinarians were working as government officials, 15.38% were working in laboratories, universities and training institutions and 46.33% were working as private practitioners. The ratio of veterinarians to technicians was 1:0.63. The global average of resources serviced by each veterinarian was as follows: 8,760 inhabitants; 189 km2 of land area and 20 km2 of arable land; 1,925 cattle, 242 buffaloes, 87 horses, 1,309 pigs, 1,533 sheep and 20,714 chickens; in abattoirs: 401 slaughtered cattle, 699 slaughtered sheep and 1,674 slaughtered pigs; the production of 336 tonnes (t) of meat, 708 t cow milk and 74 t hen eggs; in international trade: 12 cattle, 23 sheep, 22 pigs, 1 horse, 1,086 chickens, 33 t meat and meat products; 2,289 units of livestock (50 minutes of annual veterinary working time for each unit). These averages were also analysed according to employment categories. The author also discusses factors influencing veterinary personnel analyses and planning.

Costs and outcomes associated with IVF using recombinant FSH.

PubMed

Ledger, W; Wiebinga, C; Anderson, P; Irwin, D; Holman, A; Lloyd, A

2009-09-01

Cost and outcome estimates based on clinical trial data may not reflect usual clinical practice, yet they are often used to inform service provision and budget decisions. To expand understanding of assisted reproduction treatment in clinical practice, an economic evaluation of IVF/intracytoplasmic sperm injection (ICSI) data from a single assisted conception unit (ACU) in England was performed. A total of 1418 IVF/ICSI cycles undertaken there between October 2001 and January 2006 in 1001 women were analysed. The overall live birth rate was 22% (95% CI: 19.7-24.2), with the 30- to 34-year age group achieving the highest rate (28%). The average recombinant FSH (rFSH) dose/cycle prescribed was 1855 IU. Average cost of rFSH/cycle was 646 pound(SD: 219 pound), and average total cost/cycle was 2932 pound (SD: 422 pound). Economic data based on clinical trials informing current UK guidance assumes higher doses of rFSH dose/cycle (1750-2625 IU), higher average cost of drugs/cycle (1179 pound), and higher average total cost/cycle (3266 pound). While the outcomes in this study matched UK averages, total cost/cycle was lower than those cited in UK guidelines. Utilizing the protocols and (lower) rFSH dosages reported in this study may enable other ACU to provide a greater number of IVF/ICSI cycles to patients within given budgets.

Proceedings of the NSW Thermal Workshop, Held in Virginia Beach, Virginia on 16-17 September 1991

DTIC Science & Technology

1992-09-01

average of only 1.2 ’C over the 4- and 6-hour trials. HOT/DRY STRESS PHYSIOLOGICAL RESPONSES Heat stroke: we see a rapid rise in core temperature to...protective measurement? And yet, my data will show an average low core temperature for all the "guys." Say these two guys are average or got to 350 C. 125...nations. LARRY W. LAUGHLIN CAPT, MC, USN Commanding Officer Naval Medical Research institute SJUpl’rtfV StIICAICION Oi iMi PACA REPORT DOCUMENTATION

Eight-Year Trends in Federal Graduation Rates and Graduation Success Rates at NCAA Division I Institutions

ERIC Educational Resources Information Center

National Collegiate Athletic Association (NJ1), 2009

2009-01-01

Data is presented on: (1) Comparison of GSR and Federal Graduation Rate Cohorts (1999-2002 Entering Classes); (2) Average GSRs for Division I Student-Athletes in 1998-01 Cohorts Vs. 1999-2002 Cohorts; (3) Graduation Success Rate Trends for Division I Men's Sports: Four-Class Averages for 1998-01 Cohorts vs. 1999-02 Cohorts; (4) Graduation Success…

The Introduction of a New Grading System at a Public Teaching Institution: Impact on Grading Tendencies of the Faculty.

ERIC Educational Resources Information Center

Felder, Nathaniel L.

The grading system at the University of North Carolina at Asheville before fall 1978 provided four designations: H (honors); G (good or well above average); P (pass or satisfactory); and F (failure). This range does not provide a grade for unsatisfactory but passing work. It was suspected that this led teachers to give "average" grades…

American Association of State Colleges and Universities Annual Survey of Tuition and Fees and Room and Board Charges, 1980-81.

ERIC Educational Resources Information Center

American Association of State Colleges and Universities, Washington, DC.

In 1980, full-time state resident undergraduate students attending AASCU-member institutions paid an average of $712 for tuition and fees, and $1,605 for room and board charges. These figures reflect a 10.6 percent average increase over 1979 costs. Including books and supplies, transportation, and personal expenses, the cost of college attendance…

A Note on Spatial Averaging and Shear Stresses Within Urban Canopies

NASA Astrophysics Data System (ADS)

Xie, Zheng-Tong; Fuka, Vladimir

2018-04-01

One-dimensional urban models embedded in mesoscale numerical models may place several grid points within the urban canopy. This requires an accurate parametrization for shear stresses (i.e. vertical momentum fluxes) including the dispersive stress and momentum sinks at these points. We used a case study with a packing density of 33% and checked rigorously the vertical variation of spatially-averaged total shear stress, which can be used in a one-dimensional column urban model. We found that the intrinsic spatial average, in which the volume or area of the solid parts are not included in the average process, yield greater time-spatial average of total stress within the canopy and a more evident abrupt change at the top of the buildings than the comprehensive spatial average, in which the volume or area of the solid parts are included in the average.

Immigration to the U.S.: The Unfinished Story.

ERIC Educational Resources Information Center

Bouvier, Leon F.; Gardner, Robert W.

1986-01-01

Several times early in the twentieth century total annual immigration exceeded one million people. Current immigration figures may match those record totals. Since 1979, legal immigrants have averaged 566,000 a year; newly arrived refugees and asylees approved have averaged 135,000; and the "settled" illegal immigrant population may be…

Longer biopsy cores do not increase prostate cancer detection rate: A large-scale cohort study refuting cut-off values indicated in the literature

PubMed Central

Yılmaz, Hasan; Yavuz, Ufuk; Üstüner, Murat; Çiftçi, Seyfettin; Yaşar, Hikmet; Müezzinoğlu, Bahar; Uslubaş, Ali Kemal; Dillioğlugil, Özdal

2017-01-01

Objective Only a few papers in the literature aimed to evaluate biopsy core lengths. Additionally, studies evaluated the core length with different approaches. We aimed to determine whether prostate cancer (PCa) detection is affected from core lengths according to three different approaches in a large standard cohort and compare our cut-off values with the published cut-offs. Material and methods We retrospectively analyzed 1,523 initial consecutive transrectal ultrasound-guided 12-core prostate biopsies. Biopsies were evaluated with respect to total core length (total length of each patients’ core) average core length (total core length divided by total number of cores in each patient), and mean core length (mean length of all cores pooled), and compared our cut-off values with the published cut-offs. The prostate volumes were categorized into four groups (<30, 30–59.99, 60–119.99, ≥120 cm3) and PCa detection rates in these categories were examined. Results PCa was found in 41.5% patients. There was no difference between benign and malignant mean core lengths of the pooled cores (p>0.05). Total core length and average core length were not significantly associated with PCa in multivariate logistic regression analyses (p>0.05). The core lengths (mean, average and total core lengths) increased (p<0.001) and PCa rates decreased (p<0.001) steadily with increasing prostate volume categories. PCa percentages decreased in all categories above the utilized cut-offs for mean (p>0.05), average (p<0.05), and total core lengths (p>0.05). Conclusion There was no difference between mean core lengths of benign and malignant cores. Total core length and average core length were not significantly associated with PCa. Contrary to the cut-offs used for mean and average core lengths in the published studies, PCa rates decrease as these core lengths increase. Larger studies are necessary for the determination and acceptance of accurate cut-offs. PMID:28861301

Research Productivity and Its Policy Implications in Higher Education Institutions

ERIC Educational Resources Information Center

Quimbo, Maria Ana T.; Sulabo, Evangeline C.

2014-01-01

Responding to the Commission on Higher Education's development plan of enhancing research culture among higher education institutions, this study was conducted to analyze the research productivity of selected higher education institutions. It covered five state universities in the Philippines where a total of 377 randomly selected faculty members…

Organizational Effectiveness Evaluation for Higher Education Institutions, Ministry of Tourism and Sports

ERIC Educational Resources Information Center

Kraipetch, Chanita; Kanjanawasee, Sirichai; Prachyapruit, Apipa

2013-01-01

The present research was aimed to: 1) develop the components and indicators of organizational effectiveness for public higher education institutions under the Ministry of Tourism and Sports, Thailand, and 2) develop organizational effectiveness evaluation system for these institutions. The sample included total 41 participants comprising…

How Students Use Federal, State and Institutional Aid to Pay for College: A Primer for State Policymakers. Special Report

ERIC Educational Resources Information Center

Sarubbi, Molly; Pingel, Sarah

2018-01-01

Postsecondary education is one of the largest investments that students and their families make, with average yearly cost of attendance--including tuition, fees, room and board--of just under $17,000 to attend a public institution in the 2015-16 academic year. In the context of increasing college costs, aid dollars have failed to keep pace with…

Big Gaps, Small Gaps: Some Colleges and Universities Do Better than Others in Graduating African-American Students. College Results Online

ERIC Educational Resources Information Center

Lynch, Mamie; Engle, Jennifer

2010-01-01

In this brief, the authors share what they are learning from looking beneath the averages. They identify public and private four-year institutions that appear to serve their black and white students equally well--that is, where both groups graduate at similar rates. They also identify public and private institutions that have a lot of work to do…

High Outpatient Visits among People with Intellectual Disabilities Caring in a Disability Institution in Taipei: A 4-Year Survey

ERIC Educational Resources Information Center

Lin, Jin-Ding; Loh, Ching-Hui; Choi, Im-Cheng; Yen, Chia-Feng; Hsu, Shang-Wei; Wu, Jia-Ling; Chu, Cordia M.

2007-01-01

Few studies reported in the literature have addressed the long-term trend of the use of medical care for people with intellectual disabilities (ID) in institutions. The subject cohort in this study was made of 168 individuals with ID in a public residential facility from 1999 to 2002 in Taipei, Taiwan. The average age of participants was 19.3…

[Mortality rates of circulatory system diseases and malignant neoplasms in Zagreb population younger than sixty-five--call for alarm].

PubMed

Vizintin, Marina Polić; Mrcela, Nada Tomasović; Kovacić, Luka

2012-12-01

The aim of this work was to analyze the public health indicators for circulatory heart diseases and malignant neoplasms in the population younger than 65 in the City of Zagreb, Croatia, and compare them with the European Union (EU) countries. The purpose was to evaluate the situation and propose the public health preventive measures. The study population were Zagreb citizens aged 0-64 according to the 2001 census. Total Zagreb population was 779145, making 17.6% of total Croatian population. Data from the Croatian Bureau of Statistics and Dr Andrija Stampar Institute of Public Health were used. The standardized 0-64 mortality rates of the selected diseases 2006-2010 were used in the analysis. In 2010, the standardized mortality rates of all analyzed diseases were significantly higher in Zagreb population aged 0-64 than the EU averages except for cervical cancer. In 2010, the mortality rates in Zagreb population aged 0-64 were as follows: circulatory system diseases 61.22, ischemic heart disease 28.99, cerebrovascular diseases 12.51, malignant neoplasms 94.69, tracheal and lung cancer 24.92, breast cancer 21.08 and cervical cancer 2.05. Standardized mortality rates in Zagreb population aged 0-64 for circulatory system were lower than for Croatia (61.22 vs. 63.25), but higher for malignant neoplasms (94.69 vs. 91.2), except for cervical cancer (2.05 vs. 3.14). High standardized mortality rates for the selected diseases in the City of Zagreb, Croatia, were observed. The rates were higher in Zagreb population compared to EU averages except for cervical cancer. This situation urges revision of the public health strategy and implementation of more intensive preventive and screening measures to reduce the risk factors.

Pilot Study of iPad Incorporation Into Graduate Medical Education.

PubMed

Lobo, Mark J; Crandley, Edwin F; Rumph, Jake S; Kirk, Susan E; Dunlap, Neal E; Rahimi, Asal S; Turner, A Benton; Larner, James M; Read, Paul W

2013-03-01

Increased documentation and charting requirements are challenging for residents, given duty hour limits. Use of mobile electronic devices may help residents complete these tasks efficiently. To collect initial data on usage rates, information technology (IT) support requirements, and resident use of iPads during training. In this pilot study, we provided 12 residents/fellows from various specialties at the University of Virginia with an iPad with IT support. The system used a virtual private network with access to the institution's electronic health record. Participants were allowed to develop their own methods and systems for personalized iPad use, and after 9 months they provided data on the utility of the iPad. Feedback from the IT team also was obtained. Average iPad use was 2.1 h/d (range, 0.5-6 h/d). The average self-reported reduction in administrative work due to the iPad was 2.7 h/wk (range, 0-9 h/wk). A total of 75% (9 of 12) of the users would recommend universal adoption among residents and fellows. More than 90% (11 of 12) of users reported the iPad would improve communication for coordination of care. A total of 68% (8 of 12) of users reported that an iPad facilitated their activities as educators of medical students and junior residents. Residents cited slow data entry into the electronic health record and hospital areas lacking Wi-Fi connectivity as potential drawbacks to iPad use. The IT team reported minimal support time for device setup, maintenance, and upgrades, and limited security risks. The iPad may contribute to increased clinical efficiency, reduced hours spent on administrative tasks, and enhanced educational opportunities for residents, with minimal IT support.

Economic impact of enoxaparin versus unfractionated heparin for venous thromboembolism prophylaxis in patients with acute ischemic stroke: a hospital perspective of the PREVAIL trial.

PubMed

Pineo, Graham; Lin, Jay; Stern, Lee; Subrahmanian, Tarun; Annemans, Lieven

2012-03-01

The PREVAIL (Prevention of VTE [venous thromboembolism] after acute ischemic stroke with LMWH [low-molecular-weight heparin] and UFH [unfractionated heparin]) study demonstrated a 43% VTE risk reduction with enoxaparin versus UFH in patients with acute ischemic stroke (AIS). A 1% rate of symptomatic intracranial and major extracranial hemorrhage was observed in both groups. To determine the economic impact, from a hospital perspective, of enoxaparin versus UFH for VTE prophylaxis after AIS. A decision-analytic model was constructed and hospital-based costs analyzed using clinical information from PREVAIL. Total hospital costs were calculated based on mean costs in the Premier™ database and from wholesalers acquisition data. Costs were also compared in patients with severe stroke (National Institutes of Health Stroke Scale [NIHSS] score ≥14) and less severe stroke (NIHSS score <14). The average cost per patient due to VTE or bleeding events was lower with enoxaparin versus UFH ($422 vs $662, respectively; net savings $240). The average anticoagulant cost, including drug-administration cost per patient, was lower with UFH versus enoxaparin ($259 vs $360, respectively; net savings $101). However, when both clinical events and drug-acquisition costs were considered, the total hospital cost was lower with enoxaparin versus UFH ($782 vs $922, respectively; savings $140). Hospital cost-savings were greatest ($287) in patients with NIHSS scores ≥14. The higher drug cost of enoxaparin was offset by the reduction in clinical events as compared to the use of UFH for VTE prophylaxis after an AIS, particularly in patients with severe stroke. Copyright © 2011 Society of Hospital Medicine.

Impact of ledipasvir/sofosbuvir on the work productivity of genotype 1 chronic hepatitis C patients in Asia.

PubMed

Younossi, Z M; Chan, H L Y; Dan, Y Y; Lee, M H; Lim, Y-S; Kruger, E; Tan, S C

2018-03-01

Chronic, untreated hepatitis C virus (HCV) infection is associated with a poor clinical prognosis and a detrimental impact on patients' lives, including on work productivity. To estimate the value of productivity losses due to genotype 1 (GT1) HCV infection in Hong Kong, Singapore, South Korea and Taiwan and to estimate the potential productivity gains associated with treating patients with ledipasvir/sofosbuvir (LDV/SOF) therapy, an economic model was developed with a time horizon of 1 year. Hepatitis C virus patients entered the model at 12 weeks post-treatment, having achieved or not achieved sustained virological response (SVR). Absenteeism and presenteeism rates were taken from a pooled analysis of data from the ION 1-3 studies. These rates were converted into hours of lost productivity, multiplied by the average wage and applied to the total employed, adult GT1 population in each country. Results were compared assuming no treatment, and assuming all patients were treated with LDV/SOF. Total productivity losses due to untreated HCV were: $11.3 million, $17.1 m, $146.0 m and $349.1 m in Hong Kong, Singapore, South Korea and Taiwan. LDV/SOF treatment resulted in economic gains of $4.5 m, $6.8 m, $58.7 m and $138 m, respectively. These gains were due to reduced presenteeism. The results were sensitive to changes in the prevalence of HCV and the average wage. In conclusion, productivity losses due to untreated HCV infection represent a substantial economic burden. By instituting universal HCV treatment with LDV/SOF (or other therapies with high SVR rates), productivity gains can be achieved. © 2017 John Wiley & Sons Ltd.

Comparison of ε-Aminocaproic Acid and Tranexamic Acid in Reducing Postoperative Transfusions in Total Hip Arthroplasty.

PubMed

Churchill, Jessica L; Puca, Kathleen E; Meyer, Elizabeth S; Carleton, Matthew C; Truchan, Susan L; Anderson, Michael J

2016-12-01

Use of antifibrinolytic agents in total hip arthroplasty (THA) is well supported; however, most studies used tranexamic acid (TXA), whereas few used ε-aminocaproic acid (EACA), a similar antifibrinolytic. This study compares the efficacy and cost per surgery of intraoperative infusion of EACA and TXA in reducing postoperative blood transfusion rates in THA. Retrospective chart review of 1799 primary unilateral THA cases from April 2012 through December 2014 at 5 hospitals within our health care network. In our cohort, 711 received EACA, 445 received TXA, and 643 (control group) received no antifibrinolytic. Both antifibrinolytic groups had significantly fewer patients receiving red blood cell (RBC) transfusions when compared with control group (EACA 6.8% [P < .0001], TXA 9.7% [P < .0001] vs control group 24.7%). Average number of RBC units per patient were similar for EACA and TXA (0.11 units/patient and 0.15 units/patient, respectively), and both were significantly lower than the control group (0.48 units/patient, P < .0001). No significant difference was noted in mean RBC units per patient and percentage of patients transfused between EACA and TXA groups (P = .144, P = .074). Logistic regression showed no difference between EACA and TXA when adjusting for age, gender, higher severity of illness levels, admission hemoglobin, performing surgeon, and hospital. Medication acquisition cost for EACA averaged $2.70 per surgery compared with TXA at $39.58 per surgery. Intraoperative antifibrinolytic use significantly decreases need for postoperative blood transfusions. At our institution, EACA is comparable to TXA in THA for reducing transfusion rates while at a lower cost per surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Intravenous contrast extravasation during CT: a national data registry and practice quality improvement initiative.

PubMed

Dykes, Thomas M; Bhargavan-Chatfield, Mythreyi; Dyer, Raymond B

2015-02-01

Establish 3 performance benchmarks for intravenous contrast extravasation during CT examinations: extravasation frequency, distribution of extravasation volumes, and severity of injury. Evaluate the effectiveness of implementing practice quality improvement (PQI) methodology in improving performance for these 3 benchmarks. The Society of Abdominal Radiology and ACR developed a registry collecting data for contrast extravasation events. The project includes a PQI initiative allowing for process improvement. As of December 2013, a total of 58 radiology practices have participated in this project, and 32 practices have completed the 2-cycle PQI. There were a total of 454,497 contrast-enhanced CT exams and 1,085 extravasation events. The average extravasation rate is 0.24%. The median extravasation rate is 0.21%. Most extravasations (82.9%) were between 10 mL and 99 mL. The majority of injuries, 94.6%, are mild in severity, with 4.7% having moderate and 0.8% having severe injuries. Data from practices that completed the PQI process showed a change in the average extravasation rate from 0.28% in the first 6 months to 0.23% in the second 6 months, and the median extravasation rate dropped from 0.25% to 0.16%, neither statistically significant. The distribution of extravasation volumes and the severity of injury did not change between the first and second measurement periods. National performance benchmarks for contrast extravasation rate, distribution of volumes of extravasate, and distribution of severity of injury are established through this multi-institutional practice registry. The application of PQI failed to have a statistically significant positive impact on any of the 3 benchmarks. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.