Advancing Mental Health Research: Washington University's Center for Mental Health Services Research

ERIC Educational Resources Information Center

Proctor, Enola K.; McMillen, Curtis; Haywood, Sally; Dore, Peter

2008-01-01

Research centers have become a key component of the research infrastructure in schools of social work, including the George Warren Brown School of Social Work at Washington University. In 1993, that school's Center for Mental Health Services Research (CMHSR) received funding from the National Institute of Mental Health (NIMH) as a Social Work…

Transforming a Curriculum Center for the 21st Century at Eastern Washington University Libraries

ERIC Educational Resources Information Center

Miller, Julie; Meyer, Nadean

2008-01-01

Teacher education is a vital component of Eastern Washington University's (EWU) mission and history. In 2006, after several years of decline in collections and usage of its curriculum center, EWU Libraries made a commitment to transform it into a center for twenty-first century educators. The center has changed greatly in a short time with five…

Quality-assurance plan for groundwater activities, U.S. Geological Survey, Washington Water Science Center

USGS Publications Warehouse

Kozar, Mark D.; Kahle, Sue C.

2013-01-01

This report documents the standard procedures, policies, and field methods used by the U.S. Geological Survey’s (USGS) Washington Water Science Center staff for activities related to the collection, processing, analysis, storage, and publication of groundwater data. This groundwater quality-assurance plan changes through time to accommodate new methods and requirements developed by the Washington Water Science Center and the USGS Office of Groundwater. The plan is based largely on requirements and guidelines provided by the USGS Office of Groundwater, or the USGS Water Mission Area. Regular updates to this plan represent an integral part of the quality-assurance process. Because numerous policy memoranda have been issued by the Office of Groundwater since the previous groundwater quality assurance plan was written, this report is a substantial revision of the previous report, supplants it, and contains significant additional policies not covered in the previous report. This updated plan includes information related to the organization and responsibilities of USGS Washington Water Science Center staff, training, safety, project proposal development, project review procedures, data collection activities, data processing activities, report review procedures, and archiving of field data and interpretative information pertaining to groundwater flow models, borehole aquifer tests, and aquifer tests. Important updates from the previous groundwater quality assurance plan include: (1) procedures for documenting and archiving of groundwater flow models; (2) revisions to procedures and policies for the creation of sites in the Groundwater Site Inventory database; (3) adoption of new water-level forms to be used within the USGS Washington Water Science Center; (4) procedures for future creation of borehole geophysics, surface geophysics, and aquifer-test archives; and (5) use of the USGS Multi Optional Network Key Entry System software for entry of routine water-level data

They use humor, off-beat images. These ads keep the consumers' minds OUT of the hospital.

PubMed

Botvin, Judith D

2003-01-01

Limited budgets make it more important for a healthcare campaign to stand out. NeathawkDubuque, Richmond, Va., showcases television commercials for Washington Hospital Center and Georgetown University Hospital, both in Washington, D.C.; and print ads for the University of Virginia Health System, Charlottesville, Va. Additionally, Coil Counts Ford and Cheney, Chicago, provide a distinctive campaign for Advocate Illinois Masonic Medical Center, Chicago.

Computer-aided dispatch--traffic management center field operational test : Washington State final report

DOT National Transportation Integrated Search

2006-05-01

This document provides the final report for the evaluation of the USDOT-sponsored Computer-Aided Dispatch - Traffic Management Center Integration Field Operations Test in the State of Washington. The document discusses evaluation findings in the foll...

Readmission after treatment of Grade 3 and 4 renal injuries at a Level I trauma center: Statewide assessment using the Comprehensive Hospital Abstract Reporting System.

PubMed

Winters, Brian; Wessells, Hunter; Voelzke, Bryan B

2016-03-01

One criticism of the existing renal trauma research is the limited outpatient follow-up after index hospitalization. We assessed readmission rates following treatment for American Association for the Surgery of Trauma (AAST) Grade 3 and 4 renal injury using the Comprehensive Hospital Abstract Reporting System (CHARS). We evaluated all patients with AAST Grade 3 and 4 renal injuries admitted to Harborview Medical Center (HMC) between 1998 and 2010, the only Level 1 trauma center in Washington state. Grade 4 renal injuries were stratified by collecting system laceration (CSL) or segmental vascular injury. Data were abstracted from the CHARS database for readmissions to any Washington state hospital within 6 months of renal injury. Clinical variables, diagnoses, and procedures were queried based on DRG International Classification of Diseases-9th Rev. codes. A total of 477 Grade 3 and 159 Grade 4 renal injuries were initially treated at HMC. On admission, 111 patients required intervention: 75 (16%) of 477 Grade 3 and 36 (23%) of 159 Grade 4 injuries. Within 6 months of index hospitalization, 86 (18%) of 477 Grade 3 and 38 (24%) of 159 Grade 4 patients were readmitted to any Washington state hospital. Eighty percent of Grade 3 injuries and 66% of Grade 4 injuries returned to HMC compared with secondary hospitals (p = 0.08). At readmission, 19 (22%) of 86 Grade 3 and 16 (42%) of 38 Grade 4 injuries had a urologic diagnosis. Subsequent procedural intervention was required on readmission in 6 (7%) of 86 Grade 3 and 5 (13%) of 38 Grade 4 renal injuries (all CSL injuries). A subset of patients treated for Grade 3 and 4 renal trauma will be readmitted for further management. While urologic diagnoses and additional procedures may be low overall, readmission to outside hospitals may preclude accurate determination of renal trauma outcomes. Based on these data, patients with Grade 4 CSL injuries seem to be at the highest risk for readmission and to require a subsequent

Target marketing for the hospital-based wellness center.

PubMed

Cangelosi, J D

1997-01-01

The American population is aging, medical technology is advancing, and life expectancies are on the rise. At the same time hospitals are looking for additional sources of income due to the pressures of government regulations and managed care. One of the options for hospitals looking for additional sources of income is the hospital-based but free-standing comprehensive wellness and fitness center. Such centers go beyond the facilities, programs and services offered by traditional health and fitness centers. In addition to physical fitness programs, hospital-based wellness centers offer programs in CPR, nutrition, weight control and many other programs of interest to an aging but active American populace. This research documents the hospital industry, wellness industry and the prospects of success or failure for he hospital attempting such a venture. The focus of the research is the experience of a particular hospital with regard to the programs, facilities and services deemed most important by its target market.

Hospital-based, acute care after ambulatory surgery center discharge.

PubMed

Fox, Justin P; Vashi, Anita A; Ross, Joseph S; Gross, Cary P

2014-05-01

As a measure of quality, ambulatory surgery centers have begun reporting rates of hospital transfer at discharge. This process, however, may underestimate the acute care needs of patients after care. We conducted this study to determine rates and evaluate variation in hospital transfer and hospital-based, acute care within 7 days among patients discharged from ambulatory surgery centers. Using data from the Healthcare Cost and Utilization Project, we identified adult patients who underwent a medical or operative procedure between July 2008 and September 2009 at ambulatory surgery centers in California, Florida, and Nebraska. The primary outcomes were hospital transfer at the time of discharge and hospital-based, acute care (emergency department visits or hospital admissions) within 7-days expressed as the rate per 1,000 discharges. At the ambulatory surgery center level, rates were adjusted for age, sex, and procedure-mix. We studied 3,821,670 patients treated at 1,295 ambulatory surgery centers. At discharge, the hospital transfer rate was 1.1 per 1,000 discharges (95% confidence interval 1.1-1.1). Among patients discharged home, the hospital-based, acute care rate was 31.8 per 1,000 discharges (95% confidence interval 31.6-32.0). Across ambulatory surgery centers, there was little variation in adjusted hospital transfer rates (median = 1.0/1,000 discharges [25th-75th percentile = 1.0-2.0]), whereas substantial variation existed in adjusted, hospital-based, acute care rates (28.0/1,000 [21.0-39.0]). Among adult patients undergoing ambulatory care at surgery centers, hospital transfer at time of discharge from the ambulatory care center is a rare event. In contrast, the rate of need for hospital-based, acute care in the first week afterwards is nearly 30-fold greater, varies across centers, and may be a more meaningful measure for discriminating quality. Published by Mosby, Inc.

Commitments: A Guide to Community Involvement Programs at The George Washington University.

ERIC Educational Resources Information Center

George Washington Univ., Washington, DC.

This guide to community involvement programs sponsored by the George Washington University provides a synopsis and a contact person for 33 general university programs, 38 medical school and hospital programs, eight National Law Center programs, eight School of Engineering and Applied Science programs, and two programs of the Division of…

Patient Safety Center Organization

DTIC Science & Technology

2006-06-01

Enterectomy Bariatric 7/20/05 4 hours/course (28 hours/year) Surgery R 7 Dr. Karen Horvath R5 Lap Enterectomy & Colectomy 11/30/05 4...areas in the UW Schools of Nursing and Dentistry, at the Harborview Research Center Microvascular Surgery lab, with the Seattle Children’s Hospital and...1 laboratory complex (2500 sq ft) has been designed within the University of Washington Medical Center, in the Surgery Pavilion complex

Washington, D.C. USA

NASA Image and Video Library

1984-10-13

41G-40-071 (5-13 Oct. 1984) --- Washington, D.C. -- the nation's capital -- is at right center in this phtograph from the Earth-orbiting space shuttle Challenger. J.F. Dulles Airport at lower left. Andrews Air Force Base is at right center edge. The Potomac River enters at left center, flows past Washington and as a tidal estuary at lower right. Also visible are the Great Falls of the Potomac. Photo credit: NASA

Patterns in hospitals' use of a regional poison information center.

PubMed Central

Chafee-Bahamon, C; Caplan, D L; Lovejoy, F H

1983-01-01

A statewide poison center undertook a study to identify types of hospitals which used its information services. Initial trends in calls from hospitals to the center over the center's first two years and percentages of hospitals' patient caseloads for which the center consulted were analyzed for 104 acute care hospitals by hospitals' location, size, and emergency room staffing. After the center's establishment as a regional resource, emergency room staff in urban teaching hospitals showed the greatest increase in calls within a year (88 per cent) and the highest consultation rates for poison patients seen (57 per cent). Private physician emergency room staff, and staff in distant and rural hospitals, showed lower or no increases in calls and lower consultation rates. Findings suggest that private physician emergency room staff and staff in distant and rural hospitals be considered for poison center outreach. Marketing of consultation services for non-pediatric overdoses is also indicated. PMID:6829822

The Hospital-Based Drug Information Center.

ERIC Educational Resources Information Center

Hopkins, Leigh

1982-01-01

Discusses the rise of drug information centers in hospitals and medical centers, highlighting staffing, functions, typical categories of questions received by centers, and sources used. An appendix of drug information sources included in texts, updated services, journals, and computer databases is provided. Thirteen references are listed. (EJS)

Security, Violent Events, and Anticipated Surge Capabilities of Emergency Departments in Washington State

PubMed Central

Weyand, Jonathan S.; Junck, Emily; Kang, Christopher S.; Heiner, Jason D.

2017-01-01

Introduction Over the past 15 years, violent threats and acts against hospital patients, staff, and providers have increased and escalated. The leading area for violence is the emergency department (ED) given its 24/7 operations, role in patient care, admissions gateway, and center for influxes during acute surge events. This investigation had three objectives: to assess the current security of Washington State EDs; to estimate the prevalence of and response to threats and violence in Washington State EDs; and to appraise the Washington State ED security capability to respond to acute influxes of patients, bystanders, and media during acute surge events. Methods A voluntary, blinded, 28-question Web-based survey developed by emergency physicians was electronically delivered to all 87 Washington State ED directors in January 2013. We evaluated responses by descriptive statistical analyses. Results Analyses occurred after 90% (78/87) of ED directors responded. Annual censuses of the EDs ranged from < 20,000 to 100,000 patients and represented the entire spectrum of practice environments, including critical access hospitals and a regional quaternary referral medical center. Thirty-four of 75 (45%) reported the current level of security was inadequate, based on the general consensus of their ED staff. Nearly two-thirds (63%) of EDs had 24-hour security personnel coverage, while 28% reported no assigned security personnel. Security personnel training was provided by 45% of hospitals or healthcare systems. Sixty-nine of 78 (88%) respondents witnessed or heard about violent threats or acts occurring in their ED. Of these, 93% were directed towards nursing staff, 90% towards physicians, 74% towards security personnel, and 51% towards administrative personnel. Nearly half (48%) noted incidents directed towards another patient, and 50% towards a patient’s family or friend. These events were variably reported to the hospital administration. After an acute surge event, 35

Security, Violent Events, and Anticipated Surge Capabilities of Emergency Departments in Washington State.

PubMed

Weyand, Jonathan S; Junck, Emily; Kang, Christopher S; Heiner, Jason D

2017-04-01

Over the past 15 years, violent threats and acts against hospital patients, staff, and providers have increased and escalated. The leading area for violence is the emergency department (ED) given its 24/7 operations, role in patient care, admissions gateway, and center for influxes during acute surge events. This investigation had three objectives: to assess the current security of Washington State EDs; to estimate the prevalence of and response to threats and violence in Washington State EDs; and to appraise the Washington State ED security capability to respond to acute influxes of patients, bystanders, and media during acute surge events. A voluntary, blinded, 28-question Web-based survey developed by emergency physicians was electronically delivered to all 87 Washington State ED directors in January 2013. We evaluated responses by descriptive statistical analyses. Analyses occurred after 90% (78/87) of ED directors responded. Annual censuses of the EDs ranged from < 20,000 to 100,000 patients and represented the entire spectrum of practice environments, including critical access hospitals and a regional quaternary referral medical center. Thirty-four of 75 (45%) reported the current level of security was inadequate, based on the general consensus of their ED staff. Nearly two-thirds (63%) of EDs had 24-hour security personnel coverage, while 28% reported no assigned security personnel. Security personnel training was provided by 45% of hospitals or healthcare systems. Sixty-nine of 78 (88%) respondents witnessed or heard about violent threats or acts occurring in their ED. Of these, 93% were directed towards nursing staff, 90% towards physicians, 74% towards security personnel, and 51% towards administrative personnel. Nearly half (48%) noted incidents directed towards another patient, and 50% towards a patient's family or friend. These events were variably reported to the hospital administration. After an acute surge event, 35% believed the initial additional

New Orleans Charity Hospital--your trauma center at work.

PubMed

Stockinger, Zsolt T; Holloway, Vicki L; McSwain, Norman E; Thomas, Dwayne; Fontenot, Cathi; Hunt, John P; Mederos, Eileen; Hewitt, Robert L

2004-01-01

The Medical Center of Louisiana at New Orleans-Charity Hospital stands with pride as one of only two level I trauma centers in the state and one of the largest trauma centers in the United States, seeing over 4,000 trauma patients per year. Despite perennial funding issues, Charity Hospital's Emergency Department treated almost 200,000 patients in 2003. This brief report gives an overview of the emergency- and trauma-related services provided by Charity Hospital and underscores its value as a critical asset to healthcare in the Louisiana.

Charity care in nonprofit urban hospitals: analysis of the role of size and ownership type in Washington State for 2011.

PubMed

Coyne, Joseph S; Ogle, Natalie M; McPherson, Sterling; Murphy, Sean; Smith, Gary J; Davidson, Gregg Agustín

2014-01-01

Nonprofit hospitals are expected to serve their communities as charitable organizations in exchange for the tax exemption benefits they receive. With the passage into law of the Affordable Care Act, additional guidelines were generated in 2010 to ensure nonprofit hospitals are compliant. Nonetheless, the debate continues on whether nonprofit hospitals provide adequate charity care to their patient population. In this study, charity care provided by 29 Washington State nonprofit urban hospitals was examined for 2011 using financial data from the Washington State Department of Health. Charity care levels were compared to both income tax savings and gross revenues to generate two financial ratios that were analyzed according to hospital bed size and nonprofit ownership type. For the first ratio, 97% of the hospitals (28 of 29) were providing charity care in greater amounts than the tax savings they accrued. The average ratio value using total charity care and total income tax savings of all the hospitals in the study was 6.10, and the median value was 3.46. The nonparametric Kruskal-Wallis test results by bed size and nonprofit ownership type indicate that ownership type has a significant effect on charity care to gross revenue ratios (p = .020). Our analysis indicates that church-owned hospitals had higher ratios of charity care to gross revenues than did the other two ownership types--government and voluntary--in this sample. Policy implications are offered and further studies are recommended to analyze appropriate levels of charity care in nonprofit hospitals given new requirements for maintaining a hospital's tax-exempt status.

Radio advertising increases hospital call center volume by 48%.

PubMed

2006-01-01

Since the fall of 2005, call volume at University of Southern California University Hospital of Los Angeles' call center has increased by nearly 50%. How? The hospital embarked on a long-term radio campaign to promote its presence as a premier academic medical center and to increase patient volume.

Legacy lead arsenate soil contamination at childcare centers in the Yakima Valley, Central Washington, USA.

PubMed

Durkee, Jenna; Bartrem, Casey; Möller, Gregory

2017-02-01

From the early 1900s to the 1950s, Yakima Valley orchards were commonly treated with lead arsenate (LA) insecticides. Lead (Pb) and arsenic (As) soil contamination has been identified on former orchard lands throughout Central Washington and pose a threat to human health and the environment. The levels of Pb and As in soil and interior dust at participating childcare centers in the Upper Yakima Valley (Yakima County), Washington were sampled to explore exposure potential for young children. Childcare center soils were collected from two soil depths, homogenized, and analyzed in bulk by a field-portable X-ray fluorescence spectrometer (XRF). Interior dust wipes samples were collected from at least two locations in each facility. All soil samples >250 mg/kg Pb and/or >20 As mg/kg were sieved to 250 μm, tested by XRF a second time, and analyzed via acid digestion and inductively coupled plasma mass spectrometry (ICP-MS) analysis. Bulk and sieved XRF results, as well as ICP-MS to XRF results were strongly correlated. Maximum Pb and As XRF results indicated that 4 (21%) and 8 (42%) of the 19 childcare centers surveyed exceeded the regulatory standard for Pb and As, respectively. Historic land use was significantly associated with elevated Pb and As levels. Interior dust loadings were below United States Environmental Protection Agency (EPA) guidelines. Childcare centers are areas of intensive use for children and when coupled with potential residential exposure in their homes, the total daily exposure is a potential hazard to children. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effect of severity of illness on cesarean delivery rates in Washington State.

PubMed

Hitti, Jane; Walker, Suzan; Benedetti, Thomas J

2017-10-01

, and geographic location within Washington. Hospital aggregate admission severity-of-illness score correlated with primary term singleton vertex cesarean delivery rate in all fiscal years (R 2 0.38-0.58, P < .001). For every year in the study interval, as admission severity of illness increased so did the primary term singleton vertex cesarean rate. The slope of the regression line decreased during the study interval, suggesting that statewide decrease in primary term singleton vertex cesarean rate occurred across the range of severity of illness. Admission severity-of-illness score is strongly associated with the primary term singleton vertex cesarean delivery rate among hospitals in Washington State. Approximately 50% of variation in hospital primary term singleton vertex cesarean delivery rates appeared to be related to admission severity of illness. This relationship persisted over time despite a statewide decrease in cesarean delivery, suggesting that patient acuity will likely continue to contribute to hospital variation in cesarean delivery rates despite perinatal quality improvement efforts. The major implication of this study is that patient acuity should be considered when determining optimal cesarean delivery rates. High-acuity hospitals are likely to have high cesarean rates because they provide a specific role in serving regional needs. To hold these centers to an arbitrary benchmark may jeopardize the funding necessary to support regional safety net institutions. Copyright © 2017. Published by Elsevier Inc.

A Study to Identify Functions Which Inhibit or Facilitate the Health Care Delivery Process on Ward 51 at Walter Reed Army Medical Center, Washington, D.C.

DTIC Science & Technology

1980-08-01

PROCESS ON WARD 51 AT WALTER REED ARMY MEDICAL CENTER, WASHINGTON, D.C. A Problem-Solving Project D TIC Submitted to the Faculty of ELECTE- Baylor...HEALTH CARN DELIVERY PROCESS ON WARD 51 AT WALTER RIED ARM1Y MEDICAL CENTER, WASHINGTON, D.C. 12. PERSONAL AUTHOR(S) LTC Ella L. Fletcher 130. TYPE OF...functions which Inhibit or acqpiir’o delivery- process on Ward 51 at Walter Reed Army M6edical Center. The interaction among ps physicians, nurses

Energy savings opportunity survey at Walter Reed Army Medical Center, Washington, DC. Final Submittal report

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

NONE

1987-10-22

This Energy Savings Opportunity Survey (ESOS) was performed for sixteen (16) buildings at Walter Reed Army Medical Center (WPAMC) in Washington, D.C. This survey was intended to reevaluate and update projects from a previous Energy Engineering Analysis Program (EEAP) survey performed at WRAMC. However, the previous EEAP survey was determined by the contracting officer to be incomplete and not worthy of further consideration. Therefore, this survey involved the complete reevaluation of the buildings to determine their potential energy cost savings. Six (6) projects and nine (9) low cost/no cost energy conservation opportunities (ECO`s) are recommended for implementation in the buildings.more » These projects and ECO`s are projected to annually save $448,263 at an implementation cost of $891,659. The simple payback (i.e., implementation cost divided by cost savings) for the recommendations in the survey is 1.99 years. The two (2) projects with the greatest cost savings are a stack heat recovery system (Project Number 5) and HVAC modifications (Project Number 1). These two (2) projects will provide 67% of the projected total savings for the survey. The sixteen (16) buildings in this survey represent only 22% of the total floor area of the Walter Reed Army Medical Center complex. It is believed that significant potential energy cost savings amounting to two (2) million dollars may be achieved in the remaining buildings in the complex not included in this survey. Specifically it is believed the main hospital building contains many opportunities for substantial cost savings.« less

Innovation in patient-centered care: lessons from a qualitative study of innovative health care organizations in Washington State

PubMed Central

2012-01-01

Background Growing interest in the promise of patient-centered care has led to numerous health care innovations, including the patient-centered medical home, shared decision-making, and payment reforms. How best to vet and adopt innovations is an open question. Washington State has been a leader in health care reform and is a rich laboratory for patient-centered innovations. We sought to understand the process of patient-centered care innovation undertaken by innovative health care organizations – from strategic planning to goal selection to implementation to maintenance. Methods We conducted key-informant interviews with executives at five health plans, five provider organizations, and ten primary care clinics in Washington State. At least two readers of each interview transcript identified themes inductively; final themes were determined by consensus. Results Innovation in patient-centered care was a strategic objective chosen by nearly every organization in this study. However, other goals were paramount: cost containment, quality improvement, and organization survival. Organizations commonly perceived effective chronic disease management and integrated health information technology as key elements for successful patient-centered care innovation. Inertia, resource deficits, fee-for-service payment, and regulatory limits on scope of practice were cited as barriers to innovation, while organization leadership, human capital, and adaptive culture facilitated innovation. Conclusions Patient-centered care innovations reflected organizational perspectives: health plans emphasized cost-effectiveness while providers emphasized health care delivery processes. Health plans and providers shared many objectives, yet the two rarely collaborated to achieve them. The process of innovation is heavily dependent on organizational culture and leadership. Policymakers can improve the pace and quality of patient-centered innovation by setting targets and addressing conditions for

Innovation in patient-centered care: lessons from a qualitative study of innovative health care organizations in Washington State.

PubMed

Reed, Peter; Conrad, Douglas A; Hernandez, Susan E; Watts, Carolyn; Marcus-Smith, Miriam

2012-12-14

Growing interest in the promise of patient-centered care has led to numerous health care innovations, including the patient-centered medical home, shared decision-making, and payment reforms. How best to vet and adopt innovations is an open question. Washington State has been a leader in health care reform and is a rich laboratory for patient-centered innovations. We sought to understand the process of patient-centered care innovation undertaken by innovative health care organizations - from strategic planning to goal selection to implementation to maintenance. We conducted key-informant interviews with executives at five health plans, five provider organizations, and ten primary care clinics in Washington State. At least two readers of each interview transcript identified themes inductively; final themes were determined by consensus. Innovation in patient-centered care was a strategic objective chosen by nearly every organization in this study. However, other goals were paramount: cost containment, quality improvement, and organization survival. Organizations commonly perceived effective chronic disease management and integrated health information technology as key elements for successful patient-centered care innovation. Inertia, resource deficits, fee-for-service payment, and regulatory limits on scope of practice were cited as barriers to innovation, while organization leadership, human capital, and adaptive culture facilitated innovation. Patient-centered care innovations reflected organizational perspectives: health plans emphasized cost-effectiveness while providers emphasized health care delivery processes. Health plans and providers shared many objectives, yet the two rarely collaborated to achieve them. The process of innovation is heavily dependent on organizational culture and leadership. Policymakers can improve the pace and quality of patient-centered innovation by setting targets and addressing conditions for innovation.

Promoting Breastfeeding-Friendly Hospital Practices: A Washington State Learning Collaborative Case Study.

PubMed

Freney, Emily; Johnson, Donna; Knox, Isabella

2016-05-01

Hospital breastfeeding support practices can affect breastfeeding outcomes. Learning collaboratives are an increasingly common strategy to improve practices in health care and have been applied to breastfeeding in many cases. The aims of this study of the Evidence-Based Hospital Breastfeeding Support Learning Collaborative (EBBS LC) were to describe the perceptions of participants regarding the process and effectiveness of the EBBS LC, describe perceived barriers and facilitators to implementing the Ten Steps to Successful Breastfeeding, and identify additional actions and resources needed in future learning collaboratives. Qualitative, semistructured telephone interviews were conducted with 13 key staff who represented 16 of the 18 participating hospitals. The learning collaborative was perceived positively by participants, meeting the expectations of 9 and exceeding the expectations of 4 persons interviewed. The most beneficial aspect of the program was its collaborative nature, and the most difficult aspect was the time required to participate as well as technological difficulties. The key barriers were staff time, staff changes, cost, and the difficulty of changing the existing practices of hospitals and communities. The key facilitating factors were supportive management, participation in multiple breastfeeding quality improvement projects, collecting data on breastfeeding outcomes, tangible resources regarding the Ten Steps, and positive community response. Participants in the EBBS LC stated that they would like to see the Washington State Department of Health create a resource-rich, centralized source of information for participants. This learning collaborative approach was valued by participants. Future efforts can be guided by these evaluation findings. © The Author(s) 2015.

Financial Performance of Academic Health Center Hospitals, 1994-2000.

ERIC Educational Resources Information Center

Dobson, Allen; Koenig, Lane; Sen, Namrata; Ho, Silver; Gilani, Jawaria

This study examined how competitive market dynamics between 1994 and 2000 have affected the financial stability of Academic Health Center (AHC) hospitals and their ability to support their academic and social missions. It looked at the financial challenges facing AHC hospitals through a survey involving 1,138 teaching hospitals. Findings…

Validation of Volcanic Ash Forecasting Performed by the Washington Volcanic Ash Advisory Center

NASA Astrophysics Data System (ADS)

Salemi, A.; Hanna, J.

2009-12-01

In support of NOAA’s mission to protect life and property, the Satellite Analysis Branch (SAB) uses satellite imagery to monitor volcanic eruptions and track volcanic ash. The Washington Volcanic Ash Advisory Center (VAAC) was established in late 1997 through an agreement with the International Civil Aviation Organization (ICAO). A volcanic ash advisory (VAA) is issued every 6 hours while an eruption is occurring. Information about the current location and height of the volcanic ash as well as any pertinent meteorological information is contained within the VAA. In addition, when ash is detected in satellite imagery, 6-, 12- and 18-hour forecasts of ash height and location are provided. This information is garnered from many sources including Meteorological Watch Offices (MWOs), pilot reports (PIREPs), model forecast winds, radiosondes and volcano observatories. The Washington VAAC has performed a validation of their 6, 12 and 18 hour airborne volcanic ash forecasts issued since October, 2007. The volcanic ash forecasts are viewed dichotomously (yes/no) with the frequency of yes and no events placed into a contingency table. A large variety of categorical statistics useful in describing forecast performance are then computed from the resulting contingency table.

Outcomes of antiretroviral treatment: a comparison between hospitals and health centers in Ethiopia.

PubMed

Balcha, Taye T; Jeppsson, Anders

2010-01-01

the objective of this study was to compare the outcomes of antiretroviral therapy (ART) between hospital and health center levels in Ethiopia. medical records of 1709 ART patients followed for 24 months at 2 hospitals and 3 health centers in the Oromia region of Ethiopia were reviewed. Noted outcomes of ART were currently alive and on treatment; lost to follow-up (LTFU); transferred out (TO); and died (D). of 1709 HIV-positive patients started on ART between September 2006 and February 2007, 1044 (61%) remained alive and were on treatment after 24-month follow-up. In all, 835 (57%) of ART patients at hospitals and 209 (83%) at health centers were retained in the program. Of those who were alive and receiving ART, 79% of patients at health centers and 72% at hospitals were clinically or immunologically improving. In addition, 331 (23%) patients at hospitals were LFTU as compared to 24 (10%) of patients at health centers (relative risk [RR] at 95% confidence interval [CI]: .358 [.231-.555]). While 11% was the mortality rate at hospitals, 5% of patients at health centers also died (RR at 95% CI: .360 [.192-.673]). antiretroviral therapy at health centers was associated with more favorable outcomes than at hospitals.

Genome Science: A Video Tour of the Washington University Genome Sequencing Center for High School and Undergraduate Students

ERIC Educational Resources Information Center

Flowers, Susan K.; Easter, Carla; Holmes, Andrea; Cohen, Brian; Bednarski, April E.; Mardis, Elaine R.; Wilson, Richard K.; Elgin, Sarah C. R.

2005-01-01

Sequencing of the human genome has ushered in a new era of biology. The technologies developed to facilitate the sequencing of the human genome are now being applied to the sequencing of other genomes. In 2004, a partnership was formed between Washington University School of Medicine Genome Sequencing Center's Outreach Program and Washington…

Implementation of Single Source Based Hospital Information System for the Catholic Medical Center Affiliated Hospitals

PubMed Central

Choi, Inyoung; Choi, Ran; Lee, Jonghyun

2010-01-01

Objectives The objective of this research is to introduce the unique approach of the Catholic Medical Center (CMC) integrate network hospitals with organizational and technical methodologies adopted for seamless implementation. Methods The Catholic Medical Center has developed a new hospital information system to connect network hospitals and adopted new information technology architecture which uses single source for multiple distributed hospital systems. Results The hospital information system of the CMC was developed to integrate network hospitals adopting new system development principles; one source, one route and one management. This information architecture has reduced the cost for system development and operation, and has enhanced the efficiency of the management process. Conclusions Integrating network hospital through information system was not simple; it was much more complicated than single organization implementation. We are still looking for more efficient communication channel and decision making process, and also believe that our new system architecture will be able to improve CMC health care system and provide much better quality of health care service to patients and customers. PMID:21818432

Increased hospital admissions associated with extreme-heat exposure in King County, Washington, 1990-2010

PubMed Central

Isaksen, Tania Busch; Yost, Michael G.; Hom, Elizabeth K.; Ren, You; Lyons, Hilary; Fenske, Richard A.

2016-01-01

Increased morbidity and mortality have been associated with extreme heat events, particularly in temperate climates. Few epidemiologic studies have considered the impact of extreme heat events on hospitalization rates in the Pacific Northwest region. This study quantifies the historical (May to September 1990-2010) heat-morbidity relationship in the most populous Pacific Northwest County -King County, Washington. A relative risk (RR) analysis was used to explore the association between heat and all non-traumatic hospitalizations on 99th percentile heat days, while a time series analysis using a piece-wise linear model approximation was used to estimate the effect that heat’s intensity has on hospitalizations, adjusted for temporal trends and day of the week. A non-statistically significant 2% [95% CI: 1.02 (0.98, 1.05)] increase in hospitalization risk, on a heat day versus a non-heat day, was noted for all-ages, all non-traumatic causes. When considering the effect heat intensity has on admissions, we found a statistically significant 1.59% (95% CI: 0.9%, 2.29%) increase in admissions per degree increase in humidex above 37.4 °C. Admissions stratified by cause and age produced statistically significant results with both relative risk and time series analyses for nephritis and nephrotic syndromes, acute renal failure and natural heat exposure hospitalizations. This study demonstrates that heat, expressed as humidex, is associated with increased hospital admissions. When stratified by age and cause of admission, the non-elderly (less than 85) age groups experience significant risk for: nephritis and nephrotic syndromes, acute renal failure, natural heat exposure, COPD and asthma hospitalizations. PMID:25719287

Increased hospital admissions associated with extreme-heat exposure in King County, Washington, 1990-2010.

PubMed

Isaksen, Tania Busch; Yost, Michael G; Hom, Elizabeth K; Ren, You; Lyons, Hilary; Fenske, Richard A

2015-01-01

Increased morbidity and mortality have been associated with extreme heat events, particularly in temperate climates. Few epidemiologic studies have considered the impact of extreme heat events on hospitalization rates in the Pacific Northwest region. This study quantifies the historic (May to September 1990-2010) heat-morbidity relationship in the most populous Pacific Northwest County, King County, Washington. A relative risk (RR) analysis was used to explore the association between heat and all non-traumatic hospitalizations on 99th percentile heat days, whereas a time series analysis using a piecewise linear model approximation was used to estimate the effect of heat intensity on hospitalizations, adjusted for temporal trends and day of the week. A non-statistically significant 2% [95% CI: 1.02 (0.98, 1.05)] increase in hospitalization risk, on a heat day vs. a non-heat day, was noted for all-ages and all non-traumatic causes. When considering the effect of heat intensity on admissions, we found a statistically significant 1.59% (95% CI: 0.9%, 2.29%) increase in admissions per degree increase in humidex above 37.4°C. Admissions stratified by cause and age produced statistically significant results with both relative risk and time series analyses for nephritis and nephrotic syndromes, acute renal failure, and natural heat exposure hospitalizations. This study demonstrates that heat, expressed as humidex, is associated with increased hospital admissions. When stratified by age and cause of admission, the non-elderly age groups (<85 years) experience significant risk for nephritis and nephrotic syndromes, acute renal failure, natural heat exposure, chronic obstructive pulmonary disease, and asthma hospitalizations.

Hyperspectral landcover classification for the Yakima Training Center, Yakima, Washington

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

Steinmaus, K.L.; Perry, E.M.; Petrie, G.M.

1998-04-01

The US Department of Energy`s (DOE`s) Pacific Northwest National Laboratory (PNNL) was tasked in FY97-98 to conduct a multisensor feature extraction project for the Terrain Modeling Project Office (TMPO) of the National Imagery and Mapping Agency (NIMA). The goal of this research is the development of near-autonomous methods to remotely classify and characterize regions of military interest, in support of the TMPO of NIMA. These methods exploit remotely sensed datasets including hyperspectral (HYDICE) imagery, near-infrared and thermal infrared (Daedalus 3600), radar, and terrain datasets. The study site for this project is the US Army`s Yakima Training Center (YTC), a 326,741-acremore » training area located near Yakima, Washington. Two study areas at the YTC were selected to conduct and demonstrate multisensor feature extraction, the 2-km x 2-km Cantonment Area and the 3-km x 3-km Choke Point area. Classification of the Cantonment area afforded a comparison of classification results at different scales.« less

Lucinda Huffaker and the Hospitality of the Wabash Center

ERIC Educational Resources Information Center

Placher, William C.

2007-01-01

As associate director and then director of the Wabash Center for Teaching and Learning in Theology and Religion, Lucinda Huffaker has been a key factor in the Center's reputation for hospitality. The Center's work presupposes that reflection on teaching improves teaching and learning, and good reflection on one's teaching requires taking risks and…

Developing a Family-Centered, Hospital-Based Perinatal Education Program

PubMed Central

Westmoreland, Marcia Haskins; Zwelling, Elaine

2000-01-01

The development of a family-centered, comprehensive perinatal education program for a large, urban hospital system is described. This program was developed in conjunction with the building of a new women's center and, although the authors were fortunate that several opportunities for educational program development were linked to this project, many of the steps taken and the lessons learned can be helpful to anyone desiring to develop a similar program. This article relates perinatal education to the principles of family-centered maternity care, outlines the criteria for a quality educational program, gives rationale for this type of program development, and offers practical suggestions for starting or enhancing a perinatal education program within a hospital system. PMID:17273228

Challenges of a Small Center--Lopez Children's Center, Lopez Island, Washington

ERIC Educational Resources Information Center

Hobbs, Jane; Brummel, Sherry; Holz, Connie; Lett, Shanley; Martin, Kiki; McLeland, Jules; White, Carole

2011-01-01

Lopez Island is located in the archipelago of San Juan Islands off the northwest coast of Washington State. Breathtaking mountain vistas, sparkling shorelines, forests, and pastoral landscapes filled with sheep and orchards attract many tourists to San Juan County each year. This isolated community can only be reached by traveling on ferries,…

A Partnership for Modeling the Marine Environment of Puget Sound, Washington

DTIC Science & Technology

2009-03-30

Northwest National Marine Renewable Energy Center, a joint University of Washington - Oregon State project funded by the U.S. Department of Energy. e. A... Marine Renewable Energy Center (NNMREC), a joint Washington - Oregon State project to investigate extraction of wave and tidal energy sponsored by

USGS Water Data for Washington

USGS Publications Warehouse

,

2009-01-01

The U.S. Geological Survey (USGS) has been investigating the water resources of Washington State since the latter part of the 19th century. During this time, demand for water has evolved from primarily domestic and stock needs to the current complex requirements for public-water supplies, irrigation, power generation, navigation, ecological needs, and numerous other uses. Water-resource data collected by the USGS in Washington have been, or soon will be, published by the USGS Washington Water Science Center (WAWSC) in numerous data and interpretive reports. Most of these reports are available online at the WAWSC web page http://wa.water.usgs.gov/pubs/

Comparison of CDE data in phacoemulsification between an open hospital-based ambulatory surgical center and a free-standing ambulatory surgical center.

PubMed

Chen, Ming; Chen, Mindy

2010-11-12

Mean CDE (cumulative dissipated energy) values were compared for an open hospital- based surgical center and a free-standing surgical center. The same model of phacoemulsifier (Alcon Infiniti Ozil) was used. Mean CDE values showed that surgeons (individual private practice) at the free-standing surgical center were more efficient than surgeons (individual private practice) at the open hospital-based surgical center (mean CDE at the hospital-based surgical center 18.96 seconds [SD = 12.51]; mean CDE at the free-standing surgical center 13.2 seconds [SD = 9.5]). CDE can be used to monitor the efficiency of a cataract surgeon and surgical center in phacoemulsification. The CDE value may be used by institutions as one of the indicators for quality control and audit in phacoemulsification.

The World Trade Center attack. Observations from New York's Bellevue Hospital.

PubMed

Roccaforte, J D

2001-12-01

This report describes selected aspects of the response by Bellevue Hospital Center to the World Trade Center attack of 11 September 2001. The hospital is 2.5 miles (4 km) from the site of the attack. These first-hand observations and this analysis may aid in future preparations. Key issues described relate to communication, organization, injuries treated, staffing, and logistics.

The World Trade Center Attack: Observations from New York's Bellevue Hospital

PubMed Central

Roccaforte, J David

2001-01-01

This report describes selected aspects of the response by Bellevue Hospital Center to the World Trade Center attack of 11 September 2001. The hospital is 2.5 miles (4 km) from the site of the attack. These first-hand observations and this analysis may aid in future preparations. Key issues described relate to communication, organization, injuries treated, staffing, and logistics. PMID:11737913

"Hospes": The Wabash Center as a Site of Transformative Hospitality

ERIC Educational Resources Information Center

Jones, Carolyn M.

2007-01-01

The Wabash Center for Teaching and Learning in Theology and Religion is a place of hospitality and its staff the epitome of the "good host." This essay explores the meaning of hospitality, including its problematic dimensions, drawing on a number of voices and texts: Jacques Derrida's "Of Hospitality"; Henri M. Nouwen's "Reaching Out: The Three…

Promising Practices for Achieving Patient-centered Hospital Care: A National Study of High-performing US Hospitals.

PubMed

Aboumatar, Hanan J; Chang, Bickey H; Al Danaf, Jad; Shaear, Mohammad; Namuyinga, Ruth; Elumalai, Sathyanarayanan; Marsteller, Jill A; Pronovost, Peter J

2015-09-01

Patient-centered care is integral to health care quality, yet little is known regarding how to achieve patient-centeredness in the hospital setting. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures patients' reports on clinician behaviors deemed by patients as key to a high-quality hospitalization experience. We conducted a national study of hospitals that achieved the highest performance on HCAHPS to identify promising practices for improving patient-centeredness, common challenges met, and how those were addressed. We identified hospitals that achieved the top ranks or remarkable recent improvements on HCAHPS and surveyed key informants at these hospitals. Using quantitative and qualitative methods, we described the interventions used at these hospitals and developed an explanatory model for achieving patient-centeredness in hospital care. Fifty-two hospitals participated in this study. Hospitals used similar interventions that focused on improving responsiveness to patient needs, the discharge experience, and patient-clinician interactions. To improve responsiveness, hospitals used proactive nursing rounds (reported at 83% of hospitals) and executive/leader rounds (62%); for the discharge experience, multidisciplinary rounds (56%), postdischarge calls (54%), and discharge folders (52%) were utilized; for clinician-patient interactions, hospitals promoted specific desired behaviors (65%) and set behavioral standards (60%) for which employees were held accountable. Similar strategies were also used to achieve successful intervention implementation including HCAHPS data feedback, and employee and leader engagement and accountability. High-performing hospitals used a set of patient-centered care processes that involved both leaders and clinicians in ensuring that patient needs and preferences are addressed.

Comparison of CDE data in phacoemulsification between an open hospital-based ambulatory surgical center and a free-standing ambulatory surgical center

PubMed Central

Chen, Ming; Chen, Mindy

2010-01-01

Mean CDE (cumulative dissipated energy) values were compared for an open hospital- based surgical center and a free-standing surgical center. The same model of phacoemulsifier (Alcon Infiniti Ozil) was used. Mean CDE values showed that surgeons (individual private practice) at the free-standing surgical center were more efficient than surgeons (individual private practice) at the open hospital-based surgical center (mean CDE at the hospital-based surgical center 18.96 seconds [SD = 12.51]; mean CDE at the free-standing surgical center 13.2 seconds [SD = 9.5]). CDE can be used to monitor the efficiency of a cataract surgeon and surgical center in phacoemulsification. The CDE value may be used by institutions as one of the indicators for quality control and audit in phacoemulsification. PMID:21151334

Advancing Translational Research through Facility Design in Non-AMC Hospitals.

PubMed

Pati, Debajyoti; Pietrzak, Michael P; Harvey, Thomas E; Armstrong, Walter B; Clarke, Robert; Weissman, Neil J; Rapp, Paul E; Smith, Mark S; Fairbanks, Rollin J; Collins, Jeffreyg M

2013-01-01

This article aims to explore the future of translational research and its physical design implications for community hospitals and hospitals not attached to large centralized research platforms. With a shift in medical services delivery focus to community wellness, continuum of care, and comparative effectiveness research, healthcare research will witness increasing pressure to include community-based practitioners. The roundtable discussion group, comprising 14 invited experts from 10 institutions representing the fields of biomedical research, research administration, facility planning and design, facility management, finance, and environmental design research, examined the issue in a structured manner. The discussion was conducted at the Washington Hospital Center, MedStar Health, Washington, D.C. Institutions outside the AMCs will be increasingly targeted for future research. Three factors are crucial for successful research in non-AMC hospitals: operational culture, financial culture, and information culture. An operating culture geared towards creation, preservation, and protection of spaces needed for research; creative management of spaces for financial accountability; and a flexible information infrastructure at the system level that enables complete link of key programmatic areas to academic IT research infrastructure are critical to success of research endeavors. Hospital, interdisciplinary, leadership, planning, work environment.

Genome Science: A Video Tour of the Washington University Genome Sequencing Center for High School and Undergraduate Students

PubMed Central

2005-01-01

Sequencing of the human genome has ushered in a new era of biology. The technologies developed to facilitate the sequencing of the human genome are now being applied to the sequencing of other genomes. In 2004, a partnership was formed between Washington University School of Medicine Genome Sequencing Center's Outreach Program and Washington University Department of Biology Science Outreach to create a video tour depicting the processes involved in large-scale sequencing. “Sequencing a Genome: Inside the Washington University Genome Sequencing Center” is a tour of the laboratory that follows the steps in the sequencing pipeline, interspersed with animated explanations of the scientific procedures used at the facility. Accompanying interviews with the staff illustrate different entry levels for a career in genome science. This video project serves as an example of how research and academic institutions can provide teachers and students with access and exposure to innovative technologies at the forefront of biomedical research. Initial feedback on the video from undergraduate students, high school teachers, and high school students provides suggestions for use of this video in a classroom setting to supplement present curricula. PMID:16341256

Cost inefficiency under financial strain: a stochastic frontier analysis of hospitals in Washington State through the Great Recession.

PubMed

Izón, Germán M; Pardini, Chelsea A

2017-06-01

The importance of increasing cost efficiency for community hospitals in the United States has been underscored by the Great Recession and the ever-changing health care reimbursement environment. Previous studies have shown mixed evidence with regards to the relationship between linking hospitals' reimbursement to quality of care and cost efficiency. Moreover, current evidence suggests that not only inherently financially disadvantaged hospitals (e.g., safety-net providers), but also more financially stable providers, experienced declines to their financial viability throughout the recession. However, little is known about how hospital cost efficiency fared throughout the Great Recession. This study contributes to the literature by using stochastic frontier analysis to analyze cost inefficiency of Washington State hospitals between 2005 and 2012, with controls for patient burden of illness, hospital process of care quality, and hospital outcome quality. The quality measures included in this study function as central measures for the determination of recently implemented pay-for-performance programs. The average estimated level of hospital cost inefficiency before the Great Recession (10.4 %) was lower than it was during the Great Recession (13.5 %) and in its aftermath (14.1 %). Further, the estimated coefficients for summary process of care quality indexes for three health conditions (acute myocardial infarction, pneumonia, and heart failure) suggest that higher quality scores are associated with increased cost inefficiency.

A tale of two cultures: examining patient-centered care in a forensic mental health hospital

PubMed Central

Livingston, James D.; Nijdam-Jones, Alicia; Brink, Johann

2012-01-01

Several questions remain unanswered regarding the extent to which the principles and practices of patient-centered care are achievable in the context of a forensic mental health hospital. This study examined patient-centered care from the perspectives of patients and providers in a forensic mental health hospital. Patient-centered care was assessed using several measures of complementary constructs. Interviews were conducted with 30 patients and surveys were completed by 28 service providers in a forensic mental health hospital. Patients and providers shared similar views of the therapeutic milieu and recovery orientation of services; however, providers were more likely to perceive the hospital as being potentially unsafe. Overall, the findings indicated that characteristics of patient-centered care may be found within a forensic mental health hospital. The principles of patient-centered care can be integrated into service delivery in forensic mental health hospitals, though special attention to providers’ perceptions of safety is needed. PMID:22815648

Geriatric resources in acute care hospitals and trauma centers: a scarce commodity.

PubMed

Maxwell, Cathy A; Mion, Lorraine C; Minnick, Ann

2013-12-01

The number of older adults admitted to acute care hospitals with traumatic injury is rising. The purpose of this study was to examine the location of five prominent geriatric resource programs in U.S. acute care hospitals and trauma centers (N = 4,865). As of 2010, 5.8% of all U.S. hospitals had at least one of these programs. Only 8.8% of trauma centers were served by at least one program; the majorities were in level I trauma centers. Slow adoption of geriatric resource programs in hospitals may be due to lack of champions who will advocate for these programs, lack of evidence of their impact on outcomes, or lack of a business plan to support adoption. Future studies should focus on the benefits of geriatric resource programs from patients' perspectives, as well as from business case and outcomes perspectives. Copyright 2013, SLACK Incorporated.

Hospital image and the positioning of service centers: an application in market analysis and strategy development.

PubMed

Smith, S M; Clark, M

1990-09-01

The research confirms the coexistence of different images for hospitals, service centers within the same hospitals, and service programs offered by each of the service centers. The images of individual service centers are found not to be tied to the image of the host facility. Further, service centers and host facilities have differential rankings on the same service decision attributes. Managerial recommendations are offered for "image differentiation" between a hospital and its care centers.

Ambulatory surgery center and general hospital competition: entry decisions and strategic choices.

PubMed

Al-Amin, Mona; Housman, Michael

2012-01-01

General hospitals are consistently under pressure to control cost and improve quality. In addition to mounting payers' demands, hospitals operate under evolving market conditions that might threaten their survival. While hospitals traditionally were concerned mainly with competition from other hospitals, today's reimbursement schemes and entrepreneurial activities encouraged the proliferation of outpatient facilities such as ambulatory surgery centers (ASCs) that can jeopardize hospitals' survival. The purpose of this article was to examine the relationship between ASCs and general hospitals. More specifically, we apply the niche overlap theory to study the impact that competition between ASCs and general hospitals has on the survival chances of both of these organizational populations. Our analysis examined interpopulation competition in models of organizational mortality and market demand. We utilized Cox proportional hazard models to evaluate the impact of competition from each on ASC and hospital exit while controlling for market factors. We relied on two data sets collected and developed by Florida's Agency for Health Care Administration: outpatient facility licensure data and inpatient and outpatient surgical procedure data. Although ASCs do tend to exit markets in which there are high levels of ASC competition, we found no evidence to suggest that ASC exit rates are affected by hospital density. On the other hand, hospitals not only tend to exit markets with high levels of hospital competition but also experience high exit rates in markets with high ASC density. The implications from our study differ for ASCs and hospitals. When making decisions about market entry, ASCs should choose their markets according to the following: demand for outpatient surgery, number of physicians who would practice in the surgery center, and the number of surgery centers that already exist in the market. Hospitals, on the other hand, should account for competition from ASCs

A Study of the System Safety Concept as it Relates to the New Walter Reed Army Medical Center, Washington, DC.

DTIC Science & Technology

1978-03-31

established the safety level of the% * originally designed facility and the extent of current safety * modifications. The objectives evaluated the...Program could identify many safety hazards thus leading to design improvements. The study provided several recommendations to formalize the Systems Safety... design , construction, and proposed systems management of the new Walter Reed Army Medical Center (WRAMC), Washington, D.C., was conducted during the

A management plan for hospitals and medical centers facing radiation incidents.

PubMed

Davari, Fereshteh; Zahed, Arash

2015-09-01

Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

THE WASHINGTON DATA PROCESSING TRAINING STORY.

ERIC Educational Resources Information Center

MCKEE, R.L.

A DATA PROCESSING TRAINING PROGRAM IN WASHINGTON HAD 10 DATA PROCESSING CENTERS IN OPERATION AND EIGHT MORE IN VARIOUS STAGES OF PLANNING IN 1963. THESE CENTERS WERE FULL-TIME DAY PREPARATORY 2-YEAR POST-HIGH SCHOOL TECHNICIAN TRAINING PROGRAMS, OPERATED AND ADMINISTERED BY THE LOCAL BOARDS OF EDUCATION. EACH SCHOOL HAD A COMPLETE DATA PROCESSING…

Stennis Space Center goes to Washington Folklife Festival

NASA Image and Video Library

2008-07-03

Bryon Maynard (left), an aerospace technologist for Propulsion Systems & Tech in Stennis' Engineering and Science Directorate, uses a 'pocket rocket' to demonstrate the concept of rocket propulsion as part of NASA's exhibit at the Smithsonian Folklife Festival in Washington, D.C. Maynard is joined by Bradley Messer (right), chief of the Systems Engineering & Integration Division in Stennis' Engineering and Science Directorate, and a pair of exhibit visitors.

Stennis Space Center goes to Washington Folklife Festival

NASA Technical Reports Server (NTRS)

2008-01-01

Bryon Maynard (left), an aerospace technologist for Propulsion Systems & Tech in Stennis' Engineering and Science Directorate, uses a 'pocket rocket' to demonstrate the concept of rocket propulsion as part of NASA's exhibit at the Smithsonian Folklife Festival in Washington, D.C. Maynard is joined by Bradley Messer (right), chief of the Systems Engineering & Integration Division in Stennis' Engineering and Science Directorate, and a pair of exhibit visitors.

[The specialty clinical centers within the structure of the regional multi-specialty hospital].

PubMed

Fadeev, M G

2008-01-01

The analysis of the functioning of the regional referral clinical center of hand surgery, the eye injury center, the pediatric burns center and the neurosurgical center situated on the basis of large multi-field hospitals of the City of Ekaterinburg is presented. Such common conditions of their activity as experienced manpower availability and medical Academy chairs maintenance are revealed. The special referral clinical centers organized prior to the perstroyka and reformation, continue to function successfully providing high-tech medical care to the patients of the megapolis and to the inhabitants of the Sverdlovskaya Oblast. The effectiveness and perspectiveness of further functioning of the special referral clinical centers embedded into the structure of the municipal multi-field hospitals in the conditions of health reforms is demonstrated.

Financial Stability of Level I Trauma Centers Within Safety-Net Hospitals.

PubMed

Knowlton, Lisa M; Morris, Arden M; Tennakoon, Lakshika; Spain, David A; Staudenmayer, Kristan L

2018-04-20

Level I trauma centers often exist within safety-net hospitals (SNHs), facilities servicing high proportions of low-income and uninsured patients. Given the current health care funding environment, trauma centers within SNHs may be at particular risk. Using California as a model, we hypothesized that SNHs with trauma centers vary in terms of financial stability. We performed a retrospective cohort study using data from publicly available financial disclosure reports from California's Office of Statewide Health Planning and Development. Safety-net hospitals were identified from the California Association of Public Hospitals and Health Systems. The primary outcomes metric for financial performance was operating margin. California hospitals with Level I trauma centers were analyzed (11 SNH sites, 2 non SNH). The SNHs did not behave uniformly, and were clustered into county-owned SNHs (36%, n = 4) and nonprofit-owned SNHs (64%, n = 7). Mean operating margins for county SNHs, nonprofit SNHs, and non SNHs were -16.5%, 8.4%, and 9.5%, respectively (p < 0.001). From 2010 to 2015, operating margins improved for all hospitals, partly due to increases in the percent of insured patients and changes in payer mix. Nonprofit SNHs had a payer mix similar to that of non SNHs; county SNHs had the highest proportions of MediCal (California Medicaid) (45% vs 36% vs 12%, respectively, p < 0.001) and uninsured patients (17% vs 5% vs 0%, respectively, p < 0.001) compared with nonprofit SNHs and non SNHs, respectively. The majority (85%) of Level I trauma centers are within SNHs, whose financial stability is highly variable. A group of SNHs rely on infusions of government funds and are therefore susceptible to changes in policy. These findings suggest deliberate funding efforts are critical to protect the health of the US academic trauma system. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Children's hospitals and PACS: six profiles of planning and implementation.

PubMed

Keen, C

1999-01-01

Six pediatric hospitals were interviewed at length about the status of PACS in their facilities. Children's Hospital Medical Center in Cincinnati, Ohio entered electronic imaging communications in 1993. Several nearby clinics were connected through teleradiology and by 1998, the radiology department had developed a business plan for the implementation of PACS. Two hospitals in Atlanta, Egleston Hospital and Scottish Rite Children's. Medical Center, merged in 1998 to become one entity with two medical campuses. They now treat 60 percent of Atlanta's pediatric patients. Merging incompatible systems has been the administrator's most immediate problem. One director of imaging services is responsible for the recently merged Mary Bridge Children's Hospital and Tacoma General Hospital, plus a network of clinics and medical facilities scatted throughout Tacoma and the South Puget Sound area in Washington state. A state-of-the-art mini-PACS and teleradiology system were implemented at Primary Children's Medical Center, Salt Lake City, in 1991. Over the years, it has added modalities into an electronic system that now results in significantly improved use of physicians' time and patient relations. St. Louis Children's Hospital, with both a director of radiology and a PACS administrator, has implemented teleradiology and an ultrasound mini-PACS, and has plans for an enterprise-wide PACS. Children's Hospital in Birmingham, Ala., a major trauma center, provides specialized pediatric care to nearly all 67 counties in Alabama. With a 20-year history of online computerization, it is now reengineering its emergency department and will implement CR there first.

Surface-water quality-assurance plan for the U.S. Geological Survey Washington Water Science Center

USGS Publications Warehouse

Mastin, Mark C.

2016-02-19

This Surface-Water Quality-Assurance Plan documents the standards, policies, and procedures used by the U.S. Geological Survey Washington Water Science Center (WAWSC) for activities related to the collection, processing, storage, analysis, and publication of surface-water data. This plan serves as a guide to all WAWSC personnel involved in surface-water data activities, and changes as the needs and requirements of the WAWSC change. Regular updates to this plan represent an integral part of the quality-assurance process. In the WAWSC, direct oversight and responsibility by the hydrographer(s) assigned to a surface-water station, combined with team approaches in all work efforts, assure highquality data, analyses, reviews, and reports for cooperating agencies and the public.

Prehospital transportation to therapeutic hypothermia centers and survival from out-of-hospital cardiac arrest.

PubMed

DeLia, Derek; Wang, Henry E; Kutzin, Jared; Merlin, Mark; Nova, Jose; Lloyd, Kristen; Cantor, Joel C

2015-12-02

Clinical trials supporting the use of therapeutic hypothermia (TH) in the treatment of out-of-hospital cardiac arrest (OHCA) are based on small patient samples and do not reflect the wide variation in patient selection, cooling methods, and other elements of post-arrest care that are used in everyday practice. This study provides a real world evaluation of the effectiveness of post-arrest care in TH centers during a time of growing TH dissemination in the state of New Jersey (NJ). Using a linked database of prehospital, hospital, and mortality records for NJ in 2009-2010, we compared rates of neurologically intact survival at discharge and at 30 days for OHCA patients transported to TH centers (N = 2363) versus other hospitals (N = 2479). We used logistic regression to adjust for patient and hospital covariates. To account for potential endogeneity in prehospital transportation decisions, we used an instrumental variable (IV) based on differential distance to the nearest TH and non-TH hospitals. Patients taken to TH centers were older, more likely to have a witnessed arrest, more likely to receive defibrillation, and waited a shorter amount of time for initial EMS response. Also, TH hospitals were larger, more likely to be teaching facilities, and operated in a service area with a relatively lower poverty rate compared to hospitals statewide. A Stock-Yogo test confirmed the strength of our IV (F = 2349.91, p < 0.0001). Nevertheless, the data showed no evidence of endogenous transportation to TH centers related to in-hospital survival (Z = -0.08, p = 0.934) or 30-day survival (Z = 0.94, p = 0.349). In logistic regression models, treatment at a TH center was associated with greater odds of 30-day neurologically intact survival (OR = 1.70; 95% CI: 1.19 - 2.42) but not associated with the odds of neurologically intact survival to hospital discharge (OR = 0.90; 95% CI: 0.61 - 1.31). Post-arrest outcomes are more favorable at TH centers but these improved outcomes are

ASTER Washington, D.C.

NASA Image and Video Library

2000-10-06

The White House, the Jefferson Memorial, and the Washington Monument with its shadow are all visible in this image of Washington, D.C. With its 15-meter spatial resolution, ASTER can see individual buildings. Taken on June 1, 2000, this image covers an area 14 kilometers (8.5 miles) wide and 13.7 kilometers (8.2 miles) long in three bands of the reflected visible and infrared wavelength region. The combination of visible and near infrared bands displays vegetation in red and water in dark grays. The Potomac River flows from the middle left to the bottom center. The large red area west of the river is Arlington National Cemetery. http://photojournal.jpl.nasa.gov/catalog/PIA02655

Exploratory Use of Microaerosol Decontamination Technology (PAEROSOL) in Enclosed, Unoccupied Hospital Setting

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

Rainina, Evguenia I.; McCune, D. E.; Luna, Maria L.

2012-05-31

The goal of this study was to validate the previously observed high biological kill performance of PAEROSOL, a semi-dry, micro-aerosol decontamination technology, against common HAI in a non-human subject trial within a hospital setting of Madigan Army Medical Center (MAMC) on Joint Base Lewis-McChord in Tacoma, Washington. In addition to validating the disinfecting efficacy of PAEROSOL, the objectives of the trial included a demonstration of PAEROSOL environmental safety, (i.e., impact to hospital interior materials and electronic equipment exposed during testing) and PAEROSOL parameters optimization for future deployment.

Occupational phosphine gas poisoning at veterinary hospitals from dogs that ingested zinc phosphide--Michigan, Iowa, and Washington, 2006-2011.

PubMed

2012-04-27

Zinc phosphide (Zn3P2) is a readily available rodenticide that, on contact with stomach acid and water, produces phosphine (PH3), a highly toxic gas. Household pets that ingest Zn3P2 often will regurgitate, releasing PH3 into the air. Veterinary hospital staff members treating such animals can be poisoned from PH3 exposure. During 2006-2011, CDC's National Institute for Occupational Safety and Health (NIOSH) received reports of PH3 poisonings at four different veterinary hospitals: two in Michigan, one in Iowa, and one in Washington. Each of the four veterinary hospitals had treated a dog that ingested Zn3P2. Among hospital workers, eight poisoning victims were identified, all of whom experienced transient symptoms related to PH3 inhalation. All four dogs recovered fully. Exposure of veterinary staff members to PH3 can be minimized by following phosphine product precautions developed by the American Veterinary Medical Association (AVMA). Exposure of pets, pet owners, and veterinary staff members to PH3 can be minimized by proper storage, handling, and use of Zn3P2 and by using alternative methods for gopher and mole control, such as snap traps.

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

PubMed

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

1993-02-01

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

Goldman visits Washington, D.C.

NASA Image and Video Library

2009-03-24

Stennis Space Center Director Gene Goldman (right) visited Washington, D.C,. last month, where he called on Louisiana and Mississippi leaders to update them on work at the rocket engine testing facility. Rep. Gene Taylor, D-Miss., was among those visited by Goldman on March 24.

Quality-assurance plan for water-quality activities in the U.S. Geological Survey Washington Water Science Center

USGS Publications Warehouse

Conn, Kathleen E.; Huffman, Raegan L.; Barton, Cynthia

2017-05-08

In accordance with guidelines set forth by the Office of Water Quality in the Water Mission Area of the U.S. Geological Survey, a quality-assurance plan has been created for use by the Washington Water Science Center (WAWSC) in conducting water-quality activities. This qualityassurance plan documents the standards, policies, and procedures used by the WAWSC for activities related to the collection, processing, storage, analysis, and publication of water-quality data. The policies and procedures documented in this quality-assurance plan for water-quality activities complement the quality-assurance plans for surface-water and groundwater activities at the WAWSC.

An examination of blood center structure and hospital customer satisfaction: what can centralized and decentralized blood centers learn from each other?

PubMed

Carden, Robert; DelliFraine, Jami L

2005-01-01

The cost of blood and blood products has increased rapidly over the last several years while the supply of available blood donors has simultaneously decreased. Higher blood costs and donor shortages have put a strain on the relationship between blood suppliers and their hospital customers. This study examines the association between blood center centralization or decentralization and several aspects of hospital satisfaction. Centralized and decentralized blood centers have significant differences in various aspects of hospital customer satisfaction. Advantages and disadvantages of the two structures are discussed, as well as areas for future research.

A Study to Develop Transition Plan Requirements for the Occupancy of the New Madigan Army Medical Center at Fort Lewis, Washington

DTIC Science & Technology

1988-07-01

DISTRIBUTION, AVAILABILITY OF REPORTAD-A209 747 JoUL01 UNCLASSIFIED/ UNLIMITED S ..- ,,*,* crui NUMBER 5. MONITORING ORGANIZATION REPORT NUMBER( S ) S ...OCCUPANCY OF THE NEW MADIGAN ARMY MEDICAL CENTER AT FORT LEWIS, WASHINGTON 12. PERSONAL AUTHOR( S ) Peterson, John Phillip 13a. TYPE OF REPORT 113b. TIME...transition areas N requiring extensive development.-.(continuep) \\ 20, DISTRIBUTION/AVAILABILITY OF ABSTRACT 21. ABSTRACT SECURITY CLASSIFICATION S

Association of Expanded Medicaid Coverage With Hospital Length of Stay After Injury.

PubMed

Holzmacher, Jeremy L; Townsend, Kerry; Seavey, Caleb; Gannon, Stephanie; Schroeder, Mary; Gondek, Stephen; Collins, Lois; Amdur, Richard L; Sarani, Babak

2017-10-01

The expansion of Medicaid eligibility under the Affordable Care Act is a state-level decision that affects how patients with traumatic injury (trauma patients) interact with locoregional health care systems. Washington, DC; Maryland; and Virginia represent 3 unique payer systems with liberal, moderate, and no Medicaid expansion, respectively, under the Affordable Care Act. Characterizing the association of Medicaid expansion with hospitalization after injury is vital in the disposition planning for these patients. To determine the association between expanded Medicaid eligibility under the Affordable Care Act and duration of hospitalization after injury. This retrospective cohort study included patients admitted from Virginia, Maryland, and Washington, DC, to a single level I trauma center. Data were collected from January 1, 2013, through March 6, 2016, in Virginia and Washington, DC, and from May 1, 2013, through March 6, 2016, in Maryland. All patients with Medicare or Medicaid coverage and all uninsured patients were included. Patients with private insurance, patients with severe head or pelvic injuries, and those who died during hospitalization were excluded. Hospital length of stay (LOS) and whether its association with patient insurance status varied by state of residence. A total of 2314 patients (1541 men [66.6%] and 773 women [33.4%]; mean [SD] age, 52.9 [22.8] years) were enrolled in the study. The uninsured rate in the Washington, DC, cohort (190 of 1699 [11.2%]) was significantly lower compared with rates in the Virginia (141 of 296 [47.6%]) or the Maryland (106 of 319 [33.2%]) cohort (P < .001). On multivariate regression controlling for injury severity and demographic variables, the difference in LOS for Medicaid vs non-Medicaid recipients varied significantly by state. For Medicaid recipients, mean LOS in Washington, DC, was significantly shorter (2.57 days; 95% CI, 2.36-2.79 days) than in Maryland (3.51 days; 95% CI, 2.81-4.38 days; P = .02

The Relationship Between Hospital Volume and Outcome in Bariatric Surgery at Academic Medical Centers

PubMed Central

Nguyen, Ninh T.; Paya, Mahbod; Stevens, C Melinda; Mavandadi, Shahrzad; Zainabadi, Kambiz; Wilson, Samuel E.

2004-01-01

Objective: To examine the effect of hospital volume of bariatric surgery on morbidity, mortality, and costs at academic centers. Summary Background Data: The American Society for Bariatric Surgery recently proposed categorization of certain bariatric surgery centers as “Centers of Excellence.” Some of the proposed inclusion criteria were hospital volume and operative outcomes. The volume–outcome relationship has been well established in several complex abdominal operations; however, few studies have examined this relationship in patients undergoing bariatric surgery. Methods: Using the International Classification of Diseases, 9th edition, diagnosis and procedure codes, we obtained data from the University HealthSystem Consortium Clinical Data Base for all patients who underwent Roux-en-Y gastric bypass for the treatment of morbid obesity between 1999 and 2002 (n = 24,166). Outcomes of bariatric surgery, including length of hospital stay, 30-day readmission, morbidity, observed and expected (risk-adjusted) mortality, and costs were compared between high-volume (>100 cases/year), medium-volume (50–100 cases/year), and low-volume hospitals (<50 cases/year). Results: There were 22 high-volume (n = 13,810), 27 medium-volume (n = 7634), and 44 low-volume (n = 2722) hospitals included in our study. Compared with low-volume hospitals, patients who underwent gastric bypass at high-volume hospitals had a shorter length of hospital stay (3.8 versus 5.1 days, P < 0.01), lower overall complications (10.2% versus 14.5%, P < 0.01), lower complications of medical care (7.8% versus 10.8%, P < 0.01), and lower costs ($10,292 versus $13,908, P < 0.01). The expected mortality rate was similar between high- and low-volume hospitals (0.6% versus 0.6%), demonstrating similarities in characteristics and severity of illness between groups. The observed mortality, however, was significantly lower at high-volume hospitals (0.3% versus 1.2%, P < 0.01). In a subset of patients older

Orthopedic specialty hospitals: centers of excellence or greed machines?

PubMed

Badlani, Neil; Boden, Scott; Phillips, Frank

2012-03-07

Orthopedic specialty hospitals have recently been the subject of debate. They are patient-centered, physician-friendly health care alternatives that take advantage of the economic efficiencies of specialization. Medically, they provide a higher quality of care and increase patient and physician satisfaction. Economically, they are more efficient and profitable than general hospitals. They also positively affect society through the taxes they pay and the beneficial aspects of the competition they provide to general hospitals. Their ability to provide a disruptive innovation to the existing hospital industry will lead to lower costs and greater access to health care. However, critics say that physician ownership presents potential conflicts of interest and leads to overuse of medical care. Some general hospitals are suffering as a result of unfair specialty hospital practices, and a few drastic medical complications have occurred at specialty hospitals. Specialty hospitals have been scrutinized for increasing the inequality of health care and continue to be a target of government regulations. In this article, the pros and cons are examined, and the Emory Orthopaedics and Spine Hospital is analyzed as an example. Orthopedic specialty hospitals provide excellent care and are great assets to society. Competition between specialty and general hospitals has provided added value to patients and taxpayers. However, physicians must take more responsibility in their appropriate and ethical leadership. It is critical to recognize financial conflicts of interest, disclose ownership, and act ethically. Patient care cannot be compromised. With thoughtful and efficient leadership, specialty hospitals can be an integral part of improving health care in the long term. Copyright 2012, SLACK Incorporated.

A midwifery-led in-hospital birth center within an academic medical center: successes and challenges.

PubMed

Perdion, Karen; Lesser, Rebecca; Hirsch, Jennifer; Barger, Mary; Kelly, Thomas F; Moore, Thomas R; Lacoursiere, D Yvette

2013-01-01

The University of California San Diego Community Women's Health Program (CWHP) has emerged as a successful and sustainable coexistence model of women's healthcare. The cornerstone of this midwifery practice is California's only in-hospital birth center. Located within the medical center, this unique and physically separate birth center has been the site for more than 4000 births. With 10% cesarean delivery and 98% breast-feeding rates, it is an exceptional example of low-intervention care. Integrating this previously freestanding birth center into an academic center has brought trials of mistrust and ineffectual communication. Education, consistent leadership, and development of multidisciplinary guidelines aided in overcoming these challenges. This collaborative model provides a structure in which residents learn to be respectful consultants and appreciate differences in medical practice. The CWHP and its Birth Center illustrates that through persistence and flexibility a collaborative model of maternity services can flourish and not only positively influence new families but also future generations of providers.

Alternative Maternity Services in Washington State.

ERIC Educational Resources Information Center

Starzyk, Patricia M.

The nature of maternity services has changed in the past 20 years, with a movement away from traditional (physician delivery in a hospital) towards other alternative services. This study examined alternative maternity services in Washington State, which ranks eighth in the country in the use of such services. Data were collected from birth and…

Hospitalization in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients.

PubMed

Weinhandl, Eric D; Nieman, Kimberly M; Gilbertson, David T; Collins, Allan J

2015-01-01

Cardiovascular disease is a common cause of hospitalization in dialysis patients. Daily hemodialysis improves some parameters of cardiovascular function, but whether it associates with lower hospitalization risk is unclear. Observational cohort study using US Renal Data System data. Medicare-enrolled daily (5 or 6 sessions weekly) home hemodialysis (HHD) patients initiating NxStage System One use from January 1, 2006, through December 31, 2009, and contemporary thrice-weekly in-center hemodialysis patients, matched 5 to 1. Daily HHD or thrice-weekly in-center hemodialysis. All-cause and cause-specific hospital admissions, hospital readmissions, and hospital days assessed from Medicare Part A claims. For 3,480 daily HHD and 17,400 thrice-weekly in-center hemodialysis patients in intention-to-treat analysis, the HR of all-cause admission for daily HHD versus in-center hemodialysis was 1.01 (95%CI, 0.98-1.03). Cause-specific admission HRs were 0.89 (95%CI, 0.86-0.93) for cardiovascular disease, 1.18 (95%CI, 1.13-1.23) for infection, 1.01 (95%CI, 0.93-1.09) for vascular access dysfunction, and 1.02 (95%CI, 0.99-1.06) for other morbidity. Regarding cardiovascular disease, first admission and readmission HRs for daily HHD versus in-center hemodialysis were 0.91 and 0.87, respectively. Regarding infection, first admission and readmission HRs were 1.35 and 1.03, respectively. Protective associations of daily HHD with heart failure and hypertensive disease were most pronounced, as were adverse associations of daily HHD with bacteremia/sepsis, cardiac infection, osteomyelitis, and vascular access infection. Results may be confounded by unmeasured factors, including vascular access type; information about dialysis frequency, duration, and dose was lacking; causes of admission may be misclassified; results may not apply to patients without Medicare coverage. All-cause hospitalization risk was similar in daily HHD and thrice-weekly in-center hemodialysis patients. However

Licensed Child Care in Washington State: 1998.

ERIC Educational Resources Information Center

Miller, Marna Geyer; Schrager, Laura

This study is one of an ongoing series of biennial surveys of all child care centers and some licensed family home providers by Washington State's Department of Social and Health Services (DSHS). A total of 1,137 child care centers and 1,527 family home providers were interviewed in spring 1998. Major findings include: (1) Over the period 1990 to…

Social Welfare Centers Protect Outpatients with Mood Disorders from Risk of Hospital Admission.

PubMed

Han, Kyu-Tae; Jang, Suk Yong; Park, Sohee; Cho, Kyung Hee; Yoo, Ki-Bong; Choi, Young; Park, Eun-Cheol

2016-01-01

South Korea faces difficulties in the management of mental disorders, and those difficulties are expected to gradually worsen. Therefore, we analyzed the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders. We used data from the National Health Insurance Service National Sample Cohort 2002-2013, which included all medical claims filed for the 50,160 patients who were newly diagnosed with a mood disorder among the 1,025,340 individuals in a nationally representative sample. We performed a logistic regression analysis using generalized estimating equation (GEE) models to examine the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders (ICD-10: F3). There was a 3.9% admission rate among a total of 99,533 person-years. Outpatients who lived in regions with more social welfare centers were less likely to be admitted to a hospital (per increase of five social welfare centers per 100,000 people; OR: 0.958; 95% CI: 0.919-0.999). Social welfare centers had an especially strong protective effect on patients with relatively mild mood disorders and those who were vulnerable to medical expenditures. Considering the protective role of social welfare centers in managing patients with mood disorders, health-policy makers need to consider strategies for activating mental healthcare.

Social Welfare Centers Protect Outpatients with Mood Disorders from Risk of Hospital Admission

PubMed Central

Han, Kyu-Tae; Jang, Suk Yong; Park, Sohee; Cho, Kyung Hee; Yoo, Ki-Bong; Choi, Young; Park, Eun-Cheol

2016-01-01

Background South Korea faces difficulties in the management of mental disorders, and those difficulties are expected to gradually worsen. Therefore, we analyzed the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders. Methods We used data from the National Health Insurance Service National Sample Cohort 2002–2013, which included all medical claims filed for the 50,160 patients who were newly diagnosed with a mood disorder among the 1,025,340 individuals in a nationally representative sample. We performed a logistic regression analysis using generalized estimating equation (GEE) models to examine the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders (ICD-10: F3). Results There was a 3.9% admission rate among a total of 99,533 person-years. Outpatients who lived in regions with more social welfare centers were less likely to be admitted to a hospital (per increase of five social welfare centers per 100,000 people; OR: 0.958; 95% CI: 0.919–0.999). Social welfare centers had an especially strong protective effect on patients with relatively mild mood disorders and those who were vulnerable to medical expenditures. Conclusions Considering the protective role of social welfare centers in managing patients with mood disorders, health-policy makers need to consider strategies for activating mental healthcare. PMID:26745728

Dynamics of ambulatory surgery centers and hospitals market entry.

PubMed

Housman, Michael; Al-Amin, Mona

2013-08-01

In this article, we investigate the diversity of healthcare delivery organizations by comparing the market determinants of hospitals entry rates with those of ambulatory surgery centers (ASCs). Unlike hospitals, ASCs is one of the growing populations of specialized healthcare delivery organizations. There are reasons to believe that firm entry patterns differ within growing organizational populations since these markets are characterized by different levels of organizational legitimacy, technological uncertainty, and information asymmetry. We compare the entry patterns of firms in a mature population of hospitals to those of firms within a growing population of ASCs. By using patient-level datasets from the state of Florida, we break down our explanatory variables by facility type (ASC vs. hospital) and utilize negative binomial regression models to evaluate the impact of niche density on ASC and hospital entry. Our results indicate that ASCs entry rates is higher in markets with overlapping ASCs while hospitals entry rates are less in markets with overlapping hospitals and ASCs. These results are consistent with the notion that firms in growing populations tend to seek out crowded markets as they compete to occupy the most desirable market segments while firms in mature populations such as general hospitals avoid direct competition. © The Author(s) 2013 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.

[Development and application of hospital customer service center platform].

PubMed

Chen, Minya; Zheng, Konglin; Xia, Yong

2012-01-01

This paper introduces the construction and application of the platform of client service center in the general hospital and discusses how to provide patients with an entire service including service before clinic, on clinic and after clinic. It can also provide references for a new service mode for clinic service.

[Safe and family-centered maternity hospitals: organizational culture of maternity hospitals in the province of Buenos Aires].

PubMed

Ramos, Silvina; Romero, Mariana; Ortiz, Zulma; Brizuela, Vanessa

2015-12-01

In 2010, the Safe and Family-Centered Maternity Hospitals initiative was launched in order to transform large public maternity centers into settings where safe practices are implemented and the rights of women, newborn infants and families are warranted. As a result, the paradigm of perinatal care was modified. This article reports on the findings of organizational culture as a component for the implementation of the initiative. The sample was selected in a non-probabilistic way and was made up of 29 public hospitals located in the province of Buenos Aires that participated in the initiative. During 2011 and 2012, an anonymous, self-administered survey was completed by members of the Department of Neonatology and the Department of Obstetrics. The survey collected information on three dimensions of the organizational culture: organizational environment, safe practices, and facilitation of change. A total of 1828 surveys were collected; 51% of survey respondents stated that there is a need to improve communication by having more meetings, while 60% made a positive assessment of various aspects of leadership. Work overload was described as the main cause of conflicts by 60%. Approximately 25% agreed and showed commitment with the initiative of transforming maternity centers. Adherence to practices was dissimilar depending on the practice, but half of survey respondents reported that there were genuine reasons for change. The assessment of the organizational culture showed that commitment to the Safe and Family-Centered Maternity Hospitals initiative is yet to be consolidated, and the evaluation of leadership is not comprehensive. Work overload and communication failures are the main reasons for conflict.

The Impact of Interstate Migration on Human Capital Development in Washington

ERIC Educational Resources Information Center

Spaulding, Randy

2010-01-01

Washington State is a leader in the innovation economy largely due to the combination of aerospace, software, and biomedical industries centered in the greater Seattle area; and, the state's high level of international trade. Despite Washington's national ranking, the state is overly reliant on importing educated workers from other states and…

[Drug information management through the intranet of a hospital center].

PubMed

Juárez Giménez, J C; Mendarte Barrenechea, L; Gil Luján, G; Sala Piñol, F; Lalueza Broto, P; Girona Brumós, L; Monterde Junyent, J

2006-01-01

This paper describes the methodology used for the implementation and validation of a network resource incorporated to the intranet of the Hospital, in order to retain and disseminate information from the Drug Information Center (DIC) of a pharmacy service in a hospital center. A working group designed the structure, contents, memory needs, priority of access for users and a quality assessment questionnaire. The resource developed by the working group had a capacity of 70 Gb and its structure was based on HTML documents, including files with different format and 12 theme areas. Two levels of priority of access were established depending on the user and two persons were in charge of the resource. The questionnaire was delivered after three months of use. Sixty nine per cent of the users regarded the resource as very useful and 31%, as useful. The final structure, according to the results of the survey, had 11 theme areas. The use of the hospital Intranet in order to include and organize DIC information can be very simple and economic. Furthermore, the involvement of all the users in its design and structure can facilitate the practical use of this tool and improve its quality.

Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers.

PubMed

Ho, Vivian; Metcalfe, Leanne; Dark, Cedric; Vu, Lan; Weber, Ellerie; Shelton, George; Underwood, Howard R

2017-12-01

We compare utilization, price per visit, and the types of care delivered across freestanding emergency departments (EDs), hospital-based EDs, and urgent care centers in Texas. We analyzed insurance claims processed by Blue Cross Blue Shield of Texas from 2012 to 2015 for patient visits to freestanding EDs, hospital-based EDs, or urgent care centers in 16 Texas metropolitan statistical areas containing 84.1% of the state's population. We calculated the aggregate number of visits, average price per visit, proportion of price attributable to facility and physician services, and proportion of price billed to Blue Cross Blue Shield of Texas versus out of pocket, by facility type. Prices for the top 20 diagnoses and procedures by facility type are compared. Texans use hospital-based EDs and urgent care centers much more than freestanding EDs, but freestanding ED utilization increased 236% between 2012 and 2015. The average price per visit was lower for freestanding EDs versus hospital-based EDs in 2012 ($1,431 versus $1,842), but prices in 2015 were comparable ($2,199 versus $2,259). Prices for urgent care centers were only $164 and $168 in 2012 and 2015. Out-of-pocket liability for consumers for all these facilities increased slightly from 2012 to 2015. There was 75% overlap in the 20 most common diagnoses at freestanding EDs versus urgent care centers and 60% overlap for hospital-based EDs and urgent care centers. However, prices for patients with the same diagnosis were on average almost 10 times higher at freestanding and hospital-based EDs relative to urgent care centers. Utilization of freestanding EDs is rapidly expanding in Texas. Higher prices at freestanding and hospital-based EDs relative to urgent care centers, despite substantial overlap in services delivered, imply potential inefficient use of emergency facilities. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

American College of Surgeons Level I trauma centers outcomes do not correlate with patients' perception of hospital experience.

PubMed

Joseph, Bellal; Azim, Asad; O'Keeffe, Terence; Ibraheem, Kareem; Kulvatunyou, Narong; Tang, Andrew; Vercruysse, Gary; Friese, Randall; Latifi, Rifat; Rhee, Peter

2017-04-01

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a data collection methodology for measuring a patient's perception of his/her hospital experience, and it has been selected by the Centers of Medicare and Medicaid Services as the validated and transparent national survey tool with publicly available results. Since 2012, hospital reimbursements rates have been linked to HCAHPS data based on patient satisfaction scores. The aim of this study was, therefore, to assess whether HCAHPS scores of Level I trauma centers correlate with actual hospital performance. Retrospective analysis of the latest publicly available HCAHPS data (2014-2015) was performed. American College of Surgeons (ACS) verified Level I trauma centers for each state were identified from the ACS registry and then the following data points were collected for each hospital: HCAHPS linear mean scores regarding cleanliness of the hospital, doctor and nurse communication with the patient, staff responsiveness, pain management, overall hospital rating, and patient willingness to recommend the hospital. Our outcome measure were serious complication scores, failure-to-rescue (FTR) scores and readmission-after-discharge scores. Spearman correlation analysis was performed. A total of 119 ACS verified Level I trauma centers across 46 states were included. The median [IQR] overall hospital rating score for Level I trauma centers was 89 (87-90). The mean ± SD score for serious complication was 0.96 ± 0.266, FTR was 123.06 ± 22.5, and readmission after discharge was 15.71 ± 1.07. The Spearman correlation analysis showed that overall HCAHP-based hospital rating scores did not correlate with serious complications (correlation coefficient = 0.14 p = 0.125), FTR (correlation coefficient = -0.15 p = 0.073), or readmission after discharge (correlation coefficient = -0.18 p = 0.053). The findings of our study suggest that no correlation exists between HCAHPS patient satisfaction

38 CFR 17.112 - Services or ceremonies on Department of Veterans Affairs hospital or center reservations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... will be considered partisan and therefore inappropriate. (b) Requests for permission to hold services... Affairs hospital or center involved. Such applications will describe the proposed activity in sufficient... section. If permission is granted, the Director of the hospital or center involved will assign an...

Managing the Development of the Public Telecommunications Center, Spokane, Washington.

ERIC Educational Resources Information Center

Schaar, Walter

When the city council of Spokane (Washington) decided in 1971 to establish a cable franchise, it created a citizens' committee to set cable specifications. Representing Spokane School District 81 and KSPS-TV (a public television station licensed to the public schools of Spokane), the author of this document served on the committee that set five…

Fred Hutchinson Cancer Research Center, Seattle, Washington: Laboratories for the 21st Century Case Studies

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

Not Available

2001-12-01

This case study was prepared by participants in the Laboratories for the 21st Century program, a joint endeavor of the U.S. Environmental Protection Agency and the U.S. Department of Energy's Federal Energy Management Program. The goal of this program is to foster greater energy efficiency in new laboratory buildings for both the public and the private sectors. Retrofits of existing laboratories are also encouraged. The energy-efficient features of the laboratories in the Fred Hutchinson Cancer Research Center complex in Seattle, Washington, include extensive use of efficient lighting, variable-air-volume controls, variable-speed drives, motion sensors, and high-efficiency chillers and motors. With aboutmore » 532,000 gross square feet, the complex is estimated to use 33% less electrical energy than most traditional research facilities consume because of its energy-efficient design and features.« less

76 FR 55157 - Final Public Meeting in Washington, DC for the Proposed Keystone XL Project

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-06

... along the pipeline route, a final meeting will be held in Washington, DC. Friday, October 7, 2011 Ronald Reagan Building and International Trade Center, Atrium Hall, 1300 Pennsylvania Avenue, Washington...

Making Our Presence Felt: Librarians Come to Washington and Get Their Concerns on the Agenda

ERIC Educational Resources Information Center

Albanese, Andrew; Bardales, Aida; Berry, John N., III; Datema, Jay; Fialkoff, Francine; Fox, Bette-Lee; Oder, Norman; Rogers, Michael; Williams, Wilda

2007-01-01

This article presents the highlights of the 2007 American Library Association (ALA) annual conference held at the Washington Convention Center in Washington, D.C. Hundreds of librarians showed up early for a day of service, volunteering in libraries, schools, and other Washington-area institutions. As the conference wound down, some 2000…

Space Radar Image of Washington D.C.

NASA Technical Reports Server (NTRS)

1994-01-01

The city of Washington, D.C., is shown is this space radar image. Images like these are useful tools for urban planners and managers, who use them to map and monitor land use patterns. Downtown Washington is the bright area between the Potomac (upper center to lower left) and Anacostia (middle right) rivers. The dark cross shape that is formed by the National Mall, Tidal Basin, the White House and Ellipse is seen in the center of the image. Arlington National Cemetery is the dark blue area on the Virginia (left) side of the Potomac River near the center of the image. The Pentagon is visible in bright white and red, south of the cemetery. Due to the alignment of the radar and the streets, the avenues that form the boundary between Washington and Maryland appear as bright red lines in the top, right and bottom parts of the image, parallel to the image borders. This image is centered at 38.85 degrees north latitude, 77.05 degrees west longitude. North is toward the upper right. The area shown is approximately 29 km by 26 km (18 miles by 16 miles). Colors are assigned to different frequencies and polarizations of the radar as follows: Red is the L-band horizontally transmitted, horizontally received; green is the L-band horizontally transmitted, vertically received; blue is the C-band horizontally transmitted, vertically received. The image was acquired by the Spaceborne Imaging Radar-C/X-band Synthetic Aperture (SIR-C/X-SAR) imaging radar when it flew aboard the space shuttle Endeavour on April 18, 1994. SIR-C/X-SAR, a joint mission of the German, Italian and United States space agencies, is part of NASA's Mission to Planet Earth program.

A Study to Determine the Most Efficient Provision of Surgical Care at Darnall Army Community Hospital

DTIC Science & Technology

1987-09-01

the health care facility, the nursing staff, the patients , and quality of care. There are several reasons for hospitals to provide ambulatory surgery...Anestnesiologists (ASA) Category 2-- Patients in moderately good health with well controlteC systemic disease. Free standing ambuiatory center (FASC)--is...costs. (GAO/HRO-85-23). Washington, DC: Author.- Health Services Command. (1986, July). The workload management system for nursing: Patient acuity system

Patient-centered care, nurse work environment and implicit rationing of nursing care in Swiss acute care hospitals: A cross-sectional multi-center study.

PubMed

Bachnick, Stefanie; Ausserhofer, Dietmar; Baernholdt, Marianne; Simon, Michael

2018-05-01

Patient-centered care is a key element of high-quality healthcare and determined by individual, structural and process factors. Patient-centered care is associated with improved patient-reported, clinical and economic outcomes. However, while hospital-level characteristics influence patient-centered care, little evidence is available on the association of patient-centered care with characteristic such as the nurse work environment or implicit rationing of nursing care. The aim of this study was to describe patient-centered care in Swiss acute care hospitals and to explore the associations with nurse work environment factors and implicit rationing of nursing care. This is a sub-study of the cross-sectional multi-center "Matching Registered Nurse Services with Changing Care Demands" study. We included 123 units in 23 acute care hospitals from all three of Switzerland's language regions. The sample consisted of 2073 patients, hospitalized for at least 24 h and ≥18 years of age. From the same hospital units, 1810 registered nurses working in direct patient care were also included. Patients' perceptions of patient-centered care were assessed using four items from the Generic Short Patient Experiences Questionnaire. Nurses completed questionnaires assessing perceived staffing and resource adequacy, adjusted staffing, leadership ability and level of implicit rationing of nursing care. We applied a Generalized Linear Mixed Models for analysis including individual-level patient and nurse data aggregated to the unit level. Patients reported high levels of patient-centered care: 90% easily understood nurses, 91% felt the treatment and care were adapted for their situation, 82% received sufficient information, and 70% felt involved in treatment and care decisions. Higher staffing and resource adequacy was associated with higher levels of patient-centered care, e.g., sufficient information (β 0.638 [95%-CI: 0.30-0.98]). Higher leadership ratings were associated with

Hospital competition and financial performance: the effects of ambulatory surgery centers.

PubMed

Carey, Kathleen; Burgess, James F; Young, Gary J

2011-05-01

Ambulatory surgery centers (ASCs), limited-service alternatives for treating surgery patients not requiring an overnight stay, are a health-care service innovation that has proliferated in the U.S. and other countries in recent years. This paper examines the effects of ASC competition on revenues, costs, and profit margins of hospitals that also provided these services as a subset of their general services in Arizona, California, and Texas during the period 1997-2004. We identified all ASCs operating during the period in the 49 Dartmouth Hospital Referral Regions in the three states. The results of fixed effects models suggested that ASCs are meaningful competitors to general hospitals. We found downward pressure on revenues, costs, and profits in general hospitals associated with ASC presence. Copyright © 2010 John Wiley & Sons, Ltd.

HMO penetration, hospital competition, and growth of ambulatory surgery centers.

PubMed

Bian, John; Morrisey, Michael A

2006-01-01

Using metropolitan statistical area (MSA) panel data from 1992-2001 constructed from the 2002 Medicare Online Survey Certification and Reporting (OSCAR) System, we estimate the market effects of health maintenance organization (HMO) penetration and hospital competition on the growth of freestanding ambulatory surgery centers (ASCs). Our regression models with MSA and year fixed effects suggest that a 10-percentage-point increase in HMO penetration is associated with a decrease of 3 ASCs per 1 million population. A decrease from 5 to 4 equal-market-shared hospitals in a market is associated with an increase of 2.5 ASCs per 1 million population.

Southwest Washington, Urban Renewal Area, Bounded by Independence Avenue, Washington ...

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

Southwest Washington, Urban Renewal Area, Bounded by Independence Avenue, Washington Avenue, South Capitol Street, Canal Street, P Street, Maine Avenue & Washington Channel, Fourteenth Street, D Street, & Twelfth Street, Washington, District of Columbia, DC

77 FR 12598 - Notice Correction; A Multi-Center International Hospital-Based Case-Control Study of Lymphoma in...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-01

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Notice Correction; A Multi-Center International Hospital-Based Case-Control Study of Lymphoma in Asia (AsiaLymph) (NCI) The Federal... project titled, ``A multi-center international hospital-based case-control study of lymphoma in Asia (Asia...

Obstructive Sleep Apnea in Obese Hospitalized Patients: A Single Center Experience

PubMed Central

Sharma, Sunil; Mather, Paul J.; Efird, Jimmy T.; Kahn, Daron; Shiue, Kristin Y.; Cheema, Mohammed; Malloy, Raymond; Quan, Stuart F.

2015-01-01

Study Objectives: Obstructive sleep apnea (OSA) is an important health problem associated with significant morbidity and mortality. This condition often is underrecognized in hospitalized patients. The aim of this study was to conduct a clinical pathway evaluation (CPE) among obese patients admitted to a tertiary care hospital. We also assessed oxygen desaturation index (ODI, measured by overnight pulse oximetry) as a potential low-cost screening tool for identifying OSA. Methods: This was a prospective study of 754 patients admitted to an academic medical center between February 2013 and February 2014. Consecutive obese patients (body mass index ≥ 30) admitted to the hospital (medical services) were screened and evaluated for OSA with the snoring, tiredness during daytime, observed apnea, high blood pressure (STOP) questionnaire. The admitting team was advised to perform follow-up evaluation, including polysomnography, if the test was positive. Results: A total of 636 patients were classified as high risk and 118 as low risk for OSA. Within 4 w of discharge, 149 patients underwent polysomnography, and of these, 87% (129) were shown to have OSA. An optimal screening cutoff point for OSA (apnea-hypopnea index ≥ 10/h) was determined to be ODI ≥ 10/h [Matthews correlation coefficient = 0.36, 95% confidence interval = 0.24–0.47]. Significantly more hospitalized patients were identified and underwent polysomnography compared with the year prior to introduction of the CPE. Conclusions: Our results indicate that the CPE increased the identification of OSA in this population. Furthermore, ODI derived from overnight pulse oximetry may be a cost-effective strategy to screen for OSA in hospitalized patients. Citation: Sharma S, Mather PJ, Efird JT, Kahn D, Shiue KY, Cheema M, Malloy R, Quan SF. Obstructive sleep apnea in obese hospitalized patients: a single center experience. J Clin Sleep Med 2015;11(7):717–723. PMID:25766715

Legal Issues and Small High Schools: Strategies to Support Innovation in Washington State

ERIC Educational Resources Information Center

Warner-King, Kelly; Price, Mitch

2004-01-01

In 2003, education program officials at the Bill & Melinda Gates Foundation asked attorneys at the University of Washington's Center on Reinventing Public Education to explore legal issues affecting the establishment and operation of small high schools in Washington State. Although this guide will be of interest to small school advocates…

Hospital costs by cost center of inpatient hospitalization for medicare patients undergoing major abdominal surgery.

PubMed

Stey, Anne M; Brook, Robert H; Needleman, Jack; Hall, Bruce L; Zingmond, David S; Lawson, Elise H; Ko, Clifford Y

2015-02-01

This study aims to describe the magnitude of hospital costs among patients undergoing elective colectomy, cholecystectomy, and pancreatectomy, determine whether these costs relate as expected to duration of care, patient case-mix severity and comorbidities, and whether risk-adjusted costs vary significantly by hospital. Correctly estimating the cost of production of surgical care may help decision makers design mechanisms to improve the efficiency of surgical care. Patient data from 202 hospitals in the ACS-NSQIP were linked to Medicare inpatient claims. Patient charges were mapped to cost center cost-to-charge ratios in the Medicare cost reports to estimate costs. The association of patient case-mix severity and comorbidities with cost was analyzed using mixed effects multivariate regression. Cost variation among hospitals was quantified by estimating risk-adjusted hospital cost ratios and 95% confidence intervals from the mixed effects multivariate regression. There were 21,923 patients from 202 hospitals who underwent an elective colectomy (n = 13,945), cholecystectomy (n = 5,569), or pancreatectomy (n = 2,409). Median cost was lowest for cholecystectomy ($15,651) and highest for pancreatectomy ($37,745). Room and board costs accounted for the largest proportion (49%) of costs and were correlated with length of stay, R = 0.89, p < 0.001. The patient case-mix severity and comorbidity variables most associated with cost were American Society of Anesthesiologists (ASA) class IV (estimate 1.72, 95% CI 1.57 to 1.87) and fully dependent functional status (estimate 1.63, 95% CI 1.53 to 1.74). After risk-adjustment, 66 hospitals had significantly lower costs than the average hospital and 57 hospitals had significantly higher costs. The hospital costs estimates appear to be consistent with clinical expectations of hospital resource use and differ significantly among 202 hospitals after risk-adjustment for preoperative patient characteristics and procedure type

The contributions of library and information services to hospitals and academic health sciences centers: a preliminary taxonomy

PubMed Central

Abels, Eileen G.; Cogdill, Keith W.; Zach, Lisl

2002-01-01

Objectives: This article presents a taxonomy of the contributions of library and information services (LIS) in hospitals and academic health sciences centers. The taxonomy emerges from a study with three objectives: to articulate the value of LIS for hospitals and academic health sciences centers in terms of contributions to organizational missions and goals, to identify measures and measurable surrogates associated with each LIS contribution, and to document best practices for communicating the value of LIS to institutional administrators. Methods: The preliminary taxonomy of LIS contributions in hospitals and academic health sciences centers is based on a review of the literature, twelve semi-structured interviews with LIS directors and institutional administrators, and a focus group of administrators from five academic, teaching, and nonteaching hospitals. Results: Derived from the balanced scorecard approach, the taxonomy of LIS contributions is organized on the basis of five mission-level concepts and fifteen organizational goals. LIS contributions are included only if they have measurable surrogates. Conclusions: The taxonomy of LIS contributions offers a framework for the collection of both quantitative and qualitative data in support of communicating the value of LIS in hospitals and academic health sciences centers. PMID:12113510

Fred Hutchinson Cancer Research Center, Seattle, Washington: Laboratories for the 21st Century Case Studies (Revision)

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

Not Available

2002-03-01

This case study was prepared by participants in the Laboratories for the 21st Century program, a joint endeavor of the U.S. Environmental Protection Agency and the U.S. Department of Energy's Federal Energy Management Program. The goal of this program is to foster greater energy efficiency in new laboratory buildings for both the public and the private sectors. Retrofits of existing laboratories are also encouraged. The energy-efficient features of the laboratories in the Fred Hutchinson Cancer Research Center complex in Seattle, Washington, include extensive use of efficient lighting, variable-air-volume controls, variable-speed drives, motion sensors, and high-efficiency chillers and motors. With aboutmore » 532,000 gross square feet, the complex is estimated to use 33% less electrical energy than most traditional research facilities consume because of its energy-efficient design and features.« less

HMO Penetration, Hospital Competition, and Growth of Ambulatory Surgery Centers

PubMed Central

Bian, John; Morrisey, Michael A.

2006-01-01

Using metropolitan statistical area (MSA) panel data from 1992-2001 constructed from the 2002 Medicare Online Survey Certification and Reporting (OSCAR) System, we estimate the market effects of health maintenance organization (HMO) penetration and hospital competition on the growth of freestanding ambulatory surgery centers (ASCs). Our regression models with MSA and year fixed effects suggest that a 10-percentage-point increase in HMO penetration is associated with a decrease of 3 ASCs per 1 million population. A decrease from 5 to 4 equal-market-shared hospitals in a market is associated with an increase of 2.5 ASCs per 1 million population. PMID:17290661

The Logistics Of Installing Pacs In An Existing Medical Center

NASA Astrophysics Data System (ADS)

Saarinen, Allan O.; Goodsitt, Mitchell M.; Loop, John W.

1989-05-01

A largely overlooked issue in the Picture Archiving and Communication Systems (PACS) area is the tremendous amount of site planning activity required to install such a system in an existing medical center. Present PACS equipment requires significant hospital real estate, specialized electrical power, cabling, and environmental controls to operate properly. Marshaling the hospital resources necessary to install PACS equipment requires many different players. The site preparation costs are nontrivial and usually include a number of hidden expenses. This paper summarizes the experience of the University of Washington Department of Radiology in installing an extensive digital imaging network (DIN) and PACS throughout the Department and several clinics in the hospital. The major logistical problems encountered at the University are discussed, a few recommendations are made, and the installation costs are documented. Overall, the University's site preparation costs equalled about seven percent (7%) of the total PACS equipment expenditure at the site.

A population-based survival assessment of categorizing level III and IV rural hospitals as trauma centers.

PubMed

Arthur, Melanie; Newgard, Craig D; Mullins, Richard J; Diggs, Brian S; Stone, Judith V; Adams, Annette L; Hedges, Jerris R

2009-01-01

Patients injured in rural areas are hypothesized to have improved outcomes if statewide trauma systems categorize rural hospitals as Level III and IV trauma centers, though evidence to support this belief is sparse. To determine if there is improved survival among injured patients hospitalized in states that categorize rural hospitals as trauma centers. We analyzed a retrospective cohort of injured patients included in the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample from 1997 to 1999. We used generalized estimating equations to compare survival among injured patients hospitalized in states that categorize rural hospitals as Level III and IV trauma centers versus those that do not. Multivariable models adjusted for important confounders, including patient demographics, co-morbid conditions, injury severity, and hospital-level factors. There were 257,044 admitted patients from 7 states with a primary injury diagnosis, of whom 64,190 (25%) had a "serious" index injury, 32,763 (13%) were seriously injured (by ICD-9 codes), and 12,435 (5%) were very seriously injured (by ICD-9 codes). There was no survival benefit associated with rural hospital categorization among all patients with a primary injury diagnosis or for those with specific index injuries. However, seriously injured patients (by ICD-9 codes) had improved survival when hospitalized in a categorizing state (OR for mortality 0.72, 95% confidence interval [CI] 0.53-0.97; OR for very seriously injured 0.68, 95% CI 0.52-0.90). There was no survival benefit to categorizing rural hospitals among a broad, heterogeneous group of hospitalized patients with a primary injury diagnosis; however the most seriously injured patients did have increased survival in such states.

Estimating the unit costs of public hospitals and primary healthcare centers.

PubMed

Younis, Mustafa Z; Jaber, Samer; Mawson, Anthony R; Hartmann, Michael

2013-01-01

Many factors have affected the rise of health expenditures, such as high-cost medical technologies, changes in disease patterns and increasing demand for health services. All countries allocate a significant portion of resources to the health sector. In 2008, the gross domestic product of Palestine was estimated to be at $6.108bn (current price) or about $1697 per capita. Health expenditures are estimated at 15.6% of the gross domestic product, almost as much as those of Germany, Japan and other developed countries. The numbers of hospitals, hospital beds and primary healthcare centers in the country have all increased. The Ministry of Health (MOH) currently operates 27 of 76 hospitals, with a total of 3074 beds, which represent 61% of total beds of all hospitals in the Palestinian Authorities area. Also, the MOH is operating 453 of 706 Primary Health Care facilities. By 2007, about 40 000 people were employed in different sectors of the health system, with 33% employed by the MOH. This purpose of this study was to develop a financing strategy to help cover some or all of the costs involved in operating such institutions and to estimate the unit cost of primary and secondary programs and departments. A retrospective study was carried out on data from government hospitals and primary healthcare centers to identify and analyze the costs and output (patient-related services) and to estimate the unit cost of health services provided by hospitals and PHCs during the year 2008. All operating costs are assigned and allocated to the departments at MOH hospitals and primary health care centers (PPHCs) and are identified as overhead departments, intermediate-service and final-service departments. Intermediate-service departments provide procedures and services to patients in the final-service departments. The costs of the overhead departments are distributed to the intermediate-service and final-service departments through a step-down method, according to allocation

Testing family-centered, function-focused care in hospitalized persons with dementia.

PubMed

Boltz, Marie; Chippendale, Tracy; Resnick, Barbara; Galvin, James E

2015-01-01

Hospital-acquired disability causes decreased quality of life for patients with dementia and family caregivers, and increased societal costs. A comparative, repeated measures study tested the feasibility and preliminary efficacy of the family-centered, function-focused care intervention (Fam-FFC) in dyads of hospitalized, medical patients with dementia and family caregivers (FCGs). The intervention group demonstrated better activities of daily living and walking performance, and less severity/duration of delirium and hospital readmissions, but no significant differences in gait/balance. FCGs showed increased preparedness for caregiving and less anxiety but no significant differences in depression, strain and mutuality. Fam-FFC presents a possible pathway to meeting the Triple Aim of improved patient care, improved patient health and reduced costs for persons with dementia.

Hydrogeologic controls on ground-water discharge to the Washington METRO subway tunnel near the Medical Center station and Crossover, Montgomery County, Maryland

USGS Publications Warehouse

Greene, Earl A.; Shapiro, Allen M.; LaMotte, Andrew E.

2004-01-01

Excessive water intrusion has been observed inside several of the Washington Metropolitan Area Transit Authority subway tunnels, with the worst leakage occurring along the Red Line tunnels and stations north of Dupont Circle in Washington, D.C. These tunnels were constructed in bedrock that contains permeable (water-bearing) joints and fractures. Excessive water leakage through the walls and water inside the underground facilities has damaged mechanical and electrical components in the tunnel, and has escalated the deterioration rate of the rail system. The U.S. Geological Survey and the Washington Metropolitan Area Transit Authority have worked cooperatively on a study from 200003 to describe and quantify the factors controlling ground-water flow into the Red Line subway tunnel near the Medical Center Station and Crossover in Montgomery County, Maryland. The Red Line near the Medical Center Station and Crossover passes through or beneath the gneissic Sykesville Formation and the biotite-hornblende tonalite member of the Georgetown Intrusive Suite, both of which contain numerous fractures. The mapped foliation and joints of the Sykesville Formation in the vicinity of the Medical Center Station and Crossover are generally orientated north-south. Fractures in the Sykesville Formation in outcrops appear to be poorly connected. In the biotite-hornblende tonalite member of the Georgetown Intrusive Suite, the general orientation of the mapped foliation and joints is east-west. In contrast to the fractures in the Sykesville Formation, the fractures in the Georgetown Intrusive Suite in outcrops appear to be more numerous and have a greater degree of connectivity. Fractures intersecting four bedrock wells near the Medical Center Station and Crossover that were drilled into the biotite-hornblende tonalite member of the Georgetown Intrusive Suite show an east-west orientation matching the foliation and joints shown on geologic maps. The excessive water intrusion at the

Cesarean Outcomes in US Birth Centers and Collaborating Hospitals: A Cohort Comparison.

PubMed

Thornton, Patrick; McFarlin, Barbara L; Park, Chang; Rankin, Kristin; Schorn, Mavis; Finnegan, Lorna; Stapleton, Susan

2017-01-01

High rates of cesarean birth are a significant health care quality issue, and birth centers have shown potential to reduce rates of cesarean birth. Measuring this potential is complicated by lack of randomized trials and limited observational comparisons. Cesarean rates vary by provider type, setting, and clinical and nonclinical characteristics of women, but our understanding of these dynamics is incomplete. We sought to isolate labor setting from other risk factors in order to assess the effect of birth centers on the odds of cesarean birth. We generated low-risk cohorts admitted in labor to hospitals (n = 2527) and birth centers (n = 8776) using secondary data obtained from the American Association of Birth Centers (AABC). All women received prenatal care in the birth center and midwifery care in labor, but some chose hospital admission for labor. Analysis was intent to treat according to site of admission in spontaneous labor. We used propensity score adjustment and multivariable logistic regression to control for cohort differences and measured effect sizes associated with setting. There was a 37% (adjusted odds ratio [OR], 0.63; 95% confidence interval [CI], 0.50-0.79) to 38% (adjusted OR, 0.62; 95% CI, 0.49-0.79) decreased odds of cesarean in the birth center cohort and a remarkably low overall cesarean rate of less than 5% in both cohorts. These findings suggest that low rates of cesarean in birth centers are not attributable to labor setting alone. The entire birth center care model, including prenatal preparation and relationship-based midwifery care, should be studied, promoted, and implemented by policy makers interested in achieving appropriate cesarean rates in the United States. © 2016 by the American College of Nurse-Midwives.

Famous Americans: George Washington and Abraham Lincoln.

ERIC Educational Resources Information Center

Fleming, Maria

This book provides background information and ideas for teaching about George Washington and Abraham Lincoln at the primary grade level. Cross-curricular activities include work in music, writing, art, research, plays, and games. A pull-out poster with a poem on "President's Day" is stapled in the center of the book. Chapters in the book…

Death with dignity in Washington patients with amyotrophic lateral sclerosis

PubMed Central

Elliott, Michael A.; Jung Henson, Lily; Gerena-Maldonado, Elba; Strom, Susan; Downing, Sharon; Vetrovs, Jennifer; Kayihan, Paige; Paul, Piper; Kennedy, Kate; Benditt, Joshua O.; Weiss, Michael D.

2016-01-01

Objectives: To describe the amyotrophic lateral sclerosis (ALS) patients who sought medication under the Washington State Death with Dignity (DWD) Act since its inception in 2009. Methods: Chart review at 3 tertiary medical centers in the Seattle/Puget Sound region and comparison to publicly available data of ALS and all-cause DWD cohorts from Washington and Oregon. Results: In Washington State, 39 patients with ALS requested DWD from the University of Washington, Virginia Mason, and Swedish Medical Centers beginning in 2009. The median age at death was 65 years (range 46–86). Seventy-seven percent of the patients used the prescriptions. All of the patients who used the medications passed away without complications. The major reasons for patients to request DWD as reported by participating physicians were loss of autonomy and dignity and decrease in enjoyable activities. Inadequate pain control, financial cost, and loss of bodily control were less commonly indicated. These findings were similar to those of the 92 patients who sought DWD in Oregon. In Washington and Oregon, the percentage of patients with ALS seeking DWD is higher compared to the cancer DWD cohort. Furthermore, compared to the all-cause DWD cohort, patients with ALS are more likely to be non-Hispanic white, married, educated, enrolled in hospice, and to have died at home. Conclusions: Although a small number, ALS represents the disease with the highest proportion of patients seeking to participate in DWD. Patients with ALS who choose DWD are well-educated and have access to palliative or life-prolonging care. The use of the medications appears to be able to achieve the patients' goals without complications. PMID:27770068

Death with dignity in Washington patients with amyotrophic lateral sclerosis.

PubMed

Wang, Leo H; Elliott, Michael A; Jung Henson, Lily; Gerena-Maldonado, Elba; Strom, Susan; Downing, Sharon; Vetrovs, Jennifer; Kayihan, Paige; Paul, Piper; Kennedy, Kate; Benditt, Joshua O; Weiss, Michael D

2016-11-15

To describe the amyotrophic lateral sclerosis (ALS) patients who sought medication under the Washington State Death with Dignity (DWD) Act since its inception in 2009. Chart review at 3 tertiary medical centers in the Seattle/Puget Sound region and comparison to publicly available data of ALS and all-cause DWD cohorts from Washington and Oregon. In Washington State, 39 patients with ALS requested DWD from the University of Washington, Virginia Mason, and Swedish Medical Centers beginning in 2009. The median age at death was 65 years (range 46-86). Seventy-seven percent of the patients used the prescriptions. All of the patients who used the medications passed away without complications. The major reasons for patients to request DWD as reported by participating physicians were loss of autonomy and dignity and decrease in enjoyable activities. Inadequate pain control, financial cost, and loss of bodily control were less commonly indicated. These findings were similar to those of the 92 patients who sought DWD in Oregon. In Washington and Oregon, the percentage of patients with ALS seeking DWD is higher compared to the cancer DWD cohort. Furthermore, compared to the all-cause DWD cohort, patients with ALS are more likely to be non-Hispanic white, married, educated, enrolled in hospice, and to have died at home. Although a small number, ALS represents the disease with the highest proportion of patients seeking to participate in DWD. Patients with ALS who choose DWD are well-educated and have access to palliative or life-prolonging care. The use of the medications appears to be able to achieve the patients' goals without complications. © 2016 American Academy of Neurology.

Planning a new library in an age of transition: the Washington University School of Medicine Library and Biomedical Communications Center.

PubMed Central

Crawford, S; Halbrook, B

1990-01-01

In an era of great technological and socioeconomic changes, the Washington University School of Medicine conceptualized and built its first Library and Biomedical Communications Center in seventy-eight years. The planning process, evolution of the electronic library, and translation of functions into operating spaces are discussed. Since 1983, when the project was approved, a whole range of information technologies and services have emerged. The authors consider the kind of library that would operate in a setting where people can do their own searches, order data and materials through an electronic network, analyze and manage information, and use software to create their own publications. Images PMID:2393757

Child Care Rates in Washington State: 1992.

ERIC Educational Resources Information Center

Miller, Marna Geyer; Mayfield, Jim

The Washington State Department of Social and Health Services (DSHS) subsidizes child care for about 30,000 children each month. In 1992, telephone interviews were conducted with 1,179 child care centers and 1,277 licensed family child care homes throughout the state. An estimated 140,000 children were in licensed care at that time. Three major…

Maternal and neonatal outcomes in birth centers versus hospitals among women with low-risk pregnancies in Japan: A retrospective cohort study.

PubMed

Kataoka, Yaeko; Masuzawa, Yuko; Kato, Chiho; Eto, Hiromi

2018-01-01

In order for low-risk pregnant women to base birth decisions on the risks and benefits, they need evidence of birth outcomes from birth centers. The purpose of this study was to describe and compare the maternal and neonatal outcomes of low-risk women who gave birth in birth centers and hospitals in Japan. The participants were 9588 women who had a singleton vaginal birth at 19 birth centers and two hospitals in Tokyo. The data were collected from their medical records, including their age, parity, mode of delivery, maternal position at delivery, duration of labor, intrapartum blood loss, perineal trauma, gestational weeks at birth, birth weight, Apgar score, and stillbirths. For the comparison of birth centers with hospitals, adjusted odds ratios for the birth outcomes were estimated by using a logistic regression analysis. The number of women who had a total blood loss of >1 L was higher in the midwife-led birth centers than in the hospitals but the incidence of perineal lacerations was lower. There were fewer infants who were born at the midwife-led birth centers with Apgar scores of <7, compared to the hospitals. This study was the first to compare important maternal and neonatal outcomes of birth centers and hospitals. Additional research, using matched baseline characteristics, could clarify the comparisons for maternal and neonatal outcomes. © 2017 Japan Academy of Nursing Science.

Evaluating organizational change in health care: the patient-centered hospital model.

PubMed

Fiorio, Carlo V; Gorli, Mara; Verzillo, Stefano

2018-02-08

An increasing number of hospitals react to recent demographic, epidemiological and managerial challenges moving from a traditional organizational model to a Patient-Centered (PC) hospital model. Although the theoretical managerial literature on the PC hospital model is vast, quantitative evaluations of the performance of hospitals that moved from the traditional to the PC organizational structure is scarce. However, quantitative analysis of effects of managerial changes is important and can provide additional argument in support of innovation. We take advantage of a quasi-experimental setting and of a unique administrative data set on the population of hospital discharge charts (HDCs) over a period of 9 years of Lombardy, the richest and one of the most populated region of Italy. During this period three important hospitals switched to the PC model in 2010, whereas all the others remained with the functional organizational model. This allowed us to develop a difference-in-difference analysis of some selected measures of efficiency and effectiveness for PC hospitals focusing on the "between-variability" of the 25 major diagnostic categories (MDCs) in each hospital and estimating a difference-in-difference model. We contribute to the literature that addresses the evaluation of healthcare and hospital change by providing a quantitative estimation of efficiency and effectiveness changes following to the implementation of the PC hospital model. Results show that both efficiency and effectiveness have significantly increased in the average MDC of PC hospitals, thus confirming the need for policy makers to invest in new organizational models close to the principles of PC hospital structures. Although an organizational change towards the PC model can be a costly process, implying a rebalancing of responsibilities and power among hospital personnel (e.g. medical and nursing staff), our results suggest that changing towards a PC model can be worthwhile in terms of both

Development of a Hospital-based Massage Therapy Course at an Academic Medical Center.

PubMed

Dion, Liza J; Cutshall, Susanne M; Rodgers, Nancy J; Hauschulz, Jennifer L; Dreyer, Nikol E; Thomley, Barbara S; Bauer, Brent

2015-03-01

Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. The present article summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center. A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course had three components in its educational experience: online learning, classroom study, and a 25-hr shadowing experience. The in-classroom study portion included an entire day in the simulation center. The hospital-based massage therapy course addressed the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course indicated key learning opportunities and additional content that are needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment. The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This course provides an example initial step in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment.

Development of a Hospital-based Massage Therapy Course at an Academic Medical Center

PubMed Central

Dion, Liza J.; Cutshall, Susanne M.; Rodgers, Nancy J.; Hauschulz, Jennifer L.; Dreyer, Nikol E.; Thomley, Barbara S.; Bauer, Brent

2015-01-01

Background: Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. The present article summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center. Methods: A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course had three components in its educational experience: online learning, classroom study, and a 25-hr shadowing experience. The in-classroom study portion included an entire day in the simulation center. Results: The hospital-based massage therapy course addressed the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course indicated key learning opportunities and additional content that are needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment. Conclusions: The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This course provides an example initial step in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment. PMID

The epidemiological profile of Pediatric Intensive Care Center at Hospital Israelita Albert Einstein.

PubMed

Lanetzki, Camila Sanches; de Oliveira, Carlos Augusto Cardim; Bass, Lital Moro; Abramovici, Sulim; Troster, Eduardo Juan

2012-01-01

This study outlined the epidemiological profiles of patients who were admitted to the Pediatric Intensive Care Center at Albert Einstein Israelite Hospital during 2009. Data were retrospectively collected for all patients admitted to the PICC during 2009. A total of 433 medical charts were reviewed, and these data were extracted using the DATAMARTS System and analyzed using the statistical software package STATA, version 11.0. There were no statistically significant differences in regards to patient gender, and the predominant age group consisted of patients between the ages of 1 to 4 years. The average occupancy rate was 69.3% per year, and there was a greater number of admissions during April, August, and October. The average length of stay at the hospital ranged from 9.7 to 19.1 days. Respiratory diseases were the main cause for admission to the Pediatric Intensive Care Center, and the mortality rate of the patients admitted was 1.85%. Respiratory diseases were the most common ailment among patients admitted to the Pediatric Intensive Care Center, and the highest mortality rates were associated with neoplastic diseases.

Hospital CIO Explains Blockchain Potential: An Interview with Beth Israel Deaconess Medical Center's John Halamka.

PubMed

Mertz, Leslie

2018-01-01

Work is already underway to bring blockchain technology to the healthcare industry, and hospital administrators are trying to figure out what it can do for them, their clinicians, and their patients. That includes administrators at Beth Israel Deaconess Medical Center, a leading academic medical center located in Boston.

The Liver Transplant Program at Tianjin First Center Hospital.

PubMed

Shen, Zhongyang

2011-01-01

The liver transplant program at the transplant center of Tianjin First Center Hospital opened in 1994 and has become a leading center for academic research and development in clinical liver transplantation during the past 18 years. As of Nov 30, 2011, we had performed 4,103 liver transplantations in patients ranging from 6 months to 79 years old. Since 1998, the program has ranked first in mainland China in the annual number of liver transplants performed, the cumulative total liver transplants and the number of long-surviving patients. We've accomplished a number of "firsts" among the Chinese liver transplant centers, including: the first split liver transplantation, the first pediatric liver transplant, the first living donor simultaneous liver-kidney transplant, the first dual-graft liver transplant using a domino right lobe and a living donor left lobe, the first laparoscopic assisted live donor right hepatectomy including the middle hepatic vein and we have assembled the first liver transplant chain comprising multiple donors and recipients. We have performed the largest number of living related and split liver transplantations in mainland China. The combined prophylactic protocol of "Lamivudine and HBIG" to prevent HBV recurrence post transplantation was first used by our center in China and now is utilized by most of the domestic transplant centers. We have begun using livers from donors after cardiac death (DCD) during the past 2 years, with careful donor selection and recipient management. All the approaches and techniques we've developed are aimed at the utilization of all types of available grafts. However, increasing the rate of transplantation with excellent graft and recipient survival are still the challenges facing us.

Four Decades of Ground-Breaking Research in the Reproductive and Developmental Sciences: The Infant Primate Research Laboratory at the University of Washington National Primate Research Center

PubMed Central

Burbacher, Thomas M.; Grant, Kimberly S.; Worlein, Julie; Ha, James; Curnow, Eliza; Juul, Sandra; Sackett, Gene P.

2017-01-01

The Infant Primate Research Laboratory (IPRL) was established in the 1970s at the University of Washington as a visionary project of Dr. Gene (Jim) P. Sackett. Supported by a collaboration between the Washington National Primate Research Center and the Center on Human Health and Disability, the IPRL operates under the principle that learning more about the causes of abnormal development in macaque monkeys will provide important insights into mechanisms underlying childhood neurodevelopmental disorders. Over the past forty years, a broad range of research projects have been conducted at the IPRL. Some have described the normal expression of species-typical behaviors in nursery-reared macaques while others have focused on specific issues in perinatal medicine and research. This article will review the unique history of the IPRL and the scientific contributions produced by research conducted in the laboratory. Past and present investigations at the IPRL have explored the consequences of adverse early rearing, low-birth-weight, prematurity, epilepsy, chemical/drug exposure, viral infection, diarrheal disease, vaccine safety, assisted reproductive technologies and perinatal hypoxia on growth and development. New directions of investigation include the production of a transgenic primate model using our embryonic stem cell-based technology to better understand and treat heritable forms of human mental retardation such as fragile X. PMID:23873400

Physician-led, hospital-linked, birth care centers can decrease cesarean section rates without increasing rates of adverse events.

PubMed

O'Hara, Margaret H; Frazier, Linda M; Stembridge, Travis W; McKay, Robert S; Mohr, Sandra N; Shalat, Stuart L

2013-09-01

This study compares outcomes at a hospital-linked, physician-led, birthing center to a traditional hospital labor and delivery service. Using de-identified electronic medical records, a retrospective cohort design was employed to evaluate 32,174 singleton births during 1998-2005. Compared with hospital service, birth care center delivery was associated with a lower rate of cesarean sections (adjusted Relative Risk = 0.73, 95% confidence interval 0.59-0.91; p < 0.001) without an increased rate of operative vaginal delivery (adjusted Relative Risk = 1.04, 95% confidence interval 0.97-1.13; p = 0.25) and a higher initiation of breastfeeding (adjusted Relative Risk = 1.28, 95% confidence interval 1.25-1.30; p ≤ 0.001). A maternal length of stay greater than 72 hours occurred less frequently in the birth care center (adjusted Relative Risk = 0.60, 95% confidence interval 0.55-0.66; p < 0.001). Comparing only women without major obstetrical risk factors, the differences in outcomes were reduced but not eliminated. Adverse maternal and infant outcomes were not increased at the birth care center. A hospital-linked, physician-led, birth care center has the potential to lower rates of cesarean sections without increasing rates of operative vaginal delivery or other adverse maternal and infant outcomes. © 2013, Copyright the Authors Journal compilation © 2013, Wiley Periodicals, Inc.

Biotechnology Process Engineering Center at MIT Home

Science.gov Websites

Bioengineering / Engineering Research Centers Georgia Tech / Emory Center for the Engineering of Living Tissues University of Washington / Engineered Biomaterials Engineering Research Center Vanderbilt University / VaNTH Surgical Systems and Technology Univesity of Hawaii / Marine Bioproducts Engineering Center Funding Sources

Evaluation of Policy Options for Increasing the Availability of Primary Care Services in Rural Washington State.

PubMed

Friedberg, Mark W; Martsolf, Grant R; White, Chapin; Auerbach, David I; Kandrack, Ryan; Reid, Rachel O; Butcher, Emily; Yu, Hao; Hollands, Simon; Nie, Xiaoyu

2017-01-01

The Washington State legislature has recently considered several policy options to address a perceived shortage of primary care physicians in rural Washington. These policy options include opening the new Elson S. Floyd College of Medicine at Washington State University in 2017; increasing the number of primary care residency positions in the state; expanding educational loan-repayment incentives to encourage primary care physicians to practice in rural Washington; increasing Medicaid payment rates for primary care physicians in rural Washington; and encouraging the adoption of alternative models of primary care, such as medical homes and nurse-managed health centers, that reallocate work from physicians to nurse practitioners (NPs) and physician assistants (PAs). RAND Corporation researchers projected the effects that these and other policy options could have on the state's rural primary care workforce through 2025. They project a 7-percent decrease in the number of rural primary care physicians and a 5-percent decrease in the number of urban ones. None of the policy options modeled in this study, on its own, will offset this expected decrease by relying on physicians alone. However, combinations of these strategies or partial reallocation of rural primary care services to NPs and PAs via such new practice models as medical homes and nurse-managed health centers are plausible options for preserving the overall availability of primary care services in rural Washington through 2025.

Causes of prolonged hospitalization among general internal medicine patients of a tertiary care center.

PubMed

Ruangkriengsin, Darat; Phisalprapa, Pochamana

2014-03-01

Unnecessary days of prolonged hospitalization may lead to the increase in hospital-related complications and costs, especially in tertiary care center Currently, there have not been many studies about the causes of prolonged hospitalization. Some identified causes could, however, be prevented and improved. To identify the prevalence, causes, predictive factors, prognosis, and economic burden of prolonged hospitalization in patients who had been in general internal medicine wards of the tertiary care center for 7 days or more. Retrospective chart review study was conducted among all patients who were admitted for 7 days or more in general internal medicine wards of Siriraj Hospital, the largest tertiary care center in Thailand. The period of this study was from 1 August 2012 to 30 September 2012. Demographic data, principle diagnosis, comorbid diseases, complications, discharge status, total costs of admission and percentage of reimbursement were collected. The causes of prolonged hospitalization at day 7, 14, 30, and 90 were assessed. Five hundred and sixty-two charts were reviewed. The average length of stay was 25.9 days. The two most common causes of prolonged admission at day 7 were treatment of main diagnosed disease with stable condition (27.6%) and waiting for completion of intravenous antibiotics administration with stable condition (19.5%). The causes of prolonged hospitalization at day 14 were unstable condition from complications (22.6%) and those waiting for completion of intravenous antibiotics administration with stable condition (15.8%). The causes of prolonged admission at day 30 were unstable conditions from complications (25.6%), difficulty weaning or ventilator dependence (17.6%), and caregiver problems (15.2%). The causes of prolonged hospitalization at day 90 were unstable condition from complications (30.0%), caregiver problems (30.0%), and palliative care (25.0%). Poor outcomes were shown in the patients admitted more than 90 days. Percentage

Two Programs for Primary Care Practitioners: Family Medicine Training in an Affiliated University Hospital Program and Primary Care Graduate Training in an Urban Private Medical Center

ERIC Educational Resources Information Center

Farley, Eugene S.; Piemme, Thomas E.

1975-01-01

Eugene Farley describes the University of Rochester and Highland Hospital Family Medicine Program for teaching of primary care internists, primary care pediatricians, and family doctors. Thomas Piemme presents the George Washington University School of Medicine alternative, a 2-year program in an ambulatory setting leading to broad eligibility in…

Hospital Characteristics Associated With Penalties in the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program.

PubMed

Rajaram, Ravi; Chung, Jeanette W; Kinnier, Christine V; Barnard, Cynthia; Mohanty, Sanjay; Pavey, Emily S; McHugh, Megan C; Bilimoria, Karl Y

2015-07-28

In fiscal year (FY) 2015, the Centers for Medicare & Medicaid Services (CMS) instituted the Hospital-Acquired Condition (HAC) Reduction Program, which reduces payments to the lowest-performing hospitals. However, it is uncertain whether this program accurately measures quality and fairly penalizes hospitals. To examine the characteristics of hospitals penalized by the HAC Reduction Program and to evaluate the association of a summary score of hospital characteristics related to quality with penalization in the HAC program. Data for hospitals participating in the FY2015 HAC Reduction Program were obtained from CMS' Hospital Compare and merged with the 2014 American Hospital Association Annual Survey and FY2015 Medicare Impact File. Logistic regression models were developed to examine the association between hospital characteristics and HAC program penalization. An 8-point hospital quality summary score was created using hospital characteristics related to volume, accreditations, and offering of advanced care services. The relationship between the hospital quality summary score and HAC program penalization was examined. Publicly reported process-of-care and outcome measures were examined from 4 clinical areas (surgery, acute myocardial infarction, heart failure, pneumonia), and their association with the hospital quality summary score was evaluated. Penalization in the HAC Reduction Program. Hospital characteristics associated with penalization. Of the 3284 hospitals participating in the HAC program, 721 (22.0%) were penalized. Hospitals were more likely to be penalized if they were accredited by the Joint Commission (24.0% accredited, 14.4% not accredited; odds ratio [OR], 1.33; 95% CI, 1.04-1.70); they were major teaching hospitals (42.3%; OR, 1.58; 95% CI, 1.09-2.29) or very major teaching hospitals (62.2%; OR, 2.61; 95% CI, 1.55-4.39; vs nonteaching hospitals, 17.0%); they cared for more complex patient populations based on case mix index (quartile 4 vs quartile

Costs of Providing Infusion Therapy for Rheumatoid Arthritis in a Hospital-based Infusion Center Setting.

PubMed

Schmier, Jordana; Ogden, Kristine; Nickman, Nancy; Halpern, Michael T; Cifaldi, Mary; Ganguli, Arijit; Bao, Yanjun; Garg, Vishvas

2017-08-01

Many hospital-based infusion centers treat patients with rheumatoid arthritis (RA) with intravenous biologic agents, yet may have a limited understanding of the overall costs of infusion in this setting. The purposes of this study were to conduct a microcosting analysis from a hospital perspective and to develop a model using an activity-based costing approach for estimating costs associated with the provision of hospital-based infusion services (preparation, administration, and follow-up) in the United States for maintenance treatment of moderate to severe RA. A spreadsheet-based model was developed. Inputs included hourly wages, time spent providing care, supply/overhead costs, laboratory testing, infusion center size, and practice pattern information. Base-case values were derived from data from surveys, published studies, standard cost sources, and expert opinion. Costs are presented in year-2017 US dollars. The base case modeled a hospital infusion center serving patients with RA treated with abatacept, tocilizumab, infliximab, or rituximab. Estimated overall costs of infusions per patient per year were $36,663 (rituximab), $36,821 (tocilizumab), $44,973 (infliximab), and $46,532 (abatacept). Of all therapies, the biologic agents represented the greatest share of overall costs, ranging from 87% to $91% of overall costs per year. Excluding infusion drug costs, labor accounted for 53% to 57% of infusion costs. Biologic agents represented the highest single cost associated with RA infusion care; however, personnel, supplies, and overhead costs also contributed substantially to overall costs (8%-16%). This model may provide a helpful and adaptable framework for use by hospitals in informing decision making about services offered and their associated financial implications. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Water use trends in Washington, 1985-2005

USGS Publications Warehouse

Lane, R.C.

2010-01-01

Since 1950, the U.S. Geological Survey Washington Water Science Center (USGS-WAWSC) has collected, compiled, and published, at 5-year intervals, statewide estimates of the amounts of water withdrawn and used for various purposes in Washington State. As new data and methods became available, some of the original datasets were recompiled. The most recent versions of these datasets were used in this fact sheet. The datasets are available online along with other USGS-WAWSC water-use publications at the USGS-WAWSC water use web page: http://wa.water.usgs.gov/data/wuse/. Values on these datasets and in this fact sheet may not sum to the indicated total due to independent rounding. Due to variations in data requirements, collection methods, terminology, and data sources, the direct assessment of water-use trends between compilations is difficult. This fact sheet focuses on the trends in total State and public-supplied populations, freshwater withdrawals and use, public-supply withdrawals and deliveries, and crop irrigation withdrawals and acreage in Washington from 1985 through 2005. These four categories were included in all five compilations and were the most stable in terms of data requirements, collection methods, terminology, and data sources.

Digital Learning Compass: Distance Education State Almanac 2017. Washington

ERIC Educational Resources Information Center

Seaman, Julia E.; Seaman, Jeff

2017-01-01

This brief report uses data collected under the U.S. Department of Education's National Center for Educational Statistics (NCES) Integrated Postsecondary Education Data System (IPEDS) Fall Enrollment survey to highlight distance education data in the state of Washington. The sample for this analysis is comprised of all active, degree-granting…

Report of a workshop on nuclear forces and nonproliferation Woodrow Wilson international center for scholars, Washington, DC October 28, 2010

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

Pilat, Joseph F

2010-12-08

A workshop sponsored by the Los Alamos National Laboratory in cooperation with the Woodrow Wilson International Center for Scholars was held at the Wilson Center in Washington, DC, on October 28, 2010. The workshop addressed evolving nuclear forces and their impacts on nonproliferation in the context of the new strategic environment, the Obama Administration's Nuclear Posture Review and the 2010 NPT Review Conference. The discussions reflected the importance of the NPR for defining the role of US nuclear forces in dealing with 21st century threats and providing guidance for National Nuclear Security Administration (NNSA) and Department of Defense (DoD) programsmore » and, for many but not all participants, highlighted its role in the successful outcome of the NPT RevCon. There was widespread support for the NPR and its role in developing the foundations for a sustainable nuclear-weapon program that addresses nuclear weapons, infrastructure and expertise in the broader nonproliferation, disarmament and international security contexts. However, some participants raised concerns about its implementation and its long-term effectiveness and sustainability.« less

75 FR 28757 - Security Zone; Potomac River, Washington Channel, Washington, DC

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-24

...-AA87 Security Zone; Potomac River, Washington Channel, Washington, DC AGENCY: Coast Guard, DHS. ACTION: Temporary final rule. SUMMARY: The Coast Guard is establishing a temporary security zone in certain waters of Washington Channel on the Potomac River. The security zone is necessary to provide for the...

A Population-Based Survival Assessment of Categorizing Level III and IV Rural Hospitals as Trauma Centers

ERIC Educational Resources Information Center

Arthur, Melanie; Newgard, Craig D.; Mullins, Richard J.; Diggs, Brian S.; Stone, Judith V.; Adams, Annette L.; Hedges, Jerris R.

2009-01-01

Context: Patients injured in rural areas are hypothesized to have improved outcomes if statewide trauma systems categorize rural hospitals as Level III and IV trauma centers, though evidence to support this belief is sparse. Purpose: To determine if there is improved survival among injured patients hospitalized in states that categorize rural…

Washington State's model of physician leadership in cardiac outcomes reporting.

PubMed

Goss, J R; Whitten, R W; Phillips, R C; Johnston, G G; Hofer, B O; Mansfield, P B; Tidwell, S L; Spertus, J A; LoGerfo, J P

2000-09-01

In 1993, the cardiac surgery community in Washington State opposed an effort by the state Health Care Authority (HCA) to identify "centers of excellence" for selective contracting of coronary artery bypass grafting (CABG) procedures, and proposed an alternate model that would create a statewide cardiac outcomes registry under physician governance to be used by all institutions for internal quality improvement activities. A prospective pilot data collection effort, which examined preoperative and postoperative patient-reported health status, served as the basis for evaluating the capacity of a physician-led organization to develop a collaborative atmosphere and facilitate universal hospital participation. A surgical steering group met on a regular basis and reached consensus on governance issues, protocols for standardized data collection, and policies regarding data dissemination. All 14 centers that performed bypass surgery in the state participated. Patients who were surveyed reported statistically significant improvements in physical, emotional, and anginal-specific health status after bypass surgery. Baseline patient characteristics and longitudinal outcomes were compared across institutions. Based on the feasibility of this collaborative outcomes reporting program, the HCA revised its policy regarding selective contracting and has helped to support an ongoing physician-led and -governed cardiac outcomes reporting system that is particularly notable for the subsequent integration of both CABG surgery and catheterization-based procedures into one standardized registry.

The Black Leader's Rhetorical Dilemma: An Analysis of the Debate Between W.E.B. DuBois and Booker T. Washington.

ERIC Educational Resources Information Center

Harris, Thomas E.

Improving the economic condition of the Negro was a fundamental concern of both W. E. B. DuBois and Booker T. Washington. It was Washington's view that the Negro should be willing to perform menial tasks as a means for gaining a foothold in the economic structure. He counseled the Negro to start at the bottom. Washington's philosophy centered on…

Factors Influencing Adoption of Hospital-Acquired Pressure Ulcer Prevention Programs in US Academic Medical Centers.

PubMed

Padula, William V; Valuck, Robert J; Makic, Mary Beth F; Wald, Heidi L

2015-01-01

Recent data show a decrease in hospital-acquired pressure ulcers (PUs) throughout US hospitals; these changes may be associated with increased success in implementing evidence-based practices for PU prevention. The purpose of this study was to identify wound care nurse perceptions of the primary factors that influenced the overall reduction of PUs. Cross-sectional descriptive survey. Surveys were sent to wound care nurses at 98 University HealthSystem Consortium (UHC) hospitals. The UHC consists of more than 120 academic medical centers and affiliated facilities across the United States. Responses solicited from this survey represented a geographically diverse set of hospitals from less than 200 beds to more than 1000 beds. The survey questionnaire used a framework of 7 internal and 5 external influential factors for implementing evidence-based practices for PU prevention. Internal influential factors queried included availability of nurse specialists, high nursing job turnover, high PU rates, and prevention campaigns. External influential factors included data sharing, Medicare nonpayment policy, and applications for Magnet recognition. Hospital-acquired PU prevention experts at UHC hospitals were contacted through the Wound, Ostomy and Continence Nurses Society membership directory to complete the questionnaire. Consenting participants were e-mailed a disclosure and online questionnaire; they were also sent monthly reminders until they either responded to the survey or declined participation. Fifty-five respondents (59% response rate) indicated several internal factors that influenced evidence-based practice: hospital prevention campaigns; the availability of nursing specialists; and the level of preventive knowledge among hospital staff. External influential factors included financial concerns; application for Magnet recognition; data sharing among peer institutions; and regulatory issues. These findings suggest that the Centers for Medicare & Medicaid Services

Interprofessional Initiatives at the University of Washington

PubMed Central

Robins, Lynne; Murphy, Nanci; Belza, Basia; Brock, Doug; Gallagher, Thomas H.; Lindhorst, Taryn; Morton, Tom; Schaad, Doug; Mitchell, Pamela

2009-01-01

Pharmacists must collaborate with other health professionals to promote the optimal use of medications, relying on coordinated, interprofessional communication and care to do so. In 2003, the Institute of Medicine (IOM) recommended “all health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.”2 At the University of Washington, the Center for Health Sciences Interprofessional Education (CHSIE) was established in 1997 to promote interprofessional curricular and clinical innovation in education, faculty development, and student activities, and to conduct evaluative research regarding the impact of interprofessional innovations. In this manuscript, we will describe the Center for Health Sciences Interprofessional Education, and highlight key projects that serve as examples of pharmacy involvement in interprofessional education, research, and service. PMID:19657496

1971 Washington timber harvest.

Treesearch

Brian R. Wall

1972-01-01

Washington's 1971 timber harvest of 6.45 billion board feet was nearly the same as the 1970 harvest level. The total timber harvest on public lands increased nearly 4 percent with a 30-percent increase in eastern Washington more than offsetting a 5-percent decline in western Washington. Part of the increase in eastern Washington reflects salvage of a large volume...

78 FR 59414 - Environmental Impact Statement; King County, Washington

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-26

... Island, and partial tolls collected on trips within a segment. In addition to these three tolling... improvements on I-90. The total length of the corridor is approximately seven (7) miles. The scoping period for... centers over Lake Washington, a 22-mile-long body of water. The FHWA is issuing this notice to advise the...

Reorganizing departments of psychiatry, hospitals, and medical centers for the 21st century.

PubMed

Schreter, R K

1998-11-01

Market forces are reshaping health care, transforming it from a public service into a product that is sold in a highly competitive marketplace. This transformation has been particularly disruptive for hospital departments of psychiatry and medical centers that were the early targets for managed care efforts at cost containment. To survive, health care institutions have embarked on a clinical and administrative re-engineering process. The author describes a series of steps for reconfiguring departments, hospitals, and medical centers as they enter the 21st century. The steps include identifying the leadership team, formulating a mission statement and strategic plan, creating a legal entity capable of achieving the organization's goals, drawing up an organizational chart, and developing the provider network. Other steps in the process include enhancing the continuum of services offered, developing administrative capability, dealing with managed care, paying attention to fundamental business practices, integrating psychiatric services into the health care system, and marketing psychiatric services.

Overview of Mount Washington Icing Sensors Project

NASA Technical Reports Server (NTRS)

Ryerson, Charles C.; Politovich, Marcia K.; Rancourt, Kenneth L.; Koenig, George G.; Reinking, Roger F.; Miller, Dean R.

2003-01-01

NASA, the FAA, the Department of Defense, the National Center for Atmospheric Research and NOAA are developing techniques for retrieving cloud microphysical properties from a variety of remote sensing technologies. The intent is to predict aircraft icing conditions ahead of aircraft. The Mount Washington Icing Sensors Project MWISP), conducted in April, 1999 at Mt. Washington, NH, was organized to evaluate technologies for the prediction of icing conditions ahead of aircraft in a natural environment, and to characterize icing cloud and drizzle environments. April was selected for operations because the Summit is typically in cloud, generally has frequent freezing precipitation in spring, and the clouds have high liquid water contents. Remote sensing equipment, consisting of radars, radiometers and a lidar, was placed at the base of the mountain, and probes measuring cloud particles, and a radiometer, were operated from the Summit. NASA s Twin Otter research aircraft also conducted six missions over the site. Operations spanned the entire month of April, which was dominated by wrap-around moisture from a low pressure center stalled off the coast of Labrador providing persistent upslope clouds with relatively high liquid water contents and mixed phase conditions. Preliminary assessments indicate excellent results from the lidar, radar polarimetry, radiosondes and summit and aircraft measurements.

Critical congenital heart disease screening practices among licensed midwives in washington state.

PubMed

Evers, Patrick D; Vernon, Margaret M; Schultz, Amy H

2015-01-01

Since 2011, pulse oximetry screening for critical congenital heart disease (CCHD) has been recommended for newborns. Initial implementation guidelines focused on in-hospital births. Recent publications affirm the importance of universal screening, including for out-of-hospital births. No published data describe CCHD screening rates for out-of-hospital births. Licensed midwives in Washington state were surveyed regarding their current CCHD screening practices, volume of births attended annually, and typical newborn follow-up practices. For those who indicated they were screening, additional information was obtained about equipment used, timing of screening, and rationale for voluntarily initiating screening. For those who indicated that they were not screening, information regarding barriers to implementation was solicited. Of the 61 midwives in our sample, 98% indicated they were aware of published guidelines recommending universal newborn screening for CCHD utilizing pulse oximetry. Furthermore, 52% indicated that they were screening for CCHD currently. Ten percent stated they do not intend to screen, whereas the remaining respondents indicated that they plan to screen in the future. The primary barriers to screening were the cost of pulse oximetry equipment and inadequate training in screening technique and interpretation. Although voluntary implementation of CCHD screening by licensed midwives in Washington is increasing, it lags behind the implementation rates reported for in-hospital births. © 2015 by the American College of Nurse-Midwives.

Pregnancy Outcomes Among Deaf Women in Washington State, 1987-2012.

PubMed

Schiff, Melissa A; Doody, David R; Crane, Deborah A; Mueller, Beth A

2017-11-01

To evaluate pregnancy and neonatal outcomes among deaf women using population-based vital records data in Washington State from 1987 to 2012. We performed a retrospective cohort study using the Washington State birth and fetal death records linked to state hospital discharge records to identify women with diagnosis codes for deafness indicated at their delivery hospitalization and compared them with randomly selected women without these codes. Pregnancy conditions and outcomes evaluated included gestational diabetes, preeclampsia, placental abruption, labor induction, and cesarean delivery. Neonatal outcomes evaluated included preterm gestational age (less than 28, 28 to less than 37 weeks) at delivery and low birth weight. We also assessed length of maternal and neonatal delivery hospitalization. We performed Poisson regression to estimate relative risks (RRs) and 95% CIs for each outcome, adjusting for birth year, maternal age, and parity. Most adverse pregnancy and neonatal outcomes were similar for deaf and comparison women. Among women who underwent vaginal delivery, deaf women were more than twofold (RR 2.15, 95% CI 1.43-3.22) more likely to have a delivery hospitalization of 4 or more days (6.0% compared with 2.8%). We found a modestly increased risk of cesarean delivery (RR 1.15, 95% CI 1.01-1.30), with 29.9% of deaf compared with 25.6% of nondeaf women having a cesarean delivery. Deaf women are not at increased risk of the majority of adverse pregnancy and neonatal outcomes. Obstetric care providers may use our findings in counseling this special population of prenatal patients.

Compliance with Baby-Friendly policies and practices in hospitals and community health centers in Quebec.

PubMed

Haiek, Laura N

2012-08-01

Since 2001, Quebec's ministry of health and social services has prioritized implementation of the Baby-Friendly Initiative (BFI), which includes the original hospital initiative and its expansion to community services. The objective was to document across the province compliance with the BFI's Ten Steps to Successful Breastfeeding in hospitals, Seven Point Plan in community health centers (CHCs), and International Code of Marketing of Breast-Milk Substitutes (Code). Using managers/staff, mothers, and observers, the author measured the extent of implementation of indicators formulated for each step/point and the Code, based on the revised WHO/UNICEF recommendations. Mean compliance scores in Quebec were 3.13 for 140 CHCs (range, 0 to 7) and 4.54 for 60 hospitals/birthing centers (range, 0 to 10). The mean compliance score for the Code was 0.69 for both CHCs and hospitals/birthing centers. The evaluation documented marked variations in implementation level for each of the steps/points and the Code. Also, managers/staff, mothers, and observers differed in their report of BFI compliance for most steps/points and the Code. Facilities that had applied for or obtained BFI designation demonstrated higher compliance with the BFI than those that had not. Results disseminated to participating organizations allowed comparisons on a regional/provincial perspective and in relation to BFI-designated facilities. Furthermore, this first portrait of BFI compliance in Quebec provided provincial, regional, and local health authorities with valuable information that can be used to bring about policy and organizational changes to achieve the international standards required for Baby-Friendly certification.

Length of stay and medical stability for spinal cord-injured patients on admission to an inpatient rehabilitation hospital: a comparison between a model SCI trauma center and non-SCI trauma center.

PubMed

Ploumis, A; Kolli, S; Patrick, M; Owens, M; Beris, A; Marino, R J

2011-03-01

Retrospective database review. To compare lengths of stay (LOS), pressure ulcers and readmissions to the acute care hospital of patients admitted to the inpatient rehabilitation facility (IRF) from a model spinal cord injury (SCI) trauma center or from a non-SCI acute hospital. Only sparse data exist comparing the status of patients admitted to IRF from a model SCI trauma center or from a non-SCI acute hospital. Acute care, IRF and total LOS were compared between patients transferred to IRF from the SCI center (n=78) and from non-SCI centers (n=131). The percentages of pressure ulcers on admission to IRF and transfer back to acute care were also compared. Patients admitted to IRF from the SCI trauma center (SCI TC) had significantly shorter (P=0.01) acute care LOS and total LOS compared with patients admitted from non-SCI TCs. By neurological category, acute-care LOS was less for all groups admitted from the SCI center, but statistically significant only for tetraplegia. There was no significant difference in the incidence of readmissions to acute care from IRF. More patients from non-SCI centers (34%) than SCI centers (12%) had pressure ulcers (P<0.001). Acute care in organized SCI TCs before transfer to IRF can significantly lower acute-care LOS or total LOS and incidence of pressure ulcers compared with non-SCI TCs. Patients admitted to IRF from SCI TCs are no more likely to be sent back to an acute hospital than those from non-SCI TCs.

Potato-related research at USDA-ARS laboratories in Washington and Idaho

USDA-ARS?s Scientific Manuscript database

Potato-related research currently being conducted at three USDA-ARS laboratories in Idaho and Washington is reviewed. Objectives of research programs at the Temperate Tree Fruit & Vegetable Research Unit (Wapato, WA), the Irrigated Agriculture Research and Extension Center (Prosser, WA), and the Sm...

Evidence synthesis activities of a hospital evidence-based practice center and impact on hospital decision making.

PubMed

Jayakumar, Kishore L; Lavenberg, Julia A; Mitchell, Matthew D; Doshi, Jalpa A; Leas, Brian; Goldmann, David R; Williams, Kendal; Brennan, Patrick J; Umscheid, Craig A

2016-03-01

Hospital evidence-based practice centers (EPCs) synthesize and disseminate evidence locally, but their impact on institutional decision making is unclear. To assess the evidence synthesis activities and impact of a hospital EPC serving a large academic healthcare system. Descriptive analysis of the EPC's database of rapid systematic reviews since EPC inception (July 2006-June 2014), and survey of report requestors from the EPC's last 4 fiscal years. Descriptive analyses examined requestor and report characteristics; questionnaire examined report usability, impact, and requestor satisfaction (higher scores on 5-point Likert scales reflected greater agreement). The EPC completed 249 evidence reviews since inception. The most common requestors were clinical departments (29%, n = 72), chief medical officers (19%, n = 47), and purchasing committees (14%, n = 35). The most common technologies reviewed were drugs (24%, n = 60), devices (19%, n = 48), and care processes (12%, n = 31). Mean report completion time was 70 days. Thirty reports (12%) informed computerized decision support interventions. More than half of reports (56%, n = 139) were completed in the last 4 fiscal years for 65 requestors. Of the 64 eligible participants, 46 responded (72%). Requestors were satisfied with the report (mean = 4.4), and agreed it was delivered promptly (mean = 4.4), answered the questions posed (mean = 4.3), and informed their final decision (mean = 4.1). This is the first examination of evidence synthesis activities by a hospital EPC in the United States. Our findings suggest hospital EPCs can efficiently synthesize and disseminate evidence addressing a range of clinical topics for diverse stakeholders, and can influence local decision making. © 2015 Society of Hospital Medicine.

Hospital-Based Comparative Effectiveness Centers: Translating Research into Practice to Improve the Quality, Safety and Value of Patient Care

PubMed Central

Williams, Kendal; Brennan, Patrick J.

2010-01-01

Hospital-based comparative effectiveness (CE) centers provide a model that clinical leaders can use to improve evidence-based practice locally. The model is used by integrated health systems outside the US, but is less recognized in the US. Such centers can identify and adapt national evidence-based policies for the local setting, create local evidence-based policies in the absence of national policies, and implement evidence into practice through health information technology (HIT) and quality initiatives. Given the increasing availability of CE evidence and incentives to meaningfully use HIT, the relevance of this model to US practitioners is increasing. This is especially true in the context of healthcare reform, which will likely reduce reimbursements for care deemed unnecessary by published evidence or guidelines. There are challenges to operating hospital-based CE centers, but many of these challenges can be overcome using solutions developed by those currently leading such centers. In conclusion, these centers have the potential to improve the quality, safety and value of care locally, ultimately translating into higher quality and more cost-effective care nationally. To better understand this potential, the current activity and impact of hospital-based CE centers in the US should be rigorously examined. PMID:20697961

Howard University Hospital finds partner in helping children succeed.

PubMed

Botvin, Judith D

2005-01-01

Howard University Hospital, Washington, D.C., becomes the site for the launch of a national ad campaign by the nonprofit youth education organization, Communities in Schools. The hospital and university share the organization's mission of supporting young people in the community.

Expanding Hospital Human Immunodeficiency Virus Testing in the Bronx, New York and Washington, District of Columbia: Results From the HPTN 065 Study.

PubMed

Branson, Bernard M; Chavez, Pollyanna R; Hanscom, Brett; Greene, Elizabeth; McKinstry, Laura; Buchacz, Kate; Beauchamp, Geetha; Gamble, Theresa; Zingman, Barry S; Telzak, Edward; Naab, Tammey; Fitzpatrick, Lisa; El-Sadr, Wafaa M

2018-05-02

Human immunodeficiency virus (HIV) testing is critical for both HIV treatment and prevention. Expanding testing in hospital settings can identify undiagnosed HIV infections. To evaluate the feasibility of universally offering HIV testing during emergency department (ED) visits and inpatient admissions, 9 hospitals in the Bronx, New York and 7 in Washington, District of Columbia (DC) undertook efforts to offer HIV testing routinely. Outcomes included the percentage of encounters with an HIV test, the change from year 1 to year 3, and the percentages of tests that were HIV-positive and new diagnoses. From 1 February 2011 to 31 January 2014, HIV tests were conducted during 6.5% of 1621016 ED visits and 13.0% of 361745 inpatient admissions in Bronx hospitals and 13.8% of 729172 ED visits and 22.0% of 150655 inpatient admissions in DC. From year 1 to year 3, testing was stable in the Bronx (ED visits: 6.6% to 6.9%; inpatient admissions: 13.0% to 13.6%), but increased in DC (ED visits: 11.9% to 15.8%; inpatient admissions: 19.0% to 23.9%). In the Bronx, 0.4% (408) of ED HIV tests were positive and 0.3% (277) were new diagnoses; 1.8% (828) of inpatient tests were positive and 0.5% (244) were new diagnoses. In DC, 0.6% (618) of ED tests were positive and 0.4% (404) were new diagnoses; 4.9% (1349) of inpatient tests were positive and 0.7% (189) were new diagnoses. Hospitals consistently identified previously undiagnosed HIV infections, but universal offer of HIV testing proved elusive.

[Hypertensive emergencies at the University Hospital Center in Brazzaville, Congo].

PubMed

Ellenga, Mbolla B F; Gombet, T R; Mahoungou, Guimbi K C; Otiobanda, G F; Ossou, Nguiet P M; Ikama, M S; Kimbally-Kaky, G; Etitiele, F

2011-02-01

The purpose of this retrospective study conducted in the emergency department of the University Hospital Center in Brazzaville, Congo was to determine the prevalence and clinical characteristics of hypertensive emergencies. With a total of 76 patients admitted during the study period, the prevalence of hypertensive emergency was 4%. The sex ratio was 1 and mean patient age was 57.3 years (range, 30 to 80 years). Risk factors included obesity in 62 cases (81.6%), history of hypertension in 65 (85.5%) and low socioeconomic level in 58 (76.3%). Mean delay for consultation was 50 hours (range, 1 to 240 hours). The disease underlying the hypertensive emergency was stroke with 38 cases (50%), heart failure in 20 (26.3%), hypertensive encephalopathy in 11 (14.4%), malignant hypertension in 9 (11.8%), and renal failure in 10 (13.1%). The mean length of emergency treatment was 14.7 hours (range, 5 to 48 hours). Eight deaths (10.5%) occurred during hospitalization in the emergency department.

Program of Research in Flight Dynamics in The George Washington University at NASA Langley Research Center, Hampton, Virginia

NASA Technical Reports Server (NTRS)

Klein, Vladislav

2002-01-01

The program objectives were defined in the original proposal entitled 'Program of Research in Flight Dynamics in the JIAFS at NASA Langley Research Center' which was originated March 20, 1975, and yearly renewals of the research program dated December 1, 1998 to December 31, 2002. The program included three major topics: 1) Improvement of existing methods and development of new methods for flight and wind tunnel data analysis based on system identification methodology; 2) Application of these methods to flight and wind tunnel data obtained from advanced aircraft; 3) Modeling and control of aircraft. The principal investigator of the program was Dr. Vladislav Klein, Professor Emeritus at The George Washington University, DC. Seven Graduate Research Scholar Assistants (GRSA) participated in the program. The results of the research conducted during four years of the total co-operative period were published in 2 NASA Technical Reports, 3 thesis and 3 papers. The list of these publications is included.

On the practice of ignoring center-patient interactions in evaluating hospital performance.

PubMed

Varewyck, Machteld; Vansteelandt, Stijn; Eriksson, Marie; Goetghebeur, Els

2016-01-30

We evaluate the performance of medical centers based on a continuous or binary patient outcome (e.g., 30-day mortality). Common practice adjusts for differences in patient mix through outcome regression models, which include patient-specific baseline covariates (e.g., age and disease stage) besides center effects. Because a large number of centers may need to be evaluated, the typical model postulates that the effect of a center on outcome is constant over patient characteristics. This may be violated, for example, when some centers are specialized in children or geriatric patients. Including interactions between certain patient characteristics and the many fixed center effects in the model increases the risk for overfitting, however, and could imply a loss of power for detecting centers with deviating mortality. Therefore, we assess how the common practice of ignoring such interactions impacts the bias and precision of directly and indirectly standardized risks. The reassuring conclusion is that the common practice of working with the main effects of a center has minor impact on hospital evaluation, unless some centers actually perform substantially better on a specific group of patients and there is strong confounding through the corresponding patient characteristic. The bias is then driven by an interplay of the relative center size, the overlap between covariate distributions, and the magnitude of the interaction effect. Interestingly, the bias on indirectly standardized risks is smaller than on directly standardized risks. We illustrate our findings by simulation and in an analysis of 30-day mortality on Riksstroke. © 2015 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.

A cross-sectional survey of policies guiding second stage labor in urban Japanese hospitals, clinics and midwifery birth centers.

PubMed

Baba, Kaori; Kataoka, Yaeko; Nakayama, Kaori; Yaju, Yukari; Horiuchi, Shigeko; Eto, Hiromi

2016-02-24

The Japan Academy of Midwifery developed and disseminated the '2012 Evidence-based Guidelines for Midwifery Care (Guidelines for Midwives)' for low-risk births to achieve a more uniform standard of care during childbirth in Japan. The objective of this study was to cross-sectional survey policy implementation regarding care during the second stage of labor at Japanese hospitals, clinics, and midwifery birth centers, and to compare those policies with the recommendations in Guidelines for Midwives. This study was conducted in the four major urbanized areas (e.g. Tokyo) of the Kanto region of Japan. Respondents were chiefs of the institutions (obstetricians/midwives), nurse administrators (including midwives) of the obstetrical departments, or other nurse/midwives who were well versed in the routine care of the targeted institutions. The Guidelines implementation questionnaire comprised 12 items. Data was collected from October 2010 to July 2011. The overall response was 255 of the 684 institutions (37%). Of the total responses 46% were hospitals, 26% were clinics and 28% were midwifery birth centers. Few institutions reported perineal massage education for 'almost all cases'. Using 'active birth' were all midwifery birth centers, 56% hospitals and 32% clinics. Few institutions used water births. The majority of hospitals (73%) and clinics (80%) but a minority (39%) of midwifery birth centers reported 'not implemented' about applying warm compress to the perineum. Few midwifery birth centers (10%) and more hospitals (38%) and clinics (50%) had a policy for valsalva as routine care. Many hospitals (90%) and clinics (88%) and fewer midwifery birth centers (54%) offered hands-on technique to provide perineal support during birth. A majority of institutions used antiseptic solution for perineal disinfection. Few institutions routinely used episiotomies for multiparas, however routine use for primiparas was slightly more in hospitals (21%) and clinics (25%). All

Meeting patients' health information needs in breast cancer center hospitals - a multilevel analysis.

PubMed

Kowalski, Christoph; Lee, Shoou-Yih D; Ansmann, Lena; Wesselmann, Simone; Pfaff, Holger

2014-11-25

Breast cancer patients are confronted with a serious diagnosis that requires them to make important decisions throughout the journey of the disease. For these decisions to be made it is critical that the patients be well informed. Previous studies have been consistent in their findings that breast cancer patients have a high need for information on a wide range of topics. This paper investigates (1) how many patients feel they have unmet information needs after initial surgery, (2) whether the proportion of patients with unmet information needs varies between hospitals where they were treated and (3) whether differences between the hospitals account for some of these variation. Data from 5,024 newly-diagnosed breast cancer patients treated in 111 breast center hospitals in Germany were analyzed and combined with data on hospital characteristics. Multilevel linear regression models were calculated taking into account hospital characteristics and adjusting for patient case mix. Younger patients, those receiving mastectomy, having statutory health insurance, not living with a partner and having a foreign native language report higher unmet information needs. The data demonstrate small between-hospital variation in unmet information needs. In hospitals that provide patient-specific information material and that offer health fairs as well as those that are non-teaching or have lower patient-volume, patients are less likely to report unmet information needs. We found differences in proportions of patients with unmet information needs between hospitals and that hospitals' structure and process-related attributes of the hospitals were associated with these differences to some extent. Hospitals may contribute to reducing the patients' information needs by means that are not necessarily resource-intensive.

78 FR 15053 - Simpson Lumber Company, LLC, Shelton, Washington; Simpson Lumber Company, LLC, Tacoma, Washington...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-08

...,372B] Simpson Lumber Company, LLC, Shelton, Washington; Simpson Lumber Company, LLC, Tacoma, Washington; Simpson Lumber Company, LLC, Longview, Washington; Notice of Revised Determination on Reconsideration On... Reconsideration for the workers and former workers of Simpson Lumber Company, LLC, Shelton, Washington (TA-W-81...

Washington Correlator

NASA Technical Reports Server (NTRS)

Hall, David M.; Boboltz, David

2013-01-01

This report summarizes the activities of the Washington Correlator for 2012. The Washington Correlator provides up to 80 hours of attended processing per week plus up to 40 hours of unattended operation, primarily supporting Earth Orientation and astrometric observations. In 2012, the major programs supported include the IVS-R4, IVS-INT, APSG, and CRF observing sessions.

Ambulatory Surgery Centers and Prices in Hospital Outpatient Departments.

PubMed

Carey, Kathleen

2017-04-01

Specialty providers claim to offer a new competitive benchmark for efficient delivery of health care. This article explores this view by examining evidence for price competition between ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). I studied the impact of ASC market presence on actual prices paid to HOPDs during 2007-2010 for four common surgical procedures that were performed in both provider types. For the procedures examined, HOPDs received payments from commercial insurers in the range of 3.25% to 5.15% lower for each additional ASC per 100,000 persons in a market. HOPDs may have less negotiating leverage with commercial insurers on price in markets with high ASC market penetration, resulting in relatively lower prices.

[Evolution and viability of an outpatient surgery center for cataract surgery on a large scale in a university hospital].

PubMed

Kara-Junior, Newton; Espíndola, Rodrigo França de

2010-01-01

To analyze the number of surgeries performed in outpatient surgical center at a university hospital and to assess its financial viability during and after the interruption of the Cataract National Campaign in 2006. Retrospective analytical study between 2005 and 2009 at the Clinical Hospital of the University of São Paulo (HC-FMUSP) which evaluated the economic viability of the outpatient surgical center, the number of cataract surgeries performed and the number of surgeons present daily in that unit. It would be necessary to perform at least 400 procedures monthly to ensure the financial viability of the outpatient surgical center. This number was lower than the expected in the years of 2008 and 2009 (average of 370.6 and 390.1 surgeries respectively). The number of cataract fellows decreased from 13 in 2005 to 3 in 2009. The main factor for the reduction in the number of cataract surgeries performed in the outpatient surgical center after 2006 was the difficulty of access of the population to the hospital due to restrictions on the development of screening projects. The increased use of the operating rooms by other clinics and the decrease in the admission of new surgeons, made the outpatient surgical center appropriate and viable for the new political-economic reality.

Core elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention.

PubMed

Pollack, Loria A; Srinivasan, Arjun

2014-10-15

The proven benefits of antibiotic stewardship programs (ASPs) for optimizing antibiotic use and minimizing adverse events, such as Clostridium difficile and antibiotic resistance, have prompted the Centers for Disease Control and Prevention (CDC) to recommend that all hospitals have an ASP. This article summarizes Core Elements of Hospital Antibiotic Stewardship Programs, a recently released CDC document focused on defining the infrastructure and practices of coordinated multidisciplinary programs to improve antibiotic use and patient care in US hospitals. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

1975 Washington timber harvest.

Treesearch

J.D. Jr. Lloyd

1977-01-01

In 1975, the Washington timber harvest declined for the 2d year to 6.2 billion board feet, 10 percent below 1974, and the lowest level in 8 years. The decrease, which occurred on almost all ownerships, amounted to 561 million board feet in western Washington and 130 million board feet in eastern Washington.

Hospital activity and hospital profits.

PubMed

Hegji, Charles E

2007-01-01

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

The experience of Latino parents of hospitalized children during family-centered rounds.

PubMed

Walker-Vischer, Lisa; Hill, Constance; Mendez, Suzanne S

2015-03-01

The aim of this study is to describe the experience of Latino parents of hospitalized children during family-centered rounds (FCRs). Family-centered rounds provide a mechanism to exchange information and facilitate shared decision making. Latino parents may have a suboptimal experience during FCRs. Understanding this experience helps nurse leaders improve patient satisfaction. Using a convenience sample, written surveys in Spanish were given to 20 parents who had attended at least 2 FCRs. The surveys were translated into English for data analysis. The narrative data were analyzed for common themes using content analysis. Four themes were identified: valued perception, inclusion and care, facilitated communication, and meeting expectations. Parents in this study felt that their participation and input were valued and that these positively impacted care. Family-centered rounds helped them understand the plan and facilitated communication when done in Spanish. Nurse leaders play a key role in improving satisfaction and increasing access to translation services or bilingual staff.

Perception of the nursing team of a Surgical Center regarding Hospital Accreditation at a University Hospital.

PubMed

Fernandes, Hellen Maria de Lima Graf; Peniche, Aparecida de Cássia Giani

2015-02-01

Objective To analyze the perception of nursing teams at a surgical center regarding the process of hospital accreditation, in the evaluative aspects of structure, process, and result. Method The study takes a quantitative and exploratory-descriptive approach, carried out at a university hospital. Result The population consisted of 69 nursing professionals, and the data collection was performed in the months of January and February 2014 by way of a questionnaire, utilizing the Likert scale. The methodology used a Cronbach's Alpha equal to 0.812. In the comparison of the three aspects, the one with the highest favorability score was "result", with an average of 47.12 (dp±7.23), and the smallest was "structure," with an average of 40.70 (dp±5.19). Conclusion This situational diagnostic can assist in the restructuring of the vulnerable areas evaluated in these three aspects, mainly in the aspect of structure, with a goal of level 2 accreditation by the ONA (Brazilian's National Organization for Accreditation) defended by the Institution.

Evaluation of the Cincinnati Veterans Affairs Medical Center Hospital-in-Home Program.

PubMed

Cai, Shubing; Grubbs, Andrew; Makineni, Rajesh; Kinosian, Bruce; Phibbs, Ciaran S; Intrator, Orna

2018-04-20

To examine hospital readmissions, costs, mortality, and nursing home admissions of veterans who received Hospital-in-Home (HIH) services. Retrospective cohort study. Cincinnati Veterans Affairs Medical Center (VAMC). Study cohort included veterans who received HIH services as an alternative to inpatient care between October 1, 2012, and November 30, 2015, and non-HIH veterans who were hospitalized for similar conditions in the Cincinnati VAMC during the same period. We identified 138 veterans who used HIH services and 694 non-HIH veterans. HIH veterans received hospital-equivalent care at home. Non-HIH veterans received traditional inpatient services in the Cincinnati VAMC. Total costs of care for treating an acute episode (HIH services vs inpatient) and likelihood of hospital readmission, death, or nursing home admission within 30 days of discharge from HIH services or hospitalization. Average per person costs were $7,792 for HIH services and $10,960 for traditional inpatient care (P<0.001). HIH veterans were less likely to use a nursing home within 30 days of discharge (3.1%) than non-HIH veterans (12.6%) (P<0.001). Thirty-day readmission rates and mortality were not statistically different between HIH and non-HIH veterans. The substitutive HIH model implemented in the Cincinnati VAMC delivered acute services in veterans' homes at lower cost and with lower likelihood of postdischarge nursing home use. Broader implementation of this innovative delivery model may benefit older adults in need of care while reducing healthcare system costs. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Caring for Young Adolescent Sexual Abuse Victims in a Hospital-Based Children's Advocacy Center

ERIC Educational Resources Information Center

Edinburgh, Laurel; Saewyc, Elizabeth; Levitt, Carolyn

2008-01-01

Objectives: This study compared health care assessments, referrals, treatment, and outcomes for young adolescent sexual assault/sexual abuse victims seen at a hospital-based Child Advocacy Center (CAC), to that provided to similar victims evaluated by other community providers. A second purpose was to document how common DNA evidence is found…

Combined external and internal hospital disaster: impact and response in a Houston trauma center intensive care unit.

PubMed

Nates, Joseph L

2004-03-01

To increase awareness of specific risks to healthcare systems during a natural or civil disaster. We describe the catastrophic disruption of essential services and the point-by-point response to the crisis in a major medical center. Case report, review of the literature, and discussion. A 28-bed intensive care unit in a level I trauma center in the largest medical center in the world. In June 2001, tropical storm Allison caused >3 feet of rainfall and catastrophic flooding in Houston, TX. Memorial Hermann Hospital, one of only two level I trauma centers in the community, lost electrical power, communications systems, running water, and internal transportation. All essential hospital services were rendered nonfunctional. Life-saving equipment such as ventilators, infusion pumps, and monitors became useless. Patients were triaged to other medical facilities based on acuity using ground and air ambulances. No patients died as result of the internal disaster. Adequate training, teamwork, communication, coordination with other healthcare professionals, and strong leadership are essential during a crisis. Electricity is vital when delivering care in today's healthcare system, which depends on advanced technology. It is imperative that hospitals take the necessary measures to preserve electrical power at all times. Hospitals should have battery-operated internal and external communication systems readily available in the event of a widespread disaster and communication outage. Critical services such as pharmacy, laboratories, blood bank, and central supply rooms should be located at sites more secure than the ground floors, and these services should be prepared for more extensive performances. Contingency plans to maintain protected water supplies and available emergency kits with batteries, flashlights, two-way radios, and a nonelectronic emergency system for patient identification are also very important. Rapid adaptation to unexpected adverse conditions is critical to

Center for Applied Linguistics, Washington DC, USA

ERIC Educational Resources Information Center

Sugarman, Julie; Fee, Molly; Donovan, Anne

2015-01-01

The Center for Applied Linguistics (CAL) is a private, nonprofit organization with over 50 years' experience in the application of research on language and culture to educational and societal concerns. CAL carries out its mission to improve communication through better understanding of language and culture by engaging in a variety of projects in…

1967 Washington timber harvest.

Treesearch

Brian R. Wall

1968-01-01

Washington's 1967 timber harvest declined to 5.9 billion board feet, 2.3 percent below the 1966 harvest. The cut on public lands remained about the same as in 1966 with a 6.7-percent increase in public cut in eastern Washington, offsetting a 2.2-percent decrease in western Washington. The Indian lands had the greatest increase in harvest, up 35 million board feet...

1970 Washington timber harvest.

Treesearch

Brian R. Wall

1971-01-01

Washington's 1970 timber harvest of 6.46 billion board feet was 7.8 percent below the near record harvest of 7 billion board feet established in 1969. Timber harvests on all public lands declined 13 percent with a 9.0-percent reduction in western Washington and a 22.9-percent drop in eastern Washington. State lands led the decline in public production with a 142-...

The story of the Howard University Transplant Center: (a project of the people).

PubMed

Callender, C O; Spaulding, P A

1977-08-01

It took almost two years for Howard University Hospital to receive certification as a kidney transplant hospital under the federal government's end-stage renal disease program, although Howard had a transplant program that was comparable to many in the country.By the time the Department of Health, Education, and Welfare approved Howard's program, many successful transplants had already been carried out there, largely on indigent patients who probably could not have received transplants elsewhere or on patients whose chances of survival, because of other complications, were so risky that other hospitals had turned them down. At first the high cost of these operations had to be absorbed by the University since the government reimbursed only those hospitals which had an approved transplant program.Howard has now received reimbursement (payments of more than $500,000) for its transplants because its certification was granted retroactive to July 1, 1973, when the federal program was started. So the Transplant Center is now enabled, and committed, to provide the best possible transplant care to the Washington, D.C. community which, incidentally, has one of the highest incidences of kidney failure in the country.

A Monumental Experience: The Undergraduate Program in Washington, DC

NASA Astrophysics Data System (ADS)

Betsock, Lori

2009-08-01

All undergraduate chemical science students are invited to attend the Undergraduate Program at the 238th ACS National Meeting in Washington, DC on August 16-17, 2009. This educational and career-oriented program is designed to increase our understanding of the world with chemistry. Symposia will focus on the chemistry of our oceans and atmosphere. Nobel Laureate Susan Solomon will be the featured Eminent Scientist speaker. Attend the Graduate School Reality Check and graduate school networking events to meet and talk with graduate school recruiters. All events will take place in the Capital Hilton (1001 16th Street NW), except for the Undergraduate Poster Session and Sci-Mix, which will be held in the Walter E. Washington Convention Center, located between 7th and 9th Streets and N Street and Mt. Vernon Place (approximately K Street).

Positioning academic medical centers and teaching hospitals to thrive in the next decade.

PubMed

Morris, D E

1985-06-01

Market share for academic medical centers and teaching hospitals will decline over the next five years necessitating new strategies to ensure growth and profitability. These types of institutions are, however, in a strong position to compete and gain market share locally by building a defensible competitive advantage. This article offers three avenues for increasing market share: networking, brand name product differentiation, and business diversification.

Geologic Map of the North Cascade Range, Washington

USGS Publications Warehouse

Haugerud, Ralph A.; Tabor, Rowland W.

2009-01-01

The North Cascade Range, commonly referred to as the North Cascades, is the northern part of the Cascade Range that stretches from northern California into British Columbia, where it merges with the Coast Mountains of British Columbia at the Fraser River. The North Cascades are generally characterized by exposure of plutonic and metamorphic rocks in contrast to the volcanic terrain to the south. The rocks of the North Cascades are more resistant to erosion, display greater relief, and show evidence of more pronounced uplift and recent glaciation. Although the total length of the North Cascade Range, extending north from Snoqualmie Pass in Washington, is about 200 mi (320 km), this compilation map at 1:200,000 scale covers only that part (~150 mi) in the United States. The compilation map is derived mostly from eight 1:100,000-scale quadrangle maps that include all of the North Cascade Range in Washington and a bit of the mostly volcanic part of the Cascade Range to the south (fig. 1, sheet 2). Overall, the area represented by this compilation is about 12,740 mi2 (33,000 km2). The superb alpine scenery of the North Cascade Range and its proximity to major population centers has led to designation of much of the area for recreational use or wilderness preservation. A major part of the map area is in North Cascade National Park. Other restricted use areas are the Alpine Lakes, Boulder River, Clearwater, Glacier Peak, Henry M. Jackson, Lake Chelan-Sawtooth, Mount Baker, Noisy-Diobsud, Norse Peak, and Pasayten Wildernesses and the Mount Baker, Lake Chelan, and Ross Lake National Recreation Areas. The valleys traversed by Washington State Highway 20 east of Ross Lake are preserved as North Cascades Scenic Highway. The map area is traversed by three major highways: U.S. Interstate 90, crossing Snoqualmie Pass; Washington State Highway 2, crossing Stevens Pass; and Washington State Highway 20, crossing Washington Pass. Major secondary roads, as well as a network of U

Feasibility of using a pediatric call center as part of a quality improvement effort to prevent hospital readmission.

PubMed

Kirsch, Sallie Davis; Wilson, Lauren S; Harkins, Michelle; Albin, Dawn; Del Beccaro, Mark A

2015-01-01

The primary aim of this intervention was to assess the feasibility of using call center nurses who are experts in telephone triage to conduct post discharge telephone calls, as part of a quality improvement effort to prevent hospital readmission. Families of patients with bronchiolitis were called between 24 and 48 hours after discharge. The calls conducted by the nurses were efficient (average time was 12 minutes), and their assessments helped to identify gaps in inpatient family education. Overall, the project demonstrated the efficacy in readmission prevention by using nurses who staff a call center to conduct post-hospitalization telephone calls. Copyright © 2015 Elsevier Inc. All rights reserved.

An Analysis of Interlibrary Loan Requests Made to the Neoucom Information Center from Its Associated Council Hospital Libraries: Maximizing Service to Hospital Libraries in the Era of Hospital Downsizing.

ERIC Educational Resources Information Center

Gonda-Farley, Kristine M.

This study examines the interlibrary loan requests made to NEOUCOM's (Northeastern Ohio Universities College of Medicine) Oliver Ocasek Regional Medical Information Center in Rootstown, OH from its associated council hospital libraries. A total of 636 interlibrary loan requests from the period July 1994-July 1995 were analyzed. Components of the…

Exploring "patient-centered" hospitals: a systematic review to understand change.

PubMed

Gabutti, Irene; Mascia, Daniele; Cicchetti, Americo

2017-05-22

The healthcare scenario in developed countries is changing deeply: patients, who are frequently affected by multi-pathological chronic conditions, have risen their expectations. Simultaneously, there exist dramatic financial pressures which require healthcare organizations to provide more and better services with equal (or decreasing) resources. In response to these challenges, hospitals are facing radical transformations by bridging, redesigning and engaging their organization and staff. This study has the ambitious aim to shed light and clearly label the trends of change hospitals are enhancing in developed economies, in order to fully understand the presence of common trends and which organizational models and features are inspiring the most innovative organizations. The purpose is to make stock of what is known in the field of hospital organization about how hospitals are changing, as well as of how such change may be implemented effectively through managerial tools. To do so the methodology adopted integrates a systematic literature review to a wider engaged research approach. Evidence suggests that the three main pillars of change of the system are given by the progressive patient care model, the patient-centered approach and the lean approach. However, there emerge a number of gaps in what is known about how to exploit drivers of change and their effects. This study confirms that efforts in literature are concentrated in analyzing circumscribed experiences in the implementation of new models and approaches, failing therefore to extend the analysis at the organizational and inter-organizational level in order to legitimately draw consequences to be generalized. There seem to be a number of "gaps" in what is known about how to exploit drivers of change and their effects, suggesting that the research approach privileged till now fails in providing a clear guidance to policy makers and to organizations' management on how to concretely and effectively implement

[ISO 9002 at the Center of Pediatric Intensive Care at the Albert Einstein Israeli Hospital].

PubMed

Gé Lacerda, D P; Rocha, M L; Santos, R P

2000-01-01

This study shows the process of implementation of a quality program in Pediatric Intensive Therapy Center of "Hospital Israelita Albert Einstein" which resulted in the certification of this service for the Standards ISO 9002/94. It points out the nurse's role as a leader in this process.

Case Study III: The University of Washington and Bellevue School District Partnership

ERIC Educational Resources Information Center

Coburn, Cynthia E.; Penuel, William R.; Geil, Kimberly E.

2015-01-01

This design-research partnership involves learning scientists, design researchers, and graduate students from the Learning in Informal and Formal Environments (LIFE) Center and the College of Education at the University of Washington (UW), and district staff, teachers, and students from the Bellevue School District (BSD). The goal of their work is…

Marine Safety Center briefing book

DOT National Transportation Integrated Search

1997-10-30

The U.S. Coast Guard Marine Safety Center was established in 1986 as a consolidation of district Merchant Marine Technical Offices. Our offices are located on the sixth floor of the DOT Headquarters building in Washington, DC. This document provides ...

JFK Center for the Performing Arts

EPA Pesticide Factsheets

Under National Pollutant Discharge Elimination System permit number DC0000248, the JFK Center for the Performing Arts, in authorized to discharge from a facility in Washington, DC to the receiving waters named Potomac River.

Control of scabies outbreaks in an Italian hospital: an information-centered management strategy.

PubMed

Capobussi, Matteo; Sabatino, Giuliana; Donadini, Annalisa; Tersalvi, Carlo A; Castaldi, Silvana

2014-03-01

Scabies is a dermatologic infestation caused by Sarcoptes scabiei. In industrialized countries, hospitals and other health structures can sometimes be hit. The optimal management of scabies outbreaks still has to be established, mass prophylaxis being one possible option. To identify the optimal approach to containing this re-emerging disease, a local health authority in Lombardy, Northern Italy, carried out an epidemiologic study into 2 scabies epidemics that took place from September to December 2012 in a 600-bed hospital with 26,000 admissions a year. Over a 3-month period, there were 12 cases of scabies on 4 wards; 43 contacts received prophylaxis. When the first cases were identified, an information campaign involving all hospital personnel was immediately set up. Regular staff meetings were organized, and information leaflets were distributed to patients. Family doctors of discharged patients were informed of the outbreak. A management model based on an information-centered strategy was used in place of mass prophylaxis to deal with scabies epidemics. The success of this approach was confirmed by the managers of the hospital involved (reduced expenditure for prophylactic drugs) and by hospital staff who did not have to deal with potential drug adverse effects. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Academic health center teaching hospitals in transition: a perspective from the field.

PubMed

Cyphert, S T; Colloton, J W; Levey, S

1997-01-01

A study of 11 Academic Health Center Teaching Hospitals (ATHs) in 11 states found that cost reduction programs, internal reorganizations, reengineering, benchmarking, and broadened entrepreneurial activity were prominent among the strategic initiatives reported in dealing with an increasingly turbulent environment. Although none of the ATHs had experienced negative net margins, we conclude that today's competitive healthcare system requires ATHs be reimbursed separately for their educational and other societally related costs to assist them in competing on a level playing fields.

Betrayed trust: healing a broken hospital through servant leadership.

PubMed

Yancer, Deborah A

2012-01-01

An investigative reporter with The Washington Post broke the news of a no-confidence vote by the medical staff of a hospital in the suburbs of Washington, District of Columbia. The chaos that followed created a perfect storm for needed change and offered the rare opportunity for unbridled deep and creative collaboration. Issues the hospital faced as a result of this crisis and subsequent events that tested the authenticity of change are summarized. This article focuses on the approach used by the registered nurse chief executive officer (RN-CEO) to humanize the hospital, viewing it as though it were a patient and leading a clinical approach to organizational recovery and health. The relationship that developed between the medical staff leaders and the RN-CEO was pivotal to the hospital's recovery and evolved as a hybrid of servant leadership. Outcomes achieved over a 7-year period and attributable to this relational model are summarized. Finally, the RN-CEO shares lessons learned through experience and reflection and advice for nurses interested in pursuing executive leadership roles.

Space Radar Image of Wenatchee, Washington

NASA Technical Reports Server (NTRS)

1994-01-01

This spaceborne radar image shows a segment of the Columbia River as it passes through the area of Wenatchee, Washington, about 220 kilometers (136 miles) east of Seattle. The Wenatchee Mountains, part of the Cascade Range, are shown in green at the lower left of the image. The Cascades create a 'rain shadow' for the region, limiting rainfall east of the range to less than 26 centimeters (10 inches) per year. The radar's ability to see different types of vegetation is highlighted in the contrast between the pine forests, that appear in green and the dry valley plain that shows up as dark purple. The cities of Wenatchee and East Wenatchee are the grid-like areas straddling the Columbia River in the left center of the image. With a population of about 60,000, the region produces about half of Washington state's lucrative apple crop. Several orchard areas appear as green rectangular patches to the right of the river in the lower right center. Radar images such as these can be used to monitor land use patterns in areas such as Wenatchee, that have diverse and rapidly changing urban, agricultural and wild land pressures. This image was acquired by Spaceborne Imaging Radar-C/X-Band Synthetic Aperture Radar (SIR-C/X-SAR) onboard the space shuttle Endeavour on October 10, 1994. The image is 38 kilometers by 45 kilometers (24 miles by 30 miles) and is centered at 47.3 degrees North latitude, 120.1 degrees West longitude. North is toward the upper left. The colors are assigned to different radar frequencies and polarizations of the radar as follows: red is L-band, horizontally transmitted and received; green is L-band, horizontally transmitted, vertically received; and blue is C-band, horizontally transmitted, vertically received. SIR-C/X-SAR, a joint mission of the German, Italian, and United States space agencies, is part of NASA's Mission to Planet Earth.

12 CFR 4.4 - Washington office.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Washington office. 4.4 Section 4.4 Banks and... EXAMINERS Organization and Functions § 4.4 Washington office. The Washington office of the OCC is the main office and headquarters of the OCC. The Washington office directs OCC policy, oversees OCC operations...

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

PubMed

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

2015-09-01

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

Historical changes to Lake Washington and route of the Lake Washington Ship Canal, King County, Washington

USGS Publications Warehouse

Chrzastowski, Michael J.

1983-01-01

Lake Washington, in the midst of the greater Seattle metropolitan area of the Puget Sound region (fig. 1), is an exceptional commercial, recreational, and esthetic resource for the region . In the past 130 years, Lake Washington has been changed from a " wild " lake in a wilderness setting to a regulated lake surrounded by a growing metropolis--a transformation that provides an unusual opportunity to study changes to a lake's shoreline and hydrologic characteristics -resulting from urbanization.

Mental Health Services in a Rural Area: The Integrated Relationship between State Hospital and Community Mental Health Centers. Notes from the Field.

ERIC Educational Resources Information Center

Bittle, Ronald G.

1988-01-01

Describes "linkage agreement" system between Illinois community mental health centers and Anna Mental Health and Developmental Center serving 28 rural counties. Agreements specify responsibilities of community centers and hospital staff regarding referrals, client treatment, and discharge. Describes improvements over previous…

Kennedy Center Salute To Apollo

NASA Image and Video Library

2009-07-17

The audience applauds during the "Salute to Apollo" ceremony at the Kennedy Center for the Performing Arts, Saturday, July 18, 2009 in Washington. The event was part of NASA's week long celebration of the Apollo 40th Anniversary. Photo Credit: (NASA/Bill Ingalls)

Moral dilemmas faced by hospitals in time of war: the Rambam Medical Center during the second Lebanon war.

PubMed

Bar-El, Yaron; Reisner, Shimon; Beyar, Rafael

2014-02-01

Rambam Medical Center, the only tertiary care center and largest hospital in northern Israel, was subjected to continuous rocket attacks in 2006. This extreme situation posed serious and unprecedented ethical dilemmas to the hospital management. An ambiguous situation arose that required routine patient care in a tertiary modern hospital together with implementation of emergency measures while under direct fire. The physicians responsible for hospital management at that time share some of the moral dilemmas faced, the policy they chose to follow, and offer a retrospective critical reflection in this paper. The hospital's first priority was defined as delivery of emergency surgical and medical services to the wounded from the battlefields and home front, while concomitantly providing the civilian population with all elective medical and surgical services. The need for acute medical service was even more apparent as the situation of conflict led to closure of many ambulatory clinics, while urgent or planned medical care such as open heart surgery and chemotherapy continued. The hospital management took actions to minimize risks to patients, staff, and visitors during the ongoing attacks. Wards were relocated to unused underground spaces and corridors. However due to the shortage of shielded spaces, not all wards and patients could be relocated to safer areas. Modern warfare will most likely continue to involve civilian populations and institutes, blurring the division between peaceful high-tech medicine and the rough battlefront. Hospitals in high war-risk areas must be prepared to function and deliver treatment while under fire or facing similar threats.

[Management of Grave's disease in the tropics (experience at Bouffard Army Hospital Center in Djibouti].

PubMed

Coulet, O; Kraemer, P; Leyral, G; Cloatre, G

2004-01-01

Based on their experience in managing Grave's disease at the Bouffard Army Hospital Center within the local health care context in Djibouti, the authors advocate surgery as the first line treatment. Medical and economical factors supporting this preference are discussed so that readers can adapt them to his own local context.

Report of the Annual Scientific Sessions of the American College of Cardiology (ACC), Washington DC.

PubMed

Hiro, Takafumi

2017-05-25

The 66 th Annual Scientific Sessions and Expo of the American College of Cardiology (ACC) were held at the Walter E. Washington Convention Center, Washington DC, from March 17 th to 19 th , 2017. This meeting offered 23 Late-Breaking Clinical Trial (LBCT) presentations, 17 Featured Clinical Research presentations with and without LBCT, and 2,572 abstracts presented in oral and poster sessions by over 2,000 experts. This report presents the highlights of this meeting, including the opening showcase, several important LBCTs and some international joint symposiums.

National and Regional Representativeness of Hospital Emergency Department Visit Data in the National Syndromic Surveillance Program, United States, 2014

PubMed Central

Coates, Ralph J.; Pérez, Alejandro; Baer, Atar; Zhou, Hong; English, Roseanne; Coletta, Michael; Dey, Achintya

2016-01-01

Objective We examined the representativeness of the nonfederal hospital emergency department (ED) visit data in the National Syndromic Surveillance Program (NSSP). Methods We used the 2012 American Hospital Association Annual Survey Database, other databases, and information from state and local health departments participating in the NSSP about which hospitals submitted data to the NSSP in October 2014. We compared ED visits for hospitals submitting 15 data with all ED visits in all 50 states and Washington, DC. Results Approximately 60.4 million of 134.6 million ED visits nationwide (~45%) were reported to have been submitted to the NSSP. ED visits in 5 of 10 regions and the majority of the states were substantially underrepresented in the NSSP. The NSSP ED visits were similar to national ED visits in terms of many of the characteristics of hospitals and their service areas. However, visits in hospitals with the fewest annual ED visits, in rural trauma centers, and in hospitals serving populations with high percentages of Hispanics and Asians were underrepresented. Conclusions NSSP nonfederal hospital ED visit data were representative for many hospital characteristics and in some geographic areas but were not very representative nationally and in many locations. Representativeness could be improved by increasing participation in more states and among specific types of hospitals. PMID:26883318

Jackson Park Hospital Green Building Medical Center

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

William Dorsey; Nelson Vasquez

2010-03-31

Jackson Park Hospital completed the construction of a new Medical Office Building on its campus this spring. The new building construction has adopted the City of Chicago's recent focus on protecting the environment, and conserving energy and resources, with the introduction of green building codes. Located in a poor, inner city neighborhood on the South side of Chicago, Jackson Park Hospital has chosen green building strategies to help make the area a better place to live and work. The new green building houses the hospital's Family Medicine Residency Program and Specialty Medical Offices. The residency program has been vital inmore » attracting new, young physicians to this medically underserved area. The new outpatient center will also help to allure needed medical providers to the community. The facility also has areas designated to women's health and community education. The Community Education Conference Room will provide learning opportunities to area residents. Emphasis will be placed on conserving resources and protecting our environment, as well as providing information on healthcare access and preventive medicine. The new Medical Office Building was constructed with numerous energy saving features. The exterior cladding of the building is an innovative, locally-manufactured precast concrete panel system with integral insulation that achieves an R-value in excess of building code requirements. The roof is a 'green roof' covered by native plantings, lessening the impact solar heat gain on the building, and reducing air conditioning requirements. The windows are low-E, tinted, and insulated to reduce cooling requirements in summer and heating requirements in winter. The main entrance has an air lock to prevent unconditioned air from entering the building and impacting interior air temperatures. Since much of the traffic in and out of the office building comes from the adjacent Jackson Park Hospital, a pedestrian bridge connects the two buildings, further

78 FR 9940 - Naugatuck Valley Surgical Center, Department of Saint Mary's Hospital, Waterbury, CT: Notice of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-12

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-82,137] Naugatuck Valley Surgical Center, Department of Saint Mary's Hospital, Waterbury, CT: Notice of Affirmative Determination... application, I conclude that the claim is of sufficient weight to justify reconsideration of the U.S...

View of southeastern Washington State

NASA Image and Video Library

1973-08-30

SL3-22-0214 (July-September 1973) --- A vertical view of southeastern Washington State as photographed from Earth orbit by one of the six lenses of the Itek-furnished S190-A Multispectral Photographic Facility Experiment aboard the Skylab space station. The Snake River flows into the Columbia River in the most southerly corner of the picture. The Wallula Lake is below the junction of the two rivers. The Yakima Valley is at the southwestern edge of the photograph. The Columbia Basin is in the center of the picture. The Cascade Range extends across the northwest corner of the photograph. This picture was taken with type SO-356 regular color film. The S190-A experiment is part of the Earth Resources Experiments Package. Federal agencies participating with NASA on the EREP project are the Departments of Agriculture, Commerce, Interior, the Environmental Protection Agency and the Corps of Engineers. All EREP photography is available to the public through the Department of Interior?s Earth Resources Observations Systems Data Center, Sioux Falls, South Dakota, 57198. Photo credit: NASA

Forest industries of eastern Washington.

Treesearch

Brian R. Wall; Donald R. Gedney; Robert B. Forster

1966-01-01

A sawmill, built in 1872, marked the beginning of the forest industry in eastern Washington -- almost half a century after the emergence of the lumber industry in western Washington. Since then, this industry has increased in importance to eastern Washington's economy, now furnishing about one-fifth of the total manufacturing employment and wages paid—in...

Kennedy Center Salute To Apollo

NASA Image and Video Library

2009-07-17

Opera singer Denyce Graves sings during the "Salute to Apollo" ceremony at the Kennedy Center for the Performing Arts, Saturday, July 18, 2009 in Washington. The event was part of NASA's week long celebration of the Apollo 40th Anniversary. Photo Credit: (NASA/Bill Ingalls)

Kennedy Center Salute To Apollo

NASA Image and Video Library

2009-07-17

Singer Chaka Khan performs during the "Salute to Apollo" ceremony at the Kennedy Center for the Performing Arts, Saturday, July 18, 2009 in Washington. The event was part of NASA's week long celebration of the Apollo 40th Anniversary. Photo Credit: (NASA/Bill Ingalls)

Trends and Characteristics of United States Out-of-Hospital Births 2004-2014: New Information on Risk Status and Access to Care.

PubMed

MacDorman, Marian F; Declercq, Eugene

2016-06-01

Out-of-hospital births are increasing in the United States. Our purpose was to examine trends in out-of-hospital births from 2004 to 2014, and to analyze newly available data on risk status and access to care. Newly available data from the revised birth certificate for 47 states and Washington, DC, were used to examine out-of-hospital births by characteristics and to compare them with hospital births. Trends from 2004 to 2014 were also examined. Out-of-hospital births increased by 72 percent, from 0.87 percent of United States births in 2004 to 1.50 percent in 2014. Compared with mothers who had hospital births, those with out-of-hospital births had lower prepregnancy obesity (12.5% vs 25.0%) and smoking (2.8% vs 8.5%) rates, and higher college graduation (39.3% vs 30.0%) and breastfeeding initiation (94.3% vs 80.8%) rates. Among planned home births, 67.1 percent were self-paid, compared with 31.9 percent of birth center and 3.4 percent of hospital births. Vaginal births after cesarean (VBACs) comprised 4.6 percent of planned home births and 1.6 percent of hospital and birth center births. Sociodemographic and medical risk status of out-of-hospital births improved substantially from 2004 to 2014. Improvements in risk status of out-of-hospital births from 2004 to 2014 suggest that appropriate selection of low-risk women is improving. High rates of self-pay for the costs of out-of-hospital birth suggest serious gaps in insurance coverage, whereas higher-than-average rates of VBAC could reflect lack of access to hospital VBACs. Mandating private insurance and Medicaid coverage could substantially improve access to out-of-hospital births. Improving access to hospital VBACs might reduce the number of out-of-hospital VBACs. © 2016 Wiley Periodicals, Inc.

Resisting Charters: A Comparative Policy Development Analysis of Washington and Kentucky, 2002-2012

ERIC Educational Resources Information Center

Johnston, Joseph B.

2014-01-01

Over the past two decades, most states have adopted laws enabling charter schools, as charter advocates successfully presented charters as the solution to core problems in urban public education. Yet some states with large urban centers, notably Washington and Kentucky, resisted this seemingly inexorable trend for years. What explains their…

A Study in Child Care (Case Study from Volume II-A): "Children as 'Kids'." Day Care Programs Reprint Series.

ERIC Educational Resources Information Center

O'Farrell, Brigid

The Georgetown Day Care Center, in Washington, D.C., is dually sponsored by a large hospital and a private non-profit organization and offers day care services to a small number of the children of parents who work at the hospital. The center also functions as a halfway house for children in a diagnostic center which identifies preschool children…

Proposed center for advanced industrial processes. Washington State University, College of Engineering and Architecture

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

NONE

1995-03-01

The DOE proposes to authorize Washington State University (WSU) to proceed with the detailed design, construction, and equipping of the proposed Center for Advanced Industrial Processes (CAIP). The proposed project would involve construction of a three story building containing laboratories, classrooms, seminar rooms, and graduate student and administrative office space. Existing buildings would be demolished. The proposed facility would house research in thermal/fluid sciences, bioengineering, manufacturing processes, and materials processing. Under the {open_quotes}no-action{close_quotes} DOE would not authorize WSU to proceed with construction under the grant. WSU would then need to consider alternatives for proceeding without DOE funds. Such alternatives (includingmore » delaying or scaling back the project), would result in a postponement or slight reduction in the minor adverse environmental, safety and health Impacts of the project evaluated in this assessment. More importantly, these alternatives would affect the important environmental, safety, health, and programmatic benefits of the projects. The surrounding area is fully urbanized and the campus is intensely developed around the proposed site. The buildings scheduled for demolition do not meet State energy codes, are not air conditioned, and lack handicapped access. Sensitive resources (historical/archeological, protected species/critical habitats, wetlands/floodplains, national forests/parks/trails, prime farmland and special sources of water) would not be affected as they do not occur on or near the proposed site. Cumulative impacts would be small. The proposed action is not related to other actions being considered under other NEPA reviews. There is no conflict between the proposed action and any applicable Federal, State, regional or local land use plans and policies.« less

"RAPID" team triage: one hospital's approach to patient-centered team triage.

PubMed

Shea, Sheila Sanning; Hoyt, K Sue

2012-01-01

Patients who present to the emergency department want definitive care by a health care provider who can perform an initial assessment, initiate treatment, and implement a disposition plan. The traditional "nurse triage" model often creates barriers to the process of rapidly evaluating patients. Therefore, innovative strategies must be explored to improve the time of patient arrival to the time seen by a qualified provider in order to complete a thorough medical screening examination. One such approach is a rapid team triage system that provides a patient-centered process. This article describes the implementation of a rapid team triage model in an urban community hospital.

Better Jobs, Brighter Futures, a Stronger Washington. Washington's Community and Technical Colleges

ERIC Educational Resources Information Center

Washington State Board for Community and Technical Colleges, 2015

2015-01-01

The world is changing rapidly. With changes in technology, demographics, and workforce trends, Washington needs colleges to not only keep pace, but lead the way. Washington's 34 community and technical colleges answer that call. The community and technical colleges have proven uniquely positioned to adapt to, embrace, and ignite change. Community…

Kennedy Center Salute To Apollo

NASA Image and Video Library

2009-07-17

12 year old singer Jamia Nash performs during the "Salute to Apollo" ceremony at the Kennedy Center for the Performing Arts, Saturday, July 18, 2009 in Washington. The event was part of NASA's week long celebration of the Apollo 40th Anniversary. Photo Credit: (NASA/Bill Ingalls)

Measurement of Wheel/Rail Forces at the Washington Metropolitan Area Transit Authority. Volume II. Test Report.

DOT National Transportation Integrated Search

1980-07-01

Measurements of wheel/rail forces were made in August 1979 by the Transportation Systems Center (TSC) with the assistance of Battelle Columbus Laboratories to determine the causes of excessive wheel/rail wear experiences by the Washington Metropolita...

High Skills, High Wages. Washington's Comprehensive Plan for Workforce Training and Education, 1998.

ERIC Educational Resources Information Center

Washington State Workforce Training and Education Coordinating Board, Olympia.

In Washington, urban centers enjoy rising wages and low employment; rural areas have stagnating wages and high unemployment. Most family-wage job opportunities are in occupations that require some postsecondary education but not a four-year degree. The shortage is most severe in the supply of skilled workers with vocational training. Technology…

Kennedy Center Salute To Apollo

NASA Image and Video Library

2009-07-17

Emil de Cou conducts the National Symphony Orchestra during the "Salute to Apollo" ceremony at the Kennedy Center for the Performing Arts, Saturday, July 18, 2009 in Washington. The event was part of NASA's week long celebration of the Apollo 40th Anniversary. Photo Credit: (NASA/Bill Ingalls)

75 FR 49946 - National Drug Intelligence Center: Agency Information Collection Activities: Proposed Extension...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-16

... DEPARTMENT OF JUSTICE [OMB Number 1105-0087] National Drug Intelligence Center: Agency Information...), National Drug Intelligence Center (NDIC), will be submitting the following information collection request... Kevin M. Walker, General Counsel, National Drug Intelligence Center, Fifth Floor, 319 Washington Street...

Impact of airbags on a Level I trauma center: injury patterns, infectious morbidity, and hospital costs.

PubMed

Williams, Regan F; Fabian, Timothy C; Fischer, Peter E; Zarzaur, Ben L; Magnotti, Louis J; Croce, Martin A

2008-05-01

To date, no study has evaluated the potential impact of supplemental restraint use on resource use at a Level I trauma center. We hypothesized that airbag use would be related to decreased injury severity of motor vehicle collision survivors admitted to a Level I trauma center, leading to a decrease in infectious morbidity and hospital resource use. Using the trauma registry, motor vehicle collision victims admitted during an 11-year period were identified. Restraint groups were defined as unrestrained (reference group), seatbelt only, airbag only, or airbag and seatbelt. Multivariable logistic regression was used to determine the relationship between restraint type and injury patterns. Other outcomes measured included prevalence of ventilator-associated pneumonia and bacteremia, hospital length of stay, days in the ICU, and hospital mortality. A total of 14,390 patients (unrestrained, n = 7,881; airbag only, n = 692; seatbelt only, n = 4,909; airbag and seatbelt, n = 908) had restraint data available. Both airbag and seatbelt use were associated with a substantial reduction in injury to the brain, face, cervical spine, thorax, and abdomen. The largest reduction occurred when these restraints were used in combination. The only injury associated with airbag deployment was extremity fractures. Compared with unrestrained persons, any restraint use was associated with substantially reduced injury severity, significant infectious morbidity, and resource use. Airbags are associated with reduced in-hospital mortality. Airbags are also associated with decreased injury severity, substantial infectious morbidity, and resource use. Cost savings from reduced resource use associated with supplemental restraints could be tremendous.

Washington, D.C. - Local Information | NREL

Science.gov Websites

International Airport (IAD), and Baltimore/Washington International Thurgood Marshall Airport (BWI). DCA is the additional information. Reagan National Airport - DCA Dulles International Airport - IAD Baltimore/Washington International Thurgood Marshall Airport - BWI Public Transportation The Washington Metropolitan Area Transit

Test of wind predictions for peak fire-danger stations in Oregon and Washington.

Treesearch

Owen P. Cramer

1957-01-01

Relative accuracy of several wind-speed forecasting methods was tested during the forest fire seasons of 1950 and 1951. For the study, three fire-weather forecast centers of the U. S. Weather Bureau prepared individual station forecasts for 11 peak stations within the national. forests of Oregon and Washington. These spot forecasts were considered...

Radiology Online Patient Education Materials Provided by Major University Hospitals: Do They Conform to NIH and AMA Guidelines?

PubMed

Prabhu, Arpan V; Donovan, Ashley L; Crihalmeanu, Tudor; Hansberry, David R; Agarwal, Nitin; Beriwal, Sushil; Kale, Hrishikesh; Heller, Matthew

The internet creates opportunities for Americans to access medical information about imaging tests and modalities to guide them in their medical decision-making. Owing to health literacy variations in the general population, the American Medical Association and National Institutes of Health recommend patient education resources to be written between the third and seventh grade levels. Our purpose is to quantitatively assess the readability levels of online radiology educational materials, written for the public, in 20 major university hospitals. In September and October 2016, we identified 20 major university hospitals with radiology residency-affiliated hospital systems. On each hospital׳s website, we downloaded all radiology-related articles written for patient use. A total of 375 articles were analyzed for readability level using 9 quantitative readability scales that are well validated in the medical literature. The 375 articles from 20 hospital systems were collectively written at an 11.4 ± 3.0 grade level (range: 8.4-17.1). Only 11 (2.9%) articles were written at the recommended third to seventh grade levels. Overall, 126 (33.6%) were written above a full high-school reading level. University of Washington Medical Center׳s articles were the most readable with a reading level corresponding to 7.9 ± 0.9. The vast majority of websites at major academic hospitals with radiology residencies designed to provide patients with information about imaging were written above the nationally recommended health literacy guidelines to meet the needs of the average American. This may limit the benefit that patients can derive from these educational materials. Copyright © 2018 Elsevier Inc. All rights reserved.

Colonization with hospital flora and its associated risk factors in neonates hospitalized in neonatal ward of a teaching center in Isfahan, Iran.

PubMed

Shirani, Kiana; Mostafavizadeh, Kamyar; Ataei, Behrouz; Akhani, Khatere

2018-01-01

Due to the high incidence and prevalence of infection in neonatal ward, especially Neonatal Intensive Care Units (NICUs) reported by different studies and the important role of colonization with hospital germs in the development of nosocomial infections, we intended to evaluate the risk of colonization with hospital germs in neonates and its associated risk factors. This cross-sectional, descriptive-analytical study was conducted in 2016 in a Teaching Center in Iran. In total, 51 neonates were selected based on the inclusion criteria, and after recording their information in a checklist, samples were taken by swab from outer ear, axilla, and groin for culture. Neonates with negative culture from mentioned regions were enrolled in the study. The swab samples again were taken and sent for culture from mentioned regions in at least 3 days after hospitalization. Culture results from first and second sampling were collected and analyzed statistically. This study was conducted on 51 neonates. The mean gestational age among the neonates ranged from 35.25 (Week) ± 2.98. 22 girls (43.1%) and 29 boys (56.9%), most of them were born by cesarean. Based on the results of logistic regression, a significant association was found between the occurrence of colonization of hospital flora and the place hospitalization of the newborns (odds ratio (OR): 4.750; 95% confidence interval (CI): 1.26-17.85). This study revealed that the only risk factors of colonization with hospital flora in neonates are the type of delivery and place of hospitalization. Based on findings of the study, it is recommended to focus on efforts in increasing the rate of natural birth as well as improving conditions of infection control in NICUs to reduce the number of incidences of colonization with hospital flora in neonates.

Day hospital and psychosocial care center: Expanding the discussion of partial hospitalization in mental health.

PubMed

Weber, César Augusto Trinta; Juruena, Mario Francisco

2016-07-01

Since the second half of the twentieth century the discussions about mental patient care reveal ongoing debate between two health care paradigms: the biomedical/biopsychosocial paradigm and the psychosocial paradigm. The struggle for hegemony over the forms of care, on how to deal optimally with the experience of becoming ill is underpinned by an intentionality of reorganizing knowledge about the health/disease dichotomy, which is reflected in the models proposed for the implementation of actions and services for the promotion, prevention, care and rehabilitation of human health. To discuss the guidelines of care in mental health day hospitals (MHDH) in contrast to type III psychosocial care centers (CAPS III). Review of mental health legislation from 1990 to 2014. A definition of therapeutic project could not be found, as well as which activities and techniques should be employed by these health services. The MHDH and PCC III are services that replace psychiatric hospital admission and are characterized by their complementarity in the care to the mentally ill. Due to their varied and distinctive intervention methods, which operate synergistically, the contributions from both models of care are optimized. Discussions on the best mental health care model reveal polarization between the biomedical/biopsychosocial and psychosocial paradigms. This reflects the supremacy of the latter over the former in the political-ideological discourse that circumscribes the reform of psychiatric care, which may hinder a better clinical outcome for patients and their families.

Designated Stroke Center Status and Hospital Characteristics as Predictors of In-Hospital Mortality among Hemorrhagic Stroke Patients in New York, 2008-2012.

PubMed

Gatollari, Hajere J; Colello, Anna; Eisenberg, Bonnie; Brissette, Ian; Luna, Jorge; Elkind, Mitchell S V; Willey, Joshua Z

2017-01-01

Although designated stroke centers (DSCs) improve the quality of care and clinical outcomes for ischemic stroke patients, less is known about the benefits of DSCs for patients with intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Compared to non-DSCs, hospitals with the DSC status have lower in-hospital mortality rates for hemorrhagic stroke patients. We believed these effects would sustain over a period of time after adjusting for hospital-level characteristics, including hospital size, urban location, and teaching status. We evaluated ICH (International Classification of Diseases, Ninth Revision; ICD-9: 431) and SAH (ICD-9: 430) hospitalizations documented in the 2008-2012 New York State Department of Health Statewide Planning and Research Cooperative System inpatient sample database. Generalized estimating equation logistic regression was used to evaluate the association between DSC status and in-hospital mortality. We calculated ORs and 95% CIs adjusted for clustering of patients within facilities, other hospital characteristics, and individual level characteristics. Planned secondary analyses explored other hospital characteristics associated with in-hospital mortality. In 6,352 ICH and 3,369 SAH patients in the study sample, in-hospital mortality was higher among those with ICH compared to SAH (23.7 vs. 18.5%). Unadjusted analyses revealed that DSC status was related with reduced mortality for both ICH (OR 0.7, 95% CI 0.5-0.8) and SAH patients (OR 0.4, 95% CI 0.3-0.7). DSC remained a significant predictor of lower in-hospital mortality for SAH patients (OR 0.6, 95% CI 0.3-0.9) but not for ICH patients (OR 0.8, 95% CI 0.6-1.0) after adjusting for patient demographic characteristics, comorbidities, hospital size, teaching status and location. Admission to a DSC was independently associated with reduced in-hospital mortality for SAH patients but not for those with ICH. Other patient and hospital characteristics may explain the benefits of DSC

[Construction of the collaborative relationship for the complicated patients with the Critical care centers and the Emergency departments in regional hospitals in Japan].

PubMed

Miyake, Yasufumi

2016-02-01

All the people have the right to die with dignity, but increase of elderly people and progress of the depauperation and isolation in Japan make it more difficult in this decade. As one of some solutions, we propose structuring the collaborative relationship between the critical care centers and the regional hospitals for the complicated patients. Patients inferred seriously ill should be transported first to the critical care center with substantial medical equipment and enough staff, diagnosed and stabilized in it. After those procedures, patients are transfered to and followed in the regional hospital for a certain period. These allotments of functions between hospitals are useful in the present condition.

Kennedy Center Salute To Apollo

NASA Image and Video Library

2009-07-17

Members of the U.S. Army Chorus and Alumni sing during the "Salute to Apollo" ceremony at the Kennedy Center for the Performing Arts, Saturday, July 18, 2009 in Washington. The event was part of NASA's week long celebration of the Apollo 40th Anniversary. Photo Credit: (NASA/Bill Ingalls)

Booker T. Washington Rediscovered

ERIC Educational Resources Information Center

Bieze, Michael Scott, Ed.; Gasman, Marybeth, Ed.

2012-01-01

Booker T. Washington, a founding father of African American education in the United States, has long been studied, revered, and reviled by scholars and students. Born into slavery, freed and raised in the Reconstruction South, and active in educational reform through the late nineteenth and early twentieth centuries, Washington sought to use…

Work ability among nursing personnel in public hospitals and health centers in Campinas--Brazil.

PubMed

Monteiro, Inês; Chillida, Manuela de Santana Pi; Moreno, Luciana Contrera

2012-01-01

Nursing personnel is essential in hospital, health centers and enterprises and is the large work force in health system. A cross-sectional study was conducted in a large city in two public hospitals and five health centre with the objective of to evaluate the work ability and health aspects of nursing staff. The sample was composed by 570 workers. The Work Ability Index - WAI and a questionnaire with socio-demographic, health and life style data was applied. The majority of workers was women (83%), married (50.4%), and was working in night shift work (65.6%); 61.4% was auxiliary nursing, 22.3% was registered nurses (RN). The average age was 38.9 years (SD 7.8) and the Body Mass Index mean was 25.8 (SD 5.3). Only 17.2% referred to practice at least 150 minutes of physical exercise five times per week or more. 26.8% had a second job. The work ability mean was 39.3 (SD 5.3) points. Age had a negative correlation with WAI (p=0.0052). Public hospital and health centre workers had poor work ability score when compared with workers from another branches. Public policies related to workplace health promotion need to be implemented in public hospital and health centre to improve the work ability.

Procurement of Human Tissues for Research Banking in the Surgical Pathology Laboratory: Prioritization Practices at Washington University Medical Center

PubMed Central

Chernock, Rebecca D.; Leach, Tracey A.; Kahn, Ajaz A.; Yip, James H.; Rossi, Joan; Pfeifer, John D.

2011-01-01

Academic hospitals and medical schools with research tissue repositories often derive many of their internal human specimen acquisitions from their site's surgical pathology service. Typically, such acquisitions come from appropriately consented tissue discards sampled from surgical resections. Because the practice of surgical pathology has patient care as its primary mission, competing needs for tissue inevitably arise, with the requirement to preserve adequate tissue for clinical diagnosis being paramount. A set of best-practice gross pathology guidelines are summarized here, focused on the decision for tissue banking at the time specimens are macroscopically evaluated. These reflect our collective experience at Washington University School of Medicine, and are written from the point of view of our site biorepository. The involvement of trained pathology personnel in such procurements is very important. These guidelines reflect both good surgical pathology practice (including the pathologic features characteristic of various anatomic sites) and the typical objectives of research biorepositories. The guidelines should be helpful to tissue bank directors, and others charged with the procurement of tissues for general research purposes. We believe that appreciation of these principles will facilitate the partnership between surgical pathologists and biorepository directors, and promote both good patient care and strategic, value-added banking procurements. PMID:23386925

76 FR 63314 - Center for Scientific Review Notice of Closed Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-12

..., (Telephone Conference Call). Contact Person: Suzan Nadi, PhD, Scientific Review Officer, Center for... Mandarin Oriental, 1330 Maryland Avenue, SW., Washington, DC 20024. Contact Person: Mark Lindner, PhD.... Contact Person: Lilia Topol, PhD, Scientific Review Officer, Center for Scientific Review, National...

77 FR 65570 - Center for Scientific Review; Notice of Closed Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-29

... Conference Call). Contact Person: Carol Hamelink, Ph.D., Scientific Review Officer, Center for Scientific...--Convention Center, 900 10th Street NW., Washington, DC 20001. Contact Person: Mark P Rubert, Ph.D... for Scientific Review Special Emphasis Panel; Fellowships: Chemistry, Biochemistry and Biophysics...

77 FR 74675 - Center for Scientific Review; Notice of Closed Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-17

... Scientific Review Special Emphasis Panel Member Conflict: Healthcare Delivery and Methodologies. Date... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Center for Scientific Review... Road NW., Washington, DC 20015. Contact Person: Bo Hong, Ph.D., Scientific Review Officer, Center for...

Genetics Home Reference: transcobalamin deficiency

MedlinePlus

... also have a shortage of white blood cells (neutropenia), which can lead to reduced immune system function. ... deficiency Seattle Children's Hospital: Anemia Seattle Children's Hospital: Neutropenia Washington University, St. Louis: Neuromuscular Disease Center: Vitamin ...

[STRATEGY OF USE AND MAINTENANCE OF CLINICAL HOSPITAL CENTER RIJEKA IN ACCORDANCE WITH KEY PERFORMANCE INDICATORS FOR STRATEGIC HEALTHCARE FACILITIES MAINTENANCE].

PubMed

Sjekavica, Mariela; Haller, Herman; Cerić, Anita

2015-01-01

Building usage is the phase in the building life cycle that is most time-consuming, most functional, most significant due to building purpose and often systematically ignored. Maintenance is the set of activities that ensure the planned duration of facility exploitation phase in accordance with the requirements for quality maintenance of a large number of important building features as well as other elements immanent to the nature of facilities' life. The aim of the study is to show the analysis of the current state of organized, planned and comprehensive managerial approach in hospital utilization and maintenance in the Republic of Croatia, given on the case study of Clinical hospital center in Rijeka. The methodology used consists of relevant literature section of theory of facility utilization, maintenance and management in general, hospital buildings especially, display of practice on case study, and comparison of key performance indicators values obtained through interview with those that author Igal M. Shohet defined in his study by field surveys and statistical analyses. Despite many positive indicators of Clinical hospital center Rijeka maintenance, an additional research is needed in order to define a more complete national hospital maintenance strategy.

Regional trends and the impact of various patient and hospital factors on outcomes and costs of hospitalization between academic and nonacademic centers after deep brain stimulation surgery for Parkinson's disease: a United States Nationwide Inpatient Sample analysis from 2006 to 2010.

PubMed

Sharma, Mayur; Ambekar, Sudheer; Guthikonda, Bharat; Wilden, Jessica; Nanda, Anil

2013-11-01

The aim of this study was to analyze the incidence of adverse outcomes, complications, inpatient mortality, length of hospital stay, and the factors affecting them between academic and nonacademic centers after deep brain stimulation (DBS) surgery for Parkinson's disease (PD). The authors also analyzed the impact of various factors on the total hospitalization charges after this procedure. This is a retrospective cohort study using the Nationwide Inpatient Sample (NIS) from 2006 to 2010. Various patient and hospital variables were analyzed from the database. The adverse discharge disposition and the higher cost of hospitalization were taken as the dependent variables. A total of 2244 patients who underwent surgical treatment for PD were identified from the database. The mean age was 64.22 ± 9.8 years and 68.7% (n = 1523) of the patients were male. The majority of the patients was discharged to home or self-care (87.9%, n = 1972). The majority of the procedures was performed at high-volume centers (64.8%, n = 1453), at academic institutions (85.33%, n = 1915), in urban areas (n = 2158, 96.16%), and at hospitals with a large bedsize (86.6%, n = 1907) in the West or South. Adverse discharge disposition was more likely in elderly patients (OR > 1, p = 0.011) with high comorbidity index (OR 1.508 [95% CI 1.148-1.98], p = 0.004) and those with complications (OR 3.155 [95% CI 1.202-8.279], p = 0.033). A hospital with a larger annual caseload was an independent predictor of adverse discharge disposition (OR 3.543 [95% CI 1.781-7.048], p < 0.001), whereas patients treated by physicians with high case volumes had significantly better outcomes (p = 0.006). The median total cost of hospitalization had increased by 6% from 2006 through 2010. Hospitals with a smaller case volume (OR 0.093, p < 0.001), private hospitals (OR 11.027, p < 0.001), nonteaching hospitals (OR 3.139, p = 0.003), and hospitals in the West compared with hospitals in Northeast and the Midwest (OR 1.885 [p

Kennedy Center Salute To Apollo

NASA Image and Video Library

2009-07-17

Emil de Cou, Conductor of the National Symphony Orchestra, talks to the audience during the "Salute to Apollo" ceremony at the Kennedy Center for the Performing Arts, Saturday, July 18, 2009 in Washington. The event was part of NASA's week long celebration of the Apollo 40th Anniversary. Photo Credit: (NASA/Bill Ingalls)

Kennedy Center Salute To Apollo

NASA Image and Video Library

2009-07-17

Members of the National Symphony Orchestra, under Conductor Emil de Cou, perform during the "Salute to Apollo" ceremony at the Kennedy Center for the Performing Arts, Saturday, July 18, 2009 in Washington. The event was part of NASA's week long celebration of the Apollo 40th Anniversary. Photo Credit: (NASA/Bill Ingalls)

Trauma center staffing, infrastructure, and patient characteristics that influence trauma center need.

PubMed

Faul, Mark; Sasser, Scott M; Lairet, Julio; Mould-Millman, Nee-Kofi; Sugerman, David

2015-01-01

The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care. We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443). The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions ("trauma center need") as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM) was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need. Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need. Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the construction of new trauma centers or when coordinating care within state or regional

Patients transferred to academic medical centers and other hospitals: characteristics, resource use, and outcomes.

PubMed

Wyatt, S M; Moy, E; Levin, R J; Lawton, K B; Witter, D M; Valente, E; Lala, R; Griner, P F

1997-10-01

As purchasers of health care increasingly rely on hospital resource use and outcomes profiles to guide quality improvement efforts and contract decisions, a better understanding of the contribution of the most severely ill patients to aggregate resource use and outcomes is needed to develop measures that make fair comparisons between hospitals. In this article, the authors examine the distribution, resource utilization, and outcomes of transferred patients ("transfers"), a group known to be highly complex. The study examines the contributions to resource use and outcomes of these patients at academic medical centers (AMCs) and non-teaching hospitals. The authors go beyond previous work by comparing AMCs with non-teaching hospitals, and by using a nationally representative sample for the year 1992. The detailed findings demonstrated that AMCs provided a disproportionate share of care to transfers in 1992, and that transfers to AMCs are more complex and require more specialized care than do transfers to non-teaching hospitals. The study also determined that, during the time studied, AMCs received a disproportionate share of Medicaid and indigentcare transfers. Finally, the findings demonstrated that transfers increased in absolute numbers and as a percentage of total patient volumes for all hospitals from 1988 to 1994. The rate of increase was greatest for AMCs. The authors explain why they believe that their findings are applicable today, although they caution that study of more recent data should be made. The authors comment that purchasers of health care may find the study useful in better understanding benchmarking tools used to evaluate hospitals. This study may also help those involved in health policy to more fully understand the magnitude of the contribution to transfer patient care provided by AMCs. Finally, health policymakers and planners may find this work useful as they prepare for increasing numbers of transfers in the future, particularly at AMCs.

1969 Washington timber harvest.

Treesearch

Brian R. Wall

1970-01-01

Washington's timber harvest increased slightly in 1969 to a 40-year high of 7 billion board feet. This is slightly below the record timber harvest of 7.38 billion board feet established in 1829. Private timberland owners in western Washington increased their production 10.9 percent, accounting for most of the increase in the 1969 total harvest. In eastern...

Hospitalizations for asthma among adults exposed to the September 11, 2001 World Trade Center terrorist attack.

PubMed

Miller-Archie, Sara A; Jordan, Hannah T; Alper, Howard; Wisnivesky, Juan P; Cone, James E; Friedman, Stephen M; Brackbill, Robert M

2018-04-01

We described the patterns of asthma hospitalization among persons exposed to the 2001 World Trade Center (WTC) attacks, and assessed whether 9/11-related exposures or comorbidities, including posttraumatic stress disorder (PTSD) and gastroesophageal reflux symptoms (GERS), were associated with an increased rate of hospitalization. Data for adult enrollees in the WTC Health Registry, a prospective cohort study, with self-reported physician-diagnosed asthma who resided in New York State on 9/11 were linked to administrative hospitalization data to identify asthma hospitalizations during September 11, 2001-December 31, 2010. Multivariable zero-inflated Poisson regression was used to examine associations among 9/11 exposures, comorbid conditions, and asthma hospitalizations. Of 11 471 enrollees with asthma, 406 (3.5%) had ≥1 asthma hospitalization during the study period (721 total hospitalizations). Among enrollees diagnosed before 9/11 (n = 6319), those with PTSD or GERS had over twice the rate of hospitalization (adjusted rate ratio (ARR) = 2.5, 95% CI = 1.4-4.1; ARR = 2.1, 95% CI = 1.3-3.2, respectively) compared to those without. This association was not statistically significant in enrollees diagnosed after 9/11. Compared to higher educational attainment, completing less than college was associated with an increased hospitalization rate among participants with both pre-9/11- and post-9/11-onset asthma (ARR = 1.9, 95% CI = 1.2-2.9; ARR = 2.6, 95% CI = 1.6-4.1, respectively). Sinus symptoms, exposure to the dust cloud, and having been a WTC responder were not associated with asthma hospitalization. Among enrollees with pre-9/11 asthma, comorbid PTSD and GERS were associated with an increase in asthma hospitalizations. Management of these comorbidities may be an important factor in preventing hospitalization.

Comparison of the outcomes for laparoscopic gastrectomy performed by the same surgeon between a low-volume hospital and a high-volume center.

PubMed

Kim, Min Gyu; Kwon, Sung Joon

2014-05-01

The volume-outcome relationship in laparoscopic surgery is controversial. This study was designed to identify differences in laparoscopic gastrectomy outcomes between a low-volume hospital and a high-volume center and to provide guidelines for overcoming the problems associated with a low-volume hospital. From April 2009 to November 2012, one surgeon performed 134 totally laparoscopic distal gastrectomies (TLDGs) at a high-volume center (HVC; ASAN Medical Center) and at a low-volume hospital (LVH; Hanyang University Guri Hospital). All laparoscopically assisted gastrectomies were excluded from this study. During the early period of laparoscopic gastrectomy at the low-volume hospital, TLDG with Roux-en-Y gastrojejunostomy (RYGJ) was performed according to the surgeon's choice. The reconstruction method was classified as gastroduodenostomy (GD) or RYGJ. Early surgical outcomes achieved at the LVH were investigated and compared with those obtained at the HVC. The early surgical outcomes differed significantly between the two hospitals. In particular, the postoperative complication rate for the patients who underwent TLDG RYGJ at the LVH was higher than at the HVC (LVH 15.4 % vs. HVC 0 %; p = 0.037). Furthermore, significant differences were observed in the mean operation time (TLDG GD: LVH 141.0 min vs. HVC 117.4 min, p = 0.001; TLDG RYGJ: LVH 186.3 min vs. HVC 134.6 min, p = 0.009) and length of hospital stay (TLDG GD: LVH 8.1 days vs. HVC 7.2 days, p = 0.044; TLDG RYGJ: LVH 11.5 day vs. HVC 6.8 day, p = 0.009). Although all the operations were performed by one experienced surgeon, the early surgical outcomes differed significantly between the low- and high-volume hospitals. Low-volume hospitals often lack well-trained surgical professionals such as first assistants and scrub nurses. Therefore, the authors recommend that a surgeon who works at an LVH should assess potential personnel shortages and find a solution before operating.

Effect of physician ownership of specialty hospitals and ambulatory surgery centers on frequency of use of outpatient orthopedic surgery.

PubMed

Mitchell, Jean M

2010-08-01

Physician-owned specialty hospitals and ambulatory surgery centers have become commonplace in many markets throughout the United States. Little is known about whether the financial incentives linked to ownership affect frequency of outpatient surgery. To evaluate if financial incentives linked to physician ownership influence frequency of outpatient orthopedic surgical procedures. We analyzed 5 years of claims data from a large private insurer in Idaho to compare frequency by orthopedic surgeon owners and nonowners of surgical procedures that could be performed in either ambulatory surgery centers or hospital outpatient surgery departments. Frequency of use, calculated as number of patients treated with the specific diagnoses who received the surgical procedure of interest divided by the number of patients with such diagnoses treated by each physician. Age- and sex-adjusted odds ratios indicate that the likelihood of having carpal tunnel repair was 54% to 129% higher for patients of surgeon owners compared with surgeon nonowners. For rotator cuff repair, the adjusted odds ratios of having surgery were 33% to 100% higher for patients treated by physician owners. The age- and sex-adjusted probability of arthroscopic surgery was 27% to 78% higher for patients of surgeon owners compared with surgeon nonowners. The consistent finding of higher use rates by physician owners across time clearly suggests that financial incentives linked to ownership of either specialty hospitals or ambulatory surgery centers influence physicians' practice patterns.

Percutaneous injuries among dental professionals in Washington State

PubMed Central

Shah, Syed M; Merchant, Anwar T; Dosman, James A

2006-01-01

Background Percutaneous exposure incidents facilitate transmission of bloodborne pathogens such as human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV). This study was conducted to identify the circumstances and equipment related to percutaneous injuries among dental professionals. Methods We used workers' compensation claims submitted to the Department of Labor and Industries State Fund during a 7-year period (1995 through 2001) in Washington State for this study. We used the statement submitted by the injured worker on the workers' compensation claim form to determine the circumstances surrounding the injury including the type of activity and device involved. Results Of a total of 4,695 accepted State Fund percutaneous injury claims by health care workers (HCWs), 924 (20%) were submitted by dental professionals. Out of 924 percutaneous injuries reported by dental professionals 894 (97%) were among dental health care workers in non-hospital settings, including dentists (66, 7%), dental hygienists (61, 18%) and dental assistants (667, 75%). The majority of those reporting were females (638, 71%). Most (781, 87%) of the injuries involved syringes, dental instruments (77, 9%), and suture needles (23%). A large proportion (90%) of injuries occurred in offices and clinics of dentists, while remainder occurred in offices of clinics and of doctors of medicine (9%), and a few in specialty outpatient facilities (1%). Of the 894 dental health care workers with percutaneous injuries, there was evidence of HBV in 6 persons, HCV in 30 persons, HIV in 3 persons and both HBV and HVC (n = 2) exposure. Conclusion Out of hospital percutaneous injuries are a substantial risk to dental health professionals in Washington State. Improved work practices and safer devices are needed to address this risk. PMID:17074095

Howard University Hospital fire, Washington, D.C.--successful construction and reactions prevent fatalities.

PubMed

Best, R

1981-01-01

If the arsonist who set fire to the fourth floor of this hospital intended to destroy the whole hospital, his plans were foiled by the hospital's lifesafety systems and the quick action of the hospital staff. Corridor smoke detectors activated the building fire alarm system, notified the hospital fire brigade and staff, notified the fire department, and closed the corridor smokestop doors. Members of the staff immediately closed the doors to all patient rooms in the area of the fire that were exposed to smoke and heat, and then began evacuating patients from the area. There were no fatalities in this fire. Although this fire is four years old, we think it is worth studying for its contrasts with Mississauga.

Cardiovascular disease hospitalizations in relation to exposure to the September 11, 2001 World Trade Center disaster and posttraumatic stress disorder.

PubMed

Jordan, Hannah T; Stellman, Steven D; Morabia, Alfredo; Miller-Archie, Sara A; Alper, Howard; Laskaris, Zoey; Brackbill, Robert M; Cone, James E

2013-10-24

A cohort study found that 9/11-related environmental exposures and posttraumatic stress disorder increased self-reported cardiovascular disease risk. We attempted to replicate these findings using objectively defined cardiovascular disease hospitalizations in the same cohort. Data for adult World Trade Center Health Registry enrollees residing in New York State on enrollment and no cardiovascular disease history (n = 46,346) were linked to a New York State hospital discharge-reporting system. Follow-up began at Registry enrollment (2003-2004) and ended at the first cerebrovascular or heart disease (HD) hospitalization, death, or December 31, 2010, whichever was earliest. We used proportional hazards models to estimate adjusted hazard ratios (AHRs) for HD (n = 1151) and cerebrovascular disease (n = 284) hospitalization during 302,742 person-years of observation (mean follow-up, 6.5 years per person), accounting for other factors including age, race/ethnicity, smoking, and diabetes. An elevated risk of HD hospitalization was observed among women (AHR 1.32, 95% CI 1.01 to 1.71) but not men (AHR 1.16, 95% CI 0.97 to 1.40) with posttraumatic stress disorder at enrollment. A high overall level of World Trade Center rescue and recovery-related exposure was associated with an elevated HD hospitalization risk in men (AHR 1.82, 95% CI 1.06 to 3.13; P for trend = 0.05), but findings in women were inconclusive (AHR 3.29, 95% CI 0.85 to 12.69; P for trend = 0.09). Similar associations were observed specifically with coronary artery disease hospitalization. Posttraumatic stress disorder increased the cerebrovascular disease hospitalization risk in men but not in women. 9/11-related exposures and posttraumatic stress disorder appeared to increase the risk of subsequent hospitalization for HD and cerebrovascular disease. This is consistent with findings based on self-reported outcomes.

Upper gastrointestinal bleeding in children from a hospital center of Northeast Romania.

PubMed

Gimiga, Nicoleta; Olaru, Claudia; Diaconescu, Smaranda; Miron, Ingrith; Burlea, Marin

2016-06-01

The aim of this study was to investigate the common etiologies, clinical and biological patterns of upper gastrointestinal bleeding (UGIB) in children from a hospital center in Northeast Romania. This seven-year retrospective study was performed from 2007 to 2013 in St. Mary Children's Emergency Hospital, Jassy, Romania and included all children who referred to our center with UGIB exteriorized by hematemesis or melena. Endoscopy was performed under conscious sedation/general anesthesia after the informed consent was obtained. One hundred and three patients aged 1-18 years were included in this study. There were 57 males and 46 females with male to female ratio 1.2:1; 43.69% presented with hematemesis, 31.07% had melena and 25.24% had both. The most common causes of UGIB were erosive gastritis (33.98%), followed by esophagitis (14.56%), duodenitis (11.65%), duodenal ulcer (10.68%), gastric ulcer (5.83%), esophageal varices (4.85%), Mallory-Weiss syndrome (1.94%); multiple etiologies counted for 16.50% cases. A certain bleeding source was found in 34.95% cases, a possible one in 39.81% of the patients; the source could not be ascertained in 25.24% of cases. Nonsteroidal anti-inflammatory drug (NSAID) consumption was documented in in 17.51% of patients. The incidence of H. pylori infection was 36.89%. The most common cause of of upper GI bleeding in our series was gastritis, followed by oesophagitis and duodenitis. Most of the patients presented with hematemesis; previous consumption of NSAIDs and H. pylori infection were associated with gastroduodenal ulceration and bleeding. Early endoscopy was associated with a higher detection rate of the bleeding source.

Medical Robotic and Telesurgical Simulation and Education Research

DTIC Science & Technology

2013-09-01

Hospital Nicholson Center 601 E Rollins St Orlando, FL 32803 9. SPONSORING / MONITORING AGENCY NAME( S ) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S...Principal Investigators: R.M. Satava, University of Washington School of Medicine, Seattle , WA R.D. Smith, Florida Hospital Nicholson Center...Blalock 1210 Baltimore, MD 21287 USA Thomas S . Lendvay, MD, FACS Associate Professor Co-Director, Seattle Children’s Robotics Surgery Center

Kennedy Center Salute To Apollo

NASA Image and Video Library

2009-07-17

Apollo 11 astronaut Buzz Aldrin reads an introduction to Gustav Holst: The Planets Suite during the "Salute to Apollo" ceremony at the Kennedy Center for the Performing Arts, Saturday, July 18, 2009 in Washington. The event was part of NASA's week long celebration of the Apollo 40th Anniversary. Photo Credit: (NASA/Bill Ingalls)

Hospital laboratories as profit centers.

PubMed

Gray, S P; Steiner, J

1988-11-01

An aggressive business venture offers one solution to the growing competition and financial pressures hospital laboratories must overcome. For such a venture to be a success, a number of issues must be carefully considered. Properly met, today's challenges in the laboratory can become tomorrow's opportunities.

78 FR 66028 - Center for Scientific Review; Cancellation of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-04

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Center for Scientific Review; Cancellation of Meeting Notice is hereby given of the cancellation of the Center for Scientific Review Special Emphasis Panel, October 04, 2013, 11:00 a.m. to October 04, 2013, 2:00 p.m., Washington Hilton, 1919...

75 FR 32229 - National Declassification Center (NDC)

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-07

...) of Executive Order 13526, Classified National Security Information, announcement is made for the... attend must be submitted to the National Declassification Center. Information may be submitted via e-mail..., Washington, DC 20408. FOR FURTHER INFORMATION CONTACT: Don McIlwain, Supervisory Archivist, National...

Evaluation -- Northern Virginia Smart Traffic Center (NVSTC) integration program

DOT National Transportation Integrated Search

2002-02-01

The Northern Virginia Smart Traffic Center (NVSTC) Integration Program was an ambitious undertaking to enhance the effectiveness of intelligent transportation systems (ITS) in the Washington metropolitan area by interconnecting regional systems. The ...

Outcomes of Surgeries Performed in Physician Offices Compared With Ambulatory Surgery Centers and Hospital Outpatient Departments in Florida

PubMed Central

Ohsfeldt, Robert L; Li, Pengxiang; Schneider, John E; Stojanovic, Ivana; Scheibling, Cara M

2017-01-01

Background: The proportion of outpatient surgeries performed in physician offices has been increasing over time, raising concern about the impact on outcomes. Objective: To use a private insurance claims database to compare 7-day and 30-day hospitalization rates following relatively complex outpatient surgical procedures across physician offices, freestanding ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPDs). Methods: A multivariable logistic regression model was used to compare the risk-adjusted probability of hospitalization among patients after any of the 88 study outpatient procedures at physician offices, ASCs, and HOPDs over 2008-2012 in Florida. Results: Risk-adjusted hospitalization rates were higher following procedures performed in physician offices compared with ASCs for all procedures grouped together, for most procedures grouped by type, and for many individual procedures. Conclusions: Hospitalizations following surgery were more likely for procedures performed in physician offices compared with ASCs, which highlights the need for ongoing research on the safety and efficacy of office-based surgery. PMID:28469457

Alternative model for a pediatric trauma center: efficient use of physician manpower at a freestanding children's hospital.

PubMed

Vernon, Donald D; Bolte, Robert G; Scaife, Eric; Hansen, Kristine W

2005-01-01

Freestanding children's hospitals may lack resources, especially surgical manpower, to meet American College of Surgeons trauma center criteria, and may organize trauma care in alternative ways. At a tertiary care children's hospital, attending trauma surgeons and anesthesiologists took out-of-hospital call and directed initial care for only the most severely injured patients, whereas pediatric emergency physicians directed care for patients with less severe injuries. Survival data were analyzed using TRISS methodology. A total of 903 trauma patients were seen by the system during the period 10/1/96-6/30/01. Median Injury Severity Score was 16, and 508 of patients had Injury Severity Score > or =15. There were 83 deaths, 21 unexpected survivors, and 13 unexpected deaths. TRISS analysis showed that z-score was 4.39 and W-statistic was 3.07. Mortality outcome from trauma in a pediatric hospital using this alternative approach to trauma care was significantly better than predicted by TRISS methodology.

Highlights from the 24th Conference on Retroviruses and Opportunistic Infections: 13-16 February 2017, Seattle, Washington, USA.

PubMed

Crowell, Trevor A; Lyall, Hermione; Malatinkova, Eva; Bhagani, Sanjay; Hsu, Denise; Colby, Donn J; Polyak, Christina; Psomas, Christina; Hill, Andrew; Gathogo, Esther N; Trypsteen, Wim; Vandekerckhove, Linos; Kinloch, Sabine

2017-04-01

From the 13th to 16th February 2017, researchers from around the world convened for the 24th annual Conference on Retroviruses and Opportunistic Infections (CROI) at the Washington State Convention Center in Seattle, Washington. The conference was organised by the International Antiviral Society-USA (IAS-USA) in partnership with the CROI Foundation. The conference included over 1000 oral and poster presentations of peer-reviewed original research as well as lectures and symposia featuring insights from leading basic, translational and clinical researchers. Highlighted here are key data presented at the conference.

Does procedure profitability impact whether an outpatient surgery is performed at an ambulatory surgery center or hospital?

PubMed

Plotzke, Michael Robert; Courtemanche, Charles

2011-07-01

Ambulatory surgery centers (ASCs) are small (typically physician owned) healthcare facilities that specialize in performing outpatient surgeries and therefore compete against hospitals for patients. Physicians who own ASCs could treat their most profitable patients at their ASCs and less profitable patients at hospitals. This paper asks if the profitability of an outpatient surgery impacts where a physician performs the surgery. Using a sample of Medicare patients from the National Survey of Ambulatory Surgery, we find that higher profit surgeries do have a higher probability of being performed at an ASC compared to a hospital. After controlling for surgery type, a 10% increase in a surgery's profitability is associated with a 1.2 to 1.4 percentage point increase in the probability the surgery is performed at an ASC. Copyright © 2010 John Wiley & Sons, Ltd.

Kennedy Center Salute To Apollo

NASA Image and Video Library

2009-07-17

Apollo 11 astronaut Buzz Aldrin, left, meets with Gene Kranz, retired NASA Flight Director and manager, back stage after the "Salute to Apollo" ceremony at the Kennedy Center for the Performing Arts, Saturday, July 18, 2009 in Washington. The event was part of NASA's week long celebration of the Apollo 40th Anniversary. Photo Credit: (NASA/Bill Ingalls)

Post-9/11 drug- and alcohol- related hospitalizations among World Trade Center Health Registry enrollees, 2003-2010.

PubMed

Hirst, Andrew; Miller-Archie, Sara A; Welch, Alice E; Li, Jiehui; Brackbill, Robert M

2018-06-01

To describe patterns of drug- and alcohol-related hospitalizations among persons exposed to the 2001 World Trade Center (WTC) terrorist attacks and to assess whether 9/11-related exposures or post-9/11 post-traumatic stress disorder (PTSD) were associated with increased odds of hospitalization. Data for adult enrollees in the WTC Health Registry, a prospective cohort study, were linked to New York State (NYS) administrative hospitalization data to identify alcohol- and drug-related hospitalizations from enrollment to December 31, 2010. Logistic regression was used to analyze the associations between substance use-related hospitalization, 9/11-related exposure and PTSD. Of 41,176 NYS resident enrollees, we identified 626 (1.5%) who had at least one alcohol- or drug-related hospitalization; 53.4% (n = 591) of these hospitalizations were for alcohol only diagnoses and 46.6% (n = 515) were drug-related. Witnessing ≥3 traumatic events on 9/11 was significantly associated with having a drug-related hospitalization (AOR 1.4, 95% CI = [1.1, 1.9]). PTSD was significantly associated with both having a drug-related hospitalization as well as an alcohol only-related hospitalization. (AOR 2.6, 95% CI = [2.0, 3.3], AOR 1.8, 95% CI = [1.4, 2.3], respectively). Witnessing traumatic events and having PTSD were independently associated with substance use-related hospitalizations. Targeting people who witnessed traumatic events on 9/11 and/or who have PTSD for substance use- treatment could reduce alcohol and drug-related hospitalizations connected to 9/11. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Creating a "culture of research" in a community hospital: Strategies and tools from the National Cancer Institute Community Cancer Centers Program.

PubMed

Dimond, Eileen P; St Germain, Diane; Nacpil, Lianne M; Zaren, Howard A; Swanson, Sandra M; Minnick, Christopher; Carrigan, Angela; Denicoff, Andrea M; Igo, Kathleen E; Acoba, Jared D; Gonzalez, Maria M; McCaskill-Stevens, Worta

2015-06-01

The value of community-based cancer research has long been recognized. In addition to the National Cancer Institute's Community Clinical and Minority-Based Oncology Programs established in 1983, and 1991 respectively, the National Cancer Institute established the National Cancer Institute Community Cancer Centers Program in 2007 with an aim of enhancing access to high-quality cancer care and clinical research in the community setting where most cancer patients receive their treatment. This article discusses strategies utilized by the National Cancer Institute Community Cancer Centers Program to build research capacity and create a more entrenched culture of research at the community hospitals participating in the program over a 7-year period. To facilitate development of a research culture at the community hospitals, the National Cancer Institute Community Cancer Centers Program required leadership or chief executive officer engagement; utilized a collaborative learning structure where best practices, successes, and challenges could be shared; promoted site-to-site mentoring to foster faster learning within and between sites; required research program assessments that spanned clinical trial portfolio, accrual barriers, and outreach; increased identification and use of metrics; and, finally, encouraged research team engagement across hospital departments (navigation, multidisciplinary care, pathology, and disparities) to replace the traditionally siloed approach to clinical trials. The health-care environment is rapidly changing while complexity in research increases. Successful research efforts are impacted by numerous factors (e.g. institutional review board reviews, physician interest, and trial availability). The National Cancer Institute Community Cancer Centers Program sites, as program participants, had access to the required resources and support to develop and implement the strategies described. Metrics are an important component yet often challenging to

Clinical characteristics of dental emergencies and prevalence of dental trauma at a university hospital emergency center in Korea.

PubMed

Bae, Ji-Hyun; Kim, Young-Kyun; Choi, Yong-Hoon

2011-10-01

The aim of this study was to examine the clinical characteristics of dental emergency patients who visited a university hospital emergency center and to evaluate the incidence of dental trauma. A retrospective chart review of patients with dental complaints and who visited the Seoul National University Bundang Hospital (SNUBH) emergency center in Gyeonggi-do, Korea, from January 2009 to December 2009 was conducted. Information regarding age, gender, the time, day, and month of presentation, diagnosis, treatment, and follow up was collected and analyzed. One thousand four hundred twenty-five patients with dental problems visited the SNUBH emergency center. Dental patients accounted for 1.47% of the total 96,708 patients at the emergency center. The male-to-female ratio was 1.68:1, with a considerably larger number of male patients (62.7%). The age distribution peak was at 0-9 years (27.5%), followed by patients in their forties (14.1%). The number of patients visiting the dental emergency center peaked in May (14.2%), on Sundays (22.4%), and between 2100 and 2400 h (20.8%). The patients' chief complaints were as follows: dental trauma, dental infection, oral bleeding, and temporomandibular joint disorder (TMD). The prevalence of dental trauma was 66%. The reasons for dental emergency visits included the following: dental trauma, dental infection, oral bleeding, and TMD, with 66% of the patients requiring management of dental trauma. It is important that dentists make a prompt, accurate diagnosis and initiate effective treatment in case of dental emergencies, especially dental trauma. © 2011 John Wiley & Sons A/S.

Status of respectful and non-abusive care during facility-based childbirth in a hospital and health centers in Addis Ababa, Ethiopia.

PubMed

Asefa, Anteneh; Bekele, Delayehu

2015-04-16

According to the 2011 Ethiopian Demographic and Health Survey, 90.1% of mothers do not deliver in health facilities, with 29.5% citing non-customary service as causative. A low level of skilled attendance at birth is among the leading causes of maternal mortality in low--and middle-income countries. A cross-sectional study was undertaken in four health facilities (one specialized teaching hospital and its three catchment health centers) in Addis Ababa, Ethiopia, to quantitatively determine the level and types of disrespect and abuse faced by women during facility-based childbirth, along with their subjective experiences of disrespect and abuse. A questionnaire was administered to 173 mothers immediately prior to discharge from their respective health facility. Reported disrespect and abuse during childbirth was measured under seven categories using 23 performance indicators. Among multigravida mothers (n = 103), 71.8% had a history of a previous institutional birth and 78% (75.3% in health centers and 81.8% in hospital; p = 0.295) of respondents experienced one or more categories of disrespect and abuse. The violation of the right to information, informed consent, and choice/preference of position during childbirth was reported by all women who gave birth in the hospital and 89.4% of respondents in health centers. Mothers were left without attention during labor in 39.3% of cases (14.1% in health centers and 63.6% in hospital; p < 0.001). Although 78.6% (n = 136) of respondents objectively faced disrespect and abuse, only 22 (16.2%) subjectively experienced disrespect and abuse. This quantitative study reveals a high level of disrespect and abuse during childbirth that was not perceived as such by the majority of respondents. It is every woman's right to give birth in woman-centered environment free from disrespect and abuse. Understanding how women define abuse is crucial if Ethiopia is to succeed in increasing the uptake of facility-based births.

Computers and Media Centers--A Winning Combination.

ERIC Educational Resources Information Center

Graf, Nancy

1984-01-01

Profile of the computer program offered by the library/media center at Chief Joseph Junior High School in Richland, Washington, highlights program background, operator's licensing procedure, the trainer license, assistance from high school students, need for more computers, handling of software, and helpful hints. (EJS)

Abstracts of State Legislated Hospital Cost-Containment Programs

PubMed Central

Esposito, Alfonso; Hupfer, Michael; Mason, Cynthia; Rogler, Diane

1982-01-01

This report summarizes State legislated efforts to control rising hospital costs and the status of these efforts in May 1982. The abstract for each of 17 State programs summarizes key legislative features and operating aspects. The States included in this report are: Arizona, California, Connecticut, Florida, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Oregon, Rhode Island, Virginia, Washington, West Virginia, and Wisconsin. The abstracts focus on programs requiring the disclosure, review, or legislation of hospital rates and budgets. PMID:10309910

Polar Science Weekend: A University / Science Center Collaboration

NASA Astrophysics Data System (ADS)

Stern, H. L.; Moritz, R. E.; Lettvin, E.; Schatz, D.; Russell, L.

2008-12-01

Polar Science Weekend (PSW) is a four-day event featuring hands-on activities, live demonstrations, and a variety of exhibits about the polar regions and current polar research, presented by scientists from the University of Washington's Polar Science Center, and held at Seattle's Pacific Science Center. PSW was conceived and organized jointly by the Polar Science Center and Pacific Science Center, which is Washington State's most well-attended museum. The first PSW in March 2006 drew over 5000 visitors, and subsequent PSWs in 2007 and 2008 have both surpassed that figure. The success of this university / science center partnership has made PSW an annual event, and has served as a model for Pacific Science Center's Portal to the Public program, in which partnerships with other scientific institutions have been built. Researchers at the Polar Science Center (PSC) study the physical processes controlling high-latitude oceans, atmosphere, sea ice, and ice sheets, and are involved in numerous IPY projects. PSC scientists also engage in many outreach efforts such as classroom visits and public lectures, but PSW stands out as the highlight of the year. The partnership with Pacific Science Center brings access to facilities, publicity, and a large audience that would not otherwise be readily available to PSC. Pacific Science Center, constructed for the 1962 World's Fair in Seattle, serves more than one million visitors per year. Pacific Science Center's mission is to inspire a lifelong interest in science, math and technology by engaging diverse communities through interactive and innovative exhibits and programs. PSW helps to advance this mission by bringing students, teachers, and families face-to-face with scientists who work in some of the most remote and challenging places on earth, to learn first-hand about polar research in a fun and informal setting. This is made possible only by the partnership with PSC. In this talk we will present descriptions and photos of PSW

A 2-year retrospective study of pediatric dental emergency visits at a hospital emergency center in Taiwan.

PubMed

Jung, Chia-Pei; Tsai, Aileen I; Chen, Ching-Ming

2016-06-01

There is a paucity of information regarding pediatric dental emergencies in Taiwan. This study investigates the prevalence and characteristics of the pediatric dental emergency services provided at a medical center. This study included a retrospective chart review of patients under 18 years of age with dental complaints who visited the Emergency Department (ED) of Linkou Medical Center of Chang Gung Memorial Hospital from January 2012 to December 2013. Information regarding age, gender, time/day/month of presentation, diagnosis, treatment, and follow-up was collected and analyzed. Statistical analysis included descriptive statistics and Pearson's Chi-square test with the significance level set as p < 0.05. This study revealed that dental emergencies in the medical center ED were predominantly related to orodental trauma (47.1%) and pulpal pain (29.9%). Most patients were male (p < 0.001) and <5 years of age (p < 0.001). The most frequent orodental trauma was luxation, both in primary and permanent dentition. The major management for dental emergencies was prescribing medication for pulp-related problems and orodental trauma. The follow-up rate of orodental trauma was the highest (p < 0.001). For children, trauma and toothache constituted the most common reasons for dental emergency visits at a hospital emergency center in Taiwan. While dental emergencies are sometimes unforeseeable or unavoidable, developing community awareness about proper at-home care as well as regular dental preventive measures can potentially reduce the number of emergency visits. Copyright © 2016 Chang Gung University. Published by Elsevier B.V. All rights reserved.

Testing a Family-centered Intervention to Promote Functional and Cognitive Recovery in Hospitalized Older Adults

PubMed Central

Boltz, Marie; Resnick, Barbara; Chippendale, Tracy; Galvin, James

2016-01-01

A comparative trial using repeated measures design evaluated the feasibility and outcomes of the Family-centered Function-focused Care (Fam-FFC) intervention intended to promote functional recovery in the hospitalized older adult. A three component intervention (1) environmental assessment/ modification, 2) staff education, 3) family/patient education and partnership in care planning with post-acute follow-up) was implemented by a family-centered resource nurse and a facility champion. Control units were exposed to function-focused care education only. Ninety-seven dyads of medical patients age 65 and older and family caregivers (FCGs) were recruited from three medical units of a community teaching hospital. The majority of patients were female (53%); white (89%), married (51%) or widowed (40%), with a mean age of 80.8 (± 7.5). The majority of FCGs were married (78%) daughters (34%), followed by female spouses/partners (31%), in the age range of 46–65 (38%). Outcomes for patients included: functional outcomes (ADL and walking performance, gait, balance), and delirium severity and duration. FCG outcomes included preparedness for caregiving, anxiety, depression, role strain, and mutuality. The intervention group demonstrated less severity and duration of delirium, and better ADL and walking performance, but not gait/balance as compared to the control group. FCG who participated in Fam-FFC showed a significant increase in preparedness for caregiving, less anxiety and less depression from admission to two months post-discharge, but no significant differences in strain and mutuality, as compared to FCG in the control group. Fam-FFC is feasible and has the potential to improve outcomes for hospitalized older adults and family caregivers. PMID:25481973

Current status of the western gray squirrel population in the Puget Trough, Washington.

Treesearch

R. Bayrakci; A.B. Carey; T.M. Wilson

2001-01-01

The Puget Trough population of Washington’s state-threatened western gray squirrel is centered in Oregon white oak ecotones adjacent to conifer forests and prairies on the Fort Lewis Military Reservation. Our goal was to determine the current status of western gray squirrels in this region. In 1998, we found five western gray squirrels in 538 hours of foot surveys in...

Mount St. Helens (Washington, USA) and World Trade Center (New York, USA) collapse: a fluid dynamic analogy

NASA Astrophysics Data System (ADS)

Doronzo, Domenico; de Tullio, Marco; Pascazio, Giuseppe; Dellino, Pierfrancesco

2013-04-01

When a skyscraper collapses, the non-fragmented material is rapidly deposited close to the source, whereas the fragmented counterpart is loaded turbulently in the associated currents. Indeed, on impact with the ground, collapses of volcanic columns, domes, or sectors of volcanoes generate thick deposits of coarser material, and from there on the finer material is suspended over the landscape, to be re-deposited far away in thin deposits. Here, we explore the multiphase fluid dynamic behavior of the World Trade Center (New York, USA) collapse, which on 11 September 2001 followed the fragmentation of the Twin Towers, and generated shear dusty currents. These currents had a multiphase and turbulent behavior, and resemble the volcanic flow generated during the 18 May 1980 explosive eruption of Mount St. Helens (Washington, USA), in which a sector of the volcano collapsed, then a highly mobile, multiphase turbulent current followed and heavily interacted with the surrounding landscape. This analogy allows to focus on the comparison between volcanic and skyscraper collapse. A computational fluid dynamic investigation, along with a locally refined Cartesian grid, are adopted to simulate numerically the propagation of the 11 September dusty currents in Manhattan. Results of flow dynamic pressure, the parameter of volcanic hazard, and particle deposition reveal that the pressure can locally increase up to a factor 10 because of flow-building interaction. Also, the surrounding buildings make the urban setting as of a high turbulence and exponential decay of deposit thickness.

George Washington: A Hero for American Students?

ERIC Educational Resources Information Center

Jordan, Ervin L., Jr.; Bennett, Clifford T.

1997-01-01

Discusses the career of George Washington with specific emphasis on his racial views and his role as a slaveholder. Describes Washington as a man bound by racial and political mores of his time. Although troubled by certain aspects of slavery, Washington directly benefited from the operation of this system. (MJP)

How to market an affiliation. St. Elizabeth Hospital and Mercy Medical Center affiliate to create Affinity Health System.

PubMed

1996-01-01

When Wisconsin's St. Elizabeth Hospital and Mercy Medical Center affiliated to create Affinity Health System, Inc., strategic planning and a solid marketing plan carefully executed were instrumental in its success. A corporate identity campaign and product line identification were follow-up phases to the merger approval.

Health Wellness and Hospital Learning Center.

ERIC Educational Resources Information Center

Bromberg, Bonnie; And Others

This paper describes activities conducted by an early childhood classroom in its health play center. A major purpose of this play center was to reduce children's fears and anxieties about medical personnel and emergency vehicles, and to raise awareness of the many aspects of health and wellness. The classroom environment contained a variety of…

Change in MS-DRG assignment and hospital reimbursement as a result of Centers for Medicare & Medicaid changes in payment for hospital-acquired conditions: is it coding or quality?

PubMed

McNutt, Robert; Johnson, Tricia J; Odwazny, Richard; Remmich, Zachary; Skarupski, Kimberly; Meurer, Steven; Hohmann, Samuel; Harting, Brian

2010-01-01

In October 2008, the Centers for Medicare & Medicaid Services reduced payments to hospitals for a group of hospital-acquired conditions (HACs) not documented as present on admission (POA). It is unknown what proportion of Medicare severity diagnosis related group (MS-DRG) assignments will change when the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis code for the HAC is not taken into account even before considering the POA status. The primary objectives were to estimate the proportion of cases that change MS-DRG assignment when HACs are removed from the calculation, the subsequent changes in reimbursement to hospitals, and the attenuation in changes in MS-DRG assignment after factoring in those that may be POA. Last, we explored the effect of the numbers of ICD-9-CM diagnosis codes on MS-DRG assignment. We obtained 2 years of discharge data from academic medical centers that were members of the University Health System Consortium and identified all cases with 1 of 7 HACs coded through ICD-9-CM diagnosis codes. We calculated the MS-DRG for each case with and without the HAC and, hence, the proportion where MS-DRG assignment changed. Next, we used a bootstrap method to calculate the range in the proportion of cases changing assignment to account for POA status. Changes in reimbursement were estimated by using the 2008 MS-DRG weights payment formula. Of 184,932 cases with at least 1 HAC, 27.6% (n = 52,272) would experience a change in MS-DRG assignment without the HAC factored into the assignment. After taking into account those conditions that were potentially POA, 7.5% (n = 14,176) of the original cases would change MS-DRG assignment, with an average loss in reimbursement per case ranging from $1548 with a catheter-associated urinary tract infection to $7310 for a surgical site infection. These reductions would translate into a total reimbursement loss of $50 261,692 (range: $38 330,747-$62 344,360) for the 86

Northwest Tribal Interaction with Washington State University: Research and Education Opportunities Afforded Through the Center for Multiphase Environmental Research

NASA Astrophysics Data System (ADS)

Rumburg, B.; Yonge, D.; Jacob, J.

2003-12-01

The under-representation of Native Americans in engineering and science at the student and practicing engineer or scientist level is a national problem. To begin addressing this problem Washington State University (WSU) has initiated discussio with local Native American tribes to strengthen the relationship between WSU and the tribes and to improve the educational opportunities available to tribal members. The Center for Multiphase Environmental Research (CMER) received a 1999 National Science Foundation (NSF) Integrative Graduate Education and Research Training (IGERT) grant to train Ph.D. students. The main goal of the program is to foster multidisciplinary research and education for future scientists and engineers in the broad field of study that incorporates the fate and transport of environmentally significant species between interfaces. We are also focused on recruiting and educating Native American students. CMER is committed to cultivating its relationship with Native American tribes by identifying the environmental concerns of the tribes and developing collaborative research efforts utilizing CMER's infrastructure. Through these collaborative projects the CMER hopes to better understand the social and cultural aspects important to the tribes and develop the familiarity needed to effectively enhance student recruitment. This poster highlights the CMER's interdisciplinary research and teaching efforts and focuses on Native American recruitment.

The Relationships among Achievement, Low Income, and Ethnicity in Washington State--A Second Look. Technical Report

ERIC Educational Resources Information Center

Abbott, Martin; Hart, Christopher; Lybrand, Jasmine; Nouri, Leila

2009-01-01

The purpose of this report is to discuss the continuing difficulties school leaders and students face as they grapple with the "achievement gap" among students of different ethnic and socio-economic backgrounds. Several years ago, researchers at the Washington School Research Center sought to evaluate the "unique contribution of low…

Kennedy Center Salute To Apollo

NASA Image and Video Library

2009-07-17

National Symphony Orchestra Conductor Emil de Cou, left, meets with Gene Kranz, retired NASA Flight Director and manager, back stage after the "Salute to Apollo" ceremony at the Kennedy Center for the Performing Arts, Saturday, July 18, 2009 in Washington. The event was part of NASA's week long celebration of the Apollo 40th Anniversary. Photo Credit: (NASA/Bill Ingalls)

Kennedy Center Salute To Apollo

NASA Image and Video Library

2009-07-17

Gene Kranz, retired NASA Flight Director and manager, thanks the audience after having guest conducted of the National Symphony Orchestra during the "Salute to Apollo" ceremony at the Kennedy Center for the Performing Arts, Saturday, July 18, 2009 in Washington. The event was part of NASA's week long celebration of the Apollo 40th Anniversary. Photo Credit: (NASA/Bill Ingalls)

Kennedy Center Salute To Apollo

NASA Image and Video Library

2009-07-17

Gene Kranz, retired NASA Flight Director and manager, conducts the National Symphony Orchestra, while the U.S. Army Chorus and Alumni sing during the "Salute to Apollo" ceremony at the Kennedy Center for the Performing Arts, Saturday, July 18, 2009 in Washington. The event was part of NASA's week long celebration of the Apollo 40th Anniversary. Photo Credit: (NASA/Bill Ingalls)

The Center for Healthy Weight: an academic medical center response to childhood obesity

PubMed Central

Robinson, T N; Kemby, K M

2012-01-01

Childhood obesity represents a worldwide medical and public health challenge. Academic medical centers cannot avoid the effects of the obesity epidemic, and must adopt strategies for their academic, clinical and public policy responses to childhood obesity. The Center for Healthy Weight at Stanford University and Lucile Packard Children's Hospital at Stanford provides an example and model of one such strategy. The design provides both breadth and depth through six cores: Research, Patient Care, Community Programs, Advocating for Public Policy Change, Training and Professional Education, and the Healthy Hospital Initiative. The Center and its cores are designed to facilitate interdisciplinary collaboration across the university, medical school, children's hospital and surrounding community. The foci of these cores are likely to be relevant to almost any academic medical center's mission and functions. PMID:25089192

Organizational culture and the implementation of person centered care: results from a change process in Swedish hospital care.

PubMed

Alharbi, Tariq Saleem J; Ekman, Inger; Olsson, Lars-Eric; Dudas, Kerstin; Carlström, Eric

2012-12-01

Sweden has one of the oldest, most coherent and stable healthcare systems in the world. The culture has been described as conservative, mechanistic and increasingly standardized. In order to provide a care adjusted to the patient, person centered care (PCC) has been developed and implemented into some parts of the health care industry. The model has proven to decrease patient uncertainty. However, the impact of PCC has been limited in some clinics and hospital wards. An assumption is that organizational culture has an impact on desired outcomes of PCC, such as patient uncertainty. Therefore, in this study we identify the impact of organizational culture on patient uncertainty in five hospital wards during the implementation of PCC. Data from 220 hospitalized patients who completed the uncertainty cardiovascular population scale (UCPS) and 117 nurses who completed the organizational values questionnaire (OVQ) were investigated with regression analysis. The results seemed to indicate that in hospitals where the culture promotes stability, control and goal setting, patient uncertainty is reduced. In contrast to previous studies suggesting that a culture of flexibility, cohesion and trust is positive, a culture of stability can better sustain a desired outcome of reform or implementation of new care models such as person centered care. It is essential for health managers to be aware of what characterizes their organizational culture before attempting to implement any sort of new healthcare model. The organizational values questionnaire has the potential to be used as a tool to aid health managers in reaching that understanding. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Creating a “culture of research” in a community hospital: Strategies and tools from the National Cancer Institute Community Cancer Centers Program

PubMed Central

St. Germain, Diane; Nacpil, Lianne M; Zaren, Howard A; Swanson, Sandra M; Minnick, Christopher; Carrigan, Angela; Denicoff, Andrea M; Igo, Kathleen E; Acoba, Jared D; Gonzalez, Maria M; McCaskill-Stevens, Worta

2015-01-01

Background The value of community-based cancer research has long been recognized. In addition to the National Cancer Institute’s Community Clinical and Minority-Based Oncology Programs established in 1983, and 1991 respectively, the National Cancer Institute established the National Cancer Institute Community Cancer Centers Program in 2007 with an aim of enhancing access to high-quality cancer care and clinical research in the community setting where most cancer patients receive their treatment. This article discusses strategies utilized by the National Cancer Institute Community Cancer Centers Program to build research capacity and create a more entrenched culture of research at the community hospitals participating in the program over a 7-year period. Methods To facilitate development of a research culture at the community hospitals, the National Cancer Institute Community Cancer Centers Program required leadership or chief executive officer engagement; utilized a collaborative learning structure where best practices, successes, and challenges could be shared; promoted site-to-site mentoring to foster faster learning within and between sites; required research program assessments that spanned clinical trial portfolio, accrual barriers, and outreach; increased identification and use of metrics; and, finally, encouraged research team engagement across hospital departments (navigation, multidisciplinary care, pathology, and disparities) to replace the traditionally siloed approach to clinical trials. Limitations The health-care environment is rapidly changing while complexity in research increases. Successful research efforts are impacted by numerous factors (e.g. institutional review board reviews, physician interest, and trial availability). The National Cancer Institute Community Cancer Centers Program sites, as program participants, had access to the required resources and support to develop and implement the strategies described. Metrics are an important

Unintentional carbon monoxide poisoning following a winter storm--Washington, January 1993.

PubMed

1993-02-19

Carbon monoxide (CO) poisoning was a major health consequence of a severe storm that struck the Puget Sound region of western Washington state the morning of January 20, 1993. Wind gusts up to 94 miles per hour interrupted electrical power for an estimated 776,000 residents, and during the 4 nights following the storm, temperatures fell to near freezing. Because of the use of alternative sources of energy for indoor cooking and home heating, the risk of exposure to CO increased for many persons. This report summarizes cases of storm-related CO poisoning among persons who were initially evaluated at Seattle's Harborview Medical Center (HMC) or who were referred to the Virginia Mason Medical Center (VMMC) for hyperbaric oxygen therapy.

Dubois and Washington -- Opposite or Similar: An Evaluation of the Philosophies of Washington and Dubois.

ERIC Educational Resources Information Center

Reedom, John Anthony

Although comparative analysis of the philosophies of Booker T. Washington and W.E.B. DuBois reveals significant differences in preferred solutions to problems of blacks in the United States, the philosophies of the two men are not as diametrically opposed as scholars have generally maintained. Washington's philosophy was one of conciliation…

Conference on Workforce Quality Assessment Held in Washington, DC on 8 May 1989

DTIC Science & Technology

1989-09-01

of Education Statistics Sar Levitan, Director Department of Education Center for Social Policy Studies George Washington University Michael G. Hansen...wO. it’" Merit Systems Protection Board Office of Personnel Management A Federal Government which is staffed by well qualified and motivated ...long been national policy to provide for a merit-based civil service system. The question of whether we have met the objective of a well qualified

2013 EFRC PI Meeting -- Science for Our Nation's Energy Future: Energy Frontier Research Centers Principal Investigators' Meeting, Washington, D.C., July 18-19, 2013

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

None, None

2013 EFRC Principal Investigators’ Meeting, July 18-19, 2013 in Washington D.C. By invitation only--about 500 attendees from the EFRCs and DOE, 235 senior EFRC members and 165 EFRC early career scientists from more than 80 institutions in 31 states, 2 foreign countries and Washington D.C. Over 115 talks and 225 posters

Is Treating Oral and Maxillofacial Trauma Profitable? An Analysis of Hospital and Surgeon Reimbursement at an Academic Medical Center.

PubMed

DeLuke, Dean M; Agarwal, Vickas; Holleman, Trevor; Carrico, Caroline K; Laskin, Daniel M

2017-02-01

During the past 2 decades, there has been a marked decrease in the willingness of community-based oral and maxillofacial surgeons to participate in trauma call. Although many factors can influence the decision not to take trauma call, 1 primary disincentive is the perception that managing facial trauma might be profitable for the hospital, but not profitable for the surgeon. The purpose of this study was to compare the profitability of facial trauma management for the hospital and the surgeon at the Virginia Commonwealth University (VCU) Medical Center (Richmond, VA). In this retrospective cohort study, records were collected for patients who were seen for primary trauma management by the Department of Oral and Maxillofacial Surgery at VCU (VCUOMS) from June 2011 through July 2014. Cost and reimbursement data were analyzed for these patients from the VCU Health System (VCUHS) and the VCUOMS. For the hospital, actual cost data were provided; for the surgeon, cost was calculated based on an average overhead of 50%. For uniformity, patients were excluded if they remained in the hospital for longer than a 23-hour observation period. Patients younger than 18 years also were excluded. In total, 169 patients met the inclusion criteria. There was a statistically relevant difference in the percentage of costs recouped and the actual profit. The average percentage of costs recouped was 230% for the VCUHS versus 47% for the VCUOMS. This amounts to an average profit per case of $3,461 for the hospital versus a loss of $1,162 for the surgeon. The results of this study indicate that in the VCU Medical Center, maxillofacial trauma yields a net profit for the hospital and a net loss for the operating surgeon. Although the results are limited to outpatient management at 1 academic institution, they suggest that hospitals in some settings might be in a position to incentivize surgeons for trauma management. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons

PACS for imaging centers.

PubMed

Farnsworth, T J

2003-01-01

PACS can be a difficult and confusing decision for any radiology provider, but it can be an even more dynamic question for an outpatient imaging center. Every center represents a unique situation and requires a specialized solution. Typically, most of what is said and discussed about PACS concentrates on solutions and requirements for hospital radiology facilities. Administrators of imaging centers have different problems from hospital administrators, and they need different answers. For imaging centers, the financial justification for PACS may be less immediate than for hospitals. The first thing that must be understood is that no PAC system can make a typical imaging center completely filmless, at least not for quite a while. A hospital has the ability to dictate to its internal referring physicians how a radiological study is delivered, whereas in an imaging center environment, the roles are very much reversed. Once the justification are made for the financial viability of PACS in an imaging center, the next question is how to finance the acquisition of PACS. The decision will depend on how you cost justify your PACS, as well as the shape of your business model, and it will come to a decision between capital purchase or contracting with an application service provider, or ASP. Historically, in the hospital-dominated marketplace, PAC systems have been treated as capital acquisitions. However, for most imaging center, owning the system is more of a problem than a benefit. ASPs increasingly represent a successful alternative for imaging centers. One of the biggest things to consider with PACS is how to store all of those images. There are typically two options, on-site and off-site, with a new "hybrid" option surfacing more recently. Each option has benefits for the user, but the benefits of off-site storage are increasing as the technology advances. Some of the benefits are data security and access. Other issues to address are HIPAA compliance, standardized

75 FR 4576 - Center for Scientific Review; Notice of Closed Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-28

...: Center for Scientific Review Special Emphasis Panel, Academic-Industry Partnership in Cancer Imaging.... Place: Ritz Carlton Hotel, 1150 22nd Street, NW., Washington, DC 20037. Contact Person: Fouad A. El...

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

Code of Federal Regulations, 2010 CFR

2010-10-01

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

Energy survey, study and report of hospitals in Michigan: Appendix A: Volume 2, Bay Medical Center, Bay City, Michigan: Final report

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

Not Available

1988-08-01

This study is part of a three-phased demonstration project to reduce energy consumption in hospitals through practical life-cycle, cost-effective modifications and alterations. Funds for the demonstration project are provided by the American Hospital Association (AHA), the Department of Energy (DOE), and the Department of Health and Human Services (DHHS). Two hospitals in Michigan were selected for the project, Bay Medical Center in Bay City and St. Mary's Hospital in Grand Rapids. The objectives of this study, which is funded by HHS, are to investigate and analyze energy usage of the facilities and to identify all life-cycle, cost-effective changes required tomore » effect a reduction in energy consumption.« less

The application of hospitality elements in hospitals.

PubMed

Wu, Ziqi; Robson, Stephani; Hollis, Brooke

2013-01-01

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

Key Facts about Higher Education in Washington. 2012

ERIC Educational Resources Information Center

Washington Higher Education Coordinating Board, 2012

2012-01-01

"Key Facts about Higher Education in Washington" provides vital data to chart higher education's progress and challenges. First published in 2002 by the Washington Higher Education Coordinating Board, this annual report highlights "Key Facts" about Washington's postsecondary institutions--including faculty, students, budgets,…

Implementing a Death with Dignity program at a comprehensive cancer center.

PubMed

Loggers, Elizabeth Trice; Starks, Helene; Shannon-Dudley, Moreen; Back, Anthony L; Appelbaum, Frederick R; Stewart, F Marc

2013-04-11

The majority of Death with Dignity participants in Washington State and Oregon have received a diagnosis of terminal cancer. As more states consider legislation regarding physician-assisted death, the experience of a comprehensive cancer center may be informative. We describe the implementation of a Death with Dignity program at Seattle Cancer Care Alliance, the site of care for the Fred Hutchinson-University of Washington Cancer Consortium, a comprehensive cancer center in Seattle that serves the Pacific Northwest. Institution-level data were compared with publicly available statewide data from Oregon and Washington. A total of 114 patients inquired about our Death with Dignity program between March 5, 2009, and December 31, 2011. Of these, 44 (38.6%) did not pursue the program, and 30 (26.3%) initiated the process but either elected not to continue or died before completion. Of the 40 participants who, after counseling and upon request, received a prescription for a lethal dose of secobarbital (35.1% of the 114 patients who inquired about the program), all died, 24 after medication ingestion (60% of those obtaining prescriptions). The participants at our center accounted for 15.7% of all participants in the Death with Dignity program in Washington (255 persons) and were typically white, male, and well educated. The most common reasons for participation were loss of autonomy (97.2%), inability to engage in enjoyable activities (88.9%), and loss of dignity (75.0%). Eleven participants lived for more than 6 months after prescription receipt. Qualitatively, patients and families were grateful to receive the lethal prescription, whether it was used or not. Overall, our Death with Dignity program has been well accepted by patients and clinicians.

Washington State Biofuels Industry Development

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

Gustafson, Richard

2017-04-09

The funding from this research grant enabled us to design, renovate, and equip laboratories to support University of Washington biofuels research program. The research that is being done with the equipment from this grant will facilitate the establishment of a biofuels industry in the Pacific Northwest and enable the University of Washington to launch a substantial biofuels and bio-based product research program.

33 CFR 117.1051 - Lake Washington Ship Canal.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Lake Washington Ship Canal. 117.1051 Section 117.1051 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Washington § 117.1051 Lake Washington Ship...

33 CFR 117.1051 - Lake Washington Ship Canal.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Lake Washington Ship Canal. 117.1051 Section 117.1051 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Washington § 117.1051 Lake Washington Ship...

33 CFR 117.1051 - Lake Washington Ship Canal.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Lake Washington Ship Canal. 117.1051 Section 117.1051 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Washington § 117.1051 Lake Washington Ship...

33 CFR 117.1051 - Lake Washington Ship Canal.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Lake Washington Ship Canal. 117.1051 Section 117.1051 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Washington § 117.1051 Lake Washington Ship...

33 CFR 117.1051 - Lake Washington Ship Canal.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Lake Washington Ship Canal. 117.1051 Section 117.1051 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Washington § 117.1051 Lake Washington Ship...

Washington, D.C. and the Baltimore, Maryland area

NASA Image and Video Library

1973-08-15

SL3-83-166 (July-September 1973) --- A vertical view of the Washington D.C. and the Baltimore, Maryland area is seen in the Skylab 3 Earth Resources Experiments Package S190-B (five-inch Earth terrain camera) photograph taken from the Skylab space station in Earth orbit. The Chesapeake Bay is on the right (east) side of the picture. The Potomac River flows through the Washington area in the lower left (southwest) corner of the photograph. Several transportation routes and major highways stand out very distinctly. Especially conspicuous are the beltways around the cities, Interstate 95 between Baltimore and the nation?s capitol and Interstate 70N leading west from Baltimore. The tunnel and harbor facilities in Baltimore show clearly, also. Identifiable features in the Washington area include the Capitol Building, the Mall area, Robert F. Kennedy Stadium (white circle), the five bridges across the Potomac, Andrews Air Force Base (on east loop), and the smaller Anacostia River. The extent of the urbanization in this area is dramatically illustrated in this picture. The photograph has sufficient resolution that the housing patterns for individual suburban areas are clearly defined with the houses shown as pink gray, wooded areas as dark green and cleared areas light green. Chesapeake Bay circulation patterns are indicated by contrast of dark and light blue. Sediment plumes (red) are seen entering the bay north and east of Baltimore. The bay bridge stands out white against the blue water. The detailed information contained in this one photograph will be of direct use to several EREP investigator teams in land use analysis, sedimentation and circulation patterns in the bay, and resource surveys of Maryland. All EREP photography is available to the public through the Department of Interior?s Earth Resources Observations Systems Data Center, Sioux Falls, South Dakota, 57198. Photo credit: NASA

Community health politics: transition of the Seattle USPHS Hospital.

PubMed Central

Hughes, R G; Tompkins, R K

1984-01-01

To achieve transition of the Seattle US Public Health Service Hospital from federal to local control, the community overcame large obstacles; the most difficult was federal preference for closing the hospital rather than incurring additional costs essential for transition. The Washington State Congressional Delegation, local officials, hospital staff, patients and numerous community volunteers--individuals and private organizations--worked together to save the hospital and secure federal resources for its transition. Going through the transition influenced the hospital as it developed a new corporate structure, designed new administrative systems, and prepared to operate in a new environment while facing an uncertain future. The hospital has continued to cope with issues arising from transition, such as operating in a competitive context while reaffirming its community service heritage. Despite the difficulties of transition, Seattle preserved a valuable community health resource. PMID:6547029

Community health politics: transition of the Seattle USPHS Hospital.

PubMed

Hughes, R G; Tompkins, R K

1984-06-01

To achieve transition of the Seattle US Public Health Service Hospital from federal to local control, the community overcame large obstacles; the most difficult was federal preference for closing the hospital rather than incurring additional costs essential for transition. The Washington State Congressional Delegation, local officials, hospital staff, patients and numerous community volunteers--individuals and private organizations--worked together to save the hospital and secure federal resources for its transition. Going through the transition influenced the hospital as it developed a new corporate structure, designed new administrative systems, and prepared to operate in a new environment while facing an uncertain future. The hospital has continued to cope with issues arising from transition, such as operating in a competitive context while reaffirming its community service heritage. Despite the difficulties of transition, Seattle preserved a valuable community health resource.

Customizing national models for a medical center's population to rapidly identify patients at high risk of 30-day all-cause hospital readmission following a heart failure hospitalization.

PubMed

Cox, Zachary L; Lai, Pikki; Lewis, Connie M; Lindenfeld, JoAnn; Collins, Sean P; Lenihan, Daniel J

2018-05-28

Nationally-derived models predicting 30-day readmissions following heart failure (HF) hospitalizations yield insufficient discrimination for institutional use. Develop a customized readmission risk model from Medicare-employed and institutionally-customized risk factors and compare the performance against national models in a medical center. Medicare patients age ≥ 65 years hospitalized for HF (n = 1,454) were studied in a derivation cohort and in a separate validation cohort (n = 243). All 30-day hospital readmissions were documented. The primary outcome was risk discrimination (c-statistic) compared to national models. A customized model demonstrated improved discrimination (c-statistic 0.72; 95% CI 0.69 - 0.74) compared to national models (c-statistics of 0.60 and 0.61) with a c-statistic of 0.63 in the validation cohort. Compared to national models, a customized model demonstrated superior readmission risk profiling by distinguishing a high-risk (38.3%) from a low-risk (9.4%) quartile. A customized model improved readmission risk discrimination from HF hospitalizations compared to national models. Copyright © 2018 Elsevier Inc. All rights reserved.

The University of Washington Health Sciences Library BioCommons: an evolving Northwest biomedical research information support infrastructure

PubMed Central

Minie, Mark; Bowers, Stuart; Tarczy-Hornoch, Peter; Roberts, Edward; James, Rose A.; Rambo, Neil; Fuller, Sherrilynne

2006-01-01

Setting: The University of Washington Health Sciences Libraries and Information Center BioCommons serves the bioinformatics needs of researchers at the university and in the vibrant for-profit and not-for-profit biomedical research sector in the Washington area and region. Program Components: The BioCommons comprises services addressing internal University of Washington, not-for-profit, for-profit, and regional and global clientele. The BioCommons is maintained and administered by the BioResearcher Liaison Team. The BioCommons architecture provides a highly flexible structure for adapting to rapidly changing resources and needs. Evaluation Mechanisms: BioCommons uses Web-based pre- and post-course evaluations and periodic user surveys to assess service effectiveness. Recent surveys indicate substantial usage of BioCommons services and a high level of effectiveness and user satisfaction. Next Steps/Future Directions: BioCommons is developing novel collaborative Web resources to distribute bioinformatics tools and is experimenting with Web-based competency training in bioinformation resource use. PMID:16888667

2007 Washington State collision data summary

DOT National Transportation Integrated Search

2008-10-13

In 2007, Washingtons traffic fatality rate decreased to 1.00 per 100 million vehicle miles traveled (VMT), the lowest fatality rate in state history. : Washington State is 27% below the 2007 U.S. fatality rate of 1.37 fatalities per 100 VMT. : Bet...

2009 Washington State collision data summary

DOT National Transportation Integrated Search

2010-07-02

In 2009, Washingtons traffic fatality rate decreased to 0.87 per 100 million vehicle miles traveled (VMT), the lowest fatality rate in state history. : Washington State is 33% below the 2009 U.S. preliminary fatality rate of 1.16 fatalities per 10...

2008 Washington State collision data summary

DOT National Transportation Integrated Search

2009-07-28

In 2008, Washingtons traffic fatality rate decreased to 0.94 per 100 million vehicle miles traveled (VMT), the lowest fatality rate in state history. : Washington State is 35% below the 2008 U.S. fatality rate of 1.27 fatalities per 100 VMT. : Bet...

1979-1980 Geothermal Resource Assessment Program in Washington

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

Korosec, M.A.; Schuster, J.E.

1980-01-01

Separate abstracts were prepared for seven papers. Also included are a bibliography of geothermal resource information for the State of Washington, well temperature information and locations in the State of Washington, and a map of the geology of the White Pass-Tumac Mountain Area, Washington. (MHR)

SUNY Health Science Center at Syracuse: Controls over Some Hospital Expenses Could Be Improved. Report 92-S-50.

ERIC Educational Resources Information Center

Walsh, John T.; And Others

An audit was done of the Health Science Center, a teaching hospital in the State University of New York (SUNY) system at Syracuse. The audit addressed whether Syracuse has effective controls over selected payroll, equipment and inventory expenses. Syracuse reported an operating loss for 1990 of over $21 million dollars. The audit found that…

The Health Literacy Environment of Hospitals and Health Centers. Partners for Action: Making Your Healthcare Facility Literacy-Friendly

ERIC Educational Resources Information Center

Rudd, Rima E.; Anderson, Jennie E.

2006-01-01

The "health literacy environment" of a healthcare facility represents the expectations, preferences, and skills of those providing health information and services. Some of these demands are in the form of physical aspects of the hospital or health center, such as signs and postings. At the same time, access to and navigation of health services…

Road map to a patient-centered research agenda at the intersection of hospital medicine and geriatric medicine.

PubMed

Wald, Heidi L; Leykum, Luci K; Mattison, Melissa L P; Vasilevskis, Eduard E; Meltzer, David O

2014-06-01

As the United States ages, the patient population in acute care hospitals is increasingly older and more medically complex. Despite evidence of a high burden of disease, high costs, and often poor outcomes of care, there is limited understanding of the presentation, diagnostic strategies, and management of acute illness in older adults. In this paper, we present a strategy for the development of a research agenda at the intersection of hospital and geriatric medicine. This approach is informed by the Patient-Centered Outcomes Research Institute (PCORI) framework for identification and prioritization of research areas, emphasizing input from patients and caregivers. The framework's four components are: 1) Topic generation, 2) Gap Analysis in Systematic Review, 3) Value of information (VOI) analysis, and 4) Peer Review. An inclusive process for topic generation requiring the systematic engagement of multiple stakeholders, especially patients, is emphasized. In subsequent steps, researchers and stakeholders prioritize research topics in order to identify areas that optimize patient-centeredness, population impact, impact on clinical decision making, ease of implementation, and durability. Finally, next steps for dissemination of the research agenda and evaluation of the impact of the patient-centered research prioritization process are described.

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

Code of Federal Regulations, 2013 CFR

2013-10-01

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

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

Code of Federal Regulations, 2014 CFR

2014-10-01

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

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

Code of Federal Regulations, 2010 CFR

2010-10-01

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

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

Code of Federal Regulations, 2012 CFR

2012-10-01

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

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

Code of Federal Regulations, 2011 CFR

2011-10-01

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

Native Nutrition--Northwest Indian Treatment Center Honors Culture to Heal the Mind

ERIC Educational Resources Information Center

Krohn, Elise

2011-01-01

The Northwest Indian Treatment Center runs a 45-day inpatient treatment program in Elma, Washington. The Squaxin Island Tribe created the program to address an unmet need for culturally based drug and alcohol treatment centers for Indian people who grew up on reservations. The program specializes in treating people with chronic relapse patterns…

Impact of hospital and surgeon case volume on morbidity in colorectal endometriosis management: a plea to define criteria for expert centers.

PubMed

Bendifallah, Sofiane; Roman, Horace; Rubod, Chrystel; Leguevaque, Pierre; Watrelot, Antoine; Bourdel, Nicolas; Ballester, Marcos; Darai, Emile

2018-04-01

National and international guidelines recommend referring patients with severe forms of endometriosis to expert centers. However, there is a lack of clear criteria to define an expert center. We examined the roles of surgeon and hospital procedure volumes as determinants of morbidity in deep infiltrating endometriosis of the rectum and sigmoid colon (DIERS). We conducted a French retrospective multicenter study of hospital facilities performing colorectal surgery for DIERS in 2015. The primary end point was to analyze the relation between case volume and the incidence of complications. We estimated the optimal cut-off (OCO) determined by a minimal p-value approach. The study included 56 hospital facilities and collected data of 1135 cases of surgical management of colorectal endometriosis. The mean and median number of procedures per year and per surgeon were 9.17 and 5.58, respectively. The overall rate of grade III-V complication was 7.6% (82/1135). One grade V complication occurred. The rates of rectovaginal fistula, anastomotic leakage, pelvic abscess, and ureteral fistula were: 2.7% (31/1135), 0.79% (9/1135), 3.4% (39/1135), and 0.70% (8/1135), respectively. An OCO of 20 procedures per center and per year (p < 0.001) was defined. The OCO per surgeon and per year varied between seven (p = 0.007) and 13 procedures (p = 0.03). In a multivariate analysis, we found that only the volume of activity was independently correlated to complication outcomes (p = 0.0013). Our results contribute to providing objective morbidity data to determine criteria for defining expert centers for colorectal surgery for endometriosis.

Strategic response by providers to specialty hospitals, ambulatory surgery centers, and retail clinics.

PubMed

Burns, Lawton R; David, Guy; Helmchen, Lorens A

2011-04-01

Radical innovation and disruptive technologies are frequently heralded as a solution to delivering higher quality, lower cost health care. According to the literature on disruption, local hospitals and physicians (incumbent providers) may be unable to competitively respond to such "creative destruction" and alter their business models for a host of reasons, thus threatening their future survival. However, strategic management theory and research suggest that, under certain conditions, incumbent providers may be able to weather the discontinuities posed by the disrupters. This article analyzes 3 disruptive innovations in service delivery: single-specialty hospitals, ambulatory surgical centers, and retail clinics. We first discuss the features of these innovations to assess how disruptive they are. We then draw on the literature on strategic adaptation to suggest how incumbents develop competitive responses to these disruptive innovations that assure their continued survival. These arguments are then evaluated in a field study of several urban markets based on interviews with both incumbents and entrants. The interviews indicate that entrants have failed to disrupt incumbent providers primarily as a result of strategies pursued by the incumbents. The findings cast doubt on the prospects for these disruptive innovations to transform health care.

[Kidney transplant experience at the Specialty Hospital Bernardo Sepulveda National Medical Center Century XXI, Mexican Institute of Social Security].

PubMed

Gracida-Juárez, Carmen; Espinoza-Pérez, Ramón; Cancino-López, Jorge David; Ibarra-Villanueva, Araceli; Cedillo-López, Urbano; Villegas-Anzo, Fernando; Martínez-Alvarez, Julio

2011-09-01

The first kidney transplant in Mexico was done on October 22, 1963 at the General Hospital of National Medical Center (CMN) of the Mexican Institute of Social Security. After the earthquake in 1985, the transplantation activity was continued at the Specialty Hospital of National Medical Center Century XXI. Our program has a continue activity for almost 48 years and a total of 2019 kidney transplants from October 1963 to December 2010. We describe our experience in 20 years. Retrospective cohort study that includes all kidney transplants performed in the period from January 1991 to December 2010. Descriptive statistics were used. The survival analysis was performed using the Kaplan Meier method. We show the patient survival, graft survival censored for death with functional graft and total graft survival (uncensored). We analyzed a total of 1544 kidney transplants. The percentage of living donor was 82.9 vs. deceased donor of 17.1%. Patient survival at 1, 5, 10, 15 and 20 years was 95.0, 91.8, 87.2, 81.1 and 70.1%, respectively; allograft survival rate censored for death with functional allograft at 1, 5, 10, 15 and 20 years was 93.0, 86.2, 76.2, 63.7 and 50.9%, respectively. Our Transplant center also take care of around 1300 living donors in the long term, looking for morbidities as risk factors for the unique kidney as metabolic syndrome, diabetes, hypertension and others. In our program, the main source of renal allografts was living donors. Our transplant center has to increase the organ procurement from deceased donors. An important contribution of our center has been the long follow up of living donors according to international consensus.

18. Station Service Control and Motor Control Center #2, view ...

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

18. Station Service Control and Motor Control Center #2, view to the northeast. Note the circuit breaker switch on cart in left corner of photograph. This switch is part of the motor control center which has been temporarily removed from the slot marked with a tag that is visible at lower left end of control center. - Washington Water Power Clark Fork River Noxon Rapids Hydroelectric Development, Powerhouse, South bank of Clark Fork River at Noxon Rapids, Noxon, Sanders County, MT

Kennedy Center Salute To Apollo

NASA Image and Video Library

2009-07-17

Conductor Emil de Cou and The U.S. Army Chorus and Alumni sing while Gene Kranz, retired NASA Flight Director and manager, acts as guest conductor of the National Symphony Orchestra, during the "Salute to Apollo" ceremony at the Kennedy Center for the Performing Arts, Saturday, July 18, 2009 in Washington. The event was part of NASA's week long celebration of the Apollo 40th Anniversary. Photo Credit: (NASA/Bill Ingalls)

Sleep and Performance Research Center

DTIC Science & Technology

2012-05-01

upon the placement of the work period with respect to the circadian rhythm. Additional studies were published by SPRC care factually during the...Research Center (SPRC) conducts human and animal studies in laboratory and field settings in support of basic and applied sleep research at Washington...Program of Research Field Studies in Humans In a field study of serving police officers, Charles, et al. (2011) found that perceived shorter

30 CFR 947.700 - Washington Federal program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... PROGRAMS FOR THE CONDUCT OF SURFACE MINING OPERATIONS WITHIN EACH STATE WASHINGTON § 947.700 Washington... necessary because of the nature of the terrain, climate, biological, chemical, or other relevant physical...

30 CFR 947.700 - Washington Federal program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... PROGRAMS FOR THE CONDUCT OF SURFACE MINING OPERATIONS WITHIN EACH STATE WASHINGTON § 947.700 Washington... necessary because of the nature of the terrain, climate, biological, chemical, or other relevant physical...

30 CFR 947.700 - Washington Federal program.

Code of Federal Regulations, 2012 CFR

2012-07-01

... PROGRAMS FOR THE CONDUCT OF SURFACE MINING OPERATIONS WITHIN EACH STATE WASHINGTON § 947.700 Washington... necessary because of the nature of the terrain, climate, biological, chemical, or other relevant physical...

30 CFR 947.700 - Washington Federal program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... PROGRAMS FOR THE CONDUCT OF SURFACE MINING OPERATIONS WITHIN EACH STATE WASHINGTON § 947.700 Washington... necessary because of the nature of the terrain, climate, biological, chemical, or other relevant physical...

Inpatient satisfaction and usage patterns of personalized smart bedside station system for patient-centered service at a tertiary university hospital.

PubMed

Ryu, Borim; Kim, Seok; Lee, Kee-Hyuck; Hwang, Hee; Yoo, Sooyoung

2016-11-01

for patient-centered services. Further research should be directed at developing sophisticated patient-centered services as a communication tool between the hospital and the patient. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Hydrogeology and history of Washington, D.C.

NASA Astrophysics Data System (ADS)

For Washington, D.C., inhabitants or anyone planning a trip to the area, interesting information on the hydrology, geology, and natural and cultural history is available.To provide geographic and historical background for field trips in the area, a book was published for the 28th International Geological Congress, held in Washington in July 1989. Geology, Hydrology, and History of the Washington, D.C. Area, edited by John E. Moore of the U.S. Geological Survey, Reston, Va., and Julia A. Jackson of the American Geological Institute, Alexandria, Va., describes such interesting items as the Washington Canal, which ran from the Potomac River to the Capitol and is now Constitution Avenue, and the Cabin John Aqueduct, where a 297-foot granite arch was the longest masonry arch in the world for 40 years. The aqueduct has carried water to Washington since 1863. The 114-page book contains many historic photographs and maps and can be purchased from the American Geological Institute, 4220 King Street, Alexandria, VA 22302-1507, tel. 703-379-2480.

Analysis of Sleep Parameters in Patients with Obstructive Sleep Apnea Studied in a Hospital vs. a Hotel-Based Sleep Center

PubMed Central

Hutchison, Kimberly N.; Song, Yanna; Wang, Lily; Malow, Beth A.

2008-01-01

Background: Polysomnography is associated with changes in sleep architecture called the first-night effect. This effect is believed to result from sleeping in an unusual environment and the technical equipment used to study sleep. Sleep experts hope to decrease this variable by providing a more familiar, comfortable atmosphere for sleep testing through hotel-based sleep centers. In this study, we compared the sleep parameters of patients studied in our hotel-based and hospital-based sleep laboratories. Methods: We retrospectively reviewed polysomnograms completed in our hotel-based and hospital-based sleep laboratories from August 2003 to July 2005. All patients were undergoing evaluation for obstructive sleep apnea. Hospital-based patients were matched for age and apnea-hypopnea index with hotel-based patients. We compared the sleep architecture changes associated with the first-night effect in the two groups. The associated conditions and symptoms listed on the polysomnography referral forms are also compared. Results: No significant differences were detected between the two groups in sleep onset latency, sleep efficiency, REM sleep latency, total amount of slow wave sleep (NREM stages 3 and 4), arousal index, and total stage 1 sleep. Conclusions: This pilot study failed to show a difference in sleep parameters associated with the first-night effect in patients undergoing sleep studies in our hotel and hospital-based sleep laboratories. Future studies need to compare the first-night effect in different sleep disorders, preferably in multi-night recordings. Citation: Hutchison KN; Song Y; Wang L; Malow BA. Analysis of sleep parameters in patients with obstructive sleep apnea studied in a hospital vs. A hotel-based sleep center. J Clin Sleep Med 2008;4(2):119–122. PMID:18468309

Washington: "...By Ability, Politeness, and Attention."

ERIC Educational Resources Information Center

Bingham, Marjorie Wall

1997-01-01

Examines the career of George Washington, particularly emphasizing his skills as a mediator and negotiator. Postulates that the origins of these skills are in Washington's upbringing and his role as the leader of a large extended family. Argues that, as a national leader, he effectively employed these same skills. (MJP)

Are Evidence-based Practices Associated With Effective Prevention of Hospital-acquired Pressure Ulcers in US Academic Medical Centers?

PubMed

Padula, William V; Gibbons, Robert D; Valuck, Robert J; Makic, Mary B F; Mishra, Manish K; Pronovost, Peter J; Meltzer, David O

2016-05-01

In 2008, the Centers for Medicare and Medicaid Services (CMS) established nonpayment policies resulting from costliness of hospital-acquired pressure ulcers (HAPUs) to hospitals. This prompted hospitals to adopt quality improvement (QI) interventions that increase use of evidence-based practices (EBPs) for HAPU prevention. To evaluate the longitudinal impact of CMS policy and QI adoption on HAPU rates. We characterized longitudinal adoption of 25 QI interventions that support EBPs through hospital leadership, staff, information technology, and performance and improvement. Quarterly counts of HAPU incidence and inpatient characteristics were collected from 55 University HealthSystem Consortium hospitals between 2007 and 2012. Mixed-effects regression models tested the longitudinal association of CMS policy, HAPU coding, and QI on HAPU rates. The models assumed level-2 random intercepts and random effects for CMS policy and EBP implementation to account for between-hospital variability in HAPU incidence. Controlling for all 25 QI interventions, specific updates to EBPs for HAPU prevention had a significant, though modest reduction on HAPU rates (-1.86 cases/quarter; P=0.002) and the effect of CMS nonpayment policy on HAPU prevention was much greater (-11.32 cases/quarter; P<0.001). HAPU rates were significantly lower after changes in CMS reimbursement. Reductions are associated with hospital-wide implementation of EBPs for HAPU prevention. Given that administrative data were used, it remains unknown whether these improvements were due to changes in coding or improved quality of care.

Washington Tsunami Hazard Mitigation Program

NASA Astrophysics Data System (ADS)

Walsh, T. J.; Schelling, J.

2012-12-01

Washington State has participated in the National Tsunami Hazard Mitigation Program (NTHMP) since its inception in 1995. We have participated in the tsunami inundation hazard mapping, evacuation planning, education, and outreach efforts that generally characterize the NTHMP efforts. We have also investigated hazards of significant interest to the Pacific Northwest. The hazard from locally generated earthquakes on the Cascadia subduction zone, which threatens tsunami inundation in less than hour following a magnitude 9 earthquake, creates special problems for low-lying accretionary shoreforms in Washington, such as the spits of Long Beach and Ocean Shores, where high ground is not accessible within the limited time available for evacuation. To ameliorate this problem, we convened a panel of the Applied Technology Council to develop guidelines for construction of facilities for vertical evacuation from tsunamis, published as FEMA 646, now incorporated in the International Building Code as Appendix M. We followed this with a program called Project Safe Haven (http://www.facebook.com/ProjectSafeHaven) to site such facilities along the Washington coast in appropriate locations and appropriate designs to blend with the local communities, as chosen by the citizens. This has now been completed for the entire outer coast of Washington. In conjunction with this effort, we have evaluated the potential for earthquake-induced ground failures in and near tsunami hazard zones to help develop cost estimates for these structures and to establish appropriate tsunami evacuation routes and evacuation assembly areas that are likely to to be available after a major subduction zone earthquake. We intend to continue these geotechnical evaluations for all tsunami hazard zones in Washington.

1. View of Pier G (center photo, on the water ...

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

1. View of Pier G (center photo, on the water line) taken from the foot of Washington Street. The view is of the southeastern, northeastern, and northern sides of the structure. - Lehigh Valley Railroad, Pier G, Jersey City, Hudson County, NJ

A trauma outreach program provided by a level I trauma center is an effective way to initiate peer review at referring hospitals and foster process improvements.

PubMed

Byrnes, Matthew C; Irwin, Eric; Becker, Leslie; Thorson, Melissa; Beilman, Greg; Horst, Patrick; Croston, Kevin

2010-04-01

The initial care of critically injured patients has profound effects on ultimate outcomes. The "golden hour" of trauma care is often provided by rural hospitals before definitive transfer. There are, however, no standardized methods for providing educational feedback to these hospitals for the purposes of performance improvement. We hypothesized that an outreach program would stimulate peer review and identify systematic deficiencies in the care of patients with injuries. We developed a quality improvement program aimed at providing educational feedback to hospitals that referred patients to our American College of Surgeons-verified level I trauma center. We traveled to each referral center to provide feedback on the initial treatment and ultimate outcome of patients that were transferred to us. These feedback sessions were presented in the format of case presentations and case discussions. The outreach program was presented at each hospital every 3 months to 6 months. Nine hospitals were included in our program. We received 334 patients in transfer from these hospitals during the study period. Formal peer review that focused on trauma patients increased from 14% of hospitals to 100% of hospitals after institution of the program. Eighty-five percent of hospitals thought that the care of patients with injuries was improved as a result of the program. Eighty-five percent of hospitals developed process improvement initiatives as a result of the program. A formal outreach program can stimulate peer review at rural hospitals, provide continuing education in the care of patients with injuries, and foster process improvements at referring hospitals.

42 CFR 419.20 - Hospitals subject to the hospital outpatient prospective payment system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... prospective payment system. 419.20 Section 419.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL... Outpatient Prospective Payment System § 419.20 Hospitals subject to the hospital outpatient prospective...

Evaluation of the Washington State Target Zero teams project.

DOT National Transportation Integrated Search

2015-01-01

As part of its Target Zero strategic highway safety plan that has the goal to reduce traffic fatalities in Washington to zero by the year 2030, the State of Washington established three detachments of Washington State Patrol (WSP) troopers to f...

Cincinnati Children's Hospital Medical Center: transforming care for children and families.

PubMed

Britto, Maria T; Anderson, James M; Kent, William M; Mandel, Keith E; Muething, Stephen E; Kaminski, Gerry M; Schoettker, Pamela J; Pandzik, Gerry; Carter, Lee A; Kotagal, Uma R

2006-10-01

Cincinnati Children's Hospital Medical Center pursues its vision to be the leader in improving child health through the creation of new knowledge, education of professionals and the community, and transformation of our health care delivery system. The strategic plan focuses on achieving the best medical and quality of life outcomes, patient and family experience of care, and value through horizontal integration of research and delivery system design, thereby accelerating the transfer of new knowledge to the bedside. Family members and patients participate at all levels of the organization, from the organizationwide family advisory council, to unit-based inpatient teams, to serving as family faculty who teach pediatric residents and orient new employees. Family members ensure that children's and parents' voices are heard. Key factors contributing to ongoing transformation include senior leaders' drive for change, focus on perfection or near-perfection goals, vertical alignment in measures, accountability, improvement capability, commitment to internal and external transparency, and focus on measurement and constancy of purpose.

Transfusion safety: is this the business of blood centers?

PubMed

Slapak, Colleen; Fredrich, Nanci; Wagner, Jeffrey

2011-12-01

ATSO is in a unique position to break down organizational silos between hospitals and blood centers through the development of a collaborative relationship between the two entities. Use of the TSO as blood center staff centralizes the role into a consultative position thereby retaining the independence of the hospitals. The TSO position then becomes a value-added service offered by the blood center designed to supplement processes within the hospital.Whether the TSO is based in the hospital or the blood center, improvements are gained through appropriate utilization of blood components, reductions in hospital costs, ongoing education of hospital staff involved in transfusion practice, and increased availability of blood products within the community. Implementation and standardization of best practice processes for ordering and administration of blood products developed by TSOs leads to improved patient outcomes. As a liaison between hospitals and blood centers, the TSO integrates the mutual goal of transfusion safety: the provision of the safest blood product to the right patient at the right time for the right reason.

The National Center of the U.S. Geological Survey

USGS Publications Warehouse

,

1974-01-01

In August of 1973, the U. S. Geological Survey moved its first group of employees into the John Wesley Powell Federal Building of its newly constructed National Center at Reston, Virginia. The move signaled the fruition of more than a decade of planning and work to consolidate the agency's widespread activities into one location which could truly serve as a National Center. The Survey's leadership in the natural resources field has been materially strengthened through the availability of the Center's outstanding research and engineering facilities. Also the Center affords important professional and administrative advantages by bringing together the 2,200 Survey employees in the Washington, D.C, metropolitan area.

Supporting Students Who Are Deaf or Hard of Hearing in General Education Classrooms: A Washington State Case Study

ERIC Educational Resources Information Center

Berndsen, Maura; Luckner, John

2012-01-01

The majority of students who are deaf or hard of hearing currently receive educational services in general education settings. Trends that have led to this shift in placement as well as potential benefits and barriers are presented. A unique partnership between the Washington State Center for Childhood Deafness and Hearing Loss (formerly the…

Identifying and communicating the contributions of library and information services in hospitals and academic health sciences centers.

PubMed

Abels, Eileen G; Cogdill, Keith W; Zach, Lisl

2004-01-01

This article introduces a systematic approach to identifying and communicating the value of library and information services (LIS) from the perspective of their contributions to achieving organizational goals. The contributions of library and information services (CLIS) approach for identifying and communicating the value of LIS draws on findings from a multimethod study of hospitals and academic health sciences centers. The CLIS approach is based on the concept that an individual unit's value to an organization can be demonstrated by identifying and measuring its contributions to organizational goals. The CLIS approach involves seven steps: (1) selecting appropriate organizational goals that are meaningful in a specific setting; (2) linking LIS contributions to organizational goals; (3) obtaining data from users on the correspondence between LIS contributions and LIS services; (4) selecting measures for LIS services; (5) collecting and analyzing data for the selected measures; (6) planning and sustaining communication with administrators about LIS contributions; and (7) evaluating findings and revising selected goals, contributions, and services as necessary. The taxonomy of LIS contributions and the CLIS approach emerged from research conducted in hospitals and academic health sciences centers and reflect the mission and goals common in these organizations. However, both the taxonomy and the CLIS approach may be adapted for communicating the value of LIS in other settings.

Supplemental Environmental Assessment of the Ambulatory Care Center at Joint Base Andrews-Naval Air Facility Washington, Maryland

DTIC Science & Technology

2011-06-01

DOLAN, GS-14, USAF Chief, Asset Management Flight MARYLAND DEPARTMENT OF THE ENVIRONMENT MDE Martin O’Malley Governor 1800 Washington Boulevard...t.e.(~;vJ ~-so- ll ( HtfM.;r-\\<.U ) -l. ~- II J~~ Ms. Anne Hodges March 29, 2011 Page Two Again, thank you for giving MDE the opportunity to...Joane D. Mueller MDE Clearinghouse Coordinator Office of Communications Enclosure cc: Bob Rosenbush, State Clearinghouse • Andrews Airforce Base

78 FR 22911 - Delta Air Lines, Inc., Reservation Sales and Customer Care Call Center, Seatac, WA; Delta Air...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-17

... Lines, Inc., Reservation Sales and Customer Care Call Center, Seatac, WA; Delta Air Lines, Inc., Reservation Sales and Customer Care Call Center, Sioux City, IA; Notice of Revised Determination on..., Inc., Reservation Sales and Customer Care Call Center, Seatac, Washington (TA-W-82,197) and Delta Air...

The Post-Hospital Mental Patient and Family Therapy: Prospects and Populations.

ERIC Educational Resources Information Center

Goldman, Howard H.

1980-01-01

Increasing numbers of patients will be discharged from mental hospitals because of changes in delivery services. Approximately 650,000 patients will return to their families. This presents new challenges to family therapists. Presented at the Annual Conference of the American Association of Marriage and Family Therapy, Washington, DC, October…

Two-year hospital records of burns from a referral center in Western Iran: March 2010-March 2012.

PubMed

Ahmadijouybari, Touraj; Najafi, Farid; Moradinazar, Mehdi; Karami-matin, Behzad; Karami-matin, Reza; Ataie, Maria; Hatami, Masoumeh; Purghorbani, Samira; Amee, Vahid

2014-01-01

Burns are among the most common injuries affecting a great number of people worldwide annually. In Iran, especially in its western region and in Kermanshah province, burns have a relatively high incidence. The present study was aimed at investigating epidemiological characteristics in Western Iran. Within a cross-sectional study, the data on all patients attending the Burns Center at Imam Khomeini Hospital (Kermanshah, Iran) during 2010-2011 and 2011-2012 (24 months) were collected. Then, age, gender, cause of burns, total body surface area, and time of the occurrence were extracted from the hospital records. The data were analyzed using the SPSS statistical package (Version 19, for Windows). We used chi-squared test when we compared the categorical responses between two or more groups. For comparing means between two groups we used t-test. In addition, trends were investigated using linear regression. Overall 13,248 people were referred to the Burns Center at Imam Khomeini Hospital (Kermanshah, Iran) during the period of study, including 328 cases of self-immolation. The mean age of the patients was 27±19 years and 29±13 years for unintentional burns and self-immolation respectively. Out of the total number of unintentional cases, 6,519 (50.5%) were men, while the corresponding percentage of men among the self-immolation cases was 16.6% (p less than 0.001). Trends in the number of cases were cyclic, with the highest and lowest number of burns cases being in March and May. Overall, hot liquids and flammable materials were the two most important causes of unintentional burns. However, flammable materials were the main cause of burns among self-immolation cases. During hospital admission, 168 (51%) self-immolation victims and 43 (0.33%) unintentional burn victims died. While major preventive measures are not adequately used in developing countries, burns and their burden can be significantly reduced by increasing public awareness and by applying simple preventive

Timber resource statistics for southwest Washington.

Treesearch

John W. Hazard

1965-01-01

This publication summarizes the results of the third reinventory of six counties in southwest Washington: Clark, Cowlitz, Lewis, Pacific, Skamania, and Wahkiakurn. This block of 6 counties is one of 10 such blocks set up in the States of Oregon and Washington by the Forest Survey to facilitate orderly reinventories of the timber resources. Each block will be...

78 FR 63206 - Vacancy on Board of Governors of the Patient-Centered Outcomes Research Institute (PCORI)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-23

... GOVERNMENT ACCOUNTABILITY OFFICE Vacancy on Board of Governors of the Patient-Centered Outcomes... Outcomes Research Institute and for filling vacancies that may occur. Board members must meet the... Care, Attention: Patient Centered Outcomes Research Institute, 441 G Street NW., Washington, DC 20548...

Baltimore-Washington Parkway, Maryland : traffic safety plan

DOT National Transportation Integrated Search

2015-06-01

Over the past decade, a number of studies have documented the traffic safety issues on the National Park Services (NPS) portion of the Baltimore-Washington (B-W) Parkway. The Baltimore-Washington Parkway Traffic Safety Plan provides an action plan...

LULAC National Educational Service Centers Inc. (LNESC) Progress Report, 1977: Building Leadership Through Education.

ERIC Educational Resources Information Center

Lorber, Erin, Ed.; And Others

Since 1973, the LULAC National Education Service Centers, Inc. (LNESC) has been functioning to increase Hispanic access to and participation in post-secondary education. A national educational outreach network consisting of 12 field center offices and a headquarters in Washington, D.C. LNESC is dedicated to the principle that the essential…

42 CFR 412.331 - Determining hospital-specific rates in cases of hospital merger, consolidation, or dissolution.

Code of Federal Regulations, 2012 CFR

2012-10-01

... hospital merger, consolidation, or dissolution. 412.331 Section 412.331 Public Health CENTERS FOR MEDICARE... cases of hospital merger, consolidation, or dissolution. (a) New hospital merger or consolidation. If... dissolution. If a hospital separates into two or more hospitals that are subject to capital payments under...

42 CFR 412.331 - Determining hospital-specific rates in cases of hospital merger, consolidation, or dissolution.

Code of Federal Regulations, 2014 CFR

2014-10-01

... hospital merger, consolidation, or dissolution. 412.331 Section 412.331 Public Health CENTERS FOR MEDICARE... cases of hospital merger, consolidation, or dissolution. (a) New hospital merger or consolidation. If... dissolution. If a hospital separates into two or more hospitals that are subject to capital payments under...

42 CFR 412.331 - Determining hospital-specific rates in cases of hospital merger, consolidation, or dissolution.

Code of Federal Regulations, 2011 CFR

2011-10-01

... hospital merger, consolidation, or dissolution. 412.331 Section 412.331 Public Health CENTERS FOR MEDICARE... cases of hospital merger, consolidation, or dissolution. (a) New hospital merger or consolidation. If... dissolution. If a hospital separates into two or more hospitals that are subject to capital payments under...

42 CFR 412.331 - Determining hospital-specific rates in cases of hospital merger, consolidation, or dissolution.

Code of Federal Regulations, 2013 CFR

2013-10-01

... hospital merger, consolidation, or dissolution. 412.331 Section 412.331 Public Health CENTERS FOR MEDICARE... cases of hospital merger, consolidation, or dissolution. (a) New hospital merger or consolidation. If... dissolution. If a hospital separates into two or more hospitals that are subject to capital payments under...

1. AERIAL VIEW, LOOKING WEST OF 'THE BIRMINGHAM MEDICAL CENTER,' ...

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

1. AERIAL VIEW, LOOKING WEST OF 'THE BIRMINGHAM MEDICAL CENTER,' WITH HILLMAN HOSPITAL, THE FIVE-STORY BUILDING (CENTER RIGHT AT 20TH STREET AND SIXTH AVENUE SOUTH), JEFFERSON TOWER (CENTER LEFT AT 20TH STREET AND SEVENTH AVENUE SOUTH, AND THE MANY HOSPITALS AND TEACHING FACILITIES OF THE UNIVERSITY OF ALABAMA AT BIRMINGHAM MEDICAL CENTER. - Hillman Hospital, 600 Block Westside Twentieth Street South, Birmingham, Jefferson County, AL

Fixed drug eruption associated with sulfonamides sold in Latino grocery stores - Greater Washington, DC, area, 2012-2013.

PubMed

2013-11-22

In March 2012, a Salvadoran-American boy aged 7 years living in Maryland developed three slightly painful, well-demarcated, flat, gray-brown patches on his torso. A dermatologist in Washington, DC, suspected a fixed drug eruption (an erythema multiforme-like adverse drug reaction that occurs in the same location each time the person uses a particular medication). The child had recently taken a cough and cold remedy, Baczol Antigripal, which was made in El Salvador and purchased in a Maryland suburb of Washington, DC, without a prescription. The Baczol Antigripal ingredients included the sulfonamide-containing antibiotic trimethoprim-sulfamethoxazole (TMP/SMX), which is a common cause of fixed drug eruption. In June 2013, another Salvadoran-American child, a girl aged 14 years living in northern Virginia, was evaluated for a similar fixed drug eruption likely caused by a Baczol product purchased near her home. In August 2013, staff members from the Children's National Medical Center investigated the availability of Baczol products in grocery stores in Salvadoran neighborhoods of Washington, DC, and neighboring suburbs. TMP/SMX-containing products were found in seven of 19 stores.

An examination of hospital satisfaction with blood suppliers.

PubMed

Carden, Robert; DelliFraine, Jami L

2004-11-01

The purpose of this study was to identify factors that predict overall hospital satisfaction with blood suppliers. The data for this study came from a 2001 satisfaction survey of hospital blood bank managers conducted by the National Blood Data Resource Center. A total of 1325 blood-utilizing hospitals were included in the final study database. The measurement of hospital satisfaction with its blood supplier encompasses the five composites of the SERVQUAL model. The five composites are 1) tangibles, 2) reliability, 3) responsiveness, 4) assurance, and 5) empathy. Linear regression was performed with overall hospital satisfaction as the dependent variable and the five composites of the SERVQUAL model and control variables as predictors of overall hospital satisfaction with blood suppliers. Significant predictors of hospital satisfaction with blood suppliers are satisfaction with medical and clinical support provided by the blood center, satisfaction with the routine delivery schedule, and price (service fee) of red cells. Prior studies have demonstrated the importance of customer satisfaction to organizations. As organizations, blood centers can benefit from improved satisfaction from their hospital customers. Blood center strategies that focus on improving these three predictors of overall hospital satisfaction with primary blood suppliers will be the most likely to improve and/or maintain hospital customer satisfaction with primary blood suppliers.

Access Washington Home

Science.gov Websites

- state and local licensing and registration requirements. Watch - Find out what legal aid clients and Microsoft President Brad Smith have to say in this short video - Civil Legal Aid in Washington State. Health

Firearm-related hospitalization and risk for subsequent violent injury, death, or crime perpetration: a cohort study.

PubMed

Rowhani-Rahbar, Ali; Zatzick, Douglas; Wang, Jin; Mills, Brianna M; Simonetti, Joseph A; Fan, Mary D; Rivara, Frederick P

2015-04-07

Risk for violent victimization or crime perpetration after firearm-related hospitalization (FRH) must be determined to inform the need for future interventions. To compare the risk for subsequent violent injury, death, or crime perpetration among patients with an FRH, those hospitalized for noninjury reasons, and the general population. Retrospective cohort study. All hospitals in Washington. Patients with an FRH and a random sample of those with a non-injury-related hospitalization in 2006 to 2007 (index hospitalization). Primary outcomes included subsequent FRH, firearm-related death, and the combined outcome of firearm- or violence-related arrest ascertained through 2011. Among patients with an index FRH (n = 613), rates of subsequent FRH, firearm-related death, and firearm- or violence-related arrest were 329 (95% CI, 142 to 649), 100 (CI, 21 to 293), and 4221 (CI, 3352 to 5246) per 100 000 person-years, respectively. Compared with the general population, standardized incidence ratios among patients with an index FRH were 30.1 (CI, 14.9 to 61.0) for a subsequent FRH and 7.3 (CI, 2.4 to 22.9) for firearm-related death. In survival analyses that accounted for competing risks, patients with an index FRH were at greater risk for subsequent FRH (subhazard ratio [sHR], 21.2 [CI, 7.0 to 64.0]), firearm-related death (sHR, 4.3 [CI, 1.3 to 14.1]), and firearm- or violence-related arrest (sHR, 2.7 [CI, 2.0 to 3.5]) than those with a non-injury-related index hospitalization. Lack of information on whether patients continued to reside in Washington during follow-up may have introduced outcome misclassification. Hospitalization for a firearm-related injury is associated with a heightened risk for subsequent violent victimization or crime perpetration. Further research at the intersection of clinical care, the criminal justice system, and public health to evaluate the effectiveness of interventions delivered to survivors of firearm-related injury is warranted. Seattle City

A Multi-Disciplinary Approach to a School-Centered Rehabilitation Program for Pregnant School-Age Girls in Washington, D.C.

ERIC Educational Resources Information Center

Goodman, Elizabeth M.; Gill, Fobola M. L.

In 1963, the Washington, D.C. Public School Department began a special demonstration project on the secondary school level, the Webster Girls School Program, to reduce the number of dropouts due to pregnancy and recidivism. An interagency, multidisciplinary plan was devised to provide comprehensive services to the girls. Social case work, academic…

The Direct Referral to Endovascular Center criteria: a proposal for pre-hospital evaluation of acute stroke in the Madrid Stroke Network.

PubMed

Rodríguez-Pardo, J; Fuentes, B; Alonso de Leciñana, M; Ximénez-Carrillo, Á; Zapata-Wainberg, G; Álvarez-Fraga, J; Barriga, F J; Castillo, L; Carneado-Ruiz, J; Díaz-Guzman, J; Egido-Herrero, J; de Felipe, A; Fernández-Ferro, J; Frade-Pardo, L; García-Gallardo, Á; García-Pastor, A; Gil-Núñez, A; Gómez-Escalonilla, C; Guillán, M; Herrero-Infante, Y; Masjuan-Vallejo, J; Ortega-Casarrubios, M Á; Vivancos-Mora, J; Díez-Tejedor, E

2017-03-01

For patients with acute ischaemic stroke due to large-vessel occlusion, it has recently been shown that mechanical thrombectomy (MT) with stent retrievers is better than medical treatment alone. However, few hospitals can provide MT 24 h/day 365 days/year, and it remains unclear whether selected patients with acute stroke should be directly transferred to the nearest MT-providing hospital to prevent treatment delays. Clinical scales such as Rapid Arterial Occlusion Evaluation (RACE) have been developed to predict large-vessel occlusion at a pre-hospital level, but their predictive value for MT is low. We propose new criteria to identify patients eligible for MT, with higher accuracy. The Direct Referral to Endovascular Center criteria were defined based on a retrospective cohort of 317 patients admitted to a stroke center. The association of age, sex, RACE scale score and blood pressure with the likelihood of receiving MT were analyzed. Cut-off points with the highest association were thereafter evaluated in a prospective cohort of 153 patients from nine stroke units comprising the Madrid Stroke Network. Patients with a RACE scale score ≥ 5, systolic blood pressure <190 mmHg and age <81 years showed a significantly higher probability of undergoing MT (odds ratio, 33.38; 95% confidence interval, 12-92.9). This outcome was confirmed in the prospective cohort, with 68% sensitivity, 84% specificity, 42% positive and 94% negative predictive values for MT, ruling out 83% of hemorrhagic strokes. The Direct Referral to Endovascular Center criteria could be useful for identifying patients suitable for MT. © 2017 EAN.

The unintended consequences of The Centers for Medicare and Medicaid Services pay-for-performance structures on safety-net hospitals and the low-income, medically vulnerable population.

PubMed

Fos, Elmer B

2017-02-01

Safety-net hospitals are hospitals with patient mix that is substantially composed of the uninsured, underinsured, and low-income, medically vulnerable patient populations. They are the hospitals of last resort for poor patients. This article examined the impact of The Centers for Medicare and Medicaid Services pay-for-performance reimbursement policies on the financial viability of safety-net hospitals. Studies showed that these policies, which are based on the principle of reward and punishment, might have unintentionally placed safety-net hospitals on financial disadvantage compared to other hospital organizations. Several studies implied that these payment structures might have resulted in a situation where safety-net hospitals that are serving poor patient populations become more susceptible to penalties than hospitals that are serving affluent patients.

Workforce: Washington

ERIC Educational Resources Information Center

Western Interstate Commission for Higher Education, 2006

2006-01-01

In Washington, the demand for well-educated employees will only increase over the next several years. In the decade leading up to 2012, healthcare occupations will see growth of 20 percent. Teachers will be in demand: nearly 9,000 new elementary and middle-school educators will need to be hired. Computer fields will undergo growth of 24 percent,…

A Sustained Partnership between a Haitian Children’s Hospital and North American Academic Medical Centers

PubMed Central

Koster, Michael P.; Williams, Jackson H.; Gautier, Jacqueline; Alce, Renee; Trappey, Bernard E.

2017-01-01

Global health initiatives from academic medical centers have rapidly proliferated over the last decade. This paper endeavors to describe our 5-year experience as an academic medical collaborative supporting healthcare delivery, medical training, and research at Hôpital Saint Damien-Nos Petits Frères et Soeurs, the only freestanding children’s hospital in Haiti. Descriptions of the history and current activities of our academic medical collaborative, its partnership and communication structure, its evolution to fill the expressed needs of our host site, its funding mechanisms, and its challenges and opportunities for the future are included. PMID:28611976

Joint-venture proposals strengthen hospital-physician relationship.

PubMed

Rovinsky, M

2000-12-01

By proposing the joint-venture development of an ambulatory surgery center and medical office space with a group practice, one hospital succeeded in enhancing its relationship with the practice and paved the way for future collaboration. Although the hospital's proposal to jointly develop an ambulatory surgery center was not accepted, the hospital was able to dissuade the group practice from developing a competing ambulatory surgery facility while increasing the group's trust in and loyalty to the hospital. As a result, the hospital potentially will benefit from increased inpatient admissions.

Hospital-Acquired Pressure Ulcers at Academic Medical Centers in the United States, 2008-2012: Tracking Changes Since the CMS Nonpayment Policy.

PubMed

Padula, William V; Makic, Mary Beth F; Wald, Heidi L; Campbell, Jonathan D; Nair, Kavita V; Mishra, Manish K; Valuck, Robert J

2015-06-01

In 2007, the Centers for Medicare & Medicaid Services (CMS) announced its intention to no longer reimburse hospitals for costs associated with hospital-acquired pressure ulcers (HAPUs) and a list of other hospital-acquired conditions (HACs), which was followed by enactment of the nonpayment policy in October 2008. This study was conducted to define changes in HAPU incidence and variance since 2008. In a retrospective observational study, HAPU cases were identified at 210 University HealthSystem Consortium (UHC) academic medical centers in the United States. HAPU incidence rates were calculated as a ratio of HAPU cases to the total number of UHC inpatients between the first quarter of 2008 and the second quarter of 2012. HAPU cases were defined by multiple criteria: not present on admission (POA); coded for stage III or IV pressure ulcers; and a length of stay greater than four days. Among the UHC hospitals between 2008 and June 2012, 10,386 HAPU cases were identified among 4.08 million inpatients. The HAPU incidence rate decreased significantly from 11.8 cases per 1,000 inpatients in 2008 to 0.8 cases per 1,000 in 2012 (p < .001; 95% confidence interval: 8.39-8.56). Among HAPU cases were trends of more elderly patients, greater case-mix index, and more surgical cases. The analysis of covariance model identified CMS non-payment policy as a significant covariate of changing trends in HAPU incidence rates. HAPU incidence rates decreased significantly among 210 UHC AMCs after the enactment of the CMS nonpayment policy. The hospitals appeared to be reacting efficiently to economic policy incentives by improving prevention efforts.

Does hospital accreditation impact bariatric surgery safety?

PubMed

Morton, John M; Garg, Trit; Nguyen, Ninh

2014-09-01

To evaluate the impact of hospital accreditation upon bariatric surgery outcomes. Since 2004, the American College of Surgeons and the American Society of Metabolic and Bariatric Surgery have accredited bariatric hospitals. Few studies have evaluated the impact of hospital accreditation on all bariatric surgery outcomes. Bariatric surgery hospitalizations were identified using International Classification of Diseases, Ninth Revision (ICD9) codes in the 2010 Nationwide Inpatient Sample (NIS). Hospital names and American Hospital Association (AHA) codes were used to identify accredited bariatric centers. Relevant ICD9 codes were used for identifying demographics, length of stay (LOS), total charges, mortality, complications, and failure to rescue (FTR) events. There were 117,478 weighted bariatric patient discharges corresponding to 235 unique hospitals in the 2010 NIS data set. A total of 72,615 (61.8%) weighted discharges, corresponding to 145 (61.7%) named or AHA-identifiable hospitals were included. Among the 145 hospitals, 66 (45.5%) were unaccredited and 79 (54.5%) accredited. Compared with accredited centers, unaccredited centers had a higher mean LOS (2.25 vs 1.99 days, P < 0.0001), as well as total charges ($51,189 vs $42,212, P < 0.0001). Incidence of any complication was higher at unaccredited centers than at accredited centers (12.3% vs 11.3%, P = 0.001), as was mortality (0.13% vs 0.07%, P = 0.019) and FTR (0.97% vs 0.55%, P = 0.046). Multivariable logistic regression analysis identified unaccredited status as a positive predictor of incidence of complication [odds ratio (OR) = 1.08, P < 0.0001], as well as mortality (OR = 2.13, P = 0.013). Hospital accreditation status is associated with safer outcomes, shorter LOS, and lower total charges after bariatric surgery.

Outcomes for Students on a Fast Track to College: Early College Entrance Programs at the University of Washington

ERIC Educational Resources Information Center

Hertzog, Nancy B.; Chung, Rachel U.

2015-01-01

Radical acceleration from middle school to university is an unusual option in the United States. The Early Entrance Program and the University of Washington (UW) Academy for Young Scholars housed in the Halbert and Nancy Robinson Center for Young Scholars are two of only 21 early university entrance programs offered in the United States. Due to…

Are Evidence-based Practices Associated with Effective Prevention of Hospital-acquired Pressure Ulcers in U.S. Academic Medical Centers?

PubMed Central

Padula, William V.; Gibbons, Robert D.; Valuck, Robert J.; Makic, Mary Beth F.; Mishra, Manish K.; Pronovost, Peter J.; Meltzer, David O.

2016-01-01

Background In 2008, the Centers for Medicare and Medicaid Services (CMS) established nonpayment policies resulting from costliness of hospital-acquired pressure ulcers (HAPUs) to hospitals. This prompted hospitals to adopt quality improvement (QI) interventions that increase use of evidence-based practices (EBPs) for HAPU prevention. Objective To evaluate the longitudinal impact of CMS policy and QI adoption on HAPU rates. Methods We characterized longitudinal adoption of 25 QI interventions that support EBPs through hospital leadership, staff, information technology, and performance and improvement. Quarterly counts of HAPU incidence and inpatient characteristics were collected from 55 UHC hospitals between 2007–2012. Mixed-effects regression models tested the longitudinal association of CMS policy, HAPU coding and QI on HAPU rates. The models assumed level-2 random-intercepts and random effects for CMS policy and EBP implementation to account for between-hospital variability in HAPU incidence. Results Controlling for all 25 QI interventions, specific updates to EBPs for HAPU prevention had a significant, though modest reduction on HAPU rates (−1.86 cases/quarter; p=0.002) and the effect of CMS nonpayment policy on HAPU prevention was much greater (−11.32 cases/quarter; p<0.001). Conclusions HAPU rates were significantly lower following changes in CMS reimbursement. Reductions are associated with hospital-wide implementation of EBPs for HAPU prevention. Given that administrative data were used, it remains unknown whether these improvements were due to changes in coding or improved quality of care. PMID:27078824

Management of blood shortages in a tertiary care academic medical center: the Yale-New Haven Hospital frozen blood reserve.

PubMed

Erickson, Michelle L; Champion, Melanie H; Klein, Roger; Ross, Rebecca L; Neal, Zena M; Snyder, Edward L

2008-10-01

Threats to national and local blood supplies in America mandate development of an effective blood management system for emergency preparedness and efficient blood inventory management. Seasonal or acute blood shortages could be compounded by the unavoidable distribution inefficiencies of the blood pipeline during an emergency. The Yale-New Haven Hospital (YNHH) Blood Bank has developed a comprehensive emergency blood management plan, which includes maintenance of a tactical, limited frozen blood supply. A computer spreadsheet-based disaster prediction model has been designed to guide the use of the frozen reserve by testing various emergency scenarios. The frozen blood reserve can likely support normal hospital red blood cell (RBC) demands during typical (3-4 days) seasonal shortages, provide a reduced supply for up to 10 days, or meet an unexpected transient increased RBC demand without requiring intensive support from the regional blood center. However, the frozen blood supply is not designed to meet the massive transfusion demand associated with extreme or sustained disasters. Rather, it serves as a short-term bridge-over supply until blood center support can be reestablished. We review the reasons for initiating a blood management plan and describe how YNHH has implemented and sustains a frozen blood reserve as part of a comprehensive disaster management plan. Despite the operational complexity, the benefits of self-sufficiency, the ability to support routine hospital requirements, and the security of having a backup supply justify the expense and difficulty of maintaining a frozen blood reserve.

Association of Centers for Medicare & Medicaid Services Overall Hospital Quality Star Rating With Outcomes in Advanced Laparoscopic Abdominal Surgery.

PubMed

Koh, Christina Y; Inaba, Colette S; Sujatha-Bhaskar, Sarath; Nguyen, Ninh T

2017-12-01

The Centers for Medicare & Medicaid Services (CMS) recently released the Overall Hospital Quality Star Rating to help patients compare hospitals based on a 5-star scale. The star rating was designed to assess overall quality of the institution; thus, its validity toward specifically assessing surgical quality is unknown. To examine whether CMS high-star hospitals (HSHs) have improved patient outcomes and resource use in advanced laparoscopic abdominal surgery compared with low-star hospitals (LSHs). Using the University HealthSystem Consortium database (which includes academic centers and their affiliate hospitals) from January 1, 2013, through December 31, 2015, this administrative database observational study compared outcomes of 72 662 advanced laparoscopic abdominal operations between HSHs (4-5 stars) and LSHs (1-2 stars). The star rating includes 57 measures across 7 areas of quality. Patients who underwent advanced laparoscopic abdominal surgery, including bariatric surgery (sleeve gastrectomy, Roux-en-Y gastric bypass), colorectal surgery (colectomy, proctectomy), or hiatal hernia surgery (paraesophageal hernia repair, Nissen fundoplication), were included. Risk adjustment included exclusion of patients with major and extreme severity of illness. Main outcome measures included serious morbidity, in-hospital mortality, intensive care unit admissions, and cost. A total of 72 662 advanced laparoscopic abdominal operations were performed in patients at 66 HSHs (n = 38 299; mean [SD] age, 51.26 [15.25] years; 12 096 [31.5%] male and 26 203 [68.4%] female; 28 971 [75.6%] white and 9328 [24.4%] nonwhite) and 78 LSHs (n = 34 363; mean [SD] age, 49.77 [14.77] years; 9902 [28.8%] male and 24 461 [71.2%] female; 21 876 [67.6%] white and 12 487 [32.4%] nonwhite). The HSHs were observed to have fewer intensive care unit admissions (1007 [2.6%] vs 1711 [5.0%], P < .001) and lower mean cost ($7866 vs $8708, P < .001). No significant difference was

Hospitalizations of Adults with Intellectual Disability in Academic Medical Centers

ERIC Educational Resources Information Center

Ailey, Sarah H.; Johnson, Tricia; Fogg, Louis; Friese, Tanya R.

2014-01-01

Individuals with intellectual disability (ID) represent a small but important group of hospitalized patients who often have complex health care needs. Individuals with ID experience high rates of hospitalization for ambulatory-sensitive conditions and high rates of hospitalizations in general, even when in formal community care systems; however,…

Epidemiology, Risk Factors, and In-Hospital Mortality of Venous Thromboembolism in Liver Cirrhosis: A Single-Center Retrospective Observational Study

PubMed Central

Zhang, Xintong; Qi, Xingshun; De Stefano, Valerio; Hou, Feifei; Ning, Zheng; Zhao, Jiancheng; Peng, Ying; Li, Jing; Deng, Han; Li, Hongyu; Guo, Xiaozhong

2016-01-01

Background Risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), may be increased in liver cirrhosis. We conducted a single-center study to explore the epidemiology, risk factors, and in-hospital mortality of VTE in Chinese patients with liver cirrhosis. Material/Methods All patients with liver cirrhosis who were consecutively admitted to our hospital between January 2011 and December 2013 were retrospectively included. Results Of 2006 patients with liver cirrhosis included, 9 patients were diagnosed with or developed VTE during hospitalization, including 5 patients with a previous history of DVT, 1 patient with either a previous history of DVT or new onset of PE, and 3 patients with new onset of VTE (PE, n=1; DVT, n=2). Risk factors for VTE included a significantly higher proportion of hypertension and significantly higher red blood cells, hemoglobin, alanine aminotransferase, aspartate aminotransferase, prothrombin time (PT), international normalized ratio (INR), D-dimer, and Child-Pugh scores. The in-hospital mortality was significantly higher in patients with VTE than those without VTE (33.3% [3/9] versus 3.4% [67/1997], P<0.001). Conclusions VTE was observed in 0.4% of patients with liver cirrhosis during hospitalization and it significantly increased the in-hospital mortality. Elevated PT/INR aggravated the risk of VTE. PMID:27009380

29 CFR 2.2 - Employees attached to Washington office.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 1 2013-07-01 2013-07-01 false Employees attached to Washington office. 2.2 Section 2.2 Labor Office of the Secretary of Labor GENERAL REGULATIONS General § 2.2 Employees attached to Washington office. No person who has been an employee of the Department and attached to the Washington office...

29 CFR 2.2 - Employees attached to Washington office.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 1 2014-07-01 2013-07-01 true Employees attached to Washington office. 2.2 Section 2.2 Labor Office of the Secretary of Labor GENERAL REGULATIONS General § 2.2 Employees attached to Washington office. No person who has been an employee of the Department and attached to the Washington office...

29 CFR 2.2 - Employees attached to Washington office.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Employees attached to Washington office. 2.2 Section 2.2 Labor Office of the Secretary of Labor GENERAL REGULATIONS General § 2.2 Employees attached to Washington office. No person who has been an employee of the Department and attached to the Washington office...

29 CFR 2.2 - Employees attached to Washington office.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 1 2011-07-01 2011-07-01 false Employees attached to Washington office. 2.2 Section 2.2 Labor Office of the Secretary of Labor GENERAL REGULATIONS General § 2.2 Employees attached to Washington office. No person who has been an employee of the Department and attached to the Washington office...

29 CFR 2.2 - Employees attached to Washington office.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 1 2012-07-01 2012-07-01 false Employees attached to Washington office. 2.2 Section 2.2 Labor Office of the Secretary of Labor GENERAL REGULATIONS General § 2.2 Employees attached to Washington office. No person who has been an employee of the Department and attached to the Washington office...

12 CFR 4.4 - Washington office and web site.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 1 2013-01-01 2013-01-01 false Washington office and web site. 4.4 Section 4.4... EXAMINERS Organization and Functions § 4.4 Washington office and web site. The Washington office of the OCC...'s Web site is at http://www.occ.gov. [76 FR 43561, July 21, 2011] ...

12 CFR 4.4 - Washington office and web site.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 1 2014-01-01 2014-01-01 false Washington office and web site. 4.4 Section 4.4... EXAMINERS Organization and Functions § 4.4 Washington office and web site. The Washington office of the OCC...'s Web site is at http://www.occ.gov. [76 FR 43561, July 21, 2011] ...

12 CFR 4.4 - Washington office and web site.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Washington office and web site. 4.4 Section 4.4... EXAMINERS Organization and Functions § 4.4 Washington office and web site. The Washington office of the OCC...'s Web site is at http://www.occ.gov. [76 FR 43561, July 21, 2011] ...

30 CFR 947.700 - Washington Federal program.

Code of Federal Regulations, 2010 CFR

2010-07-01

....700 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR PROGRAMS FOR THE CONDUCT OF SURFACE MINING OPERATIONS WITHIN EACH STATE WASHINGTON § 947.700 Washington Federal program. (a) This part contains all rules that are applicable to surface coal mining operations in...

Smoke-free law associated with higher-than-expected taxable retail sales for bars and taverns in Washington State.

PubMed

Boles, Myde; Dilley, Julia; Maher, Julie E; Boysun, Michael J; Reid, Terry

2010-07-01

Continued progress in implementing smoke-free laws throughout the United States would benefit from documenting positive economic effects, particularly for the hospitality industry. This study describes changes in sales revenue in bars and taverns since December 2005, when a statewide smoke-free law in Washington State went into effect. Using 24 quarters of inflation-adjusted taxable retail sales data from 2002 through 2007, we fitted a regression model to estimate the effect of the smoke-free law on sales revenue, controlling for seasonality and other economic factors. We found no immediate change in bar revenues in the first quarter of 2006, but taxable retail sales grew significantly through the fourth quarter of 2007. In the 2 years after the smoke-free law was implemented, sales revenues were $105.5 million higher than expected for bars and taverns in Washington State. The higher-than-expected revenue from taxable sales in bars and taverns after the implementation of smoke-free laws in Washington State provided extra funds to the state general fund. Potential increases in revenue in other jurisdictions that implement smoke-free indoor air policies could provide funds to benefit residents of those jurisdictions.

5. 30 DIAMETER ACCESS MANHOLE IN THE CENTER OF THE ...

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

5. 30 DIAMETER ACCESS MANHOLE IN THE CENTER OF THE GATE HOUSE, LOOKING SOUTH. - Washington Water Power Spokane River Upper Falls Hydroelectric Development, Gates & Gate-Lifting Mechanisms, Spokane River, approximately 0.5 mile northeast of intersection of Spokane Falls Boulevard & Post Street, Spokane, Spokane County, WA

Practice Hospital Bed Safety

MedlinePlus

... Administration’s (FDA) Center for Devices and Radiological Health (CDRH). "They are used not only in hospitals, but ... long-term care facilities, and in private homes." CDRH reports that about 2.5 million hospital beds ...

Impact of Hospital Information Systems on Emergency Patient Processing

PubMed Central

Rusnak, James E.

1981-01-01

The Emergency Department offers the Hospital Information System's designer some unique problems to solve in the operational areas of patient registration, order entry, charge recording, and treatment processing. In a number of instances, Hospital Information Systems implementers have encountered serious difficulties in trying to design system components to support the requirements of the Emergency Services Department's operations. Washington Hospital has developed a very effective system for Emergency Services. The system's features are designed to meet the special requirements of the department and to maximize the use of the data captured by the Hospital Information System. The system supports accurate and timely charging for services. The treatment of the patient has been dramatically improved through the use of a computerized order processing and control. The installed systems resulted in a higher quality of care and cost effective operations.

Understanding health care provider barriers to hospital affiliated medical fitness center facility referral: a questionnaire survey and semi structured interviews.

PubMed

Smock, Carissa; Alemagno, Sonia

2017-08-03

The purpose of this study is to understand health care provider barriers to referring patients to Medical Fitness Center Facilities within an affiliated teaching hospital system using referral of diabetic services as an example. The aims of this study include: (1) to assess health care providers' awareness and use of facilities, (2) to determine barriers to referring patients to facilities, (3) identify current and needed resources and/or changes to increase referral to facilities. A 20-item electronic survey and requests for semi-structured interviews were administered to hospital system directors and managers (n = 51). Directors and managers instructed physicians and staff to complete the survey and interviews as applicable. Perceived barriers, knowledge, utilization, and referral of patients to Medical Fitness Center Facilities were collected and examined. Descriptive statistics were generated regarding practice characteristics, provider characteristics, and referral. Of the health care providers surveyed and interviewed (n = 25) 40% indicated verbally suggesting use of facilities, 24% provided a flyer about the facilities. No respondents indicated that they directly referred patients to the facilities. However, 16% referred patients to other locations for physical activity - including their own department's management and prevention services. 20% do not refer to Medical Fitness Center Facilities or any other lifestyle programs/locations. Lack of time (92%) and lack of standard guidelines and operating procedures (88%) are barriers to referral. All respondents indicated a strong ability to refer patients to Medical Fitness Center Facilities if given education about referral programs available as well as standard clinical guidelines and protocol for delivery. The results of this study indicate that, although few healthcare providers are currently referring patients to Medical Fitness Center Facilities, health care providers with an affiliated Medical Fitness

School-Based Health Centers

MedlinePlus

... care group, such as a community health center, hospital, or health department. A few are run by the school district itself. Centers often get money from charities and the government so they can give care ...

Malnutrition Diagnosis during Adult Inpatient Hospitalizations: Analysis of a Multi-Institutional Collaborative Database of Academic Medical Centers.

PubMed

Tobert, Conrad M; Mott, Sarah L; Nepple, Kenneth G

2018-01-01

Malnutrition is a significant problem for hospitalized patients. However, the true prevalence of reported malnutrition diagnosis in real-world clinical practice is largely unknown. Using a large collaborative multi-institutional database, the rate of malnutrition diagnosis was assessed and used to assess institutional variables associated with higher rates of malnutrition diagnosis. The aim of this study was to define the prevalence of malnutrition diagnosis reported among inpatient hospitalizations. The University Health System Consortium (Vizient) database was retrospectively reviewed for reported rates of malnutrition diagnosis. All adult inpatient hospitalization at 105 member institutions during fiscal years 2014 and 2015 were evaluated. Malnutrition diagnosis based on the presence of an International Classification of Diseases-Ninth Revision diagnosis code. Hospital volume and publicly available hospital rankings and patient satisfaction scores were obtained. Multiple regression analysis was performed to assess the association between these variables and reported rates of malnutrition. A total of 5,896,792 hospitalizations were identified from 105 institutions during the 2-year period. It was found that 292,754 patients (5.0%) had a malnutrition diagnosis during their hospital stay. By institution, median rate of malnutrition diagnosis during hospitalization was 4.0%, whereas the rate of severe malnutrition diagnosis was 0.9%. There was a statistically significant increase in malnutrition diagnosis from 4.0% to 4.9% between 2014 and 2015 (P<0.01). Institutional factors associated with increased diagnosis of malnutrition were higher hospital volume, hospital ranking, and patient satisfaction scores (P<0.01). Missing a malnutrition diagnosis appears to be a universal issue because the rate of malnutrition diagnosis was consistently low across academic medical centers. Institutional variables were associated with the prevalence of malnutrition diagnosis, which

Selected natural attenuation monitoring data, Operable Unit 1, Naval Undersea Warfare Center, Division Keyport, Washington, June 2001

USGS Publications Warehouse

Dinico, Richard Steven

2003-01-01

Previous investigations have shown that natural attenuation and biodegradation of chlorinated volatile organic compounds (CVOCs) are substantial in shallow ground water beneath the 9-acre former landfill at Operable Unit 1 (OU 1), Naval Undersea Warfare Center (NUWC), Division Keyport, Washington. The U.S. Geological Survey (USGS) has continued to monitor ground-water geochemistry to assure that conditions remain favorable for contaminant biodegradation. This report presents the ground-water geochemical and selected CVOC data collected at OU 1 by the USGS during June 11-14, 2001 in support of the long-term monitoring for natural attenuation. Overall, the June 2001 data indicate that redox conditions in the upper aquifer remain favorable for reductive dechlorination of CVOCs because strongly reducing conditions persisted beneath much of the former landfill. Redox conditions in the intermediate aquifer down gradient of the landfill appear to have become more favorable for reductive dechlorination because June 2001 dissolved hydrogen concentrations indicated strongly reducing conditions there for the first time. Although changes in redox conditions were observed at certain wells during 2001, a longer monitoring period is needed to ascertain if phytoremediation activities are affecting the ground-water chemistry. A minor change to future monitoring is proposed. Filtered organic carbon (previously referred to as dissolved, and defined as that which passes through a 0.45-micrometer membrane filter) should be analyzed in the future rather than unfiltered (previously referred to as total) organic carbon because the filtered analysis may be a better measure of bioavailable organic carbon. Unfiltered and filtered organic carbon data were collected during June 2001 for comparison. Filtered organic carbon data collected in the future could be reasonably compared with historical unfiltered organic carbon data by multiplying the historical data by a factor of about 0.9.

Three-dimensional velocity structure of Siletzia and other accreted terranes in the Cascadia forearc of Washington

USGS Publications Warehouse

Parsons, T.; Wells, R.E.; Fisher, M.A.; Flueh, E.; ten Brink, Uri S.

1999-01-01

Eocene mafic crust with high seismic velocities underlies much of the Oregon and Washington forearc and acts as a backstop for accretion of marine sedimentary rocks from the obliquely subducting Juan de Fuca slab. Arc-parallel migration of relatively strong blocks of this terrane, known as Siletzia, focuses upper crustal deformation along block boundaries, which are potential sources of earthquakes. In a three-dimensional velocity model of coastal Washington, we have combined surface geology, well data, and travel times from earthquakes and controlled source seismic experiments to resolve the major boundaries of the Siletz terrane with the adjacent accreted sedimentary prism and volcanic arc. In southern Washington and northern Oregon the Siletz terrane appears to be a thick block (???20 km) that extends west of the coastline and makes a high-angle contact with the offshore accreted sedimentary prism. On its east flank the high-velocity Siletz terrane boundary coincides with an en echelon zone of seismicity in the arc. In northern Washington the western edge of Siletzia makes a lower-angled, fault-bound contact with the accretionary prism. In addition, alternating, east-west trending uplifts and downwarps of the Siletz terrane centered on the antiformal Olympic Mountains may reflect focusing of north-south compression in the northern part of the Siletz terrane. This compressional strain may result from northward transport and clockwise rotation of the Siletz terrane into the relatively fixed Canadian Coast Mountains restraining bend along the coast.

Distribution of specialized care centers in the United States.

PubMed

Wang, Henry E; Yealy, Donald M

2012-11-01

As a recommended strategy for optimally managing critical illness, regionalization of care involves matching the needs of the target population with available hospital resources. The national supply and characteristics of hospitals providing specialized critical care services is currently unknown. We seek to characterize the current distribution of specialized care centers in the United States. Using public data linked with the American Hospital Association directory and US Census, we identified US general acute hospitals providing specialized care for ST-segment elevation myocardial infarction (STEMI) (≥40 annual primary percutaneous coronary interventions reported in Medicare Hospital Compare), stroke (The Joint Commission certified stroke centers), trauma (American College of Surgeons or state-designated, adult or pediatric, level I or II), and pediatric critical care (presence of a pediatric ICU) services. We determined the characteristics and state-level distribution and density of specialized care centers (centers per state and centers per state population). Among 4,931 acute care hospitals in the United States, 1,325 (26.9%) provided one of the 4 defined specialized care services, including 574 STEMI, 763 stroke, 508 trauma, and 457 pediatric critical care centers. Approximately half of the 1,325 hospitals provided 2 or more specialized services, and one fifth provided 3 or 4 specialized services. There was variation in the number of each type of specialized care center in each state: STEMI median 7 interquartile range (IQR 2 to 14), stroke 8 (IQR 3 to 17), trauma 6 (IQR 3 to 11), pediatric specialized care 6 (IQR 3 to 11). Similarly, there was variation in the number of each type of specialized care center per population: STEMI median 1 center per 585,135 persons (IQR 418,729 to 696,143), stroke 1 center per 412,188 persons (IQR 321,604 to 572,387), trauma 1 center per 610,589 persons (IQR 406,192 to 917,588), and pediatric critical care 1 center per 665

Building a patient-centered hospital web site: best practices in china.

PubMed

Huang, Edgar

2015-01-01

In this case study, based on six criteria, four Chinese hospitals were chosen from a national sample to showcase, through content analysis and in-depth interviews, the best practices of serving patients online. The extensive findings have addressed the following three questions: what these hospitals have in common in their Web development, what problems and challenges they are facing, and how they have excelled in serving their patients online. The study concludes that, like larger hospitals, smaller hospitals can also excel in creating an outstanding Web site to serve their patients so long as they truly care about their patients, have a clear vision and strong expertise in IT development. The study also concludes that Chinese private hospitals can learn from these state-owned hospitals in establishing a good reputation through professional and responsible interaction with patients. The four hospitals studied may shed light on the Web development in many other Chinese hospitals that are going through the same healthcare new media adoption. The findings from this study can also help Chinese hospitals form their visions in serving patients online.

Pre-IGY Ionosphere Over Washington D.C

NASA Astrophysics Data System (ADS)

Rice, D. D.; Sojka, J. J.; Eccles, J. V.; Hunsucker, R. D.

2012-12-01

A data recovery study has been sponsored by the NSF to determine how successfully the ionosphere during a pre-IGY era can be inferred from archived ionogram films. This pilot study targets the Washington, DC ionosonde WA938 located at Ft. Belvoir in Fairfax, VA (38.7° N, -77.1° E). The focus of the study is 1951, 61 years ago, or about 5 1/2 solar cycles ago. The ionosonde was a model C-3 designed by the National Bureau of Standards (NBS). Ionograms were taken at approximately six per hour, but not uniformly spaced in time. These were recorded on an extended frame 35 mm film. Between 2-4 weeks of ionograms were recorded on a single film reel. These films were archived at the NOAA's National Geophysical Data Center (NGDC), also known as a World Data Center . Over the past five years, NGDC has been able to digitize several months from selected years of these films. These digitized ionogram images are the starting point for the ionospheric data analysis for this study. SEC has developed an image processing technique called the Expert System for Ionogram Reduction (ESIR), which has been patented [Sojka et al. 2009]. This software was developed specifically to recognize and invert an ionogram from a photographic image, producing an equivalent ionospheric electron density profile. The recognition of both virtual height and frequency axes in these ionogram photos is discussed. We demonstrate how we can validate and calibrate these scales independent of the ionosonde's virtual height and frequency markings. Examples during several months of 1951 of the automated ESIR ionogram reduction will be provided. These examples will be presented in the context of how the mid-latitude ionosphere over Washington DC in 1951 compares with the present-day ionosphere. Limitations in the data extraction are discussed from a point of view of how they might affect confidence in the inferred long-term trends in the ionosphere. Reference: Sojka J. J., D. C. Thompson, D. D. Rice (2009

Stimulated Recall Methodology for Assessing Work System Barriers and Facilitators in Family-Centered Rounds in a Pediatric Hospital

PubMed Central

Carayon, Pascale; Li, Yaqiong; Kelly, Michelle M.; DuBenske, Lori L.; Xie, Anping; McCabe, Brenna; Orne, Jason; Cox, Elizabeth D.

2014-01-01

Human factors and ergonomics methods are needed to redesign healthcare processes and support patient-centered care, in particular for vulnerable patients such as hospitalized children. We implemented and evaluated a stimulated recall methodology for collective confrontation in the context of family-centered rounds. Five parents and five healthcare team members reviewed video records of their bedside rounds, and were then interviewed using the stimulated recall methodology to identify work system barriers and facilitators in family-centered rounds. The evaluation of the methodology was based on a survey of the participants, and a qualitative analysis of interview data in light of the work system model of Smith and Carayon (1989; 2000). Positive survey feedback from the participants was received. The stimulated recall methodology identified barriers and facilitators in all work system elements. Participatory ergonomics methods such as the stimulated recall methodology allow a range of participants, including parents and children, to participate in healthcare process improvement. PMID:24894378

[Evolution of the number of incident cases of prostate cancer in France from 2001 to 2012 from 5 hospital centers].

PubMed

Helfrich, O; Crouzet, S; Ruffion, A; Houlgatte, A; Cavillon, C; Gerard, C; Villers, A

2015-03-01

The main objective is the study of the evolution of the number of incident cases of prostate cancer in France from 2001 to 2012 from 5 hospital centers of urology. The secondary objective is to describe the characteristics of the incident cases and to compare them to those of the patients of the national registers of cancer for the period. Prospective observational multicentric study from 01/01/2001 to 31/12/2012 of databases in 5 French, public and private hospital centers of urology. The inclusive centers were selected outside departments with cancer register. The collected data were the prostatic biopsies performed in every center and the number of positive biopsies. The biopsies in cases of already known cancer and in re-evaluation were excluded. The data of age and stage (PSA and Gleason grade) were collected. The estimation of the incidence standardized in France is established after a period of observation of 3 years. The data updated in 2009 show a peak of incidence in 2005 then a decrease from 2006 (64,518 cases) until 2009 (53,465 cases). The median age in the diagnosis was of 70 years in 2005. Overall, 18,392 prostatic biopsies were included in the analysis. The average rate of positive biopsies was stable over the period 51.41% (IQR 0,02). The total number of cases of positive biopsies increased from 2001 to 2007 (482 cases in 1028 cases) in 2007, then decreased from 2008 to 2012 (649 cases). There was no difference in this variation between the centers. The median age in the diagnosis was of 70 years (EIQ=1.5) in 2001 and 68 years (EIQ=2.75) in 2012. PSA at diagnosis was<10ng/mL in 65% of cases and 10 to 20ng/mL in 22% of cases in 2012. The population of patients of the study differed significantly from that of FRANCIM on the distribution by age ranges (year 2005, P<0.0001 and year 2009, P<0.001), which explains the gap of one year (on 2007 instead of 2006) of the peak of incidental cases. The evolution of the number of incidental cases of prostate

Aerial view southwest from center of square showing south portion ...

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

Aerial view southwest from center of square showing south portion of alley, rears of 1007 E Street, 1009 E Street, and the National Capital Press Building and alley (east) wall of 1101 E Street - Square 347 (Commercial Buildings), Tenth, Eleventh, E, & F Streets, Northwest, Washington, District of Columbia, DC

Efficacy of Implementation of a Chest Pain Center at a Community Hospital.

PubMed

Davis, Alexandra; Chiu, Jason; Lau, Stanley K; Kok, Yih Jen; Wu, Jonathan Y H

2017-12-01

Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, <20% of the patients have acute coronary syndrome that require immediate attention. The HEART score is designed for rapid risk stratification of ED chest pain patients using the following criteria: history, electrocardiogram, age, risk factors, and troponin. It has been shown to be superior in identifying patients with low (HEART score 0-3) and high (7-10) risk of major adverse cardiac events, who can then be rapidly discharged or admitted for intervention. This retrospective review and assessment sought to evaluate the efficacy of implementation of a Chest Pain Center (CPC) at a predominantly Asian-based community hospital in the United States. Additionally, this assessment sought to evaluate the effectiveness and safety of a HEART protocol in the first 4 months after its adoption. The facility implemented the CPC, an observation unit, in October 2016. ED physicians risk stratified patients using the HEART score. The guidelines allow ED physicians to stratify patients into 3 categories: to discharge low-risk patients, observe moderate-risk patients in the CPC, and admit high-risk patients. Patients in the CPC received additional diagnostic work-up under the care of ED physicians and cardiologists for less than 24 hours. In addition, CPC patients were followed-up 2 and 30 days after discharge. A total of 172 patients presented at the ED with a chief complaint of chest pain. The majority of the patients were classified into the moderate-risk group (n = 101). Low-risk patients spent significantly less hours in the hospital than the moderate- and high-risk groups, and the high-risk group spent more time in the hospital than the moderate-risk group. The staff followed-up with 74 CPC patients through telephone calls to assess if patients were still experiencing chest pain and if they had followed-up with a cardiologist or primary care physician. The 2- and 30-day

Are the CMS Hospital Outpatient Quality Measures Relevant for Rural Hospitals?

ERIC Educational Resources Information Center

Casey, Michelle M.; Prasad, Shailendra; Klingner, Jill; Moscovice, Ira

2012-01-01

Context: Quality measures focused on outpatient settings are of increasing interest to policy makers, but little research has been conducted on hospital outpatient quality measures, especially in rural settings. Purpose: To evaluate the relevance of Centers for Medicare and Medicaid Services' (CMS) outpatient quality measures for rural hospitals,…

2013 NIEHS/EPA Children's Centers Annual Meeting: Protecting Children's Health for a Lifetime

EPA Science Inventory

This report includes proceedings from the 2013 NIEHS/EPA Children's Centers Annual Meeting, held in Washington D.C. in October, 2013. Summaries of presentations, speaker biosketches, poster abstracts, and a meeting participant list are all included.

Father Secchi Goes to Washington

NASA Astrophysics Data System (ADS)

McCarthy, M. F.

1994-12-01

In 1848 a small group of Jesuit refugees arrived at Georgetown College near Washington, D.C. Among them was a young priest, Angelo Secchi, who had finished theology studies in Rome, but had not been able to complete his final examinations. This done successfully, Secchi turned to astronomy and the new facilities of the Georgetown College Observatory, directed by its founder, Fr. James Curley. During his two years in Washington, Secchi studied physics, wrote an article on Electrical Rheometry for the Smithsonian Institution, and formed a friendship with Matthew Fontaine Maury of the U.S. Navy, who headed the Chart Service and in 1844 was named superintendent of the National Observatory. This was later named the U.S. Naval Observatory. Secchi's friendships formed during the Washington visit proved most helpful for relations between European astronomers and U.S. colleagues. Secchi, after his return to Rome constructed the Observatory of the Collegio Romano atop the baroque Church of St. Ignatius in Rome and began his work in spectral classification of stars.

[RABIN MEDICAL CENTER - A TERTIARY CENTER OF EXCELLENCE IN SERVICE, TEACHING AND RESEARCH].

PubMed

Niv, Yaron; Halpern, Eyran

2017-04-01

Rabin Medical Center (RMC) belongs to Clalit Health Services and is a tertiary, academic medical center with all the facilities of modern and advanced medicine. Annually in the RMC, 650,000 patients are treated in the outpatient clinics, and 100,000 patients are hospitalized in the hospital departments. All these patients are treated by 4500 devoted staff members, including 1000 physicians and 2000 nurses. RMC is one of the largest, centrally located medical centers for medical and nursing students' education in Israel, taking place in clinical departments, as well as in basic sciences courses. We also have a nursing school attached to the hospital. Our vision supports excellence in research. We have a special Research Department that supports RMC researchers, with research coordinators, and all the relevant facilities to assist in clinical and basic science studies. We also promote collaboration efforts with many academic centers in Israel and abroad. The scope of RMC research is broad, including 700 new studies every year and 1500 active studies currently. This issue of Harefuah is dedicated to the clinical and basic science research conducted at RMC with original papers presenting research performed by our departments and laboratories.

Washington State Survey of Adolescent Health Behaviors.

ERIC Educational Resources Information Center

Washington State Dept. of Social and Health Services, Olympia.

The 1992 Washington State Survey of Adolescent Health Behaviors (WSSAHB) was created to collect information regarding a variety of adolescent health behaviors among students in the state of Washington. It expands on two previous administrations of a student tobacco, alcohol, and other drug survey and includes questions about medical care, safety,…

Aerospace Training. Washington's Community and Technical Colleges

ERIC Educational Resources Information Center

Washington State Board for Community and Technical Colleges, 2014

2014-01-01

Aerospace is an economic powerhouse that generates jobs and fuels our economy. Washington's community and technical colleges produce the world-class employees needed to keep it that way. With about 1,250 aerospace-related firms employing more than 94,000 workers, Washington has the largest concentration of aerospace expertise in the nation. To…

Corrections Education. Washington's Community and Technical Colleges

ERIC Educational Resources Information Center

Washington State Board for Community and Technical Colleges, 2015

2015-01-01

The Washington State Department of Corrections contracts with community colleges to provide basic education and job training at each of the state's 12 adult prisons so upon release, individuals are more likely to get jobs and less likely to return. Washington State community colleges build a bridge for offenders to successfully re-enter…

Implementation of a clinical pharmacy specialist-managed telephonic hospital discharge follow-up program in a patient-centered medical home.

PubMed

Anderson, Sarah L; Marrs, Joel C; Vande Griend, Joseph P; Hanratty, Rebecca

2013-08-01

The objectives of this retrospective study were to examine the feasibility and characteristics that define successful implementation of a Clinical Pharmacy Specialist (CPS) telephonic hospital discharge follow-up quality improvement initiative, as well as the impact of this initiative. Adult patients who were discharged from a safety-net hospital between July 1, 2010 and June 30, 2011 and who were part of a patient-centered medical home were included in this quality improvement initiative. CPSs attempted to contact 470 patients; of those, 207 received the intervention and 263 did not. Patients in the contacted group were more likely to attend a hospital discharge follow-up appointment (66.2% vs. 44.5%, P<0.01) and had lower rates of 30-day readmission (22 vs. 52, P<0.01) compared to those who were not contacted. Institutions should consider allocating resources for pharmacist-managed posthospital discharge follow-up services because of the potential for positive clinical and financial impact.

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

PubMed

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

2016-06-01

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

Community & Technical College Share of Washington's Educational Attainment Goals for 2023

ERIC Educational Resources Information Center

Washington State Board for Community and Technical Colleges, 2015

2015-01-01

In 2013, the Washington Student Achievement Council (WSAC) set a 10 year plan for improving the educational attainment of Washington residents. The Roadmap included two educational attainment goals for 2023: (1) All adults in Washington, ages 25-44, will have a high school diploma or equivalent; and (2) At least 70 percent of Washington adults,…

78 FR 46258 - Drawbridge Operation Regulation Lake Washington, Seattle, WA

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-31

... Operation Regulation Lake Washington, Seattle, WA AGENCY: Coast Guard, DHS. ACTION: Notice of deviation from... that governs the Evergreen Point Floating Bridge (State Route 520 across Lake Washington) at Seattle... Route 520 across Lake Washington) remain closed to vessel traffic to facilitate safe passage of...

State of Washington Population Trends, 1977. Washington State Information Report.

ERIC Educational Resources Information Center

Washington State Office of Program Planning and Fiscal Management, Olympia.

As of April 1, 1977, Washington's population was estimated at 3,661,975--an increase of 248,725 since 1970. Prepared yearly, this report presents data on the official April 1 population estimates for cities, towns, and counties; components of population change; planned population forecasting activities; procedures which help make the housing unit…

108th Convention of the American Psychological Association. Washington, DC, August 4-8, 2000

PubMed

2000-04-01

Washington, DC--the nation's capital--celebrates a history rich in diversity and character. One of the most popular cities for sightseeing, Washington contains countless points of interest for its visitors. The world's largest museum complex, the Smithsonian Institution, invites you to explore exhibits that highlight the scientific, cultural, political, and technological developments of the United States and its people. Visit the home to original pieces of the American heritage, such as the Declaration of Independence, the Constitution, and the Bill of Rights, that have helped to shape the way we live today. The art lovers among you will delight in the seven major art galleries. See the modern art and sculpture of the Hirshhorn Museum and the newly opened Sculpture Garden; the Sackler Gallery's collection of Asian art; and the only museum devoted to the art and culture of Africa, the National Museum of African Art. In Washington, there is music in the air, from the Kennedy Center's many stages and the clubs of Georgetown and Adams Morgan to the military bands that give concerts on the Mall. Whatever your culinary desire, be it authentic Texas chili or the finest Asian cuisine, you'll find it at one of the city's internationally famous eateries. What a perfect place for APA to convene its first annual convention of the new millennium!

Remote Antimicrobial Stewardship in Community Hospitals

PubMed Central

Wood, Zachary H.; Nicolsen, Nicole C.; Allen, Nichole; Cook, Paul P.

2015-01-01

Antimicrobial stewardship has become standard practice at university medical centers, but the practice is more difficult to implement in remote community hospitals that lack infectious diseases trained practitioners. Starting in 2011, six community hospitals within the Vidant Health system began an antimicrobial stewardship program utilizing pharmacists who reviewed charts remotely from Vidant Medical Center. Pharmacists made recommendations within the electronic medical record (EMR) to streamline, discontinue, or switch antimicrobial agents. Totals of charts reviewed, recommendations made, recommendations accepted, and categories of intervention were recorded. Linear regression was utilized to measure changes in antimicrobial use over time. For the four larger hospitals, recommendations for changes were made in an average of 45 charts per month per hospital and physician acceptance of the pharmacists’ recommendations varied between 83% and 88%. There was no significant decrease in total antimicrobial use, but much of the use was outside of the stewardship program’s review. Quinolone use decreased by more than 50% in two of the four larger hospitals. Remote antimicrobial stewardship utilizing an EMR is feasible in community hospitals and is generally received favorably by physicians. As more community hospitals adopt EMRs, there is an opportunity to expand antimicrobial stewardship beyond the academic medical center. PMID:27025642

75 FR 73073 - Washington Gas Light Company; Notice of Filing

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-29

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR11-74-000] Washington Gas Light Company; Notice of Filing November 18, 2010. Take notice that on November 15, 2010, Washington Gas Light Company (Washington Gas) filed its annual actual lost and unaccounted for volumes (LAUF...

76 FR 26719 - Washington 10 Storage Corporation; Notice of Filing

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-09

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR11-80-001] Washington 10 Storage Corporation; Notice of Filing Take notice that on April 29, 2011, Washington 10 Storage Corporation (Washington 10) filed a revised Statement of Operating Conditions (SOC) to comply with an April 25...

76 FR 78915 - Washington 10 Storage Corporation; Notice of Filing

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-20

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR12-10-000] Washington 10 Storage Corporation; Notice of Filing Take notice that on December 13, 2011, Washington 10 Storage Corporation (Washington 10) filed a Statement of Operating Conditions to revise certain provisions of its Firm...

Creating a Resource Center for Homeschoolers: The Impact of Technology.

ERIC Educational Resources Information Center

Javid, Mahnaz A.

1998-01-01

Summarizes the findings of a two-month case study of Edmonds Cyberschool (Washington), a resource center for homeschoolers. The study focused on the impact of technology on students' learning as indicated in three areas: attitude toward technology, the use of technology, and value of technology versus other available resources. (Author/LRW)

Economic viability of geriatric hip fracture centers.

PubMed

Clement, R Carter; Ahn, Jaimo; Mehta, Samir; Bernstein, Joseph

2013-12-01

Management of geriatric hip fractures in a protocol-driven center can improve outcomes and reduce costs. Nonetheless, this approach has not spread as broadly as the effectiveness data would imply. One possible explanation is that operating such a center is not perceived as financially worthwhile. To assess the economic viability of dedicated hip fracture centers, the authors built a financial model to estimate profit as a function of costs, reimbursement, and patient volume in 3 settings: an average US hip fracture program, a highly efficient center, and an academic hospital without a specific hip fracture program. Results were tested with sensitivity analysis. A local market analysis was conducted to assess the feasibility of supporting profitable hip fracture centers. The results demonstrate that hip fracture treatment only becomes profitable when the annual caseload exceeds approximately 72, assuming costs characteristic of a typical US hip fracture program. The threshold of profitability is 49 cases per year for high-efficiency hip fracture centers and 151 for the urban academic hospital under review. The largest determinant of profit is reimbursement, followed by costs and volume. In the authors’ home market, 168 hospitals offer hip fracture care, yet 85% fall below the 72-case threshold. Hip fracture centers can be highly profitable through low costs and, especially, high revenues. However, most hospitals likely lose money by offering hip fracture care due to inadequate volume. Thus, both large and small facilities would benefit financially from the consolidation of hip fracture care at dedicated hip fracture centers. Typical US cities have adequate volume to support several such centers.

42 CFR 413.83 - Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital...

Code of Federal Regulations, 2010 CFR

2010-10-01

... target amount or prospective payment hospital-specific rate. 413.83 Section 413.83 Public Health CENTERS... Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital-specific...-increase ceiling or prospective payment base year for purposes of adjusting the hospital's target amount or...

42 CFR 413.83 - Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital...

Code of Federal Regulations, 2011 CFR

2011-10-01

... target amount or prospective payment hospital-specific rate. 413.83 Section 413.83 Public Health CENTERS... Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital-specific...-increase ceiling or prospective payment base year for purposes of adjusting the hospital's target amount or...

The Experience of Hospital Death: Assessing the Quality of Care at an Academic Medical Center.

PubMed

Carey, Elise C; Dose, Ann M; Humeniuk, Katherine M; Kuan, Yichen C; Hicks, Ashley D; Ottenberg, Abigale L; Tilburt, Jon C; Koenig, Barbara

2018-02-01

The quality of perimortem care received by patients who died at our hospitals was unknown. To describe the quality of hospital care experienced in the last week of life, as perceived by decedents' families. Telephone survey that included established measures and investigator-developed content. Large, tertiary care center known for high-quality, cost-effective care. Family members of 104 patients who died in-hospital (10% of annual deaths) over the course of 1 year. None. Participant perceptions of the decedent's care, including symptom management, personal care, communication, and care coordination. Decedents were mostly male (64%), white (96%), married (73%), and Christian (91%). Most survey participants were spouses of the decedent (68%); they were predominately white (98%), female (70%), and Christian (90%) and had a median age of 70 years (range, 35-91 years). Overall satisfaction was high. Pain, dyspnea, and anxiety or sadness were highly prevalent among decedents (73%, 73%, and 55%, respectively) but largely well managed. Most participants believed that decedents were treated respectfully and kindly by staff (87%) and that sufficient help was available to assist with medications and dressing changes (97%). Opportunities for improvement included management of decedents' anxiety or sadness (29%) and personal care (25%), emotional support of the family (57%), communication regarding decedents' illness (29%), and receiving contradictory or confusing information (33%). Despite high satisfaction with care overall, we identified important unmet needs. Addressing these gaps will improve the care of dying patients.

Is healthy competition healthy? New evidence of the impact of hospital competition.

PubMed

Gift, Thomas L; Arnould, Richard; DeBrock, Larry

2002-01-01

Competition among hospitals is commonly regarded as inefficient due to the medical arms race phenomenon, but most evidence for this hypothesis predates the Medicare prospective payment system and preferred provider legislation. Recent studies indicate hospital competition reduces costs and prices, but nearly all such research has focused on California. We add to the body of literature that analyzes the effects of competition in hospital markets. Using data from the state of Washington, we show that hospitals assume more risk in competitive markets by being more likely to accept prospective payment arrangements with insurers. If the arrangement is retrospective, the hospital is more likely to offer a discount as the number of competing hospitals increases. Both findings indicate that competitive forces operate the same in hospital markets as in most others: as the number of competitors increases, prices decrease and market power shifts from the suppliers to purchasers. The medical arms race hypothesis that favors more concentrated hospital markets no longer appears to be valid.

Western Fisheries Research Center--Forage fish studies in Puget Sound

USGS Publications Warehouse

Liedtke, Theresa L.

2012-01-01

Researchers at the Western Fisheries Research Center are working with other U.S. Geological Survey (USGS) Centers to better understand the interconnected roles of forage fishes throughout the ecosystem of Puget Sound, Washington. Support for these studies primarily is from the USGS Coastal Habitats in Puget Sound (CHIPS) program, which supports studies of the nearshore areas of Puget Sound. Human perturbations in the nearshore area such as shoreline armoring or urban development can affect the nearshore habitats critical to forage fish.

75 FR 53964 - Washington Gas Light Company; Notice of Filing

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-02

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR09-8-004] Washington Gas Light Company; Notice of Filing August 27, 2010. Take notice that on August 24, 2010, Washington Gas Light Company (Washington Gas) filed to revise the Statement of Interstate Service Rates of its Firm...

Reshaping the Image of Booker T. Washington

ERIC Educational Resources Information Center

Norrell, Robert J.

2009-01-01

Booker T. Washington, founder of the Tuskegee Institute and the recognized leader of American black people from 1895 until his death in 1915, has been viewed as an accommodationist to segregation, an African-American leader who traded black equality and voting rights for his own influence among white bigots. Washington rose to national fame with a…

Early Childhood Injury Deaths in Washington State.

ERIC Educational Resources Information Center

Starzyk, Patricia M.

This paper discusses data on the deaths of children aged 1-4 years in Washington State. A two-fold approach was used in the analysis. First, Washington State death certificate data for 1979-85 were used to characterize the deaths and identify hazardous situations. Second, death certificates were linked to birth certificates of children born in…

Geologic map of the Richland 1:100,000 quadrangle, Washington

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

Reidel, S.P.; Fecht, K.R.

1993-09-01

This map of the Richland 1:100,000-scale quadrangle, Washington, shows the geology of one of fifteen complete or partial 1:100,000-scale quadrangles that cover the southeast quadrant of Washington. Geologic maps of these quadrangles have been compiled by geologists with the Washington Division of Geology and Earth Resources (DGER) and Washington State University and are the principal data sources for a 1:250,000-scale geologic map of the southeast quadrant of Washington, which is in preparation. Eleven of these quadrangles are being released as DGER open-file reports. The map of the Wenatchee quadrangle has been published by the US Geological Survey, and the Mosesmore » Lake, Ritzville quadrangles have already been released.« less

Plasma Science and Innovation Center at Washington, Wisconsin, and Utah State: Final Scientific Report for the University of Wisconsin-Madison

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

Sovinec, Carl R.

The University of Wisconsin-Madison component of the Plasma Science and Innovation Center (PSI Center) contributed to modeling capabilities and algorithmic efficiency of the Non-Ideal Magnetohydrodynamics with Rotation (NIMROD) Code, which is widely used to model macroscopic dynamics of magnetically confined plasma. It also contributed to the understanding of direct-current (DC) injection of electrical current for initiating and sustaining plasma in three spherical torus experiments: the Helicity Injected Torus-II (HIT-II), the Pegasus Toroidal Experiment, and the National Spherical Torus Experiment (NSTX). The effort was funded through the PSI Center's cooperative agreement with the University of Washington and Utah State University overmore » the period of March 1, 2005 - August 31, 2016. In addition to the computational and physics accomplishments, the Wisconsin effort contributed to the professional education of four graduate students and two postdoctoral research associates. The modeling for HIT-II and Pegasus was directly supported by the cooperative agreement, and contributions to the NSTX modeling were in support of work by Dr. Bickford Hooper, who was funded through a separate grant. Our primary contribution to model development is the implementation of detailed closure relations for collisional plasma. Postdoctoral associate Adam Bayliss implemented the temperature-dependent effects of Braginskii's parallel collisional ion viscosity. As a graduate student, John O'Bryan added runtime options for Braginskii's models and Ji's K2 models of thermal conduction with magnetization effects and thermal equilibration. As a postdoctoral associate, O'Bryan added the magnetization effects for ion viscosity. Another area of model development completed through the PSI-Center is the implementation of Chodura's phenomenological resistivity model. Finally, we investigated and tested linear electron parallel viscosity, leveraged by support from the Center for Extended

Requirements for a Washington State freight simulation model.

DOT National Transportation Integrated Search

2009-12-01

WSDOT and TransNow have already allocated $190,000 to researchers at the University of Washington and the : Washington State University to explore the flow of goods through the transportation system, the dynamics of that flow in : response to disrupt...

Nationwide survey of cancer center programs in Korea

PubMed Central

Kim, Ji-Youn; Yi, Eun-Surk

2017-01-01

This study was conducted to investigate cancer centers established for the purpose of satisfying various needs about cancer, improving the cancer treatment environment, and subdividing services ranging from diagnosis, treatment, and rehabilitation to palliative care. To this end, the authors have surveyed programs in 17 cancer centers representing Korea, including 12 national cancer centers and five major hospitals. As a result, it was found that the most common type of lecture program was disease management, followed by health care and hospitalization, while the most common type of participation program was psychological relief, followed by physical activity. The most frequently operated type of program was found to be psychological relief, followed by physical activity and health care in the regional cancer centers, while the most frequently operated type was disease management, followed by psychological relief and health care in the five major hospitals. The proportion of physical activity was very high in two regional cancer centers, whereas five regional cancer centers did not offer physical activity programs at all. In the five major hospitals, physical activity programs were conducted regularly at least once a month or at least once a week. In addition, further studies are required to provide professional and detailed medical services for the establishment and operation of programs for cancer patient management and the environmental aspects of the hospital. PMID:28702441

Notes from the field: Acute pesticide-related illness resulting from occupational exposure to acrolein - Washington and California, 1993-2009.

PubMed

2013-04-26

Acrolein is an aquatic herbicide used in the western United States to prevent impaired water flow in irrigation canals. Despite its toxicity, few cases of acrolein-related illness have been reported in the literature. On August 15, 2012, an irrigation district notified the Washington State Department of Labor & Industries (L&I) of acrolein-related illness in one of its pesticide applicators. L&I inspected the site and interviewed the exposed worker, coworkers, and employer. The Washington State Department of Health assisted by obtaining medical records, interviewing the patient and hospital staff, and reviewing information obtained from L&I. To look for additional cases, CDC reviewed data from the SENSOR-Pesticides program* and the California Department of Pesticide Regulation for 1993-2009, the most recent years of data availability, and identified seven additional cases of acute acrolein-related illness.

76 FR 377 - Land Acquisitions; Cowlitz Indian Tribe of Washington

Federal Register 2010, 2011, 2012, 2013, 2014