Pelone, F.; Basso, D.; Lilli, S.; Belvis, A.G. de; Rosano, A.; Zee, J. van der; Ricciardi, W.
Background: Ambulatory care sensitive conditions (ACSCs) are diseases where the provision of primary health care (PHC) interventions may affect the severity of the disease and prevent hospitalization. This study aimed at exploring changes of different definitions and classification of ACSCs and the
U.S. Department of Health & Human Services — About 25 percent of the hospitalizations for dual eligible beneficiaries in 2005 were potentially avoidable. Medicare and Medicaid spending for those potentially...
Hantel, Andrew; Wroblewski, Kristen; Balachandran, Jay S.; Chow, Selina; DeBoer, Rebecca; Fleming, Gini F.; Hahn, Olwen M.; Kline, Justin; Liu, Hongtao; Patel, Bhakti K.; Verma, Anshu; Witt, Leah J.; Fukui, Mayumi; Kumar, Aditi; Howell, Michael D.; Polite, Blase N.
Purpose: Terminal oncology intensive care unit (ICU) hospitalizations are associated with high costs and inferior quality of care. This study identifies and characterizes potentially avoidable terminal admissions of oncology patients to ICUs. Methods: This was a retrospective case series of patients cared for in an academic medical center’s ambulatory oncology practice who died in an ICU during July 1, 2012 to June 30, 2013. An oncologist, intensivist, and hospitalist reviewed each patient’s electronic health record from 3 months preceding terminal hospitalization until death. The primary outcome was the proportion of terminal ICU hospitalizations identified as potentially avoidable by two or more reviewers. Univariate and multivariate analysis were performed to identify characteristics associated with avoidable terminal ICU hospitalizations. Results: Seventy-two patients met inclusion criteria. The majority had solid tumor malignancies (71%), poor performance status (51%), and multiple encounters with the health care system. Despite high-intensity health care utilization, only 25% had documented advance directives. During a 4-day median ICU length of stay, 81% were intubated and 39% had cardiopulmonary resuscitation. Forty-seven percent of these hospitalizations were identified as potentially avoidable. Avoidable hospitalizations were associated with factors including: worse performance status before admission (median 2 v 1; P = .01), worse Charlson comorbidity score (median 8.5 v 7.0, P = .04), reason for hospitalization (P = .006), and number of prior hospitalizations (median 2 v 1; P = .05). Conclusion: Given the high frequency of avoidable terminal ICU hospitalizations, health care leaders should develop strategies to prospectively identify patients at high risk and formulate interventions to improve end-of-life care. PMID:27601514
van der Horst, H E
From an analysis of data from 23 European countries to determine the impact of primary care on avoidable hospital admissions for uncontrolled diabetes it appeared that, contrary to expectation, countries with strong primary care did not have a lower rate of avoidable hospital admission. It is clear that Roemer's law, 'a bed built is a bed filled,' still applies. However, the validity of this sort of analysis can be questioned, as these data are highly aggregated, and registration quality differs between countries. It is also questionable if these datasets can be considered as 'big data' as there are relatively small numbers per country. Big data analyses are useful for discerning patterns and formulating hypotheses, but not for proving causality. An unwanted side effect of this kind of analysis might be that policymakers use these not so valid results to underpin their policy to their advantage.
Full Text Available Background: Delirium is a common, but potentially preventable complication of acute illness that is associated with important adverse outcomes including increased length of hospital admission, risk of dementia and admission to long-term care. In-hospital risk assessment and diagnosis: Age over 65, severe illness, current hip fracture and presence of cognitive impairment or dementia are important risk factors for delirium. Assess people with any of these risk factors for recent changes or fluctuations in behaviour that might indicate delirium. If any indicators are present, complete a full cognitive assessment to confirm the diagnosis of delirium. In-hospital risk management: Multicomponent delirium prevention interventions can reduce the incidence of delirium in hospital by around one third and should be provided to people with any of the important risk factors that do not have delirium at admission. A medication review that considers both the number and type of prescribed medications is an important part of the multicomponent delirium prevention intervention. Which medications to avoid in people at risk of delirium: For people at risk of delirium, avoid new prescriptions of benzodiazepines or consider reducing or stopping these medications where possible. Opioids should be prescribed with caution in people at risk of delirium but this should be tempered by the observation that untreated severe pain can itself trigger delirium. Caution is also required when prescribing dihydropyridines and antihistamine H1 antagonists for people at risk of delirium and considered individual patient assessment is advocated. Conclusion: Delirium is common, distressing to patients, relatives and carers and is associated with important adverse outcomes. Multicomponent delirium prevention interventions can reduce the incidence of delirium by approximately one third and usually incorporate a medication review. Identification of which medications to avoid in people at
Pracht, Etienne E; Orban, Barbara L; Comins, Meg M; Large, John T; Asin-Oostburg, Virginia
Avoidable hospitalizations represent a key indicator for access to, and the quality of, primary care. Therefore, understanding their behavior is essential in terms of management of healthcare resources and costs. This analysis examines the affect of 2 healthcare strategies on the rate of avoidable hospitalization, managed care and the healthcare safety net. The avoidable hospitalizations definition developed by Weissman et al. (1992) was used to identify relevant inpatient episodes. A 2-stage simultaneous equations multivariate regression model with instrumental variables was used to estimate the relative influence of HMO penetration and the composition of local hospital markets on the rate of avoidable hospitalizations. Control variables in the model include healthcare supply and demand, demographic, socioeconomic, and health status characteristics. Increased market presence of public hospitals significantly reduced avoidable hospitalizations. HMO penetration did not influence the rate of avoidable hospitalizations. The results suggest that public investments in healthcare facilities and infrastructure are more effective in reducing avoidable hospitalizations. © 2011 National Association for Healthcare Quality.
Strandjord, Sarah E; Sieke, Erin H; Richmond, Miranda; Rome, Ellen S
Avoidant/restrictive food intake disorder (ARFID), a recently defined Diagnostic and Statistical Manual of Mental Disorders-5 eating disorder diagnosis, has not been extensively studied in the inpatient population. This study compares hospitalized ARFID and anorexia nervosa (AN) patients, including differences in presentation, treatment response, and 1-year outcomes. We conducted a retrospective chart review of ARFID and AN patients hospitalized between 2008 and 2014 for acute medical stabilization at an academic medical center. Data, including characteristics on admission, during hospitalization, and 1 year after discharge, were recorded for each patient and compared between ARFID and AN patients. On presentation, ARFID patients (n = 41) were younger with fewer traditional eating disorder behaviors and less weight loss, comorbidity, and bradycardia than AN patients (n = 203). During hospitalization, although ARFID and AN patients had similar caloric intake, ARFID patients relied on more enteral nutrition and required longer hospitalizations than AN patients (8 vs. 5 days; p = .0006). One year after discharge, around half of ARFID and AN patients met criteria for remission (62% vs. 46%; p = .18), and less than one-quarter required readmission (21% vs. 24%; p = .65). The findings from this study reveal several differences in hospitalized eating disorder patients and emphasize the need for further research on ARFID patients, including research on markers of illness severity and optimal approaches to refeeding. Similar remission and readmission rates among ARFID and AN patients highlight both the success and the continued need for improvement in eating disorder treatment regardless of diagnosis. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Thygesen, Lau C; Christiansen, Terkel; Garcia-Armesto, Sandra
INTRODUCTION: Potentially avoidable hospitalizations in chronic conditions are used to evaluate health-care performance. However, evidence comparing different countries at small geographical areas is still scarce. The aim of the present study is to describe and discuss differences in rates and time......-trends across health-care areas from five European countries. METHODS: Observational, ecological study, on virtually all discharges produced in five European countries between 2002 and 2009. Potentially avoidable hospitalizations were operationally defined as a joint indicator composed of six chronic conditions....... Episodes flagged as potentially avoidable were allocated to 913 geographical health-care areas. Age-sex standardized rates and standardized hospitalization ratios, as well as several statistics of variation, were estimated. RESULTS: Four hundred sixty-two thousand seven hundred and ninety-two episodes were...
Buerhaus, Peter I
The imposition of mandatory hospital nurse staffing ratios is among the more visible public policy initiatives affecting the nursing profession. Although the practice is intended to address problems in hospital nurse staffing and quality of patient care, this commentary argues that staffing ratios will lead to negative consequences for nurses involving the equity, efficiency, and costs of producing nursing care in hospitals. Rather than spend time and effort attempting to regulate nurse staffing, this commentary offers alternatives strategies that are directed at fixing the problems that motivate the advocates of staffing ratios.
Declercq, Mieke; De Houwer, Jan; Baeyens, Frank
In most studies on avoidance learning, participants receive an aversive unconditioned stimulus after a warning signal is presented, unless the participant performs a particular response. Lovibond (2006) recently proposed a cognitive theory of avoidance learning, according to which avoidance behaviour is a function of both Pavlovian and instrumental conditioning. In line with this theory, we found that avoidance behaviour was based on an integration of acquired knowledge about, on the one hand, the relation between stimuli and, on the other hand, the relation between behaviour and stimuli.
Pracht, Etienne E; Bass, Elizabeth
This paper explores the link between utilization of ambulatory care and the likelihood of rehospitalization for an avoidable reason in veterans served by the Veteran Health Administration (VA). The analysis used administrative data containing healthcare utilization and patient characteristics stored at the national VA data warehouse, the Corporate Franchise Data Center. The study sample consisted of 284 veterans residing in Florida who had been hospitalized at least once for an avoidable reason. A bivariate probit model with instrumental variables was used to estimate the probability of rehospitalization. Veterans who had at least 1 ambulatory care visit per month experienced a significant reduction in the probability of rehospitalization for the same avoidable hospitalization condition. The findings suggest that ambulatory care can serve as an important substitute for more expensive hospitalization for the conditions characterized as avoidable. © 2011 National Association for Healthcare Quality.
McGregor, Margaret J.; Baumbusch, Jennifer; Abu-Laban, Riyad B.; McGrail, Kimberlyn M.; Andrusiek, Dug; Globerman, Judith; Berg, Shannon; Cox, Michelle B.; Salomons, Kia; Volker, Jan; Ronald, Lisa
Hospitalization of nursing home residents can be futile as well as costly, and now evidence indicates that treating nursing home residents in place produces better outcomes for some conditions. We examined facility organizational characteristics that previous research showed are associated with potentially avoidable hospital transfers and with…
...-1 Evidence of purpose to avoid income tax. (a) In general. (1) The Commissioner's determination that a corporation was formed or availed of for the purpose of avoiding income tax with respect to... shall be determinative of the purpose to avoid the income tax with respect to shareholders unless the...
Alan J. Auerbach; Leonard E. Burman; Jonathan Siegel
Previous theoretical analyses of the capital gains tax have suggested that investors have considerable opportunity to avoid the tax. Yet, past empirical work has found relatively little evidence of such activity. Using a previously unavailable panel data set with a very large sample of high-income individuals, this paper aims to bring the theory and evidence closer together by examining the behavior of individual taxpayers over time. Though confirming past findings that avoidance of tax on re...
Dalla Zuanna, Teresa; Spadea, Teresa; Milana, Marzio; Petrelli, Alessio; Cacciani, Laura; Simonato, Lorenzo; Canova, Cristina
The numbers of migrants living in Europe are growing rapidly, and has become essential to assess their access to primary health care (PHC). Avoidable Hospitalization (AH) rates can reflect differences across migrant and ethnic minority groups in the performance of PHC. We aimed to conduct a systematic review of all published studies on AH comparing separately migrants with natives or different racial/ethnic groups, in Europe and elsewhere. We ran a systematic search for original articles indexed in primary electronic databases on AH among migrants or ethnic minorities. Studies presenting AH rates and/or rate ratios between at least two different ethnic minority groups or between migrants and natives were included. Of the 35 papers considered in the review, 28 (80%) were conducted in the United States, 4 in New Zealand, 2 in Australia, 1 in Singapore, and none in Europe. Most of the studies (91%) used a cross-sectional design. The exposure variable was defined in almost all articles by ethnicity, race, or a combination of the two; country of birth was only used in one Australian study. Most of the studies found significant differences in overall AH rates, with minorities (mainly Black and Hispanics) showing higher rates than non-Hispanic Whites. AH has been used, mostly in the US, to compare different racial/ethnic groups, while it has never been used in Europe to assess migrants' access to PHC. Studies comparing AH rates between migrants and natives in European settings can be helpful in filling this lack of evidence. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
BACKGROUND: Warfarin is an oral anticoagulant (OAT) that needs active management to ensure therapeutic range. Initial management is often carried out as an inpatient, though not requiring inpatient facilities. This mismatch results in financial costs which could be directed more efficaciously. The extent of this has previously been unknown. Here we aim to calculate the potential number of bed nights which may be saved among those being dose optimized as inpatients and examine associated factors. METHODS: A 6 week prospective audit of inpatients receiving OAT, at Cork University Hospital, was carried out. The study period was from 11th June 2007 to 20th July 2007. Data was collected from patient\\'s medications prescription charts, medical record files, and computerised haematology laboratory records. The indications for OAT, the patient laboratory coagulation results and therapeutic intervals along with patient demographics were analysed. The level of potentially avoidable inpatient nights in those receiving OAT in hospital was calculated and the potential cost savings quantified. Potential avoidable bed nights were defined as patients remaining in hospital for the purpose of optimizing OAT dosage, while receiving subtherapeutic or therapeutic OAT (being titred up to therapeutic levels) and co-administered covering low molecular weight heparin, and requiring no other active care. The average cost of euro638 was taken as the per night hospital stay cost for a non-Intensive Care bed. Ethical approval was granted from the Ethical Committee of the Cork Teaching Hospitals, Cork, Ireland. RESULTS: A total of 158 patients were included in the audit. There was 94 men (59.4%) and 64 women (40.6%). The mean age was 67.8 years, with a median age of 70 years.Atrial Fibrillation (43%, n = 70), followed by aortic valve replacement (15%, n = 23) and pulmonary emboli (11%, n = 18) were the commonest reasons for prescribing OAT. 54% had previously been prescribed OAT prior to
Full Text Available Abstract Background The study of Hospitalizations for ambulatory care sensitive conditions (ACSH has been proposed as an indirect measure of access to and receipt of care by older persons at the entryway to the Spanish public health system. The aim of this work is to identify the rates of ACSH in persons 65 years or older living in different small-areas of the Community of Madrid (CM and to detect possible differences in ACSH. Methods Cross-sectional, ecologic study, which covered all 34 health districts of the CM. The study population consisted of all individuals aged 65 years or older residing in the CM between 2001 and 2003, inclusive. Using hospital discharge data, avoidable ACSH were selected from the list of conditions validated for Spain. Age- and sex-adjusted ACSH rates were calculated for the population of each health district and the statistics describing the data variability. Point graphs and maps were designed to represent the ACSH rates in the different health districts. Results Of all the hospitalizations, 16.5% (64,409 were ACSH. Globally, the rate was higher among men: 33.15 per 1,000 populations vs. 22.10 in women and these differences were statistically significant (p Conclusion A significant variation is demonstrated in "preventable" hospitalizations between the different districts. In all the districts the men present rates significantly higher than women. Important variations in the access are observed the Primary Attention in spite of existing a universal sanitary cover.
Terra, Sandra Marlene; Byrne, Amanda
This article reviews the various types of technical and clinical denials that are usually "written off" and proposes strategies to prevent this loss. For purposes of this writing, avoidable technical and clinical denial write-offs are defined as revenue lost from "first-pass" denials rejections. For example, a procedure that requires an authorization is performed without having had an authorization obtained. After appeals and attempts to recoup the revenue, often unsuccessful, the organization ultimately "writes off" the revenue as not collectable. The question to ask is: Are these claims really not collectable or can actionable steps be taken to conserve these dollars and improve the bottom line? Acute care hospitals, physician offices, and clinics. In today's environment, the need to manage costs is ubiquitous. Cost management is on the priority list of all savvy health care executives, even if margins are healthy, revenue is under pressure, and the magnitude of cost reduction needed is greater than what past efforts have achieved. As hospitals and physician clinics prioritize areas for improvement, reduction in lost revenue-especially avoidable lost revenue-should be at the top of the list. Attentively managing claim denial write-offs will significantly reduce lost revenue. There is significant interface between case management and the revenue cycle. Developing core competencies for reducing clinical and technical denials should be a critical imperative in overall cost management strategy. Case managers are well placed to prevent these unnecessary losses through accurate status determination and clinical documentation review. These clinical professionals can also provide insight into work flow and other processes inherent in the preauthorization process.
Bourdais, D; Hance, T
Mechanisms for inbreeding avoidance should be prevalent in insects that reproduce by arrhenotokous haplodiploidy because of the higher potential production of unviable diploid males in inbred matings. Few studies have focused on mating strategies in insect parasitoids and even less on kinship relationships during mate choice. In this study we tested avoidance of kin as mate in the parasitic wasp Aphidius matricariae (Hymenoptera: Braconidae) using an ethological approach. Key mating parameters, such as male wing fanning, latent period before genitalia contact and duration of copulation were measured. No evidence for kin avoidance in mate choice in both A. matricariae males and females was observed in our behaviour (no choice or choice tests) tests. This lack of ethological sib mating avoidance could be due to different factors such as sex determination rule different than the single locus complementary sex determination, making lower the proportion of diploid males in case of sib matings and thus its negative consequence. The existence of other inbreeding avoidance strategies and mechanisms that reduce the probability of 2 receptive relatives meeting in nature may be common, for example, inbred mating may be rare through differential dispersal, delayed maturation, or protandry.
Falster, Kathleen; Banks, Emily; Lujic, Sanja; Falster, Michael; Lynch, John; Zwi, Karen; Eades, Sandra; Leyland, Alastair H; Jorm, Louisa
Australian Aboriginal children experience a disproportionate burden of social and health disadvantage. Avoidable hospitalizations present a potentially modifiable health gap that can be targeted and monitored using population data. This study quantifies inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children. This statewide population-based cohort study included 1 121 440 children born in New South Wales, Australia, between 1 July 2000 and 31 December 2012, including 35 609 Aboriginal children. Using linked hospital data from 1 July 2000 to 31 December 2013, we identified pediatric avoidable, ambulatory care sensitive and non-avoidable hospitalization rates for Aboriginal and non-Aboriginal children. Absolute and relative inequalities between Aboriginal and non-Aboriginal children were measured as rate differences and rate ratios, respectively. Individual-level covariates included age, sex, low birth weight and/or prematurity, and private health insurance/patient status. Area-level covariates included remoteness of residence and area socioeconomic disadvantage. There were 365 386 potentially avoidable hospitalizations observed over the study period, most commonly for respiratory and infectious conditions; Aboriginal children were admitted more frequently for all conditions. Avoidable hospitalization rates were 90.1/1000 person-years (95 % CI, 88.9-91.4) in Aboriginal children and 44.9/1000 person-years (44.8-45.1) in non-Aboriginal children (age and sex adjusted rate ratio = 1.7 (1.7-1.7)). Rate differences and rate ratios declined with age from 94/1000 person-years and 1.9, respectively, for children aged primary care, have potential to narrow this gap.
Lawn, Sharon; Zabeen, Sara; Smith, David; Wilson, Ellen; Miller, Cathie; Battersby, Malcolm; Masman, Kevin
Objective The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health's Hospital Admission Risk Program (HARP). Methods A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model. Results The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P=0.037) and complex needs (Pmanage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help individuals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation. What does this paper add? This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia's health system. What are the implications for practitioners? Programs targeting vulnerable populations and applying evidence-based chronic condition management and self
Maarten C Eisma
Full Text Available Rumination is a risk factor in adjustment to bereavement. It is associated with and predicts psychopathology after loss. Yet, the function of rumination in bereavement remains unclear. In the past, researchers often assumed rumination to be a maladaptive confrontation process. However, based on cognitive avoidance theories of worry in generalised anxiety disorder (GAD and rumination after post-traumatic stress disorder (PTSD, others have suggested that rumination may serve to avoid painful aspects of the loss, thereby contributing to complicated grief. To examine if rumination is linked with loss avoidance, an eye-tracking study was conducted with 54 bereaved individuals (27 high and 27 low ruminators. On 24 trials, participants looked for 10 seconds at a picture of the deceased and a picture of a stranger, randomly combined with negative, neutral or loss-related words. High ruminators were expected to show initial vigilance followed by subsequent disengagement for loss stimuli (i.e., picture deceased with a loss word in the first 1500 ms. Additionally, we expected high ruminators to avoid these loss stimuli and to show attentional preference for non-loss-related negative stimuli (i.e., picture stranger with a negative word on longer exposure durations (1500-10000 ms. Contrary to expectations, we found no evidence for an effect of rumination on vigilance and disengagement of loss stimuli in the first 1500 ms. However, in the 1500-10000 ms interval, high ruminators showed shorter gaze times for loss stimuli and longer gaze times for negative (and neutral non-loss-related stimuli, even when controlling for depression and complicated grief symptom levels. Effects of rumination on average fixation times mirrored these findings. This suggests that rumination and loss avoidance are closely associated. A potential clinical implication is that rumination and grief complications after bereavement may be reduced through the use of exposure and acceptance
Penning Margaret J
Full Text Available Abstract Background Researchers and policy makers have focussed on the development of indicators to help monitor the success of regionalization, primary care reform and other health sector restructuring initiatives. Certain indicators are useful in examining issues of equity in service provision, especially among older populations, regardless of where they live. AHRs are used as an indicator of primary care system efficiency and thus reveal information about access to general practitioners. The purpose of this paper is to examine trends in avoidable hospitalization rates (AHRs during a period of time characterized by several waves of health sector restructuring and regionalization in British Columbia. AHRs are examined in relation to non-avoidable and total hospitalization rates as well as by urban and rural geography across the province. Methods Analyses draw on linked administrative health data from the province of British Columbia for 1990 through 2000 for the population aged 50 and over. Joinpoint regression analyses and t-tests are used to detect and describe trends in the data. Results Generally speaking, non-avoidable hospitalizations constitute the vast majority of hospitalizations in a given year (i.e. around 95% with AHRs constituting the remaining 5% of hospitalizations. Comparing rural areas and urban areas reveals that standardized rates of avoidable, non-avoidable and total hospitalizations are consistently higher in rural areas. Joinpoint regression results show significantly decreasing trends overall; lines are parallel in the case of avoidable hospitalizations, and lines are diverging for non-avoidable and total hospitalizations, with the gap between rural and urban areas being wider at the end of the time interval than at the beginning. Conclusion These data suggest that access to effective primary care in rural communities remains problematic in BC given that rural areas did not make any gains in AHRs relative to urban areas
Thomas, Arun Z
To examine the magnitude of potentially avoidable iatrogenic complications of male urethral catheterization (UC) within a tertiary-care supra-regional teaching hospital, and to evaluate risk factors and subjective feeling of interns in our institution on the adequacy of training on UC.
Woodhams, Victoria; de Lusignan, Simon; Mughal, Shakeel; Head, Graham; Debar, Safia; Desombre, Terry; Hilton, Sean; Al Sharifi, Houda
Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR - Patients at risk of readmission and ACG - Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don't change.
Evans, Bridie Angela; Ali, Khalid; Bulger, Jenna; Ford, Gary A; Jones, Matthew; Moore, Chris; Porter, Alison; Pryce, Alan David; Quinn, Tom; Seagrove, Anne C; Snooks, Helen; Whitman, Shirley; Rees, Nigel
To identify the features and effects of a pathway for emergency assessment and referral of patients with suspected transient ischaemic attack (TIA) in order to avoid admission to hospital. Scoping review. PubMed, CINAHL Web of Science, Scopus. Reports of primary research on referral of patients with suspected TIA directly to specialist outpatient services. We screened studies for eligibility and extracted data from relevant studies. Data were analysed to describe setting, assessment and referral processes, treatment, implementation and outcomes. 8 international studies were identified, mostly cohort designs. 4 pathways were used by family doctors and 3 pathways by emergency department physicians. No pathways used by paramedics were found. Referrals were made to specialist clinic either directly or via a 24-hour helpline. Practitioners identified TIA symptoms and risk of further events using a checklist including the ABCD2 tool or clinical assessment. Antiplatelet medication was often given, usually aspirin unless contraindicated. Some patients underwent tests before referral and discharge. 5 studies reported reduced incident of stroke at 90 days, from 6-10% predicted rate to 1.3-2.1% actual rate. Between 44% and 83% of suspected TIA cases in these studies were referred through the pathways. Research literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalisation of patients with TIA. No pathways for paramedical use were reported. We will use results of this scoping review to inform development of a paramedical referral pathway to be tested in a feasibility trial. ISRCTN85516498. Stage: pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Eggleston, Karen; Lu, Mingshan; Li, Congdong; Wang, Jian; Yang, Zhe; Zhang, Jing; Quan, Hude
The literature comparing private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from high-income and established market economies. Studies from developing and transitional economies remain scarce, especially regarding patient case-mix and quality of care in public and private hospitals, even though countries such as China have expanded a mixed-ownership approach to service delivery. The purpose of this study is to compare the operations and performance of public and private hospitals in Guangdong Province, China, focusing on differences in patient case-mix and quality of care. We analyze survey data collected from 362 government-owned and private hospitals in Guangdong Province in 2005, combining mandatorily reported administrative data with a survey instrument designed for this study. We use univariate and multi-variate regression analyses to compare hospital characteristics and to identify factors associated with simple measures of structural quality and patient outcomes. Compared to private hospitals, government hospitals have a higher average value of total assets, more pieces of expensive medical equipment, more employees, and more physicians (controlling for hospital beds, urban location, insurance network, and university affiliation). Government and for-profit private hospitals do not statistically differ in total staffing, although for-profits have proportionally more support staff and fewer medical professionals. Mortality rates for non-government non-profit and for-profit hospitals do not statistically differ from those of government hospitals of similar size, accreditation level, and patient mix. In combination with other evidence on health service delivery in China, our results suggest that changes in ownership type alone are unlikely to dramatically improve or harm overall quality. System incentives need to be designed to reward desired hospital performance and protect vulnerable patients, regardless of
Full Text Available Abstract Background The literature comparing private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from high-income and established market economies. Studies from developing and transitional economies remain scarce, especially regarding patient case-mix and quality of care in public and private hospitals, even though countries such as China have expanded a mixed-ownership approach to service delivery. The purpose of this study is to compare the operations and performance of public and private hospitals in Guangdong Province, China, focusing on differences in patient case-mix and quality of care. Methods We analyze survey data collected from 362 government-owned and private hospitals in Guangdong Province in 2005, combining mandatorily reported administrative data with a survey instrument designed for this study. We use univariate and multi-variate regression analyses to compare hospital characteristics and to identify factors associated with simple measures of structural quality and patient outcomes. Results Compared to private hospitals, government hospitals have a higher average value of total assets, more pieces of expensive medical equipment, more employees, and more physicians (controlling for hospital beds, urban location, insurance network, and university affiliation. Government and for-profit private hospitals do not statistically differ in total staffing, although for-profits have proportionally more support staff and fewer medical professionals. Mortality rates for non-government non-profit and for-profit hospitals do not statistically differ from those of government hospitals of similar size, accreditation level, and patient mix. Conclusions In combination with other evidence on health service delivery in China, our results suggest that changes in ownership type alone are unlikely to dramatically improve or harm overall quality. System incentives need to be designed to reward desired hospital
Wasserfallen, Jean-Blaise; Zufferey, Jade
Thirty-day readmissions can be classified as potentially avoidable (PARs) or not avoidable (NARs) by following a specific algorithm (SQLape®). We wanted to assess the financial impact of the Swiss-DRG system, which regroups some readmissions occurring within 18 days after discharge within the initial hospital stay, on PARs at our hospital. First, PARs were identified from all hospitalisations recorded in 2011 at our university hospital. Second, 2012 Swiss-DRG readmission rules were applied, regrouped readmissions (RR) were identified, and their financial impact computed. Third, RRs were classified as potentially avoidable (PARRs), not avoidable (NARRs), and others causes (OCRRs). Characteristics of PARR patients and stays were retrieved, and the financial impact of PARRS was computed. A total of 36,777 hospitalisations were recorded in 2011, of which 3,140 were considered as readmissions (8.5%): 1,470 PARs (46.8%) and 1,733 NARs (53.2%). The 2012 Swiss-DRG rules would have resulted in 910 RRs (2.5% of hospitalisations, 29% of readmissions): 395 PARRs (43% of RR), 181 NARRs (20%), and 334 OCRRs (37%). Loss in reimbursement would have amounted to CHF 3.157 million (0.6% of total reimbursement). As many as 95% of the 395 PARR patients lived at home. In total, 28% of PARRs occurred within 3 days after discharge, and 58% lasted less than 5 days; 79% of the patients were discharged home again. Loss in reimbursement would amount to CHF 1.771 million. PARs represent a sizeable number of 30-day readmissions, as do PARRs of 18-day RRs in the 2012 Swiss DRG system. They should be the focus of attention, as the PARRs represent an avoidable loss in reimbursement.
Full Text Available Abstract Background Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. Method We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN. We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. Results We identified three types of intervention: pre-hospital; within the emergency department (ED; and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR – Patients at risk of readmission and ACG – Adjusted Clinical Groups sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. Conclusions Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don’t change.
Mohammad S. Alyahya
Full Text Available Introduction: Hospital readmissions impose not only an extra burden on health care systems but impact patient health outcomes. Identifying modifiable behavioural risk factors that are possible causes of potentially avoidable readmissions can lower readmission rates and healthcare costs. Methods: Using the core principles of evidence based medicine and public health, the purpose of this study was to develop a heuristic guide that could identify what behavioural risk factors influence hospital readmissions through adopting various methods of analysis including regression models, t-tests, data mining, and logistic regression. This study was a retrospective cohort review of internal medicine patients admitted between December 1, 2012 and December 31, 2013 at King Abdullah University Hospital, in Jordan. Results: 29% of all hospitalized patients were readmitted during the study period. Among all readmissions, 44% were identified as potentially avoidable. Behavioural factors including smoking, unclear follow-up and discharge planning, and being non-compliant with treatment regimen as well as discharge against medical advice were all associated with increased risk of avoidable readmissions. Conclusion: Implementing evidence based health programs that focus on modifiable behavioural risk factors for both patients and clinicians would yield a higher response in terms of reducing potentially avoidable readmissions, and could reduce direct medical costs.
Hijazi, Heba H.; Alshraideh, Hussam A.; Alsharman, Mohammad Aser; Al Abdi, Rabah; Harvey, Heather Lea
Introduction: Hospital readmissions impose not only an extra burden on health care systems but impact patient health outcomes. Identifying modifiable behavioural risk factors that are possible causes of potentially avoidable readmissions can lower readmission rates and healthcare costs. Methods: Using the core principles of evidence based medicine and public health, the purpose of this study was to develop a heuristic guide that could identify what behavioural risk factors influence hospital readmissions through adopting various methods of analysis including regression models, t-tests, data mining, and logistic regression. This study was a retrospective cohort review of internal medicine patients admitted between December 1, 2012 and December 31, 2013 at King Abdullah University Hospital, in Jordan. Results: 29% of all hospitalized patients were readmitted during the study period. Among all readmissions, 44% were identified as potentially avoidable. Behavioural factors including smoking, unclear follow-up and discharge planning, and being non-compliant with treatment regimen as well as discharge against medical advice were all associated with increased risk of avoidable readmissions. Conclusion: Implementing evidence based health programs that focus on modifiable behavioural risk factors for both patients and clinicians would yield a higher response in terms of reducing potentially avoidable readmissions, and could reduce direct medical costs. PMID:28413365
The primary aims of this study are to identify whether there is any relationship between corporate tax avoidance and the cost of debt, and whether the level of institutional ownership moderates this relationship, with two hypotheses tests on sample of 110 listed firms in the main board of Bursa Malaysia during the year 2005 - 2009. This study supports prior papers with negative relationship between tax avoidance and the cost of debt, suggesting corporate tax avoidance activity can reduce the ...
Bartle, David; Finlay, Fiona; Atherton, Fiona
To review paediatric admissions with a primary diagnosis of constipation to see whether some could have been managed in the community instead. A review of the medical notes of all patients admitted with a primary diagnosis of constipation to the children's ward of a district general hospital over a 12-month period. Of 41 admissions (19 girls and 22 boys, age range 6 weeks to 12 years), the average length of stay was less than two nights. The short duration of hospital stay implies rapid improvement. It is likely that many of these children could have been managed in the community if suitable resources, such as a community nurse specialising in constipation, were available.
Dwyer, Trudy; Craswell, Alison; Rossi, Dolene; Holzberger, Darren
Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. This study provides valuable insights into the contribution of the NP model of care within an aged care
Costanzo, Maria Rosa; Negoianu, Daniel; Fonarow, Gregg C; Jaski, Brian E; Bart, Bradley A; Heywood, J Thomas; Nabut, Jose L; Schollmeyer, Michael P
In patients hospitalized with acutely decompensated heart failure, unresolved signs and symptoms of fluid overload have been consistently associated with poor outcomes. Regardless of dosing and type of administration, intravenous loop diuretics have not reduced heart failure events or mortality in patients with acutely decompensated heart failure. The results of trials comparing intravenous loop diuretics to mechanical fluid removal by isolated venovenous ultrafiltration have yielded conflicting results. Studies evaluating early decongestive strategies have shown that ultrafiltration removed more fluid and was associated with fewer heart failure-related rehospitalization than intravenous loop diuretics. In contrast, when used in the setting of worsening renal function, ultrafiltration was associated with poorer renal outcomes and no reduction in heart failure events. The AVOID-HF trial seeks to determine if an early strategy of ultrafiltration in patients with acutely decompensated heart failure is associated with fewer heart failure events at 90 days compared with a strategy based on intravenous loop diuretics. Study subjects from 40 highly experienced institutions are randomized to either early ultrafiltration or intravenous loop diuretics. In both treatment arms, fluid removal therapies are adjusted according to the patients' hemodynamic condition and renal function. The study was unilaterally terminated by the sponsor in the absence of futility and safety concerns after the enrollment of 221 subjects, or 27% of the originally planned sample size of 810 patients. The AVOID-HF trial's principal aim is to compare the safety and efficacy of ultrafiltration vs that of intravenous loop diuretics in patients hospitalized with acutely decompensated heart failure. Because stepped treatment approaches are applied in both ultrafiltration and intravenous loop diuretics groups and the primary end point is time to first heart failure event within 90 days, it is hoped that
Muhammad Irham Kurniawan
Full Text Available This study aims to examine the effect of corporate tax avoidance to the corporate cash holdings. Recent tax avoidance research found that tax avoidance is able to facilitate managerial rent extraction in the form of transfer of resources owned by the company. This study attempts to test how the relationship of tax avoidance with the amount of cash held by the company. The sample consists of 46 non-financial, non-property, non-real estate and non-construction companies from 2009-2016, with a total 368 observations. The study uses two different cash holdings measures to test the robustness of the research results. This study cannot find evidence that tax avoidance have a significant relationship to the level of cash holdings in public companies in Indonesia. Both measurements of cash holdings gave the same conclusions to the results of the study. This study provides an insight that agency theory in the context of tax avoidance and corporate cash holdings in developing countries such as Indonesia needs to be explored further as the agency conflict in Indonesia as a developing country is more principal-principal conflicts.
Full Text Available The primary objective of this research is to investigate the relationship between tax avoidance, income and cash held in companies listed on the Tehran Stock Exchange from 2009 to 2013. In this regard, avoidance of paying taxes is independent variables and criteria for evaluating financial performance; namely return on assets, return on average equities, economic value added, market value added, and the ratio of free cash flow are considered as dependent variables. Firm size and financial leverage are also considered as control variables. In general, the statistical method used in this research is correlation and regression. The results of the research showed that there was a significant and reverse relationship between avoidance of paying taxes and performance evaluation criteria, cash held.
Bilde, T.; Maklakov, A.A.; Schilling, Nadia
avoidance can be because of low risk of inbreeding, variation in tolerance to inbreeding or high costs of outbreeding. We examined the relationship between inbreeding depression and inbreeding avoidance adaptations under two levels of inbreeding in the spider Oedothorax apicatus, asking whether preference...... for unrelated sperm via pre- and/or post-copulatory mechanisms could restore female fitness when inbreeding depression increases. Using inbred isofemale lines we provided female spiders with one or two male spiders of different relatedness in five combinations: one male sib; one male nonsib; two male sibs; two...
Osborne, Andrew; Taylor, Louise; Reuber, Markus; Grünewald, Richard A; Parkinson, Martin; Dickson, Jon M
Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies. Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration. The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
Combining click data from a Swedish newspaper and administrative data on asylum seekers in Sweden, I examine whether a larger presence of refugees in a municipality induces people to avoid news that may encourage welcoming the newcomers. Exploiting the unexpected inflow of refugees to Sweden during
Rydval, Ondřej; Ortmann, Andreas
Roč. 88, č. 1 (2005), s. 101-107 ISSN 0165-1765 Institutional research plan: CEZ:AV0Z70850503 Keywords : loss avoidance * selection principles * stag-hunt games Subject RIV: AH - Economics Impact factor: 0.381, year: 2005 http://dx.doi.org/10.1016/j.econlet.2004.12.027
Gu, Ruolei; Wu, Runguo; Broster, Lucas S.; Jiang, Y.; xu, Rui; Yang, Qiwei; Xu, Pengfei; Luo, Yue-jia
According to previous literature, trait anxiety is related to the tendency to choose safety options during risk decision-making, that is, risk avoidance. In our opinion, anxious peoples risk preference might actually reflect their hypersensitivity to emotional information. To examine this
Suely Arruda Vidal
Full Text Available OBJETIVOS: classificar os óbitos de menores de um ano ocorridos de janeiro a dezembro de 2000, em hospital de referência em Pernambuco, segundo critérios de evitabilidade da causa básica. MÉTODOS: estudo descritivo de corte transversal, utilizando-se como fonte de dados o Sistema de Informação sobre Mortalidade, processado na instituição. As causas básicas presentes nas Declarações de Óbitos, corrigidas a partir do prontuário médico e codificadas segundo as regras da 10 revisão da Classificação Internacional de Doenças, foram agrupadas segundo os critérios de evitabilidade de óbitos propostos pela Fundação SEADE em 1991. Calculou-se o coeficiente de mortalidade infantil hospitalar. RESULTADOS: a maioria dos óbitos estava classificada entre as causas reduzíveis por medidas de atenção à saúde, com mortalidade proporcional de 77,4% (infantil, 75,3% (neonatal e 60,1% (pós-neonatal representando um coeficiente de mortalidade infantil hospitalar de 103,7 óbitos por 1.000 internações. Quase metade era neonatos, desses, 31% eram reduzíveis por diagnóstico e tratamento precoces. No grupo pós-neonatal, 44% foram causadas principalmente pelas doenças infecciosas intestinais e do aparelho respiratório. CONCLUSÕES: os altos percentuais de mortes por causas evitáveis, sugerem problemas de acesso aos serviços de saúde, cobertura e/ou na qualidade da assistência prestada.OBJECTIVES: to classify deaths of children under one year old from January to December 2000, at a public Hospital of Pernambuco, according to avoidable basic causes of death. METHODS: descriptive cross sectional study using data from the Information System on Mortality processed at the Hospital. The basic causes stated in Death Certificates collected from the medical records and codified under the rules of the Tenth International Disease Classification were grouped according to the criteria proposed by the SEADE Foundation (1991. The coefficient of
del Saz Moreno, Vicente; Alberquilla Menéndez-Asenjo, Ángel; Camacho Hernández, Ana M; Lora Pablos, David; Enríquez de Salamanca Lorente, Rafael; Magán Tapia, Purificación
To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF). Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health. Health area of the region of Madrid (n=466.901). There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n=3.277). The cases were patients who were hospitalized for HF while the controls did not require admission, during 2007. risk of ACSH for HF related to the process of care considered both overall and for each separate standard of appropiate care. Differences in clinical complexity of the groups were measured using the Adjusted Clinical Group (ACG) classification system. 227 cases and 3.050 controls. Clinical complexity was greater in cases. The standards of appropriate care were met to a greater degree in the control group, but none of the two groups met all the standards that would define a process of care as fully appropriate. A significantly lower risk of ACSH was seen for only two standards of appropriate care. For each additional standard of appropriate care not met, the probability of admission was significantly greater (OR: 1,33, 95% CI: 1,19-1,49). Higher quality in the process of care in primary health was associated with a lower risk of hospitalization for HF. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
Gu, Ruolei; Wu, Runguo; Broster, Lucas S; Jiang, Yang; Xu, Rui; Yang, Qiwei; Xu, Pengfei; Luo, Yue-Jia
According to previous literature, trait anxiety is related to the tendency to choose safety options during risk decision-making, that is, risk avoidance. In our opinion, anxious people's risk preference might actually reflect their hypersensitivity to emotional information. To examine this hypothesis, a decision-making task that could elicit the framing effect was employed. The framing effect indicates that risk preference could be modulated by emotional messages contained in the description (i.e., frame) of options. The behavioral results have showed the classic framing effect. In addition, individual level of trait anxiety was positively correlated with the framing effect size. However, trait anxiety was not correlated with risk-avoidance ratio in any condition. Finally, the relationship between anxiety and the framing effect remained significant after the level of depression was also taken into account. The theoretical significance and the major limitations of this study are discussed.
It is commonly argued that high tax rates motivate individuals to start a business as it is easier to avoid and evade taxes if self-employed compared to employed. If this is the case we would expect small business owners to be more responsive to tax rate changes than employees. This study investigates how responsive existing small business owners are to tax rate changes by estimating the elasticities of taxable income, gross income and reported income from business ventures for small business...
Gu, Ruolei; Wu, Runguo; Broster, Lucas S.; Jiang, Yang; Xu, Rui; Yang, Qiwei; Xu, Pengfei; Luo, Yue-Jia
According to previous literature, trait anxiety is related to the tendency to choose safety options during risk decision-making, that is, risk avoidance. In our opinion, anxious people’s risk preference might actually reflect their hypersensitivity to emotional information. To examine this hypothesis, a decision-making task that could elicit the framing effect was employed. The framing effect indicates that risk preference could be modulated by emotional messages contained in the description ...
Jia, Yuncheng; Cheng, Gang; Zhang, Dajun; Ta, Na; Xia, Mu; Ding, Fangyuan
Objective: To determine the influence of adult attachment orientations on infant preference. Methods: We adopted eye-tracking technology to monitor childless college women's eye movements when looking at pairs of faces, including one adult face (man or woman) and one infant face, with three different expressions (happy, sadness, and neutral). The participants ( N = 150; 84% Han ethnicity) were aged 18-29 years ( M = 19.22, SD = 1.72). A random intercepts multilevel linear regression analysis was used to assess the unique contribution of attachment avoidance, determined using the Experiences in Close Relationships scale, to preference for infant faces. Results: Women with higher attachment avoidance showed less infant preference, as shown by less sustained overt attentional bias to the infant face than the adult face based on fixation time and count. Conclusion: Adult attachment might be related to infant preference according to eye movement indices. Women with higher attachment avoidance may lack attentional preference for infant faces. The findings may aid the treatment and remediation of the interactions between children and mothers with insecure attachment.
Norris, Mark L; Spettigue, Wendy; Hammond, Nicole G; Katzman, Debra K; Zucker, Nancy; Yelle, Katie; Santos, Alexandre; Gray, Madeline; Obeid, Nicole
To examine characteristics of patients with Avoidant/Restrictive Food Intake Disorder (ARFID) in an effort to identify and describe subtypes of the disorder. A retrospective chart review was completed for patients aged 8-17 years assessed over a 17-year period. Seventy-seven patients were included in the study, the majority of whom were female (n = 56, 73%). The average age of patients was 13.7 years (SD = 2.4 years). Three specific subtypes of ARFID (aligning with example presentations outlined in the DSM-5) were identified: (a) those with weight loss and/or medical compromise as a consequence of apparent lack of interest in eating (n = 30, 39%); (b) restriction arising as a result of sensory sensitivity (n = 14, 18%); and (c) restriction based upon food avoidance and/or fear of aversive consequences of eating (n = 33, 43%). Clinical characteristics of patients varied depending on the assigned subtype. Our findings highlight the need for further research into the relative merit of subtype-assignment in patients with ARFID and whether such practice would aid in the recommended treatment. Further research is required to understand whether these categories are generalizable and applicable to other samples such as young children or adults with ARFID, and how treatment options might differ according to subtype. © 2017 Wiley Periodicals, Inc.
Barker, Dianne C; Wang, Shu; Merriman, David; Crosby, Andrew; Resnick, Elissa A; Chaloupka, Frank J
A number of recent studies document the proportion of all cigarette packs that are 'contraband' using discarded packs to measure tax avoidance and evasion, which we call tax non-compliance. To date, academic studies using discarded packs focused on relatively small geographical areas such as a city or a neighbourhood. We visited 160 communities across 38 US states in 2012 and collected data from littered cigarette packs as part of the State and Community Tobacco Control (SCTC) Research Initiative and the Bridging the Gap Community Obesity Measures Project (BTG-COMP). Data collectors were trained in a previously tested littered pack data collection protocol. Field teams collected 2116 packs with cellophane across 132 communities. We estimate a national tax non-compliance rate of 18.5% with considerable variation across regions. Suburban areas had lower non-compliance than urban areas as well as areas with high and low median household income areas compared with middle income areas. We present the first academic national study of tax non-compliance using littered cigarette packs. We demonstrate the feasibility of meaningful large-scale data collection using this methodology and document considerable variation in tax non-compliance across areas, suggesting that both policy differences and geography may be important in control of illicit tobacco use. Given the geography of open borders among countries with varying tax rates, this simple methodology may be appropriate to estimate tax non-compliance in countries that use tax stamps or other pack markings, such as health warnings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Winer, E. Samuel; Salem, Taban
Cognitive theories of depression and anxiety have traditionally emphasized the role of attentional biases in the processing of negative information. The dot-probe task has been widely used to study this phenomenon. Recent findings suggest that biased processing of positive information might also be an important aspect of developing psychopathological symptoms. However, despite some evidence suggesting persons with symptoms of depression and anxiety may avoid positive information, many dot-probe studies have produced null findings. The present review used conventional and novel meta-analytic methods to evaluate dot-probe attentional biases away from positive information and, for comparison, toward negative information, in depressed and anxious individuals. Results indicated that avoidance of positive information is a real effect exhibiting substantial evidential value among persons experiencing psychopathology, with individuals evidencing primary symptoms of depression clearly demonstrating this effect. Different theoretical explanations for these findings are evaluated, including those positing threat-processing structures, even-handedness, self-regulation, and reward devaluation, with the novel theory of reward devaluation emphasized and expanded. These novel findings and theory suggest that avoidance of prospective reward helps to explain the cause and sustainability of depressed states. Suggestions for future research and methodological advances are discussed. PMID:26619211
Full Text Available Background: Attentional bias refers to a preference for (e.g., vigilance or a shifting away (e.g., avoidance of one’s focus with respect to specific stimuli. Accumulating evidence suggests that an attentional bias toward death/threat-related stimuli exists in bereaved individuals experiencing prolonged grief (PG. Measuring for different processing may reflect different cognitive characteristics. Therefore, this study sought to compare information-processing biases in Chinese individuals with high versus low levels of PG symptomatology at supraliminal and subliminal levels, respectively.Method: A 2 (grief level × 2 (consciousness level × 2 (word type three-factor mixed design with supraliminal and subliminal tasks was utilized in the current study. Based on their Prolonged Grief Questionnaire-13 (PG-13 scores, 38 participants were included in the low-PG group, and 34 individuals were included in the high-PG group. All the participants completed a dot-probe task in which they were primed with death-related and life-related words paired with neutral stimuli.Results: High-PG individuals were slower in reacting to the death-related information in both supraliminal and subliminal tasks. After controlling for other symptoms in the backward deletion regression, PG-13 scores significantly predicted the avoidance tendency to death-related words in the supraliminal task, while anxiety was the best predictor of turning one’s vision away from death-related stimuli in the subliminal trials.Conclusion: The results suggested that high PG is associated with a tendency to avoid death-related words. Future research is needed to explore interventions that address the avoidance of death-related stimuli among individuals with elevated, or diagnosable, levels of PG.
Bosomworth, N John
This review aims to determine whether active adults who begin statins and develop myalgia reduce or stop activity to become less symptomatic. If this occurs, strategies to mitigate symptoms are explored. Should these strategies fail, the question of whether exercise is an adequate alternative to statin therapy is addressed. PubMed, Google Scholar, and the Cochrane Database were searched with keywords designed to retrieve information on statin myopathy in exercising adults. Statins are well tolerated by most people who exercise; however, caution is warranted in those who exercise at high levels, in the elderly, and in those receiving high-dose therapy. Several strategies improve statin tolerance while maintaining exercise levels, based on low-quality evidence. If statins are not tolerated, a continuing physical activity program can provide equivalent or superior cardiometabolic protection. Statins may occasionally present a barrier to physical activity. A number of strategies exist that can reduce the risk of myopathy. If a choice between exercise and statins becomes necessary, exercise provides equal benefit in terms of cardiovascular protection and superior mortality reduction, with improved quality of life. © Copyright 2016 by the American Board of Family Medicine.
Saitone, T L; Sexton, R J; Sexton Ward, A
The Affordable Care Act (ACA) established the Hospital-Acquired Condition (HAC) Reduction Program. The Centers for Medicare and Medicaid Services (CMS) established a total HAC scoring methodology to rank hospitals based upon their HAC performance. Hospitals that rank in the lowest quartile based on their HAC score are subject to a 1% reduction in their total Medicare reimbursements. In FY 2017, 769 hospitals incurred payment reductions totaling $430 million. This study analyzes how improvements in the rate of catheter-associated urinary tract infections (CAUTI), based on the implementation of a cranberry-treatment regimen, impact hospitals' HAC scores and likelihood of avoiding the Medicare-reimbursement penalty. A simulation model is developed and implemented using public data from the CMS' Hospital Compare website to determine how hospitals' unilateral and simultaneous adoption of cranberry to improve CAUTI outcomes can affect HAC scores and the likelihood of a hospital incurring the Medicare payment reduction, given results on cranberry effectiveness in preventing CAUTI based on scientific trials. The simulation framework can be adapted to consider other initiatives to improve hospitals' HAC scores. Nearly all simulated hospitals improved their overall HAC score by adopting cranberry as a CAUTI preventative, assuming mean effectiveness from scientific trials. Many hospitals with HAC scores in the lowest quartile of the HAC-score distribution and subject to Medicare reimbursement reductions can improve their scores sufficiently through adopting a cranberry-treatment regimen to avoid payment reduction. The study was unable to replicate exactly the data used by CMS to establish HAC scores for FY 2018. The study assumes that hospitals subject to the Medicare payment reduction were not using cranberry as a prophylactic treatment for their catheterized patients, but is unable to confirm that this is true in all cases. The study also assumes that hospitalized catheter
The Aged Residential Care Healthcare Utilization Study (ARCHUS): a multidisciplinary, cluster randomized controlled trial designed to reduce acute avoidable hospitalizations from long-term care facilities.
Connolly, Martin J; Boyd, Michal; Broad, Joanna B; Kerse, Ngaire; Lumley, Thomas; Whitehead, Noeline; Foster, Susan
To assess effect of a complex, multidisciplinary intervention aimed at reducing avoidable acute hospitalization of residents of residential aged care (RAC) facilities. Cluster randomized controlled trial. RAC facilities with higher than expected hospitalizations in Auckland, New Zealand, were recruited and randomized to intervention or control. A total of 1998 residents of 18 intervention facilities and 18 control facilities. A facility-based complex intervention of 9 months' duration. The intervention comprised gerontology nurse specialist (GNS)-led staff education, facility bench-marking, GNS resident review, and multidisciplinary (geriatrician, primary-care physician, pharmacist, GNS, and facility nurse) discussion of residents selected using standard criteria. Primary end point was avoidable hospitalizations. Secondary end points were all acute admissions, mortality, and acute bed-days. Follow-up was for a total of 14 months. The intervention did not affect main study end points: number of acute avoidable hospital admissions (RR 1.07; 95% CI 0.85-1.36; P = .59) or mortality (RR 1.11; 95% CI 0.76-1.61; P = .62). This multidisciplinary intervention, packaging selected case review, and staff education had no overall impact on acute hospital admissions or mortality. This may have considerable implications for resourcing in the acute and RAC sectors in the face of population aging. Australian and New Zealand Clinical Trials Registry (ACTRN12611000187943). Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
Konrad, Denise; Roberts, Scott; Corrigan, Mandy L; Hamilton, Cindy; Steiger, Ezra; Kirby, Donald F
Administration of home parenteral support (HPS) has proven to be cost-effective over hospital care. Avoiding hospital readmissions became more of a focus for healthcare institutions in 2012 with the implementation of the Affordable Care Act. In 2010, our service developed a protocol to treat dehydration at home for HPS patients by ordering additional intravenous fluids to be kept on hand and to focus patient education on the symptoms of dehydration. A retrospective analysis was completed through a clinical management database to identify HPS patients with dehydration. The hospital finance department and homecare pharmacy were utilized to determine potential cost avoidance. In 2009, 64 episodes (77%) of dehydration were successfully treated at home versus 6 emergency department (ED) visits (7.5%) and 13 readmissions (15.5%). In 2010, we successfully treated 170 episodes (84.5%) at home, with 9 episodes (4.5%) requiring ED visits and 22 hospital readmissions (11%). The number of dehydration episodes per patient was significantly higher in 2010 ( P dehydration identified and treated at home in 2010 versus 2009. Our protocol helped educate and provide the resources required to resolve dehydration at home when early signs were recognized. By reducing ED visits and hospital readmissions, healthcare costs were avoided by a factor of 29 when home treatment was successful.
This paper aims at analysing the impact of prospective payment schemes on cost efficiency of acute care hospitals in Switzerland. We study a panel of 121 public hospitals subject to one of four payment schemes. While several hospitals are still reimbursed on a per diem basis for the treatment of patients, most face flat per-case rates-or mixed schemes, which combine both elements of reimbursement. Thus, unlike previous studies, we are able to simultaneously analyse and isolate the cost-efficiency effects of different payment schemes. By means of stochastic frontier analysis, we first estimate a hospital cost frontier. Using the two-stage approach proposed by Battese and Coelli (Empir Econ 20:325-332, 1995), we then analyse the impact of these payment schemes on the cost efficiency of hospitals. Controlling for hospital characteristics, local market conditions in the 26 Swiss states (cantons), and a time trend, we show that, compared to per diem, hospitals which are reimbursed by flat payment schemes perform better in terms of cost efficiency. Our results suggest that mixed schemes create incentives for cost containment as well, although to a lesser extent. In addition, our findings indicate that cost-efficient hospitals are primarily located in cantons with competitive markets, as measured by the Herfindahl-Hirschman index in inpatient care. Furthermore, our econometric model shows that we obtain biased estimates from frontier analysis if we do not account for heteroscedasticity in the inefficiency term.
Begum, Farhana; Hossain, Akmal
ABSTRACT This study was designed to explore sources of funds for health expenditure of patients if they are hospitalized. We have included 379 patients of 3 private and 7 public hospitals to estimate total expenditure. Of them, 229 (60.4%) were from public and 150 (39.6%) from private hospitals. Mean expenditure was Tk 60,613.3 and 8,262.7, and duration of hospital stay was 10.7 and 11.8 days in private and public hospitals respectively. More than half (55%) of the patients from middle class were treated in private hospitals. Of them, 278 (74.0%) were funded by themselves, 48 (12.8%) by loan with interest rate of 100% to 180%, 23 (6.1%) by loan without interest, 17 (4.5%) by losing their fixed asset, and 4 (1.1%) by begging in the street. Most of the patients did bear expenditure by themselves, followed by loan with high interest rate. ‘Distress’ selling of property was also a source. Middle-class patients could be comfortable with expenditure if they were in public hospitals. PMID:25395909
Begum, Farhana; Alam, Shahinul; Hossain, Akmal
This study was designed to explore sources of funds for health expenditure of patients if they are hospitalized. We have included 379 patients of 3 private and 7 public hospitals to estimate total expenditure. Of them, 229 (60.4%) were from public and 150 (39.6%) from private hospitals. Mean expenditure was Tk 60,613.3 and 8,262.7, and duration of hospital stay was 10.7 and 11.8 days in private and public hospitals respectively. More than half (55%) of the patients from middle class were treated in private hospitals. Of them, 278 (74.0%) were funded by themselves, 48 (12.8%) by loan with interest rate of 100% to 180%, 23 (6.1%) by loan without interest, 17 (4.5%) by losing their fixed asset, and 4 (1.1%) by begging in the street. Most of the patients did bear expenditure by themselves, followed by loan with high interest rate. 'Distress' selling of property was also a source. Middle-class patients could be comfortable with expenditure if they were in public hospitals.
Full Text Available Abstract Background Evidence-based obstetric care is widely promoted in developing countries, but the success of implementation is not known. Using selected childbirth care procedures in four hospitals in Shanghai, we compared practice against evidence-based information, and explored user and provider views about each procedure. Methods Observational study. Using the Cochrane Library, we identified six procedures that should be avoided as routine and two that should be encouraged. Procedure rate determined by exit interviews with women, verified using hospital notes. Views of women and providers explored with in depth interviews. The study sites were three hospitals in Shanghai and one in neighbouring province of Jiangsu. 150 women at each centre for procedure rate, and 48 in-depth interviews with women and providers. Results Vaginal births were 50% (303/599 of the total. Of the six practices where evidence suggests they should be avoided as routine, three were performed with rates above 70%: pubic shaving (3 hospitals, rectal examination (3 hospitals, and episiotomy (3 hospitals. Most women delivered lying down, pain relief was rarely given, and only in the urban district hospital did women routinely have a companion. Most women wanted support or companionship during labour and to be given pain relief; but current practice is insufficient to meet women's needs. Conclusion Obstetric practice is not following best available evidence in the hospitals studied. There is a need to adjust hospital policy to support the use of interventions proven to be of benefit to women during childbirth, and develop approaches that ensure clinical practice changes.
Pickett, Scott M; Kurby, Christopher A
Experiential avoidance is a functional class of maladaptive strategies that contribute to the development and maintenance of psychopathology. Although previous research has demonstrated group differences in the interpretation of aversive stimuli, there is limited work on the influence of experiential avoidance during the online processing of emotion. An experimental design investigated the influence of self-reported experiential avoidance during emotion processing by assessing emotion inferences during the comprehension of narratives that imply different emotions. Results suggest that experiential avoidance is partially characterized by an emotional information processing bias. Specifically, individuals reporting higher experiential avoidance scores exhibited a bias towards activating negative emotion inferences, whereas individuals reporting lower experiential avoidance scores exhibited a bias towards activating positive emotion inferences. Minimal emotional inference was observed for the non-bias affective valence. Findings are discussed in terms of the implications of experiential avoidance as a cognitive vulnerability for psychopathology.
Costa, Luana Bonome Message; Filho, Moacir Godinho; Rentes, Antonio Freitas; Bertani, Thiago Moreno; Mardegan, Ronaldo
The present study evaluates how five sectors of two Brazilian hospitals have implemented lean healthcare concepts in their operations. The main characteristics of the implementation process are analyzed in the present study: the motivational factor for implementation, implementation time, form (consultancy or internal), team (hospital and consultants), lean implementation continuity/sustainability, lean healthcare tools and methods implemented, problems/improvement opportunities, lean healthcare barriers faced during the implementation process, and critical factors that affected the implementation and the results obtained in each case. The case studies indicate that reducing patient lead times and costs and making financial improvements were the primary factors that motivated lean healthcare implementation in the hospitals studied. Several tools and methods were used in the cases studied, especially value stream mapping and DMAIC. The barriers found in both hospitals are primarily associated with the human factor. Additionally, the results obtained after implementation were analyzed and improvements in financial aspects, productivity and capacity, and lead time reduction of the analyzed sectors were observed. Further, this study also exhibited four propositions elaborated from the results obtained from the cases that highlighted barriers and challenges to lean healthcare implementation in developing countries. Two of these barriers are hospital organizational structure (and, consequently, how the senior management works with medical staff), and outsourcing hospital activities. This study also concluded that the initialization and maintenance of lean healthcare implementation rely heavily on external support because lean healthcare subject knowledge is not yet available in the healthcare organization, which represents a challenge. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
Full Text Available Abstract Background A variety of international organizations, professional groups and individuals are promoting evidence-informed obstetric care in China. We measured change in obstetric practice during vaginal delivery that could be attributed to the diffusion of evidence-based messages, and explored influences on practice change. Methods Sample surveys of women at postnatal discharge in three government hospitals in Shanghai and one in neighbouring Jiangsu province carried out in 1999, repeated in 2003, and compared. Main outcome measures were changes in obstetric practice and influences on provider behaviour. "Routine practice" was defined as more than 65% of vaginal births. Semi-structured interviews with doctors explored influences on practice. Results In 1999, episiotomy was routine at all four hospitals; pubic shaving, rectal examination (to monitor labour and electronic fetal heart monitoring were routine at three hospitals; and enema on admission was common at one hospital. In 2003, episiotomy rates remained high at all hospitals, and actually significantly increased at one; pubic shaving was less common at one hospital; one hospital stopped rectal examination for monitoring labour, and the one hospital where enemas were common stopped this practice. Mobility during labour increased in three hospitals. Continuous support was variable between hospitals at baseline and showed no change with the 2003 survey. Provider behaviour was mainly influenced by international best practice standards promoted by hospital directors, and national legislation about clinical practice. Conclusion Obstetric practice became more evidence-informed in this selected group of hospitals in China. Change was not directly related to the promotion of evidence-based practice in the region. Hospital directors and national legislation seem to be particularly important influences on provider behaviour at the hospital level.
Kruse, Alexandra Y; Phuong, Cam N; Ho, Binh T T
AIM: Neonatal deaths (≤28 days) account for more than half of child mortality in Vietnam. Presumably most die in hospital, but data are scarce. This study aimed to identify risk factors of death among hospitalised neonates. METHODS: We prospectively studied all neonatal deaths and expected deaths...... (discharged alive after withdrawal of life-sustaining treatment) in a Vietnamese tertiary paediatric hospital during a 12-month period in 2009-2010. The medical files were audited classifying admission prognosis, discharge outcome, cause of death/expected death according to two classifications, and important...... and potentially avoidable risk factors during the hospital stay. RESULTS: Among 5763 neonates admitted, 235 deaths and 67 expected deaths were included. According to both classifications, major causes were congenital malformations, prematurity and severe infections. Six risk factors were identified in 85% (60...
Mileski, Michael; Topinka, Joseph Baar; Lee, Kimberly; Brooks, Matthew; McNeil, Christopher; Jackson, Jenna
The main objective was to investigate the applicability and effectiveness of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility (SNF)-to-hospital readmissions. The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature and PubMed to collect data about quality improvement implemented in SNFs. The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. These strategy examples can be useful to acute care hospitals attempting to lower bounce back from subacute care providers and long-term care facilities seeking quality improvement initiatives to reduce hospital readmissions.
Ektare, V; Khachatryan, A; Xue, M; Dunne, M; Johnson, K; Stephens, J
To estimate, from a US payer perspective, the cost offsets of treating gram positive acute bacterial skin and skin-structure infections (ABSSSI) with varied hospital length of stay (LOS) followed by outpatient care, as well as the cost implications of avoiding hospital admission. Economic drivers of care were estimated using a literature-based economic model incorporating inpatient and outpatient components. The model incorporated equal efficacy, adverse events (AE), resource use, and costs from literature. Costs of once- and twice-daily outpatient infusions to achieve a 14-day treatment were analyzed. Sensitivity analyses were performed. Costs were adjusted to 2015 US$. Total non-drug medical cost for treatment of ABSSSI entirely in the outpatient setting to avoid hospital admission was the lowest among all scenarios and ranged from $4039-$4924. Total non-drug cost for ABSSSI treated in the inpatient setting ranged from $9813 (3 days LOS) to $18,014 (7 days LOS). Inpatient vs outpatient cost breakdown was: 3 days inpatient ($6657)/11 days outpatient ($3156-$3877); 7 days inpatient ($15,017)/7 days outpatient ($2495-$2997). Sensitivity analyses revealed a key outpatient cost driver to be peripherally inserted central catheter (PICC) costs (average per patient cost of $873 for placement and $205 for complications). Drug and indirect costs were excluded and resource use was not differentiated by ABSSSI type. It was assumed that successful ABSSSI treatment takes up to 14 days per the product labels, and that once-daily and twice-daily antibiotics have equal efficacy. Shifting ABSSSI care to outpatient settings may result in medical cost savings greater than 53%. Typical outpatient scenarios represent 14-37% of total medical cost, with PICC accounting for 28-43% of the outpatient burden. The value of new ABSSSI therapies will be driven by eliminating the need for PICC line, reducing length of stay and the ability to completely avoid a hospital stay.
Zarei, Ehsan; Arab, Mohammad; Tabatabaei, Seyed Mahmoud Ghazi; Rashidian, Arash; Forushani, Abbas Rahimi; Khabiri, Roghayeh
In the ever-increasing competitive market of private hospital industry, creating a strong relationship with the customers that shapes patients' loyalty has been considered a key factor in obtaining market share. The purpose of this paper is to test a model of customer loyalty among patients of private hospitals in Iran. This cross-sectional study was carried out in Tehran, the capital of the Islamic Republic of Iran in 2010. The study samples composed of 969 patients who were consecutively selected from eight private hospitals. The survey instrument was designed based on a review of the related literature and included 36 items. Data analysis was performed using structural equation modeling. For the service quality construct, three dimensions extracted: Process, interaction, and environment. Both process and interaction quality had significant effects on perceived value. Perceived value along with the process and interaction quality were the most important antecedents of patient overall satisfaction. The direct effect of the process and interaction quality on behavioral intentions was insignificant. Perceived value and patient overall satisfaction were the direct antecedents of patient behavioral intentions and the mediators between service quality and behavioral intentions. Environment quality of service delivery had no significant effect on perceived value, overall satisfaction, and behavioral intentions. Contrary to previous similar studies, the role of service quality was investigated not in a general sense, but in the form of three types of qualities including quality of environment, quality of process, and quality of interaction.
Vaz Patto, M.C.; Rubiales, D.; Martin, A.; Hernandez, P.; Lindhout, W.H.; Niks, R.E.; Stam, P.
In cereals, rust fungi are among the most harmful pathogens. Breeders usually rely on short-lived hypersensitivity resistance. As an alternative, "avoidance" may be a more durable defence mechanism to protect plants to rust fungi. In Hordeum chilense avoidance is based on extensive wax covering of
Kruse, Alexandra Y; Phuong, Cam N; Ho, Binh T T; Stensballe, Lone G; Pedersen, Freddy K; Greisen, Gorm
Neonatal deaths (≤28 days) account for more than half of child mortality in Vietnam. Presumably most die in hospital, but data are scarce. This study aimed to identify risk factors of death among hospitalised neonates. We prospectively studied all neonatal deaths and expected deaths (discharged alive after withdrawal of life-sustaining treatment) in a Vietnamese tertiary paediatric hospital during a 12-month period in 2009-2010. The medical files were audited classifying admission prognosis, discharge outcome, cause of death/expected death according to two classifications, and important and potentially avoidable risk factors during the hospital stay. Among 5763 neonates admitted, 235 deaths and 67 expected deaths were included. According to both classifications, major causes were congenital malformations, prematurity and severe infections. Six risk factors were identified in 85% (60/71) of the neonates with a relatively good prognosis: recognition or response to danger signs, internal transfers, nosocomial infections, sepsis management, access to usual equipment/staff, and family perception. Among 302 neonatal deaths/expected deaths, the major causes were congenital malformations, prematurity and severe infections. Six important and potentially avoidable risk factors could be addressed in the subgroup with relatively good admission prognosis, without implementing new technology or major organisational changes. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Portman, Robert M
Hospitals routinely enter into contracts with radiology groups for the right to be the exclusive providers of radiologic services at the facilities in exchange for the groups' agreeing to provide and manage all aspects of those services within the hospitals. These exclusive contracts generally result in radiology departments and associated equipment being closed off to physicians who are not part of the contracting groups. Although exclusive contracts offer obvious benefits to the physicians who receive them and obvious disadvantages for those who are excluded, they also present pitfalls for physicians in the chosen group. Part 1 of this article discussed the legal issues raised by exclusive contracts. Part 2 weighs the practical advantages and disadvantages of exclusive contracts for physicians covered and not covered by such contracts and strategies for avoiding them, as well as provisions that can be included in medical staff bylaws to protect physicians from the automatic termination of privileges when a hospital enters into or terminates an exclusive contract. The remainder of the article provides tips on specific provisions of exclusive contracts that should be included or avoided.
Ein-Dor, Tsachi; Reizer, Abira; Shaver, Phillip R; Dotan, Eyal
Attachment-related avoidance and anxiety have repeatedly been associated with poorer adjustment in various social, emotional, and behavioral domains. We examined 2 domains in which avoidant individuals might be better equipped than their less avoidant peers to succeed and be satisfied--professional singles tennis and computer science. These fields may reward self-reliance, independence, and the ability to work without proximal social support from loved ones. In study 1, we followed 58 professional singles tennis players for 16 months and found that scores on attachment-related avoidance predicted a higher ranking, above and beyond the contributions of training and coping resources. In study 2, we sampled 100 students and found that those who scored higher on avoidance were happier with their choice of computer science as a career than those who scored lower on avoidance. Results are discussed in relation to the possible adaptive functions of certain personality characteristics often viewed as undesirable. © 2011 The Authors. Journal of Personality © 2011, Wiley Periodicals, Inc.
Mozaffar, Hajar; Cresswell, Kathrin M; Williams, Robin; Bates, David W; Sheikh, Aziz
Hospital electronic prescribing (ePrescribing) systems offer a wide range of patient safety benefits. Like other hospital health information technology interventions, however, they may also introduce new areas of risk. Despite recent advances in identifying these risks, the development and use of ePrescribing systems is still leading to numerous unintended consequences, which may undermine improvement and threaten patient safety. These negative consequences need to be analysed in the design, implementation and use of these systems. We therefore aimed to understand the roots of these reported threats and identify candidate avoidance/mitigation strategies. We analysed a longitudinal, qualitative study of the implementation and adoption of ePrescribing systems in six English hospitals, each being conceptualised as a case study. Data included semistructured interviews, observations of implementation meetings and system use, and a collection of relevant documents. We analysed data first within and then across the case studies. Our dataset included 214 interviews, 24 observations and 18 documents. We developed a taxonomy of factors underlying unintended safety threats in: (1) suboptimal system design, including lack of support for complex medication administration regimens, lack of effective integration between different systems, and lack of effective automated decision support tools; (2) inappropriate use of systems-in particular, too much reliance on the system and introduction of workarounds; and (3) suboptimal implementation strategies resulting from partial roll-outs/dual systems and lack of appropriate training. We have identified a number of system and organisational strategies that could potentially avoid or reduce these risks. Imperfections in the design, implementation and use of ePrescribing systems can give rise to unintended consequences, including safety threats. Hospitals and suppliers need to implement short- and long-term strategies in terms of the
Jha, Ashish K; DesRoches, Catherine M; Shields, Alexandra E; Miralles, Paola D; Zheng, Jie; Rosenbaum, Sara; Campbell, Eric G
Some hospitals that disproportionately care for poor patients are falling behind in adopting electronic health records (EHRs). Data from a national survey indicate early evidence of an emerging digital divide: U.S. hospitals that provide care to large numbers of poor patients also had minimal use of EHRs. These same hospitals lagged others in quality performance as well, but those with EHR systems seemed to have eliminated the quality gap. These findings suggest that adopting EHRs should be a major policy goal of health reform measures targeting hospitals that serve large populations of poor patients.
Full Text Available Background: Improving diabetic patients’ foot care behaviors is one of the most effective strategies in minimizing diabetic foot ulceration and its further negative impacts, either in diabetic hospitalized patients or outpatients.Purpose: To describe foot care knowledge and behaviors among hospitalized diabetic patients, to apply selected foot care knowledge and behaviors improvement evidence, and to evaluate its effectiveness.Method: Four diabetic patients who were under our care for at least three days and could communicate in Thai language were selected from a surgical ward in a university hospital. The authors applied educational program based on patients’ learning needs, provided diabetic foot care leaflet, and assisted patients to set their goal and action plans. In the third day of treatment, we evaluated patients’ foot care knowledge and their goal and action plan statements in improving foot care behaviors.Result: Based on the data collected among four hospitalized diabetic patients, it was shown that all patients needed foot care behaviors improvement and the educational program improved hospitalized patients’ foot care knowledge and their perceived foot care behaviors. The educational program that combined with goal setting and action plans method was easy, safe, and seemed feasibly applicable for diabetic hospitalized patients.Conclusion: The results of this study provide valuable information for improvement of hospitalized diabetic patients’ foot care knowledge and behaviors. The authors recommend nurses to use this evidence-based practice to contribute in improving the quality of diabetic care.Keywords: Intervention, diabetic foot care, hospitalized diabetic patients
Collins, Timothy P.; Crawford, Jarret T.; Brandt, M.J.
Nam, Jost, and van Bavel (2013) found that conservatives were more likely than liberals to avoid dissonance-arousing situations (viz., writing counter-attitudinal essays in a high-choice situation). A close replication of this original research was unsuccessful, as both liberals and conservatives
Sheringham, Jessica; Asaria, Miqdad; Barratt, Helen; Raine, Rosalind; Cookson, Richard
Objectives Reducing health inequalities is an explicit goal of England's health system. Our aim was to compare the performance of English local administrative areas in reducing socioeconomic inequality in emergency hospital admissions for ambulatory care sensitive chronic conditions. Methods We used local authority area as a stable proxy for health and long-term care administrative geography between 2004/5 and 2011/12. We linked inpatient hospital activity, deprivation, primary care, and population data to small area neighbourhoods (typical population 1500) within administrative areas (typical population 250,000). We measured absolute inequality gradients nationally and within each administrative area using neighbourhood-level linear models of the relationship between national deprivation and age-sex-adjusted emergency admission rates. We assessed local equity performance by comparing local inequality against national inequality to identify areas significantly more or less equal than expected; evaluated stability over time; and identified where equity performance was steadily improving or worsening. We then examined associations between change in socioeconomic inequalities and change in within-area deprivation (gentrification). Finally, we used administrative area-level random and fixed effects models to examine the contribution of primary care to inequalities in admissions. Results Data on 316 administrative areas were included in the analysis. Local inequalities were fairly stable between consecutive years, but 32 areas (10%) showed steadily improving or worsening equity. In the 21 improving areas, the gap between most and least deprived fell by 3.9 admissions per 1000 (six times the fall nationally) between 2004/5 and 2011/12, while in the 11 areas worsening, the gap widened by 2.4. There was no indication that measured improvements in local equity were an artefact of gentrification or that changes in primary care supply or quality contributed to changes in
Kostagiolas, Petros A; Aggelopoulou, Vasiliki A; Niakas, Dimitris
Hospital pharmacists need access to high-quality information in order to constantly update their knowledge and improve their skills. In their modern role, they are expected to address three types of challenges: scientific, organizational and administrative, thus having an increased need for adequate information and library services. This study investigates the information-seeking behaviour of public hospital pharmacists providing evidence from Greece that could be used to encourage the development of effective information hospital services and study the links between the information seeking behaviour of hospital pharmacists and their modern scientific and professional role. An empirical research was conducted between January and February 2010 with the development and distribution of a structured questionnaire. The questionnaire was filled in and returned by 88 public hospital pharmacists from a total of 286 working in all Greek public hospitals, providing a response rate of 31%. The hospital pharmacists in Greece are in search of scientific information and, more particularly, pharmaceutical information (e.g., drug indications, storage, dosage and prices). The Internet and the National Organization of Medicines are their main information sources, while the lack of time and organized information are the main obstacles they have to face when seeking information. The modern professional role of hospital pharmacists as invaluable contributors to efficient and safer healthcare services may be further supported through the development of specialized libraries and information services within Greek public hospitals. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.
Clement, J P
The purpose of this paper is to determine whether dynamic cost shifting occurred among acute care hospitals during the period from the early 1980s to the early 1990s and, if so, whether market factors affected the ability to shift costs. Evidence from this study of California acute care hospitals during three time intervals shows that the hospital did practice dynamic cost shifting, but that their ability to shift costs decreased over time. Surprisingly, hospital competition and HMO penetration did not influence cost shifting. However, increasing HMO penetration (measured as the HMO percentage of hospital discharges) did decrease both net prices and costs for the early part of the study, but later was associated with increases in both.
Smith, Peter Mark; Harbias, Aman; Robinson, Richard; Palmer, Anne; Grey, Benjamin Robin
Polyembolokoilamania refers to the practice of inserting foreign bodies (FBs) into natural orifices. A FB within the urethra is a relatively rare phenomenon with 646 cases recorded last year in the United Kingdom. Management of these patients presents technical challenges and complexities because of underlying psychiatric disorders that are often associated. This case illustrates a novel way of removing FBs from the genitourinary tract, requiring less resources, preventing hospital admission, and attempts to break the cycle of behavior, leading to recurrent attendance with polyembolokoilamania. A 38-year-old Caucasian male prisoner, with psychiatric history presented to the emergency department (ED) with a history of inserting FBs into his urethra on 12 different occasions over a 6-week period. Of these 12 attendances, 3 resulted in admission and 2 required emergency intervention in theater under general anesthesia. After the third attendance in 5 days, it was decided to use Isiris™, a single-use flexible cystoscopy device with a built-in ureteral stent grasper, to remove the FBs and check the integrity of the urethra. The procedure was performed within the ED, without the need for admission to a ward bed or general anesthesia. Furthermore, only two members of staff were required to remove all of the urethral FBs. Isiris, although marketed as a stent removal device, enabled us to remove all the patient's FBs in one procedure. Isiris is an easy to use device, similar to a flexible cystoscope, that a specialist nurse or resident would be familiar using. It allows efficient and safe removal of lower urinary tract FBs, even out of hours. It requires minimal staffing support and can be done in the ED. It has the potential to reduce associated sequela of urethral polyembolokoilamania, saving resources while preserving the availability of the emergency theater.
Bigham, Blair; Welsford, Michelle
The practice of emergency medicine (EM) has been intertwined with emergency medical services (EMS) for more than 40 years. In this commentary, we explore the practice of translating hospital based evidence into the prehospital setting. We will challenge both EMS and EM dogma-bringing hospital care to patients in the field is not always better. In providing examples of therapies championed in hospitals that have failed to translate into the field, we will discuss the unique prehospital environment, and why evidence from the hospital setting cannot necessarily be translated to the prehospital field. Paramedicine is maturing so that the capability now exists to conduct practice-specific research that can inform best practices. Before translation from the hospital environment is implemented, evidence must be evaluated by people with expertise in three domains: critical appraisal, EM, and EMS. Scientific evidence should be assessed for: quality and bias; directness, generalizability, and validity to the EMS population; effect size and anticipated benefit from prehospital application; feasibility (including economic evaluation, human resource availability in the mobile environment); and patient and provider safety.
Stuchlík, Aleš; Petrásek, Tomáš; Valeš, Karel
Roč. 104, Suppl.2 (2008), s. 1135-1135 ISSN 1212-0383. [World congress of psychiatry /14./. 20.09.2008-25.09.2008, Prague] R&D Projects: GA ČR(CZ) GA309/07/0341; GA MZd(CZ) NR9178; GA MŠk(CZ) LC554; GA MŠk(CZ) 1M0517 Institutional research plan: CEZ:AV0Z50110509 Keywords : cpo1 * avoidance * memory * rat Subject RIV: FH - Neurology
Shuman, Clayton J; Xie, Xian-Jin; Herr, Keela A; Titler, Marita G
Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based acute pain management practices and mean pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation. Further work is needed to identify factors affecting sustainability of EBPs to guide development and testing of sustainability strategies.
Gift, Thomas L; Arnould, Richard; DeBrock, Larry
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.
Sharp, Carla; Kalpakci, Allison; Mellick, William; Venta, Amanda; Temple, Jeff R
At least two leading developmental models of borderline personality disorder (BPD) emphasize the role of accurate reflection and understanding of internal states as significant to the development of BPD features (Fonagy, Int J Psycho-Anal 72:639-656, 1991; Linehan, Cognitive-behavioral treatment of borderline personality disorder, 1993). The current study used the construct of experiential avoidance (EA) to operationalize avoidance of internal states and sought to examine (1) the concurrent relations between EA and borderline features in a large and diverse community sample; and (2) the prospective relation between EA and borderline features over a 1-year follow-up, controlling for baseline levels of borderline features. N = 881 adolescents recruited from public schools in a large metropolitan area participated in baseline assessments and N = 730 completed follow-up assessments. Two main findings were reported. First, EA was associated with borderline features, depressive, and anxiety symptoms at the bivariate level, but when all variables were considered together, depression and anxiety no longer remained significantly associated with borderline features, suggesting that the relations among these symptom clusters may be accounted for by EA as a cross-cutting underlying psychological process. Second, EA predicted levels of borderline symptoms at 1-year follow-up, controlling for baseline levels of borderline symptoms, and symptoms of anxiety and depression. Results are interpreted against the background of developmental theories of borderline personality disorder.
Hammer, Jennifer L; Marsh, Abigail A
Despite communicating a "negative" emotion, fearful facial expressions predominantly elicit behavioral approach from perceivers. It has been hypothesized that this seemingly paradoxical effect may occur due to fearful expressions' resemblance to vulnerable, infantile faces. However, this hypothesis has not yet been tested. We used a combined approach-avoidance/implicit association test (IAT) to test this hypothesis. Participants completed an approach-avoidance lever task during which they responded to fearful and angry facial expressions as well as neutral infant and adult faces presented in an IAT format. Results demonstrated an implicit association between fearful facial expressions and infant faces and showed that both fearful expressions and infant faces primarily elicit behavioral approach. The dominance of approach responses to both fearful expressions and infant faces decreased as a function of psychopathic personality traits. Results suggest that the prosocial responses to fearful expressions observed in most individuals may stem from their associations with infantile faces. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
Cooke, Steven J; Birnie-Gauvin, Kim; Lennox, Robert J; Taylor, Jessica J; Rytwinski, Trina; Rummer, Jodie L; Franklin, Craig E; Bennett, Joseph R; Haddaway, Neal R
Policy development and management decisions should be based upon the best available evidence. In recent years, approaches to evidence synthesis, originating in the medical realm (such as systematic reviews), have been applied to conservation to promote evidence-based conservation and environmental management. Systematic reviews involve a critical appraisal of evidence, but studies that lack the necessary rigour (e.g. experimental, technical and analytical aspects) to justify their conclusions are typically excluded from systematic reviews or down-weighted in terms of their influence. One of the strengths of conservation physiology is the reliance on experimental approaches that help to more clearly establish cause-and-effect relationships. Indeed, experimental biology and ecology have much to offer in terms of building the evidence base that is needed to inform policy and management options related to pressing issues such as enacting endangered species recovery plans or evaluating the effectiveness of conservation interventions. Here, we identify a number of pitfalls that can prevent experimental findings from being relevant to conservation or would lead to their exclusion or down-weighting during critical appraisal in a systematic review. We conclude that conservation physiology is well positioned to support evidence-based conservation, provided that experimental designs are robust and that conservation physiologists understand the nuances associated with informing decision-making processes so that they can be more relevant.
Aravind, Maya; Chung, Kevin C
The use of reliable evidence to evaluate health care interventions has gained strong support within the medical community and in the field of plastic surgery in particular. Evidence-based medicine aims to improve health care and reduce costs through the use of sound clinical evidence in evaluating treatments, procedures, and outcomes. The field is hardly new, however, and most trace its origins back to the work of Cochrane in the 1970s and Sackett in the 1990s. Though she wouldn't know it, Florence Nightingale was applying the concepts of evidence-based reform to the medical profession more than a century before. She used medical statistics to reveal the nature of infection in hospitals and on the battlefield. Moreover, Nightingale marshaled data and evidence to establish guidelines for health care reform. Tracing the origins of evidence-based medicine back to Nightingale underscores how critical this movement is to improving the quality and effectiveness of patient care today.
Norlyk, Annelise; Haahr, Anita; Dreyer, Pia; Martinsen, Bente
Drawing on previous empirical research, we provide an exemplary narrative to illustrate how patients have experienced hospital care organized according to evidence-based fast-track programmes. The aim of this paper was to analyse and discuss if and how it is possible to include patients' individual perspectives in an evidence-based practice as seen from the point of view of nursing theory. The paper highlights two conflicting courses of development. One is a course of standardization founded on evidence-based recommendations, which specify a set of rules that the patient must follow rigorously. The other is a course of democratization based on patients' involvement in care. Referring to the analysis of the narrative, we argue that, in the current implementation of evidence-based practice, the proposed involvement of patients resembles empty rhetoric. We argue that the principles and values from evidence-based medicine are being lost in the transformation into the current evidence-based hospital culture which potentially leads to a McDonaldization of nursing practice reflected as 'one best way'. We argue for reviving ethics of care perspectives in today's evidence practice as the fundamental values of nursing may potentially bridge conflicts between evidence-based practice and the ideals of patient participation thus preventing a practice of 'McNursing'. © 2017 John Wiley & Sons Ltd.
Rauscher, Simone; Wheeler, John R C
Increased financial pressures on hospitals have elevated the importance of working capital management, that is, the management of current assets and current liabilities, for hospitals' profitability. Efficient working capital management allows hospitals to reduce their holdings of current assets, such as inventory and accounts receivable, which earn no interest income and require financing with short-term debt. The resulting cash inflows can be reinvested in interest-bearing financial instruments or used to reduce short-term borrowing, thus improving the profitability of the organization. This study examines the relationship between hospitals' profitability and their performance at managing two components of working capital: accounts receivable, measured in terms of hospitals' average collection periods, and accounts payable, measured in terms of hospitals' average payment periods. Panel data derived from audited financial statements for 1,397 bond-issuing, not-for-profit U.S. hospitals for 2000-2007 were analyzed using hospital-level fixed-effects regression analysis. The results show a negative relationship between hospitals' average collection period and profitability. That is, hospitals that collected on their patient revenue faster reported higher profit margins than did hospitals that have larger balances of accounts receivable outstanding. We also found a negative relationship between hospitals' average payment period and their profitability. Hospital managers did not appear to delay paying their vendors. Rather, the findings indicated that more profitable hospitals paid their suppliers faster, possibly to avoid high effective interest rates on outstanding accounts payable, whereas less profitable hospitals waited longer to pay their bills. The findings of this study suggest that working capital management indeed matters for hospitals' profitability. Efforts aimed at reducing large balances in both accounts receivable and accounts payable may frequently be
Xie, Weizhen; Li, Huanhuan; Luo, Xinwei; Fu, Rong; Ying, Xiangyu; Wang, Ning; Yin, Qifeng; Zou, Yingmin; Cui, Yanyan; Wang, Xiang; Shi, Chuan
Psychological pain may be helpful in conceptualizing suicidal behavior, in that high motivation to avoid pain combined with painful feelings may contribute to an increased risk of suicide. However, no experimental study has tested this hypothesis. The aim of the present study is to provide empirical evidence for the relationship between anhedonia, pain avoidance motivation, and suicidal ideation. The sample comprised 40 depressed outpatients and 20 healthy control subjects. All participants completed the Beck Scale for Suicide Ideation (BSS), Beck Depression Inventory, Psychache Scale, Three-Dimensional Psychological Pain Scale, the monetary incentive delay (MID), and affective incentive delay (AID) tasks. Based on BSS scores, clinical participants were divided into high suicidal ideation (HSI) and low suicidal ideation (LSI) groups. In the AID task, the HSI group had longer response times (RTs) under the reward condition than those under the punishment condition (p = .002). The LSI and control groups had shorter RTs under the reward condition compared with those under the neural condition (p <.001 and p = .008, respectively). The LSI group also had shorter RTs under the reward condition than under the punishment condition (p = .003). Pain arousal (r = -.33, p <.01) and BSS scores were significantly negatively correlated with differences in RTs between neutral and reward conditions. Pain avoidance (r = .35, p <.01) and BSS scores were positively correlated with differences in RTs between neutral and punishment conditions. The AID task was more sensitive than the MID task for the detection of participants' motivation in approaching hedonic experiences and avoiding pain. A suicidal mindset is manifested as decreased motivation to experience hedonia and increased motivation to avoid pain, which could be strong predictors of suicidal behavior. © 2013 Wiley Periodicals, Inc.
Baloh, Jure; Zhu, Xi; Ward, Marcia M
Implementation models, frameworks, and theories recognize the importance of activities that facilitate implementation success. However, little is known about internal facilitation activities that hospital personnel engage in during implementation efforts. The aim of the study was to examine internal facilitation activities at 10 critical access hospitals in rural Iowa during their implementation of TeamSTEPPS, a patient safety intervention, and to identify characteristics that distinguish different types of facilitation activities. We followed 10 critical access hospitals for 2 years after the onset of implementation, conducting quarterly interviews with key informants. On the basis of the transcripts from the first two quarters, a coding template was developed using inductive analyses. The template was then applied deductively to code all interview transcripts. Using comparative analysis, we examined the characteristics that distinguish between the facilitation types. We identified four types of facilitation activities-Leadership, Buy-in, Customization, and Accountability. Individuals and teams engaged in different types of facilitation activities, both in a planned and an ad hoc manner. These activities targeted at both people and practices and exhibited varying temporal patterns (start and peak time). There are four types of facilitation activities that hospitals engage in while implementing evidence-based practices, offering a parsimonious way to characterize facilitation activities. New theoretical and empirical research opportunities are discussed. Understanding the types of facilitation activities and their distinguishing characteristics can assist managers in planning and executing implementations of evidence-based interventions.
Koivunen, Marita; Välimäki, Maritta; Hätönen, Heli
Nursing professionals have long recognized the importance to practice of research and the value of research evidence. Nurses still do not use research findings in practice. The purpose of this paper was to describe nurses' skills in using literature databases and the Internet in psychiatric hospitals and associations of nurses' gender, age, and job position with their information retrieval skills. The study was carried out in 2004 among nursing staff (N=183) on nine acute psychiatric wards in two psychiatric hospitals in Finland (n=180, response rate 98%). The Finnish version of the European Computer Driving Licence test (ECDL) was used as a data collection instrument. The study showed that there were clear deficits in information retrieval skills among nurses working in psychiatric hospitals. Thus, nurses' competence does not support the realization of evidence-based practice in the hospitals. Therefore, it is important to increase nurses' information retrieval skills by tailoring continuing education modules. It would be also advisable to develop centralized systems for the internal dissemination of research findings for the use of nursing staff.
Scharman, Elizabeth J; Erdman, Andrew R; Cobaugh, Daniel J; Olson, Kent R; Woolf, Alan D; Caravati, E Martin; Chyka, Peter A; Booze, Lisa L; Manoguerra, Anthony S; Nelson, Lewis S; Christianson, Gwenn; Troutman, William G
A review of US poison center data for 2004 showed over 8,000 ingestions of methylphenidate. A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial out-of-hospital management of patients with suspected ingestions of methylphenidate by 1) describing the process by which a specialist in poison information should evaluate an exposure to methylphenidate, 2) identifying the key decision elements in managing cases of methylphenidate ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This review focuses on the ingestion of more than a single therapeutic dose of methylphenidate and the effects of an overdose and is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses. 1) All patients with suicidal intent, intentional abuse, or in cases in which
Studies indicate that a fraction of nursing professionals believe in a "lunar effect"-a purported correlation between the phases of the Earth's moon and human affairs, such as birth rates, blood loss, or fertility. This article addresses some of the methodological errors and cognitive biases that can explain the human tendency of perceiving a lunar effect where there is none. This article reviews basic standards of evidence and, using an example from the published literature, illustrates how disregarding these standards can lead to erroneous conclusions. Román, Soriano, Fuentes, Gálvez, and Fernández (2004) suggested that the number of hospital admissions related to gastrointestinal bleeding was somehow influenced by the phases of the Earth's moon. Specifically, the authors claimed that the rate of hospital admissions to their bleeding unit is higher during the full moon than at other times. Their report contains a number of methodological and statistical flaws that invalidate their conclusions. Reanalysis of their data with proper procedures shows no evidence that the full moon influences the rate of hospital admissions, a result that is consistent with numerous peer-reviewed studies and meta-analyses. A review of the literature shows that birth rates are also uncorrelated to lunar phases. Data collection and analysis shortcomings, as well as powerful cognitive biases, can lead to erroneous conclusions about the purported lunar effect on human affairs. Adherence to basic standards of evidence can help assess the validity of questionable beliefs.
Physicians, nurses, and other clinicians readily acknowledge being troubled by encounters with patients who trigger moral judgments. For decades social scientists have noted that moral judgment of patients is pervasive, occurring not only in egregious and criminal cases but also in everyday situations in which appraisals of patients' social worth and culpability are routine. There is scant literature, however, on the actual prevalence and dynamics of moral judgment in healthcare. The indirect evidence available suggests that moral appraisals function via a complex calculus that reflects variation in patient characteristics, clinician characteristics, task, and organizational factors. The full impact of moral judgment on healthcare relationships, patient outcomes, and clinicians' own well-being is yet unknown. The paucity of attention to moral judgment, despite its significance for patient-centered care, communication, empathy, professionalism, healthcare education, stereotyping, and outcome disparities, represents a blind spot that merits explanation and repair. New methodologies in social psychology and neuroscience have yielded models for how moral judgment operates in healthcare and how research in this area should proceed. Clinicians, educators, and researchers would do well to recognize both the legitimate and illegitimate moral appraisals that are apt to occur in healthcare settings. PMID:20618947
Full Text Available Background: The application of the concept of Evidenced Based Practice into clinical decision-making and practicehas outstanding benefits both to clinicians and the patient. However, the utilization of this concept has not been copiously utilized in most health facilities by the physiotherapists in Kenya. Therefore, the objectives for this study was to determine the level of awareness of evidence based practice among Physiotherapist, establish the availability of resource for Evidence Based Practice and to assess the challenges encountered by physiotherapist in engaging in evidence based practice at Moi Teaching and Referral Hospital. Methods: All physiotherapists working in Moi Teaching and Referral Hospital (42 took part in a cross-sectional descriptive survey. Questionnaires were used for data collection and analyzed by SPSS version 22. Results: there was high level of awareness on Evidence Based Practice (95 % and confidence in EBP (72.5 %. However, lack of information resources, poor skills to implement EBP, poor organization support 90%, insufficient authority to induct change in the practice setting 85%, inadequate facilities 74% and lack of time were identified as the major challenges in implementation of EBP Conclusion: Strategies should be developed to provide PTs with EBP resources, such as access to databases or links to guidelines, and continuous education regarding specific topics. Professional organizations and Associations should aim at changing the current practice to ensure full utilization of EBP.
De Geyndt, Willy
Governments in middle and low income countries have sought ways for the past decades to make their public hospitals more performing. The objectives of this assessment are to: (a) synthesize the experience of eleven countries at granting autonomy to their public hospitals and the obstacles encountered; (b) deduce which autonomy policies have or have not been effective documenting successes and failures; and (c) propose evidence-based recommendations to policy makers. Data for five countries are derived from the author's participation in the autonomy process augmented by current updates provided by national colleagues. Data for the other six countries are derived from publications available in the literature. Policies granting autonomy to public hospitals have had limited success. In all cases Boards of Directors have been created. Governance of autonomized hospitals by Boards however is obstructed by the resistance of central level entities to have their authority diminished. The Ministry of Finance tends to maintain control over revenues and expenditures. The Public Service Commission resists abdicating its role to hire, promote, transfer and dismiss government employees. The Ministry of Health attempts to keep its authority to appoint hospital staff, procure medical supplies and equipment; it may do so directly or indirectly by selecting and appointing Board members. Management information systems continue to collect activity measures to be aggregated at the national level for statistical purposes and do not provide financial and clinical data useful for decision making by the Boards and by senior management. Decentralizing decision making to the operational level has had limited success. Stakeholders at the central level devise strategies to maintain their power. Two main obstacles are delegating authority over human resources and finances that are sine qua non conditions for governing and increasing the performance of public hospitals. Copyright © 2017 Elsevier
Ornstein, Rollyn M; Essayli, Jamal H; Nicely, Terri A; Masciulli, Emily; Lane-Loney, Susan
Avoidant/restrictive food intake disorder (ARFID) is a recently named condition to classify patients who present with restricted nutritional intake without body image distortion or fear of weight gain. We sought to compare treatment outcomes of patients with ARFID in a family-centered partial hospital program (PHP) to those with other eating disorders (ED). A retrospective chart review of 130 patients 7-17 years of age admitted to the program from 2008 to 2012 was performed. Intake and discharge data included: length of stay; percentage median body mass index (%MBMI); and scores on the Children's Eating Attitudes Test (ChEAT) and Revised Children's Manifest Anxiety Scale (RCMAS). Between and within group effects were measured for intake and discharge data. Patients with ARFID spent significantly fewer weeks in program than those with anorexia nervosa (AN) and experienced a similar increase in %MBMI as patients with AN and other specified/unspecified feeding and eating disorders. All patients exhibited significant improvements in psychopathology over the course of treatment as measured by scores on the ChEAT and RCMAS. Our findings suggest that patients with ARFID can be successfully treated in the same PHP as patients with other ED, with comparable improvements in weight and psychopathology over a shorter time period. Results are limited to patients with ARFID who exhibit an acute onset of severe food restriction. Future research should incorporate measures relevant to the diagnosis of ARFID and explore how patients with different ARFID subtypes may respond to various treatments. © 2017 Wiley Periodicals, Inc.
Lankston, Louise; Cusack, Pearce; Fremantle, Chris; Isles, Chris
In 2006 a Department of Health Working Group on Arts and Health reported that the arts have 'a clear contribution to make and offer major opportunities in the delivery of better health, wellbeing and improved experience for patients, service users and staff alike'. In this review we examine the evidence underpinning this statement and evaluate the visual art of three of Scotland's newest hospitals: the Royal Infirmary of Edinburgh, the new Stobhill Hospital, and the new Victoria Infirmary in Glasgow. We conclude that art in hospitals is generally viewed positively by both patients and staff, but that the quality of the evidence is not uniformly high. Effects may be mediated by psychological responses to colour hue, brightness and saturation. Colours that elicit high levels of pleasure with low levels of arousal are most likely to induce a state of calm, while those causing displeasure and high levels of arousal may provoke anxiety. The fact that patients frequently express a preference for landscape and nature scenes is consistent with this observation and with evolutionary psychological theories which predict positive emotional responses to flourishing natural environments. Contrary to a view which may prevail among some contemporary artists, patients who are ill or stressed about their health may not always be comforted by abstract art, preferring the positive distraction and state of calm created by the blues and greens of landscape and nature scenes instead.
Lankston, Louise; Cusack, Pearce; Fremantle, Chris; Isles, Chris
Summary In 2006 a Department of Health Working Group on Arts and Health reported that the arts have ‘a clear contribution to make and offer major opportunities in the delivery of better health, wellbeing and improved experience for patients, service users and staff alike’. In this review we examine the evidence underpinning this statement and evaluate the visual art of three of Scotland's newest hospitals: the Royal Infirmary of Edinburgh, the new Stobhill Hospital, and the new Victoria Infirmary in Glasgow. We conclude that art in hospitals is generally viewed positively by both patients and staff, but that the quality of the evidence is not uniformly high. Effects may be mediated by psychological responses to colour hue, brightness and saturation. Colours that elicit high levels of pleasure with low levels of arousal are most likely to induce a state of calm, while those causing displeasure and high levels of arousal may provoke anxiety. The fact that patients frequently express a preference for landscape and nature scenes is consistent with this observation and with evolutionary psychological theories which predict positive emotional responses to flourishing natural environments. Contrary to a view which may prevail among some contemporary artists, patients who are ill or stressed about their health may not always be comforted by abstract art, preferring the positive distraction and state of calm created by the blues and greens of landscape and nature scenes instead. PMID:21127332
Croes, R R; Krabbe-Alkemade, Y J F M; Mikkers, M C
There is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be characterized as a system involving managed competition and mandatory healthcare insurance. Information about the quality of care provided by hospitals has been publicly available since 2008. In this paper, we evaluate the relationship between quality scores for three diagnosis groups and the market power indicators of hospitals. We estimate the impact of competition on quality in an environment of liberalized pricing. For this research, we used unique price and production data relating to three diagnosis groups (cataract, adenoid and tonsils, bladder tumor) produced by Dutch hospitals in the period 2008-2011. We also used the quality indicators relating to these diagnosis groups. We reveal a negative relationship between market share and quality score for two of the three diagnosis groups studied, meaning that hospitals in competitive markets have better quality scores than those in concentrated markets. We therefore conclude that more competition is associated with higher quality scores.
Post, Brady; Buchmueller, Tom; Ryan, Andrew M
Hospital-physician vertical integration is on the rise. While increased efficiencies may be possible, emerging research raises concerns about anticompetitive behavior, spending increases, and uncertain effects on quality. In this review, we bring together several of the key theories of vertical integration that exist in the neoclassical and institutional economics literatures and apply these theories to the hospital-physician relationship. We also conduct a literature review of the effects of vertical integration on prices, spending, and quality in the growing body of evidence ( n = 15) to evaluate which of these frameworks have the strongest empirical support. We find some support for vertical foreclosure as a framework for explaining the observed results. We suggest a conceptual model and identify directions for future research. Based on our analysis, we conclude that vertical integration poses a threat to the affordability of health services and merits special attention from policymakers and antitrust authorities.
Gwyn Bevan; Matthew Skellern
Gwyn Bevan and Matthew Skellern review evidence on the effects of hospital competition on quality of care within the English NHS and question whether they support government proposals to extend competition.
Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and...
Full Text Available Background: Evidence-based patient information (EBPI is a prerequisite for informed decision-making. However, presentation of EBPI may lead to irrational reactions causing avoidance, minimisation and devaluation of the information. Objective: To explore whether the theory of cognitive dissonance is applicable to medical decision-making and useful to explain these phenomena. Setting and participants: 261 volunteers from Hamburg (157 women, ≥50 years old without diagnosis of colorectal cancer. Design and variables: Within an experiment we simulated information seeking on colorectal cancer screening. Consumers’ attitudes towards screening were surveyed using a rating scale from -5 (participate in no way to +5 (participate unconditionally (independent variable. Using a cover story, participants were asked to sort 5 article headlines according to their reading preferences. The headlines simulated the pro to contra variety of contents to be found in print media about colorectal cancer screening. The dependent variable was the sequence of article headlines. Results: Participants were very much in favour of screening with scores for faecal occult blood test of 4.0 (0.1 and for colonoscopy 3.3 (0.1. According to our hypothesis we found statistically significant positive correlations between the stimuli in favour of screening and attitudes and significant negative correlations between the stimuli against screening and attitudes. Conclusion: The theory of cognitive dissonance is applicable to medical decision-making. It may explain some phenomena of irrational reactions to evidence-based patient information.
Steckelberg, Anke; Kasper, Jürgen; Mühlhauser, Ingrid
Evidence-based patient information (EBPI) is a prerequisite for informed decision-making. However, presentation of EBPI may lead to irrational reactions causing avoidance, minimisation and devaluation of the information. To explore whether the theory of cognitive dissonance is applicable to medical decision-making and useful to explain these phenomena. 261 volunteers from Hamburg (157 women), >or=50 years old without diagnosis of colorectal cancer. DESIGN AND VARIABLES: Within an experiment we simulated information seeking on colorectal cancer screening. Consumers' attitudes towards screening were surveyed using a rating scale from -5 (participate in no way) to +5 (participate unconditionally) (independent variable). Using a cover story, participants were asked to sort 5 article headlines according to their reading preferences. The headlines simulated the pro to contra variety of contents to be found in print media about colorectal cancer screening. The dependent variable was the sequence of article headlines. Participants were very much in favour of screening with scores for faecal occult blood test of 4.0 (0.1) and for colonoscopy 3.3 (0.1). According to our hypothesis we found statistically significant positive correlations between the stimuli in favour of screening and attitudes and significant negative correlations between the stimuli against screening and attitudes. The theory of cognitive dissonance is applicable to medical decision-making. It may explain some phenomena of irrational reactions to evidence-based patient information.
McLaughlan, Rebecca; Pert, Alan
As the dominant research paradigm within the construction of contemporary healthcare facilities, evidence-based design (EBD) will increasingly impact our expectations of what hospital architecture should be. Research methods within EBD focus on prototyping incremental advances and evaluating what has already been built. Yet medical care is a rapidly evolving system; changes to technology, workforce composition, patient demographics and funding models can create rapid and unpredictable changes to medical practice and modes of care. This dynamism has the potential to curtail or negate the usefulness of current best practice approaches. To imagine new directions for the role of the hospital in society, or innovative ways in which the built environment might support well-being, requires a model that can project beyond existing constraints. Speculative design employs a design-based research methodology to imagine alternative futures and uses the artefacts created through this process to enable broader critical reflection on existing practices. This paper examines the contribution of speculative design within the context of the paediatric hospital as a means of facilitating critical reflection regarding the design of new healthcare facilities. While EBD is largely limited by what has already been built, speculative design offers a complementary research method to meet this limitation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Alving, Berit Elisabeth; Christensen, Janne Buck; Thrysøe, Lars
The purpose of this literature review is to provide an overview of the information retrieval behaviour of clinical nurses, in terms of the use of databases and other information resources and their frequency of use. Systematic searches carried out in five databases and handsearching were used to identify the studies from 2010 to 2016, with a populations, exposures and outcomes (PEO) search strategy, focusing on the question: In which databases or other information resources do hospital nurses search for evidence based information, and how often? Of 5272 titles retrieved based on the search strategy, only nine studies fulfilled the criteria for inclusion. The studies are from the United States, Canada, Taiwan and Nigeria. The results show that hospital nurses' primary choice of source for evidence based information is Google and peers, while bibliographic databases such as PubMed are secondary choices. Data on frequency are only included in four of the studies, and data are heterogenous. The reasons for choosing Google and peers are primarily lack of time; lack of information; lack of retrieval skills; or lack of training in database searching. Only a few studies are published on clinical nurses' retrieval behaviours, and more studies are needed from Europe and Australia. © 2018 Health Libraries Group.
I exploit a plausibly exogenous change in hospital financial incentives to examine whether the behavior of private not-for-profit hospitals varies with the share of nearby hospitals organized as for-profit firms. My results show that not-for-profit hospitals in for-profit intensive areas are significantly more responsive to an increased incentive to treat low-income patients insured by the Medicaid program than are other not-for-profit providers. The heterogeneity in behavior is not due to di...
Kaplan, Heather C; Sherman, Susan N; Cleveland, Charlena; Goldenhar, Linda M; Lannon, Carole M; Bailit, Jennifer L
Antenatal corticosteroids (ANCS) reduce complications of preterm birth; however, not all eligible women receive them. Many hospitals and providers do not have the right processes and conditions to enable ANCS administration with high reliability. The objective of this study was to understand conditions that enable delivery of ANCS with high reliability among hospitals participating in an Ohio Perinatal Quality Collaborative (OPQC) ANCS project. We conducted focus groups and semistructured interviews with members of the OPQC project team (n=27) and other care providers (n=70) using a purposeful sample of 6 sites involved in the OPQC ANCS project. Participants including nurses (n=57), attending obstetricians (n=17), physician trainees (n=21) and certified nurse midwives (n=2) were asked to reflect on their experiences and to identify factors contributing to optimal use of ANCS. Focus groups and interviews were transcribed verbatim and were analysed by a multidisciplinary team using an iterative approach that combined inductive and deductive methods to identify and categorise themes. Six major themes supporting reliable implementation of ANCS at these hospitals emerged including: (1) presence of a high reliability culture, (2) processes that emphasise high reliability, (3) timely and efficient administration process, (4) multiple disciplines are involved, (5) evidence of benefit supports ANCS use and (6) benefit is recognised at all levels of the care team. Our findings identify the key processes and supports needed to ensure delivery of ASCS with high reliability and are reinforced by implementation and reliability science. They are useful for foundation of the successful implementation of other evidence-based practices at high levels of reliability. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Ross Hutchison Francis
Full Text Available Objective: Hospital systems and regulating agencies enforce strict guidelines barring personal items from entering the Operating Room - touting surgical site infections and patient safety as the rationale. We sought to determine whether or not evidence supporting this recommendation exists by reviewing available literature.Background data: Rules and guidelines that are not evidence based may lead to increased hospital expenses and limitations on healthcare provider autonomyMethods: PubMed, Embase, Scopus, Cochrane Library, Web of Science, and CINAHL were searched in order to find articles that correlated personal items in the OR to documented surgical site infections. Articles that satisfied the following criteria were included: (1 studies looking at personal items in the OR such as handbags, purses, badges, pagers, backpacks, jewelry phones, and eyeglasses, etc., but not just operating room equipment; and (2 the primary outcome measure was infection at the surgical site.Results: Seventeen articles met inclusion criteria and were evaluated. Of the 17, the majority did not determine if personal items increased risk for surgical site infection. Only 1 article examined the correlation between a personal item near the operative site and surgical site infection, concluding that wedding rings worn in the OR had no impact on surgical site infections. Most studies examined colonization rates on personal items as potential infection risk; however, no personal items were causally linked to surgical site infection in any of these studies.Conclusion: There is no objective evidence to suggest that personal items in the OR increase risk for surgical site infections.
Amato, Laura; Fusco, Danilo; Acampora, Anna; Bontempi, Katia; Rosa, Alessandro Cesare; Colais, Paola; Cruciani, Fabio; D'Ovidio, Mariangela; Mataloni, Francesca; Minozzi, Silvia; Mitrova, Zuzana; Pinnarelli, Luigi; Saulle, Rosella; Soldati, Salvatore; Sorge, Chiara; Vecchi, Simona; Ventura, Martina; Davoli, Marina
BACKGROUND Improving quality and effectiveness of healthcare is one of the priorities of health policies. Hospital or physician volume represents a measurable variable with an impact on effectiveness of healthcare. An Italian law calls for the definition of «qualitative, structural, technological, and quantitative standards of hospital care». There is a need for an evaluation of the available scientific evidence in order to identify qualitative, structural, technological, and quantitative standards of hospital care, including the volume of care above or below which the public and private hospitals may be accredited (or not) to provide specific healthcare interventions. OBJECTIVES To identify conditions/interventions for which an association between volume and outcome has been investigated. To identify conditions/interventions for which an association between volume and outcome has been proved. To analyze the distribution of Italian health providers by volume of activity. To measure the association between volume of care and outcomes of the health providers of the Italian National Health Service (NHS). METHODS Systematic review An overview of systematic reviews was performed searching PubMed, EMBASE, and The Cochrane Library up to November 2016. Studies were evaluated by 2 researchers independently; quality assessment was performed using the AMSTAR checklist. For each health condition and outcome, if available, total number of studies, participants, high volume cut-off values, and metanalysis have been reported. According to the considered outcomes, health topics were classified into 3 groups: positive association: a positive association was demonstrated in the majority of studies/participants and/or a pooled measure (metanalysis) with positive results was reported; lack of association: both studies and/or metanalysis showed no association; no sufficient evidence of association: both results of single studies and metanalysis do not allow to draw firm conclusions
This thesis provides a comprehensive reporting of the work undertaken to identify evidence supporting pre-hospital management of supraventricular tachycardia (SVT), delivering an evidence base for paramedic treatment of these patients. The literature search identified absences in evidence supporting therapies used within existing clinical guidelines. The vagal manoeuvres, the simplest and least invasive therapy to employ in the stable patient, were insufficiently evidenced regarding technique...
Objective The pricing of follow-on drugs, that offer only limited health benefits over existing therapeutic alternatives, is a recurring health policy debate. This study investigates whether follow-on therapeutic substitutes create price competition between branded hospital medicines. Methods New...... pioneer products were significantly reduced as a reaction to competition from follow-on drugs. Conclusion Competition between patented therapeutic substitutes did not seem to increase price competition and containment of pharmaceutical expenditures in the Danish hospital market. Strengthening hospitals......’ incentives to consider the price of alternative treatment options paired with a more active formulary management may increase price competition between therapeutic substitutes in the Danish hospital sector in the future....
Pogrebna, Ganna; Oswald, Andrew J; Haig, David
Using ultrasound scan data from paediatric hospitals, and the exogenous 'shock' of learning the gender of an unborn baby, the paper documents the first causal evidence that offspring gender affects adult risk-aversion. On a standard Holt-Laury criterion, parents of daughters, whether unborn or recently born, become almost twice as risk-averse as parents of sons. The study demonstrates this in longitudinal and cross-sectional data, for fathers and mothers, for babies in the womb and new-born children, and in a West European nation and East European nation. These findings may eventually aid our understanding of risky health behaviors and gender inequalities. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.
Cookson, Richard; Laudicella, Mauro; Li Donni, Paolo
Increasing evidence shows that hospital competition under fixed prices can improve quality and reduce cost. Concerns remain, however, that competition may undermine socio-economic equity in the utilisation of care. We test this hypothesis in the context of the pro-competition reforms of the English National Health Service progressively introduced from 2004 to 2006. We use a panel of 32,482 English small areas followed from 2003 to 2008 and a difference in differences approach. The effect of competition on equity is identified by the interaction between market structure, small area income deprivation and year. We find a negative association between market competition and elective admissions in deprived areas. The effect of pro-competition reform was to reduce this negative association slightly, suggesting that competition did not undermine equity. Copyright © 2012 Elsevier B.V. All rights reserved.
Al-Jazairi, Abdulrazaq S; Alharbi, Reem
Background Many studies have previously looked at the perceptions, attitude, and use of Evidence-based Practice (EBP) among healthcare providers. However, limited data is available on the implementation of EBP among pharmacists in general, and Saudi Arabia in particular. Objective To evaluate the awareness, attitude, and practice of EBP among hospital practicing pharmacists in Saudi Arabia. Setting Secondary and tertiary care hospitals in Saudi Arabia with a bed capacity of ≥200 Methods This is a cross sectional, survey-based study where a validated selfadministrated questionnaire was utilized. Pharmacists working in secondary and tertiary care hospitals with a bed capacity of ≥200 were targeted. The descriptive data consisted of percentages for discrete and medians for continuous statistics. Results The survey was distributed to a total of 1136 pharmacists. Total number of respondents is 228 which represent a response rate of 20%. Most of them (75% median score = 8) have a positive attitude toward EBP. In addition to clinical expertise, only 48.6% of them were able to identify EBP resource as the second component of EBP concept, while only 1.7% of the respondents were able to identify patient preference as a third component. Lack of personal time, critical appraisal skills, and resources, (40%, 15.6% and 13.9% respectively) are considered as the major barriers to implementing EBP in pharmacy. Conclusion The majority of pharmacists in Saudi Arabia hold a positive attitude of EBP. Unfortunately, most of pharmacists do not consider patients' values as a component of EBP. The major barriers to practicing EBP are lack of personal time, critical appraisal skills, and resources availability.
Rostgaard, Klaus; Wohlfahrt, Jan; Hjalgrim, Henrik
Circumstantial evidence from genome-wide association and family studies of various Epstein-Barr virus-associated diseases suggests a substantial genetic component in infectious mononucleosis (IM) etiology. However, familial aggregation of IM has scarcely been studied. We used data from the Danish Civil Registration System and the Danish National Hospital Discharge Register to study rate ratios of IM in a cohort of 2 823 583 Danish children born between 1971 and 2011. Specifically, we investigated the risk of IM in twins and in first-, second-, and third-degree relatives of patients with IM. In the analyses, IM was defined as a diagnosis of IM in a hospital contact. Effects of contagion between family members were dealt with by excluding follow-up time the first year after the occurrence of IM in a relative. A total of 16 870 cases of IM were observed during 40.4 million person-years of follow-up from 1977 to 2011. The rate ratios and the associated 95% confidence intervals were 9.3 (3.0-29) in same-sex twins, 3.0 (2.6-3.5) in siblings, 1.9 (1.6-2.2) in children, 1.4 (1.3-1.6) in second-degree relatives, and 1.0 (0.9-1.2) in third-degree relatives of IM patients. The rate ratios were very similar for IM in children (aged 0-6 years) and older children/adolescents (aged 7-19 years). We found evidence of familial aggregation of IM that warrants genome-wide association studies on IM disease etiology, especially to examine commonalities with causal pathways in other Epstein-Barr virus-related diseases. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: email@example.com.
Kashdan, Todd B.; Goodman, Fallon R.; Machell, Kyla A.; Kleiman, Evan M.; Monfort, Samuel S.; Ciarrochi, Joseph; Nezlek, John B.
Experiential avoidance, the tendency to avoid internal, unwanted thoughts and feelings, is hypothesized to be a risk factor for social anxiety. Existing studies of experiential avoidance rely on trait measures with minimal contextual consideration. In two studies, we examined the association between experiential avoidance and anxiety within real-world social interactions. In the first study, we examined the effect of experiential avoidance on social anxiety in everyday life. For two weeks, 37 participants with Social Anxiety Disorder [SAD] and 38 healthy controls provided reports of experiential avoidance and social anxiety symptoms during face-to-face social interactions. Results showed that momentary experiential avoidance was positively related to anxiety symptoms during social interactions and this effect was stronger among people with SAD. People low in EA showed greater sensitivity to the level of situational threat than high EA people. In the second study, we facilitated an initial encounter between strangers. Unlike Study 1, we experimentally created a social situation where there was either an opportunity for intimacy (self-disclosure conversation) or no such opportunity (small-talk conversation). Results showed that greater experiential avoidance during the self-disclosure conversation temporally preceded increases in social anxiety for the remainder of the interaction; no such effect was found in the small-talk conversation. Our findings provide insight into the association between experiential avoidance on social anxiety in laboratory and naturalistic settings, and demonstrate that the effect of EA depends upon level of social threat and opportunity. PMID:24749634
Jehu-Appiah, Caroline; Sekidde, Serufusa; Adjuik, Martin; Akazili, James; Almeida, Selassi D; Nyonator, Frank; Baltussen, Rob; Asbu, Eyob Zere; Kirigia, Joses Muthuri
In order to measure and analyse the technical efficiency of district hospitals in Ghana, the specific objectives of this study were to (a) estimate the relative technical and scale efficiency of government, mission, private and quasi-government district hospitals in Ghana in 2005; (b) estimate the magnitudes of output increases and/or input reductions that would have been required to make relatively inefficient hospitals more efficient; and (c) use Tobit regression analysis to estimate the impact of ownership on hospital efficiency. In the first stage, we used data envelopment analysis (DEA) to estimate the efficiency of 128 hospitals comprising of 73 government hospitals, 42 mission hospitals, 7 quasi-government hospitals and 6 private hospitals. In the second stage, the estimated DEA efficiency scores are regressed against hospital ownership variable using a Tobit model. This was a retrospective study. In our DEA analysis, using the variable returns to scale model, out of 128 district hospitals, 31 (24.0%) were 100% efficient, 25 (19.5%) were very close to being efficient with efficiency scores ranging from 70% to 99.9% and 71 (56.2%) had efficiency scores below 50%. The lowest-performing hospitals had efficiency scores ranging from 21% to 30%.Quasi-government hospitals had the highest mean efficiency score (83.9%) followed by public hospitals (70.4%), mission hospitals (68.6%) and private hospitals (55.8%). However, public hospitals also got the lowest mean technical efficiency scores (27.4%), implying they have some of the most inefficient hospitals.Regarding regional performance, Northern region hospitals had the highest mean efficiency score (83.0%) and Volta Region hospitals had the lowest mean score (43.0%).From our Tobit regression, we found out that while quasi-government ownership is positively associated with hospital technical efficiency, private ownership negatively affects hospital efficiency. It would be prudent for policy-makers to examine the
Norgaard, A.; Stensballe, J.; de Lichtenberg, T. H.
of the implementation of evidence-based transfusion practice. Materials and Methods: Red blood cell transfusion quality indicators were compared with the evidence-based guideline at hospital and department level. Based on this evaluation, wards were selected for interventions targeting doctors and nurses......Background and Objectives: Traditionally, Denmark has had a high rate of allogeneic red blood cell transfusion caused by a liberal transfusion practice despite the existence of restrictive guidelines. We established a Patient Blood Management programme in a tertiary hospital and report the results...... procedures and 28% in admissions (P blood cell transfusion for non-bleeding patients, and led to significantly fewer patients being exposed to transfusion....
Cicchetti, Americo; Iacopino, Valentina; Coretti, Silvia; Fiore, Alessandra; Marchetti, Marco; Sampietro-Colom, Laura; Kidholm, Kristian; Wasserfallen, Jean-Blaise; Kahveci, Rabia; Halmesmäki, Esa; Rosenmöller, Magdalene; Wild, Claudia; Kivet, Raul-Allan
Hospital-based health technology assessment (HB-HTA) is becoming increasingly relevant because of its role in managing the introduction and withdrawal of health technologies. The organizational arrangement in which HB-HTA activities are conducted depends on several contextual factors, although the dominant models have several similarities. The aims of this study were to explore, describe, interpret, and explain seven cases of the application of HB-HTA logic and to propose a classification for HB-HTA organizational models which may be beneficial for policy makers and HTA professionals. The study was part of the AdHopHTA Project, granted under the European 7th Framework Research Programme. A case study methodology was applied to analyze seven HB-HTA initiatives in seven countries, with collection of qualitative and quantitative data. Cross-case analysis was performed within the framework of contingent organizational theory. Evidence showed that some organizational or "structural" variables, namely the level of procedure formalization/structuration and the level of integration with other HTA bodies at the national, regional, and provincial levels, predominantly shape the HB-HTA approach, determining a contingency model of HB-HTA. Crossing the two variables, four options have emerged: integrated specialized HTA unit, stand-alone HTA unit, integrated-essential HTA, independent group unit. No one-best-way approach can be used for HTA at the hospital level. Rather, the characteristics of HTA models depend on many contextual factors. Such conceptualization may aid the diffusion of HB-HTA to inform managerial decision making and clinical practice.
The challenge could be briefly seen in these terms: hospitals as places for treatment where there’s a technology focus and hospitals for healing where there’s a human focus. In the 60s - 70s wave of new hospital building, an emphasis on technology can be seen. It’s time to move from the technology...... focus. It is not enough to consider only the factors of function within architecture, hygiene, economy and logistics. We also need to look at aspects of aesthetics, bringing nature into the building, art, color, acoustics, volume and space as we perceive them. Contemporary methods and advances...... placed, accessible, provided with plenty of greenery, and maximize sensory impressions, providing sounds, smells, sight and the possibility to be touched. This is a very well documented area I can say. Hygiene, in terms of architecture can give attention to hand wash facilities and their positioning...
Everson, Jordan; Lee, Shoou-Yih Daniel; Adler-Milstein, Julia
In response to evolving policies and conditions, hospitals have increased health information technology (HIT) adoption and strived to improve hospital-physician integration. While evidence suggests that both HIT and integration confer independent benefits, when combined, they may provide complementary means to achieve high performance or overlap to offset each other's contribution. We explore this relationship in the context of hospital adherence to evidence-based practices (EBPs). Using the American Hospital Association's Annual and IT Supplement surveys, and Centers for Medicare and Medicaid Services's Hospital Compare, we estimate the independent relationships and interactions between HIT and hospital-physician integration with respect to EBP adherence. HIT adoption and tight (but not loose) integration are independently associated with greater adherence to EBPs. The interaction between HIT adoption and tight integration is negative, consistent with an offsetting association between HIT adoption and integration in their relationship to EBP adherence. This finding reveals the need to be aware of potential substitutive effects from simultaneous pursuit of multiple approaches to performance improvement. © The Author(s) 2016.
Oliveri, Roberto S; Gluud, Christian; Wille-Jørgensen, Peer A
Problems in understanding basic aspects of evidence-based medicine (EBM) may form barriers to its implementation into clinical practice. We examined hospital doctors' skills in EBM terms and related these skills to their use of information sources, critical appraisal, and implementation of EBM...
Brisky, Livia; Fatović-Ferencić, Stella
We investigated the circumstances of building of the Civic Hospital in Split in the light of new archival evidence. The study necessitated a thorough review of the older historiography and previously unpublished archival sources kept in the State Archives in Venice and Zadar. The findings showed that construction of the hospital building finished in 1797, ie, five years later than officially cited. The topographical plan and the original project of the Split Civic Hospital were found, as well as the name of the project's author and the building supervisor. The data on the earliest efforts of Ergovac brothers to acquire land and building permission were corrected. The study revealed a recognizable pattern in the attitude of the authorities toward the establishment of a hospital at the end of 18th century.
Padula, William V; Gibbons, Robert D; Valuck, Robert J; Makic, Mary B F; Mishra, Manish K; Pronovost, Peter J; Meltzer, David O
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.
Chang, Shu-Fang; Lin, Hsiang-Chun; Cheng, Chih-Ling
This research explored the relationship between the stages of frailty and risk for hospitalization in older adults and evaluated the risk for hospitalization among the elderly in relation to various frailty assessment indexes. A systematic literature review and meta-analysis were carried out. A total of 32,998 older people, 8,666 of whom were hospitalized, were included in this study. Two of the researchers independently collected and reviewed the literature. The key search terms used were "frailty" or "frail," "hospitalization," and "older people" or "older" or "geriatric" or "senior." Data were recorded from January 2001 to July 2016. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adopted for quality assessment. A systematic search was carried out using Embase and Scopus to analyze the collected literature. A meta-analysis was conducted on eight studies that discussed the relationship between frailty and hospitalization risk in older adults 65 years of age or older. The results showed that frail older people exhibited the highest risk for hospitalization, following by prefrail and robust older people. Next, different frailty assessment indicators were used to predict the risk for hospitalization among older people. All of these indexes also showed that older persons with frailty had the highest risk for hospitalization, followed by prefrail older people. Frailty is a vital issue in geriatric care and is a crucial factor in the hospitalization of older people. Frail older people were at the highest risk for hospitalization, following by prefrail and robust older people. Assessing frailty as early as possible can reduce the hospitalization risk among older people. Professional nursing staff should use frailty indicators in a timely fashion to assess the status of frailty in older people and should effectively develop frailty prevention strategies to decrease the risk for hospitalization and to enhance quality of life
Qian, Xufeng; Russell, Louise B.; Valiyeva, Elmira; Miller, Jane E.
Previous studies of Medicare’s prospective payment system for hospitals (PPS), introduced in 1983, evaluated only its first few years, using data collected during the hospital stay to control for patients’ health. We examine transitions among health care settings over a full decade following implementation of PPS, using survival models and a national longitudinal survey with independent information on health. We find that the rate of discharge from hospitals to nursing homes continued to rise...
Keers, Richard N; Williams, Steven D; Cooke, Jonathan; Ashcroft, Darren M
Underlying systems factors have been seen to be crucial contributors to the occurrence of medication errors. By understanding the causes of these errors, the most appropriate interventions can be designed and implemented to minimise their occurrence. This study aimed to systematically review and appraise empirical evidence relating to the causes of medication administration errors (MAEs) in hospital settings. Nine electronic databases (MEDLINE, EMBASE, International Pharmaceutical Abstracts, ASSIA, PsycINFO, British Nursing Index, CINAHL, Health Management Information Consortium and Social Science Citations Index) were searched between 1985 and May 2013. Inclusion and exclusion criteria were applied to identify eligible publications through title analysis followed by abstract and then full text examination. English language publications reporting empirical data on causes of MAEs were included. Reference lists of included articles and relevant review papers were hand searched for additional studies. Studies were excluded if they did not report data on specific MAEs, used accounts from individuals not directly involved in the MAE concerned or were presented as conference abstracts with insufficient detail. A total of 54 unique studies were included. Causes of MAEs were categorised according to Reason's model of accident causation. Studies were assessed to determine relevance to the research question and how likely the results were to reflect the potential underlying causes of MAEs based on the method(s) used. Slips and lapses were the most commonly reported unsafe acts, followed by knowledge-based mistakes and deliberate violations. Error-provoking conditions influencing administration errors included inadequate written communication (prescriptions, documentation, transcription), problems with medicines supply and storage (pharmacy dispensing errors and ward stock management), high perceived workload, problems with ward-based equipment (access, functionality
Collum, Taleah H; Menachemi, Nir; Sen, Bisakha
The aim of this study was to examine the impact of electronic health record (EHR) adoption on hospital financial performance. We constructed a longitudinal panel using data from the three secondary sources: (a) the 2007-2010 American Hospital Association (AHA) Annual Survey, (b) the 2007-2010 AHA Annual Survey Information Technology Supplement, and (c) the 2007-2011 Medicare Cost Reports from Centers for Medicare and Medicaid Services. Because potential financial benefits attributable to EHR adoption may take some time to accrue, we ran regressions with lags of 1 and 2 years that included hospital and year fixed effects to examine the relationship between the level of EHR adoption and three hospital financial performance measures. A change in the level of EHR adoption was not associated with changes in operating margin or return on assets within hospitals. However, total margin was significantly improved, after 2 years, in hospitals that moved from no EHR to having a comprehensive EHR in all areas of their hospital (β = 0.030, p financial performance measures examined. The improvements in total margin, as opposed to operating margin, are likely due to hospital incentive payments under the Health Information Technology for Economic and Clinical Health Act that are reflected in nonpatient revenues and therefore show up in total margin calculations. Thus, after 2 years of EHR adoption, hospital financial performance is observed to improve based only on meaningful use incentive payments. More research will be needed to determine whether EHR adoption impacts financial performance on a longer time horizon.
Renolen, Åste; Høye, Sevald; Hjälmhult, Esther; Danbolt, Lars Johan; Kirkevold, Marit
Evidence-based practice is considered a foundation for the provision of quality care and one way to integrate scientific knowledge into clinical problem-solving. Despite the extensive amount of research that has been conducted to evaluate evidence-based practice implementation and research utilization, these practices have not been sufficiently incorporated into nursing practice. Thus, additional research regarding the challenges clinical nurses face when integrating evidence-based practice into their daily work and the manner in which these challenges are approached is needed. The aim of this study was to generate a theory about the general patterns of behaviour that are discovered when clinical nurses attempt to integrate evidence-based practice into their daily work. We used Glaser's classical grounded theory methodology to generate a substantive theory. The study was conducted in two different medical wards in a large Norwegian hospital. In one ward, nurses and nursing assistants were developing and implementing new evidence-based procedures, and in the other ward, evidence-based huddle boards for risk assessment were being implemented. A total of 54 registered nurses and 9 assistant nurses were observed during their patient care and daily activities. Of these individuals, thirteen registered nurses and five assistant nurses participated in focus groups. These participants were selected through theoretical sampling. Data were collected during 90h of observation and 4 focus groups conducted from 2014 to 2015. Each focus group session included four to five participants and lasted between 55 and 65min. Data collection and analysis were performed concurrently, and the data were analysed using the constant comparative method. "Keeping on track" emerged as an explanatory theory for the processes through which the nurses handled their main concern: the risk of losing the workflow. The following three strategies were used by nurses when attempting to integrate evidence
An Investigation of Technology Avoidance Effect into Higher Education Environments: Some Empirical Evidence of Marketing Students' Background and Their Use of Personal Computers Outside the Academic Culture
Spais, George S.; Vasileiou, Konstantinos Z.
The major objective of this study was to test a research hypothesis in order to explain the technology avoidance effect in higher educational environments. We addressed the core research themes of our study using a survey. Our intention was to test marketing students' perceptions in order to investigate the potent influence of a climate of…
Clemmensen, Kim K B; Randbøll, Ingelise; Ryborg, Malene F.
. OBJECTIVES: The aim of the present study was to investigate exposures related to cleaning and the effect of an evidence-based educational intervention on the prevention of hand eczema among hospital cleaners. PATIENTS/MATERIALS/METHODS: The intervention consisted of a 1 hr course in hand protective behaviour.......8 to 1.8 at follow-up (p = 0.002). CONCLUSIONS: Data indicates a positive effect of a low-cost on-site educational intervention for hospital cleaners....
Britton, Lauren; Rosenwax, Lorna; McNamara, Beverley
Increased accountability and growing fiscal limitations in global health care continue to challenge how occupational therapy practices are undertaken. Little is known about how these changes affect current practice in acute hospital settings. This article reviews the relevant literature to further understanding of occupational therapy practice in acute physical hospital settings. A scoping review of five electronic databases was completed using the keywords Occupational therapy, acute hospital settings/acute physical hospital settings, acute care setting/acute care hospital setting, general medicine/general medical wards, occupational therapy service provision/teaching hospitals/tertiary care hospitals. Criteria were applied to determine suitability for inclusion and the articles were analysed to uncover key themes. In total 34 publications were included in the review. Analysis of the publications revealed four themes: (1) Comparisons between the practice of novice and experienced occupational therapists in acute care (2) Occupational therapists and the discharge planning process (3) Role of occupation in the acute care setting and (4) Personal skills needed and organisation factors affecting acute care practice. The current literature has highlighted the challenges occupational therapists face in practicing within an acute setting. Findings from this review enhance understanding of how occupational therapy department managers and educators can best support staff that practise in acute hospital settings. © 2015 Occupational Therapy Australia.
Abel, Gary A; Saunders, Catherine L; Lyratzopoulos, Georgios
This study aims to explore differences between crude and case mix-adjusted estimates of hospital performance with respect to the experience of cancer patients. This study analyzed the English 2011/2012 Cancer Patient Experience Survey covering all English National Health Service hospitals providing cancer treatment (n = 160). Logistic regression analysis was used to predict hospital performance for each of the 64 evaluative questions, adjusting for age, gender, ethnic group and cancer diagnosis. The degree of reclassification was explored across three categories (bottom 20%, middle 60% and top 20% of hospitals). There was high concordance between crude and adjusted ranks of hospitals (median Kendall's τ = 0.84; interquartile range: 0.82-0.88). Across all questions, a median of 5.0% (eight) of hospitals (interquartile range: 3.8-6.4%; six to ten hospitals) moved out of the extreme performance categories after case mix adjustment. In this context, patient case mix has only a small impact on measured hospital performance for cancer patient experience.
Arasli, Huseyin; Ekiz, Erdogan Haktan; Katircioglu, Salih Turan
The purpose of this research is to develop and compare some determinants of service quality in both the public and private hospitals of Northern Cyprus. There is considerable lack of literature with respect to service quality in public and private hospitals. Randomly, 454 respondents, who have recently benefited from hospital services in Famagusta, were selected to answer a modified version of the SERVQUAL Instrument. The instrument contained both service expectations and perceptions questions. This study identifies six factors regarding the service quality as perceived in both public and private Northern Cyprus hospitals. These are: empathy, giving priority to the inpatients needs, relationships between staff and patients, professionalism of staff, food and the physical environment. Research results revealed that the various expectations of inpatients have not been met in either the public or the private hospitals At the micro level, the lack of management commitment to service quality in both hospital settings leads doctors and nurses to expend less effort increasing or improving inpatient satisfaction. Hospital managers should also satisfy their employees, since job satisfaction leads to customer satisfaction and loyalty. Additionally, hospital administrations need to gather systematic feedback from their inpatients, establish visible and transparent complaint procedures so that inpatients' complaints can be addressed effectively and efficiently. The hospitals need to organize training sessions based on the critical importance of service quality and the crucial role of inpatient satisfaction in the health care industry. Future studies should include the remaining regions in Cyprus in order to increase research findings' generalizability. Additionally, including other dimensions such as hospital processes and discharge management and co-ordination may provide further insights into understanding inpatients' perceptions and intentions.
Ginsburg, Paul B
Wide variation in private insurer payment rates to hospitals and physicians across and within local markets suggests that some providers, particularly hospitals, have significant market power to negotiate higher-than-competitive prices, according to a new study by the Center for Studying Health System Change (HSC). Looking across eight health care markets--Cleveland; Indianapolis; Los Angeles; Miami; Milwaukee; Richmond, Va.; San Francisco; and rural Wisconsin--average inpatient hospital payment rates of four large national insurers ranged from 147 percent of Medicare in Miami to 210 percent in San Francisco. In extreme cases, some hospitals command almost five times what Medicare pays for inpatient services and more than seven times what Medicare pays for outpatient care. Variation within markets was just as dramatic. For example, the hospital with prices at the 25th percentile of Los Angeles hospitals received 84 percent of Medicare rates for inpatient care, while the hospital with prices at the 75th percentile received 184 percent of Medicare rates. The highest-priced Los Angeles hospital with substantial inpatient claims volume received 418 percent of Medicare. While not as pronounced, significant variation in physician payment rates also exists across and within markets and by specialty. Few would characterize the variation in hospital and physician payment rates found in this study to be consistent with a highly competitive market. Purchasers and public policy makers can address provider market power, or the ability to negotiate higher-than-competitive prices, through two distinct approaches. One is to pursue market approaches to strengthen competitive forces, while the other is to constrain payment rates through regulation.
Roberts, C M; Barnes, S; Lowe, D; Pearson, M G
The 1997 BTS/RCP national audit of acute care of chronic obstructive pulmonary disease (COPD) found wide variations in mortality between hospitals which were only partially explained by known audit indicators of outcome. It was hypothesised that some of the unexplained variation may result from differences in hospital type, organisation and resources. This pilot study examined the hypothesis as a factor to be included in a future national audit programme. Thirty hospitals in England and Wales were randomly selected by geographical region and hospital type (teaching, large district general hospital (DGH), small DGH). Data on process and outcome of care (death and length of stay) were collected retrospectively at 90 days on all prospectively identified COPD admissions over an 8 week period. Each centre completed a questionnaire relating to organisation and resources available for the care of COPD patients. Eleven teaching hospitals, nine large DGHs, and 10 small DGHs provided data on 1274 cases. Mortality was high (14%) with wide variation between centres (IQR 9-19%). Small DGHs had a higher mortality (17.5%) than teaching hospitals (11.9%) and large DGHs (11.2%). When corrected for confounding factors, an excess of deaths in small DGHs was still observed (OR 1.56 (CI 1.04 to 2.35)) v teaching hospitals. Analysis of resource and organisational factors suggested higher mortality was associated with fewer doctors (OR 1.5) and with fewer patients being under the care of a specialist physician (OR 1.8). Small DGHs had fewest resources. Significant differences in mortality may exist between hospital types. The findings justify further study in a proposed national audit.
Full Text Available This study aimed to explore an evidence-based nursing practice model of CRF management in hospitalized adult patients using the PARIHS evidence-implementation framework as the theoretical structure to provide guidance for similar nursing practices. The implementation of guideline evidence into clinical practice was conducted on the oncology and radiotherapy wards of a university-affiliated hospital. The process of integrating the guideline into the symptom management system of cancer patients was described. The impact of the evidence implementation was evaluated from three aspects: organizational innovations and outcome measures associated with nurses and with patients pre- and post-evidence implementation. During the implementation of evidence into practice on the wards, a nursing process, health education, a quality control sheet and CRF training courses were established. Through this implementation, compliance with evidence related to CRF increased significantly on the two wards, with that of ward B being higher than that of ward A. Regarding nursing outcomes, nursing knowledge, attitude and behavior scores with respect to CRF nursing care increased substantially after its application on the two wards, and the ward B nurses' scoring was higher than that of the ward A nurses. Qualitative analysis concerning the nurses suggested that leadership, patient concern about CRF management, and the need for professional development were the main motivators of the application, whereas the shortage and mobility of nursing human resources and insufficient communication between doctors and nurses were the main barriers. Additionally, most nurses felt more professional and confident about their work. Regarding patient outcomes, patient knowledge, attitude and behavior scores regarding CRF self-management increased significantly. Patients' post-implementation CRF was alleviated compared with the pre-implementation treatment cycle. The PARIHS framework may
Tuffrey-Wijne, Irene; Goulding, Lucy; Gordon, Vanessa; Abraham, Elisabeth; Giatras, Nikoletta; Edwards, Christine; Gillard, Steve; Hollins, Sheila
There has been evidence in recent years that people with intellectual disabilities in acute hospitals are at risk of preventable deterioration due to failures of the healthcare services to implement the reasonable adjustments they need. The aim of this paper is to explore the challenges in monitoring and preventing patient safety incidents involving people with intellectual disabilities, to describe patient safety issues faced by patients with intellectual disabilities in NHS acute hospitals, and investigate underlying contributory factors. This was a 21-month mixed-method study involving interviews, questionnaires, observation and monitoring of incident reports to assess the implementation of recommendations designed to improve care provided for patients with intellectual disabilities and explore the factors that compromise or promote patient safety. Six acute NHS Trusts in England took part. Data collection included: questionnaires to clinical hospital staff (n = 990); questionnaires to carers (n = 88); interviews with: hospital staff including senior managers, nurses and doctors (n = 68) and carers (n = 37); observation of in-patients with intellectual disabilities (n = 8); monitoring of incident reports (n = 272) and complaints involving people with intellectual disabilities. Staff did not always readily identify patient safety issues or report them. Incident reports focused mostly around events causing immediate or potential physical harm, such as falls. Hospitals lacked effective systems for identifying patients with intellectual disabilities within their service, making monitoring safety incidents for this group difficult.The safety issues described by the participants were mostly related to delays and omissions of care, in particular: inadequate provision of basic nursing care, misdiagnosis, delayed investigations and treatment, and non-treatment decisions and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders. The events leading to avoidable harm
Full Text Available After January 25th 2011 Egypt witnessed political, economic and social instability leading to drastic consequences in the hospitality and tourism industry. Thus unstable situation reflected on the deteriorated occupancy percentages that led to declined profit margins, higher employee layoffs and degraded quality of product and services. The objectives of this research is to examine how the Egyptian hospitality properties manage this dilemma through their marketing practices, and to propose a new marketing mix model that adds new layers of depth to the traditional marketing mix model. A methodological framework was designed to help in the assessment process of management practices pertaining to marketing initiatives during times of crisis. Results indicated the presence of tactical elements that assembled the traditional marketing mix model in the investigated hotels. However, these elements are not effectively used and the interaction between them not appears very clear. Results also indicated that the new proposed model would help in providing a framework for the Egyptian hospitality industry to maintain their competitive position during crisis time and avoiding undesired situations for labour force and decline of companies׳ revenues.
Kramer, Jeffrey; Santerre, Rexford E
This paper uses observations from a panel data set of 35 chief executive officers (CEOs) from 29 not-for-profit hospitals in Connecticut over the period 1998 to 2006 to investigate the relationship between CEO performance and pay. Both economic and charity performance measures are specified in the empirical model. The multiple regression results reveal that not-for-profit hospital CEOs, at least in Connecticut, are driven at the margin to increase the occupancy rate of privately insured patients at the expense of uncompensated care and public-pay patients. This type of behavior on the part of not-for-profit hospital CEOs calls into question the desirability of allowing these hospitals a tax exemption on earned income, property, and purchases.
James, Chris D; Peabody, John; Hanson, Kara; Solon, Orville
In low- and middle-income countries, government budgets are rarely sufficient to cover a public hospital's operating costs. Shortfalls are typically financed through a combination of health insurance contributions and user charges. The mixed nature of this financing arrangement potentially creates financial incentives to treat patients with equal health need unequally. Using data from the Philippines, the authors analyzed whether doctors respond to such incentives. After controlling for a patient's condition, they found that patients using insurance, paying more for hospital accommodation, and being treated in externally monitored hospitals were likely to receive more care. This highlights the worrying possibility that public hospital patients with equal health needs are not always equally treated. © 2011 APJPH.
Kelly, E.; Stoye, G.; Vera-Hernández, M.
© 2016 The Authors. Fiscal Studies published by John Wiley & Sons Ltd. on behalf of Institute for Fiscal StudiesHealth spending per capita in England has almost doubled since 1997, yet relatively little is known about how that spending is distributed across the population. This paper uses administrative National Health Service (NHS) hospital records to examine key features of public hospital spending in England. We describe how costs vary across the life cycle, and the concentration of spendi...
Kelly, Elaine; Stoye, George; Vera-Hernández, Marcos
Health spending per capita in England has more than doubled since 1997, yet relatively little is known about how that spending is distributed across the population. This paper uses administrative National Health Service (NHS) hospital records to examine key features of public hospital spending in England. We describe how costs vary across the lifecycle, and the concentration of spending among people and over time. We find that costs per person start to increase after age 50 and escalate after...
Anna Marina; Sentot Imam Wahjono
The purpose of this study is to examine how business ethics can support business sustainability in hospitals. Business ethics is associated with: Hospital professional ethics, medical professional ethics, professional accounting ethics, and Islamic business ethics. This study used a qualitative approach with phenomenological analysis techniques to process the data collected from key informants, through Focus Group Discussions (FGD) with 20 supervisors, in-depth interviews with six members of ...
Roberts, C; Barnes, S; Lowe, D; Pearson, M
Background: The 1997 BTS/RCP national audit of acute care of chronic obstructive pulmonary disease (COPD) found wide variations in mortality between hospitals which were only partially explained by known audit indicators of outcome. It was hypothesised that some of the unexplained variation may result from differences in hospital type, organisation and resources. This pilot study examined the hypothesis as a factor to be included in a future national audit programme.
Shafiq, Muhammad; Naeem, Muhammad Azhar; Munawar, Zartasha; Fatima, Iram
Hospitals vary from one another in terms of their specialty, services offered, and resource availability. Their services are widely measured with scales that gauge patients' perspective. Therefore, there is a need for research to develop a scale that measures hospital service quality in Asian hospitals, regardless of their nature or ownership. To address this research need, this study adapted the SERVQUAL instrument to develop a service quality measurement scale. Data were collected from inpatients and outpatients at 9 different hospitals, and the scale was developed using structural equation modeling. The developed scale was then validated by identifying service quality gaps and ranking the areas that require managerial effort. The findings indicated that all 5 dimensions of SERVQUAL are valid in Asian countries such as Pakistan, with 13 items retained. Reliability, tangibility, responsiveness, empathy, and assurance were ranked first, second, third, fourth, and fifth, respectively, in terms of the size of the quality gap. The gaps were statistically significant, with values ≤.05; therefore, hospital administrators must focus on each of these areas. By focusing on the identified areas of improvement, health care authorities, managers, practitioners, and decision makers can bring substantial change within hospitals.
Full Text Available This study was carried out with the view to address two fundamental issues: first, to determine if there is any association between budget, budgetary control and performance evaluation; second, to ascertain if there is any significant variation in the budget, budgetary control and performance evaluation measures of hospitality firms in Nigeria. The study employed descriptive design and primary data (questionnaire was the major source of data collection. Questionnaire was administered to a total of six hundred (600 employees of ten (10 selected hospitality firms in Nigeria. The data obtained were analyzed using both descriptive and inferential statistics. Findings indicated that budget and budgetary control could serve as an avenue through which hospitality firms in Nigeria can be evaluated. In addition, it was revealed that there is a significant variation in the budget, budgetary control and performance evaluation of hospitality firms in Nigeria. On the basis of the findings, it was recommended that hospitality firms in Nigeria should carry out performance evaluation on every aspect of their budget and budgetary activities as a way of ensuring that budgeted outcomes are met. Also, budgetary costs should be a basis of choosing the most-fit performance evaluation technique for hospitality firms since such
Full Text Available Introduction: Reducing infant mortality rate during delivery is a priority in the world. Even with the existing activities that take place in hospitals, due to a lack of simple and effective methods, this mortality reduction trend is slow. The objects of this study were to apply and investigate the effects of WHO evidence-based guidelines for safe delivery on the quality of maternal and neonatal support. Materials and Methods: This is a semi-experimental study with external control. After forward and backward translation of WHO safe childbirth checklist, in an expert meeting irrelevant/infeasible items in the checklist were omitted or modified. Personnel performance on checklist items was evaluated by researchers who were present in the whole period of mother and neonate hospitalization in two phases. Intervention was done in two hospitals and one hospital was considered as control. At first, the instructions were provided for all the collaborating personnel in forms of pamphlets, posters and booklets and after two weeks second phase began by arranging an educational session for personnel. The data of these two phases is being compared. Discussion: If our prior assumption be proved, we anticipate improvements in some items of checklist .Some of these items are skin contact, breast feeding rate in first hour postpartum, hand hygiene, and mother's knowledge regarding the parturition during the time in which they are hospitalized together with a decrease in episiotomy infection/dehiscence prevalence. These changes can be regarded as an overall promotion in maternal/neonatal support.
Bauer, Anika; Schneider, Silvia; Waldorf, Manuel; Cordes, Martin; Huber, Thomas J; Braks, Karsten; Vocks, Silja
The vigilance-avoidance theory postulates a specific threat-related pattern of attention deployment, characterized by initial orientation towards fear-evoking stimuli and subsequent directing of attention away from them. The current eye-tracking study was the first to examine the applicability of the theory for patients with eating disorders, who perceive their own body as a highly aversive, threat-evoking stimulus. N = 56 female adolescents with anorexia nervosa (AN) and n = 43 healthy controls (HC) aged 13-18 viewed own-body pictures while their eye movements were recorded. Relative fixation times on self-defined unattractive body areas were compared between the groups by sequencing the overall presentation time of 6,000 ms into six intervals à 1,000 ms. Participants with AN showed a significantly stronger attentional bias for unattractive body areas than HC within the time intervals 1, 2, and 3. However, for intervals 4, 5, and 6, no significant group differences occurred. Within the AN group, the bias for unattractive body areas was significantly stronger in interval 1 compared to intervals 4, 5, and 6; whereas within the HC group, a stable pattern of attention deployment emerged. In AN, early attention deployment was positively correlated with the negative affect reported after photo presentation. The early vigilance in AN and the subsequent decrease in attention to unattractive body parts is in line with our assumptions. However, no indication of attentional avoidance was found. The current findings partially support the vigilance-avoidance theory for the exposure to one's own body in adolescents with AN. © 2017 Wiley Periodicals, Inc.
Chirikos, T N
This study examines whether American hospitals continued to engage in non-price or quality competition over the recent past as health care markets underwent fundamental structural changes and the economic incentives facing hospital managers were correspondingly altered. It also investigates the degree to which such rivalrous behavior contributes to losses in economic welfare. An econometric model of quality competition is specified that tests, among other things, for the effect of spending by the hospital to enhance the quality of output on annual changes in its share of the local (inpatient) market as well as the effects of competitive conditions in the local market on the annual sum spent on quality enhancement. The model is estimated with panel data on 195 acute care hospitals in the State of Florida for the years 1982-1988. The results suggest that quality competitive behavior continued unabated over this period and that it was stimulated as much by the growth in physician supply and alternative delivery mechanisms as it was by other competing hospitals in the local market. Furthermore, the results show that quality competition yields some inefficiency or waste, but much of it also meets the test of the market.
Eskicioglu, Cagla; Gagliardi, Anna R; Fenech, Darlene S; Forbes, Shawn S; McKenzie, Marg; McLeod, Robin S; Nathens, Avery B
A gap exists between the best evidence and practice with regards to surgical site infection (SSI) prevention. Awareness of evidence is the first step in knowledge translation. A web-based survey was distributed to 59 general surgeons and 68 residents at University of Toronto teaching hospitals. Five domains pertaining to SSI prevention with questions addressing knowledge of prevention strategies, efficacy of antibiotics, strategies for changing practice and barriers to implementation of SSI prevention strategies were investigated. Seventy-six individuals (60%) responded. More than 90% of respondents stated there was evidence for antibiotic prophylaxis and perioperative normothermia and reported use of these strategies. There was a discrepancy in the perceived evidence for and the self-reported use of perioperative hyperoxia, omission of hair removal and bowel preparation. Eighty-three percent of respondents felt that consulting published guidelines is important in making decisions regarding antibiotics. There was also a discrepancy between what respondents felt were important strategies to ensure timely administration of antibiotics and what strategies were in place. Checklists, standardized orders, protocols and formal surveillance programs were rated most highly by 75%-90% of respondents, but less than 50% stated that these strategies were in place at their institutions. Broad-reaching initiatives that increase surgeon and trainee awareness and implementation of multifaceted hospital strategies that engage residents and attending surgeons are needed to change practice.
Schrijver, E J M; de Graaf, K; de Vries, O J; Maier, A B; Nanayakkara, P W B
Haloperidol is generally considered the drug of choice for in-hospital delirium management. We conducted a systematic review to evaluate the evidence for the efficacy and safety of haloperidol for the prevention and treatment of delirium in hospitalized patients. PubMed, Embase, Cumulative Index to Nursing and Allied Health (CINAHL), PsycINFO, and the Cochrane Library were systematically searched up to April 21, 2015. We included English full-text randomized controlled trials using haloperidol for the prevention or treatment of delirium in adult hospitalized patients reporting on delirium incidence, duration, or severity as primary outcome. Quality of evidence was graded. Meta-analysis was not conducted because of between-study heterogeneity. Twelve studies met our inclusion criteria, four prevention and eight treatment trials. Methodological limitations decreased the graded quality of included studies. Results from placebo-controlled prevention studies suggest a haloperidol-induced protective effect for delirium in older patients scheduled for surgery: two studies reported a significant reduction in ICU delirium incidence and one study found a significant reduction in delirium severity and duration. Although placebo-controlled trials are missing, pharmacological treatment of established delirium reduced symptom severity. Haloperidol administration was not associated with treatment-limiting side-effects, but few studies used a systematic approach to identify adverse events. Although results on haloperidol for delirium management seem promising, current prevention trials lack external validity and treatment trials did not include a placebo arm on top of standard nonpharmacological care. We therefore conclude that the current use of haloperidol for in-hospital delirium is not based on robust and generalizable evidence. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Arocena, Pablo; García-Prado, Ariadna
This paper provides insights into how Costa Rican public hospitals responded to the pressure for increased efficiency and quality introduced by the reforms carried out over the period 1997-2001. To that purpose we compute a generalized output distance function by means of non-parametric mathematical programming to construct a productivity index, which accounts for productivity changes while controlling for quality of care. Our results show an improvement in hospital performance mainly driven by quality increases. The adoption of management contracts seems to have contributed to such enhancement, more notably for small hospitals. Further, productivity growth is primarily due to technical and scale efficiency change rather than technological change. A number of policy implications are drawn from these results. Copyright (c) 2006 John Wiley & Sons, Ltd.
Full Text Available Abstract Background In most countries of the sub-Saharan Africa, health care needs have been increasing due to emerging and re-emerging health problems. However, the supply of health care resources to address the problems has been continuously declining, thus jeopardizing the progress towards achieving the health-related Millennium Development Goals. Namibia is no exception to this. It is therefore necessary to quantify the level of technical inefficiency in the countries so as to alert policy makers of the potential resource gains to the health system if the hospitals that absorb a lion's share of the available resources are technically efficient. Method All public sector hospitals (N = 30 were included in the study. Hospital capacity utilization ratios and the data envelopment analysis (DEA technique were used to assess technical efficiency. The DEA model used three inputs and two outputs. Data for four financial years (1997/98 to 2000/2001 was used for the analysis. To test for the robustness of the DEA technical efficiency scores the Jackknife analysis was used. Results The findings suggest the presence of substantial degree of pure technical and scale inefficiency. The average technical efficiency level during the given period was less than 75%. Less than half of the hospitals included in the study were located on the technically efficient frontier. Increasing returns to scale is observed to be the predominant form of scale inefficiency. Conclusion It is concluded that the existing level of pure technical and scale inefficiency of the district hospitals is considerably high and may negatively affect the government's initiatives to improve access to quality health care and scaling up of interventions that are necessary to achieve the health-related Millennium Development Goals. It is recommended that the inefficient hospitals learn from their efficient peers identified by the DEA model so as to improve the overall performance of the health
Ettelt, Stefanie; Nolte, Ellen; McKee, Martin; Haugen, Odd Arild; Karlberg, Ingvar; Klazinga, Niek; Ricciardi, Walter; Teperi, Juha
BACKGROUND: Evidence-based policies have become increasingly accepted in clinical practice. However, policies on many of the non-clinical activities that take place in health care facilities may be less frequently evidence based. METHODS: We carried out a review of literature on safety of mobile
Lewis, Frank D; Horn, Gordon J
There is increasing need for a well-organized continuum of post-hospital rehabilitative care to reduce long term disability resulting from acquired brain injury. This study examined the effectiveness of four levels of post-hospital care (active neurorehabilitation, neurobehavioral intensive, day treatment, and supported living) and the functional variables most important to their success. Participants were 1276 adults with acquired brain injury who were being treated in one of the four program levels. A Repeated Measures MANOVA was used to evaluate change from admission to discharge on the Mayo Portland Adaptability Inventory-4 T-scores. Regression analyses were used to identify predictors of outcome. Statistical improvement on the MPAI-4 was observed at each program level. Self-care and Initiation were the strongest predictors of outcome. The results support the effectiveness of a continuum of care for acquired brain injury individuals beyond hospitalization and acute in-hospital rehabilitation. It is particularly noteworthy that reduction in disability was achieved for all levels of programming even with participants whose onset to admission exceeded 7 years post-injury.
Asfaw, Abay; Lamanna, Francesca; Klasen, Stephan
The 'missing women' dilemma in India has sparked great interest in investigating gender discrimination in the provision of health care in the country. No studies, however, have directly examined discrimination in health-care financing strategies in the case of severe illness of sons versus daughters. In this paper, we hypothesize that households who face tight budget constraints are more likely to spend their meager resources on hospitalization of boys rather than girls. We use the 60th round of the Indian National Sample Survey (2004) and a multinomial logit model to test this hypothesis and to throw some light on this important but overlooked issue. The results reveal that boys are much more likely to be hospitalized than girls. When it comes to financing, the gap in the usage of household income and savings is relatively small, while the gender gap in the probability of hospitalization and usage of more onerous financing strategies is very high. Ceteris paribus, the probability of boys to be hospitalized by financing from borrowing, sale of assets, help from friends, etc. is much higher than that of girls. Moreover, in line with our theoretical framework, the results indicate that the gender gap intensifies as we move from the richest to poorest households. (c) 2009 John Wiley & Sons, Ltd.
Schuts, Emelie C.; Hulscher, Marlies E. J. L.; Mouton, Johan W.; Verduin, Cees M.; Stuart, James W. T. Cohen; Overdiek, Hans W. P. M.; van der Linden, Paul D.; Natsch, Stephanie; Hertogh, Cees M. P. M.; Wolfs, Tom F. W.; Schouten, Jeroen A.; Kullberg, Bart Jan; Prins, Jan M.
Antimicrobial stewardship is advocated to improve the quality of antimicrobial use. We did a systematic review and meta-analysis to assess whether antimicrobial stewardship objectives had any effects in hospitals and long-term care facilities on four predefined patients' outcomes: clinical outcomes,
Schuts, Emelie C.; Hulscher, Marlies E J L; Mouton, Johan W.; Verduin, Cees M.; Stuart, James W T Cohen; Overdiek, Hans W P M; van der Linden, Paul D.; Natsch, Stephanie; Hertogh, Cees M P M; Wolfs, Tom F W; Schouten, Jeroen A.; Kullberg, Bart Jan; Prins, Jan M.
BACKGROUND: Antimicrobial stewardship is advocated to improve the quality of antimicrobial use. We did a systematic review and meta-analysis to assess whether antimicrobial stewardship objectives had any effects in hospitals and long-term care facilities on four predefined patients' outcomes:
Schuts, E.C.; Hulscher, M.E.J.L.; Mouton, J.W.; Verduin, C.M.; Stuart, J.W.; Overdiek, H.W.; Linden, P.D. van der; Natsch, S.S.; Hertogh, C.M.; Wolfs, T.F.; Schouten, J.A.; Kullberg, B.J.; Prins, J.M.
BACKGROUND: Antimicrobial stewardship is advocated to improve the quality of antimicrobial use. We did a systematic review and meta-analysis to assess whether antimicrobial stewardship objectives had any effects in hospitals and long-term care facilities on four predefined patients' outcomes:
Norman, R; Hall, J
To explore factors predicting hospital-based doctors' desire to work less, and then their success in making that change. Consecutive waves of an Australian longitudinal survey of doctors (Medicine in Australia-Balancing Employment and Life). There were 6285 and 6337 hospital-based completers in the two waves, consisting of specialists, hospital-based non-specialists and specialist registrars. Forty-eight per cent stated a preference to reduce hours. Predictive characteristics were being female and working more than 40 h/week (both P less likely to state the preference. Factors associated with not wanting to reduce working hours were being in excellent health and being satisfied with work (both P working hours, only 32% successfully managed to do so in the subsequent year (defined by a reduction of at least 5 h/week). Predictors of successfully reducing hours were being older, female and working more than 40 h/week (all P hours and then their subsequent success in doing so. Designing policies that seek to reduce attrition may alleviate some of the ongoing pressures in the Australian hospital system. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.
Full Text Available The purpose of this study is to examine how business ethics can support business sustainability in hospitals. Business ethics is associated with: Hospital professional ethics, medical professional ethics, professional accounting ethics, and Islamic business ethics. This study used a qualitative approach with phenomenological analysis techniques to process the data collected from key informants, through Focus Group Discussions (FGD with 20 supervisors, in-depth interviews with six members of the management, 11 outside observations, and documentation over a period of six months. The business ethics theory was used to guide the research’s findings. The business sustainability theory was used to find the relationship of the research’s findings with the opinions of four expert informants for the purpose of triangulation on the reasons for conducting Islamic business ethics for a sustainable business. The finding of this study is the reason for running the hospital ethically. The finding of this study can be used to redesign the vision and mission of the hospital as a basis for achieving better performance. The implication of the finding of this research is the need for business ethics in the design of internal systems.
Full Text Available The Hospital facilities built under Evidence Based Design (EBD will create a safe and comfortable environment, lower the nosocomial infection, quicken the patient recovery, lower the treatment cost, and improve staffs’ performance. The emergency room of public hospital of Dr.R.Sosodoro Djatikoesoemo Bojonegoro needs to be redesigned because the existing design does not meet physical safety. The reparation should refer to Facilities and Safety Management (FMS, Indonesian regulation, EBD concept and benchmarking to RSCM Jakarta considered as an application sample. This research applies case study with descriptive single case study design. The result of the research shows that reparation should be done that includes site and location, building components, and rooms lay out. The width of the rooms should meet minimal standard. The placing of triage room and resuscitation should be in the front area. Sinks should be located near the entrance of every room. The isolation and decontamination rooms should be provided.
Full Text Available Though military interventions seem endemic in sub-Saharan Africa, more than a third of all countries have been able to avoid military coups. To solve this puzzle, this article relates the likelihood of military coups to the degree of ethnic congruence between civilian and military leaders, arguing that coup avoidance is most likely when government and army either exhibit the same ethnic bias or are both ethnically balanced. This argument is illustrated by a comparison of the diverging experiences of Zambia and Uganda. While Zambia is among Africa’s coup-free countries, Uganda’s vulnerability to military intervention has varied over time – with four coups under Obote and the Uganda National Liberation Front (UNLF but no coups under Amin and Museveni. Drawing on original longitudinal data on the ethnic distribution of political and military posts, the article shows that the absence of military coups in Zambia goes back to the balanced composition of government and army. In Uganda, coup avoidance under Amin and Museveni can be linked to the fact that government and army exhibited the same ethnic bias, whereas the coups against the Obote and UNLF regimes reflected either ethnic incongruence between civilian and military leaders or the destabilising combination of a similarly polarised government and army.Politische Interventionen von Militärs scheinen im subsaharischen Afrika allgegenwärtig zu sein. In mehr als einem Drittel der afrikanischen Staaten kam es jedoch bislang nicht zu einem Militärputsch. Der Autor dieses Beitrags vermutet eine Verbindung zwischen dem Grad ethnischer Kongruenz in der zivilen und der militärischen Führung eines Staates und der Wahrscheinlichkeit von Militärinterventionen; er argumentiert, dass ein Putsch immer dann vermieden werden kann, wenn Regierung und militärische Führung entweder von der gleichen ethnischen Gruppe dominiert werden oder wenn beide ethnisch ausgewogen zusammengesetzt sind. Dieser Erkl
Surr, Claire A; Gates, Cara
The quality of care delivered to people with dementia in hospital settings is of international concern. People with dementia occupy up to one quarter of acute hospital beds, however, staff working in hospitals report lack of knowledge and skills in caring for this group. There is limited evidence about the most effective approaches to training hospital staff on dementia. The purpose of this literature review was to examine published evidence on the most effective approaches to dementia training and education for hospital staff. The review was conducted using critical synthesis and included qualitative, quantitative and mixed/multi- methods studies. Kirkpatrick's four level model for the evaluation of training interventions was adopted to structure the review. The following databases were searched: MEDLINE, PsycINFO, CINAHL, AMED, British Education Index, Education Abstracts, ERIC (EbscoHost), The Cochrane Library-Cochrane reviews, Economic evaluations, CENTRAL (Wiley), HMIC (Ovid), ASSIA, IBSS (Proquest), Conference Proceedings Citation Indexes (Web of Science), using a combination of keyword for the following themes: Dementia/Alzheimer's, training/education, staff knowledge and patient outcomes. A total of 20 papers were included in the review, the majority of which were low or medium quality, impacting on generalisability. The 16 different training programmes evaluated in the studies varied in terms of duration and mode of delivery, although most employed face-to-face didactic techniques. Studies predominantly reported on reactions to training and knowledge, only one study evaluated outcomes across all of the levels of the Kirkpatrick model. Key features of training that appeared to be more acceptable and effective were identified related to training content, delivery methods, practicalities, duration and support for implementation. The review methodology enabled inclusion of a broad range of studies and permitted common features of successful programmes to be
Liew, Steven; Sundaram, Hema; De Boulle, Koenraad L.; Goodman, Greg J.; Monheit, Gary; Wu, Yan; Trindade de Almeida, Ada R.; Swift, Arthur; Vieira Braz, André
Background: Although the safety profile of hyaluronic acid fillers is favorable, adverse reactions can occur. Clinicians and patients can benefit from ongoing guidance on adverse reactions to hyaluronic acid fillers and their management. Methods: A multinational, multidisciplinary group of experts in cosmetic medicine convened the Global Aesthetics Consensus Group to review the properties and clinical uses of Hylacross and Vycross hyaluronic acid products and develop updated consensus recommendations for early and late complications associated with hyaluronic acid fillers. Results: The consensus panel provided specific recommendations focusing on early and late complications of hyaluronic acid fillers and their management. The impact of patient-, product-, and technique-related factors on such reactions was described. Most of these were noted to be mild and transient. Serious adverse events are rare. Early adverse reactions to hyaluronic acid fillers include vascular infarction and compromise; inflammatory reactions; injection-related events; and inappropriate placement of filler material. Among late reactions are nodules, granulomas, and skin discoloration. Most adverse events can be avoided with proper planning and technique. Detailed understanding of facial anatomy, proper patient and product selection, and appropriate technique can further reduce the risks. Should adverse reactions occur, the clinician must be prepared and have tools available for effective treatment. Conclusions: Adverse reactions with hyaluronic acid fillers are uncommon. Clinicians should take steps to further reduce the risk and be prepared to treat any complications that arise. PMID:27219265
Meyling, Nicolai V.; Ormond, Emma; Roy, Helen E.; Pell, Judith K.
Insects can detect cues related to the risk of attack by their natural enemies. Pathogens are among the natural enemies of insects and entomopathogenic fungi attack a wide array of host species. Evidence documents that social insects in particular have adapted behavioural mechanisms to avoid infection by fungal pathogens. These mechanisms are referred to as 'behavioural resistance'. However, there is little evidence for similar adaptations in non-social insects. We have conducted experime...
Qin, Ping; Nordentoft, Merete
history increases suicide risk relatively more in women than in men; and suicide risk is substantial for substance disorders and for multiple admissions in women but not in men. CONCLUSIONS: Suicide risk peaks in periods immediately after admission and discharge. The risk is particularly high in persons...... with affective disorders and in persons with short hospital treatment. These findings should lead to systematic evaluation of suicide risk among inpatients before discharge and corresponding outpatient treatment, and family support should be initiated immediately after the discharge...
Grunau, Brian; Hornby, Laura; Singal, Rohit K; Christenson, Jim; Ortega-Deballon, Ivan; Shemie, Sam D; Bashir, Jamil; Brooks, Steve C; Callaway, Clifton W; Guadagno, Elena; Nagpal, Dave
Out-of-hospital cardiac arrest (OHCA) affects 134 per 100,000 citizens annually. Extracorporeal cardiopulmonary resuscitation (ECPR), providing mechanical circulatory support, may improve the likelihood of survival among those with refractory OHCA. Compared with in-hospital ECPR candidates, those in the out-of-hospital setting tend to be sudden unexpected arrests in younger and healthier patients. The aims of this review were to summarize, and identify the limitations of, the evidence evaluating ECPR for OHCA, and to provide an approach for ECPR program application. Although there are many descriptions of ECPR-treated cohorts, we identified a paucity of robust data showing ECPR effectiveness compared with conventional resuscitation. However, it is highly likely that ECPR, provided after a prolonged attempt with conventional resuscitation, does benefit select patient populations compared with conventional resuscitation alone. Although reliable data showing the optimal patient selection criteria for ECPR are lacking, most implementations sought young previously healthy patients with rapid high-quality cardiopulmonary resuscitation. Carefully planned development of ECPR programs, in high-performing emergency medical systems at experienced extracorporeal membrane oxygenation centres, may be reasonable as part of systematic efforts to determine ECPR effectiveness and globally improve care. Protocol evaluation requires regional-level assessment, examining the incremental benefit of survival compared with standard care, while accounting for resource utilization. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
Croes, Ramsis; Krabbe, Yvonne; Mikkers, Misja
There is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be characterized as a
Croes, R.R.; Krabbe-Alkemade, Y.J.F.M.; Mikkers, M.C.
textabstractThere is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be
Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind......Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind...
Dunham, C Michael; Cutrona, Anthony F; Gruber, Brian S; Calderon, Javier E; Ransom, Kenneth J; Flowers, Laurie L
Objective: In the past, the authors performed a comprehensive literature review to identify all randomized controlled trials assessing the impact of early tracheostomy on severe brain injury outcomes. The search produced only two trials, one by Sugerman and another by Bouderka. Subjects and methods: The current authors initiated an Institutional Review Board-approved severe brain injury randomized trial to evaluate the impact of early tracheostomy on ventilator-associated pneumonia rates, intensive care unit (ICU)/ventilator days, and hospital mortality. Current study results were compared with the other randomized trials and a meta-analysis was performed. Results: Early tracheostomy pneumonia rates were Sugerman-48.6%, Bouderka-58.1%, and current study-46.7%. No early tracheostomy pneumonia rates were Sugerman-53.1%, Bouderka-61.3%, and current study-44.4%. Pneumonia rate meta-analysis showed no difference for early tracheostomy and no early tracheostomy (OR 0.89; p = 0.71). Early tracheostomy ICU/ventilator days were Sugerman-16 ± 5.9, Bouderka-14.5 ± 7.3, and current study-14.1 ± 5.7. No early tracheostomy ICU/ventilator days were Sugerman-19 ± 11.3, Bouderka-17.5 ± 10.6, and current study-17 ± 5.4. ICU/ventilator day meta-analysis showed 2.9 fewer days with early tracheostomy (p = 0.02). Early tracheostomy mortality rates were Sugerman-14.3%, Bouderka-38.7%, and current study-0%. No early tracheostomy mortality rates were Sugerman-3.2%, Bouderka-22.6%, and current study-0%. Randomized trial mortality rate meta-analysis showed a higher rate for early tracheostomy (OR 2.68; p = 0.05). Because the randomized trials were small, a literature assessment was undertaken to find all retrospective studies describing the association of early tracheostomy on severe brain injury hospital mortality. The review produced five retrospective studies, with a total of 3,356 patients. Retrospective study mortality rate meta-analysis demonstrated a larger mortality for early
Extant literature suggested that positive organizational climate leads to higher levels of organizational commitment, which is an important concept in terms of employee attitudes, likewise, the concept of perceived organizational performance, which can be assumed as a mirror of the actual performance. For healthcare settings, these are important matters to consider due to the fact that the service is delivered thoroughly by healthcare workers to the patients. Therefore, attitudes and perceptions of the employees can influence how they deliver the service. The aim of this study was to evaluate healthcare employees' perceptions of organizational climate and test the hypothesized impact of organizational climate on organizational commitment and perceived organizational performance. The study adopted a quantitative approach, by collecting data from the healthcare workers currently employed in public hospitals in North Cyprus, utilizing a self-administered questionnaire. Collected data was analyzed with the help of Statistical Package for Social Sciences, and ANOVA and Linear Regression analyses were used to test the hypothesis. Results revealed that organizational climate is highly correlated with organizational commitment and perceived organizational performance. Simple linear regression outcomes indicated that organizational climate is significant in predicting organizational commitment and perceived organizational performance. There was a positive and linear relationship between organizational climate with organizational commitment and perceived organizational performance. Results from the regression analysis suggested that organizational climate has an impact on predicting organizational commitment and perceived organizational performance of the employees in public hospitals of North Cyprus. Organizational climate was found to be statistically significant in determining the organizational commitment of the employees. The results of the study provided some critical
Grigorakis, Nikolaos; Floros, Christos; Tsangari, Haritini; Tsoukatos, Evangelos
The Greek state has reduced their funding on health as part of broader efforts to limit the large fiscal deficits and rising debt ratios to GDP. Benefits cuts and limitations of Social Health Insurance (SHI) reimbursements result in substantial Out of Pocket (OOP) payments in the Greek population. In this paper, we examine social health insurance's risk pooling mechanisms and the catastrophic impact that OOP payments may have on insured's income and well-being. Using data collected from a cross sectional survey in Greece, we find that the OOP payments for inpatient care in private hospitals have a positive relationship with SHI funding. Moreover, we show that the SHI funding is inadequate to total inpatient financing. We argue that the Greek health policy makers have to give serious consideration to the perspective of a SHI system which should be supplemented by the Private Health Insurance (PHI) sector. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Roy, Kakoli; Howard, David Hill
The lack of formal health insurance and inadequate social safety nets cause families in most low-income countries to finance health spending through out-of-pocket (OOP) payments, leaving poor families unable to insure their consumption during periods of major illnesses. To examine how well the Indian healthcare system protects households of differing living standards against the financial consequences of unanticipated health shocks. The data are drawn from the 52nd round of National Sample Survey, a nationally representative socioeconomic and health survey conducted in 1995-1996. The sample comprises 24,379 (3.84%) households where a member was hospitalized during the 1-year reference period. We estimate, using ordinary least squares, the relationship between household consumption (proxy for ability to pay) and OOP payments for hospitalization. We also estimate the relationship between consumption and OOP share in consumption. Our results indicate that both utilization (payments) and the consequent financial burden (payment share) increases with increasing ability to pay (ATP). While this relationship is retained across the different subgroups (e.g., gender, social code, region, etc.), comparisons across groups indicate horizontal inequities including differences in both degrees of progressivity and the redistributive effect. The finding that OOP payments do not decline with ATP could be an indication of: (1) the lack of insurance which implies that the better-off must pay from OOP to secure quality health care and (2) the absence of risk-pooling or prepayments mechanisms which poses financial impediments to the consumption of health care by the poor.
Hennessee, Ian; Chinkhumba, Jobiba; Briggs-Hagen, Melissa; Bauleni, Andy; Shah, Monica P; Chalira, Alfred; Moyo, Dubulao; Dodoli, Wilfred; Luhanga, Misheck; Sande, John; Ali, Doreen; Gutman, Julie; Lindblade, Kim A; Njau, Joseph; Mathanga, Don P
With 71% of Malawians living on malaria are likely a major economic burden for low income families and may constitute an important barrier to care seeking. Nevertheless, few efforts have been made to examine these costs. This paper describes household costs associated with seeking and receiving inpatient care for malaria in health facilities in Malawi. A cross-sectional survey was conducted in a representative nationwide sample of 36 health facilities providing inpatient treatment for malaria from June-August, 2012. Patients admitted at least 12 h before study team visits who had been prescribed an antimalarial after admission were eligible to provide cost information for their malaria episode, including care seeking at previous health facilities. An ingredients-based approach was used to estimate direct costs. Indirect costs were estimated using a human capital approach. Key drivers of total household costs for illness episodes resulting in malaria admission were assessed by fitting a generalized linear model, accounting for clustering at the health facility level. Out of 100 patients who met the eligibility criteria, 80 (80%) provided cost information for their entire illness episode to date and were included: 39% of patients were under 5 years old and 75% had sought care for the malaria episode at other facilities prior to coming to the current facility. Total household costs averaged $17.48 per patient; direct and indirect household costs averaged $7.59 and $9.90, respectively. Facility management type, household distance from the health facility, patient age, high household wealth, and duration of hospital stay were all significant drivers of overall costs. Although malaria treatment is supposed to be free in public health facilities, households in Malawi still incur high direct and indirect costs for malaria illness episodes that result in hospital admission. Finding ways to minimize the economic burden of inpatient malaria care is crucial to protect
Bryson, Amanda E; Scipioni, Anna M; Essayli, Jamal H; Mahoney, Johnna R; Ornstein, Rollyn M
To assess long-term outcomes of patients with avoidant/restrictive food intake disorder (ARFID) treated in a partial hospitalization program (PHP) for eating disorders (ED). A cross-sectional study comparing patients with ARFID to those with anorexia nervosa (AN) who had been discharged from a PHP for at least 12 months was performed. Percent median body mass index (%MBMI), scores on the Children's Eating Attitudes Test (ChEAT), and treatment utilization were assessed, with intake and discharge data collected via retrospective chart review. Of the 137 eligible patients, 62 (45.3%) consented to follow-up data collection. Patients with ARFID and AN exhibited similar increases in %MBMI from intake to discharge and reported low scores on the ChEAT by discharge. Patients with ARFID and AN maintained good weight outcomes and low ChEAT scores at follow-up. Most participants were still receiving outpatient treatment from a variety of providers, although fewer with ARFID than AN continued to receive services from our multidisciplinary ED clinic. Patients with ARFID and AN exhibit similar improvements in %MBMI when treated in the same PHP and appear to maintain treatment gains at long-term follow-up. Additionally, most patients continue to utilize outpatient services after being discharged from a PHP. © 2018 Wiley Periodicals, Inc.
Khan, Babar A.; Zawahiri, Mohammed; Campbell, Noll L.; Fox, George C.; Weinstein, Eric J.; Nazir, Arif; Farber, Mark O.; Buckley, John D.; MacLullich, Alasdair; (UK), MRCP; Boustani, Malaz A.
BACKGROUND Despite the significant burden of delirium among hospitalized adults, critical appraisal of systematic data on delirium diagnosis, pathophysiology, treatment, prevention, and outcomes is lacking. PURPOSE To provide evidence-based recommendations for delirium care to practitioners, and identify gaps in delirium research. DATA SOURCES Medline, PubMed, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) information systems fromJanuary 1966 to April 2011. STUDY SELECTION All published systematic evidence reviews (SERs) on delirium were evaluated. DATA EXTRACTION Three reviewers independently extracted the data regarding delirium risk factors, diagnosis, prevention, treatment, and outcomes, and critically appraised each SER as good, fair, or poor using the United States Preventive Services Task Force criteria. DATA SYNTHESIS Twenty-two SERs graded as good or fair provided the data. Age, cognitive impairment, depression, anticholinergic drugs, and lorazepam use were associated with an increased risk for developing delirium. The Confusion Assessment Method (CAM) is reliable for delirium diagnosis outside of the intensive care unit. Multicomponent nonpharmacological interventions are effective in reducing delirium incidence in elderly medical patients. Low-dose haloperidol has similar efficacy as atypical antipsychotics for treating delirium. Delirium is associated with poor outcomes independent of age, severity of illness, or dementia. CONCLUSION Delirium is an acute, preventable medical condition with short- and long-term negative effects on a patient’s cognitive and functional states. PMID:22684893
Andrade, Rafaela Garcia Santos; Madeiro, Fernanda; Genta, Pedro Rodrigues; Lorenzi-Filho, Geraldo
Continuous positive airway pressure (CPAP) delivered by nasal mask is the gold standard treatment for obstructive sleep apnea (OSA). However, oral and oronasal masks are also available. We considered experimental evidence and reviewed clinical trials that evaluated the impact of oral and oronasal mask on OSA treatment. One recent study in 18 OSA patients that slept with a customized oronasal mask with two sealed compartments showed that the change of CPAP flow from nasal to oronasal and oral caused upper airway obstruction because of posterior displacement of the tongue demonstrated by nasoendoscopy. Oral masks use a mouthpiece that may stabilize the jaw and the tongue and have shown to be effective. However, oral masks are not widely used in clinical practice. Four out of five observational studies and all five reviewed randomized studies showed a worse performance of oronasal when compared with nasal masks. Oronasal masks were associated with higher residual apnea-hypopnea index, lower adherence, more leaks, and less satisfaction than nasal mask in the majority of the studies. Nasal CPAP must be the first choice to treat OSA. Patients on oronasal mask should be carefully followed. VIDEO ABSTRACT.
Butler, Michael K; Kaiser, Michael; Johnson, Jolene; Besse, Jay; Horswell, Ronald
The Louisiana State University Health Care Services Division system assessed the effectiveness of implementing a multisite disease management program targeting diabetes mellitus in an indigent patient population. A population-based disease management program centered on evidence-based clinical care guidelines was applied from the system level. Specific clinic modifications and models were used, as well as ancillary services such as medication assistance and equipment subsidies. Marked improvement in process goals led to improved clinical outcomes. From 2001 to 2008, the percentage of patients with a hemoglobin A1c management programs can be successfully implemented and achieve statistically significant results.
Lolita Dopico da Silva
Full Text Available This study aimed to identify the characteristics of nurses’ publications about medication errors. It was used an Integrative methodology review covering January 2005 to October 2010 with "medication errors" and "nursing" descriptors and it was also collected data from electronic databases via “Capes Portal”. Results show four categories, the conduct of health professionals in medication errors, types and rates of errors, medication system weaknesses, and barriers to error. Discussion of the prevalent practice was not to notify the error. The prevalent error type was administration and error rates which ranged from 14.8 to 56.7%. Ilegible handwriting, communication failures among professionals, and lack of technical knowledge were weaknesses. Among the barriers, the civility from patient, nurses and technology were evident. Advances in researches for testing barriers were found and some gaps were apparent concerning lack of study that address pharmacodynamics or pharmacokinetic aspects of drugs involved in errors.
Chen, Chi-Chen; Cheng, Shou-Hsia
To examine the effects of market competition on patient-perceived quality of care under a single-payer system in Taiwan. Data came from two nationwide surveys conducted on discharged patients and National Health Insurance (NHI) hospital claim datasets in 2002 and 2004. Competition was measured by the Herfindahl-Hirschman Index (HHI). Quality of care was measured by patient-rated hospital performance including interpersonal skills and clinical competence domains. We used the instrumental variable approach to address the endogeneity between competition and patient-perceived quality of care. The results showed that HHI was significantly associated with a decrease in the perceived interpersonal skills (coefficient of -0.460; pcompetition. A similar association was found for the perceived clinical competence (coefficient of -0.457; p=0.001). Quality of care from the patients' perspective is sensitive to the degree of competition. By using patient-reported data, this study provides new evidence concerning competition and quality of care. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Sving, Eva; Fredriksson, Lennart; Gunningberg, Lena; Mamhidir, Anna-Greta
To describe registered nurses', assistant nurses' and first-line managers' experiences and perceptions of a multifaceted hospital setting intervention focused on implementing evidence-based pressure ulcer prevention. Pressure ulcer prevention is deficient. Different models exist to support implementation of evidence-based care. Little is known about implementation processes. A descriptive qualitative approach. Five focus-group nurse interviews and five individual first-line manager interviews were conducted at five Swedish hospital units. Qualitative content analysis was used. The findings support that the intervention and the implementation process changed the understanding and way of working with pressure ulcer prevention: from treating to preventing. This became possible as 'Changed understanding enables changed actions - through one's own performance and reflection on pressure ulcer prevention'. Having a common outlook on pressure ulcer prevention, easy access to pressure-reducing equipment, and external and internal facilitator support were described as important factors for changed practices. Bedside support, feedback and discussions on current results increased the awareness of needed improvements. The multifaceted intervention approach and the participants' positive attitudes seemed to be crucial for changing understanding and working more preventatively. The strategies used and the skills of the facilitators need to be tailored to the problems surrounding the context. Feedback discussions among the staff regarding the results of the care provided also appear to be vital. It is crucial that dedicated facilitators are involved to promote the implementation process. A preventative mindset should be strived for. Creating an implementation plan with an outcome and a process evaluation should be emphasised. It is important to give the staff regular feedback on the quality of care and on those occasions allocate time for discussion and reflection. © 2016 John
Hospitalization of children under five years of age due to avoidable causes Hospitalizaciones en menores de cinco años por causas evitables Hospitalizações de menores de cinco anos por causas evitáveis
Rosana Rosseto de Oliveira
Full Text Available This study characterizes the profile of hospital morbidity according to the main diagnosis upon admission, in individuals younger than five years old, residents of three cities (Maringá, Sarandi and Paiçandu in the Paraná state, Brazil. Information contained in hospital admission forms from 1998 to 2009 was used. The hospitalizations of 41,220 individuals younger than five years old were analyzed. The results indicate a decline of 16.1% in hospital admissions of patients younger than five years old in relation to the total number of admissions in all age groups. As for the main diagnoses, there were diseases of the respiratory system (55.6%, infectious and parasitic diseases (14.8% and diseases originating in the perinatal period (12.9%. Such conditions can be avoided by implementing primary health care measures, which shows the need to intensify the actions recommended by the programs directed to child health.El objetivo de este estudio fue caracterizar el perfil de la morbilidad hospitalaria según el diagnóstico principal de internación, en menores de cinco años, residentes en las ciudades de Maringá, Sarandi y Paiçandu. Fueron utilizadas informaciones registradas en los formularios de Autorización de Internación Hospitalaria, en los años de 1998 a 2009. Se analizaron 41.220 internaciones en menores de 5 años. Los resultados evidencian una disminución de 16,1% de internaciones de menores de cinco años en relación al total de internaciones en todos los intervalos de edad. En cuanto a las principales causas de hospitalización se encontraron las enfermedades del aparato respiratorio (55,6%, enfermedades infecciosas y parasitarias (14,8% y afecciones originadas en el período perinatal (12,9%; estas enfermedades pueden evitadas con medidas de atención básica, señalando la necesidad de intensificar las acciones preconizadas por los programas dirigidos a la salud del niño.O estudo objetivou caracterizar o perfil da morbidade
Blanc, D S; Gomes Magalhaes, B; Abdelbary, M; Prod'hom, G; Greub, G; Wasserfallen, J B; Genoud, P; Zanetti, G; Senn, L
During an environmental investigation of Pseudomonas aeruginosa in intensive care units, the liquid hand soap was found to be highly contaminated (up to 8 × 10(5)cfu/g) with this pathogen. It had been used over the previous five months and was probably contaminated during manufacturing. To evaluate the burden of this contamination on patients by conducting an epidemiological investigation using molecular typing combined with whole genome sequencing (WGS). P. aeruginosa isolates from clinical specimens were analysed by double locus sequence typing (DLST) and compared with isolates recovered from the soap. Medical charts of patients infected with a genotype identical to those found in the soap were reviewed. WGS was performed on soap and patient isolates sharing the same genotype. P. aeruginosa isolates (N = 776) were available in 358/382 patients (93.7%). Only three patients (0.8%) were infected with a genotype found in the soap. Epidemiological investigations showed that the first patient was not exposed to the soap, the second could have been exposed, and the third was indeed exposed. WGS showed a high number of core single nucleotide polymorphism differences between patients and soap isolates. No close genetic association was observed between soap and patient isolates, ruling out the hypothesis of transmission. Despite a highly contaminated soap, the combined investigation with DLST and WGS ruled out any impact on patients. Hand hygiene performed with alcohol-based solution for >15 years was probably the main reason. However, such contamination represents a putative reservoir of pathogens that should be avoided in the hospital setting. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
Verloo, Henk; Desmedt, Mario; Morin, Diane
Evidence-based practice (EBP) is upheld as a means for patients to receive the most efficient care in a given context. Despite the available evidence and positive beliefs about it, implementing EBP as standard daily practice still faces many obstacles. This study investigated the beliefs about and implementation of EBP among nurses and allied healthcare providers (AHP) in 9 acute care hospitals in the canton of Valais, Switzerland. A cross-sectional descriptive survey was conducted. The target population was composed of 1899 nurses and 126 AHPs. Beliefs about and implementation of EBP were measured using EBP-Beliefs and EBP-Implementation scales of Melnyk et al. The initial sample consisted in 491 participants (overall response rate 24.2%): 421 nurses (22.4% response rate) and 78 AHPs (61.9% response rate). The final sample, composed only of those who declared previous exposure to EBP, included 391 participants (329 nurses and 62 AHPs). Overall, participants had positive attitudes towards EBP and were willing to increase their knowledge to guide practice. However, they acknowledged poor implementation of EBP in daily practice. A significantly higher level of EBP implementation was declared by those formally trained in it (P = 0.006) and by those occupying more senior professional functions (P = 0.004). EBP-Belief scores predicted 13% of the variance in the EBP-Implementation scores (R 2 = 0.13). EBP is poorly implemented despite positive beliefs about it. Continuing education and support on EBP would help to ensure that patients receive the best available care based on high-quality evidence, patient needs, clinical expertise, and a fair distribution of healthcare resources. This study's results will be used to guide institutional strategy to increase the use of EBP in daily practice. © 2016 John Wiley & Sons, Ltd.
Ahn, Henry; Singh, Jeffrey; Nathens, Avery; MacDonald, Russell D.; Travers, Andrew; Tallon, John; Fehlings, Michael G.
Abstract An interdisciplinary expert panel of medical and surgical specialists involved in the management of patients with potential spinal cord injuries (SCI) was assembled. Four key questions were created that were of significant interest. These were: (1) what is the optimal type and duration of pre-hospital spinal immobilization in patients with acute SCI?; (2) during airway manipulation in the pre-hospital setting, what is the ideal method of spinal immobilization?; (3) what is the impact of pre-hospital transport time to definitive care on the outcomes of patients with acute spinal cord injury?; and (4) what is the role of pre-hospital care providers in cervical spine clearance and immobilization? A systematic review utilizing multiple databases was performed to determine the current evidence about the specific questions, and each article was independently reviewed and assessed by two reviewers based on inclusion and exclusion criteria. Guidelines were then created related to the questions by a national Canadian expert panel using the Delphi method for reviewing the evidence-based guidelines about each question. Recommendations about the key questions included: the pre-hospital immobilization of patients using a cervical collar, head immobilization, and a spinal board; utilization of padded boards or inflatable bean bag boards to reduce pressure; transfer of patients off of spine boards as soon as feasible, including transfer of patients off spinal boards while awaiting transfer from one hospital institution to another hospital center for definitive care; inclusion of manual in-line cervical spine traction for airway management in patients requiring intubation in the pre-hospital setting; transport of patients with acute traumatic SCI to the definitive hospital center for care within 24 h of injury; and training of emergency medical personnel in the pre-hospital setting to apply criteria to clear patients of cervical spinal injuries, and immobilize patients
Turner Tari J
Full Text Available Abstract Background Evidence-based clinical practice guidelines support clinical decision-making by making recommendations to guide clinical practice. These recommendations are developed by integrating the expertise of a multidisciplinary group of clinicians with the perspectives of consumers and the best available research evidence. However studies have raised concerns about the quality of guideline development, and particularly the link between research and recommendations. The reasons why guideline developers are not following the established development methods are not clear. We aimed to explore the barriers to developing evidence-based guidelines in eleven hospitals in Australia, Indonesia, Malaysia, the Philippines and Thailand, so as to better understand how evidence-based guideline development could be facilitated in these settings. The research aimed to identify the value clinicians place on guidelines, what clinicians want in guidelines developed in hospital settings and what factors limit rigorous evidence-based guideline development in these settings. Methods Semi-structured, face-to-face interviews were undertaken with senior and junior healthcare providers (nurses, midwives, doctors, allied health from the maternal and neonatal services of the eleven participating hospitals. Interviews were audio-recorded, transcribed and a thematic analysis undertaken. Results Ninety-three individual, 25 pair and eleven group interviews were conducted. Participants were clear that they want guidelines that are based on evidence and updated regularly. They were also clear that there are major barriers to this. Most of the barriers were shared across countries, and included lack of time, lack of skills in finding, appraising and interpreting evidence, lack of access to relevant evidence and difficulty arranging meetings and achieving consensus. Barriers that were primarily identified in Australian hospitals include cumbersome organisational
Evans, Jessica; Kobewka, Daniel; Thavorn, Kednapa; D'Egidio, Gianni; Rosenberg, Erin; Kyeremanteng, Kwadwo
To use theoretical modelling exercises to determine the effect of reduced intensive care unit (ICU) length of stay (LOS) on total hospital costs at a Canadian centre. We conducted a retrospective cost analysis from the perspective of one tertiary teaching hospital in Canada. Cost, demographic, clinical, and LOS data were retrieved through case-costing, patient registry, and hospital abstract systems of The Ottawa Hospital Data Warehouse for all new in-patient ward (30,483) and ICU (2,239) encounters between April 2012 and March 2013. Aggregate mean daily variable direct (VD) costs for ICU vs ward encounters were summarized by admission day number, LOS, and cost centre. The mean daily VD cost per ICU patient was $2,472 (CAD), accounting for 67.0% of total daily ICU costs per patient and $717 for patients admitted to the ward. Variable direct cost is greatest on the first day of ICU admission ($3,708), and then decreases by 39.8% to plateau by the fifth day of admission. Reducing LOS among patients with ICU stays ≥ four days could potentially result in an annual hospital cost saving of $852,146 which represents 0.3% of total in-patient hospital costs and 1.2% of ICU costs. Reducing ICU LOS has limited cost-saving potential given that ICU costs are greatest early in the course of admission, and this study does not support the notion of reducing ICU LOS as a sole cost-saving strategy.
Young, Gary J.; Daniel Lee, Shoou-Yih; Song, Paula H.; Alexander, Jeffrey A.
Objectives. We investigated whether federally tax-exempt hospitals consider community health needs when deciding how much and what types of community benefits to provide. Methods. Using 2009 data from hospital tax filings to the Internal Revenue Service and the 2010 County Health Rankings, we employed both univariate and multivariate analyses to examine the relationship between community health needs and the types and levels of hospitals’ community benefit expenditures. The study sample included 1522 private, tax-exempt hospitals throughout the United States. Results. We found some patterns between community health needs and hospitals’ expenditures on community benefits. Hospitals located in communities with greater health needs spent more as a percentage of their operating budgets on benefits directly related to patient care. By contrast, spending on community health improvement initiatives was unrelated to community health needs. Conclusions. Important opportunities exist for tax-exempt hospitals to improve the alignment between their community benefit activities and the health needs of the community they serve. The Affordable Care Act requirement that hospitals conduct periodic community health needs assessments may be a first step in this direction. PMID:25790412
Dong, Gang Nathan
Fiscal constraints faced by U.S. hospitals as a result of the recent economic downturn are leading to business practices that reduce costs and improve financial and operational efficiency in hospitals. There naturally arises the question of how this finance-driven management culture could affect the quality of care. This paper attempts to determine whether the process measures of treatment quality are correlated with hospital financial performance. Panel study of hospital care quality and financial condition between 2005 and 2010 for cardiovascular disease treatment at acute care hospitals in the United States. Process measures for condition-specific treatment of heart attack and heart failure and hospital-level financial condition ratios were collected from the CMS databases of Hospital Compare and Cost Reports. There is a statistically significant relationship between hospital financial performance and quality of care. Hospital profitability, financial leverage, asset liquidity, operating efficiency, and costs appear to be important factors of health care quality. In general, public hospitals provide lower quality care than their nonprofit counterparts, and urban hospitals report better quality score than those located in rural areas. Specifically, the first-difference regression results indicate that the quality of treatment for cardiovascular patients rises in the year following an increase in hospital profitability, financial leverage, and labor costs. The results suggest that, when a hospital made more profit, had the capacity to finance investment using debt, paid higher wages presumably to attract more skilled nurses, its quality of care would generally improve. While the pursuit of profit induces hospitals to enhance both quantity and quality of services they offer, the lack of financial strength may result in a lower standard of health care services, implying the importance of monitoring the quality of care among those hospitals with poor financial health.
National Aeronautics and Space Administration — Collision avoidance for unmanned aerial systems (UAS) traveling at high relative speeds is a challenging task. It requires both the detection of a possible collision...
Full Text Available Excessive avoidance behavior, in which an instrumental action prevents an upcoming aversive event, is a defining feature of anxiety disorders. Left unchecked, both fear and avoidance of potentially threatening stimuli may generalize to perceptually related stimuli and situations. The behavioral consequences of generalization mean that aversive learning experiences with specific threats may lead people to infer that classes of related stimuli are threatening, potentially dangerous, and need to be avoided, despite differences in physical form. Little is known about avoidance generalization in humans and the learning pathways by which it may be transmitted. In the present study, we compared two pathways to avoidance, instructions and social observation, on subsequent generalization of avoidance behavior, fear expectancy and physiological arousal. Participants first learned that one cue was a danger cue (conditioned stimulus, CS+ and another was a safety cue (CS-. Groups then were either instructed that a simple avoidance response in the presence of the CS+ cancelled upcoming shock presentations (instructed-learning group or observed a short movie showing a demonstrator performing the avoidance response to prevent shock (observational-learning group. During generalization testing, danger and safety cues were presented along with generalization stimuli that parametrically varied in perceptual similarity to the CS+. Reinstatement of fear and avoidance was also tested. Findings demonstrate, for the first time, generalization of socially transmitted and instructed avoidance: both groups showed comparable generalization gradients in fear expectancy, avoidance behavior and arousal. Return of fear was evident, suggesting that generalized avoidance remains persistent following extinction testing. The utility of the present paradigm for research on avoidance generalization is discussed.
Schmaltz Heidi N
Full Text Available Abstract Delirium occurs in up to 65% of older hip fracture patients. Developing delirium in hospital has been associated with a variety of adverse outcomes. Trials have shown that multi-component preventive interventions can lower delirium rates. The objective of this study was to implement and evaluate the effectiveness of an evidence-based electronic care pathway, which incorporates multi-component delirium strategies, among older hip fracture patients. We conducted a pragmatic study using an interrupted time series design in order to evaluate the use and impact of the intervention. The target population was all consenting patients aged 65 years or older admitted with an acute hip fracture to the orthopedic units at two Calgary, Alberta hospitals. The primary outcome was delirium rates. Secondary outcomes included length of hospital stay, in-hospital falls, in-hospital mortality, new discharges to long-term care, and readmissions. A Durbin Watson test was conducted to test for serial correlation and, because no correlation was found, Chi-square statistics, Wilcoxon test and logistic regression analyses were conducted as appropriate. At study completion, focus groups were conducted at each hospital to explore issues around the use of the order set. During the 40-week study period, 134 patients were enrolled. The intervention had no effect on the overall delirium rate (33% pre versus 31% post; p = 0.84. However, there was a significant interaction between study phase and hospital (p = 0.03. Although one hospital did not experience a decline in delirium rate, the delirium rate at the other hospital declined from 42% to 19% (p = 0.08. This difference by hospital was mirrored in focus group feedback. The hospital that experienced a decline in delirium rates was more supportive of the intervention. Overall, post-intervention there were no significant differences in mean length of stay (12 days post versus 14 days pre; p = 0.74, falls (6% post
Abilleira, Sònia; Gallofré, Miquel; Ribera, Aida; Sánchez, Emília; Tresserras, Ricard
Evidence-based standards are used worldwide to determine quality of care. We assessed quality of in-hospital stroke care in all acute-care hospitals in Catalonia by determining adherence to 13 evidence-based performance measures (PMs) of process of care. Data on PMs were collected by retrospective review of medical records of consecutive stroke admissions (January to June, 2005). Compliance with PMs was calculated according to 3 hospital levels determined by their annual stroke case-load (level 1, 350). We defined sampling weights that represented each patient's inverse probability of inclusion in the study sample. Sampling weights were applied to produce estimates of compliance. Factors that predicted good/bad compliance were determined by multivariate weighted logistic regression models. An external monitoring of 10% of cases recruited at each hospital was undertaken, after random selection, to assess quality of data. We analyzed data from 1791 stroke cases (17% of all stroke admissions). Global interobserver agreement was 0.7. Eight PMs achieved compliances >or=75%, 4 of which were more than 90%, and the remaining showed adherences Catalonia was heterogeneous across hospital levels. Rehabilitation-related measures showed poor compliances compared to acute care-related ones, which achieved more satisfactory adherences.
Scharf, Daniel; Acikmese, Behcet; Ploen, Scott; Hadaegh, Fred
The reactive collision avoidance (RCA) algorithm allows a spacecraft to find a fuel-optimal trajectory for avoiding an arbitrary number of colliding spacecraft in real time while accounting for acceleration limits. In addition to spacecraft, the technology can be used for vehicles that can accelerate in any direction, such as helicopters and submersibles. In contrast to existing, passive algorithms that simultaneously design trajectories for a cluster of vehicles working to achieve a common goal, RCA is implemented onboard spacecraft only when an imminent collision is detected, and then plans a collision avoidance maneuver for only that host vehicle, thus preventing a collision in an off-nominal situation for which passive algorithms cannot. An example scenario for such a situation might be when a spacecraft in the cluster is approaching another one, but enters safe mode and begins to drift. Functionally, the RCA detects colliding spacecraft, plans an evasion trajectory by solving the Evasion Trajectory Problem (ETP), and then recovers after the collision is avoided. A direct optimization approach was used to develop the algorithm so it can run in real time. In this innovation, a parameterized class of avoidance trajectories is specified, and then the optimal trajectory is found by searching over the parameters. The class of trajectories is selected as bang-off-bang as motivated by optimal control theory. That is, an avoiding spacecraft first applies full acceleration in a constant direction, then coasts, and finally applies full acceleration to stop. The parameter optimization problem can be solved offline and stored as a look-up table of values. Using a look-up table allows the algorithm to run in real time. Given a colliding spacecraft, the properties of the collision geometry serve as indices of the look-up table that gives the optimal trajectory. For multiple colliding spacecraft, the set of trajectories that avoid all spacecraft is rapidly searched on
Huesch, Marco D; Currid-Halkett, Elizabeth; Doctor, Jason N
Publicly available hospital quality reports seek to inform consumers of important healthcare quality and affordability attributes, and may inform consumer decision-making. To understand how much consumers search for such information online on one Internet search engine, whether they mention such information in social media and how positively they view this information. A leading Internet search engine (Google) was the main focus of the study. Google Trends and Google Adwords keyword analyses were performed for national and Californian searches between 1 August 2012 and 31 July 2013 for keywords related to 'top hospital', best hospital', and 'hospital quality', as well as for six specific hospital quality reports. Separately, a proprietary social media monitoring tool was used to investigate blog, forum, social media and traditional media mentions of, and sentiment towards, major public reports of hospital quality in California in 2012. (1) Counts of searches for keywords performed on Google; (2) counts of and (3) sentiment of mentions of public reports on social media. National Google search volume for 75 hospital quality-related terms averaged 610 700 searches per month with strong variation by keyword and by state. A commercial report (Healthgrades) was more commonly searched for nationally on Google than the federal government's Hospital Compare, which otherwise dominated quality-related search terms. Social media references in California to quality reports were generally few, and commercially produced hospital quality reports were more widely mentioned than state (Office of Statewide Healthcare Planning and Development (OSHPD)), or non-profit (CalHospitalCompare) reports. Consumers are somewhat aware of hospital quality based on Internet search activity and social media disclosures. Public stakeholders may be able to broaden their quality dissemination initiatives by advertising on Google or Twitter and using social media interactively with consumers looking
Schlatter, Rosane Paixão; Hirakata, Vânia Naomi; Polanczyk, Carisi Anne
Coronary artery disease is the most prevalent cardiovascular disease. In the United States, 7% of adults over 20 years of age are estimated to have coronary artery disease. In Brazil, a prevalence of 5 to 8% has been estimated in adults over 40 years of age, with an increased number of hospitalizations associated with both stable and acute clinical manifestations; and health care costs have quadrupled in the last decade. To estimate the direct costs of managing ischemic heart disease patient care in a teaching hospital in Brazil from the perspective of the service payer, the Brazilian Unified Health System. This study was a retrospective cohort study for the identification and valuation of resources used at both the outpatient and in-hospital levels in a sample of 330 patients selected from the hospital's ischemic heart disease clinic. Data were collected from computerized hospital records and patients' hospital bills from January 2000 to October 2015. A bivariate analysis and binary logistic regression were performed with p cost of outpatient management was US $1,521 per patient. The mean cost per hospitalization was US $1,976, and the expenses were higher in the first and last years of follow-up. Unstable angina, revascularization procedures, diabetes, hypertension and obesity were predictors of higher hospitalization costs (p cost estimates in this study indicate a high proportion of drug treatment costs in the treatment of ischemic heart disease. Treatment costs are higher in the first year and at the end of treatment, and some clinical factors are associated with greater hospital care costs. These results may serve as a basis for the evaluation of existing public policies and inputs for cost-effectiveness studies in coronary artery disease. CEP HCPA 11-0460 . Ethics Committee of Hospital de Clínicas de Porto Alegre.
Bill B. Francis
Full Text Available We investigate whether tax avoidance substitutes for external financing. We exploit interstate banking deregulation as a quasi-external shock to examine whether firms engage in less tax avoidance after banking deregulation, because of cheaper and easier access to credit from banks. We find no empirical evidence to support this substitutive relation, even for firms with higher financial constraints or firms with higher external financing dependence.
Andrew, R R
A comparative study of costs per bed per day in teaching hospitals affiliated with Monash University compared with large non-teaching metropolitan hospitals (1964 to 1974) shows they are much higher in teaching hospitals. There is no evidence that this is due to the additional costs arising from the clinical schools. Research in the teaching hospitals and the accompanying high professional standards and demands on services are major factors accounting for the difference. Over the decade studied, the resident staff have increased by 77% and other salaried staff by 24%. The index of expenditure for the three teaching hospitals in the decade has increased by 386%.
Discusses how and why college students commit plagiarism, suggesting techniques that instructors can use to help student avoid plagiarism. Instructors should define and discuss plagiarism thoroughly; discuss hypothetical cases; review the conventions of quoting and documenting material; require multiple drafts of essays; and offer responses…
Tybur, J.M.; Lieberman, D.
Over the past few decades, researchers have become increasingly interested in the adaptations guiding the avoidance of disease-causing organisms. Here we discuss the latest developments in this area, including a recently developed information-processing model of the adaptations underlying pathogen
... Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also ... urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...
Full Text Available This paper examines the effects of hospital closures on geographical access by potential patients, using data from four southeastern U.S. states. Using optimization models designed to minimize the adverse effects of hospital closures, extensive computations are performed and the results are discussed. The effects of the closures on the rural areas is also investigated. Finally, the paper determines which hospitals are most likely among those to be closed assuming that up to 10% of the existing hospitals in each of the four states were to be shut down. The overall conclusion of the empirical findings is that while differences exist among the states, efficiency, coverage, and equality measures for geographical access do not suffer significantly if only a few hospitals are closed in each state, provided these closures are done optimally to minimize impact. Further, for efficiency objectives, decision makers can follow a sequential strategy for closures and still be guaranteed optimality. The paper also discusses the effects of hospital closures on equity and it examines whether or not rural areas are disproportionately affected by closures. Keywords: Health care, Access to health care, Proximity, Hospital closures, Location problems, Facility planning
Huesch, Marco D; Currid-Halkett, Elizabeth; Doctor, Jason N
Objectives Publicly available hospital quality reports seek to inform consumers of important healthcare quality and affordability attributes, and may inform consumer decision-making. To understand how much consumers search for such information online on one Internet search engine, whether they mention such information in social media and how positively they view this information. Setting and design A leading Internet search engine (Google) was the main focus of the study. Google Trends and Google Adwords keyword analyses were performed for national and Californian searches between 1 August 2012 and 31 July 2013 for keywords related to ‘top hospital’, best hospital’, and ‘hospital quality’, as well as for six specific hospital quality reports. Separately, a proprietary social media monitoring tool was used to investigate blog, forum, social media and traditional media mentions of, and sentiment towards, major public reports of hospital quality in California in 2012. Primary outcome measures (1) Counts of searches for keywords performed on Google; (2) counts of and (3) sentiment of mentions of public reports on social media. Results National Google search volume for 75 hospital quality-related terms averaged 610 700 searches per month with strong variation by keyword and by state. A commercial report (Healthgrades) was more commonly searched for nationally on Google than the federal government's Hospital Compare, which otherwise dominated quality-related search terms. Social media references in California to quality reports were generally few, and commercially produced hospital quality reports were more widely mentioned than state (Office of Statewide Healthcare Planning and Development (OSHPD)), or non-profit (CalHospitalCompare) reports. Conclusions Consumers are somewhat aware of hospital quality based on Internet search activity and social media disclosures. Public stakeholders may be able to broaden their quality dissemination initiatives by
Rose Bovino, Leonie; Aquila, Anne M; Bartos, Susan; McCurry, Tina; Cunningham, C Elizabeth; Lane, Todd; Rogucki, Nicole; DosSantos, Jamie; Moody, Danielle; Mealia-Ospina, Karen; Pust-Marcone, Jancee; Quiles, Jonathan
Evidence indicates that nurses inconsistently engage in evidence-based practice (EBP). This cross-sectional study of 402 nurses at a medical-surgical hospital identifies strategies for augmenting EBP. Nurses' EBP beliefs scores were higher than their EBP implementation scores. Those with baccalaureate/postgraduate degrees had higher EBP beliefs and implementation scores than those with associate degrees or diplomas. Bedside or direct care nurses were less likely to have baccalaureate/higher degrees and had lower EBP beliefs and implementation scores than did those nurses not serving in direct care roles.
Andreas Georgiadis; Christos N. Pitelis
This paper presents empirical evidence of the relationship between human resources practices and the effectiveness of a firm to capitalise on investment in knowledge as measured by the returns to innovation and business development expenditure. The empirical design is based on exploiting a natural experiment provided by a policy intervention that offers human resources-related support to small and medium sized enterprises in the UK Tourism Hospitality and Leisure sector. Our findings suggest ...
Ruangratanatrai, Wilailuk; Lertmaharit, Somrat; Hanvoravongchai, Piya
Shortage and maldistribution of the health workforce is a major problem in the Thai health system. The expansion of healthcare access to achieve universal health coverage placed additional demand on the health system especially on the health workers in the public sector who are the major providers of health services. At the same time, the reform in hospital payment methods resulted in a lower share of funding from the government budgetary system and higher share of revenue from health insurance. This allowed public hospitals more flexibility in hiring additional staff. Financial measures and incentives such as special allowances for non-private practice and additional payments for remote staff have been implemented to attract and retain them. To understand the distributional effect of such change in health workforce financing, this study evaluates the equity in health workforce financing for 838 hospitals under the Ministry of Public Health across all 75 provinces from 2008-2012. Data were collected from routine reports of public hospital financing from the Ministry of Public Health with specific identification on health workforce spending. The components and sources of health workforce financing were descriptively analysed based on the geographic location of the hospitals, their size and the core hospital functions. Inequalities in health workforce financing across provinces were assessed. We calculated the Gini coefficient and concentration index to explore horizontal and vertical inequity in the public sector health workforce financing in Thailand. Separate analyses were carried out for funding from government budget and funding from hospital revenue to understand the difference between the two financial sources. Health workforce financing accounted for about half of all hospital non-capital expenses in 2012, about a 30 % increase from the level of spending in 2008. Almost one third of the workforce financing came from hospital revenue, an increase from only one
McGillis Hall, Linda; Peterson, Jessica; Baker, G Ross; Brown, Adalsteinn D; Pink, George H; McKillop, Ian; Daniel, Imtiaz; Pedersen, Cheryl
This study examined relationships between financial indicators for nurse staffing and organizational system integration and change indicators. These indicators, along with hospital location and type, were examined in relation to the nursing financial indicators. Results showed that different indicators predicted each of the outcome variables. Nursing care hours were predicted by the hospital type, geographic location, and the system. Both nursing and patient care hours were significantly related to dissemination and benchmarking of clinical data.
Full Text Available Background: Hospital management information systems (HMIS is a key component of national health information systems (HIS, and actions required of hospital management to support information generation in Kenya are articulated in specific policy documents. We conducted an evaluation of core functions of data generation and reporting within hospitals in Kenya to facilitate interpretation of national reports and to provide guidance on key areas requiring improvement to support data use in decision making. Design: The survey was a cross-sectional, cluster sample study conducted in 22 hospitals in Kenya. The statistical analysis was descriptive with adjustment for clustering. Results: Most of the HMIS departments complied with formal guidance to develop departmental plans. However, only a few (3/22 had carried out a data quality audit in the 12 months prior to the survey. On average 3% (range 1–8% of the total hospital income was allocated to the HMIS departments. About half of the records officer positions were filled and about half (13/22 of hospitals had implemented some form of electronic health record largely focused on improving patient billing and not linked to the district HIS. Completeness of manual patient registers varied, being 90% (95% CI 80.1–99.3%, 75.8% (95% CI 68.7–82.8%, and 58% (95% CI 50.4–65.1% in maternal child health clinic, maternity, and pediatric wards, respectively. Vital events notification rates were low with 25.7, 42.6, and 71.3% of neonatal deaths, infant deaths, and live births recorded, respectively. Routine hospital reports suggested slight over-reporting of live births and under-reporting of fresh stillbirths and neonatal deaths. Conclusions: Study findings indicate that the HMIS does not deliver quality data. Significant constraints exist in data quality assurance, supervisory support, data infrastructure in respect to information and communications technology application, human resources, financial
Inger, Kerry Katharine
This paper examines the relative valuation of alternative methods of tax avoidance. Prior studies find that firm value is positively associated with overall measures of tax avoidance; I extend this research by providing evidence that investors distinguish between methods of tax reduction in their valuation of tax avoidance. The impact of tax avoidance on firm value is a function of tax risk, permanence of tax savings, tax planning costs, implicit taxes and contrasts in disclosures of tax re...
Impact of participation in the California Healthcare-Associated Infection Prevention Initiative on adoption and implementation of evidence-based practices for patient safety and health care-associated infection rates in a cohort of acute care general hospitals.
Halpin, Helen Ann; McMenamin, Sara B; Simon, Lisa Payne; Jacobsen, Diane; Vanneman, Megan; Shortell, Stephen; Milstein, Arnold
In 2008, hospitals were selected to participate in the California Healthcare-Associated Infection Prevention Initiative (CHAIPI). This research evaluates the impact of CHAIPI on hospital adoption and implementation of evidence-based patient safety practices and reduction of health care-associated infection (HAI) rates. Statewide computer-assisted telephone surveys of California's general acute care hospitals were conducted in 2008 and 2010 (response rates, 80% and 76%, respectively). Difference-in-difference analyses were used to compare changes in process and HAI rate outcomes in CHAIPI hospitals (n = 34) and non-CHAIPI hospitals (n = 149) that responded to both waves of the survey. Compared with non-CHAIPI hospitals, CHAIPI hospitals demonstrated greater improvements between 2008 and 2010 in adoption (P = .021) and implementation (P = .012) of written evidence-based practices for overall patient safety and prevention of HAIs and in assessing their compliance (P = .033) with these practices. However, there were no significant differences in the changes in HAI rates between CHAIPI and non-CHAIPI hospitals over this time period. Participation in the CHAIPI collaborative was associated with significant improvements in evidence-based patient safety practices in hospitals. However, determining how evidence-based practices translate into changes in HAI rates may take more time. Our results suggest that all hospitals be offered the opportunity to participate in an active learning collaborative to improve patient safety. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
Dee, C R; Rankin, J A; Burns, C A
Journal usage studies, which are useful for budget management and for evaluating collection performance relative to library use, have generally described a single library or subject discipline. The Southern Chapter/Medical Library Association (SC/MLA) study has examined journal usage at the aggregate data level with the long-term goal of developing hospital library benchmarks for journal use. Thirty-six SC/MLA hospital libraries, categorized for the study by size as small, medium, or large, reported current journal title use centrally for a one-year period following standardized data collection procedures. Institutional and aggregate data were analyzed for the average annual frequency of use, average costs per use and non-use, and average percent of non-used titles. Permutation F-type tests were used to measure difference among the three hospital groups. Averages were reported for each data set analysis. Statistical tests indicated no significant differences between the hospital groups, suggesting that benchmarks can be derived applying to all types of hospital libraries. The unanticipated lack of commonality among heavily used titles pointed to a need for uniquely tailored collections. Although the small sample size precluded definitive results, the study's findings constituted a baseline of data that can be compared against future studies.
Fisher, E R; Partin, K M
Although it might seem to be a simple task for scientists to avoid plagiarism and thereby an allegation of research misconduct, assessment of trainees in the Responsible Conduct of Research and recent findings from the National Science Foundation Office of Inspector General regarding plagiarism suggests otherwise. Our experiences at a land-grant academic institution in assisting researchers in avoiding plagiarism are described. We provide evidence from a university-wide multi-disciplinary course that understanding how to avoid plagiarism in scientific writing is more difficult than it might appear, and that a failure to learn the rules of appropriate citation may cause dire consequences. We suggest that new strategies to provide training in avoiding plagiarism are required.
Hondebrink, Laura; Rietjens, Saskia J; Hunault, Claudine C; Pereira, Rob R; Kelleci, Nuriye; Yasar, Gulhan; Ghebreslasie, Ariam; Lo-A-Foe, Cindy; De Vries, Irma; Meulenbelt, Jan
CONTEXT: Methylphenidate intoxications mostly have a relatively mild course, although serious complications can occur. OBJECTIVE: We aimed to characterize methylphenidate exposures and reassess our current dose threshold for hospital referral (2 mg/kg). METHODS: In a prospective follow-up study, we
Hondebrink, Laura; Rietjens, Saskia J.; Hunault, Claudine C.; Pereira, Rob R.; Kelleci, Nuriye; Yasar, Gulhan; Ghebreslasie, Ariam; Lo-A-Foe, Cindy; De Vries, Irma; Meulenbelt, Jan
Context. Methylphenidate intoxications mostly have a relatively mild course, although serious complications can occur. Objective. We aimed to characterize methylphenidate exposures and reassess our current dose threshold for hospital referral (2 mg/kg). Methods. In a prospective follow-up study, we
Granting public hospitals greater autonomy and creating organizational arrangements that mimic the private sector and encourage competition is often promoted as a way to increase efficiency and public accountability and to improve quality of care at these facilities. The existence of good-quality health infrastructure, in turn, encourages the population to join and support the social health insurance system and achieve universal coverage. This article provides a critical review of hospital autonomization, using Vietnam's experience to assess the influence of hospital autonomy on the sustainability of Vietnam's social health insurance. The evidence suggests that a reform process based on greater autonomy of resource mobilization and on the retention and use of own-source revenues can create perverse incentives among managers and health care providers, leading to the development of a two-tiered provision of clinical care, provider-induced supply of an inefficient service mix, a high degree of duplication, wasteful investment, and cost escalation. Rather than complementing social health insurance and helping the country to achieve universal coverage, granting public hospitals greater autonomy that mimics the private sector may indeed undermine the legitimacy and sustainability of social health insurance as health care costs escalate and higher quality of care remains elusive.
Hsu, K.; Burns, M.; Priebe, S.; Robinson, P.
This report describes the activity based costing method used to acquire variable (volume dependent or avoidable) waste management cost data for routine operations at Department of Energy (DOE) facilities. Waste volumes from environmental restoration, facility stabilization activities, and legacy waste were specifically excluded from this effort. A core team consisting of Idaho National Engineering Laboratory, Los Alamos National Laboratory, Rocky Flats Environmental Technology Site, and Oak Ridge Reservation developed and piloted the methodology, which can be used to determine avoidable waste management costs. The method developed to gather information was based on activity based costing, which is a common industrial engineering technique. Sites submitted separate flow diagrams that showed the progression of work from activity to activity for each waste type or treatability group. Each activity on a flow diagram was described in a narrative, which detailed the scope of the activity. Labor and material costs based on a unit quantity of waste being processed were then summed to generate a total cost for that flow diagram. Cross-complex values were calculated by determining a weighted average for each waste type or treatability group based on the volume generated. This study will provide DOE and contractors with a better understanding of waste management processes and their associated costs. Other potential benefits include providing cost data for sites to perform consistent cost/benefit analysis of waste minimization and pollution prevention (WMIN/PP) options identified during pollution prevention opportunity assessments and providing a means for prioritizing and allocating limited resources for WMIN/PP.
Hsu, K.; Burns, M.; Priebe, S.; Robinson, P.
This report describes the activity based costing method used to acquire variable (volume dependent or avoidable) waste management cost data for routine operations at Department of Energy (DOE) facilities. Waste volumes from environmental restoration, facility stabilization activities, and legacy waste were specifically excluded from this effort. A core team consisting of Idaho National Engineering Laboratory, Los Alamos National Laboratory, Rocky Flats Environmental Technology Site, and Oak Ridge Reservation developed and piloted the methodology, which can be used to determine avoidable waste management costs. The method developed to gather information was based on activity based costing, which is a common industrial engineering technique. Sites submitted separate flow diagrams that showed the progression of work from activity to activity for each waste type or treatability group. Each activity on a flow diagram was described in a narrative, which detailed the scope of the activity. Labor and material costs based on a unit quantity of waste being processed were then summed to generate a total cost for that flow diagram. Cross-complex values were calculated by determining a weighted average for each waste type or treatability group based on the volume generated. This study will provide DOE and contractors with a better understanding of waste management processes and their associated costs. Other potential benefits include providing cost data for sites to perform consistent cost/benefit analysis of waste minimization and pollution prevention (WMIN/PP) options identified during pollution prevention opportunity assessments and providing a means for prioritizing and allocating limited resources for WMIN/PP
Pultorak, Katherine J.; Schelp, Scott A.; Isaacs, Dominic P.; Krzystyniak, Gregory
Abstract While an extensive literature supports the notion that mesocorticolimbic dopamine plays a role in negative reinforcement, recent evidence suggests that dopamine exclusively encodes the value of positive reinforcement. In the present study, we employed a behavioral economics approach to investigate whether dopamine plays a role in the valuation of negative reinforcement. Using rats as subjects, we first applied fast-scan cyclic voltammetry (FSCV) to determine that dopamine concentration decreases with the number of lever presses required to avoid electrical footshock (i.e., the economic price of avoidance). Analysis of the rate of decay of avoidance demand curves, which depict an inverse relationship between avoidance and increasing price, allows for inference of the worth an animal places on avoidance outcomes. Rapidly decaying demand curves indicate increased price sensitivity, or low worth placed on avoidance outcomes, while slow rates of decay indicate reduced price sensitivity, or greater worth placed on avoidance outcomes. We therefore used optogenetics to assess how inducing dopamine release causally modifies the demand to avoid electrical footshock in an economic setting. Increasing release at an avoidance predictive cue made animals more sensitive to price, consistent with a negative reward prediction error (i.e., the animal perceives they received a worse outcome than expected). Increasing release at avoidance made animals less sensitive to price, consistent with a positive reward prediction error (i.e., the animal perceives they received a better outcome than expected). These data demonstrate that transient dopamine release events represent the value of avoidance outcomes and can predictably modify the demand to avoid. PMID:29766047
Moja, Lorenzo; Polo Friz, Hernan; Capobussi, Matteo; Kwag, Koren; Banzi, Rita; Ruggiero, Francesca; González-Lorenzo, Marien; Liberati, Elisa Giulia; Mangia, Massimo; Nyberg, Peter; Kunnamo, Ilkka; Cimminiello, Claudio; Vighi, Giuseppe; Grimshaw, Jeremy; Bonovas, Stefanos
Computerized decision support systems (CDSSs) are information technology-based software that provide health professionals with actionable, patient-specific recommendations or guidelines for disease diagnosis, treatment, and management at the point-of-care. These messages are intelligently filtered to enhance the health and clinical care of patients. CDSSs may be integrated with patient electronic health records (EHRs) and evidence-based knowledge. We designed a pragmatic randomized controlled trial to evaluate the effectiveness of patient-specific, evidence-based reminders generated at the point-of-care by a multi-specialty decision support system on clinical practice and the quality of care. We will include all the patients admitted to the internal medicine department of one large general hospital. The primary outcome is the rate at which medical problems, which are detected by the decision support software and reported through the reminders, are resolved (i.e., resolution rates). Secondary outcomes are resolution rates for reminders specific to venous thromboembolism (VTE) prevention, in-hospital all causes and VTE-related mortality, and the length of hospital stay during the study period. The adoption of CDSSs is likely to increase across healthcare systems due to growing concerns about the quality of medical care and discrepancy between real and ideal practice, continuous demands for a meaningful use of health information technology, and the increasing use of and familiarity with advanced technology among new generations of physicians. The results of our study will contribute to the current understanding of the effectiveness of CDSSs in primary care and hospital settings, thereby informing future research and healthcare policy questions related to the feasibility and value of CDSS use in healthcare systems. This trial is seconded by a specialty trial randomizing patients in an oncology setting (ONCO-CODES). ClinicalTrials.gov, https://clinicaltrials.gov/ct2
Schlatter, Rosane Paix?o; Hirakata, V?nia Naomi; Polanczyk, Carisi Anne
Background Coronary artery disease is the most prevalent cardiovascular disease. In the United States, 7% of adults over 20 years of age are estimated to have coronary artery disease. In Brazil, a prevalence of 5 to 8% has been estimated in adults over 40 years of age, with an increased number of hospitalizations associated with both stable and acute clinical manifestations; and health care costs have quadrupled in the last decade. To estimate the direct costs of managing ischemic heart disea...
Zuraik, Christopher; Sampalis, John; Brierre, Alexa
The cost of traumatic injury is unknown in Haiti. This study aims to examine the burden of traumatic injury of patients treated and evaluated at a trauma hospital in the capital city of Port-au-Prince. A retrospective cross-sectional chart review study was conducted at the Hospital Bernard Mevs Project Medishare for all patients evaluated for traumatic injury from December 2015 to January 2016, as described elsewhere (Zuraik and Sampalis in World J Surg, https://doi.org/10.1007/s00268-017-4088-2 , 2017). Direct medical costs were obtained from patient hospital bills. Indirect and intangible costs were calculated using the human capital approach. A total of 410 patients were evaluated for traumatic injury during the study period. Total costs for all patients were $501,706 with a mean cost of $1224. Indirect costs represented 63% of all costs, direct medical costs 19%, and intangible costs 18%. Surgical costs accounted for the majority of direct medical costs (29%). Patients involved in road traffic accidents accounted for the largest number of injuries (41%) and the largest percentage of total costs (51%). Patients with gunshot wounds had the highest total mean costs ($1566). Mean costs by injury severity ranged from $62 for minor injuries, $1269 for serious injuries, to $13,675 for critical injuries. Injuries lead to a significant economic burden for individuals treated at a semi-private trauma hospital in the capital city of Port-au-Prince, Haiti. Programs aimed at reducing injuries, particularly road traffic accidents, would likely reduce the economic burden to the nation.
This is a retrospective review of the Rotunda Hospital Emergency Room (ER) documentation with respect to attendances for a 4-month period (August-November) in both 2009 and 2012. The aim was to quantify the workload and assess the quality of care offered to patients attending the ER over the two time periods and to highlight any improvements in care after changes were implemented following the initial 2009 review.
Rampatige, Rasika; Mikkelsen, Lene; Hernandez, Bernardo; Riley, Ian; Lopez, Alan D
To systematically review the reliability of hospital data on cause of death and encourage periodic reviews of these data using a standard method. We searched Google Scholar, Pubmed and Biblioteca Virtual de la Salud for articles in English, Spanish and Portuguese that reported validation studies of data on cause of death. We analysed the results of 199 studies that had used medical record reviews to validate the cause of death reported on death certificates or by the vital registration system. The screened studies had been published between 1983 and 2013 and their results had been reported in English (n = 124), Portuguese (n = 25) or Spanish (n = 50). Only 29 of the studies met our inclusion criteria. Of these, 13 had examined cause of death patterns at the population level - with a view to correcting cause-specific mortality fractions - while the other 16 had been undertaken to identify discrepancies in the diagnosis for specific diseases before and after medical record review. Most of the selected studies reported substantial misdiagnosis of causes of death in hospitals. There was wide variation in study methodologies. Many studies did not describe the methods used in sufficient detail to be able to assess the reproducibility or comparability of their results. The assumption that causes of death are being accurately reported in hospitals is unfounded. To improve the reliability and usefulness of reported causes of death, national governments should do periodic medical record reviews to validate the quality of their hospital cause of death data, using a standard.
Full Text Available In Mexico, although the majority of births are attended in hospitals, reports have emerged of obstetric violence, use of unsafe practices, and failure to employ evidence-based practices (EBP. Recent attention has refocused global efforts towards provision of quality care that is both patient-centered and evidence-based. Scaling up of local interventions should rely on strong evidence of effectiveness.To perform a secondary analysis to evaluate the impact of a simulation and team-training program (PRONTO on the performance of EBP in normal births.A pair-matched cluster randomized controlled trial of the intervention was designed to measure the impact of the program (PRONTO intervention on a sample of 24 hospitals (12 hospitals received the PRONTO training and 12 served as controls in the states of Chiapas, Guerrero, and Mexico. We estimated the impact of receiving the intervention on the probability of birth practices performance in a sample of 641 observed births of which 318 occurred in the treated hospitals and 323 occurred in control hospitals. Data was collected at 4 time points (baseline, 4th, 8th and 12th months after the training. Women were blinded to treatment allocation but observers and providers were not. Estimates were obtained by fitting difference-in-differences logistic regression models considering confounding variables. The trial is registered at clinicaltrials.gov: # NCT01477554.Significant changes were found following the intervention. At 4 months post-intervention an increase of 20 percentage points (p.p. for complete Active Management of Third Stage of Labor (AMTSL (p = 0.044, and 16 p.p. increase for Skin-to-Skin Contact (p = 0.067; at 12 months a 25 p.p. increase of the 1st step of AMTSL (p = 0.026 and a 42 p.p. increase of Delayed Cord Clamping (p = 0.004; at 4 months a 30 (p = 0.001 and at 8 months a 22 (p = 0.010 p.p. decrease for Uterine Sweeping.The intervention has an impact on adopting EBP at birth, contributing to
Wong, Carlos King Ho; Wu, Olivia; Cheung, Bernard M Y
The aim of this article is to describe the process, evaluation criteria, and possible outcomes of decision-making for new drugs listed in the Hong Kong Hospital Authority Drug Formulary in comparison to the health technology assessment (HTA) policy overseas. Details of decision-making processes including the new drug listing submission, Drug Advisory Committee (DAC) meeting, and procedures prior to and following the meeting, were extracted from the official Hong Kong Hospital Authority drug formulary management website and manual. Publicly-available information related to the new drug decision-making process for five HTA agencies [the National Institute of Health and Care Excellence (NICE), the Scottish Medicines Consortium (SMC), the Australia Pharmaceutical Benefits Advisory Committee (PBAC), the Canadian Agency for Drugs and Technologies in Health (CADTH), and the New Zealand Pharmaceutical Management Agency (PHARMAC)] were reviewed and retrieved from official documents from public domains. The DAC is in charge of systemically and critically appraising new drugs before they are listed on the formulary, reviewing submitted applications, and making the decision to list the drug based on scientific evidence to which safety, efficacy, and cost-effectiveness are the primary considerations. When compared with other HTA agencies, transparency of the decision-making process of the DAC, the relevance of clinical and health economic evidence, and the lack of health economic and methodological input of submissions are the major challenges to the new-drug listing policy in Hong Kong. Despite these challenges, this review provides suggestions for the establishment of a more transparent, credible, and evidence-based decision-making process in the Hong Kong Hospital Authority Drug Formulary. Proposals for improvement in the listing of new drugs in the formulary should be a priority of healthcare reforms.
Tuffrey-Wijne, Irene; Goulding, Lucy; Giatras, Nikoletta; Abraham, Elisabeth; Gillard, Steve; White, Sarah; Edwards, Christine; Hollins, Sheila
To identify the factors that promote and compromise the implementation of reasonably adjusted healthcare services for patients with intellectual disabilities in acute National Health Service (NHS) hospitals. A mixed-methods study involving interviews, questionnaires and participant observation (July 2011-March 2013). Six acute NHS hospital trusts in England. Reasonable adjustments for people with intellectual disabilities were identified through the literature. Data were collected on implementation and staff understanding of these adjustments. Data collected included staff questionnaires (n=990), staff interviews (n=68), interviews with adults with intellectual disabilities (n=33), questionnaires (n=88) and interviews (n=37) with carers of patients with intellectual disabilities, and expert panel discussions (n=42). Hospital strategies that supported implementation of reasonable adjustments did not reliably translate into consistent provision of such adjustments. Good practice often depended on the knowledge, understanding and flexibility of individual staff and teams, leading to the delivery of reasonable adjustments being haphazard throughout the organisation. Major barriers included: lack of effective systems for identifying and flagging patients with intellectual disabilities, lack of staff understanding of the reasonable adjustments that may be needed, lack of clear lines of responsibility and accountability for implementing reasonable adjustments, and lack of allocation of additional funding and resources. Key enablers were the Intellectual Disability Liaison Nurse and the ward manager. The evidence suggests that ward culture, staff attitudes and staff knowledge are crucial in ensuring that hospital services are accessible to vulnerable patients. The authors suggest that flagging the need for specific reasonable adjustments, rather than the vulnerable condition itself, may address some of the barriers. Further research is recommended that describes and
English, Krista M; Langley, Joanne M; McGeer, Allison; Hupert, Nathaniel; Tellier, Raymond; Henry, Bonnie; Halperin, Scott A; Johnston, Lynn; Pourbohloul, Babak
Nosocomial, or healthcare-associated infections (HAI), exact a high medical and financial toll on patients, healthcare workers, caretakers, and the health system. Interpersonal contact patterns play a large role in infectious disease spread, but little is known about the relationship between health care workers' (HCW) movements and contact patterns within a heath care facility and HAI. Quantitatively capturing these patterns will aid in understanding the dynamics of HAI and may lead to more targeted and effective control strategies in the hospital setting. Staff at 3 urban university-based tertiary care hospitals in Canada completed a detailed questionnaire on demographics, interpersonal contacts, in-hospital movement, and infection prevention and control practices. Staff were divided into categories of administrative/support, nurses, physicians, and "Other HCWs" - a fourth distinct category, which excludes physicians and nurses. Using quantitative network modeling tools, we constructed the resulting HCW "co-location network" to illustrate contacts among different occupations and with locations in hospital settings. Among 3048 respondents (response rate 38%) an average of 3.79, 3.69 and 3.88 floors were visited by each HCW each week in the 3 hospitals, with a standard deviation of 2.63, 1.74 and 2.08, respectively. Physicians reported the highest rate of direct patient contacts (> 20 patients/day) but the lowest rate of contacts with other HCWs; nurses had the most extended (> 20 min) periods of direct patient contact. "Other HCWs" had the most direct daily contact with all other HCWs. Physicians also reported significantly more locations visited per week than nurses, other HCW, or administrators; nurses visited the fewest. Public spaces such as the cafeteria had the most staff visits per week, but the least mean hours spent per visit. Inpatient settings had significantly more HCW interactions per week than outpatient settings. HCW contact patterns and spatial
Full Text Available Objectives: A perception exists that clinicians in Oman are reluctant to adopt evidence-based practice (EBP. This pilot study was undertaken to study the feasibility of using EBP pathways at the point of care in otorhinolaryngology head and neck surgery. The ultimate aim was to facilitate EBP with the probability of developing a new system for implementing research findings/translational research at the clinical point of care. Methods: A cross-sectional prospective questionnaire pilot survey of clinicians at Sultan Qaboos University Hospital (SQUH, Oman, a tertiary care medical centre, was undertaken. Respondents included 135 physicians and surgeons with between 3 months and 25 years of clinical experience and included personnel ranging from interns to senior consultants, in areas ranging from primary care to specialist care. Results: Of those polled, 90% (95% confidence interval (CI 85–95% either strongly agreed or agreed that evidence-based practice protocols (EBPP could help in decision making. A total of 87.4% of participants (95% CI 81.8–93% either strongly agreed or agreed that EBPPs can improve clinical outcomes; 91.8% of participants (95% CI 87.2–96.4% would use and apply EBPP in day-to-day care if they were available at the point of care and embedded in the hospital information system. Conclusions: The perception that clinicians at SQUH are reluctant to adopt EBP is incorrect. The introduction of EBP pathways is very feasible at the primary care level. Institutional support for embedding EBP in hospital information systems is needed as well as further outcome research to assess the improvement in quality of care.
Krantz, Mori J; Ambardekar, Amrut V; Kaltenbach, Lisa; Hernandez, Adrian F; Heidenreich, Paul A; Fonarow, Gregg C
Hospitalized patients with heart failure and decreased ejection fraction are at substantial risk for mortality and rehospitalization, yet no acute therapies are proven to decrease this risk. Therefore, in-hospital use of medications proved to decrease long-term mortality is a critical strategy to improve outcomes. Although endorsed in guidelines, predictors of initiation and continuation of angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), β blockers, and aldosterone antagonists have not been well studied. We assessed noncontraindicated use patterns for the 3 medications using the Get With the Guidelines-Heart Failure (GWTG-HF) registry from February 2009 through March 2010. Medication continuation was defined as treatment on admission and discharge. Multivariable logistic regression using generalized estimating equations was used to determine factors associated with discharge use. In total 9,474 patients were enrolled during the study period. Of those treated before hospitalization, overall continuation rates were 88.5% for ACE inhibitors/ARBs, 91.6% for β blockers, and 71.9% for aldosterone-antagonists. Of patients untreated before admission, 87.4% had ACE inhibitors/ARBs and 90.1% had β blocker initiated during hospitalization or at discharge, whereas only 25.2% were started on an aldosterone antagonist. In multivariate analysis, admission therapy was most strongly associated with discharge use (adjusted odds ratios 7.4, 6.0, and 20.9 for ACE inhibitors/ARBs, β blockers, and aldosterone antagonists, respectively). Western region, younger age, and academic affiliation were also associated with higher discharge use. Although ACE inhibitor/ARB and β-blocker continuation rates were high, aldosterone antagonist use was lower despite potential eligibility. In conclusion, being admitted on evidence-based medications is the most powerful, independent predictor of discharge use. Copyright © 2011 Elsevier Inc. All rights reserved.
This thesis consists of three essays examining determinants of aggressive tax avoidance. The first essay “Measuring the Aggressive Part of International Tax Avoidance”, co-authored with Prof. Dr. Michael Overesch, proposes a new measure that isolates the additional or even aggressive part in international tax avoidance and analyzes the determinants of aggressive tax avoidance of multinational enterprises. The second essay “Capital Injections and Aggressive Tax Planning - Can Banks Have It All...
Kannan, Viji Diane; Veazie, Peter J
Delayed medical care has negative health and economic consequences; interventions have focused on appraising symptoms, with limited success in reducing delay. To identify predictors of care avoidance and reasons for avoiding care. Using the Health Information National Trends Survey (2007), we conducted logistic regressions to identify predictors of avoiding medical visits deemed necessary by the respondents; and, we then conducted similar analyses on reasons given for avoidance behavior. Independent variables included geographic, demographic, socioeconomic, personal health, health behavior, health care system, and cognitive characteristics. Approximately one third of adults avoided doctor visits they had deemed necessary. Although unadjusted associations existed, avoiding needed care was not independently associated with geographic, demographic, and socioeconomic characteristics. Avoidance behavior is characterized by low health self-efficacy, less experience with both quality care and getting help with uncertainty about health, having your feelings attended to by your provider, no usual source of care, negative affect, smoking daily, and fatalistic attitude toward cancer. Reasons elicited for avoidance include preference for self-care or alternative care, dislike or distrust of doctors, fear or dislike of medical treatments, time, and money; respondents also endorsed discomfort with body examinations, fear of having a serious illness, and thoughts of dying. Distinct predictors distinguish each of these reasons. Interventions to reduce patient delay could be improved by addressing the health-related behavioral, belief, experiential, and emotional traits associated with delay. Attention should also be directed toward the interpersonal communications between patients and providers.
Dignath, David; Eder, Andreas B
According to a recent extension of the conflict-monitoring theory, conflict between two competing response tendencies is registered as an aversive event and triggers a motivation to avoid the source of conflict. In the present study, we tested this assumption. Over five experiments, we examined whether conflict is associated with an avoidance motivation and whether stimulus conflict or response conflict triggers an avoidance tendency. Participants first performed a color Stroop task. In a subsequent motivation test, participants responded to Stroop stimuli with approach- and avoidance-related lever movements. These results showed that Stroop-conflict stimuli increased the frequency of avoidance responses in a free-choice motivation test, and also increased the speed of avoidance relative to approach responses in a forced-choice test. High and low proportions of response conflict in the Stroop task had no effect on avoidance in the motivation test. Avoidance of conflict was, however, obtained even with new conflict stimuli that had not been presented before in a Stroop task, and when the Stroop task was replaced with an unrelated filler task. Taken together, these results suggest that stimulus conflict is sufficient to trigger avoidance.
Byrne, Sharon K
The purpose of this study is to provide a critical review and synthesis of theoretical and research literature documenting the impact of avoidance on healthcare behaviors, identify the factors that influence healthcare avoidance and delay in the adult population, and propose a direction for future research. The Theory of Reasoned Action, Theory of Planned Behavior, Theory of Care-Seeking Behavior, the Transtheoretical Model, and the Behavioral Model of Health Services Use/Utilization are utilized to elaborate on the context within which individual intention to engage in healthcare behaviors occurs. Research literature on the concept of healthcare avoidance obtained by using computerized searches of CINAHL, MEDLINE, PSYCH INFO, and HAPI databases, from 1995 to 2007, were reviewed. Studies were organized by professional disciplines. Healthcare avoidance is a common and highly variable experience. Multiple administrative, demographic, personal, and provider factors are related to healthcare avoidance, for example, distrust of providers and/or the science community, health beliefs, insurance status, or socioeconomic/income level. Although the concept is recognized by multiple disciplines, limited research studies address its impact on healthcare decision making. More systematic research is needed to determine correlates of healthcare avoidance. Such studies will help investigators identify patients at risk for avoidant behaviors and provide the basis for health-promoting interventions. Methodological challenges include identification of characteristics of individuals and environments that hinder healthcare behaviors, as well as, the complexity of measuring healthcare avoidance. Studies need to systematically explore the influence of avoidance behaviors on specific healthcare populations at risk.
von Blotzheim, Leonardo Glutz; Christen, Stefan; Wieser, Stephan; Ulrich, Silvia; Huber, Lars C
We investigated the prevalence of bronchial asthma in patients with Tako-Tsubo Syndrome (TTS). This retrospective case-series study was conducted in a primary care hospital in Zurich, Switzerland. Data of all patients with newly diagnosed TTS (2002 - 2012) were assessed electronically by the use of ICD-10. Asthma prevalence was compared to published epidemiologic data. Bronchial asthma is characterized by airway inflammation and, during attack, release of endogenous catecholamines. Sympathomimetic drugs are the mainstay of treatment for asthma patients. Likewise, catecholamine mediated diffuse microvascular myocardial dysfunction seems to be of critical importance for the development of TTS. 20 cases of TTS were identified. 90% were female, showed a median age of 70±13y [25y - 90y], an apical and/or midventricular ballooning pattern with preserved basal function and a median initial LVEF of 34±9% [25% - 55%]. 65% of patients underwent coronary angiography to rule out significant coronary artery disease. Hypertension was present in 45% of patients, 35% were smokers, none was suffering from diabetes. Prevalence of asthma in patients with TTS was significantly higher compared to the normal population (25% vs. 7%, p=0.012). In 30% of the TTS patients an iatrogenic cause for development of TTS was identified. Prevalence of asthma was significantly higher in patients with TTS compared to epidemiologic data from an age-matched population. Phenotypes of patients developing obstructive ventilatory disease and TTS might share common pathogenic mechanisms beyond the use of bronchodilatators. In addition, we identified other iatrogenic etiologies in patients with TTS.
Leone, Andrew J; Van Horn, R Lawrence
We hypothesize that, unlike for-profit firms, nonprofit hospitals have incentives to manage earnings to a range just above zero. We consider two ways managers can achieve this. They can adjust discretionary spending [Hoerger, T.J., 1991. 'Profit' variability in for-profit and not-for-profit hospitals. Journal of Health Economics 10, 259-289.] and/or they can adjust accounting accruals using the flexibility inherent in Generally Accepted Accounting Principles (GAAP). To test our hypothesis we use regressions as well as tests of the distribution of earnings by Burgstahler and Dichev [Burgstahler, D., Dichev, I., 1997. Earnings management to avoid earnings decreases and losses. Journal of Accounting and Economics 24, 99-126.] on a sample of 1,204 hospitals and 8,179 hospital-year observations. Our tests support the use of discretionary spending and accounting accrual management. Like Hoerger (1991), we find evidence that nonprofit hospitals adjust discretionary spending to manage earnings. However, we also find significant use of discretionary accruals (e.g., adjustments to the third-party-allowance, and allowance for doubtful accounts) to meet earnings objectives. These findings have two important implications. First, the previous evidence by Hoerger that nonprofit hospitals show less variation in income may at least partly be explained by an accounting phenomenon. Second, our findings provide guidance to users of these financial statements in predicting the direction of likely bias in reported earnings.
Tho, Poh Chi; Mordiffi, Siti; Ang, Emily; Chen, Helen
Nasogastric (NG) tube is a device passed through the gastrointestinal tract of patients for the purpose of feeding, gastric decompression and medication administration. However, a small risk involved in the process is that the tube may be misplaced into the trachea during insertion or may get displaced at a later stage, leading to disastrous results. Recent adverse incidences arising out of the misplacement of NG tube raised concerns among the nursing and medical community and the Patient Safety Officer of the hospital. The Evidence Based Nursing Unit, in collaboration with some of the key nursing leaders in nursing administration, was tasked to explore and institute the current best practice in confirming the correct placement of NG tube. The aim of this project was to institute the best practice to confirm the correct placement of NG tube in patients in an acute care hospital setting. The project comprised of a few stages. The first stage involved reviewing the existing recommendations and guidelines on the methods for checking correct NG tube placement. The second stage involved incorporation of the change of practice into the clinical setting. The final stage was to monitor and evaluate the impact of the new practice on the patients, nurses and other healthcare professionals. Evidence search from guidelines and journals supported the test that used pH indicator instead of the litmus test. There is no evidence that supports the method of auscultation and bubbling to confirm correct NG tube placement in the absence of aspirate. Radiology remains the 'gold standard' for checking correct NG tube placement. The revised method of NG tube placement and workflow was incorporated in the revised Standard Operating Procedures. A total of 17 roadshows were conducted to create awareness regarding the new method amongst the nurses, and the implementation of the revised method and workflow was commenced on 3 November 2008. The initial audit conducted 1 month after the
Gentizon, Jenny; Borrero, Patricia; Vincent-Suter, Sonja; Ballabeni, Pierluigi; Morin, Diane; Eicher, Manuela
Introduction : evidence-based practice (EBP) is too scarcely applied in nursing and is a key contemporary challenge for the discipline. Method and objective : This descriptive and correlational study invited 221 nurses working in three different clinical settings of university hospitals in Switzerland. The objective of this study was to describe their level of knowledge, beliefs and implementation of EBP. Results : of the 221 nurses in this study, only 67 were familiar EBP (30%). These demonstrate favorable beliefs and attitudes towards EBP, but indicate a lack of skills and knowledge to implement it. Compared to both internal medicine and geriatric nurses clinical nurse specialists (ISC) were significantly more familiar with EBP and its implementation. Results also indicate that positive nurses’ beliefs and attitudes toward EBP are predictive of better implementation in clinical practice. Discussion and Conclusion : as demonstrated in other studies, our results show that knowledge about EBP is not that widespread and its implementation remains a challenge even in university hospitals. Future work could include testing EBP implementation strategies to overcome the barriers identified.
Tagliacozzo, Daisy M.
The conditions that intensify conflict avoidance by the central administration in making strategic decisions, and the consequences of such avoidance for the management of college affairs, are discussed. The implication of an emerging decision-making style for adapting the organization to changing environments is also considered. Some of the…
Variation in state cigarette taxes provides incentives for tax avoidance through smuggling, legal border crossing to low tax jurisdictions, or Internet purchasing. When taxes rise, tax paid sales of cigarettes will decline both because consumption will decrease and because tax avoidance will increase. The key innovation of this paper is to compare cigarette sales data to cigarette consumption data from the Behavioral Risk Factor Surveillance System (BRFSS). I show that after subtracting percent changes in consumption, residual percent changes in sales are associated with state cigarette tax changes implying the existence of tax avoidance. I estimate that the tax avoidance response to tax changes is at least twice the consumption response and that tax avoidance accounted for up to 9.6% of sales between 1985 and 2001. Because of the increase in tax avoidance, tax paid sales data understate the level of smoking and overstate the drop in smoking. I also find that the level of legal border crossing was very low relative to other forms of tax avoidance. If states have strong preferences for smoking control, they must pair high cigarette taxes with effective policies to curb smuggling and other forms of tax avoidance or employ alternative policies such as counter-advertising and smoking restrictions.
Reis, Zilma Silveira Nogueira; Maia, Thais Abreu; Marcolino, Milena Soriano; Becerra-Posada, Francisco; Novillo-Ortiz, David; Ribeiro, Antonio Luiz Pinho
, monitoring infections more effectively, and enhancing the continuity of care during physician handoffs. This review identified some benefits in the quality of care but did not provide evidence that the implementation of eHealth interventions had a measurable impact on cost-effectiveness in hospital settings. However, further evidence is needed to infer the impact of standards adoption or interoperability in cost benefits of health care; this in turn requires further research. ©Zilma Silveira Nogueira Reis, Thais Abreu Maia, Milena Soriano Marcolino, Francisco Becerra-Posada, David Novillo-Ortiz, Antonio Luiz Pinho Ribeiro. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 29.08.2017.
Yokoe, Deborah S; Avery, Taliser R; Platt, Richard; Kleinman, Ken; Huang, Susan S
Hospital-specific surgical site infection (SSI) performance following colon surgery and abdominal hysterectomies can impact hospitals' relative rankings around quality metrics used to determine financial penalties. Current SSI surveillance largely focuses on SSI detected at the operative hospital. Retrospective cohort study to assess the impact on hospitals' relative SSI performance rankings when SSI detected at non-operative hospitals are included. We utilized data from a California statewide hospital registry to assess for evidence of SSI following colon surgery or abdominal hysterectomies performed 3/1/2011-11/30/2013 using previously validated claims-based SSI surveillance methods. Risk-adjusted hospital-specific rankings based on SSI detected at operative hospitals versus any California hospital were generated. Among 60,059 colon surgeries at 285 hospitals and 64,918 abdominal hysterectomies at 270 hospitals, 5,921 (9.9%) colon surgeries and 1,481 (2.3%) abdominal hysterectomies received a diagnosis code for SSI within the 30 days following surgery. 7.2% of colon surgery and 13.4% of abdominal hysterectomy SSI would have been missed by operative hospital surveillance alone. The proportion of individual hospital's SSI detected during hospitalizations at other hospitals varied widely. Including non-operative hospital SSI resulted in improved relative ranking of 11 (3.9%) colon surgery and 13 (4.8%) hysterectomy hospitals so that they were no longer in the worst performing quartile, mainly among hospitals with relatively high surgical volumes. Standard SSI surveillance that mainly focuses on infections detected at the operative hospital causes varying degrees of SSI under-estimation, leading to inaccurate assignment or avoidance of financial penalties for approximately one in eleven to sixteen hospitals.
Weinbrecht, Anna; Schulze, Lars; Boettcher, Johanna; Renneberg, Babette
This review focuses on recent research on diagnostic aspects, etiology, and treatment of avoidant personality disorder (AVPD). Current studies stress the close relation between AVPD and social anxiety disorder, the influence of genetic factors in the development of AVPD, and the relative stability of symptoms. Treatment approaches should target the pervasive patterns of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Empirical evidence for cognitive-behavior and schema therapy is promising. Few other therapeutic approaches have been developed, but until now, these have only been investigated in case studies. We conclude that AVPD qualifies as a neglected disorder and that more research specifically on avoidant personality disorder symptoms and its treatment is needed.
Pulido, Matilde; Barros, Victor
The aim of this paper is to study the longstanding relationship between corporate tax avoidance and ex ante equity cost of capital in Europe, taking into consideration country specific characteristics, which are essential in a context of corporate tax competition. We find that investors apprehend tax avoidance differently at distinct levels of tax avoidance. We provide strong evidence that as low tax avoidance firms engage in greater tax avoidance, the ex ante equity cost of capital decreases...
Monastra, Alejandro G; Smilansky, Uzy; Gnutzmann, Sven
We consider real eigenfunctions of the Schroedinger operator in 2D. The nodal lines of separable systems form a regular grid, and the number of nodal crossings equals the number of nodal domains. In contrast, for wavefunctions of non-integrable systems nodal intersections are rare, and for random waves, the expected number of intersections in any finite area vanishes. However, nodal lines display characteristic avoided crossings which we study in this work. We define a measure for the avoidance range and compute its distribution for the random wave ensemble. We show that the avoidance range distribution of wavefunctions of chaotic systems follows the expected random wave distributions, whereas for wavefunctions of classically integrable but quantum non-separable systems, the distribution is quite different. Thus, the study of the avoidance distribution provides more support to the conjecture that nodal structures of chaotic systems are reproduced by the predictions of the random wave ensemble
Alstadsæter, Annette; Jacob, Martin
This paper analyzes the sources of heterogeneity in legal tax avoidance strategies across individuals. Three conditions are required for a taxpayer to participate in tax avoidance: incentive, access, and awareness. Using rich Swedish administrative panel data with a unique link between corporate and individual tax returns, we analyze individual participation in legal tax planning around the 2006 Swedish tax reform. Our results suggest that closely held corporations are utilized to facilitate ...
Bierbach, David; Schulte, Matthias; Herrmann, Nina; Zimmer, Claudia; Arias-Rodriguez, Lenin; Indy, Jeane Rimber; Riesch, Rüdiger; Plath, Martin
Extreme habitats are often characterized by reduced predation pressures, thus representing refuges for the inhabiting species. The present study was designed to investigate predator avoidance of extremophile populations of Poecilia mexicana and P. sulphuraria that either live in hydrogen sulfide-rich (sulfidic) springs or cave habitats, both of which are known to have impoverished piscine predator regimes. Focal fishes that inhabited sulfidic springs showed slightly weaker avoidance reactions when presented with several naturally occurring predatory cichlids, but strongest differences to populations from non-sulfidic habitats were found in a decreased shoaling tendency with non-predatory swordtail (Xiphophorus hellerii) females. When comparing avoidance reactions between P. mexicana from a sulfidic cave (Cueva del Azufre) and the adjacent sulfidic surface creek (El Azufre), we found only slight differences in predator avoidance, but surface fish reacted much more strongly to the non-predatory cichlid Vieja bifasciata. Our third experiment was designed to disentangle learned from innate effects of predator recognition. We compared laboratory-reared (i.e., predator-naïve) and wild-caught (i.e., predator-experienced) individuals of P. mexicana from a non-sulfidic river and found no differences in their reaction towards the presented predators. Overall, our results indicate (1) that predator avoidance is still functional in extremophile Poecilia spp. and (2) that predator recognition and avoidance reactions have a strong genetic basis.
Bierbach, David; Schulte, Matthias; Herrmann, Nina; Zimmer, Claudia; Arias-Rodriguez, Lenin; Indy, Jeane Rimber; Riesch, Rüdiger; Plath, Martin
Extreme habitats are often characterized by reduced predation pressures, thus representing refuges for the inhabiting species. The present study was designed to investigate predator avoidance of extremophile populations of Poecilia mexicana and P. sulphuraria that either live in hydrogen sulfide-rich (sulfidic) springs or cave habitats, both of which are known to have impoverished piscine predator regimes. Focal fishes that inhabited sulfidic springs showed slightly weaker avoidance reactions when presented with several naturally occurring predatory cichlids, but strongest differences to populations from non-sulfidic habitats were found in a decreased shoaling tendency with non-predatory swordtail (Xiphophorus hellerii) females. When comparing avoidance reactions between P. mexicana from a sulfidic cave (Cueva del Azufre) and the adjacent sulfidic surface creek (El Azufre), we found only slight differences in predator avoidance, but surface fish reacted much more strongly to the non-predatory cichlid Vieja bifasciata. Our third experiment was designed to disentangle learned from innate effects of predator recognition. We compared laboratory-reared (i.e., predator-naïve) and wild-caught (i.e., predator-experienced) individuals of P. mexicana from a non-sulfidic river and found no differences in their reaction towards the presented predators. Overall, our results indicate (1) that predator avoidance is still functional in extremophile Poecilia spp. and (2) that predator recognition and avoidance reactions have a strong genetic basis. PMID:25371337
Treanor, Michael; Barry, Tom J
Pathological avoidance of benign stimuli is a hallmark of anxiety and related disorders, and exposure-based treatments have often encouraged the removal of avoidance, or safety behaviors, due to their negative effects on extinction learning. Unfortunately, empirical evidence suggests that avoidance behaviors can persist following treatment, and the mere availability of avoidance behavior can be sufficient to renew fear following successful extinction learning. The present paper critically examines the function of avoidance behavior through the lens of modern learning theory, and speculates on novel behavioral and pharmacological strategies for targeting avoidance as an adjunct to current evidence-based treatments. Copyright © 2017. Published by Elsevier Ltd.
U.S. Department of Health & Human Services — The current Medicare policy of non-payment to hospitals for Hospital Acquired Conditions (HAC) seeks to avoid payment for preventable complications identified within...
Malcolm-Smith, Susan; Koopowitz, Sheri; Pantelis, Eleni; Solms, Mark
The influential threat simulation theory (TST) asserts that dreaming yields adaptive advantage by providing a virtual environment in which threat-avoidance may be safely rehearsed. We have previously found the incidence of biologically threatening dreams to be around 20%, with successful threat avoidance occurring in approximately one-fifth of such dreams. TST asserts that threat avoidance is over-represented relative to other possible dream contents. To begin assessing this issue, we contrasted the incidence of 'avoidance' dreams with that of their opposite: 'approach' dreams. Because TST states that the threat-avoidance function is only fully activated in ecologically valid (biologically threatening) contexts, we also performed this contrast for populations living in both high- and low-threat environments. We find that 'approach' dreams are significantly more prevalent across both contexts. We suggest these results are more consistent with the view that dreaming is generated by reward-seeking systems than by fear-conditioning systems, although reward-seeking is clearly not the only factor determining the content of dreams. Copyright © 2011 Elsevier Inc. All rights reserved.
Choi, Jung Il; Jain, Mayank; Kazandjieva, Maria A.; Levis, Philip
We describe grant-to-send, a novel collision avoidance algorithm for wireless mesh networks. Rather than announce packets it intends to send, a node using grant-to-send announces packets it expects to hear others send. We present evidence that inverting collision avoidance in this way greatly improves wireless mesh performance. Evaluating four protocols from 802.11 meshes and 802.15.4 sensor networks, we find that grant-to-send matches or outperforms CSMA and RTS/CTS in all cases. For example, in a 4-hop UDP flow, grantto- send can achieve 96% of the theoretical maximum throughput while maintaining a 99.9% packet delivery ratio. Grant-tosend is also general enough to replace protocol-specific collision avoidance mechanisms common to sensor network protocols. Grant-to-send is simple. For example, incorporating it into 802.11 requires only 11 lines of driver code and no hardware changes. Furthermore, as it reuses existing 802.11 mechanisms, grant-to-send inter-operates with current networks and can be incrementally deployed. © 2010 IEEE.
Choi, Jung Il
We describe grant-to-send, a novel collision avoidance algorithm for wireless mesh networks. Rather than announce packets it intends to send, a node using grant-to-send announces packets it expects to hear others send. We present evidence that inverting collision avoidance in this way greatly improves wireless mesh performance. Evaluating four protocols from 802.11 meshes and 802.15.4 sensor networks, we find that grant-to-send matches or outperforms CSMA and RTS/CTS in all cases. For example, in a 4-hop UDP flow, grantto- send can achieve 96% of the theoretical maximum throughput while maintaining a 99.9% packet delivery ratio. Grant-tosend is also general enough to replace protocol-specific collision avoidance mechanisms common to sensor network protocols. Grant-to-send is simple. For example, incorporating it into 802.11 requires only 11 lines of driver code and no hardware changes. Furthermore, as it reuses existing 802.11 mechanisms, grant-to-send inter-operates with current networks and can be incrementally deployed. © 2010 IEEE.
Zhou, Wen-Juan; Luo, Zhen-Ni; Tang, Chang-Min; Zou, Xiao-Xu; Zhao, Lu; Fang, Peng-Qian
The improvement of antibiotic rational use in China was studied by usage analysis of combination antibiotic therapy for type I incisions in 244 hospitals. Five kinds of hospitals, including general hospital, maternity hospital, children's hospital, stomatological hospital and cancer hospital, from 30 provinces were surveyed. A systematic random sampling strategy was employed to select outpatient prescriptions and inpatient cases in 2011 and 2012. A total of 29 280 outpatient prescriptions and 73 200 inpatient cases from 244 hospitals in each year were analyzed. Data were collected with regards to the implementation of the national antibiotic stewardship program (NASP), the overall usage and the prophylactic use of antibiotic for type I incisions. Univariate analysis was used for microbiological diagnosis rate before antimicrobial therapy, prophylactic use of antibiotics for type I incision operation, and so on. For multivariate analysis, the use of antibiotics was dichotomized according to the guidelines, and entered as binary values into logistic regression analysis. The results were compared with the corresponding criteria given by the guidelines of this campaign. The antibiotic stewardship in China was effective in that more than 80% of each kind of hospitals achieved the criteria of recommended antibiotics varieties. Hospital type appeared to be a factor statistically associated with stewardship outcome. The prophylactic use of antibiotics on type I incision operations decreased by 16.22% (Pbench marking. More efforts addressing the root cause of antibiotics abuse would continue to improve the rational use of antibiotics in China.
To ensure patient safety, it is crucial that the airway is safeguarded. The single most important responsibility is to protect it. An unobstructed airway, with intact protective reflexes and respiratory drive, is essential to avoid complications. In some procedures, e.g. dental, the airway may need to be shared with the surgeon.
Plagiarism means taking the work of another and presenting it as one's own, resulting in potential upset for the original author and disrepute for the professions involved. This article aims to explore the issue of plagiarism and some mechanisms for detection and avoidance.
Farokhzadian, Jamileh; Khajouei, Reza; Ahmadian, Leila
With the explosion of medical information, and emergence of evidence-based practice (EBP) in healthcare system, searching, retrieving and selecting information for clinical decision-making are becoming required skills for nurses. The aims of this study were to examine the use of different medical information resources by nurses and their information searching and retrieving skills in the context of EBP. A descriptive, cross-sectional study was conducted in four teaching hospitals in Iran. Data were collected from 182 nurses using a questionnaire in 2014. The nurses indicated that they use more human and printed resources than electronic resources to seek information (mean=2.83, SD=1.5; mean=2.77, SD=1.07; and mean=2.13, SD=0.88, respectively). To search online resources, the nurses use quick/basic search features more frequently (mean=2.45, SD=1.15) than other search features such as advanced search, index browsing and MeSH term searching. (1.74≤mean≤2.30, SD=1.01). At least 80% of the nurses were not aware of the purpose or function of search operators such as Boolean and proximity operators. In response to the question measuring skills of the nurses in developing an effective search statement by using Boolean operators, only 20% of them selected the more appropriate statement, using some synonyms of the concepts in a given subject. The study showed that the information seeking and retrieval skills of the nurses were poor and there were clear deficits in the use of updated information resources. To compensate their EBP incompetency, nurses may resort to human resources. In order to use the latest up to date evidence independently, nurses need to improve their information literacy. To reach this goal, clinical librarians, health information specialists, nursing faculties, and clinical nurse educators and mentors can play key roles by providing educational programs. Providing access to online resources in clinical wards can also encourage nurses to learn and use
Smith, Marvin K; Werner, Brian C; Diduch, David R
To discuss the potentially significant complications associated with medial patellofemoral ligament (MPFL) reconstruction. Additionally, to review the most current and relevant literature with an emphasis on avoiding these potential complications. Multiple cadaveric studies have characterized the anatomy of the MPFL and the related morphologic abnormalities that contribute to recurrent lateral patellar instability. Such abnormalities include patella alta, excessive tibial tubercle to trochlear grove (TT-TG) distance, trochlear dysplasia, and malalignment. Recent studies have evaluated the clinical outcomes associated with the treatment of concomitant pathology in combination with MPFL reconstruction, which is critical in avoiding recurrent instability and complications. Although there remains a lack of consensus regarding various critical aspects of MPFL reconstruction, certain concepts remain imperative. Our preferred methods and rationales for surgical techniques are described. These include appropriate work up, a combination of procedures to address abnormal morphology, anatomical femoral insertion, safe and secure patellar fixation, appropriate graft length fixation, and thoughtful knee flexion during fixation.
Lisa Lampe,1 Gin S Malhi2 1Discipline of Psychiatry, University of Newcastle, Newcastle, NSW, Australia; 2Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia Abstract: Avoidant personality disorder (AVPD) is a relatively common disorder that is associated with significant distress, impairment, and disability. It is a chronic disorder with an early age at onset and a lifelong impact. Yet it is underrecognized and poorly studied. Little is known regarding the most effective t...
Full Text Available Lisa Lampe,1 Gin S Malhi2 1Discipline of Psychiatry, University of Newcastle, Newcastle, NSW, Australia; 2Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia Abstract: Avoidant personality disorder (AVPD is a relatively common disorder that is associated with significant distress, impairment, and disability. It is a chronic disorder with an early age at onset and a lifelong impact. Yet it is underrecognized and poorly studied. Little is known regarding the most effective treatment. The impetus for research into this condition has waxed and waned, possibly due to concerns regarding its distinctiveness from other disorders, especially social anxiety disorder (SAD, schizoid personality disorder, and dependent personality disorder. The prevailing paradigm subscribes to the “severity continuum hypothesis”, in which AVPD is viewed essentially as a severe variant of SAD. However, areas of discontinuity have been described, and there is support for retaining AVPD as a distinct diagnostic category. Recent research has focused on the phenomenology of AVPD, factors of possible etiological significance such as early parenting experiences, attachment style, temperament, and cognitive processing. Self-concept, avoidant behavior, early attachments, and attachment style may represent points of difference from SAD that also have relevance to treatment. Additional areas of research not focused specifically on AVPD, including the literature on social cognition as it relates to attachment and personality style, report findings that are promising for future research aimed at better delineating AVPD and informing treatment. Keywords: avoidant personality disorder, social anxiety disorder, social cognition, psychotherapy, attachment
Ren, Xiaolong; Lü, Linyuan; Liu, Runran; Zhang, Jianlin
Recommender systems use the historical activities and personal profiles of users to uncover their preferences and recommend objects. Most of the previous methods are based on objects’ (and/or users’) similarity rather than on their difference. Such approaches are subject to a high risk of increasingly exposing users to a narrowing band of popular objects. As a result, a few objects may be recommended to an enormous number of users, resulting in the problem of recommendation congestion, which is to be avoided, especially when the recommended objects are limited resources. In order to quantitatively measure a recommendation algorithm's ability to avoid congestion, we proposed a new metric inspired by the Gini index, which is used to measure the inequality of the individual wealth distribution in an economy. Besides this, a new recommendation method called directed weighted conduction (DWC) was developed by considering the heat conduction process on a user–object bipartite network with different thermal conductivities. Experimental results obtained for three benchmark data sets showed that the DWC algorithm can effectively avoid system congestion, and greatly improve the novelty and diversity, while retaining relatively high accuracy, in comparison with the state-of-the-art methods. (paper)
Rohr, Michaela; Kamm, Friederike; Koenigstorfer, Joerg; Groeppel-Klein, Andrea; Wentura, Dirk
Empirical evidence suggests that the color red acts like an implicit avoidance cue in food contexts. Thus specific colors seem to guide the implicit evaluation of food items. We built upon this research by investigating the implicit meaning of color (red vs. green) in an approach-avoidance task with healthy and unhealthy food items. Thus, we examined the joint evaluative effects of color and food: Participants had to categorize food items by approach-avoidance reactions, according to their healthfulness. Items were surrounded by task-irrelevant red or green circles. We found that the implicit meaning of the traffic light colors influenced participants' reactions to the food items. The color red (compared to green) facilitated automatic avoidance reactions to unhealthy foods. By contrast, approach behavior toward healthy food items was not moderated by color. Our findings suggest that traffic light colors can act as implicit cues that guide automatic behavioral reactions to food.
Zhou, Ying; Loeza-Cabrera, Mario; Liu, Zheng; Aleman-Meza, Boanerges; Nguyen, Julie K; Jung, Sang-Kyu; Choi, Yuna; Shou, Qingyao; Butcher, Rebecca A; Zhong, Weiwei
It is crucial for animal survival to detect dangers such as predators. A good indicator of dangers is injury of conspecifics. Here we show that fluids released from injured conspecifics invoke acute avoidance in both free-living and parasitic nematodes. Caenorhabditis elegans avoids extracts from closely related nematode species but not fruit fly larvae. The worm extracts have no impact on animal lifespan, suggesting that the worm extract may function as an alarm instead of inflicting physical harm. Avoidance of the worm extract requires the function of a cGMP signaling pathway that includes the cGMP-gated channel TAX-2/TAX-4 in the amphid sensory neurons ASI and ASK. Genetic evidence indicates that the avoidance behavior is modulated by the neurotransmitters GABA and serotonin, two common targets of anxiolytic drugs. Together, these data support a model that nematodes use a nematode-specific alarm pheromone to detect conspecific injury. Copyright © 2017 by the Genetics Society of America.
ZHAI Xianghua; XI Ping
The scalar phantom field Φ leads to various catastrophic fates of the universe including big rip,little rip and other future singularity depending on the choice of its potential.For example,little rip stems from a quadratic potential in general relativity.We suggest a new mechanism to avoid little rip in the 1/R gravity.The phantom field with different potentials,including quadratic,cubic and quantic potentials are studied via numerical calculation in the 1/R gravity with R2 correction.T...
Pavlova, Milena; Tsiachristas, Apostolos; Vermaeten, Gerhard; Groot, Wim
Portfolio analysis is a business management tool that can assist health care managers to develop new organizational strategies. The application of portfolio analysis to US hospital settings has been frequently reported. In Europe however, the application of this technique has received little attention, especially concerning public hospitals. Therefore, this paper examines the peculiarities of portfolio analysis and its applicability to the strategic management of European public hospitals. The analysis is based on a pilot application of a multi-factor portfolio analysis in a Dutch university hospital. The nature of portfolio analysis and the steps in a multi-factor portfolio analysis are reviewed along with the characteristics of the research setting. Based on these data, a multi-factor portfolio model is developed and operationalized. The portfolio model is applied in a pilot investigation to analyze the market attractiveness and hospital strengths with regard to the provision of three orthopedic services: knee surgery, hip surgery, and arthroscopy. The pilot portfolio analysis is discussed to draw conclusions about potential barriers to the overall adoption of portfolio analysis in the management of a public hospital. Copyright (c) 2008 John Wiley & Sons, Ltd.
Skinner, Timothy C.; Roberton, Terri; Allison, Garry T.
) completed a questionnaire including the depression subscale of the Depression Anxiety Stress Scale, the Acceptance and Action Questionnaire (AAQ-2; Bond et al., 2007) and the Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003). Thirty per cent of participants scored above the cut-off for possible...... depression, with equal numbers experiencing mild, moderate or severe depression. Mindfulness and experiential avoidance were significantly associated with depression, and were intercorrelated. Further, regression analysis indicated that experiential avoidance mediated the relationship between depression......This preliminary study sought to explore the link between depression, experiential avoidance and mindfulness in people with a spinal cord injury (SCI). We surveyed patients listed on the SCI database at Royal Perth Hospital who had experienced an injury over the last 10 years. Respondents (62...
... for Success Am I Rural? Evidence-based Toolkits Economic Impact Analysis Tool Community Health Gateway Sustainability Planning ... hospitals and improve access to healthcare by keeping essential services in rural communities. To accomplish this goal, ...
University of Rhode Island Geospatial Extension Program — Hospital Facilities information was compiled from several various sources. Main source was the RI Department of Health Facilities Regulation database, License 2000....
Lampe, Lisa; Malhi, Gin S
Avoidant personality disorder (AVPD) is a relatively common disorder that is associated with significant distress, impairment, and disability. It is a chronic disorder with an early age at onset and a lifelong impact. Yet it is underrecognized and poorly studied. Little is known regarding the most effective treatment. The impetus for research into this condition has waxed and waned, possibly due to concerns regarding its distinctiveness from other disorders, especially social anxiety disorder (SAD), schizoid personality disorder, and dependent personality disorder. The prevailing paradigm subscribes to the "severity continuum hypothesis", in which AVPD is viewed essentially as a severe variant of SAD. However, areas of discontinuity have been described, and there is support for retaining AVPD as a distinct diagnostic category. Recent research has focused on the phenomenology of AVPD, factors of possible etiological significance such as early parenting experiences, attachment style, temperament, and cognitive processing. Self-concept, avoidant behavior, early attachments, and attachment style may represent points of difference from SAD that also have relevance to treatment. Additional areas of research not focused specifically on AVPD, including the literature on social cognition as it relates to attachment and personality style, report findings that are promising for future research aimed at better delineating AVPD and informing treatment.
Lampe, Lisa; Malhi, Gin S
Avoidant personality disorder (AVPD) is a relatively common disorder that is associated with significant distress, impairment, and disability. It is a chronic disorder with an early age at onset and a lifelong impact. Yet it is underrecognized and poorly studied. Little is known regarding the most effective treatment. The impetus for research into this condition has waxed and waned, possibly due to concerns regarding its distinctiveness from other disorders, especially social anxiety disorder (SAD), schizoid personality disorder, and dependent personality disorder. The prevailing paradigm subscribes to the “severity continuum hypothesis”, in which AVPD is viewed essentially as a severe variant of SAD. However, areas of discontinuity have been described, and there is support for retaining AVPD as a distinct diagnostic category. Recent research has focused on the phenomenology of AVPD, factors of possible etiological significance such as early parenting experiences, attachment style, temperament, and cognitive processing. Self-concept, avoidant behavior, early attachments, and attachment style may represent points of difference from SAD that also have relevance to treatment. Additional areas of research not focused specifically on AVPD, including the literature on social cognition as it relates to attachment and personality style, report findings that are promising for future research aimed at better delineating AVPD and informing treatment. PMID:29563846
Ryan, Thomas; Poirier, Yves
Our goal was to locate and evaluate the barriers that impact and cause females to avoid secondary elective physical education courses. We sought to find answers to stop the further decline of female enrolment in secondary physical education by looking into curricula, program and instructional variables. Anecdotal evidence informed this study which…
Dreier, Gabriele; Löhler, Jan
Background: Medical treatment requires the implementation of existing evidence in the decision making process in order to be able to find the best possible diagnostic, therapeutic or prognostic measure for the individual patient based on the physician's own expertise. Clinical trials form the evidence base and ideally, their results are assembled, analyzed, summarized, and made available in systematic review articles. Beside planning, conducting, and evaluating clinical trials in conformity with GCP (good clinical practice), it is essential that all results of conducted studies are publicly available in order to avoid publication bias. This includes also the public registration of planned and cancelled trials. History: During the last 25 years, evidence-based medicine became increasingly important in medical care and research. It is closely associated with the names of Archibald Cochrane and David Sackett. About 15 years ago, the Deutsche Cochrane Zentrum (Cochrane Germany) and the Deutsche Netzwerk Evidenzbasierte Medizin e.V. (German Network for Evidence-based Medicine, DNEbM) were founded in Germany. In the International Cochrane Collaboration, clinicians and methodologists come together on an interdisciplinary level to further develop methods of evidence-based medicine and to discuss the topics of evidence generation and processing as well as knowledge transfer. Problem: Evidence is particularly important for physicians in the process of decision making, however, at the same time it is the base of a scientific proof of benefit for the patient and finally for the payers in health care. The closure of evidence gaps requires enormously high staff and financial resources, significant organizational efforts, and it is only successful when clinical and methodical expertise as well as specific knowledge in the field of clinical research are included. On the other hand, the knowledge has to be transferred into practice. For this purpose, practice guidelines, meetings
Dreier, G; Löhler, J
Treating patients requires the inclusion of existing evidence in any health care decision, to be able to choose the best diagnosis or treatment measure or to make valid prognosis statements for a particular patient in consideration of the physician's own expertise.The basis are clinical trials, the results of which are ideally gathered in systematic reviews, rated, summarized and published. In addition to the GCP (Good Clinical Practice)-compliant planning, conducting and analysis of clinical studies it is essential, that all study results are made publicly available, in order to avoid publication bias. This includes the public registration of planned and discontinued trials. In the last 25 years, the evidence-based medicine (EbM) has increasingly found its way into clinical practice and research. Here EbM is closely associated with the names Archibald Cochrane and David Sackett. In Germany, both the German Cochrane Centre (DCZ) and the network of evidence-based medicine (DNEbM) were established approximately 15 years ago. In the international Cochrane Collaboration clinicians and other scientists like statisticians interdisciplinary work side by side to develop the methods of evidence-based medicine and to address the topics of evidence generation and processing as well as the transfer of knowledge. Challenge: Existing evidence primarily serves doctors to support their decision-making, but is also the basis for providing scientific proof for a health care intervention's benefit to patients and ultimately payers/health insurances. The closure of existing evidence gaps requires substantial human and financial resources, a complex organizational structure and can only succeed with the involvement of clinical and methodological expertise and specific knowledge in the field of clinical research. In addition, the knowledge must be transferred into practice, using journals, guidelines, conferences, databases, information portals with processed evidence and not least the
Nutrition support in hospitals is becoming an area of focus because of the evidence showing improved clinical outcome with nutrition support, its status as a human rights issue and its integration into quality assurance.......Nutrition support in hospitals is becoming an area of focus because of the evidence showing improved clinical outcome with nutrition support, its status as a human rights issue and its integration into quality assurance....
The effect of a translating research into practice intervention to promote use of evidence-based fall prevention interventions in hospitalized adults: A prospective pre-post implementation study in the U.S.
Titler, Marita G; Conlon, Paul; Reynolds, Margaret A; Ripley, Robert; Tsodikov, Alex; Wilson, Deleise S; Montie, Mary
Falls are a major public health problem internationally. Many hospitals have implemented fall risk assessment tools, but few have implemented interventions to mitigate patient-specific fall risks. Little research has been done to examine the effect of implementing evidence-based fall prevention interventions to mitigate patient-specific fall risk factors in hospitalized adults. To evaluate the impact of implementing, in 3 U.S. hospitals, evidence-based fall prevention interventions targeted to patient-specific fall risk factors (Targeted Risk Factor Fall Prevention Bundle). Fall rates, fall injury rates, types of fall injuries and adoption of the Targeted Risk Factor Fall Prevention Bundle were compared prior to and following implementation. A prospective pre-post implementation cohort design. Thirteen adult medical-surgical units from three community hospitals in the Midwest region of the U.S. Nurses who were employed at least 20hours/week, provided direct patient care, and licensed as an RN (n=157 pre; 140 post); and medical records of patients 21years of age or older, who received care on the study unit for more than 24hours during the designated data collection period (n=390 pre and post). A multi-faceted Translating Research Into Practice Intervention was used to implement the Targeted Risk Factor Fall Prevention Bundle composed of evidence-based fall prevention interventions designed to mitigate patient-specific fall risks. Dependent variables (fall rates, fall injury rates, fall injury type, use of Targeted Risk Factor Fall Prevention Bundle) were collected at baseline, and following completion of the 15month implementation phase. Nurse questionnaires included the Stage of Adoption Scale, and the Use of Research Findings in Practice Scale to measure adoption of evidence-based fall prevention practices. A Medical Record Abstract Form was used to abstract data about use of targeted risk-specific fall prevention interventions. Number of falls, and number and
McHugh, John P; Foster, Andrew; Mor, Vincent; Shield, Renée R; Trivedi, Amal N; Wetle, Terrie; Zinn, Jacqueline S; Tyler, Denise A
Establishing preferred provider networks of skilled nursing facilities (SNFs) is one approach hospital administrators are using to reduce excess thirty-day readmissions and avoid Medicare penalties or to reduce beneficiaries' costs as part of value-based payment models. However, hospitals are also required to provide patients at discharge with a list of Medicare-eligible providers and cannot explicitly restrict patient choice. This requirement complicates the development of a SNF network. Furthermore, there is little evidence about the effectiveness of network development in reducing readmission rates. We used a concurrent mixed-methods approach, combining Medicare claims data for the period 2009-13 with qualitative data gathered from interviews during site visits to hospitals in eight US markets in March-October 2015, to examine changes in rehospitalization rates and differences in practices between hospitals that did and did not develop formal SNF networks. Four hospitals had developed formal SNF networks as part of their care management efforts. These hospitals saw a relative reduction from 2009 to 2013 in readmission rates for patients discharged to SNFs that was 4.5 percentage points greater than the reduction for hospitals without formal networks. Interviews revealed that those with networks expanded existing relationships with SNFs, effectively managed patient data, and exercised a looser interpretation of patient choice. Project HOPE—The People-to-People Health Foundation, Inc.
A generalized approach to the problem of collision avoidance in robotic environments is presented. This approach transforms the three dimensional but dynamic real-world changing geometric space of the robot in its environment into a multidimensional but static space such that any possible geometric arrangement of the robotic space becomes a point in hyperspace. Major advantages of this approach include clarification of and potential solution to the basic problem of finding optimized, collision free movements from an initial to a final configuration. A major disadvantage of the approach is related to computational and data storage problems. However these latter are technically solvable while the clarification of the control and guidance problem gained through the transformational approach and its general elucidation power remain prime conceptual tools for the problem of robot design and operation
Botha, Elmarie; Gwin, Teri; Purpora, Christina
The objective of this review is to identify the effectiveness of mindfulness based programs in reducing stress experienced by nurses in adult hospitalized patient care settings. Nursing professionals face extraordinary stressors in the medical environment. Many of these stressors have always been inherent to the profession: long work hours, dealing with pain, loss and emotional suffering, caring for dying patients and providing support to families. Recently nurses have been experiencing increased stress related to other factors such as staffing shortages, increasingly complex patients, corporate financial constraints and the increased need for knowledge of ever-changing technology. Stress affects high-level cognitive functions, specifically attention and memory, and this increases the already high stakes for nurses. Nurses are required to cope with very difficult situations that require accurate, timely decisions that affect human lives on a daily basis.Lapses in attention increase the risk of serious consequences such as medication errors, failure to recognize life-threatening signs and symptoms, and other essential patient safety issues. Research has also shown that the stress inherent to health care occupations can lead to depression, reduced job satisfaction, psychological distress and disruptions to personal relationships. These outcomes of stress are factors that create scenarios for risk of patient harm.There are three main effects of stress on nurses: burnout, depression and lateral violence. Burnout has been defined as a syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment, and the occurrence of burnout has been closely linked to perceived stress. Shimizu, Mizoue, Mishima and Nagata state that nurses experience considerable job stress which has been a major factor in the high rates of burnout that has been recorded among nurses. Zangaro and Soeken share this opinion and state that work related stress is largely
Full Text Available Panel studies show a consistent association between increase in the cardiovascular hospitalizations with air pollutants in economically developed regions, but little evidence in less developed inland areas. In this study, a time-series analysis was used to examine the specific effects of major air pollutants [particulate matter less than 10 microns in diameter (PM10, sulfur dioxide (SO2, and nitrogen dioxides (NO2] on daily hospital admissions for cardio-cerebrovascular diseases in Lanzhou, a heavily polluted city in China. We examined the effects of air pollutants for stratified groups by age and gender, and conducted the modifying effect of seasons on air pollutants to test the possible interaction. The significant associations were found between PM10, SO2 and NO2 and cardiac disease admissions, SO2 and NO2 were found to be associated with the cerebrovascular disease admissions. The elderly was associated more strongly with gaseous pollutants than younger. The modifying effect of seasons on air pollutants also existed. The significant effect of gaseous pollutants (SO2 and NO2 was found on daily hospital admissions even after adjustment for other pollutants except for SO2 on cardiac diseases. In a word, this study provides the evidence for the detrimental short-term health effects of urban gaseous pollutants on cardio-cerebrovascular diseases in Lanzhou.
Monhart, Z.; Grünfeldová, H.; Zvárová, Jana; Janský, P.
Roč. 122, č. 2 (2010), e244 ISSN 0009-7322. [World Congress of Cardiology . 16.06.2010-19.06.2010, Beijing] Institutional research plan: CEZ:AV0Z10300504 Keywords : cardioloy * myocardial infarction * in-hospital mortality Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery
Sun, Qiang; Yin, Jia; Yin, Xiao; Zou, Guanyang; Liang, Mingli; Zhong, Jieming; Walley, John; Wei, Xiaolin
Moving the clinical services from tuberculosis (TB) dispensary to the integrated county hospital (called integrated approach) has been practiced in China; however, it is unknown the quality of TB care in the integrated approach and in the dispensary approach. A total of 202 new TB patients were investigated using structured questionnaires in three counties implementing the integrated approach and one county implementing the dispensary approach. The quality of TB care is measured based on success rate of treatment, medical expenditure, health system delay and second-line drug use. The integrated approach showed a high success treatment rate. The medical expenditure in the integrated approach was USD 432, significantly lower than that in the dispensary approach (Z = -5.771, P < 0.001). The integrated approach had a shorter health system delay (5 days) than the dispensary approach (32 days). Twenty-six percent of patients in integrated hospitals were prescribed with second-line TB drugs, significantly lower than that in the TB dispensary (47%, χ(2) = 7.452, P = 0.006). However, the medical expenditure, use of second-line anti-TB drug and liver-protection drugs indeed varied greatly across the three integrated hospitals. The integrated approach showed better quality of TB care, but the performance of the integrated hospitals varied greatly. A method to standardize TB treatment and management of this approach is urgent.
Fatima, Iram; Humayun, Ayesha; Anwar, Muhammad Imran; Iftikhar, Adil; Aslam, Muhammad; Shafiq, Muhammad
Service quality is one of the important gears to appraise services and determine the gray areas that need improvement. In countries with a resource-poor health system, the first step of measuring quality is yet to be taken. This study seeks to inform policy makers in developing contextual service quality models by identifying service quality gaps in tertiary care teaching hospitals using patients' perspective. A cross-sectional study was performed using multistage cluster sampling, and a modified version of the SERVQUAL (SERV-service, QUAL-quality) instrument was administered to determine patient's expectations and perceptions. A total of 817 completed questionnaires were obtained from patients and/or their attendants using convenience sampling. Data analysis revealed statistically significant negative quality gaps between expectations and perceptions of tangibility, reliability, empathy, assurance, responsiveness, and communication. The difference in mean expectation and perception for responsiveness across the sexes was significant ( p quality were independent of sex. Educational status showed significant difference in expectation and perception in responsiveness ( p quality: p quality of hospitals. Tertiary care hospitals failed to meet patients' expectations in all major areas of service quality, posing a question of how hospitals implement and evaluate their quality assurance policy.
Roberts, Shelley; Wallis, Marianne; McInnes, Elizabeth; Bucknall, Tracey; Banks, Merrilyn; Ball, Lauren; Chaboyer, Wendy
Pressure ulcers place a significant burden on patients and hospitals. Our team developed and tested a pressure ulcer prevention care bundle (PUPCB) in a cluster randomized trial. As part of the process evaluation conducted alongside the trial, we explored patients' perceptions of the intervention. To identify patients' perceptions and experiences of a PUPCB in hospital. This qualitative descriptive study explored the perceptions of a subset of patients who participated in a trial testing the PUPCB across four intervention hospitals. A trained interviewer conducted semistructured interviews, which were digitally recorded, transcribed, and analyzed using thematic analysis. Nineteen patients were interviewed across the four hospitals. Three main themes emerged: (a) importance of personal contact in PUPCB delivery; (b) understanding pressure ulcer prevention (PUP) enhances participation; and (c) individual factors impact patients' engagement in PUP. The extent to which patients adopted the intervention appeared to be influenced by the complexity of education materials, compatibility with patients' existing knowledge and beliefs, and perceived advantage of the intervention; ability for human interaction; and patient-related facilitators and barriers to participating in PUP care. This study found patients accepted a PUPCB that encouraged participation in care, particularly as it involved personal and positive interactions with nurses and provision of information that was easy to understand and resonated with patients. © 2017 Sigma Theta Tau International.
Full Text Available Background One of the objectives of the health transformation plan (HTP in Iran is to reduce out-of-pocket (OOP payments for inpatient services and eradicate informal payments. The HTP has three phases: the first phase (launched in May 5, 2014 is focused on reducing OOP payments for inpatient services; the second phase (launched in May 22, 2014 is focused on primary healthcare (PHC and the third phase utilizes an updated relative value units for health services (launched in September 29, 2014 and is focused on the elimination of informal payments. This aim of this study was to determine the OOP payments and the frequency of informal cash payments to physicians for inpatient services before and after the HTP in Kurdistan province, Iran. Methods This quasi-experimental study used multistage sampling method to select and evaluate 265 patients discharged from hospitals in Kurdistan province. The study covered 3 phases (before the HTP, after the first, and third phases of the HTP. Part of the data was collected using a hospital information system form and the rest were collected using a questionnaire. Data were analyzed using Fisher exact test, logistic regression, and independent samples ttest. Results The mean OOP payments before the HTP and after the first and third phases, respectively, were US$59.4, US$17.6, and US$14.3 in hospital affiliated to the Ministry of Health and Medical Education (MoHME, US$39.6, US$33.7, and US$13.7 in hospitals affiliated to Social Security Organization (SSO, and US$153.3, US$188.7, and US$66.4 in private hospitals. In hospitals affiliated to SSO and MoHME there was a significant difference between the mean OOP payments before the HTP and after the third phase (P < .05. The percentage of informal payments to physicians in hospitals affiliated to MoHME, SSO, and private sector, respectively, were 4.5%, 8.1%, and 12.5% before the HTP, and 0.0%, 7.1%, and 10.0% after the first phase. Contrary to the time before the HTP
... Eating Disorder Bulimia Nervosa Pica Rumination Disorder Avoidant/restrictive food intake disorder is characterized by eating very little food and/or avoiding eating certain foods. People with this disorder eat ...
Abbas, Tariq; Xu, Zhiwei; Younus, Muhammad; Qayyum, Abdul; Riaz, Muhammad T.
Crimean-Congo hemorrhagic fever (CCHF) has been reported from all provinces of Pakistan. Little is known about the seasonal variations in the disease and its association with weather conditions. In this study, we explored time-series data about monthly number of CCHF admissions (2007-2010) in three public sector hospitals of Quetta—the capital city of Baluchistan province of Pakistan. Cosinor analysis was carried out to investigate seasonality in the data. To assess the effect of average monthly ambient temperature (°C) on disease, a distributed lag nonlinear model (DLNM) was applied. Cosinor model revealed statistically significant seasonality in monthly number of CCHF patients admitted to the study hospitals. The estimated amplitude was 3.24 cases per month with phase in mid-June and low point in mid-December. DLNM confirmed nonlinear and delayed effect of temperature on hospital admissions. At a lag of 2 months, the cumulative relative risk was more than 1 at temperature at 18.37 °C and above. In addition, relative risk was significantly high at 60th (21.98 °C), 70th (24.50 °C), 80th (27.33 °C), and 90th (29.25 °C) percentiles of temperature (relative to median value, 18.37 °C). Inclusion of Eid-al-Adha as a predictor did not improve the fitness of DLNM. Based on our analysis, we concluded significant seasonality in CCHF hospital admissions. Our findings also suggested average monthly ambient temperature (°C) as a significant predictor of CCHF hospitalizations. DLNM presented in this study may be improved with inclusion of other possible time-varying predictors particularly meteorological conditions of this region.
Full Text Available Objectives: Service quality is one of the important gears to appraise services and determine the gray areas that need improvement. In countries with a resource-poor health system, the first step of measuring quality is yet to be taken. This study seeks to inform policy makers in developing contextual service quality models by identifying service quality gaps in tertiary care teaching hospitals using patients’ perspective. Methods: A cross-sectional study was performed using multistage cluster sampling, and a modified version of the SERVQUAL (SERV-service, QUAL-quality instrument was administered to determine patient’s expectations and perceptions. A total of 817 completed questionnaires were obtained from patients and/or their attendants using convenience sampling. Results: Data analysis revealed statistically significant negative quality gaps between expectations and perceptions of tangibility, reliability, empathy, assurance, responsiveness, and communication. The difference in mean expectation and perception for responsiveness across the sexes was significant (p < 0.003; p < 0.037, respectively as well as in perception of communication (p < 0.026. Other dimensions and overall hospital expected and perceived quality were independent of sex. Educational status showed significant difference in expectation and perception in responsiveness (p < 0.005, but the perception of each dimension was significantly different in different educational categories (assurance: p < 0.001; empathy: p < 0.001; reliability: p < 0.001; tangibility: p < 0.001; responsiveness: p < 0.001; communication: p < 0.001; and for overall service quality: p < 0.001. Age and service departments showed no relationship with any of the perceived or expected dimension of service quality of hospitals. Conclusions: Tertiary care hospitals failed to meet patients’ expectations in all major areas of service quality, posing a question of how hospitals implement and evaluate their
Franck, Gustav Grønborg; Runchel, Daniel Theis; Mac, Martin Tuannhien; Ahmed, Jahanzeeb; Bang, Lars Seneca
The issue of tax avoidance has been subject for recommended regulations by the G20 countries in collaboration with OECD. We examine the usefulness of market failure theory to explain the economic and political issues of tax avoidance. We test our hypothesis using theory through a deductive approach incorporating content analysis to find convergence(s) between tax avoidance methods identified and the efforts of the G20 BEPS action plan to respond to those methods. The issue of tax avoidance...
Does tax avoidance have any implications for financial markets? This paper quantifies the general equilibrium implications of tax avoidance by setting up an incomplete markets production economy model in which households pay capital gains taxes and have access to tax avoidance technologies provided by financial institutions. I find that changes in the level of tax avoidance have disproportionate effects on different groups of agents and generally benefit the old, wealthy and high income house...
Barsky, Allan E.; Wood, Lorinda
This ethnographic study explores patterns of conflict avoidance among university students, professors, administrators and staff. Analysis of their narratives of conflict avoidance suggests that avoidance can be beneficial in some circumstances, depending upon personality issues, cost?benefit analysis, power imbalance, type of work, length of…
McPake, Barbara; Yepes, Francisco Jose; Lake, Sally; Sanchez, Luz Helena
Many countries are experimenting with public hospital reform - both increasing the managerial autonomy with which hospitals conduct their affairs, and separating 'purchaser' and 'provider' sides of the health system, thus increasing the degree of market pressure brought to bear on hospitals. Evidence suggesting that such reform will improve hospital performance is weak. From a theoretical perspective, it is not clear why public hospitals should be expected to behave like firms and seek to maximize profits as this model requires. Empirically, there is very slight evidence that such reforms may improve efficiency, and reason to be concerned about their equity implications. In Colombia, an ambitious reform programme includes among its measures the attempt to universalize a segmented health system, the creation of a purchaser-provider split and the transformation of public hospitals into 'autonomous state entities'. By design, the Colombian reform programme avoids the forces that produce equity losses in other developing countries. This paper reports the results of a study that has tried to track hospital performance in other dimensions in the post-reform period in Bogotá. Trends in hospital inputs, production and productivity, quality and patient satisfaction are presented, and qualitative data based on interviews with hospital workers are analyzed. The evidence we have been able to collect is capable of providing only a partial response to the study question. There is some evidence of increased activity and productivity and sustained quality despite declining staffing levels. Qualitative data suggest that hospital workers have noticed considerable changes, which include greater responsiveness to patients but also a heavier administrative burden. It is difficult to attribute specific causality to all of the changes measured and this reflects the inherent difficulty of judging the effects of large-scale reform programmes as well as weaknesses and gaps in the data
In most past studies of the effectiveness of tactical nuclear weapons vs the amount of collateral damage produced (civilian casualties), civilians have been congregated into idealized shaped towns and cities, and criteria for city avoidance were usually formulated in terms relating to a town's population. This treatment was sufficient in those studies where weapon yields were so large that great numbers of civilians were almost always placed at risk. As further studies developed, demonstrating that real progress could be made in reducing the numbers of civilians potentially placed at risk in tactical nuclear warfare situations, the inadequacies of the present treatment became obvious. The need existed for a more detailed description of the distribution of civilians. The method described determines the number of civilians at risk for a weapon under consideration being detonated at a given point and displays a symbol relating to the numbers at risk on a map or a transparency that overlays a 1:50,000 map of the region. Thus, a weapons planner making the selection of aimpoints for inflicting the necessary military damage required has the means to reduce potential civilian casualties by properly choosing the weapon and aimpoints
Piroozi, Bakhtiar; Rashidian, Arash; Moradi, Ghobad; Takian, Amirhossein; Ghasri, Hooman; Ghadimi, Tayyeb
One of the objectives of the health transformation plan (HTP) in Iran is to reduce out-of-pocket (OOP) payments for inpatient services and eradicate informal payments. The HTP has three phases: the first phase (launched in May 5, 2014) is focused on reducing OOP payments for inpatient services; the second phase (launched in May 22, 2014) is focused on primary healthcare (PHC) and the third phase utilizes an updated relative value units for health services (launched in September 29, 2014) and is focused on the elimination of informal payments. This aim of this study was to determine the OOP payments and the frequency of informal cash payments to physicians for inpatient services before and after the HTP in Kurdistan province, Iran. This quasi-experimental study used multistage sampling method to select and evaluate 265 patients discharged from hospitals in Kurdistan province. The study covered 3 phases (before the HTP, after the first, and third phases of the HTP). Part of the data was collected using a hospital information system form and the rest were collected using a questionnaire. Data were analyzed using Fisher exact test, logistic regression, and independent samples t test. The mean OOP payments before the HTP and after the first and third phases, respectively, were US$59.4, US$17.6, and US$14.3 in hospital affiliated to the Ministry of Health and Medical Education (MoHME), US$39.6, US$33.7, and US$13.7 in hospitals affiliated to Social Security Organization (SSO), and US$153.3, US$188.7, and US$66.4 in private hospitals. In hospitals affiliated to SSO and MoHME there was a significant difference between the mean OOP payments before the HTP and after the third phase (PKurdistan province. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and
U.S. Department of Health & Human Services — Hospital Compare has information about the quality of care at over 4,000 Medicare-certified hospitals across the country. You can use Hospital Compare to find...
U.S. Department of Health & Human Services — A list of hospital ratings for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a national, standardized survey of hospital...
Kash, Bita A; Baek, Juha; Davis, Elise; Champagne-Langabeer, Tiffany; Langabeer, James R
The United States has invested substantially in technologies that enable health information exchange (HIE), which in turn can be deployed to reduce avoidable hospital readmission rates in many communities. With avoidable hospital readmissions as the primary focus, this study profiles successful hospital readmission rate reduction initiatives that integrate HIE as a strategy. We hypothesized that the use of HIE is associated with decreased hospital readmissions beyond other observed population health benefits. Results of this systematic review are used to describe and profile successful readmission reduction programs that integrate HIE as a tool. A systematic review of literature provided an understanding of the use of HIE as a strategy to reduce hospital readmission rates. We conducted a review of 4,862 citations written in English about readmission reduction strategies from January 2006 to September 2016 in the MEDLINE-PubMed database. Of these, 106 studies reported 30-day readmission rates as an outcome and only 13 articles reported using HIE. Only a very small number (12%) of hospitals incorporated HIE as a primary tool for evidence-based readmission reduction initiatives. Information exchange between providers has been suggested to play a key role in reducing avoidable readmission rates, yet there is not currently evidence supporting current HIE-enabled readmission initiatives. Most successful readmission reduction programs demonstrate collaboration with primary care providers to augment transitions of care to existing care management functions without additional staff while using effective information exchange capabilities. This research confirms there is very little integration of HIE into health systems readmissions initiatives. There is a great opportunity to achieve population health targets using the HIE infrastructure. Hospitals should consider partnering with primary care clinics to implement multifaceted transitions of care programs to significantly
Ruangratanatrai, Wilailuk; Lertmaharit, Somrat; Hanvoravongchai, Piya
Background Shortage and maldistribution of the health workforce is a major problem in the Thai health system. The expansion of healthcare access to achieve universal health coverage placed additional demand on the health system especially on the health workers in the public sector who are the major providers of health services. At the same time, the reform in hospital payment methods resulted in a lower share of funding from the government budgetary system and higher share of revenue from hea...
Monhart, Z.; Faltus, Václav; Grünfeldová, Hana; Janský, P.
Roč. 117, č. 19 (2008), s. 21-22 ISSN 0009-7322. [The 2008 World Congress on Cardiology. 18.05.2008-21.05.2008, Buenos Aires] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : acute myocardial infarction * risk factors * in-hospital mortality Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery
Mariyadas, Jennifer; Amorim, Mónica J B; Jensen, John
Avoidance behaviour offers a highly relevant information as it reveals the ability to avoid (or not) possible toxic compounds in the field, hence it provides information on reasons for the presence/absence in the field. The earthworm Eisenia fetida was used to study avoidance behaviour to four si...... exposure durations and showed a continuous higher avoidance with time (based on EC50 values). The AgNMs avoidance was in the order NM300Ksoil solution fraction that correlated with EC50 across materials....
Mohammed Mohammed A
Full Text Available Abstract Background Despite increasing interest and publication of risk-adjusted hospital mortality rates, the relationship with underlying quality of care remains unclear. We undertook a systematic review to ascertain the extent to which variations in risk-adjusted mortality rates were associated with differences in quality of care. Methods We identified studies in which risk-adjusted mortality and quality of care had been reported in more than one hospital. We adopted an iterative search strategy using three databases – Medline, HealthSTAR and CINAHL from 1966, 1975 and 1982 respectively. We identified potentially relevant studies on the basis of the title or abstract. We obtained these papers and included those which met our inclusion criteria. Results From an initial yield of 6,456 papers, 36 studies met the inclusion criteria. Several of these studies considered more than one process-versus-risk-adjusted mortality relationship. In total we found 51 such relationships in a widen range of clinical conditions using a variety of methods. A positive correlation between better quality of care and risk-adjusted mortality was found in under half the relationships (26/51 51% but the remainder showed no correlation (16/51 31% or a paradoxical correlation (9/51 18%. Conclusion The general notion that hospitals with higher risk-adjusted mortality have poorer quality of care is neither consistent nor reliable.
Full Text Available Clarisse Gautier,1 Denis Charpin1,2 1Department of Pulmonology and Allergy, North Hospital, 2Faculty of Medicine, Aix-Marseille University, Marseille, France Abstract: Identifying asthma triggers forms the basis of environmental secondary prevention. These triggers may be allergenic or nonallergenic. Allergenic triggers include indoor allergens, such as house dust mites (HDMs, molds, pets, cockroaches, and rodents, and outdoor allergens, such as pollens and molds. Clinical observations provide support for the role of HDM exposure as a trigger, although avoidance studies provide conflicting results. Molds and their metabolic products are now considered to be triggers of asthma attacks. Pets, dogs, and especially cats can undoubtedly trigger asthmatic symptoms in sensitized subjects. Avoidance is difficult and rarely adhered to by families. Cockroach allergens contribute to asthma morbidity, and avoidance strategies can lead to clinical benefit. Mouse allergens are mostly found in inner-city dwellings, but their implication in asthma morbidity is debated. In the outdoors, pollens can induce seasonal asthma in sensitized individuals. Avoidance relies on preventing pollens from getting into the house and on minimizing seasonal outdoor exposure. Outdoor molds may lead to severe asthma exacerbations. Nonallergenic triggers include viral infections, active and passive smoking, meteorological changes, occupational exposures, and other triggers that are less commonly involved. Viral infection is the main asthma trigger in children. Active smoking is associated with higher asthma morbidity, and smoking cessation interventions should be personalized. Passive smoking is also a risk factor for asthma exacerbation. The implementation of public smoking bans has led to a reduction in the hospitalization of asthmatic children. Air pollution levels have been linked with asthmatic symptoms, a decrease in lung function, and increased emergency room visits and
A developmental-evolutionary perspective is used to synthesize basic research from the neurosciences, ethology, genetics, and developmental psychology into a unified framework for understanding the nature and origins of social anxiety and avoidant personality disorder. Evidence is presented that social anxiety disorder (social phobia) and avoidant personality disorder may be alternate conceptualizations of the same disorder because they have virtually the same symptoms and genetic basis, and respond to the same pharmacologic and psychotherapeutic interventions. A functionalist perspective on social anxiety is formulated to (a) explain the origins of normative states of anxiety, (b) outline developmental pathways in the transition from normative anxiety to social anxiety and avoidant personality disorders, and (c) account for the processes leading to gender-differentiated patterns of anxiety-related disorders after puberty.
Wu, Ziqi; Robson, Stephani; Hollis, Brooke
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.
Nelson-Coffey, S Katherine; Borelli, Jessica L; River, Laura M
Perhaps unlike other social roles that people may hold, caring for children offers opportunities for both immense joy and incredible frustration. Yet what predicts how parents will feel during caregiving experiences? In the current study, we examined parents' (N = 152) positive emotion, negative emotion, and felt meaning during caregiving using the Day Reconstruction Method. In addition, we tested attachment anxiety and avoidance as predictors of parents' emotion during caregiving relative to their other daily experiences. We found that attachment avoidance was associated with elevated negative emotion and reduced positive emotion and meaning in life across the entire day, whereas attachment anxiety was associated with elevated negative emotion and marginally greater meaning in life, but not positive emotion, across the entire day. Furthermore, caregiving was associated with greater positive emotion and meaning, but not negative emotion, compared to parents' other daily activities. Finally, attachment avoidance, but not anxiety, was associated with lower levels of positive emotion, negative emotion, and felt meaning during caregiving compared to other daily activities. These findings are consistent with other evidence that attachment avoidance is associated with deactivation of emotion in close relationships and suggest that attachment avoidance minimizes the joys of parenting.
Opio, Martin Otyek; Kellett, John
BACKGROUND: Although taking a radial pulse is considered to be an essential clinical skill, there have been few reports on how well it is measured in clinical practice, and how its accuracy and precision are influenced by rate, rhythm, and blood pressure. METHODS: This study is a retrospective...... quality audit carried out as part of a larger ongoing prospective observational trial. The radial pulse rates recorded by 2 research nurses were compared with the electrocardiogram (ECG) heart rates measured on acutely ill medical patients during their admission to a resource-poor hospital in sub...
Anushka B P Fernando
Full Text Available The amygdala has traditionally been associated with fear, mediating the impact of negative emotions on memory. However, this view does not fully encapsulate the function of the amygdala, nor the impact that processing in this structure has on the motivational limbic corticostriatal circuitry of which it is an important structure. Here we discuss the interactions between different amygdala nuclei with cortical and striatal regions involved in motivation; interconnections and parallel circuitries that have become increasingly understood in recent years. We review the evidence that the amygdala stores memories that allow initially motivationally neutral stimuli to become associated through pavlovian conditioning with motivationally relevant outcomes which, importantly, can be either appetitive (e.g. food or aversive (e.g. electric shock. We also consider how different psychological processes supported by the amygdala such as conditioned reinforcement and punishment, conditioned motivation and suppression, and conditioned approach and avoidance behavior, are not only psychologically but also neurobiologically dissociable, being mediated by distinct yet overlapping neural circuits within the limbic corticostriatal circuitry. Clearly the role of the amygdala goes beyond encoding aversive stimuli to also encode the appetitive, requiring an appreciation of the amygdala’s mediation of both appetitive and fearful behavior through diverse psychological processes.
Ernst, Christian; Szczesny, Andrea; Soderstrom, Naomi; Siegmund, Frank; Schleppers, Alexander
One of the declared objectives of surgical suite management in Germany is to increase operating room (OR) efficiency by reducing tardiness of first case of the day starts. We analyzed whether the introduction of OR management tools by German hospitals in response to increasing economic pressure was successful in achieving this objective. The OR management tools we considered were the appointment of an OR manager and the development and adoption of a surgical suite governance document (OR charter). We hypothesized that tardiness of first case starts was less in ORs that have adopted one or both of these tools. Using representative 2005 survey data from 107 German anesthesiology departments, we used a Tobit model to estimate the effect of the introduction of an OR manager or OR charter on tardiness of first case starts, while controlling for hospital size and surgical suite complexity. Adoption reduced tardiness of first case starts by at least 7 minutes (mean reduction 15 minutes, 95% confidence interval (CI): 7-22 minutes, P case starts figure prominently the objectives of surgical suite management in Germany. Our results suggest that the appointment of an OR manager or the adoption of an OR charter support this objective. For short-term decision making on the day of surgery, this reduction in tardiness may have economic implications, because it reduced overutilized OR time.
Rohrer, Brandon Robinson; Hogan, Neville
Evidence for the existence of discrete submovements underlying continuous human movement has motivated many attempts to extract them. Although they produce visually convincing results, all of the methodologies that have been employed are prone to produce spurious decompositions. Examples of potential failures are given. A branch-and-bound algorithm for submovement extraction, capable of global nonlinear minimization (and hence capable of avoiding spurious decompositions), is developed and demonstrated.
Risk of new acute myocardial infarction hospitalization associated with use of oral and parenteral non-steroidal anti-inflammation drugs (NSAIDs: a case-crossover study of Taiwan's National Health Insurance claims database and review of current evidence
Full Text Available Abstract Background Previous studies have documented the increased cardiovascular risk associated with the use of some nonsteroidal anti-inflammatory drugs (NSAIDs. Despite this, many old NSAIDs are still prescribed worldwide. Most of the studies to date have been focused on specific oral drugs or limited by the number of cases examined. We studied the risk of new acute myocardial infarction (AMI hospitalization with current use of a variety of oral and parenteral NSAIDs in a nationwide population, and compared our results with existing evidence. Methods We conducted a case-crossover study using the Taiwan's National Health Insurance claim database, identifying patients with new AMI hospitalized in 2006. The 1-30 days and 91-120 days prior to the admission were defined as case and matched control period for each patient, respectively. Uses of NSAIDs during the respective periods were compared using conditional logistic regression and adjusted for use of co-medications. Results 8354 new AMI hospitalization patients fulfilled the study criteria. 14 oral and 3 parenteral NSAIDs were selected based on drug utilization profile among 13.7 million NSAID users. The adjusted odds ratio, aOR (95% confidence interval, for risk of AMI and use of oral and parenteral non-selective NSAIDs were 1.42 (1.29, 1.56 and 3.35 (2.50, 4.47, respectively, and significantly greater for parenteral than oral drugs (p for interaction Conclusions The collective evidence revealed the tendency of increased AMI risk with current use of some NSAIDs. A higher AMI risk associated with use of parenteral NSAIDs was observed in the present study. Ketorolac had the highest associated risk in both oral and parenteral NSAIDs studied. Though further investigation to confirm the association is warranted, prescribing physicians and the general public should be cautious about the potential risk of AMI when using NSAIDs.
Consiglio, Maria C.; Chamberlain, James P.; Wilson, Sara R.
This paper describes a dynamic convective weather avoidance concept that compensates for weather motion uncertainties; the integration of this weather avoidance concept into a prototype 4-D trajectory-based Airborne Separation Assurance System (ASAS) application; and test results from a batch (non-piloted) simulation of the integrated application with high traffic densities and a dynamic convective weather model. The weather model can simulate a number of pseudo-random hazardous weather patterns, such as slow- or fast-moving cells and opening or closing weather gaps, and also allows for modeling of onboard weather radar limitations in range and azimuth. The weather avoidance concept employs nested "core" and "avoid" polygons around convective weather cells, and the simulations assess the effectiveness of various avoid polygon sizes in the presence of different weather patterns, using traffic scenarios representing approximately two times the current traffic density in en-route airspace. Results from the simulation experiment show that the weather avoidance concept is effective over a wide range of weather patterns and cell speeds. Avoid polygons that are only 2-3 miles larger than their core polygons are sufficient to account for weather uncertainties in almost all cases, and traffic separation performance does not appear to degrade with the addition of weather polygon avoidance. Additional "lessons learned" from the batch simulation study are discussed in the paper, along with insights for improving the weather avoidance concept. Introduction
Stodolak, Frederick; Gutierrez, Henry
Finance managers seeking to avoid lost revenue attributable to lesser-of-charge-or-fixed-fee (lesser-of) clauses in their contracts should: Identify payer contracts that contain lesser-of clauses. Prepare lesser-of lost-revenue reports for non-bundled and bundled rates. For claims with covered charges below the bundled rate, identify service codes associated with the greatest proportion of total gross revenue and determine new, higher charge levels for those codes. Establish an approach for setting charges for non-bundled fee schedules to address lost-revenue-related issues. Incorporate changes into overall strategic or hospital zero-based pricing modeling and parameters.
Gaspelin, Nicholas; Luck, Steven J
Researchers have long debated whether salient stimuli can involuntarily 'capture' visual attention. We review here evidence for a recently discovered inhibitory mechanism that may help to resolve this debate. This evidence suggests that salient stimuli naturally attempt to capture attention, but capture can be avoided if the salient stimulus is suppressed before it captures attention. Importantly, the suppression process can be more or less effective as a result of changing task demands or lapses in cognitive control. Converging evidence for the existence of this suppression mechanism comes from multiple sources, including psychophysics, eye-tracking, and event-related potentials (ERPs). We conclude that the evidence for suppression is strong, but future research will need to explore the nature and limits of this mechanism. Copyright © 2017 Elsevier Ltd. All rights reserved.
Terry, W. Scott
Choosing between 2 unpleasant alternatives (Would you rather be less intelligent or less attractive?) is more difficult than choosing between two desirable options (Would you rather be more intelligent or more attractive?). Here I describe a classroom demonstration of avoidance-avoidance conflicts. Students make a series of approach-approach and…
Renata Nogueira Braga
Full Text Available ABSTRACT This study investigates the association between mandatory International Financial Reporting Standards (IFRS adoption and corporate tax avoidance. In this study, tax avoidance is defined as a reduction in the effective corporate income tax rate through tax planning activities, whether these are legal, questionable, or even illegal. Three measures of tax avoidance are used and factors at the country and firm level (that have already been associated with tax avoidance in prior research are controlled. Using samples that range from 9,389 to 15,423 publicly-traded companies from 35 countries, covering 1999 to 2014, it is found that IFRS adoption is associated with higher levels of corporate tax avoidance, even when the level of book-tax conformity required in the countries and the volume of accruals are controlled, both of which are considered potential determinants of this relationship. Furthermore, the results suggest that after IFRS adoption, firms in higher book-tax conformity environments engage more in tax avoidance than firms in lower book-tax conformity environments. It is also identified that engagement in tax avoidance after IFRS adoption derives not only from accruals management, but also from practices that do not involve accruals. The main conclusion is that companies engage more in tax avoidance after mandatory IFRS adoption.
Chughtai, Abrar Ahmad; Seale, Holly; MacIntyre, Chandini Raina
Currently there is an ongoing debate and limited evidence on the use of masks and respirators for the prevention of respiratory infections in health care workers (HCWs). This study aimed to examine available policies and guidelines around the use of masks and respirators in HCWs and to describe areas of consistency between guidelines, as well as gaps in the recommendations, with reference to the WHO and the CDC guidelines. Policies and guidelines related to mask and respirator use for the prevention of influenza, SARS and TB were examined. Guidelines from the World Health Organization (WHO), the Center for Disease Control and Prevention (CDC), three high-income countries and six low/middle-income countries were selected. Uniform recommendations are made by the WHO and the CDC in regards to protecting HCWs against seasonal influenza (a mask for low risk situations and a respirator for high risk situations) and TB (use of a respirator). However, for pandemic influenza and SARS, the WHO recommends mask use in low risk and respirators in high risk situations, whereas, the CDC recommends respirators in both low and high risk situations. Amongst the nine countries reviewed, there are variations in the recommendations for all three diseases. While, some countries align with the WHO recommendations, others align with those made by the CDC. The choice of respirator and the level of filtering ability vary amongst the guidelines and the different diseases. Lastly, none of the policies discuss reuse, extended use or the use of cloth masks. Currently, there are significant variations in the policies and recommendations around mask and respirator use for protection against influenza, SARS and TB. These differences may reflect the scarcity of level-one evidence available to inform policy development. The lack of any guidelines on the use of cloth masks, despite widespread use in many low and middle-income countries, remains a policy gap. Health organizations and countries should
Rattel, Julina A; Miedl, Stephan F; Blechert, Jens; Wilhelm, Frank H
Theoretical models specifying the underlying mechanisms of the development and maintenance of anxiety and related disorders state that fear responses acquired through classical Pavlovian conditioning are maintained by repeated avoidance behaviour; thus, it is assumed that avoidance prevents fear extinction. The present study investigated behavioural avoidance decisions as a function of avoidance costs in a naturalistic fear conditioning paradigm. Ecologically valid avoidance costs - manipulated between participant groups - were represented via time-delays during a detour in a gamified computer task. After differential acquisitions of shock-expectancy to a predictive conditioned stimulus (CS+), participants underwent extinction where they could either take a risky shortcut, while anticipating shock signaled by the CS+, or choose a costly avoidance option (lengthy detour); thus, they were faced with an approach-avoidance conflict. Groups with higher avoidance costs (longer detours) showed lower proportions of avoiders. Avoiders gave heightened shock-expectancy ratings post-extinction, demonstrating 'protecting from extinction', i.e. failure to extinguish. Moreover, there was an indirect effect of avoidance costs on protection from extinction through avoidance behaviour. No moderating role of trait-anxiety was found. Theoretical implications of avoidance behaviour are discussed, considering the involvement of instrumental learning in the maintenance of fear responses. Copyright © 2016 Elsevier Ltd. All rights reserved.
Kannry, Joseph; Mukani, Sonia; Myers, Kristin
The experience of Mount Sinai Hospital is representative of the challenges and problems facing large academic medical centers in selecting an ambulatory EMR. The facility successfully revived a stalled process in a challenging financial climate, using a framework of science and rigorous investigation. The process incorporated several innovations: 1) There was a thorough review of medical informatics literature to develop a mission statement, determine practical objectives and guide the demonstration process; 2) The process involved rigorous investigation of vendor statements, industry statements and other institution's views of vendors; 3) The initiative focused on user-centric selection, and the survey instrument was scientifically and specifically designed to assess user feedback; 4) There was scientific analysis of validated findings and survey results at all steering meetings; 5) The process included an assessment of vendors' ability to support research by identifying funded and published research; 6) Selection involved meticulous total cost of ownership analysis to assess and compare real costs of implementing a vendor solution; and finally, 7) There were iterative meetings with stakeholders, executives and users to understand needs, address concerns and communicate the vision.
Luce Marina Freires Corrêa da Costa
Full Text Available In order to assess the importance of HCV infection as a possible risk factor for type 2 diabetes mellitus, a case-control study was conducted, comparing the prevalence of HCV infection among diabetic and non-diabetic patients. Diabetic outpatients attending to a University Hospital in Central-West Brazil were evaluated between April and October 2005. A control group composed by patients from the same institution was matched by gender and age. Candidates to control group were included only if fasting glucose measures were under 100 mg/dL. Diabetics and controls had blood samples taken in order to test for antibodies against HCV (anti-HCV by enzyme-immunoassay. Polymerase chain reaction and immunoblot were performed to confirm the anti-HCV status. Each group included 206 participants. Despite of the groups were in general comparable. The diabetics had a greater body mass average and smaller family income. The prevalence of confirmed anti-HCV in the diabetic group was of 1.4%, which was similar to the controls (1%. Finding statistical difference may have been hampered by the low frequency of HCV infection in both groups. It was not possible to demonstrate a role of HCV as an etiologic factor in type 2 diabetes, since HCV infected patients represented a small portion of the overall diabetes cases. This finding does not allow to recommend regular screening for HCV infection in type 2 diabetics in this region.
Hallford, D J; Austin, D W; Raes, F; Takano, K
Overgeneral memory (OGM) refers to the failure to recall memories of specific personally experienced events, which occurs in various psychiatric disorders. One pathway through which OGM is theorized to develop is the avoidance of thinking of negative experiences, whereby cumulative avoidance may maladaptively generalize to autobiographical memory (AM) more broadly. We tested this, predicting that negative experiences would interact with avoidance to predict AM specificity. In Study 1 (N = 281), negative life events (over six months) and daily hassles (over one month) were not related to AM specificity, nor was avoidance, and no interaction was found. In Study 2 (N = 318), we revised our measurements and used an increased timeframe of 12 months for both negative life events and daily hassles. The results showed no interaction effect for negative life events, but they did show an interaction for daily hassles, whereby increased hassles and higher avoidance of thinking about them were associated with reduced AM specificity, independent of general cognitive avoidance and depressive symptoms. No evidence was found that cognitive avoidance or AM specificity moderated the effect of negative experiences on depressive symptoms. Our findings suggest that life events over 6-12 months are not associated with AM specificity, but chronic daily hassles over 12 months predict reduced AM specificity when individuals avoid thinking about them. The findings provide evidence for the functional-avoidance hypothesis of OGM development and future directions for longitudinal studies.
Calcott, Rebecca D.; Berkman, Elliot T.
Dynamic, momentary approach or avoidance motivational states have downstream effects on eventual goal success and overall well being, but there is still uncertainty about how those states affect the proximal neurocognitive processes (e.g., attention) that mediate the longer-term effects. Attentional flexibility, or the ability to switch between different attentional foci, is one such neurocognitive process that influences outcomes in the long run. The present study examined how approach and avoidance motivational states affect the neural processes involved in attentional flexibility using fMRI with the aim of determining whether flexibility operates via different neural mechanisms under these different states. Attentional flexibility was operationalized as subjects’ ability to switch between global and local stimulus features. In addition to subjects’ motivational state, the task context was manipulated by varying the ratio of global to local trials in a block in light of recent findings about the moderating role of context on motivation-related differences in attentional flexibility. The neural processes involved in attentional flexibility differ under approach versus avoidance states. First, differences in the preparatory activity in key brain regions suggested that subjects’ preparedness to switch was influenced by motivational state (anterior insula) and the interaction between motivation and context (superior temporal gyrus, inferior parietal lobule). Additionally, we observed motivation-related differences the anterior cingulate cortex during switching. These results provide initial evidence that motivation-induced behavioral changes may arise via different mechanisms in approach versus avoidance motivational states. PMID:26000735
In March 1991, following a wide ranging inquiry into community needs and high voltage transmission line development, Sir Harry Gibbs, an ex-Chief Justice of the High Court of Australia concluded that adverse health effects from power frequency electric and magnetic fields (EMFs) had not been established. He went on to find that there was some evidence that they might pose a risk to health. On this basis, he recommended a policy of prudent avoidance in the construction of new transmission lines. Since that time, a succession of inquiries in Australia and overseas have made similar findings and recommended prudent avoidance. This paper provides practical guidance to electricity transmission and distribution utilities and other interested stakeholders in the application of prudent avoidance to the design and siting of new electrical facilities. The paper provides background information and a range of general measures which might prudently be applied. It is not the authors' intention to provide precise instructions for the application of prudent avoidance but, rather, to provide a series of guiding principles which may be applied to particular situations, having regard to the specific design practices and other policies of individual electricity utilities. Copyright (1999) Australasian Radiation Protection Society Inc
Costa, Joana; Pinto-Gouveia, José
This study explores experiential avoidance as a mediator in the relationship between coping (rational coping, avoidant coping and detached/ emotional coping) and psychopathology (depression, anxiety and stress). A battery of self-report questionnaires was used to assess coping, experiential avoidance and depression, anxiety and stress in 70 participants with a chronic pain from Portuguese primary health care units. Regression analyses were performed and showed preliminary evidence supporting the mediation role of experiential avoidance in a Portuguese sample with chronic pain. Results show that experiential avoidance partially or fully mediate the effects of rational coping and detached/emotional coping on depression and stress. Implications for clinical practice were discussed and suggest that psychopathology is not necessary direct product of coping and other processes, such as experiential avoidance, are likely involved. Copyright © 2010 John Wiley & Sons, Ltd.
Gonçalves-Bradley, Daniela C; Iliffe, Steve; Doll, Helen A; Broad, Joanna; Gladman, John; Langhorne, Peter; Richards, Suzanne H; Shepperd, Sasha
Early discharge hospital at home is a service that provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care. This is an update of a Cochrane review. To determine the effectiveness and cost of managing patients with early discharge hospital at home compared with inpatient hospital care. We searched the following databases to 9 January 2017: the Cochrane Effective Practice and Organisation of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and EconLit. We searched clinical trials registries. Randomised trials comparing early discharge hospital at home with acute hospital inpatient care for adults. We excluded obstetric, paediatric and mental health hospital at home schemes. DATA COLLECTION AND ANALYSIS: We followed the standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes. We included 32 trials (N = 4746), six of them new for this update, mainly conducted in high-income countries. We judged most of the studies to have a low or unclear risk of bias. The intervention was delivered by hospital outreach services (17 trials), community-based services (11 trials), and was co-ordinated by a hospital-based stroke team or physician in conjunction with community-based services in four trials.Studies recruiting people recovering from strokeEarly discharge hospital at home probably makes little or no difference to mortality at three to six months (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.57 to 1.48, N = 1114, 11 trials, moderate-certainty evidence) and may make little or no difference to the risk of hospital readmission (RR 1.09, 95% CI 0.71 to 1.66, N = 345, 5 trials, low-certainty evidence). Hospital at home may lower the risk of living in institutional setting at six months (RR 0.63, 96% CI
José Luis Navarro Espigares
Full Text Available Background and objectives: Efficiency-based healthcare decision-making has been widely accepted for some time, with cost per quality-adjusted life year (QALY as the main outcome measure. Nevertheless, for numerous medical procedures, little data are available on the cost per QALY gained. The aim of the present study was to calculate the cost per QALY gained with primary hip and knee replacement and to compare the result with the cost per QALY for other medical procedures, as well as with the maximum threshold cost considered acceptable in Spain. Methods: We performed a prospective cohort pre-test/post-test study of patients undergoing primary hip or knee arthroplasty. Age, sex, and clinical variables were recorded. Functional status and quality of life were measured by means of the WOMAC and EuroQol instruments, respectively, before the intervention and 6 months later. The direct costs of the intervention were calculated, with length of hospital stay and the prosthesis as the main cost drivers. Results: A total of 80 patients, 40 from each intervention, were included in this study. Both functional and perceived health status improved after the intervention. The number of QALYs gained in the knee cohort was 4.64, while that in the hip cohort was 0.86. The total cost of knee replacement was lower (6,865.52 € than that of hip replacement (7,891.21 €. The cost per QALY gained was 1,275.84 € and 7,936.12 € for knee and hip interventions, respectively. The calculations performed included a 6% discount rate for health outcomes, a 3% inflation rate for costs, and a success rate of 95% at 15 years. Conclusions: The costs of both knee and hip replacement were lower than the threshold of 30,000 € per QALY considered acceptable in Spain, and compared favorably with other medical and surgical procedures.Fundamento y objetivos: Está ampliamente aceptada la toma de decisiones sanitarias basada en la eficiencia, con el coste por año de vida ajustado
Behringer, Donald C; Butler, Mark J; Shields, Jeffrey D
Transmissible pathogens are the bane of social animals, so they have evolved behaviours to decrease the probability of infection. There is no record, however, of social animals avoiding diseased individuals of their own species in the wild. Here we show how healthy, normally gregarious Caribbean spiny lobsters (Panulirus argus) avoid conspecifics that are infected with a lethal virus. Early detection and avoidance of infected, though not yet infectious, individuals by healthy lobsters confers a selective advantage and highlights the importance of host behaviour in disease transmission among natural populations.
Lester, Kathryn J; Lisk, Stephen C; Mikita, Nina; Mitchell, Sophie; Huijding, Jorg; Rinck, Mike; Field, Andy P
This study examined the effects of verbal information and approach-avoidance training on fear-related cognitive and behavioural responses about novel animals. One hundred and sixty children (7-11 years) were randomly allocated to receive: a) positive verbal information about one novel animal and threat information about a second novel animal (verbal information condition); b) approach-avoidance training in which they repeatedly pushed away (avoid) or pulled closer (approach) pictures of the animals (approach-avoidance training), c) a combined condition in which verbal information was given prior to approach-avoidance training (verbal information + approach-avoidance training) and d) a combined condition in which approach-avoidance training was given prior to verbal information (approach-avoidance training + verbal information). Threat and positive information significantly increased and decreased fear beliefs and avoidance behaviour respectively. Approach-avoidance training was successful in training the desired behavioural responses but had limited effects on fear-related responses. Verbal information and both combined conditions resulted in significantly larger effects than approach-avoidance training. We found no evidence for an additive effect of these pathways. This study used a non-clinical sample and focused on novel animals rather than animals about which children already had experience or established fears. The study also compared positive information/approach with threat information/avoid training, limiting specific conclusions regarding the independent effects of these conditions. The present study finds little evidence in support of a possible causal role for behavioural response training in the aetiology of childhood fear. However, the provision of verbal information appears to be an important pathway involved in the aetiology of childhood fear. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
Full Text Available In this paper, a novel approach for collision avoidance for indoor mobile robots based on human-robot interaction is realized. The main contribution of this work is a new technique for collision avoidance by engaging the human and the robot in generating new collision-free paths. In mobile robotics, collision avoidance is critical for the success of the robots in implementing their tasks, especially when the robots navigate in crowded and dynamic environments, which include humans. Traditional collision avoidance methods deal with the human as a dynamic obstacle, without taking into consideration that the human will also try to avoid the robot, and this causes the people and the robot to get confused, especially in crowded social places such as restaurants, hospitals, and laboratories. To avoid such scenarios, a reactive-supervised collision avoidance system for mobile robots based on human-robot interaction is implemented. In this method, both the robot and the human will collaborate in generating the collision avoidance via interaction. The person will notify the robot about the avoidance direction via interaction, and the robot will search for the optimal collision-free path on the selected direction. In case that no people interacted with the robot, it will select the navigation path autonomously and select the path that is closest to the goal location. The humans will interact with the robot using gesture recognition and Kinect sensor. To build the gesture recognition system, two models were used to classify these gestures, the first model is Back-Propagation Neural Network (BPNN, and the second model is Support Vector Machine (SVM. Furthermore, a novel collision avoidance system for avoiding the obstacles is implemented and integrated with the HRI system. The system is tested on H20 robot from DrRobot Company (Canada and a set of experiments were implemented to report the performance of the system in interacting with the human and avoiding
Full Text Available Resumen INTRODUCCIÓN La enfermedad cardiovascular constituye la principal causa de mortalidad a nivel mundial. Cuando se presenta un infarto agudo de miocardio se deben instaurar medidas en prevención secundaria, las cuales pueden disminuir la mortalidad en 50%. Las guías de práctica clínica establecen que un tratamiento médico óptimo se basa en cuatro grupos de fármacos: antiagregantes plaquetarios, estatinas, β-bloqueadores e inhibidores de la enzima convertidora de angiotensina o antagonistas de los receptores de la angiotensina II. OBJETIVO Determinar la adherencia a las recomendaciones de las guías de práctica clínica basadas en evidencia, sobre prevención secundaria en enfermedad coronaria establecida. MÉTODOS Se realizó un estudio observacional, tipo cohorte retrospectiva, en el Hospital Cayetano Heredia en Lima, Perú. Se incluyeron pacientes con diagnóstico confirmado de síndrome coronario agudo desde el 1 de febrero de 2011 hasta el 28 de febrero de 2013. Los datos que se recolectaron incluyeron anamnesis, examen físico, exámenes auxiliares y terapia médica al alta. Además, las prescripciones médicas fueron seguidas al primer, tercer y sexto mes posterior al alta. Se compararon las prescripciones médicas con las recomendaciones tipo I, nivel de evidencia A, de la guía de práctica clínica de la American Heart Association. RESULTADOS Se estudiaron 143 pacientes. De estos, 54 (37,8% tuvieron infarto de miocardio con ST elevado y 89 (62,2% pacientes tuvieron un infarto de miocardio con ST no elevado o angina inestable. Las cuatro estrategias terapéuticas seleccionadas para la prevención secundaria en enfermedad coronaria fueron indicadas en 40 (28% pacientes al alta y solo en 12,6%, 7% y 3,5% en el primer, tercer y sexto mes de seguimiento, respectivamente. Además, se describió la adherencia del paciente a asistir a la consulta en el servicio de cardiología al primer, tercer y sexto mes, observándose una
We describe a new algorithm for the enumeration of self-avoiding walks on the square lattice. Using up to 128 processors on a HP Alpha server cluster we have enumerated the number of self-avoiding walks on the square lattice to length 71. Series for the metric properties of mean-square end-to-end distance, mean-square radius of gyration and mean-square distance of monomers from the end points have been derived to length 59. An analysis of the resulting series yields accurate estimates of the critical exponents γ and ν confirming predictions of their exact values. Likewise we obtain accurate amplitude estimates yielding precise values for certain universal amplitude combinations. Finally we report on an analysis giving compelling evidence that the leading non-analytic correction-to-scaling exponent Δ 1 = 3/2
Wagenaar, C.; Mens, N.
Hospitals as a building type have undergone a substantial evolution in the past years. Changes in healthcare, the impact of evidence-based medicine and aspects of healthcare economics (such as the clustering of diagnostic procedures in specialized clinics) pose new and different challenges for the
... Search English Español Toddlers at the Table: Avoiding Power Struggles KidsHealth / For Parents / Toddlers at the Table: ... common concerns into opportunities to teach healthy eating habits. Most Toddlers Are Picky Eaters Many toddlers express ...
... patientinstructions/000865.htm How to avoid overheating during exercise To use the sharing features on this page, ... condition can get heat illness. Stay Cool During Exercise Try these tips to help prevent heat-related ...
Kulikovskaja, Viktorija; Aschemann-Witzel, Jessica
Food waste occurs throughout the entire food supply chain, from production to consumption of food in households. Retailers are in a unique position to contribute to food waste avoidance, not only by minimizing the amount of waste in their distribution channels but also by influencing consumer...... attitudes and behaviors. This explorative study aims to identify which food waste avoidance actions are conducted by retailers in Denmark, to which extent, and how they vary across food categories and supermarket chain. Based on an analysis of secondary and empirical data collected via observations...... at retail stores, the authors identify 22 food waste avoidance actions in Danish retail. The results provide new insights into food waste avoidance in retail. Based on the findings, suggestions for further research directions are developed that should serve to identify the most efficient customer targeted...
Wang, Yu; Garcia-Luna-Aceves, J. J
This paper analyzes the performance of directional collision avoidance schemes, in which antenna systems are used to direct the transmission and reception of control and data packets in channel access...
... Global Map Premature Birth Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal ... during pregnancy Foods to avoid or limit during pregnancy E-mail to a friend Please fill in ...
... Issues Subscribe January 2014 Print this issue Avoiding Anemia Boost Your Red Blood Cells En español Send ... Disease When Blood Cells Bend Wise Choices Preventing Anemia To prevent or treat iron-deficiency anemia: Eat ...
Indah Dwi Pratama; Ujang Sumarwan; Hari Wijayanto
One factor that can interfere with the absorption rate of viewers on television advertisement is advertising avoidance which shows the difference between the number of viewers who watch advertisement programs and the number of viewers who watch television programs. The factors that affect advertising avoidance include the demography of the viewers (gender, age, area of residence, and social economic status, or SES), advertising attributes (the television stations, order of ads, genre of the p...
COVERED (From- To) 09-05-2011 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Sinkhole Avoidance Routing in Wireless Sensor Networks 5b . GRANT NUMBER . 5c...reliability of wireless sensor networks. 15. SUBJECT TERMS wireless sensor networks, sinkhole attack, routing protocol 16. SECURITY CLASSIFICATION...Include area code) Standard Form 298 (Rev. 8/98) Prescribed by ANSI Std . Z39.18 1 Sinkhole Avoidance Routing in Wireless Sensor Networks MIDN 1/C
O Nions, E.; Viding, E.; Greven, C. U.; Ronald, A.; Happé, F.
'Pathological Demand Avoidance' is a term increasingly used by practitioners in the United Kingdom. It was coined to describe a profile of obsessive resistance to everyday demands and requests, with a tendency to resort to 'socially manipulative' behaviour, including outrageous or embarrassing acts. Pathological demand avoidance is thought to share aspects of social impairment with autism spectrum disorders, but autism spectrum disorder-appropriate strategies, such as routine and repetition, ...
Full Text Available AbstractObjective: Evidence in the literature suggests peculiar personality traits for fibromyalgic patients, and it has been suggested that personality characteristics may be involved in patients' different symptomatic events and responses to treatment. The aim of the study is to investigate the personality characteristics of Italian FM patients and to explore the possibility of clustering them considering both personality traits and clinical characteristics.Design: The study used a cross-sectional methodology and involved a control group. A self-assessment procedure was used for data gathering. The study included 87 female FM patients and 83 healthy females. Patients were approached and interviewed in person during a psychiatric consultation. Healthy people were recruited from general practices with previous telephone contact.Main Outcome Measures: Participants responded to the Hospital Anxiety and Depression Scale (HADS, the Temperament and Character Inventory (TCI, the Fibromyalgia Impact Questionnaire (FIQ and the Short-Form-36 Health Survey (SF-36.Results: FM patients scored significantly different from healthy participants on the Harm-Avoidance (HA, Novelty Seeking (NS and Self-Directedness (SD. Two clusters were identified: patients in Cluster 1 (n=37 had higher scores on HA and lower scores on RD, SD and Cooperativeness and reported more serious fibromyalgia and more severe anxious-depressive symptomatology than did patients in Cluster 2 (n=46.Conclusion: This study confirms the presence of certain personality traits in the FM population. In particular, high levels of Harm Avoidance and low levels of Self-Directedness characterize a subgroup of FM patients with more severe anxious-depressive symptomatology. According to these findings, personality assessment could be useful in the diagnostic process to tailor therapeutic interventions to the personality characteristics.
Common sense dictates that one should choose tried and tested drugs with proven, concrete benefits that outweigh their adverse effects. Many new drugs are approved each year, often despite a lack of solid evidence that they are any better than existing treatments. Worse, some are approved despite being less effective or more harmful than current options. Massive promotion is used to ensure that such drugs achieve a positive image in the eyes of healthcare professionals and patients. Renowned "opinion leaders" intervene in their favour at conferences and in specialist media, and their opinions are further propagated by specialists in the field. Finally, campaigns in the lay media are used to highlight the target illness, encouraging patients to request a prescription. New data sometimes show that older, initially promising drugs are less effective or more harmful than first thought. For all these reasons, many drugs that are now present on the market are more harmful than beneficial and should be avoided. Unfortunately, negative assessment data and warnings are often drowned in the flood of promotion and advertising. Front-line healthcare professionals who are determined to act in their patients' best interests can find themselves swimming against a tide of specialist opinion, marketing authorisation, and reimbursement decisions. By leaving drugs that are more harmful than beneficial on the market and contenting themselves with simple half-measures, healthcare authorities are failing in their duty to protect patients. Prescrire, a journal funded solely by its subscribers, does not seek to do the work of health authorities, and does not have the means to do so. Prescrire's goal is simply to help healthcare professionals provide better care. The following text lists the principal drugs that we consider more harmful than beneficial, based on our reviews published between 2010 and 2012 in our French edition. These drugs should not be used. Patients and healthcare
Indah Dwi Pratama
Full Text Available One factor that can interfere with the absorption rate of viewers on television advertisement is advertising avoidance which shows the difference between the number of viewers who watch advertisement programs and the number of viewers who watch television programs. The factors that affect advertising avoidance include the demography of the viewers (gender, age, area of residence, and social economic status, or SES, advertising attributes (the television stations, order of ads, genre of the program, and advertising sector, and competition (DayPart. The study attempted to measure the level of advertising avoidance in Indonesia and its relation to various factors that influence it by using the secondary data generated by Nielsen Audience Measurement Indonesia through Television Audience Measurement (TAM. The methods utilized consisted of the t-test independent sample, one way ANOVA, Tukey, Kruskal Wallis, and Dunn Bonferoni. The result showed that the level of advertising avoidance in Indonesia reached by 23%, with relatively similar results to the other studies in various countries. The hypothesis test results also showed a significant relationship between the advertising avoidance and demographic variables, advertising attributes, and competitions affecting this avoidance. On one hand, the findings of the study are expected to be useful for the advertisers to plan their advertisements on television so that they become more effective and efficient. On the other hand, television stations can utilize these findings as a development strategy to expand their audience segmentation and to accommodate the needs of the advertisers more optimally.Keywords: advertising avoidance, television advertisement, TAM, ANOVA, Tukey
Norris, Mark L; Spettigue, Wendy J; Katzman, Debra K
Mark L Norris,1 Wendy J Spettigue,2 Debra K Katzman3 1Division of Adolescent Medicine, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada; 2Department of Psychiatry, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada; 3Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada Abstract: Avoidant/restrictive food intak...
AVOID work stream (WS1)one has produced emission scenarios that simulate potential future global emission pathways for greenhouse gases during the 21st century. The study explored the influence of three key features of such pathways: (1) the year in which emissions peak globally, (2) the rate of emission reduction, and (3) the minimum level to which emissions are eventually reduced. It examined the resultant climate change, climate change impacts and economic implications using computer simulations. Avoided impacts, carbon taxes and GDP change increase throughout the 21st century in the models. AVOID-WS1 showed that in the absence of climate policy it is very likely that global mean temperatures would exceed 3 degrees and there are evens chances that the temperature would rise by 4 degrees relative to pre-industrial times. Scenarios that peak emissions in 2016 were more effective at constraining temperatures to below 3 degrees than those that peaked in 2030: one ‘2016' scenario achieved a probability of 45% of avoiding breaching of a 2 degree threshold. Scenarios peaking in 2030 were inconsistent with constraining temperatures to below 2 degrees. Correspondingly, scenarios that peak in 2030 are more effective at avoiding climate impacts than scenarios that peak in 2016, for all sectors that we studied. Hence the date at which emissions peak is more important than the rate of subsequent emissions reduction in determining the avoided impacts. Avoided impacts increase with time, being negligible in the 2030s, significant by the 2050s and large by the 2080s. Finally, the choice of GCM influences the magnitude of the avoided impacts strongly, so that the uncertainties in our estimates of avoided impacts for each scenario are larger than the difference between the scenarios. Our economic analysis is based on models which differ greatly in the assumptions that they make, but generally show that the date at which emissions peak is a stronger driver of induced GDP changes
Wilson, Robert S; Buchman, Aron S; Arnold, Steven E; Shah, Raj C; Tang, Yuxiao; Bennett, David A
The relation of personality to disability in old age is not well understood. The authors examined the relation of harm avoidance, a trait indicating a tendency to worry, fear uncertainty, be shy, and tire easily, to disability in a group of 474 older persons without dementia. Participants completed the 35-item Harm Avoidance scale. Disability was assessed with the Rosow-Breslau scale, a self-report measure of physical mobility. Performance-based tests of lower limb functions were also administered from which composite measures of gait, balance, and strength were derived. In a logistic regression model controlled for age, sex, education, and lower limb function, persons with high levels of harm avoidance were nearly three times as likely to report mobility limitations as persons with low levels, and these effects largely reflected fatigability and fear of uncertainty. The association of harm avoidance with disability was not explained or modified by frailty, physical activity, depressive symptoms, neuroticism, extraversion, or cognition. The results suggest that harm avoidance is associated with disability in old age.
Rape has been a recurrent adaptive problem for many species, including humans. Rape is costly to women in terms of disease transmission, partner abandonment, and unwanted pregnancy (among other costs). Therefore, behavioral strategies which allow women to avoid coercive men may have been favored by selection. In line with this evolutionary reasoning, the current research documented that physically stronger women and those in a committed romantic relationship reported more rape avoidance behavior. In addition, virgin women tended to perform more rape avoidance behavior compared with their non-virgin counterparts. Women with high conception risk perceived themselves as physically stronger, which may protect them against a potential rapist. Fear of unwanted pregnancy from rape decreased as age increased, reflecting higher fertility among younger participants. However, older women reported more rape avoidance behavior, which contradicts evolutionary predictions. The results provide some support for evolutionary hypotheses of rape avoidance behavior which suggest that woman's perception of rape is influenced by parental investment and perceived physical condition.
Samuel, Joseph; Sinha, Supurna; Ghosh, Abhijit
We present a theoretical treatment of DNA stretching and twisting experiments, in which we discuss global topological subtleties of self-avoiding ribbons and provide an underlying justification for the worm-like rod chain (WLRC) model proposed by Bouchiat and Mezard. Some theoretical points regarding the WLRC model are clarified: the 'local writhe formula' and the use of an adjustable cut-off parameter to 'regularize' the model. Our treatment brings out the precise relation between the worm-like chain (WLC), the paraxial worm-like chain (PWLC) and the WLRC models. We describe the phenomenon of 'topological untwisting' and the resulting collapse of link sectors in the WLC model and note that this leads to a free energy profile periodic in the applied link. This periodicity disappears when one takes into account the topology of self-avoidance or at large stretch forces (paraxial limit). We note that the difficult non-local notion of self-avoidance can be replaced (in an approximation) by the simpler local notion of 'south avoidance'. This gives an explanation for the efficacy of the approach of Bouchiat and Mezard in explaining the 'hat curves' using the WLRC model, which is a south avoiding model. We propose a new class of experiments to probe the continuous transition between the periodic and aperiodic behaviour of the free energy
Johnson, H D; LaVoie, J C; Spenceri, M C; Mahoney-Wernli, M A
Failure to resolve peer conflict is associated with children's reports of loneliness, social anxiety, and social avoidance. Although these relationships are well established, researchers have not examined the association between the avoidance of peer conflict and various adjustment characteristics. The current study examined the association between avoidance of conflict and measures of loneliness, social anxiety, and social avoidance for 59 pupils in Grade 4 (31 boys and 28 girls) and 47 in Grade 8 (22 boys and 25 girls). Volunteers indicated that conflict avoidance based on autonomy, e.g., independence issues, and interpersonal issues, e.g., closeness and cohesion, was associated with scores on loneliness for boys and girls, respectively. Conflict avoidance for emotional and physical well-being and fear of punishment was associated with increased reports of loneliness and social anxiety for children in Grade 4.
De Callatay, A.
A project of layered software architecture is proposed: a safety-critical real-time non-stop simple kernel system includes a layer avoiding threatening actions from operators or programs in other control systems. Complex process-control applications (such as fuzzy systems) are useful for the smooth operation of the system, optimum productivity, efficient diagnostics, and safe management of degraded modes of operation. Defects in these complex process-control applications do not have an impact on safety if their commands have first to be accepted by a safety-critical module. The development, testing, and certification of complex applications computed in the outside layers can be made simpler and less expensive than for those in the kernel. Avoidance systems use rule-base systems having negative fuzzy conditions and actions. Animal and human behaviour cannot be explained without active avoidance
A new apparatus for active avoidance training in rats consists of a short, wide runway which can be tilted from a horizontal to vertical position. One half of the electrifiable grid floor is covered by a nonconducting sheet. For brightness (black-white) discrimination training a white walled goal box can be inserted into the runway and shifted from left to right during training. Avoidance training of 24 rats (female Wistar SPF) required 14.1 +/- 2.6 (mean +/- SEM) to-criterion trials (9/10) and was completed in less than 4 min. Brightness discrimination training required 21.3 +/- 2.1 to-criterion trials and the time of training did not exceed 12 min. The retention of the acquired responses was very good in both cases. The main advantage of the apparatus is very rapid acquisition of the one-way and discriminated avoidance without the necessity of manual manipulation of the animal.
M. Paul Latiolais
Full Text Available This paper is an informal, personal account of how we, as two college teachers, became interested in math anxiety, decided to explore it amongst students at our institution in order to inform our teaching, and became convinced that the massive problem is math avoidance. We tried discussion groups, but few students attended, although those that did made useful suggestions. Thus informed, we designed an innovative course, Confronting College Mathematics as a Humanities course with the possibility of credit toward the math requirement, but it was undersubscribed in its first offering and had to be canceled. How can we get college students who avoid math to break through the barrier of math avoidance? We have now begun to explore a new approach: Second Life, where students can engage math—and quantitative literacy—virtually, and anonymously.
Blumstein, Daniel T; Rangchi, Tiana N; Briggs, Tiandra; De Andrade, Fabrine Souza; Natterson-Horowitz, Barbara
Species that scavenge on dead animals are exposed to enhanced disease risks. Eight hypotheses have been suggested to explain how scavengers avoid becoming sick from their diet. We conducted a systematic review of the literature and found correlative support for four of the eight hypotheses but limited evidence of systematic studies of the hypotheses. We found no support that using urine to sterilize carcasses, having bald heads, eating rapidly, or food-washing behavior reduced disease risk in carrion eaters. With the exception of food washing, none of these hypotheses have been properly evaluated as an adaptation to avoid sickness from carrion. There is some support for having a specialized microbiome, having enhanced immunologic defenses, avoiding rotten food, and maintaining a low gastric pH to eliminate pathogens. Specialized immunologic defenses and having a low pH have the most support, but the diversity of mechanisms suggests that there is a great opportunity for even more detailed study. Increased knowledge in these mechanisms may provide biomimetic insights to help combat foodborne illnesses and enhance health.
Holst, Malene Kirstine
foundation. The basis of the present study lies in solving the architectural design problem in order to respond to functionalities and performances. The emphasis is the practical applicability for architects, engineers and hospital planners for assuring usability and a holistic approach of functionalities...... a correlation matrix. The correlation factor defines the framework for conceptual design, whereby the design considers functionalities and their requirements and preferences. It facilitates implementation of evidence-based design as it is prepared for ongoing update and it is based on actual data. Hence......, this contribution is a model for hospital design, where design derives as a response to the defined variables, requirements and preferences....
Erik, Baekkeskov; Rubin, Olivier
from day one about 2009 H1N1 flu. To explore why, this article links crisis information dilemmas to blame avoidance concepts from democratic political theories. We argue that greater Chinese transparency about infectious disease response reflects evolution in blame avoidance, from heavy reliance...... on information control to insulating leaders by using technical experts and agencies as 'lightning rods.' In 2003, the Chinese strategy of information containment and secrecy backfired, and the Chinese leadership eventually received blame at home and internationally for crisis mismanagement. In 2009, China put...... in place public health specialists and institutions as responsible for H1N1 information and responses, thereby insulating the top-tier leadership....
Full Text Available The purpose of this study is to investigate the earnings management behavior of companies listed in the Indonesia Stock Exchange (ISE. Specifically, the study investigates whether companies engaging in real earnings management or accrual management intent to avoid negative earnings; it also examines whether earnings management behavior supports efficient contracting or opportunistic behavior perspective. The sample of this study comprised 166 firm-years of manufacturing industrial sector during the period 2004 – 2005. Using multiple regressions, the study finds evidence that the companies engage in both earnings management, which are discretionary expenses (proxy of real earnings management and accruals management. This evidence supports the studies of Graham, Harvey, & Rajgopal (2005 and Roychowdhury (2006. Another result shows that the real earnings management conducted by the companies is efficient partially, while the accruals management is opportunistic.
This review summarizes past and recent findings in the empiric literature and the evolution of the concepts of avoidant personality disorder (APD) and social phobia (SP). APD is an internally consistent dimensional personality pathology that causes dysfunction that appears to be dimensional rather than a sudden jump in impairment after a certain number of criteria have been met. It has state and trait personality components. Evidence indicates that symptoms are at least partially treatable with psychological or pharmacologic interventions. APD and SP have similar symptoms and treatment response and identical genetics. We can conclude from the empiric evidence that no dividing line exists between APD and SP, with APD merely being the more severe form of the disorder. The best conceptualization is that APD is a dimensional personality pathology that in its attenuated form (SP) resembles an anxiety disorder.
Beyer, B. (Bianca)
Abstract The purpose of this thesis is to find evidence about national-scale economic instability (especially reflected in the impacts of the financial crisis) being present also on a business level, namely in the form of corporate tax avoidance. A broad strand of literature copes with the topic of corporate tax avoidance. The research stems mostly from companies located in the United States. This thesis combines the approa...
Welsh, J.S.; Turek, M.; Mackie, T.R.; Miller, P.; Mehta, M.P.; Forrest, L.J.
Helical tomotherapy provides a unique means of delivering intensity-modulated radiation therapy (IMRT) using a novel treatment unit, which merges features of a linear accelerator with a helical CT scanner. Thanks to the CT imaging capacity, targeted regions can be visualized prior to, during, or immediately after each treatment. Such image-guidance through megavoltage CT will allow the realization and refinement of the concept of adaptive radiotherapy - the reconstruction of the actually delivered daily dose (as opposed to planned dose) accompanied by prescription adjustments when appropriate. In addition to this unique feature, helical tomotherapy promises further improvements in the specific avoidance of critical normal structures, i.e. conformal avoidance, the counterpart of conformal therapy. The first definitive treatment protocol using helical tomotherapy is presently underway for dogs with nasopharyngeal tumors. In general, such tumors can be treated with conventional external beam radiation therapy but at the cost of severe ocular toxicity due to the anatomy of the canine head. These are readily measurable toxicities and are almost universal in incidence; therefore, the canine nasopharyngeal tumor presents an ideal model to assess the ability to conformally avoid critical structures. It is hoped that conformal avoidance helical tomotherapy will improve tumor control via dose-escalation while reducing ocular toxicity in these veterinary patients. A total of 10 fractions are scheduled for these patients; the first 3 dogs have all received at least 7 fractions delivered via helical tomotherapy. Although preliminary, the first 3 dogs treated have not shown any evidence of ocular toxicity in this ongoing study
Quinn, Barbara; Baker, Dian L; Cohen, Shannon; Stewart, Jennifer L; Lima, Christine A; Parise, Carol
Nonventilator hospital-acquired pneumonia (NV-HAP) is an underreported and unstudied disease, with potential for measurable outcomes, fiscal savings, and improvement in quality of life. The purpose of our study was to (a) identify the incidence of NV-HAP in a convenience sample of U.S. hospitals and (b) determine the effectiveness of reliably delivered basic oral nursing care in reducing NV-HAP. A descriptive, quasi-experimental study using retrospective comparative outcomes to determine (a) the incidence of NV-HAP and (b) the effectiveness of enhanced basic oral nursing care versus usual care to prevent NV-HAP after introduction of a basic oral nursing care initiative. We used the International Statistical Classification of Diseases and Related Problems (ICD-9) codes for pneumonia not present on admission and verified NV-HAP diagnosis using the U.S. Centers for Disease Control and Prevention diagnostic criteria. We completed an evidence-based gap analysis and designed a site-specific oral care initiative designed to reduce NV-HAP. The intervention process was guided by the Influencer Model (see Figure) and participatory action research. We found a substantial amount of unreported NV-HAP. After we initiated our oral care protocols, the rate of NV-HAP per 100 patient days decreased from 0.49 to 0.3 (38.8%). The overall number of cases of NV-HAP was reduced by 37% during the 12-month intervention period. The avoidance of NV-HAP cases resulted in an estimated 8 lives saved, $1.72 million cost avoided, and 500 extra hospital days averted. The extra cost for therapeutic oral care equipment was $117,600 during the 12-month intervention period. Cost savings resulting from avoided NV-HAP was $1.72 million. Return on investment for the organization was $1.6 million in avoided costs. NV-HAP should be elevated to the same level of concern, attention, and effort as prevention of ventilator-associated pneumonia in hospitals. Nursing needs to lead the way in the design and
Larkin, Ronald [Univ. of Illinois, Urbana, IL (United States). Board of Trustees
A DOE-sponsored research project found strong evidence that flying wildlife avoid or are attracted to commercial-scale wind turbines from a distance. Some nocturnally migrating birds avoid flying near turbines and few or none change flight paths to approach them. High-flying bats less often avoid flying near turbines and some are attracted to them from a distance, although bats’ flight paths were often complex and convoluted. The findings are being prepared for submission to a peer-reviewed scientific journal (Larkin, in prep 2013).
Li, Yu-Fang; Chao, Minston; Shih, Chih-Ting
Studies that examined the negative impact of violence in emergency departments on nurses' leave and avoidance behavior are well-documented. However, few studies provided an integrated model of how and when violence influences their leave and avoidance behavior. The study adopted Affective Events Theory to propose and examine a model of violent events, negative emotions, and (leave and avoidance) behaviors on nurses in emergency departments and further analyzed whether the model is salient to nurses' occupational burnout, nursing experience, and nursing rank. The sample included 123 emergency department nurses at a teaching hospital in northern, Taiwan. All participants had experienced violent incidents within the preceding 6 months. Moderated mediation analysis suggested that nurses experienced one of two emotional processes following violent incidents: "violence-negative feelings toward work-intention to resign" or "violence-negative emotion and physical symptoms-avoidance tendencies." Moreover, nurses with high burnout levels expressed weaker intention to resign after violent incidents, while nurses with more experience and higher rank were less likely to avoid violence after violent incidents. Emergency nurses do not simply elect to escape but may engage in avoidance behavior. This study revealed that how violent incidents affect nurses' resignation or avoidance behaviors depends on how they feel. Occupational burnout and nurses' attributes affected their behavior. Copyright © 2017 Elsevier Ltd. All rights reserved.
Knockaert, J.; Bakens, J.; Ettema, D.F.; Verhoef, E.
The Dutch road network is becoming increasingly congested. In late 2006, a group of companies, universities and government institutions established the Spitsmijden project. ‘Spitsmijden’ is the Dutch term for ‘avoiding the peak’. This joint initiative aimed to identify and assess a short-term
Shamoun-Baranes, J.; Bouten, W.; Sierdsema, H.; van Belle, J.; van Gasteren, J.R.; van Loon, E.E.
The NL-BAM was developed as a web-based decision support tool to be used by the bird hazard avoidance experts in the ecology unit of the Royal Netherlands Air Force. The NL-BAM will be used together with the ROBIN 4 radar system to provide BirdTAMS, for real time warnings and flight planning and to
Vonk Noordegraaf, D.M.; Annema, J.A.
Peak Hour Avoidance is a relatively new Dutch mobility management measure. To reduce congestion frequent car drivers are given a financial reward for reducing the proportion of trips that they make during peak hours on a specific motorway section. Although previous studies show that employers are
Noordegraaf, D.M.V.; Annema, J.A.
Peak Hour Avoidance is a relatively new Dutch mobility management measure. To reduce congestion frequent car drivers are given a financial reward for reducing the proportion of trips that they make during peak hours on a specific motorway section. Although previous studies show that employers are
Roskes, Marieke; Elliot, Andrew J.; Nijstad, Bernard A.; De Dreu, Carsten K. W.
Compared to approach motivation, avoidance motivation evokes vigilance, attention to detail, systematic information processing, and the recruitment of cognitive resources. From a conservation of energy perspective it follows that people would be reluctant to engage in the kind of effortful cognitive
Roskes, Marieke; Elliot, Andrew J.; Nijstad, Bernard A.; De Dreu, Carsten K W
Compared to approach motivation, avoidance motivation evokes vigilance, attention to detail, systematic information processing, and the recruitment of cognitive resources. From a conservation of energy perspective it follows that people would be reluctant to engage in the kind of effortful cognitive
O'Nions, Elizabeth; Viding, Essi; Greven, Corina U; Ronald, Angelica; Happé, Francesca
"Pathological Demand Avoidance" is a term increasingly used by practitioners in the United Kingdom. It was coined to describe a profile of obsessive resistance to everyday demands and requests, with a tendency to resort to "socially manipulative" behaviour, including outrageous or embarrassing acts. Pathological demand…
HAIRIAH, K; VANNOORDWIJK, M; STULEN, [No Value; KUIPER, PJC
The hypothesis was tested that the avoidance of acid subsoil by the velvet bean Mucuna pruriens is based on a mechanism acting on the whole root system rather than on individual roots. In a split-root experiment with circulating nutrient solution the growth of plants with Al-containing (+/+) or
Audit incorporating avoidability and appropriate intervention can significantly decrease perinatal mortality. H. R. G. Ward, G. R. Howarth, O. J. N. Jennings,. R. C. Pattinson .... 6 months) and seven interns. The study was .... maternity care notes study: a randomized control trial to assess the effects of giving expectant mothers ...
Loomans, B.A.C.; Mine, A.; Roeters, F.J.M.; Opdam, N.J.M.; Munck, J. De; Huysmans, M.C.D.N.J.M.; Meerbeek, B. Van
Hydrofluoric acid can be used for intra-oral repair of restorations. Contamination of tooth substrate with hydrofluoric acid cannot always be avoided. OBJECTIVES: To investigate the bonding effectiveness to hydrofluoric acid contaminated dentin by, micro-tensile bond strength testing, SEM and TEM.
Renshaw, Domeena C.
Discusses the complexities of sexual avoidance, or Hypoactive Sexual Desire (HSD), a previously neglected aspect of a couple's relationship. Suggests that learning from a therapist to accept and enjoy other forms of sexual exchange can open up new horizons of physical and emotional intimacy. (Contains 17 references.) (GCP)
Wang, Dizhong; Lin, Jiajian
Recent years, the flight control technology over quadcopter has been boosted vigorously and acquired the comprehensive application in a variety of industries. However, it is prominent for there to be problems existed in the stable and secure flight with the development of its autonomous flight. Through comparing with the characteristics of ultrasonic ranging and laser Time-of-Flight(abbreviated to ToF) distance as well as vision measurement and its related sensors, the obstacle detection and identification sensors need to be installed in order to effectively enhance the safety flying for aircraft, which is essential for avoiding the dangers around the surroundings. That the major sensors applied to objects perception at present are distance measuring instruments which based on the principle and application of non-contact detection technology . Prior to acknowledging the general principles of flight and obstacle avoiding, the aerodynamics modeling of the quadcopter and its object detection means has been initially determined on this paper. Based on such premise, this article emphasized on describing and analyzing the research on obstacle avoiding technology and its application status, and making an expectation for the trend of its development after analyzing the primary existing problems concerning its accuracy object avoidance.
... to-date information, please visit the Centers for Disease Control and Prevention's (CDC) website -- www.cdc.gov/zika . To prevent getting the Zika virus, take steps to avoid mosquito bites. Sexual transmission of the virus can be prevented by using condoms ...
Bolinger, Mark; Wiser, Ryan
The Utah Wind Working Group (UWWG) believes there are currently opportunities to encourage wind power development in the state by seeking changes to the avoided cost tariff paid to qualifying facilities (QFs). These opportunities have arisen as a result of a recent renegotiation of Pacificorp's Schedule 37 tariff for wind QFs under 3 MW, as well as an ongoing examination of Pacificorp's Schedule 38 tariff for wind QFs larger than 3 MW. It is expected that decisions made regarding Schedule 38 will also impact Schedule 37. Through the Laboratory Technical Assistance Program (Lab TAP), the UWWG has requested (through the Utah Energy Office) that LBNL provide technical assistance in determining whether an alternative method of calculating avoided costs that has been officially adopted in Idaho would lead to higher QF payments in Utah, and to discuss the pros and cons of this method relative to the methodology recently adopted under Schedule 37 in Utah. To accomplish this scope of work, I begin by summarizing the current method of calculating avoided costs in Utah (per Schedule 37) and Idaho (the ''surrogate avoided resource'' or SAR method). I then compare the two methods both qualitatively and quantitatively. Next I present Pacificorp's four main objections to the use of the SAR method, and discuss the reasonableness of each objection. Finally, I conclude with a few other potential considerations that might add value to wind QFs in Utah.
Rinck, M.; Becker, E.S.
We examined attitudes towards spiders by employing an Approach-Avoidance Task, in which participants respond to pictures by pulling a joystick towards themselves or by pushing it away from themselves. For spider fearfuls, this stimulus–response assignment is either compatible (push spiders away) or
The efficacy of diets advocating extreme macronutrient manipulation has been reviewed extensively. Studies involving participation for 12 months or longer revealed that diet adherence, length of intervention and level of calorie. ISSUES IN MEDICINE. Achieving weight loss and avoiding obesity. Maria Elizabeth Catsicas.
Leadership is increasingly recognized as an important factor in moving schools forward, yet we have been relatively random in how we prepare and support them. Four obstacles often block or diminish their effectiveness. Avoiding or overcoming each of these requires an underlying set of skills and knowledge that we believe can be learned and…
Nuralifmida Ayu Annisa
Full Text Available This study aims to find out how the influence of the corporate governance of tax avoidanceactivity in companies listed on Indonesia Stock Exchange in 2008. The samples are publiclytraded company listed on the Indonesia Stock Exchange in 2008 as many as 200 companies. Thisstudy uses data analysis and regression analysis of the elements of corporate governance and taxavoidance. The results of this study show that the elements of corporate governance that consist ofaudit quality and audit committee significantly influence the activity of tax avoidance as measuredusing proxy book tax gap. Other results show that the tax avoidance activity as measured withproxy book tax gap are not affected significantly by institutional ownership and board ofcommissioners. Limitation of this study is not to use each type of industries as control variable socan’t identify the direct effect from type of industry on tax avoidance. Another limitation of thisstudy is use corporate governance’s proxy separately, so it can’t capture the full effect ofcorporate governance. Keywords:corporate governance, ownership structure, board of commissioners, audit committee,tax avoidance, book tax gap.
Every day we encounter many threats to survival: a car speeding on a small street or an angry neighbor carrying an axe. Mostly, people go through their days not worrying that their chance of survival might be small. They avoid many dangers without even thinking about them (e.g., looking at both
Shams, Qamar A. (Inventor); Zuckerwar, Allan J. (Inventor); Knight, Howard K. (Inventor)
A wake vortex avoidance system includes a microphone array configured to detect low frequency sounds. A signal processor determines a geometric mean coherence based on the detected low frequency sounds. A display displays wake vortices based on the determined geometric mean coherence.
Andersen, Martin Marchman
In “Health, Luck and Justice” Shlomi Segall argues for a luck egalitarian approach to justice in health care. As the basis for a just distribution he suggests a principle of Reasonable Avoidability, which he takes to imply that we do not have justice-based reasons to treat diseases brought about...
Stuyt, Floran H.A.; Römer, GertWillem R.B.E.; Stuyt, Harry .J.A.
The efficiency of a rehabilitation robot is improved by offering record-and-replay to operate the robot. While automatically moving to a stored target (replay) collisions of the robot with obstacles in its work space must be avoided. A simple, though effective, generic and deterministic algorithm
Dreyer, L; Andersen, A; Pukkala, E
around the year 2000, with 1,890 among men and fewer than 25 among women. The proportions that could be avoided if industrial carcinogens were eliminated would be 70% of mesotheliomas, 20% of cancers of the nasal cavity and sinuses, 12% of lung cancers, 5% of laryngeal cancers, 2% of urinary bladder...
Reb, Jochen; Connolly, Terry
Decision makers can become trapped by "myopic regret avoidance" in which rejecting feedback to avoid short-term "outcome regret" (regret associated with counterfactual outcome comparisons) leads to reduced learning and greater long-term regret over continuing poor decisions. In a series of laboratory experiments involving repeated choices among…
Zhou, Zhuping; Cai, Yifei; Ke, Ruimin; Yang, Jiwei
Grouping is a common phenomenon in pedestrian crowds and group modeling is still an open challenging problem. When grouping pedestrians avoid each other, different patterns can be observed. Pedestrians can keep close with group members and avoid other groups in cluster. Also, they can avoid other groups separately. Considering this randomness in avoidance patterns, we propose a collision avoidance model for two-pedestrian groups. In our model, the avoidance model is proposed based on velocity obstacle method at first. Then grouping model is established using Distance constrained line (DCL), by transforming DCL into the framework of velocity obstacle, the avoidance model and grouping model are successfully put into one unified calculation structure. Within this structure, an algorithm is developed to solve the problem when solutions of the two models conflict with each other. Two groups of bidirectional pedestrian experiments are designed to verify the model. The accuracy of avoidance behavior and grouping behavior is validated in the microscopic level, while the lane formation phenomenon and fundamental diagrams is validated in the macroscopic level. The experiments results show our model is convincing and has a good expansibility to describe three or more pedestrian groups.
U.S. Department of Health & Human Services — Welcome to hospitalinspections.org, a website run by the Association of Health Care Journalists (AHCJ) that aims to make federal hospital inspection reports easier...
Full Text Available A new scale measuring patient-therapist attachment avoidance was developed. Attachment Avoidance in Therapy Scale is a new measure based on the Bartholomew model of adult attachment (Bartholomew & Horowitz, 1991 and the Experience in Close Relationships Scale (Brennan, Clark, & Shaver, 1998 to measure patients’ attachment avoidance towards therapists. With 112 patient-therapist dyads participating in the study, validation of a preliminary scale – measuring both attachment anxiety and attachment avoidance in therapy – took place using therapists’ evaluations of patients’ relational behavior and patients’ self-reports about their attitude toward psychotherapy. Analysis of the data revealed six underlying scales. Results showed all six scales to be reliable. Validation of scales measuring attachment anxiety failed. The importance of Attachment Avoidance in Therapy Scale and its subscales is discussed.
Full Text Available Decision making in invertebrates often relies on simple neural circuits composed of only a few identified neurons. The relative simplicity of these circuits makes it possible to identify the key computation and neural properties underlying decisions. In this review, we summarize recent research on the neural basis of ultrasound avoidance in crickets, a response that allows escape from echolocating bats. The key neural property shaping behavioral output is high-frequency bursting of an identified interneuron, AN2, which carries information about ultrasound stimuli from receptor neurons to the brain. AN2's spike train consists of clusters of spikes –bursts– that may be interspersed with isolated, non-burst spikes. AN2 firing is necessary and sufficient to trigger avoidance steering but only high-rate firing, such as occurs in bursts, evokes this response. AN2 bursts are therefore at the core of the computation involved in deciding whether or not to steer away from ultrasound. Bursts in AN2 are triggered by synaptic input from nearly synchronous bursts in ultrasound receptors. Thus the population response at the very first stage of sensory processing –the auditory receptor- already differentiates the features of the stimulus that will trigger a behavioral response from those that will not. Adaptation, both intrinsic to AN2 and within ultrasound receptors, scales the burst-generating features according to the stimulus statistics, thus filtering out background noise and ensuring that bursts occur selectively in response to salient peaks in ultrasound intensity. Furthermore AN2’s sensitivity to ultrasound varies adaptively with predation pressure, through both developmental and evolutionary mechanisms. We discuss how this key relationship between bursting and the triggering of avoidance behavior is also observed in other invertebrate systems such as the avoidance of looming visual stimuli in locusts or heat avoidance in beetles.
This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation.
A Hospitalidade e a Gestão de Restaurantes: Evidências de um Estudo Múltiplo de Casos em São Paulo, Brasil / The hospitality and restaurant management: evidences from a multiple case study in São Paulo, SP, Brazil
Mario da Silva Oliveira
Full Text Available O setor dos serviços de alimentação mudou significativamente nas últimas três décadas. O estilo familiar que antes imperava deu lugar a empreendimentos profissionalizados. Este artigo busca compreender esta evolução a partir da relação entre os conceitos da gestão de restaurantes e a hospitalidade. Para atender este objetivo elaborou-se um estudo múltiplo de caso envolvendo quatro restaurantes de diferentes posicionamentos, em São Paulo/SP, todos reconhecidos por seu sucesso há mais de quinze anos. O estudo da identidade dos estabelecimentos possibilita a concepção de processos operacionais e sua relação com a hospitalidade. Os resultados do estudo sugerem que a gestão da hospitalidade nos restaurantes pesquisados é prioritária para seus dirigentes, que atestam sua importância na complexa gestão do negócio efazem-no eficientemente. Conclui-se que um plano inicial de ação e o posicionamento temático são, assim como o plano de negóciose procedimentos financeiros,indispensáveis para o sucesso e perenidade destes empreendimentos. The hospitality and restaurant management: evidences from a multiple case study in São Paulo, SP, Brazil - The sector of food service has changed significantly over the past three decades. The familiar style that prevailed before gave way to professionalized endeavors. This article seeks to understand this evolution from the relationship between the concepts of hospitality and restaurant management. To meet this goal was prepared a multiple case study involving four different positions restaurants in São Paulo (Brazil, all recognized for their success for over fifteen years. The study of the identity of establishments enables the design of business processes and their relationship with the hospitality. The study results suggest that hospitality management in the surveyed restaurants is a priority for their leaders to attest to its importance in the complex management of the business and do
Full Text Available Taking ARM embedded Linux operating system as the development platform,combined with AVR microcontroller,while optimizing the ranging algorithm and using air ultrasonic transducer,the measurement range of which can be up to 50 meter,this paper designs a high-precision,range far,low price,various models suitable automobile collision avoidance warning system.The system adopts Forlinx OK6410 development board for the master.AVR microcontroller is responsible for taking the data of traveling distance between vehicles,and with the ARM development board via RS232 communication transfers vehicle′s distance and speed information to the ARM development boards.The system uses the established collision avoidance model to get alarm information.Experiments show that the system can accurately send out alarm information within a certain range.It is innovative and practical.
Freeman, Todd I
Executive compensation packages have long included stock options and deferred compensation plans in order to compete for talent. Last year, Congress passed a law in response to the Enron debacle, in which executives were perceived to be protecting their deferred compensation at the expense of employees, creditors, and investors. The new law is designed to protect companies and their shareholders from being raided by the very executives that guided the company to financial ruin. Physicians who are part owners of medical practices need to know about the changes in the law regarding deferred compensation and how to avoid costly tax penalties. This article discusses how the changes affect medical practices as well as steps physician-owned clinics can take to avoid the risk of penalty, such as freezing deferred compensation and creating a new deferred compensation plan.
Full Text Available In this paper we try to develop an algorithm for visual obstacle avoidance of autonomous mobile robot. The input of the algorithm is an image sequence grabbed by an embedded camera on the B21r robot in motion. Then, the optical flow information is extracted from the image sequence in order to be used in the navigation algorithm. The optical flow provides very important information about the robot environment, like: the obstacles disposition, the robot heading, the time to collision and the depth. The strategy consists in balancing the amount of left and right side flow to avoid obstacles, this technique allows robot navigation without any collision with obstacles. The robustness of the algorithm will be showed by some examples.
There are three specific purposes of Construction Dispute Research. First, this volume aims to summarise studies on construction dispute. Second, apart from the theoretical constructs, where appropriate empirical tests are also included. This approach serves to go beyond the commonly used anecdotal approach for the subject matters. Third, it is the sincere hope of the authors that this book will help shaping research agenda of construction dispute. The studies are mostly framed from a management perspective drawing on methods and concepts in contract law, economics, psychology and management science. The book has twenty chapters that are arranged in four parts covering conceptualisation, avoidance, negotiation and mediation. Part 1 is devoted for dispute conceptualisation. A building is only as strong as its foundation. Thus it is no better start to study construction dispute by conceptualisation. The theme of Part 2 is dispute avoidance. The conventional wisdom of ‘prevention is better than cure’ se...
Newman, Paul; McKenzie, Richard
Temporal and geographical variabilities in the future "World Expected" UV environment are compared with the "World Avoided", which would have occurred without the Montreal Protocol on protection of the ozone layer and its subsequent amendments and adjustments. Based on calculations of clear-sky UV irradiances, the effects of the Montreal Protocol have been hugely beneficial to avoid the health risks, such as skin cancer, which are associated with high UV, while there is only a small increase in health risks, such as vitamin D deficiency, that are associated with low UV. However, interactions with climate change may lead to changes in cloud and albedo, and possibly behavioural changes which could also be important.
Hirsh, H L
The liability of hospitals in tort law has been a fairly recent development. Formerly, hospitals were protected from liability under the doctrine of charitable immunity. Legal "immunity" avoids liability in tort essentially under all circumstances. It is conferred not because of the particular facts of the situation but because of the status or position of the favored defendant. It does not deny the tort, merely the resulting liability. Such immunity does not mean that conduct that would amount to a tort on the part of other defendants is not still equally tortious in character, but merely that for the protection of the particular defendant, or of the interests which he represents, he is given absolution from liability. Similarly, the "captain-of-the-ship" and the attendant "borrowed or lent servant" doctrine is being abandoned. As medical technology continues to advance, the modern hospital will undoubtedly assume a greater responsibility toward its patients--with amplified medical-legal implications. The hospital is no longer a hotel where patients stay, awaiting treatment by their private physicians. The theory that the hospital does not act through its employees--physicians, nurses, and others--no longer reflects the trend in judicial philosophy. The decisions cited reflect the current trend in judicial analysis and thinking. Medical science has provided numerous benefits to humankind, but along with those benefits, numerous risks have accrued. Whether hospitals should have to bear the responsibilities inherent in such risks is a much-argued matter. However, hospital liability, in fact, is the trend of our judicial determination. The ramifications of this trend have been many. Hospitals and physicians will closely scrutinize surgical operations and other hospitals procedures and practices. The fact remains clear that responsibility for every patient is now shared by both the physicians and the hospital--share and share alike. The present thinking is that the
Uziel, Guy; El-Yaniv, Ran
We present a novel online ensemble learning strategy for portfolio selection. The new strategy controls and exploits any set of commission-oblivious portfolio selection algorithms. The strategy handles transaction costs using a novel commission avoidance mechanism. We prove a logarithmic regret bound for our strategy with respect to optimal mixtures of the base algorithms. Numerical examples validate the viability of our method and show significant improvement over the state-of-the-art.
GUY A. FRENCH JOSEPH C. PRICE, MAJ, USAF Work Unit Manager Acting Chief, Supervisory Control and Cognition Branch Supervisory Control and Cognition...19a. NAME OF RESPONSIBLE PERSON (Monitor) a. REPORT Unclassified b. ABSTRACT Unclassified c. THIS PAGE Unclassified Guy French 19b. TELEPHONE...the ability to detect and safely avoid other aircraft in flight ( Cook & Davis, 2013). In order to increase UAS flight safety and support UAS
Full Text Available The problem of resolving issues pertaining to tax avoidance, and particularly its aggressive forms, has been the focal point of discussion among tax scholars which is increasingly gaining attention of politicians alike. As opposed to tax evasion (which is illegal, the phenomenon of tax avoidance calls for careful consideration of state fiscal interests and a highly precise demarcation of the thin line between the acceptable and unacceptable conduct. In many contemporary states, tax avoidance (which implies a formal behaviour of tax payers within the limits of tax legislation but contrary to the tax regulation objectives is declared to be illegitimate. State authorities do not want to tolerate such activity, which results in tax payers' reduction or avoidance of tax liabilities. We should also bear in mind that all tax payers have the tax planning option at their disposal, by means of which they make sure that they do not pay more tax than they are legally obliged to. However, in case they skilfully use the tax regulation flaws and loopholes for the sole purpose of tax evasion, and/or resort to misrepresentation and deceptive constructs, they are considered to be exceeding the limits of acceptable tax behaviour. In comparison to the specific anti-abuse measures which have been built into some national tax legislations, there is a growing number of states that introduce the general anti-abuse legislations, which is based on judicial doctrines or statutory legislation. Yet, there is a notable difference among the envisaged anti-abuse measures depending on whether the national legislation is based on the Anglo-American or European-Continental legal system. The efficiency of applying these general anti-abuse rules in taxation largely rests on their interpretation as well as on their relationship with the principle of legality.
the top of a flight of stairs selects for climbing ; suspending the robot and the target object above the ground and creating rungs between the two will...REPORT Avoiding Local Optimawith Interactive Evolutionary Robotics 14. ABSTRACT 16. SECURITY CLASSIFICATION OF: The main bottleneck in evolutionary... robotics has traditionally been the time required to evolve robot controllers. However with the continued acceleration in computational resources, the
The paper presents the main causes that determine double taxation, its forms, i.e. the economicdouble taxation and the international legal double taxation, the need for eliminating the double taxation andavoiding methods. In the presentation of the avoidance methods have been used practical examples forcomparison of the tax advantages for income beneficiary between: the total exemption method andprogressive exemption method, on the one hand, and total crediting method and ordinary crediting m...
Gillan, Claire M; Apergis-Schoute, Annemieke M; Morein-Zamir, Sharon; Urcelay, Gonzalo P; Sule, Akeem; Fineberg, Naomi A; Sahakian, Barbara J; Robbins, Trevor W
Objective The goal of this study was to determine the neural correlates of excessive habit formation in obsessive-compulsive disorder (OCD). We aimed to (i) test for neurobiological convergence with the known pathophysiology of OCD and (ii) infer, based on abnormalities in brain activation, whether these habits arise from dysfunction in the goal-directed or habit system. Method Thirty-seven OCD patients and 33 controls learned to avoid shocks while undergoing a functional Magnetic Resonance Imaging (fMRI) scan. Following 4 blocks of training, we tested if the avoidance response had become a habit by removing the threat of shock and measuring continued avoidance. We tested for task-related differences in brain activity in 3 ROIs, the caudate, putamen and medial orbitofrontal cortex at a statistical threshold of phabit formation in OCD patients, which was associated with hyper-activation in the caudate. Activation in this region was also associated with subjective ratings of increased urge to perform habits. The OCD group, as a whole, showed hyper-activation in the medial orbitofrontal cortex (mOFC) during the acquisition of avoidance, however this did not relate directly to habit formation. Conclusions OCD patients exhibited excessive habits that were associated with hyper-activation in a key region implicated in the pathophysiology of OCD, the caudate nucleus. Prior studies suggest that this region is important for goal-directed behavior, suggesting that habit-forming biases in OCD may be a result of impairments in this system, rather than differences in the build up of stimulus-response habits themselves. PMID:25526600
Sahawneh, Laith Rasmi
The increasing demand to integrate unmanned aircraft systems (UAS) into the national airspace is motivated by the rapid growth of the UAS industry, especially small UAS weighing less than 55 pounds. Their use however has been limited by the Federal Aviation Administration regulations due to collision risk they pose, safety and regulatory concerns. Therefore, before civil aviation authorities can approve routine UAS flight operations, UAS must be equipped with sense-and-avoid technology comparable to the see-and-avoid requirements for manned aircraft. The sense-and-avoid problem includes several important aspects including regulatory and system-level requirements, design specifications and performance standards, intruder detecting and tracking, collision risk assessment, and finally path planning and collision avoidance. In this dissertation, our primary focus is on developing an collision detection, risk assessment and avoidance framework that is computationally affordable and suitable to run on-board small UAS. To begin with, we address the minimum sensing range for the sense-and-avoid (SAA) system. We present an approximate close form analytical solution to compute the minimum sensing range to safely avoid an imminent collision. The approach is then demonstrated using a radar sensor prototype that achieves the required minimum sensing range. In the area of collision risk assessment and collision prediction, we present two approaches to estimate the collision risk of an encounter scenario. The first is a deterministic approach similar to those been developed for Traffic Alert and Collision Avoidance (TCAS) in manned aviation. We extend the approach to account for uncertainties of state estimates by deriving an analytic expression to propagate the error variance using Taylor series approximation. To address unanticipated intruders maneuvers, we propose an innovative probabilistic approach to quantify likely intruder trajectories and estimate the probability of
Hallem, Elissa A; Sternberg, Paul W
Carbon dioxide is produced as a by-product of cellular respiration by all aerobic organisms and thus serves for many animals as an important indicator of food, mates, and predators. However, whether free-living terrestrial nematodes such as Caenorhabditis elegans respond to CO2 was unclear. We have demonstrated that adult C. elegans display an acute avoidance response upon exposure to CO2 that is characterized by the cessation of forward movement and the rapid initiation of backward movement. This response is mediated by a cGMP signaling pathway that includes the cGMP-gated heteromeric channel TAX-2/TAX-4. CO2 avoidance is modulated by multiple signaling molecules, including the neuropeptide Y receptor NPR-1 and the calcineurin subunits TAX-6 and CNB-1. Nutritional status also modulates CO2 responsiveness via the insulin and TGFbeta signaling pathways. CO2 response is mediated by a neural circuit that includes the BAG neurons, a pair of sensory neurons of previously unknown function. TAX-2/TAX-4 function in the BAG neurons to mediate acute CO2 avoidance. Our results demonstrate that C. elegans senses and responds to CO2 using multiple signaling pathways and a neural network that includes the BAG neurons and that this response is modulated by the physiological state of the worm.
Milanés, Vicente; Alonso, Luciano; Villagrá, Jorge; Godoy, Jorge; de Pedro, Teresa; Oria, Juan P.
In recent years, the development of advanced driver assistance systems (ADAS) - mainly based on lidar and cameras - has considerably improved the safety of driving in urban environments. These systems provide warning signals for the driver in the case that any unexpected traffic circumstance is detected. The next step is to develop systems capable not only of warning the driver but also of taking over control of the car to avoid a potential collision. In the present communication, a system capable of autonomously avoiding collisions in traffic jam situations is presented. First, a perception system was developed for urban situations—in which not only vehicles have to be considered, but also pedestrians and other non-motor-vehicles (NMV). It comprises a differential global positioning system (DGPS) and wireless communication for vehicle detection, and an ultrasound sensor for NMV detection. Then, the vehicle's actuators - brake and throttle pedals - were modified to permit autonomous control. Finally, a fuzzy logic controller was implemented capable of analyzing the information provided by the perception system and of sending control commands to the vehicle's actuators so as to avoid accidents. The feasibility of the integrated system was tested by mounting it in a commercial vehicle, with the results being encouraging.
Kumar, P Mohan; Priya, N Swapna; Musalaiah, Svvs; Nagasree, M
Plagiarism has become more common in both dental and medical communities. Most of the writers do not know that plagiarism is a serious problem. Plagiarism can range from simple dishonesty (minor copy paste/any discrepancy) to a more serious problem (major discrepancy/duplication of manuscript) when the authors do cut-copy-paste from the original source without giving adequate credit to the main source. When we search databases like PubMed/MedLine there is a lot of information regarding plagiarism. However, it is still a current topic of interest to all the researchers to know how to avoid plagiarism. It's time to every young researcher to know ethical guidelines while writing any scientific publications. By using one's own ideas, we can write the paper completely without looking at the original source. Specific words from the source can be added by using quotations and citing them which can help in not only supporting your work and amplifying ideas but also avoids plagiarism. It is compulsory to all the authors, reviewers and editors of all the scientific journals to know about the plagiarism and how to avoid it by following ethical guidelines and use of plagiarism detection software while scientific writing.
Kumar, P Mohan; Priya, N Swapna; Musalaiah, SVVS; Nagasree, M
Plagiarism has become more common in both dental and medical communities. Most of the writers do not know that plagiarism is a serious problem. Plagiarism can range from simple dishonesty (minor copy paste/any discrepancy) to a more serious problem (major discrepancy/duplication of manuscript) when the authors do cut-copy-paste from the original source without giving adequate credit to the main source. When we search databases like PubMed/MedLine there is a lot of information regarding plagiarism. However, it is still a current topic of interest to all the researchers to know how to avoid plagiarism. It's time to every young researcher to know ethical guidelines while writing any scientific publications. By using one's own ideas, we can write the paper completely without looking at the original source. Specific words from the source can be added by using quotations and citing them which can help in not only supporting your work and amplifying ideas but also avoids plagiarism. It is compulsory to all the authors, reviewers and editors of all the scientific journals to know about the plagiarism and how to avoid it by following ethical guidelines and use of plagiarism detection software while scientific writing. PMID:25364588
Cooper, Bethany; Burton, Michael; Crase, Lin
In most urban cities across Australia, water restrictions remain the dominant policy mechanism to restrict urban water consumption. The extensive adoption of water restrictions as a means to limit demand, over several years, means that Australian urban water prices have consistently not reflected the opportunity cost of water. Given the generally strong political support for water restrictions and the likelihood that they will persist for some time, there is value in understanding households' attitudes in this context. More specifically, identifying the welfare gains associated with avoiding urban water restrictions entirely would be a nontrivial contribution to our knowledge and offer insights into the benefits of alternative policy responses. This paper describes the results from a contingent valuation study that investigates consumers' willingness to pay to avoid urban water restrictions. Importantly, the research also investigates the influence of cognitive and exogenous dimensions on the utility gain associated with avoiding water restrictions. The results provide insights into the impact of the current policy mechanism on economic welfare.
Dranove, D; White, W D; Wu, L
This study examines evidence of market segmentation on the basis of patients' insurance status, demographic characteristics, and medical condition in selected local markets in California in the years 1983 and 1989. Substantial differences exist in the probability patients may be admitted to particular hospitals based on insurance coverage, particularly Medicaid, and race. Segmentation based on insurance and race is related to hospital characteristics, but not the characteristics of the hospital's community. Medicaid patients are more likely to go to hospitals with lower costs and fewer service offerings. Privately insured patients go to hospitals offering more services, although cost concerns are increasing. Hispanic patients also go to low-cost hospitals, ceteris paribus. Results indicate little evidence of segmentation based on medical condition in either 1983 or 1989, suggesting that "centers of excellence" have yet to play an important role in patient choice of hospital. The authors found that distance matters, and that patients prefer nearby hospitals, moreso for some medical conditions than others, in ways consistent with economic theories of consumer choice.
Vanderbeke Dave; Christiaens Johan; Verbruggen Sandra
Although the number of non-profit audit fee studies recently has risen, evidence in the hospital sector is rather scarce. Apart from NHS studies, hospitals are a fairly new topic and several specific fee determinants are yet to be tested. For instance, hospitals can have a private or a public status and they have a distinct number of clinical services. These and other dependent variables known from earlier research are added to a fee model and investigated. As hypothesized the hospital status...
Full Text Available The author of this paper (Dr. Ivo Pezzuto has been one of the first authors to write back in 2008 about the alleged "subprime mortgage loans fraud" which has triggered the 2008 financial crisis, in combination with multiple other complex, highly interrelated, and concurrent factors. The author has been also one of the first authors to report in that same working paper of 2008 (available on SSRN and titled "Miraculous Financial Engineering or Toxic Finance? The Genesis of the U.S. Subprime Mortgage Loans Crisis and its Consequences on the Global Financial Markets and Real Economy" the high probability of a Eurozone debt crisis, due to a number of unsolved structural macroeconomic problems, the lack of a single crisis resolution scheme, current account imbalances, and in some countries, housing bubbles/high private debt. In the book published in 2013 and titled "Predictable and Avoidable: Repairing Economic Dislocation and Preventing the Recurrence of Crisis", Dr. Ivo Pezzuto has exposed the root causes of the financial crisis in order to enables readers to understand that the crisis we have seen was predictable and should have been avoidable, and that a recurrence can be avoided, if lessons are learned and the right action taken. Almost one year after the publication of the book "Predictable and Avoidable: Repairing Economic Dislocation and Preventing the Recurrence of Crisis", the author has decided to write this working paper to explore what happened in the meantime to the financial markets and to the financial regulation implementation. Most of all, the author with this working paper aims to provide an updated analysis as strategist and scenario analyst on the topics addressed in the book "Predictable and Avoidable" based on a forward-looking perspective and on potential "tail risk" scenarios. The topics reported in this paper relate to financial crises; Government policy; financial regulation; corporate governance; credit risk management
Mahnaz Shoghi, MSN
Conclusion: The findings showed a noticeable trend of a rising number of assaults against nurses. The findings of this study may help hospital staff and nurses to avoid, reduce and control violence and abuse.
May 20, 2015 ... minimally invasive surgery of the chest where a thoracotomy is avoided, access .... 6 patients (24%), spontaneous pneumothorax in. 5 patients (20%) ... involves less surgical trauma and results in a reduction in hospital stay..
National Aeronautics and Space Administration — IAI proposes an innovative collision avoidance radar and communication technology to detect and track both cooperative and non-cooperative targets. The system...
Guindon, G Emmanuel; Driezen, Pete; Chaloupka, Frank J; Fong, Geoffrey T
Decades of research have produced overwhelming evidence that tobacco taxes reduce tobacco use and increase government tax revenue. The magnitude and effectiveness of taxes in reducing tobacco use provide an incentive for tobacco users, manufacturers and others, most notably criminal networks, to devise ways to avoid or evade tobacco taxes. Consequently, tobacco tax avoidance and tax evasion can reduce the public health and fiscal benefit of tobacco taxes. First, this study aims to document, using data from the International Tobacco Control Policy Evaluation Project (ITC), levels and trends in cigarette users' tax avoidance and tax evasion behaviour in a sample of 16 low-, middle- and high-income countries. Second, this study explores factors associated with cigarette tax avoidance and evasion. We used data from ITC surveys conducted in 16 countries to estimate the extent and type of cigarette tax avoidance/evasion between countries and across time. We used self-reported information about the source of a smoker's last purchase of cigarettes or self-reported packaging information, or similar information gathered by the interviewers during face-to-face interviews to measure tax avoidance/evasion behaviours. We used generalised estimating equations to explore individual-level factors that may affect the likelihood of cigarette tax avoidance or evasion in Canada, the USA, the UK and France. We found prevalence estimates of cigarette tax avoidance/evasion vary substantially between countries and across time. In Canada, France and the UK, more than 10% of smokers reported last purchasing cigarettes from low or untaxed sources, while in Malaysia some prevalence estimates suggested substantial cigarette tax avoidance/evasion. We also found important associations between household income and education and the likelihood to engage in tax avoidance/evasion. These associations, however, varied both in direction and magnitude across countries.
Guindon, G. Emmanuel; Driezen, Pete; Chaloupka, Frank J.; Fong, Geoffrey T.
Background Decades of research have produced overwhelming evidence that tobacco taxes reduce tobacco use and increase government tax revenue. The magnitude and effectiveness of taxes at reducing tobacco use provide an incentive for tobacco users, manufacturers and others, most notably criminal networks, to devise ways to avoid or evade tobacco taxes. Consequently, tobacco tax avoidance and tax evasion can reduce the public health and fiscal benefit of tobacco taxes. Objectives First, this study aims to document, using data from the International Tobacco Control Policy Evaluation Project (ITC), levels and trends in cigarette users’ tax avoidance and tax evasion behaviour in a sample of sixteen low-, middle- and high-income countries. Second, this study explores factors associated with cigarette tax avoidance and evasion. Methods We use data from ITC surveys conducted in 16 countries to estimate the extent and the type of cigarette tax avoidance/evasion between countries and across time. We use self-reported information about the source of a smoker’s last purchase of cigarettes or self-reported packaging information, or similar information gathered by the interviewers during face-to-face interviews to measure tax avoidance/evasion behaviours. We use generalized estimating equations (GEE) to explore individual-level factors that may affect the likelihood of cigarette tax avoidance or evasion in Canada, United States, United Kingdom and France. Findings We find prevalence estimates of cigarette tax avoidance/evasion vary substantially between countries and across time. In Canada, France and the United Kingdom, more than 10% of smokers report last purchasing cigarettes from low or untaxed sources while in Malaysia, some prevalence estimates suggest substantial cigarette tax avoidance/evasion. We also find important associations between household income and education and the likelihood to engage in tax avoidance/evasion. These associations, however, vary both in
Laurel S. Morris
Full Text Available Background: Functional neurological disorder (FND is an elusive disorder characterized by unexplained neurological symptoms alongside aberrant cognitive processing and negative affect, often associated with amygdala reactivity. Methods: We examined the effect of negative conditioning on cognitive function and amygdala reactivity in 25 FND patients and 20 healthy volunteers (HV. Participants were first conditioned to stimuli paired with negative affective or neutral (CS+/CS− information. During functional MRI, subjects then performed an instrumental associative learning task to avoid monetary losses in the context of the previously conditioned stimuli. We expected that FND patients would be better at learning to avoid losses when faced with negatively conditioned stimuli (increased harm avoidance. Multi-echo resting state fMRI was also collected from the same subjects and a robust denoising method was employed, important for removing motion and physiological artifacts. Results: FND subjects were more sensitive to the negative CS+ compared to HV, demonstrated by a reinforcement learning model. Contrary to expectation, FND patients were generally more impaired at learning to avoid losses under both contexts (CS+/CS−, persisting to choose the option that resulted in a negative outcome demonstrated by both behavioural and computational analyses. FND patients showed enhanced amygdala but reduced dorsolateral prefrontal cortex responses when they received negative feedback. Patients also had increased resting state functional connectivity between these two regions. Conclusions: FND patients had impaired instrumental avoidance learning, findings that parallel previous observations of impaired action-outcome binding. FND patients further show enhanced behavioural and neural sensitivity to negative information. However, this did not translate to improved avoidance learning. Put together, our findings do not support the theory of harm avoidance in FND
Full Text Available A life-support service robot must avoid both static and dynamic obstacles for working in a real environment. Here, a static obstacle means an obstacle that does not move, and a dynamic obstacle is the one that moves. Assuming the robot is following a target person, we discuss how the robot avoids a crowd through which the target person passes and arrives at the target position. The purpose of this paper is to propose a crowd avoidance method that makes a robot to be able to avoid both static and dynamic obstacles. The method uses the surface points of the obstacles to form an avoidance region, and the robot moves along the edge of the region. We conducted experiments assuming various situations such that the robot was blocked, there was a wide gap in the crowd, or a person in the crowd yielded for the robot to pass through. As an experimental result, it was confirmed the robot could avoid the crowd even when the obstacles were aligned in an “inverted wedge” shape.
, results were pooled using Review Manager 5 Version 5.1; otherwise, results were summarized descriptively. Data from RCTs were analyzed using intention-to-treat protocols. In addition, a sensitivity analysis was done assigning all missing data/withdrawals to the event. P values less than 0.05 were considered significant. A priori subgroup analyses were planned for the acuity of hospital-at-home program, type of hospital-at-home program (early discharge or admission avoidance), and severity of the patients’ COPD. Additional subgroup analyses were conducted as needed based on the identified literature. Post hoc sample size calculations were performed using STATA 10.1. Quality of Evidence The quality of each included study was assessed, taking into consideration allocation concealment, randomization, blinding, power/sample size, withdrawals/dropouts, and intention-to-treat analyses. The quality of the body of evidence was assessed as high, moderate, low, or very low according to the GRADE Working Group criteria. The following definitions of quality were used in grading the quality of the evidence: High Further research is very unlikely to change confidence in the estimate of effect. Moderate Further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate. Low Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate. Very Low Any estimate of effect is very uncertain. Summary of Findings Fourteen studies met the inclusion criteria and were included in this review: 1 health technology assessment, 5 systematic reviews, and 7 RCTs. The following conclusions are based on low to very low quality of evidence. The reviewed evidence was based on RCTs that were inadequately powered to observe differences between hospital-at-home and inpatient hospital care for most outcomes, so there is a strong possibility of type II error. Given the low to very
Norbury, Agnes; Kurth-Nelson, Zeb; Winston, Joel S; Roiser, Jonathan P; Husain, Masud
Sensation-seeking is a trait that constitutes an important vulnerability factor for a variety of psychopathologies with high social cost. However, little is understood either about the mechanisms underlying motivation for intense sensory experiences or their neuropharmacological modulation in humans. Here, we first evaluate a novel paradigm to investigate sensation-seeking in humans. This test probes the extent to which participants choose either to avoid or self-administer an intense tactile stimulus (mild electric stimulation) orthogonal to performance on a simple economic decision-making task. Next we investigate in a different set of participants whether this behavior is sensitive to manipulation of dopamine D2 receptors using a within-subjects, placebo-controlled, double-blind design. In both samples, individuals with higher self-reported sensation-seeking chose a greater proportion of mild electric stimulation-associated stimuli, even when this involved sacrifice of monetary gain. Computational modelling analysis determined that people who assigned an additional positive economic value to mild electric stimulation-associated stimuli exhibited speeding of responses when choosing these stimuli. In contrast, those who assigned a negative value exhibited slowed responses. These findings are consistent with involvement of low-level, approach-avoidance processes. Furthermore, the D2 antagonist haloperidol selectively decreased the additional economic value assigned to mild electric stimulation-associated stimuli in individuals who showed approach reactions to these stimuli under normal conditions (behavioral high-sensation seekers). These findings provide the first direct evidence of sensation-seeking behavior being driven by an approach-avoidance-like mechanism, modulated by dopamine, in humans. They provide a framework for investigation of psychopathologies for which extreme sensation-seeking constitutes a vulnerability factor. © The Author 2015. Published by
Alyahya, Mohammad S; Hijazi, Heba H; Alshraideh, Hussam A; Al-Nasser, Amjad D
There is a growing concern that reduction in hospital length of stay (LOS) may raise the rate of hospital readmission. This study aims to identify the rate of avoidable 30-day readmission and find out the association between LOS and readmission. All consecutive patient admissions to the internal medicine services (n = 5,273) at King Abdullah University Hospital in Jordan between 1 December 2012 and 31 December 2013 were analyzed. To identify avoidable readmissions, a validated computerized algorithm called SQLape was used. The multinomial logistic regression was firstly employed. Then, detailed analysis was performed using the Decision Trees (DTs) model, one of the most widely used data mining algorithms in Clinical Decision Support Systems (CDSS). The potentially avoidable 30-day readmission rate was 44%, and patients with longer LOS were more likely to be readmitted avoidably. However, LOS had a significant negative effect on unavoidable readmissions. The avoidable readmission rate is still highly unacceptable. Because LOS potentially increases the likelihood of avoidable readmission, it is still possible to achieve a shorter LOS without increasing the readmission rate. Moreover, the way the DT model classified patient subgroups of readmissions based on patient characteristics and LOS is applicable in real clinical decisions.
Current concepts in leadership and governance on the level of supervisory board, management and departments are often considered as insufficient to cope with the profound structural change which actually takes place in the German health care system. While vertical and horizontal disconnecting is typical of the professional bureaucracy of hospitals, transition from functional to divisional structure further increases this risk. Accordingly, medical experts are oriented towards their professional peers and patient care on the one side; on the other side the management gets isolated and looses operative and strategic control. Several studies provide evidence for the relevance of role models to serve as agents of change, which are now developed into the concept of "Clinical Governance": evidence-based medicine, guidelines, continuous quality improvement, safety culture, resource accountability and organisational learning. The present situation makes it necessary to extend this conception, which focuses on the departmental level in an organisation with divisional features, to one of "Clinical Corporate Governance". This term, which also includes supervisory structures and the management board and is relevant for the total hospital and company, respectively, is based on the corporate governance concept. Inside the hospital, the management and the heads of the departments have to agree that (1) experts really need to be integrated into the decision process, and that (2) the outcomes of the entire hospital have to be regarded as equal or superior to the aims of a single department. The public image of the hospital should be one of a strong and reliable partner in health care and health care business on a local, regional and national level. Members of the supervisory board should clearly put corporate aspects above political and other implications and pay attention to personal independence from the leaders of the medical departments.
Phipps, Alison; Barnett, Ronald
Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…
Bedini, A; Owczarek, A L; Prellberg, T
Self-avoiding walks and self-avoiding trails, two models of a polymer coil in dilute solution, have been shown to be governed by the same universality class. On the other hand, self-avoiding walks interacting via nearest-neighbour contacts (ISAW) and self-avoiding trails interacting via multiply visited sites (ISAT) are two models of the coil-globule, or collapse transition of a polymer in dilute solution. On the square lattice it has been established numerically that the collapse transition of each model lies in a different universality class. The models differ in two substantial ways. They differ in the types of subsets of random walk configurations utilized (site self-avoidance versus bond self-avoidance) and in the type of attractive interaction. It is therefore of some interest to consider self-avoiding trails interacting via nearest-neighbour attraction (INNSAT) in order to ascertain the source of the difference in the collapse universality class. Using the flatPERM algorithm, we have performed computer simulations of this model. We present numerical evidence that the singularity in the free energy of INNSAT at the collapse transition has a similar exponent to that of the ISAW model rather than the ISAT model. This would indicate that the type of interaction used in ISAW and ISAT is the source of the difference in the universality class. (paper)
Stockley, J M; Constantine, C E; Orr, K E
Infection control input is vital throughout the planning, design and building stages of a new hospital project, and must continue through the commissioning (and decommissioning) process, evaluation and putting the facility into full clinical service. Many hospitals continue to experience problems months or years after occupying the new premises; some of these could have been avoided by infection control involvement earlier in the project. The importance of infection control must be recognized by the chief executive of the hospital trust and project teams overseeing the development. Clinical user groups and contractors must also be made aware of infection control issues. It is vital that good working relationships are built up between the infection control team (ICT) and all these parties. ICTs need the authority to influence the process. This may require their specific recognition by the Private Finance Initiative National Unit, the Department of Health or other relevant authorities. ICTs need training in how to read design plans, how to write effective specifications, and in other areas with which they may be unfamiliar. The importance of documentation and record keeping is paramount. External or independent validation of processes should be available, particularly in commissioning processes. Building design in relation to infection control needs stricter national regulations, allowing ICTs to focus on more local usage issues. Further research is needed to provide evidence regarding the relationship between building design and the prevalence of infection.
Reid, Jane M; Arcese, Peter; Keller, Lukas F; Germain, Ryan R; Duthie, A Bradley; Losdat, Sylvain; Wolak, Matthew E; Nietlisbach, Pirmin
Extra-pair reproduction is widely hypothesized to allow females to avoid inbreeding with related socially paired males. Consequently, numerous field studies have tested the key predictions that extra-pair offspring are less inbred than females' alternative within-pair offspring, and that the probability of extra-pair reproduction increases with a female's relatedness to her socially paired male. However, such studies rarely measure inbreeding or relatedness sufficiently precisely to detect subtle effects, or consider biases stemming from failure to observe inbred offspring that die during early development. Analyses of multigenerational song sparrow (Melospiza melodia) pedigree data showed that most females had opportunity to increase or decrease the coefficient of inbreeding of their offspring through extra-pair reproduction with neighboring males. In practice, observed extra-pair offspring had lower inbreeding coefficients than females' within-pair offspring on average, while the probability of extra-pair reproduction increased substantially with the coefficient of kinship between a female and her socially paired male. However, simulations showed that such effects could simply reflect bias stemming from inbreeding depression in early offspring survival. The null hypothesis that extra-pair reproduction is random with respect to kinship therefore cannot be definitively rejected in song sparrows, and existing general evidence that females avoid inbreeding through extra-pair reproduction requires reevaluation given such biases. © 2014 The Author(s). Evolution © 2014 The Society for the Study of Evolution.
Full Text Available This paper discusses how to avoid plagiarism in a research paper. Avoiding plagiarism is part of a scientific writing ethic that always stated in any publication. Every writer should pay attention to their papers submitted to a journal or a scientific forum that they are free from unethical conduct. Writing a research paper needs overall accuracy especially in avoiding plagiarism in the paper that is to be published in a journal or to be presented at a certain scientific meeting, seminar or symposium. It is based on writers’ experience as a paper writer as well as a journal reviewer. The first application that the writers use is ‘checker’, a Mac computer application, used to check spelling and grammar. It assists the writers to check how misspelling and an ungrammatical inaccuracy in the writers’ papers. The second free application is ‘plagiarism checker’. Checking originality of a paper is essential and it is not too difficult to do today. It is freely accessible that plagiarism checker can be used to check how original the paper is. By visiting “Google” then write down ‘plagiarism checker’, it will appear ‘smallseatools’ and then the writers could choose and check how original the paper is. This application is freely accessed and helps immensely to check how original a paper is and how far a paper is free from plagiarism. The unoriginal phrase will be underlined and marked red and finally will be shown how inimitable the paper is. Plagiarism scan report which consists of the date of the report, plagiarism status, total words and total characters can be downloaded.
Bischoff, Andrea; Levitt, Marc A; Lawal, Taiwo A; Peña, Alberto
Colostomy is an operation frequently performed in pediatric surgery. Despite its benefits, it can produce significant morbidity. In a previous publication we presented our experience with the errors and complications that occurred during cases of colostomy creation. We now have focused in the morbidity related to the colostomy closure. The technical details that might have contributed to the minimal morbidity we experienced are described. The medical records of 649 patients who underwent colostomy closure over a 28-year period were retrospectively reviewed looking for complications following these procedures. Our perioperative protocol for colostomy closure consisted in: clear fluids by mouth and repeated proximal stoma irrigations 24 h prior to the operation. Administration of IV antibiotics during anesthesia induction and continued for 48 h. Meticulous surgical technique that included: packing of the proximal stoma, plastic drape to immobilize the surgical field, careful hemostasis, emphasis in avoiding contamination, cleaning the edge of the stomas to allow a good 2-layer, end-to-end anastomosis with separated long-term absorbable sutures, generous irrigation of the peritoneal cavity and subsequent layers with saline solution, closure by layers to avoid dead space, and avoidance of hematomas. No drains and no nasogastric tubes were used. Oral fluids were started the day after surgery and patients were discharged 48-72 h after the operation. The original diagnoses of the patients were: anorectal malformation (583), Hirschsprung's disease (53), and others (13). 10 patients (1.5%) had complications: 6 had intestinal obstruction (5 due to small bowel adhesions, 1 had temporary delay of the function of the anastomosis due to a severe size discrepancy between proximal and distal stoma with a distal microcolon) and 4 incisional hernias. There were no anastomotic dehiscences or wound infection. There was no bleeding, no anastomotic stricture and no mortality. Based on
Robertson, Edward A.; Carson, John M., III
The Precision Landing and Hazard Avoidance (PL&HA) domain addresses the development, integration, testing, and spaceflight infusion of sensing, processing, and GN&C functions critical to the success and safety of future human and robotic exploration missions. PL&HA sensors also have applications to other mission events, such as rendezvous and docking. Autonomous PL&HA builds upon the core GN&C capabilities developed to enable soft, controlled landings on the Moon, Mars, and other solar system bodies. Through the addition of a Terrain Relative Navigation (TRN) function, precision landing within tens of meters of a map-based target is possible. The addition of a 3-D terrain mapping lidar sensor improves the probability of a safe landing via autonomous, real-time Hazard Detection and Avoidance (HDA). PL&HA significantly improves the probability of mission success and enhances access to sites of scientific interest located in challenging terrain. PL&HA can also utilize external navigation aids, such as navigation satellites and surface beacons. Advanced Lidar Sensors High precision ranging, velocimetry, and 3-D terrain mapping Terrain Relative Navigation (TRN) TRN compares onboard reconnaissance data with real-time terrain imaging data to update the S/C position estimate Hazard Detection and Avoidance (HDA) Generates a high-resolution, 3-D terrain map in real-time during the approach trajectory to identify safe landing targets Inertial Navigation During Terminal Descent High precision surface relative sensors enable accurate inertial navigation during terminal descent and a tightly controlled touchdown within meters of the selected safe landing target.
Kirsten L Armstrong
Full Text Available Aims : To complete an initial estimate of the global cost of eliminating avoidable blindness, including the investment required to build ongoing primary and secondary health care systems, as well as to eliminate the ′backlog′ of avoidable blindness. This analysis also seeks to understand and articulate where key data limitations lie. Materials and Methods : Data were collected in line with a global estimation approach, including separate costing frameworks for the primary and secondary care sectors, and the treatment of backlog. Results : The global direct health cost to eliminate avoidable blindness over a 10-year period from 2011 to 2020 is estimated at $632 billion per year (2009 US$. As countries already spend $592 billion per annum on eye health, this represents additional investment of $397.8 billion over 10 years, which is $40 billion per year or $5.80 per person for each year between 2010 and 2020. This is concentrated in high-income nations, which require 68% of the investment but comprise 16% of the world′s inhabitants. For all other regions, the additional investment required is $127 billion. Conclusions : This costing estimate has identified that low- and middle-income countries require less than half the additional investment compared with high-income nations. Low- and middle-income countries comprise the greater investment proportion in secondary care whereas high-income countries require the majority of investment into the primary sector. However, there is a need to improve sector data. Investment in better data will have positive flow-on effects for the eye health sector.
Jensen, Tina Blegind; Aanestad, Margunn
The purpose of this paper is to discuss the adoption of healthcare information systems (HIS) from a user perspective. Our case study concerns how a group of orthopaedic surgeons experienced and reacted to the adoption and mandatory use of an Electronic Patient Record system in a Danish hospital. We...... propose to use the concepts of hospitality and hostility to turn our attention to the interaction between the host (the surgeons) and the guest (the information system) and consider how the boundaries between them evolved in the everyday work practices. As an alternative to previous studies on technology...
Fara, G M; Barni, M
The paper explains the reasons according to which the newly-planned hospitals must adopt the concept of advanced flexibility (structural, technological, organizational, diagnostic and therapeutic), in order to avoid the risk of being already obsolete at the moment of their opening, and this due to the fact that too much time elapses in this Country between the moment of planning a new hospital and the moment of the start of its activity. Flexibility is needed at different levels: at low or medium levels for what concerns administrative spaces and also patient rooms (except, in this latter case, when differential intensity of care is adopted); at advanced levelfor what concerns diagnostic and therapeutic areas, which must be rapidly adaptable to new solutions offered by advances in technology and organization. From a different standpoint, flexibility applies also to the fact that hospital must increasingly become a node of a large net including territorial health services: the latter devoted to take care of chronicity, while hospitals should concentrate on acute pathology. Of course the territory surrounding the hospital, through its outpatient service and consultories, is in charge also for first level diagnosy and therapy, leaving the hospital to more sophisticated activities.
A Self controlling robot is necessary in the robot application in which operator control is difficult. Serial method such as process on the computer of van newman is difficult to be applied for self controlling robot. In this research, Neural network system for robotic control system was developed by performance expanding at the SCARA. In this research, it was shown that SCARA with application at Neural network system can avoid blocking objects without influence by number and density of the blocking objects, also departure and destination paint. robot developed by this study also can control its moving by self
Remedial well work has been, and will continue to be, an integral part of oil company operations. More than 16,000 workover operations were performed during 1993 in the US. The economic impact from workover operations is usually immediate due to flowlines, tank batteries and other equipment being in place and ready for service prior to the workover. Similarly, problems encountered during workover operations contribute an immediate negative impact to project economics. Guidelines for common mistake avoidance are presented. They will be especially helpful for those individuals not well trained in workover preparation and supervision
Full Text Available The paper presents the main causes that determine double taxation, its forms, i.e. the economicdouble taxation and the international legal double taxation, the need for eliminating the double taxation andavoiding methods. In the presentation of the avoidance methods have been used practical examples forcomparison of the tax advantages for income beneficiary between: the total exemption method andprogressive exemption method, on the one hand, and total crediting method and ordinary crediting method,on the other hand, but the comparing of tax reduction between methods of exemption and crediting.
Full Text Available Worldwide crisis has made multinational companies that are engaged in corporate social responsibility actions to manage their businesses through the lens of various tax avoidance practices. The content of this paper is important due to the fact that tries to identify the impact in case of companies active in corporate social responsibility actions versus their tax structures orientation. Corporate social responsibility literature did not paid enough attention on the impact of the tax avoidance practices of companies. Tax, as a concept, brings in itself an important corporate financial impact with subsequent effects for the life of multiple citizens in countries where private entities are operating. Even though companies are usually expressing their ethical and responsible conduct in respect of the social environment, there are many cases when the business practices were not aligned with the declared corporate behavior. This paper seeks firstly to examine whether companies engaged in tax avoidance practices (ex. offshore tax havens consider that continue to act socially responsible. Secondly, the paper examines the influence on attending the stakeholdersâ€™ goals for those companies practicing tax avoidance and its implications on corporate social responsibility actions. Moreover, the paper focuses also on the aspects described before from the perspective of the corporate entities operating in Romania. This paperâ€™s intention is to use and to develop the results of previous research carried out by Lutz Preus (University of London and, subsequently, by Senators Levin, Coleman and Obama in their â€œStop Tax Haven Abuse Billâ€. The implications and the objectives of this material are to highlight, to identify and to spot clearly the relations and the influences of the tax haven practices of corporations versus their undertaken social responsibility actions. Moreover, this paper brings a fresh perspective of this topic from the
Harms, A A [McMaster Univ., Hamilton, ON (Canada)
A novel concept for an intrinsically safe reactor, called the Pellet Suspension Reactor (PSR), has vertical fuel tubes in which fuel, in the form of micro-pellets, is suspended by an upwardly flowing liquid or (preferably) gas coolant. Then, in the event of a primary pump failure, the fuel pellets fall down into a divergent conical annulus which is surrounded by ordinary water; the divergent geometry of this catchment ensures nuclear subcriticality, and the annulus will ensure decay-heat removal by packed-bed conduction. Thus melting of the fuel is avoided, and no emergency shut-down or emergency cooling provisions are required. 7 refs., 1 tab., 1 fig.
Jones, Denise R.; Prinzel, Lawrence J., III; Otero, Sharon D.; Barker, Glover D.
An initial Collision Avoidance for Airport Traffic (CAAT) concept for the Terminal Maneuvering Area (TMA) was evaluated in a simulation study at the National Aeronautics and Space Administration (NASA) Langley Research Center. CAAT is being designed to enhance surface situation awareness and provide cockpit alerts of potential conflicts during runway, taxi, and low altitude air-to-air operations. The purpose of the study was to evaluate the initial concept for an aircraft-based method of conflict detection and resolution (CD&R) in the TMA focusing on conflict detection algorithms and alerting display concepts. This paper gives an overview of the CD&R concept, simulation study, and test results.
Cockcroft, A N
A Guide to the Collision Avoidance Rules is the essential reference to the safe operation of all vessels at sea. Published continuously since 1965, this respected and expert guide is the classic text for all who need to, practically and legally, understand and comply with the Rules. This sixth edition incorporates all of the amendments to the International Regulations for Preventing Collisions at Sea which came into force in November 2003.The books sets out all of the Rules with clear explanation of their meaning, and gives detailed examples of how the rules have been used in practice
The pressures of study, diversity of source materials, past assumptions relating to good writing practice, ambiguous writing guidance on best practice and students' insecurity about their reasoning ability, can lead to plagiarism. With the use of source checking software, there is an increased chance that plagiarised work will be identified and investigated, and penalties given. In extreme cases, plagiarised work may be reported to the Nursing and Midwifery Council and professional as well as academic penalties may apply. This article provides information on how students can avoid plagiarism when preparing their coursework for submission.
Wireless Vehicular Networks for Car Collision Avoidance focuses on the development of the ITS (Intelligent Transportation Systems) in order to minimize vehicular accidents. The book presents and analyses a range of concrete accident scenarios while examining the causes of vehicular collision and proposing countermeasures based on wireless vehicular networks. The book also describes the vehicular network standards and quality of service mechanisms focusing on improving critical dissemination of safety information. With recommendations on techniques and protocols to consider when improving road safety policies in order to minimize crashes and collision risks.
Avoidant/restrictive food intake disorder (ARFID) is a new diagnostic category in DSM-5. Although replacing Feeding Disorder of Infancy or Early Childhood, it is not restricted to childhood presentations. In keeping with the broader aim of revising and updating criteria and text to better reflect lifespan issues and clinical expression across the age range, ARFID is a diagnosis relevant to children, adolescents, and adults. This case example of a 13-year old boy with ARFID illustrates key issues in diagnosis and treatment planning. The issues discussed are not exhaustive, but serve as a guide for central diagnostic and treatment issues to be considered by the clinician. It is anticipated that the inclusion of specific criteria for ARFID as a category within Feeding and Eating Disorders in DSM-5 will stimulate research into its typology, prevalence, and incidence in different populations and facilitate the development of effective, evidence-based interventions for this patient group. Copyright © 2013 Wiley Periodicals, Inc.
Evans, Travis C; Walukevich, Katherine A; Britton, Jennifer C
Individuals with Social Anxiety Disorder (SAD) often exhibit preferential attention for social threat, demonstrating abnormal orientation to threat (i.e., vigilance-avoidance) and/or difficulty disengaging from threat. However, no research has compared the relationship between attention indices (i.e., vigilance-avoidance, difficulty disengaging from threat) and characteristic features of the disorder such as fear during social situations (social fear) and avoidant behaviors (social avoidance). To address this issue, seventy adults (19.29±1.47 years, 33 females) were separated into low (n=37) or high (n=33) socially anxious groups using clinical cutoff scores on the Social Interaction Anxiety Scale (SIAS). Participants in both groups completed a dot-probe task with congruent, incongruent, and neutral trials to obtain measures of vigilance-avoidance and difficulty disengaging. Using linear regression, we examined the associations each attention index shared with self-reported social fear and social avoidance. Exclusively in the high anxious group, greater vigilance towards threat was associated with higher self-reported social fear, but not with social avoidance. However, difficulty disengaging was not associated with either social measure. In the low anxiety group, no relationships between attention indices and either social measure emerged. Future research with clinical samples is necessary to replicate and extend these findings. The small sample size studied may have limited our ability to detect other smaller effects. Indices of attention bias may contribute differently to the etiology and maintenance of SAD, which offers important implications for novel treatments that target attention. Copyright © 2016 Elsevier B.V. All rights reserved.
de Koning, Ton; Foltran, Francesca; Gregori, Dario
Injuries due to the accidental ingestion or aspiration of small parts have became a matter of interest in the last 30 years, focusing on the relationship between a proper prevention and the diminished frequency of occurrences. Small parts in commonly used objects represent a large sector of potential danger, taking explicit mouthing behavior of children in the first four years of life. In this paper the intent is to show the current situation of design projects and legislation around the world, meant to avoid the casual accidents due to manufacturing reasons. Proposed process and quality control standards seek to eliminate production errors and control materials to avoid deviation from the design. The present study draws its data from the Susy Safe registry, a European Commission co-funded project started in February 2005, whose aim is to establish an international registry of cases of Foreign Bodies (FB) injuries in children aged 0-14 years. Information collected from the data base concern age and gender of the child, location, shape, volume, consistency and elipticity of the foreign body, any complication occurred, hospitalization, and behavioral aspects linked to the injury, like the supervision of the parents or the activity concomitant to the injury. Cases are prospectively collected using the Susy Safe system from 06/2005; moreover, also information regarding past consecutive cases available in each center adhering to the project have been entered in the Susy Safe Registry. Data evidenced that the majority of small parts related injuries are related to stationery. The majority of objects (56.7%), were located in the nose, followed by the ears (31.5%). The distribution on incidence of FB injuries by age class shows that the majority of injuries due to small parts in common objects occurred in children older than >3 years. Male and female were affected with the same frequency when concerning the nose, while all other locations showed a higher frequency in males
Rognås, Leif Kåre; Christensen, Erika Frischknecht; Sloth, Erik
Danish anaesthesiologists use ultrasound (US) to examine and treat acutely ill or traumatized patients in the emergency room, operating theatre and intensive care unit. They are also involved in pre-hospital care where US may theoretically be beneficial for both diagnostic and therapeutic purpose....... The literature concerning the potential use of emergency US in the pre-hospital setting is evaluated. Evidence from both Europe and the USA indicates that pre-hospital US improves diagnosis and visitation of acutely ill or traumatized patients. Udgivelsesdato: 2009-Aug-31...
McHugh, Matthew D.; Kelly, Lesly A.; Smith, Herbert L.; Wu, Evan S.; Vanak, Jill M.; Aiken, Linda H.
Background Although there is evidence that hospitals recognized for nursing excellence—Magnet hospitals—are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why. Objectives To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared with non-Magnet hospitals, and to determine the most likely explanations. Method and Study Design Analysis of linked patient, nurse, and hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression models were used to estimate differences in the odds of mortality and failure-to-rescue for surgical patients treated in Magnet versus non-Magnet hospitals, and to determine the extent to which differences in outcomes can be explained by nursing after accounting for patient and hospital differences. Results Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor's degrees and specialty certification. These nursing factors explained much of the Magnet hospital effect on patient outcomes. However, patients treated in Magnet hospitals had 14% lower odds of mortality (odds ratio 0.86; 95% confidence interval, 0.76–0.98; P = 0.02) and 12% lower odds of failure-to-rescue (odds ratio 0.88; 95% confidence interval, 0.77–1.01; P = 0.07) while controlling for nursing factors as well as hospital and patient differences. Conclusions The lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes. PMID:24022082
Malterud, Kirsti; Hollnagel, Hanne
To explore potentials for avoiding humiliations in clinical encounters, especially those that are unintended and unrecognized by the doctor. Furthermore, to examine theoretical foundations of degrading behaviour and identify some concepts that can be used to understand such behaviour in the cultural context of medicine. Finally, these concepts are used to build a model for the clinician in order to prevent humiliation of the patient. Empirical studies document experiences of humiliation among patients when they see their doctor. Philosophical and sociological analysis can be used to explain the dynamics of unintended degrading behaviour between human beings. Skjervheim, Vetlesen, and Bauman have identified the role of objectivism, distantiation, and indifference in the dynamics of evil acts, pointing to the rules of the cultural system, rather than accusing the individual of bad behaviour. Examining the professional role of the doctor, parallel traits embedded in the medical culture are demonstrated. According to Vetlesen, emotional awareness is necessary for moral perception, which again is necessary for moral performance. A better balance between emotions and rationality is needed to avoid humiliations in the clinical encounter. The Awareness Model is presented as a strategy for clinical practice and education, emphasizing the role of the doctor's own emotions. Potentials and pitfalls are discussed.
Walker, Shawn W.
This paper presents a softened notion of proximity (or self-avoidance) for curves. We then derive a sensitivity result, based on shape differential calculus, for the proximity. This is combined with a gradient-based optimization approach to compute three-dimensional, parameterized curves that minimize the sum of an elastic (bending) energy and a proximity energy that maintains self-avoidance by a penalization technique. Minimizers are computed by a sequential-quadratic-programming (SQP) method where the bending energy and proximity energy are approximated by a finite element method. We then apply this method to two problems. First, we simulate adsorbed polymer strands that are constrained to be bound to a surface and be (locally) inextensible. This is a basic model of semi-flexible polymers adsorbed onto a surface (a current topic in material science). Several examples of minimizing curve shapes on a variety of surfaces are shown. An advantage of the method is that it can be much faster than using molecular dynamics for simulating polymer strands on surfaces. Second, we apply our proximity penalization to the computation of ideal knots. We present a heuristic scheme, utilizing the SQP method above, for minimizing rope-length and apply it in the case of the trefoil knot. Applications of this method could be for generating good initial guesses to a more accurate (but expensive) knot-tightening algorithm.
Rehm, Jürgen; Patra, Jayadeep; Gnam, William H; Sarnocinska-Hart, Anna; Popova, Svetlana
To estimate avoidable burden and avoidable costs of alcohol abuse in Canada for the year 2002. A policy effectiveness approach was used. The impact of six effective and cost-effective alcohol policy interventions aimed to reduce alcohol consumption was modeled. In addition, the effect of privatized alcohol sales that would increase alcohol consumption and alcohol-attributable costs was also modeled. The effects of these interventions were compared with the baseline (aggregate) costs obtained from the second Canadian Study of Social Costs Attributable to Substance Abuse. It was estimated that by implementing six cost-effective policies from about 900 million to two billion Canadian dollars per year could be saved in Canada. The greatest savings due to the implementation of these interventions would be achieved in the lowering of productivity losses, followed by health care, and criminality. Substantial increases in burden and cost would occur if Canadian provinces were to privatize alcohol sales. The implementation of proven effective population-based interventions would reduce alcohol-attributable burden and its costs in Canada to a considerable degree. Copyright © 2010 S. Karger AG, Basel.
Chowdhury, N.; Billinton, R.; Gupta, R.
A simple and straightforward technique was developed to assess avoided system operating costs associated with non-utility generation (NUG). The technique was based on optimum loading configurations of the committed units both before and after the inclusion of NUG energy. The salient features of the technique were presented in this paper. Assessment of avoided operating cost with deterministic and probabilistic criteria were explained. A time differentiated price system was adopted in the algorithms to reflect the different value placed on purchased price by a utility at different times of the day. The algorithms show the utility effects of dispatchable and non-dispatchable NUG energies. The IEEE Reliability Test System (RTS) was utilized for numerical analysis. Results were illustrated. It was found that sensitivity studies similar to those performed on the IEEE-RTS could be utilized to determine the amount of energy and the time period during which utilities and NUGs can maximize their economic benefits. 7 refs., 5 figs., 1 tab
A randomized controlled trial to evaluate the impact of a geo-specific poster compared to a general poster for effecting change in perceived threat and intention to avoid drowning ‘hotspots’ among children of migrant workers: evidence from Ningbo, China
Full Text Available Abstract Background Drowning among children of migrant workers is a major, though neglected public health issue in China. Methods A randomised controlled trial was used to examine the potential impact of viewing a preventive health poster with/without geo-located drowning events on perceptions of drowning risk among Chinese migrant children. A total of 752 children from three schools in Jiangbei district were selected by multi-stage sampling and randomly assigned to the intervention (n = 380 or control (n = 372. Multilevel models were used to analyse changes in responses to the following questions after viewing the assigned poster for 10 min: (1 “Do you believe that drowning is a serious health problem in Ningbo city?”; (2 “Do you believe that there are lots of drowning-risk waters around you?”; (3 “Do you believe that the likelihood of your accessing a drowning-risk water is great?”; and (4 “Would you intend to avoid accessing to those drowning-risk waters when being exposed?” Results At baseline there were no significant differences between the intervention and control groups in perceptions of drowning risk or covariates. Following the intervention, participants that viewed the geo-specific poster were more likely to respond more favourably to the first three questions (p < 0.001 than those who viewed the standard poster. However, there was no substantive difference between the geo-specific or standard poster in terms of changing intentions to avoid drowning hotspots (p = 0.214. Conclusions Use of ‘geo-located’ information added value to the effectiveness of a drowning prevention poster for enhancing awareness of drowning hotspots among children of migrant workers. Trial registration Chinese Clinical Trial Registry ChiCTR-IOR-16008979 (Retrospectively registered (The date of trial registration: Aug 5, 2016, the date of enrolment of the first participant: Nov 10, 2015.
Halley, Marc D
Physician employment is here to stay. The challenge for healthcare finance professionals is to make physician relationships work without the financial losses experienced by hospitals that tried physician employment in the past. Capturing market share should be a key strategy in any physician employment effort. Physicians who are engaged and actively involved in the process make great business partners because they understand the productivity, efficiencies, and cost controls needed to succeed.
Lester, Kathryn J.; Lisk, Stephen C.; Mikita, Nina; Mitchell, Sophie; Huijding, Jorg; Rinck, Mike; Field, Andy P.
Background and objectives This study examined the effects of verbal information and approach-avoidance training on fear-related cognitive and behavioural responses about novel animals. Methods One hundred and sixty children (7–11 years) were randomly allocated to receive: a) positive verbal information about one novel animal and threat information about a second novel animal (verbal information condition); b) approach-avoidance training in which they repeatedly pushed away (avoid) or pulled closer (approach) pictures of the animals (approach-avoidance training), c) a combined condition in which verbal information was given prior to approach-avoidance training (verbal information + approach-avoidance training) and d) a combined condition in which approach-avoidance training was given prior to verbal information (approach-avoidance training + verbal information). Results Threat and positive information significantly increased and decreased fear beliefs and avoidance behaviour respectively. Approach-avoidance training was successful in training the desired behavioural responses but had limited effects on fear-related responses. Verbal information and both combined conditions resulted in significantly larger effects than approach-avoidance training. We found no evidence for an additive effect of these pathways. Limitations This study used a non-clinical sample and focused on novel animals rather than animals about which children already had experience or established fears. The study also compared positive information/approach with threat information/avoid training, limiting specific conclusions regarding the independent effects of these conditions. Conclusions The present study finds little evidence in support of a possible causal role for behavioural response training in the aetiology of childhood fear. However, the provision of verbal information appears to be an important pathway involved in the aetiology of childhood fear. PMID:25698069
Sheynin, Jony; Moustafa, Ahmed A.; Beck, Kevin D.; Servatius, Richard J.; Casbolt, Peter A.; Haber, Paul; Elsayed, Mahmoud; Hogarth, Lee; Myers, Catherine E.
Objective Addiction is often conceptualized as a behavioral strategy for avoiding negative experiences. In rodents, opioid intake has been associated with abnormal acquisition and extinction of avoidance behavior. Here, we tested the hypothesis that these findings would generalize to human opioid-dependent subjects. Method Adults meeting DSM-IV criteria for heroin-dependence and treated with opioid medication (n=27), and healthy controls (n=26), were recruited between March–October 2013 and given a computer-based task to assess avoidance behavior. On this task, subjects controlled a spaceship and could either gain points by shooting an enemy spaceship, or hide in safe areas to avoid on-screen aversive events. Results While groups did not differ on escape responding (hiding) during the aversive event, heroin-dependent males (but not females) made more avoidance responses during a warning signal that predicted the aversive event (ANOVA, sex × group interaction, p=0.007). This group was also slower to extinguish the avoidance response when the aversive event no longer followed the warning signal (p=0.011). This behavioral pattern resulted in reduced opportunity to obtain reward without reducing risk of punishment. Results suggest that differences in avoidance behavior cannot be easily explained by impaired task performance or by exaggerated motor activity in male patients. Conclusion This study provides evidence for abnormal acquisition and extinction of avoidance behavior in opioid-dependent patients. Interestingly, data suggest abnormal avoidance is demonstrated only by male patients. Findings shed light on cognitive and behavioral manifestations of opioid addiction, and may facilitate development of therapeutic approaches to help affected individuals. PMID:27046310
Spiegler, Kevin M; Fortress, Ashley M; Pang, Kevin C H
Differential processing of danger and safety signals may underlie symptoms of anxiety disorders and posttraumatic stress disorder. One symptom common to these disorders is pathological avoidance. The present study examined whether danger and safety signals influence avoidance differently in anxiety-vulnerable Wistar-Kyoto (WKY) rats and Sprague Dawley (SD) rats. SD and WKY rats were tested in a novel progressive ratio avoidance task with and without danger or safety signals. Two components of reinforcement, hedonic value and motivation, were determined by fitting an exponentiated demand equation to the data. Hedonic value of avoidance did not differ between SD and WKY rats, but WKY rats had greater motivation to avoid than SD rats. Removal of the safety signal reduced motivation to avoid in SD, but not WKY, rats. Removal of the danger signal did not alter avoidance in either strain. When danger and safety signals were presented simultaneously, WKY rats responded to the danger signals, whereas SD rats responded to the safety signal. The results provide evidence that 1) safety signals enhance motivation to avoid in SD rats, 2) both danger and safety signals influence motivation in WKY rats, and 3) danger signals take precedence over safety signals when presented simultaneously in WKY rats. Thus, anxiety vulnerability is associated with preferential use of danger signals to motivate avoidance. The differential use of danger and safety signals has important implications for the etiology and treatment of pathological avoidance in anxiety disorders and posttraumatic stress disorder. Copyright © 2017. Published by Elsevier Inc.
Malnutrition seen in hospitals usually occurs as some form of protein-energy malnutrition (PEM). Primary PEM results from an acute or chronic deficiency of both protein and calories. Secondary PEM, or cachexia, results from a disease or medical condition such as cancer or gastrointestinal disease that alters requirements or impairs utilization of nutrients. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.
Bender, Jeffrey M; Virgallito, Mary; Newland, Jason G; Sammons, Julia S; Thorell, Emily A; Coffin, Susan E; Pavia, Andrew T; Sandora, Thomas J; Hersh, Adam L
We surveyed hospital epidemiologists at 28 Children's Hospital Association member hospitals regarding their infection prevention and control programs. We found substantial variability between children's hospitals in both the structure and the practice of these programs. Research and the development of evidence-based guidelines addressing infection prevention in pediatrics are needed.
Levitt, Marc A.; Lawal, Taiwo A.; Peña, Alberto
Purpose Colostomy is an operation frequently performed in pediatric surgery. Despite its benefits, it can produce significant morbidity. In a previous publication we presented our experience with the errors and complications that occurred during cases of colostomy creation. We now have focused in the morbidity related to the colostomy closure. The technical details that might have contributed to the minimal morbidity we experienced are described. Methods The medical records of 649 patients who underwent colostomy closure over a 28-year period were retrospectively reviewed looking for complications following these procedures. Our perioperative protocol for colostomy closure consisted in: clear fluids by mouth and repeated proximal stoma irrigations 24 h prior to the operation. Administration of IV antibiotics during anesthesia induction and continued for 48 h. Meticulous surgical technique that included: packing of the proximal stoma, plastic drape to immobilize the surgical field, careful hemostasis, emphasis in avoiding contamination, cleaning the edge of the stomas to allow a good 2-layer, end-to-end anastomosis with separated long-term absorbable sutures, generous irrigation of the peritoneal cavity and subsequent layers with saline solution, closure by layers to avoid dead space, and avoidance of hematomas. No drains and no nasogastric tubes were used. Oral fluids were started the day after surgery and patients were discharged 48–72 h after the operation. Results The original diagnoses of the patients were: anorectal malformation (583), Hirschsprung’s disease (53), and others (13). 10 patients (1.5%) had complications: 6 had intestinal obstruction (5 due to small bowel adhesions, 1 had temporary delay of the function of the anastomosis due to a severe size discrepancy between proximal and distal stoma with a distal microcolon) and 4 incisional hernias. There were no anastomotic dehiscences or wound infection. There was no bleeding, no anastomotic
Zimmerman, Jacqueline; Fisher, Martin
Avoidant/restrictive food intake disorder (ARFID) is an entirely new diagnosis in the DSM-5. ARFID replaces "feeding disorder of infancy or early childhood," which was a diagnosis in the DSM-IV restricted to children 6 years of age or younger; ARFID has no such age limitations and it is distinct from anorexia nervosa and bulimia nervosa in that there is no body image disturbance. ARFID involves a complex and heterogenous etiology, which is reviewed herein. What is known to date regarding the characteristics and medical and psychiatric comorbidities of this patient population are described and compared to other eating disorders. Evaluation and management strategies are also discussed. No data yet exist regarding ARFID׳s prognosis and prevention; however, recommendations to guide parents in establishing appropriate infant and child feeding practices are provided. Copyright © 2017 Mosby, Inc. All rights reserved.
Meheus, Joke; Beirlaen, Mathieu; van de Putte, Frederik
In this paper, we present an adaptive logic for deontic conflicts, called P2.1 r , that is based on Goble's logic SDL a P e - a bimodal extension of Goble's logic P that invalidates aggregation for all prima facie obligations. The logic P2.1 r has several advantages with respect to SDL a P e. For consistent sets of obligations it yields the same results as Standard Deontic Logic and for inconsistent sets of obligations, it validates aggregation "as much as possible". It thus leads to a richer consequence set than SDL a P e. The logic P2.1 r avoids Goble's criticisms against other non-adjunctive systems of deontic logic. Moreover, it can handle all the 'toy examples' from the literature as well as more complex ones.
Bjerregaard, Peter; Juel, K
and several showed an increasing time trend. The regional patterns were particularly clear for infectious diseases and accidents, which showed low mortality rates in the capital and other towns and high mortality rates in settlements and in the remote East Greenland, while mortality rates from suicides...... and political will of the society. A list of avoidable deaths is proposed for Greenland which includes, inter alia, meningitis, lung cancer, acute respiratory infections, suicides, boat accidents and alcohol related diseases and accidents. All were considerably more common in Greenland than in Denmark...... and alcohol related diseases were high in the capital and East Greenland and low in West Greenlandic settlements. It is concluded that further studies on preventable diseases and causes of death, in particular certain infectious diseases, accidents and suicides, are needed....
Olivares Bøgeskov, Benjamin Miguel
aspects –first developing critical self-refection and secondly developing skills to conduct an ethical dialogue. The first aspect is addressed by finding out what the students think, do they contradict themselves and how to avoid self-contradictions. This is done by using a questionnaire with 13 ethical...... the theory and see the consequences of such theories in concrete cases, but would not use any of these theories to justify their own ethical decisions in other contexts. In other words, courses were failing to provide the students with theoretical tools that they could apply outside the classroom. Therefore......, this method focuses not so much on teaching what other people think, but rather starts by finding out what the students think, and to which degree they contradict themselves. In addition the method focuses on how students argue for their positions when entering an ethical dialogue. The method focuses on two...
Wilcox, B. H.; Gennery, D. B.; Mishkin, A. H.
A Mars rover sample return mission has been proposed for the late 1990's. Due to the long speed-of-light delays between earth and Mars, some autonomy on the rover is highly desirable. JPL has been conducting research in two possible modes of rover operation, Computer-Aided Remote Driving and Semiautonomous Navigation. A recently-completed research program used a half-scale testbed vehicle to explore several of the concepts in semiautonomous navigation. A new, full-scale vehicle with all computational and power resources on-board will be used in the coming year to demonstrate relatively fast semiautonomous navigation. The computational and power requirements for Mars rover local navigation and hazard avoidance are discussed.
Kim, Jayhyun; Woo, M.H.; Han, H.; In, Y.; Bak, J.G.; Eidietis, N.W.
The final target of Korea Superconducting Tokamak Advanced Research (KSTAR) aims advanced tokamak operation at plasma current 2 MA and toroidal field 3.5 T. In order to safely achieve the target, disruption counter-measures are unavoidable when considering the disruption risks, inevitably accompanied with high performance discharges, such as electro-magnetic load on conducting structures, collisional damage by run-away electrons, and thermal load on plasma facing components (PFCs). In this reason, the establishment of integrated disruption mitigation system (DMS) has been started for routine mega-ampere class operations of KSTAR since 2013 campaign. The DMS mainly consists of the disruption prediction and its avoidance/mitigation in company with logical/technical integration of them. We present the details of KSTAR DMS and the related experimental results in this article. (author)
Lacroix, C A; Wilson, J F
Harassment based on gender violates the rule of workplace equality established by Title VII of the Civil Rights Act and enforced by the EEOC. In 1986, the US Supreme Court, in Meritor Savings Bank v Vinson, established the criteria that must be met for a claim of hostile environment sexual harassment to be considered valid. Plaintiffs must show that they were subjected to conduct based on their gender, that it was unwelcome, and that it was severe and pervasive enough to alter their condition of employment, resulting in an abusive working environment. There have been few sexual harassment cases involving veterinary professionals, and it is our goal to help keep the number of filed actions to a minimum. The most effective way to avoid hostile environment sexual harassment claims is to confront the issue openly and to adopt a sexual harassment policy for the practice. When it comes to sexual harassment, an ounce of prevention is unquestionably worth a pound of cure.
Cardenal, Violeta; Ortiz-Tallo, Margarita; Martín Frías, Isabel; Martínez Lozano, Joaquina
Two groups of women were assessed in psychological aspects considered by some authors of interest for personal well-being. The sample consisted of 118 women, 58 diagnosed with breast cancer and 60 healthy women, of similar ages and personal circumstances. The purpose of the study was: (a) to explore the existence of stressful life events in the women's history and their degree of subjective distress and (b) to determine whether or not there is an emotional avoidance style in the group of women with breast cancer. The following assessment instruments were employed: the "Cuestionario de Formas de Afrontamiento" (CEA), the Five-Factor Inventory NEO-PI-R, and the State-Trait Anger Inventory (STAXI). The results revealed more stressful vital events in the last two years in the group of women with breast cancer and significant differences in the degree of current distress. They also obtained higher scores in current anger, resignation, and neuroticism.
Rossing, Christian Plesner; Riise Johansen, Thomas; Pearson, Thomas C.
-driven discipline to be dealt with by accounting and tax experts. Instead, MNEs face the task of establishing a complex fit with their environment beyond the typical stakeholders with transfer pricing, i.e. tax authorities. These include government officials, tax activists, and consumers who voice......This paper examines the case of Starbucks’ UK branch, which became subject to massive public criticism over alleged tax avoidance. Despite Starbucks arguing that its transfer pricing practices were in full compliance with regulatory requirements, public pressure for higher corporate tax payments...... led Starbucks to increase its UK tax payment on transfer pricing income beyond regulatory requirements. This case study suggests that MNE tax behavior on international transfer pricing is not strictly a matter of compliance with formal tax regulation. We demonstrate the way an MNE attempts to re...
García-Oliva, Carlos; Piqueras, José A
Background and aims This study focuses on the use of popular information and communication technologies (ICTs) by adolescents: the Internet, mobile phones, and video games. The relationship of ICT use and experiential avoidance (EA), a construct that has emerged as underlying and transdiagnostic to a wide variety of psychological problems, including behavioral addictions, is examined. EA refers to a self-regulatory strategy involving efforts to control or escape from negative stimuli such as thoughts, feelings, or sensations that generate strong distress. This strategy, which may be adaptive in the short term, is problematic if it becomes an inflexible pattern. Thus, the aim of this study was to explore whether EA patterns were associated with addictive or problematic use of ICT in adolescents. Methods A total of 317 students of the Spanish southeast between 12 and 18 years old were recruited to complete a questionnaire that included questions about general use of each ICTs, an experiential avoidance questionnaire, a brief inventory of the Big Five personality traits, and specific questionnaires on problematic use of the Internet, mobile phones, and video games. Results Correlation analysis and linear regression showed that EA largely explained results regarding the addictive use of the Internet, mobile phones, and video games, but not in the same way. As regards gender, boys showed a more problematic use of video games than girls. Concerning personality factors, conscientiousness was related to all addictive behaviors. Discussion and conclusions We conclude that EA is an important construct that should be considered in future models that attempt to explain addictive behaviors.
García-Oliva, Carlos; Piqueras, José A.
Background and aims This study focuses on the use of popular information and communication technologies (ICTs) by adolescents: the Internet, mobile phones, and video games. The relationship of ICT use and experiential avoidance (EA), a construct that has emerged as underlying and transdiagnostic to a wide variety of psychological problems, including behavioral addictions, is examined. EA refers to a self-regulatory strategy involving efforts to control or escape from negative stimuli such as thoughts, feelings, or sensations that generate strong distress. This strategy, which may be adaptive in the short term, is problematic if it becomes an inflexible pattern. Thus, the aim of this study was to explore whether EA patterns were associated with addictive or problematic use of ICT in adolescents. Methods A total of 317 students of the Spanish southeast between 12 and 18 years old were recruited to complete a questionnaire that included questions about general use of each ICTs, an experiential avoidance questionnaire, a brief inventory of the Big Five personality traits, and specific questionnaires on problematic use of the Internet, mobile phones, and video games. Results Correlation analysis and linear regression showed that EA largely explained results regarding the addictive use of the Internet, mobile phones, and video games, but not in the same way. As regards gender, boys showed a more problematic use of video games than girls. Concerning personality factors, conscientiousness was related to all addictive behaviors. Discussion and conclusions We conclude that EA is an important construct that should be considered in future models that attempt to explain addictive behaviors. PMID:27363463
Wilberg, Theresa; Karterud, Sigmund; Pedersen, Geir; Urnes, Øyvind
Few studies have compared the psychosocial problems associated with different types of personality disorders (PDs). The aim of this study was to investigate the functional impairment and symptomatic distress associated with six PD diagnoses coded in DSM-IV: paranoid, borderline, avoidant, dependent, obsessive-compulsive PD and PD not otherwise specified, as well as a condition of non-psychotic symptom disorders with no PD. The study included 1023 patients from eight day treatment units specialized in the treatment of PDs. Eighty-one per cent had one or more PD diagnoses. At admission to day treatment, the patients were evaluated with respect to global functioning, symptomatic and interpersonal distress, education, quality of life, social support, legal problems and previous psychotic episodes and psychiatric hospitalizations. There were few differences in global functioning or symptomatic and interpersonal distress between patients with a single PD diagnosis. Avoidant PD and borderline PD was the diagnoses that contributed most to dysfunction in most variables when taking into account the presences of several co-occurrent PD diagnoses and axis I disorders. The psychosocial problems associated with avoidant and borderline PD were partly domain specific. The study indicates that avoidant PD is associated with severe dysfunction and subjective distress, at a level comparable to that of borderline PD. Avoidant PD deserves more attention, both with respect to the specific psychopathology and dynamics underlying the disorder and the development of treatment approaches.
Emma C. SIDDALL, Nicola M. MARPLES
Full Text Available Toxic insects advertise their defended state to potential predators using warning displays. Frequently these displays use cues through more than one sensory modality, and combine color, smell and sound to produce a multimodal warning display. Signalling through more than one sensory pathway may enhance the rate of avoidance learning, and the memorability of the learned avoidance. A common insect warning odor, pyrazine, has previously been shown to increase the rate of learned avoidance of unpalatable yellow prey by domestic chicks (Gallus gallus domesticus, and the odor also improved memory of this learned avoidance. However, to date no research has examined this response to pyrazine odor using wild birds under natural conditions. This study used wild robins (Erithacus rubecula to investigate whether wild birds avoided yellow baits that smelled of pyrazine more strongly than those presented with no odor. The results provide some evidence that pyrazine odor does increase the level of protection an aposematic insect gains from a wild avian predator, but that the effect of pyrazine on learned avoidance was much weaker than was found with domestic chicks [Current Zoology 57 (2: 208–214, 2011].
Murty, Vishnu P; LaBar, Kevin S; Hamilton, Derek A; Adcock, R Alison
The present study investigated the effects of approach versus avoidance motivation on declarative learning. Human participants navigated a virtual reality version of the Morris water task, a classic spatial memory paradigm, adapted to permit the experimental manipulation of motivation during learning. During this task, participants were instructed to navigate to correct platforms while avoiding incorrect platforms. To manipulate motivational states participants were either rewarded for navigating to correct locations (approach) or punished for navigating to incorrect platforms (avoidance). Participants' skin conductance levels (SCLs) were recorded during navigation to investigate the role of physiological arousal in motivated learning. Behavioral results revealed that, overall, approach motivation enhanced and avoidance motivation impaired memory performance compared to nonmotivated spatial learning. This advantage was evident across several performance indices, including accuracy, learning rate, path length, and proximity to platform locations during probe trials. SCL analysis revealed three key findings. First, within subjects, arousal interacted with approach motivation, such that high arousal on a given trial was associated with performance deficits. In addition, across subjects, high arousal negated or reversed the benefits of approach motivation. Finally, low-performing, highly aroused participants showed SCL responses similar to those of avoidance-motivation participants, suggesting that for these individuals, opportunities for reward may evoke states of learning similar to those typically evoked by threats of punishment. These results provide a novel characterization of how approach and avoidance motivation influence declarative memory and indicate a critical and selective role for arousal in determining how reinforcement influences goal-oriented learning.
Skov Benthien, Kirstine; Nordly, Mie; von Heymann-Horan, Annika
CONTEXT: Avoidable hospital admissions are important negative indicators of quality of end-of-life care. Specialized palliative care (SPC) may support patients remaining at home. OBJECTIVES: Therefore, the purpose of this study was to investigate if SPC at home could prevent hospital admissions...... in patients with incurable cancer. METHODS: These are secondary results of Domus: a randomized controlled trial of accelerated transition to SPC with psychological intervention at home (Clinicaltrials.gov: NCT01885637). Participants were patients with incurable cancer and limited antineoplastic treatment...... significantly in overall potentially avoidable admissions. Both groups felt mostly safe about their place of care. CONCLUSION: The intervention did not prevent hospital admissions. Likely, any intervention effects were outweighed by increased identification of problems in the intervention group leading...
Silk, Benjamin J; McCoy, Morgan H; Iwamoto, Martha; Griffin, Patricia M
Listeriosis is characterized by bacteremia or meningitis. We searched for listeriosis case series and outbreak investigations published in English by 2013, and assessed the strength of evidence for foodborne acquisition among patients who ate hospital food. We identified 30 reports from 13 countries. Among the case series, the median proportion of cases considered to be hospital-acquired was 25% (range, 9%-67%). The median number of outbreak-related illnesses considered to be hospital-acquired was 4.0 (range, 2-16). All patients were immunosuppressed in 18 of 24 (75%) reports with available data. Eight outbreak reports with strong evidence for foodborne acquisition in a hospital implicated sandwiches (3 reports), butter, precut celery, Camembert cheese, sausage, and tuna salad (1 report each). Foodborne acquisition of listeriosis among hospitalized patients is well documented internationally. The number of listeriosis cases could be reduced substantially by establishing hospital policies for safe food preparation for immunocompromised patients and by not serving them higher-risk foods. 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.
Riet, van 't J.P.; Ruiter, R.A.C.; Vries, de H.
This study investigated the influence of individual differences in people's dispositional avoidance orientation on the persuasive effects of low- and high-threat messages promoting moderate drinking. First, participents (N = 99) individual differences in avoidance orientation were assessed, after
Goldstein, Larry M
"Litigation-Proof Patents: Avoiding the Most Common Patent Mistakes explains the principles of excellent patents, presents the ten most common errors in patents, and details a step-by-step method for avoiding these common errors...
Abiri, Sadat; Oakley, Linda Denise; Hitchcock, Mary E; Hall, Amanda
The purpose of this integrative review is to synthesize primary evidence of the impact of internalized stigma on avoidance in adult community treatment patients living with SMI. A keyword database search of articles published through 2015 yielded 21 papers and a total of 4256 patients. Our analyses found that stigmatizing beliefs associated with avoidance are related to significant loss of self-esteem. Factors generally thought to reduce stigma internalized as self-stigmatizing beliefs, such as improved insight, increased self-awareness, and psycho-education to improve stigma coping skills, do not appear to improve self-esteem.
Sulo, Suela; Feldstein, Josh; Partridge, Jamie; Schwander, Bjoern; Sriram, Krishnan; Summerfelt, Wm Thomas
Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay. To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention. The reduction in readmission rate and length of stay for 1269 patients enrolled in the quality improvement program (between October 13, 2014, and April 2, 2015) were compared with the pre-quality improvement program baseline and validation cohorts (4611 patients vs 1319 patients, respectively) to calculate potential cost-savings as well as to inform the design of the budget impact model. Readmission rate and length-of-stay reductions were calculated by determining the change from baseline to post-quality improvement program as well as the difference between the validation cohort and the post-quality improvement program, respectively. As a result of improved health outcomes for the treated patients, the nutrition-focused quality improvement program led to a reduction in 30-day hospital readmissions and length of stay. The avoided hospital readmissions and reduced number of days in the hospital for the patients in the quality improvement program resulted in cost-savings of $1,902,933 versus the pre-quality improvement program baseline cohort, and $4,896,758 versus the pre-quality improvement program in the
future exascale systems, communication cost must be avoided or overlapped. Communication-avoiding 2.5D algorithms improve scalability by reducing...linear algebra problems to future exascale systems, communication cost must be avoided or overlapped. Communication-avoiding 2.5D algorithms improve...will continue to grow relative to the cost of computation. With exascale computing as the long-term goal, the community needs to develop techniques
My thesis investigates the association between CEO power, corporate tax avoidance and tax aggressiveness, using two organizational theory perspectives: self-interest and stewardship. I find that a powerful CEO engages in less corporate tax avoidance activities, which lends credence to the risk minimization motive of the stewardship perspective. My findings on the association between CEO power and tax aggressiveness show that powerful CEOs avoid risky tax avoidance strategies that expose a fir...
Davies, T. R.
On 17 February 2006 a gigantic rockslide triggered a debris avalanche that overran the barangay Guinsaugon, St. Bernard in Southern Leyte Province, Philippines, burying 154 victims, with 990 missing including 246 school children. Even with satellite imagery, GIS-based landslide susceptibility modelling and real-time meteorological and seismic data analysis, scientific prediction of every potentially fatal landslide is not possible in most parts of the world. This is particular the case in steep, unstable, densely-populated country in which heavy rain is common. So how can further events of this type be prevented from turning into disasters? A number of precursory phenomena were noted by local inhabitants at Guinsaugon: a crack around the slope that failed was noticed in May 2005; coconut trees near the northern foot of the landslide scarp began to lean increasingly in the down-slope direction in December 2005; a slope around the northern edge of the 17 February 2006 landslide scarp failed on December 17, 2005; in the 9 days prior to the rockslide, 640 mm of rain fell; 450 mm in a 3-day period. Such phenomena are commonly reported by local inhabitants before large landslides (e.g. Elm, Mayunmarca, and many others). In many cases, therefore, it is in principle possible for local people to avoid the consequences of the landslide if they know enough to act appropriately in response to the precursory phenomena. For this possibility to be realized, appropriate information must be provided to and assimilated by the local population. Useful ways of achieving this include pamphlets, video, TV and radio programs and visits from civil defence personnel. The information must be properly presented; scientific language will be ineffective. A communication pyramid, leading from government agencies to local leaders, can facilitate the rapid availability of the information to all potentially susceptible communities. If science can determine those areas not vulnerable to landslide
Full Text Available Serbia's courts jurisprudence has divergent attitudes with respect to the dilemma whether a surety contract represents a contract without consideration, which may be avoided once the guarantor is subject to bankruptcy procedure without any additional conditions, or an onerous contract. Whether a surety contract is an onerous one has anyhow been disputed in the legal theory. One school of thought considers this contract as non-onerous one, since vis-a-vis guarantor's obligation no benefit to be expected from the other contractual party (i. e. creditor exists. The other school of thought understands surety (almost always as an onerous contract bearing in mind that the guarantor who enters into this contract does not have intentio liberalis. There are numerous and nuanced views based on analyses of the relation between a guarantor and a debtor focused on the argument that surety is a contract without consideration if intentio liberalis existed vis-a-vis main debtor rather than vis-a-vis creditor. Our legal literature did not pay much attention to that issue until recently. In a rare text dedicated to it the author's basic standpoint is that surety represents a contract without consideration. An exception, depending on the circumstances of the case, could be surety given by a parent company for the obligation of a subsidiary, provided the former reasonably expected a benefit in terms of an increase in the value of shares. Commercial courts followed such reasoning. In this article an opposite stance has been argued. Namely, the onerousness of surety must be assessed based on the relation between the guarantor and the main debtor rather than between the guarantor and the creditor. As a rule, surety is an onerous contract because the guarantor expects to collect from the debtor through subrogation the amount he paid to the creditor; exceptionally, surety may be a non-onerous contract if intentio liberalis existed vis-a-vis main debtor. However, this
Maynard, Olivia M; Attwood, Angela; O'Brien, Laura; Brooks, Sabrina; Hedge, Craig; Leonards, Ute; Munafò, Marcus R
Previous research with adults and adolescents indicates that plain cigarette packs increase visual attention to health warnings among non-smokers and non-regular smokers, but not among regular smokers. This may be because regular smokers: (1) are familiar with the health warnings, (2) preferentially attend to branding, or (3) actively avoid health warnings. We sought to distinguish between these explanations using eye-tracking technology. A convenience sample of 30 adult dependent smokers participated in an eye-tracking study. Participants viewed branded, plain and blank packs of cigarettes with familiar and unfamiliar health warnings. The number of fixations to health warnings and branding on the different pack types were recorded. Analysis of variance indicated that regular smokers were biased towards fixating the branding rather than the health warning on all three pack types. This bias was smaller, but still evident, for blank packs, where smokers preferentially attended the blank region over the health warnings. Time-course analysis showed that for branded and plain packs, attention was preferentially directed to the branding location for the entire 10s of the stimulus presentation, while for blank packs this occurred for the last 8s of the stimulus presentation. Familiarity with health warnings had no effect on eye gaze location. Smokers actively avoid cigarette pack health warnings, and this remains the case even in the absence of salient branding information. Smokers may have learned to divert their attention away from cigarette pack health warnings. These findings have implications for cigarette packaging and health warning policy. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
Tolerance and avoidance are the two contrasting strategies that plants may adopt to cope with herbivores. Tolerance traits define the degree to which communities remain unaffected by herbivory. Trade-offs between herbivore avoidance and competitive strength and between avoidance and colonization
Rees, Clare S; Pritchard, Rhian
Avoidant personality disorder (APD) is associated with a high level of impairment in multiple areas of functioning. However, research on the treatment of APD is scarce, and there is an absence of empirically evaluated effective treatment approaches available. This study offers a preliminary investigation of the use of brief cognitive therapy to treat APD. Two individuals, both with a principal diagnosis of APD, but who also possessed a number of comorbidities, participated in 12 weekly sessions. A series of diagnostic symptom severity, global functioning, and self-report measures were completed at pretreatment, posttreatment and at 6-week follow-up. In addition, regular monitoring of each participant's strength of belief in 4 personally identified cognitions associated with APD was completed. Reductions in APD symptoms, associated negative affect, and increases to quality of life were observed for both participants at posttreatment and follow-up phases. Results suggest that brief cognitive therapy may be an effective treatment for APD and that further studies with larger samples are warranted. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
Takigami, Satoshi; Sunada, Hiroshi; Lukowiak, Ken; Sakakibara, Manabu
We succeeded in taste avoidance conditioning with sucrose as the conditional stimulus (CS) and an electrical stimulus (∼1000V, 80μA) as the unconditional stimulus (US). With 15 paired CS-US presentations on a single day, we were able to elicit both short-term memory (STM) and long-term memory (LTM) persisting for at least one week. However, while STM was elicited with 5, 8, 10, and 20 paired presentations of the CS-US on a single day, LTM was not. We found, however, that if we inserted a 3h interval between a first and a second set of CS-US pairings that both 8 and 20 paired CS-US presentations on a single day was now sufficient to cause LTM formation. Exposing snails to bryostatin before or during training enhanced LTM formation such that 8 paired presentations of the CS-US resulted in LTM. Copyright © 2013 Elsevier Inc. All rights reserved.
McCubbin, Christopher B.; Piatko, Christine D.; Peterson, Adam V.; Donnald, Creighton R.; Cohen, David
The JHU/APL Path Planning team has developed path planning techniques to look for paths that balance the utility and risk associated with different routes through a minefield. Extending on previous years' efforts, we investigated real-world Naval mine avoidance requirements and developed a tactical decision aid (TDA) that satisfies those requirements. APL has developed new mine path planning techniques using graph based and genetic algorithms which quickly produce near-minimum risk paths for complicated fitness functions incorporating risk, path length, ship kinematics, and naval doctrine. The TDA user interface, a Java Swing application that obtains data via Corba interfaces to path planning databases, allows the operator to explore a fusion of historic and in situ mine field data, control the path planner, and display the planning results. To provide a context for the minefield data, the user interface also renders data from the Digital Nautical Chart database, a database created by the National Geospatial-Intelligence Agency containing charts of the world's ports and coastal regions. This TDA has been developed in conjunction with the COMID (Cooperative Organic Mine Defense) system. This paper presents a description of the algorithms, architecture, and application produced.
Dreyer, L; Andersen, A; Pukkala, E
million people (3.7 million men and 0.2 million women) in the Nordic countries were potentially exposed to above-average levels of one or more verified industrial carcinogens. It is expected that these exposures will result in a total of about 1,900 new cases of cancer every year in the Nordic countries...... around the year 2000, with 1,890 among men and fewer than 25 among women. The proportions that could be avoided if industrial carcinogens were eliminated would be 70% of mesotheliomas, 20% of cancers of the nasal cavity and sinuses, 12% of lung cancers, 5% of laryngeal cancers, 2% of urinary bladder...... cancers, 1% of the leukaemias, and 1% of renal cancers. Overall, it is estimated that verified industrial carcinogens will account for approximately 3% of all cancers in men and less than 0.1% of all cancers in women in the Nordic countries around the year 2000. No attempt was made to estimate...
Humm, John L.; Pizzuto, Domenico; Fleischman, Eric; Mohan, Radhe
Purpose: To develop computer software that assists the planner avoid potential gantry collisions with the patient or patient support assembly during the treatment planning process. Methods and Materials: The approach uses a simulation of the therapy room with a scale model of the treatment machine. Because the dimensions of the machine and patient are known, one can calculate a priori whether any desired therapy field is possible or will result in a collision. To assist the planner, we have developed a graphical interface enabling the accurate visualization of each treatment field configuration with a 'room's eye view' treatment planning window. This enables the planner to be aware of, and alleviate any potential collision hazards. To circumvent blind spots in the graphic representation, an analytical software module precomputes whether each update of the gantry or turntable position is safe. Results: If a collision is detected, the module alerts the planner and suggests collision evasive actions such as either an extended distance treatment or the gantry angle of closest approach. Conclusions: The model enables the planner to experiment with unconventional noncoplanar treatment fields, and immediately test their feasibility
Balashov, Oleg; Muraviev, Vadim; Strotov, Valery
In this paper image-based collision avoidance algorithm that provides detection of nearby aircraft and distance estimation is presented. The approach requires a vision system with a single moving camera and additional information about carrier's speed and orientation from onboard sensors. The main idea is to create a multi-step approach based on a preliminary detection, regions of interest (ROI) selection, contour segmentation, object matching and localization. The proposed algorithm is able to detect small targets but unlike many other approaches is designed to work with large-scale objects as well. To localize aerial vehicle position the system of equations relating object coordinates in space and observed image is solved. The system solution gives the current position and speed of the detected object in space. Using this information distance and time to collision can be estimated. Experimental research on real video sequences and modeled data is performed. Video database contained different types of aerial vehicles: aircrafts, helicopters, and UAVs. The presented algorithm is able to detect aerial vehicles from several kilometers under regular daylight conditions.
Full Text Available Occasionally, the expected effects of approach-avoidance motivation on anterior EEG alpha asymmetry fail to emerge, particularly in studies using affective picture stimuli. These null findings have been explained by insufficient motivational intensity of, and/or overshadowing interindividual variability within the responses to emotional pictures. These explanations were systematically tested using data from 70 students watching 5 types of affective pictures ranging from very pleasant to unpleasant. The stimulus categories reliably modulated self-reports as well as the amplitude of late positive potential, an ERP component reflecting orienting towards motivationally significant stimuli. The stimuli did not, however, induce expected asymmetry effects either for the sample or individual participants. Even while systematic stimulus-dependent individual differences emerged in self-reports as well as LPP amplitudes, the asymmetry variability was dominated by stimulus-independent interindividual variability. Taken together with previous findings, these results suggest that under some circumstances anterior asymmetry may not be an inevitable consequence of core affect. Instead, state asymmetry shifts may be overpowered by stable trait asymmetry differences and/or stimulus-independent yet situation-dependent interindividual variability, possibly caused by processes such as emotion regulation or anxious apprehension.
So, Cynthia; Pierluissi, Edgar
To describe expectations of, and perceived motivators and barriers to, in-hospital exercise of hospitalized older adults. Qualitative study using the framework theory. Public hospital general medical wards. Twenty-eight English- or Spanish-speaking inpatients aged 65 to 103. Semistructured interviews were conducted at the bedside. Questions explored attitudes and expectations regarding in-hospital exercise. Interviews were tape recorded and transcribed, and content analysis was performed to identify major themes. For most participants (71%), exercise in the hospital meant walking. Only 29% of participants expected to be exercising in the hospital, although three-quarters perceived it to be appropriate. Major themes included motivating factors and barriers to in-hospital exercise. Motivating factors included avoiding the negative effects of prolonged bed rest, promoting a sense of well-being, promoting functional recovery, and being asked to exercise. Barriers included symptoms related to one's illness, institutional barriers, and fear of injury. Most respondents (85%) felt that if the physician suggested exercise, it would influence their decision to do so, yet few (27%) reported that they had spoken to their physician about exercise. Hospitalized older adults have positive perceptions about in-hospital exercise, although they must overcome significant barriers to do so. Medical professionals have a strong influence over the exercise behavior of elderly adults in the hospital yet infrequently address the issue. Incorporating motivating factors and removing barriers may increase the effectiveness of in-hospital exercise programs. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.