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Sample records for avoidable hospitalizations evidence

  1. Evolution of the concept of avoidable hospitalization through the selections of causes and codes: evidence from a comprehensive review.

    NARCIS (Netherlands)

    Pelone, F.; Basso, D.; Lilli, S.; Belvis, A.G. de; Rosano, A.; Zee, J. van der; Ricciardi, W.

    2010-01-01

    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

  2. Dual Eligibles and Potentially Avoidable Hospitalizations

    Data.gov (United States)

    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...

  3. Dual Eligibles and Potentially Avoidable Hospitalizations

    Data.gov (United States)

    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...

  4. Rural-urban differences in receiving guideline-recommended diabetes care and experiencing avoidable hospitalizations under a universal coverage health system: evidence from the past decade.

    Science.gov (United States)

    Chen, C-C; Chen, L-W; Cheng, S-H

    2017-10-01

    Rural-urban differences in health remain a concern worldwide. Few studies have investigated the dynamic changes in health between rural and urban areas. This study aims to examine whether the rural-urban gap in patients' receipt of guideline-recommended care and avoidable hospitalizations has decreased in 10 years under a universal coverage health system. A retrospective cohort study design. This study utilized nationwide health insurance claims data of 3 representative cohorts of patients with newly diagnosed type 2 diabetes in 2000, 2005, and 2010 in Taiwan. The two outcome variables were receipt of guideline-recommended care and avoidable hospitalizations for diabetes. Generalized estimating equations models were used to estimate the rural-urban differences while controlling for physician-clustering effects. Rural diabetic patients were less likely to receive guideline-recommended examinations/tests in 2000 (e(β) = 0.97; 95% confidence interval [CI]: 0.96-0.99); however, the average number of examinations/tests increased and the rural-urban difference had diminished in 2010. The likelihood of avoidable hospitalizations for diabetes among rural diabetic patients was higher than that for their urban counterparts in 2000 (odds ratio [OR]: 1.13; 95% CI: 1.01-1.25). Although the likelihood of avoidable hospitalizations for diabetes decreased from 2000 to 2010, the rural-urban gap remained during this period. The rural-urban disparity in receiving recommended diabetes care diminished over the past decade. However, significant gaps between rural and urban areas in avoidable hospitalizations for diabetes persisted despite the universal health system. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  5. Reducing Avoidable Hospital Transfers From Nursing Homes in Austria

    Science.gov (United States)

    Kada, Olivia; Janig, Herbert; Likar, Rudolf; Cernic, Karl; Pinter, Georg

    2017-01-01

    Hospital transfers from nursing homes (NHs) are frequent, burdensome for residents, and often avoidable. The evidence regarding the effectiveness of interventions to reduce avoidable transfers is limited, and most projects focus on nurses’ knowledge and skills. In the present project, interventions focusing on nurses and physicians are integrated, elaborated, and implemented in 17 NHs. Results of the 6 months preintervention period are reported. Hospital transfer rates (N = 1,520) and basic data on all residents (N = 1,238) were collected prospectively. Nurses’ preintervention knowledge and self-efficacy were assessed using standardized questionnaires (N = 330). Many hospital transfers were initiated by nurses without physician involvement, polypharmacy was common, and a high potential for reducing transfers by increasing physician presence was observed. Nurses showed rather low knowledge but high self-efficacy. The results are discussed against the background of the interventions including enhancement of physician presence and geriatric quality circles. PMID:28540338

  6. What Are Nursing Facilities Doing to Reduce Potentially Avoidable Hospitalizations?

    Science.gov (United States)

    Daras, Laura Coots; Wang, Joyce M; Ingber, Melvin J; Ormond, Catherine; Breg, Nathaniel W; Khatutsky, Galina; Feng, Zhanlian

    2017-05-01

    Hospitalizations among nursing facility residents are frequent and often potentially avoidable. A number of initiatives and interventions have been developed to reduce excessive hospitalizations; however, little is known about the specific approaches nursing facilities use to address this issue. The objective of this study is to better understand which types of interventions nursing facilities have introduced to reduce potentially avoidable hospitalizations of long-stay nursing facility residents. Cross-sectional survey. 236 nursing facilities from 7 states. Nursing facility administrators. Web-based survey to measure whether facilities introduced any policies or procedures designed specifically to reduce potentially avoidable hospitalizations of long-stay nursing facility residents between 2011 and 2015. We surveyed facilities about seven types of interventions and quality improvement activities related to reducing avoidable hospitalizations, including use of Interventions to Reduce Acute Care Transfers (INTERACT) and American Medical Directors Association tools. Ninety-five percent of responding nursing facilities reported having introduced at least one new policy or procedure to reduce nursing facility resident hospitalizations since January 2011. The most common practice reported was hospitalization rate tracking or review, followed by standardized communication tools, such as Situation, Background, Assessment, Recommendation (SBAR). We found some variation in the extent and types of these reported interventions. Nearly all facilities surveyed reported having introduced a variety of initiatives to reduce potentially avoidable hospitalizations, likely driven by federal, state, and corporate initiatives to decrease hospital admissions and readmissions. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

  7. Air pollution, avoidance behaviour and children's respiratory health: evidence from England.

    Science.gov (United States)

    Janke, Katharina

    2014-12-01

    Despite progress in air pollution control, concerns remain over the health impact of poor air quality. Governments increasingly issue air quality information to enable vulnerable groups to avoid exposure. Avoidance behaviour potentially biases estimates of the health effects of air pollutants. But avoidance behaviour imposes a cost on individuals and therefore may not be taken in all circumstances. This paper exploits panel data at the English local authority level to estimate the relationship between children's daily hospital emergency admissions for respiratory diseases and common air pollutants, while allowing for avoidance behaviour in response to air pollution warnings. A 1% increase in nitrogen dioxide or ozone concentrations increases hospital admissions by 0.1%. For the subset of asthma admissions - where avoidance is less costly - there is evidence of avoidance behaviour. Ignoring avoidance behaviour, however, does not result in statistically significant underestimation of the health effect of air pollution.

  8. Trends in avoidable hospitalization rates in Italy, 2001-2008

    Directory of Open Access Journals (Sweden)

    Aldo Rosano

    2013-10-01

    Full Text Available Background: hospitalization for Ambulatory Care Sensitive Conditions (AC SC, also known as avoidable hospitalization (AH has been proposed as effect measure of the accessibility and effectiveness of primary care. In the last years in developed countries, including Italy, hospitalization rates have decreased as well as the rates of AH. The decline of AH-rates could be just an effect of the general trend of hospitalization. The objective of our study was to examine the adjusted trend of AH rates and to test possible associations with measures of primary care (reorganization.Methods: hospital discharges from 2001 to 2008 were analyzed. Main outcome measures were hospitalization rates, both as inpatient and day hospital. ACSCs were grouped in acute conditions, preventable through early diagnoses and treatment and chronic conditions, preventable through good ongoing control and management. Expected time-series rates of AH, estimated on the hypothesis of same time trends of Total Hospitalization (TH, were compared with observed ones using a Chi Square test. Adjusted hospitalization rates were analyzed in conjunction with indicators of primary care.Results: in the studied period, in Italy, the TH rates declined with an average decrease of 19.6%, while the decrease for AH was 16.4%. The rates of AH adjusted for the trend of TH significantly decreased only for chronic conditions. Decreasing trend of AH was correlated with the impact of reorganization of primary care in associative forms.Conclusions: the presented methodology can be used to evaluate the real effectiveness of policies aimed at reducing hospitalization for ACSCs.

  9. Reducing Avoidable Hospital Transfers From Nursing Homes in Austria: Project Outline and Baseline Results.

    Science.gov (United States)

    Kada, Olivia; Janig, Herbert; Likar, Rudolf; Cernic, Karl; Pinter, Georg

    2017-01-01

    Hospital transfers from nursing homes (NHs) are frequent, burdensome for residents, and often avoidable. The evidence regarding the effectiveness of interventions to reduce avoidable transfers is limited, and most projects focus on nurses' knowledge and skills. In the present project, interventions focusing on nurses and physicians are integrated, elaborated, and implemented in 17 NHs. Results of the 6 months preintervention period are reported. Hospital transfer rates (N = 1,520) and basic data on all residents (N = 1,238) were collected prospectively. Nurses' preintervention knowledge and self-efficacy were assessed using standardized questionnaires (N = 330). Many hospital transfers were initiated by nurses without physician involvement, polypharmacy was common, and a high potential for reducing transfers by increasing physician presence was observed. Nurses showed rather low knowledge but high self-efficacy. The results are discussed against the background of the interventions including enhancement of physician presence and geriatric quality circles.

  10. High-Dose Flu Shot May Help Nursing Home Residents Avoid Hospital

    Science.gov (United States)

    ... Flu Shot May Help Nursing Home Residents Avoid Hospital Rates of all-cause admission were significantly lower ... moved out of their comfortable environment to a hospital," noted Dr. Theodore Strange. "This [new vaccine] is ...

  11. Potentially avoidable hospitalizations in five European countries in 2009 and time trends from 2002 to 2009 based on administrative data

    DEFF Research Database (Denmark)

    Thygesen, Lau C; Christiansen, Terkel; Garcia-Armesto, Sandra

    2015-01-01

    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 ti...

  12. Potentially avoidable hospitalizations in five European countries in 2009 and time trends from 2002 to 2009 based on administrative data

    DEFF Research Database (Denmark)

    Thygesen, Lau C; Christiansen, Terkel; Garcia-Armesto, Sandra;

    2015-01-01

    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......, behaviour of the five health-care systems with regard to chronic care....

  13. In-hospital delirium risk assessment, diagnosis and management; medications to avoid

    Directory of Open Access Journals (Sweden)

    Andrew Clegg

    2013-03-01

    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

  14. Nursing Home Resident Symptomatology Triggering Transfer: Avoiding Unnecessary Hospitalizations

    OpenAIRE

    Ashcraft, Alyce S.; Jane Dimmitt Champion

    2012-01-01

    The purpose of this study was to describe nursing home resident symptomatology and medical diagnoses associated with nursing home to hospital transfers. A retrospective chart review of documented transfers was conducted at a 120-bed, nonprofit urban Continuing Care Retirement Center nursing home facility located in the southwestern United States. The transferred residents (n = 101) had seventy different medical diagnoses prior to hospital transfer with hypertension, coronary artery disease, a...

  15. Converging evidence of social avoidant behavior in schizophrenia from two approach-avoidance tasks.

    Science.gov (United States)

    de la Asuncion, Javier; Docx, Lise; Sabbe, Bernard; Morrens, Manuel; de Bruijn, Ellen R A

    2015-10-01

    Many people with schizophrenia suffer from social impairments characterized by active social avoidance, which is related to social phobia common in schizophrenia, while motivational impairments can also result in passive social withdrawal. Although social avoidance is frequently reported in this population, this is the first study to directly compare approach-avoidance tendencies in schizophrenia patients (N = 37) and healthy controls (N = 29). Participants performed two tasks: a computerized approach-avoidance task (AAT) to assess response tendencies toward images of happy and angry faces with direct or averted gaze and a one-to-one personal space test (PST) to gauge more naturalistic approach-avoidance behaviors toward a real person bearing a neutral expression. The AAT results showed that both groups showed faster avoidance responses to angry faces and faster approach responses to happy faces with a direct gaze. Happy faces with averted gaze, however, resulted in faster avoidance responses in the patient group only. On the PST, the patients approached the experimenter less than healthy controls did. This measure of interpersonal distance was positively related to positive symptom severity. Delusions of reference and increased sensitivity to social rejection may explain the patients' avoidance tendencies in response to pictures of happy faces with averted gaze and in the presence of an actual person. The current findings demonstrate the importance of others adopting positive and unambiguous attitudes when interacting with schizophrenia patients to minimize behavioral avoidance patterns, which is particularly relevant for relatives and clinicians whose interactions with the patients are crucial to facilitating treatment and promoting healthy social relationships.

  16. Evidence for an expectancy-based theory of avoidance behaviour.

    Science.gov (United States)

    Declercq, Mieke; De Houwer, Jan; Baeyens, Frank

    2008-01-01

    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.

  17. Avoidability of hospital transfers of nursing home residents: perspectives of frontline staff.

    Science.gov (United States)

    Lamb, Gerri; Tappen, Ruth; Diaz, Sanya; Herndon, Laurie; Ouslander, Joseph G

    2011-09-01

    To describe nursing home (NH) staff perceptions of avoidability of hospital transfers of NH residents. Mixed methods qualitative and quantitative analysis of 1,347 quality improvement (QI) review tools completed by staff at 26 NHs and transcripts of conference calls. Twenty-six NHs in three states participating in the Interventions to Reduce Acute Care Transfers (INTERACT II) QI project. Site coordinators and staff who participated in project orientation and conference calls and completed QI tools. NH and hospitalization data collected for the INTERACT II project. An interprofessional team coded and quantified reasons for hospital transfer on 1,347 QI review tools. Staff rated 76% of the transfers in the QI review tools as not avoidable. Common reasons for transfers rated as unavoidable were acute change in resident status, family insistence, and physician order for transfer. These same reasons were given for transfers rated as avoidable. Avoidable ratings were associated with a broader set of reasons and recommendations for improvement, including earlier identification and management of changes in clinical status, earlier discussion with family members about advance directives, and more-comprehensive communication with physicians. NHs that were more actively engaged in the INTERACT II interventions rated more transfers as avoidable. Percentage of transfers rated avoidable was not correlated with change in hospitalization rates. NH staff rated fewer hospital transfers as avoidable than published estimates. Greater attention to the complex array of reasons that staff provide for hospital transfer should be considered in strategies to reduce avoidable hospitalizations of NH residents. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

  18. Exploring the link between ambulatory care and avoidable hospitalizations at the Veteran Health Administration.

    Science.gov (United States)

    Pracht, Etienne E; Bass, Elizabeth

    2011-01-01

    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.

  19. A Survey of Nursing Home Organizational Characteristics Associated with Potentially Avoidable Hospital Transfers and Care Quality in One Large British Columbia Health Region

    Science.gov (United States)

    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

    2011-01-01

    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…

  20. A Survey of Nursing Home Organizational Characteristics Associated with Potentially Avoidable Hospital Transfers and Care Quality in One Large British Columbia Health Region

    Science.gov (United States)

    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

    2011-01-01

    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. Hypervigilance-avoidance in children with anxiety disorders: magnetoencephalographic evidence.

    Science.gov (United States)

    Wessing, Ida; Romer, Georg; Junghöfer, Markus

    2017-01-01

    An altered pattern of threat processing is deemed critical for the development of anxiety disorders (AD). According to the hypervigilance-avoidance hypothesis, AD patients show hypervigilance to threat cues at early stages of processing but avoid threat cues at later stages of processing. Consistently, adults with AD show enhanced neurophysiological responses to threat in early time windows and reduced responses to threat in late time windows. The presence of such a hypervigilance-avoidance effect and its underlying neural sources remain to be determined in clinically anxious children. Twenty-three children diagnosed with an AD and 23 healthy control children aged 8-14 years saw faces with angry and neutral expressions while whole-head magnetoencephalography (MEG) was recorded. Neural sources were estimated based on L2-Minimum Norm inverse source modeling and analyzed in early, midlatency, and late time windows. In visual cortical regions, early threat processing was relatively enhanced in patients compared to controls, whereas this relation was inverted in a late interval. Consistent with the idea of affective regulation, the right dorsolateral prefrontal cortex revealed relatively reduced inhibition of early threat processing but revealed enhanced inhibition at a late interval in patients. Both visual-sensory and prefrontal effects were correlated with individual trait anxiety. These results support the hypothesis of early sensory hypervigilance followed by later avoidance of threat in anxiety disordered children, presumably modulated by early reduced and later enhanced prefrontal inhibition. This neuronal hypervigilance-avoidance pattern unfolds gradually with increasing trait anxiety, reflecting a progressively biased allocation of attention to threat. © 2016 Association for Child and Adolescent Mental Health.

  2. Measuring Experiential Avoidance: Evidence toward Multidimensional Predictors of Trauma Sequelae

    Directory of Open Access Journals (Sweden)

    Meaghan Lewis

    2017-02-01

    Full Text Available The current study sought to investigate measurement discrepancies in self-report assessment of experiential avoidance (EA. Recent research indicates that EA may be more appropriately conceptualized as a multidimensional construct, operationally defined in terms of specific avoidance strategies. To test this notion, EA was measured using two self-report assessment instruments, the Acceptance and Action Questionnaire-II (AAQ-II and the Multidimensional Experiential Avoidance Questionnaire (MEAQ in a convenience sample of university students. Measurement differences across measures and unique contributions to prediction of posttraumatic stress symptoms (PTSS and engagement in problematic behaviors were evaluated. Both the AAQ-II and MEAQ were found to significantly mediate the effect of childhood trauma exposure on PTSS. However, when levels of PTSS were dummy coded into dichotomies of those with a likely PTSD diagnosis and those without, the MEAQ was a stronger predictor symptoms of those with a likely PTSD diagnosis than AAQ-II did. These results provide initial support for the discriminant validity of the MEAQ, which appears to be a more specific predictor of trauma-related symptoms.

  3. Avoiding occlusal derangement in facial fractures: An evidence based approach

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    Derick Mendonca

    2013-01-01

    Full Text Available Facial fractures with occlusal derangement describe any fracture which directly or indirectly affects the occlusal relationship. Such fractures include dento-alveolar fractures in the maxilla and mandible, midface fractures - Le fort I, II, III and mandible fractures of the symphysis, parasymphysis, body, angle, and condyle. In some of these fractures, the fracture line runs through the dento-alveolar component whereas in others the fracture line is remote from the occlusal plane nevertheless altering the occlusion. The complications that could ensue from the management of maxillofacial fractures are predominantly iatrogenic, and therefore can be avoided if adequate care is exercised by the operating surgeon. This paper does not emphasize on complications arising from any particular technique in the management of maxillofacial fractures but rather discusses complications in general, irrespective of the technique used.

  4. Reducing the hospital burden of heparin-induced thrombocytopenia: impact of an avoid-heparin program.

    Science.gov (United States)

    McGowan, Kelly E; Makari, Joy; Diamantouros, Artemis; Bucci, Claudia; Rempel, Peter; Selby, Rita; Geerts, William

    2016-04-21

    Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction occurring in up to 5% of patients exposed to unfractionated heparin (UFH). We examined the impact of a hospital-wide strategy for avoiding heparin on the incidence of HIT, HIT with thrombosis (HITT), and HIT-related costs. The Avoid-Heparin Initiative, implemented at a tertiary care hospital in Toronto, Ontario, Canada, since 2006, involved replacing UFH with low-molecular-weight heparin (LMWH) for prophylactic and therapeutic indications. Consecutive cases with suspected HIT from 2003 through 2012 were reviewed. Rates of suspected HIT, adjudicated HIT, and HITT, along with HIT-related expenditures were compared in the pre-intervention (2003-2005) and the avoid-heparin (2007-2012) phases. The annual rate of suspected HIT decreased 42%, from 85.5 per 10 000 admissions in the pre-intervention phase to 49.0 per 10 000 admissions in the avoid-heparin phase ( ITALIC! Pheparin phase. To the best of our knowledge, this is the first study demonstrating the success and feasibility of a hospital-wide HIT prevention strategy.

  5. How Avoidable are Hospitalizations for Children With Medical Complexity? Understanding Parent Perspectives.

    Science.gov (United States)

    Nelson, Bergen B; Coller, Ryan J; Saenz, Adrianna A; Chung, Paul J; Kaplan, Avery; Lerner, Carlos F; Klitzner, Thomas S

    2016-08-01

    Children with medical complexity (CMC) are a small group that utilizes large amounts of health care resources. Although parents are the primary healthcare decision-makers for their children, little is known from their perspective about why CMC are hospitalized. We sought to understand what parents think about factors leading to hospitalization and whether any recent hospitalizations might have been avoidable. We conducted qualitative, semistructured interviews with 35 parents of hospitalized CMC who receive care in the Pediatric Medical Home Program, a complex care program at University of California, Los Angeles. Interviews were conducted in English and in Spanish, audio-recorded, transcribed and translated, then coded in ATLAS.ti (Scientific Software Development Gmbh, Berlin, Germany) for qualitative analysis. We sorted qualitative codes into groups with shared concepts, to generate emergent themes. Parents described their experiences leading up to their children's hospitalization, but no one suggested that the hospitalization was potentially avoidable. Most parents perceived their children as having higher susceptibility because of underlying conditions, perceived the symptoms they observed as high-risk, and described seeking emergent care only when they no longer were comfortable at home. Decisions about where to seek care were influenced by health care system factors such as accessibility and continuity of care. Most parents expressed a desire to learn more about their children's conditions and how best to care for them at home. Parents of CMC believe that hospitalizations are largely unavoidable because of higher susceptibility and higher risk. Increasing parents' self-efficacy in caring for children at home might influence their decisions to seek emergent care. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  6. Rapid Primary Care Follow-up from the ED to Reduce Avoidable Hospital Admissions.

    Science.gov (United States)

    Carmel, Amanda S; Steel, Peter; Tanouye, Robert; Novikov, Aleksey; Clark, Sunday; Sinha, Sanjai; Tung, Judy

    2017-08-01

    Hospital admissions from the emergency department (ED) now account for approximately 50% of all admissions. Some patients admitted from the ED may not require inpatient care if outpatient care could be optimized. However, access to primary care especially immediately after ED discharge is challenging. Studies have not addressed the extent to which hospital admissions from the ED may be averted with access to rapid (next business day) primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol on avoidance of hospitalizations in a large, urban medical center. We conducted a retrospective review of patients referred from the ED to primary care (Weill Cornell Internal Medicine Associates - WCIMA) through a rapid-access-to-primary-care program developed at New York-Presbyterian / Weill Cornell Medical Center. Referrals were classified as either an avoided admission or not, and classifications were performed by both emergency physician (EP) and internal medicine physician reviewers. We also collected outcome data on rapid visit completion, ED revisits, hospitalizations and primary care engagement. EPs classified 26 (16%) of referrals for rapid primary care follow-up as avoided admissions. Of the 162 patients referred for rapid follow-up, 118 (73%) arrived for their rapid appointment. There were no differences in rates of ED revisits or subsequent hospitalizations between those who attended the rapid follow-up and those who did not attend. Patients who attended the rapid appointment were significantly more likely to attend at least one subsequent appointment at WCIMA during the six months after the index ED visit [N=55 (47%) vs. N=8 (18%), P=0.001]. A rapid-ED-to-primary-care-access program may allow EPs to avoid admitting patients to the hospital without risking ED revisits or subsequent hospitalizations. This protocol has the potential to save costs over time. A program such as this can also provide a safe and reliable ED discharge option

  7. Medical Home Features of VHA Primary Care Clinics and Avoidable Hospitalizations.

    Science.gov (United States)

    Yoon, Jean; Rose, Danielle E; Canelo, Ismelda; Upadhyay, Anjali S; Schectman, Gordon; Stark, Richard; Rubenstein, Lisa V; Yano, Elizabeth M

    2013-09-01

    As the Veterans Health Administration (VHA) reorganizes providers into the patient-centered medical home, questions remain whether this model of care can demonstrate improved patient outcomes and cost savings. We measured adoption of medical home features by VHA primary care clinics prior to widespread implementation of the patient-centered medical home and examined if they were associated with lower risk and costs of potentially avoidable hospitalizations. Secondary patient data was linked to clinic administrative and survey data. Patient and clinic factors in the baseline year (FY2009) were used to predict patient outcomes in the follow-up year. 2,853,030 patients from 814 VHA primary care clinics Patient outcomes were measured by hospitalizations for an ambulatory care sensitive condition (ACSC) and their costs and identified through diagnosis and procedure codes from inpatient records. Clinic adoption of medical home features was obtained from the American College of Physicians Medical Home Builder®. The overall mean home builder score in the study clinics was 88 (SD = 13) or 69%. In adjusted analyses an increase of 10 points in the medical home adoption score in a clinic decreased the odds of an ACSC hospitalization for patients by 3% (P = 0.032). By component, higher access and scheduling (P = 0.004) and care coordination and transitions (P = 0.020) component scores were related to lower risk of an ACSC hospitalization, and higher population management was related to higher risk (P = 0.023). Total medical home features was not related to ACSC hospitalization costs among patients with at least one (P = 0.074). Greater adoption of medical home features by VHA primary care clinics was found to be significantly associated with lower risk of avoidable hospitalizations with access and scheduling and care coordination/transitions in care as key factors.

  8. Spatial analysis of avoidable hospitalizations due to tuberculosis in Ribeirao Preto, SP, Brazil (2006-2012

    Directory of Open Access Journals (Sweden)

    Mellina Yamamura

    2016-01-01

    Full Text Available ABSTRACT OBJECTIVE To describe the spatial distribution of avoidable hospitalizations due to tuberculosis in the municipality of Ribeirao Preto, SP, Brazil, and to identify spatial and space-time clusters for the risk of occurrence of these events. METHODS This is a descriptive, ecological study that considered the hospitalizations records of the Hospital Information System of residents of Ribeirao Preto, SP, Southeastern Brazil, from 2006 to 2012. Only the cases with recorded addresses were considered for the spatial analyses, and they were also geocoded. We resorted to Kernel density estimation to identify the densest areas, local empirical Bayes rate as the method for smoothing the incidence rates of hospital admissions, and scan statistic for identifying clusters of risk. Softwares ArcGis 10.2, TerraView 4.2.2, and SaTScanTM were used in the analysis. RESULTS We identified 169 hospitalizations due to tuberculosis. Most were of men (n = 134; 79.2%, averagely aged 48 years (SD = 16.2. The predominant clinical form was the pulmonary one, which was confirmed through a microscopic examination of expectorated sputum (n = 66; 39.0%. We geocoded 159 cases (94.0%. We observed a non-random spatial distribution of avoidable hospitalizations due to tuberculosis concentrated in the northern and western regions of the municipality. Through the scan statistic, three spatial clusters for risk of hospitalizations due to tuberculosis were identified, one of them in the northern region of the municipality (relative risk [RR] = 3.4; 95%CI 2.7–4,4; the second in the central region, where there is a prison unit (RR = 28.6; 95%CI 22.4–36.6; and the last one in the southern region, and area of protection for hospitalizations (RR = 0.2; 95%CI 0.2–0.3. We did not identify any space-time clusters. CONCLUSIONS The investigation showed priority areas for the control and surveillance of tuberculosis, as well as the profile of the affected population, which shows

  9. Spatial analysis of avoidable hospitalizations due to tuberculosis in Ribeirao Preto, SP, Brazil (2006-2012)

    Science.gov (United States)

    Yamamura, Mellina; de Freitas, Isabela Moreira; Santo, Marcelino; Chiaravalloti, Francisco; Popolin, Marcela Antunes Paschoal; Arroyo, Luiz Henrique; Rodrigues, Ludmila Barbosa Bandeira; Crispim, Juliane Almeida; Arcêncio, Ricardo Alexandre

    2016-01-01

    ABSTRACT OBJECTIVE To describe the spatial distribution of avoidable hospitalizations due to tuberculosis in the municipality of Ribeirao Preto, SP, Brazil, and to identify spatial and space-time clusters for the risk of occurrence of these events. METHODS This is a descriptive, ecological study that considered the hospitalizations records of the Hospital Information System of residents of Ribeirao Preto, SP, Southeastern Brazil, from 2006 to 2012. Only the cases with recorded addresses were considered for the spatial analyses, and they were also geocoded. We resorted to Kernel density estimation to identify the densest areas, local empirical Bayes rate as the method for smoothing the incidence rates of hospital admissions, and scan statistic for identifying clusters of risk. Softwares ArcGis 10.2, TerraView 4.2.2, and SaTScanTM were used in the analysis. RESULTS We identified 169 hospitalizations due to tuberculosis. Most were of men (n = 134; 79.2%), averagely aged 48 years (SD = 16.2). The predominant clinical form was the pulmonary one, which was confirmed through a microscopic examination of expectorated sputum (n = 66; 39.0%). We geocoded 159 cases (94.0%). We observed a non-random spatial distribution of avoidable hospitalizations due to tuberculosis concentrated in the northern and western regions of the municipality. Through the scan statistic, three spatial clusters for risk of hospitalizations due to tuberculosis were identified, one of them in the northern region of the municipality (relative risk [RR] = 3.4; 95%CI 2.7–4,4); the second in the central region, where there is a prison unit (RR = 28.6; 95%CI 22.4–36.6); and the last one in the southern region, and area of protection for hospitalizations (RR = 0.2; 95%CI 0.2–0.3). We did not identify any space-time clusters. CONCLUSIONS The investigation showed priority areas for the control and surveillance of tuberculosis, as well as the profile of the affected population, which shows important

  10. Why Bangladeshi nurses avoid 'nursing': social and structural factors on hospital wards in Bangladesh.

    Science.gov (United States)

    Hadley, Mary B; Blum, Lauren S; Mujaddid, Saraana; Parveen, Shahana; Nuremowla, Sadid; Haque, Mohammad Enamul; Ullah, Mohammad

    2007-03-01

    In response to concerns that nurses spend less than 6% of their time on direct patient care, this study explored factors that influence nurses' behaviour in the provision of 'hands on' care in hospitals in Bangladesh. Through in-depth interviews with female nurses and patients and their co-workers in six hospitals, we identified conflicts between the inherited British model of nursing and Bangladeshi societal norms. This was most evident in the areas of night duty, contact with strangers, and involvement in 'dirty' work. The public was said to associate nursing activities with commercial sex work. As a consequence, their value on the 'bride market' decreases. To minimise the stigma associated with their profession, nurses in government hospitals distance themselves from patients, using nurse surrogates in the form of patients' relatives and hospital support workers to carry out their work. These adaptations are supported and sustained through unofficial activities developed over time within hospitals. In contrast nurses in NGO hospitals give more direct patient care themselves and do not rely on carers as much because of tight supervision and limited visitor hours. Initiatives undertaken to improve the quality of patient care, such as enlarging the nursing workforce or providing clinical instruction, which do not take into account the prevailing culture in hospitals and social conflicts faced by nurses, are unlikely to succeed. Fundamental decisions on how to care for the sick in Bangladesh are required. If the present nursing curriculum is followed, adequate supplies, supervision and accountability are prerequisites for its implementation.

  11. Potentially avoidable inpatient nights among warfarin receiving patients; an audit of a single university teaching hospital.

    LENUS (Irish Health Repository)

    Forde, Dónall

    2009-01-01

    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

  12. 26 CFR 1.533-1 - Evidence of purpose to avoid income tax.

    Science.gov (United States)

    2010-04-01

    ... (15 U.S.C. ch. 14B) and the regulations thereunder (13 CFR part 107) will generally be considered to... TAX (CONTINUED) INCOME TAXES (CONTINUED) Corporations Used to Avoid Income Tax on Shareholders § 1.533... shareholders is subject to disproof by competent evidence. Section 533(a) provides that the fact that...

  13. Avoidable Technical and Clinical Denial Write-Off Management in Hospitals, Physician Offices, and Clinics.

    Science.gov (United States)

    Terra, Sandra Marlene; Byrne, Amanda

    2016-01-01

    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.

  14. Decreasing avoidable hospital admissions with the implementation of an emergency department case management program.

    Science.gov (United States)

    Sharieff, Ghazala Q; Cantonis, Matt; Tressler, Michelle; Whitehead, Mary; Russe, Jamie; Lovell, Eric

    2014-01-01

    With the passage of the Affordable Care Act, increased emphasis has been placed on optimizing quality and reducing expenditures. The use of an emergency department case manager (EDCM) is reemerging as an important initiative in the quest to provide high-quality care and decrease unnecessary hospital admissions. A pilot study of the use of EDCMs was conducted in one of the authors' EDs during a 6-month trial period. By using evidence-based criteria, the EDCM helped in real time to verify admission criteria, assisted with inpatient versus outpatient designation, found community alternatives to hospital admission, and initiated discharge planning for patients who required admission and were at high risk for readmission. EDCMs also worked with pharmacists to assist with medication management for patients who required assistance with obtaining prescriptions. Because of the pilot study's success, the authors' health care system will be implementing EDCMs throughout the organization.

  15. Hospital organization based on intensity of care: potential errors to avoid

    Directory of Open Access Journals (Sweden)

    Roberto NardI

    2012-01-01

    Full Text Available IntroductionThe extreme variability of clinical severity in medical admitted patients is diluted in a “average” standard of care, that may be stronger than the real needs for someone, but clearly inadequate, sometimes even dangerous, for other ones, critically ill.DiscussionThe model of a differentiated intensity of hospital care can be defined as the organizational model structured to areas/sectors dedicated to patients with homogeneous needs of care. The intermediate care unit (“High dependency units”, “sub-intensive care areas” – “high care units” are particularly suitable for patients who have a lower risk compared to patients treated in intensive care, but liable to develop complications and needing a close monitoring much more than the “standard”, “routine” care. The implementation of the a new organizational model must be careful and consider the possible enlargement errors that can be made. The analysis of the context is necessary for assess prerequisites, excluding the elements opposed to the success of the proposed model (i.e.: wards congestion and overcrowding, with a consequential with increased risk of adverse events. Before implementing and admitting patients in new “models”, we have to define the epidemiological population characteristics, their level of complexity/criticality/instability and the current assessment tools.ConclusionsAny new proposal of hospital management change has, as first obligation, to explicit the basic visions and primary goals for “the added value” resulting to the patient and the whole organization, with the evidence of an “health technology assessment” approach, for the professional hospital overall governance. But without the presumption, or worse, the apodictic assertion, to proclaim the implementation of structures with “differentiated intensity of hospital care” organizations that are not.

  16. Avoidable iatrogenic complications of urethral catheterization and inadequate intern training in a tertiary-care teaching hospital.

    LENUS (Irish Health Repository)

    Thomas, Arun Z

    2009-10-01

    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.

  17. Is rumination after bereavement linked with loss avoidance? Evidence from eye-tracking.

    Directory of Open Access Journals (Sweden)

    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

  18. Referral pathways for patients with TIA avoiding hospital admission: a scoping review

    Science.gov (United States)

    Evans, Bridie Angela; Ali, Khalid; Bulger, Jenna; Ford, Gary A; Jones, Matthew; Moore, Chris; Porter, Alison; Pryce, Alan David; Quinn, Tom; Seagrove, Anne C; Whitman, Shirley; Rees, Nigel

    2017-01-01

    Objective 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. Design Scoping review. Data sources PubMed, CINAHL Web of Science, Scopus. Study selection Reports of primary research on referral of patients with suspected TIA directly to specialist outpatient services. Data extraction 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. Results 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. Conclusions 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. Trial registration number ISRCTN85516498. Stage: pre-results. PMID:28196949

  19. Comparing public and private hospitals in China: evidence from Guangdong.

    Science.gov (United States)

    Eggleston, Karen; Lu, Mingshan; Li, Congdong; Wang, Jian; Yang, Zhe; Zhang, Jing; Quan, Hude

    2010-03-23

    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

  20. Comparing public and private hospitals in China: Evidence from Guangdong

    Directory of Open Access Journals (Sweden)

    Yang Zhe

    2010-03-01

    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

  1. Timing vocal behaviour: experimental evidence for song overlap avoidance in Eurasian wrens.

    Science.gov (United States)

    Yang, Xiao-Jing; Ma, Xiang-Ru; Slabbekoorn, Hans

    2014-03-01

    Timing during vocal interactions can play a significant role in terms of audibility as signal overlap may lead to masking of acoustic details for both of the interacting animals as well as for third-party eavesdroppers. Here we investigated timing aspects experimentally in Eurasian wrens (Troglodytes troglodytes) using non-interactive playback. We applied a randomized overlay method incorporating the temporal pattern of singing by the focal bird to establish a null model and to test observed patterns of overlap against this null model. We used different stimulus song rates but temporal response patterns always resulted in significantly lower levels of overlap than expected by chance. The male wrens avoided overlapping by timing their song starts predominately right after the end of stimulus songs, but they did not avoid being overlapped by the stimulus songs. The territorial males typically raised their song rates during and after playback with a tendency to shorten between-song intervals while keeping song durations unchanged. Higher song rates of the playback stimuli increased the extent to which responders were being overlapped by the stimulus songs. Our data provide experimental evidence for a timing ability in Eurasian wrens by which they reduce mutual interference during vocal interactions.

  2. Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network

    Directory of Open Access Journals (Sweden)

    Woodhams Victoria

    2012-06-01

    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.

  3. Integrating the Principles of Evidence Based Medicine and Evidence Based Public Health: Impact on the Quality of Patient Care and Hospital Readmission Rates in Jordan

    Directory of Open Access Journals (Sweden)

    Mohammad S. Alyahya

    2016-08-01

    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.

  4. Integrating the Principles of Evidence Based Medicine and Evidence Based Public Health: Impact on the Quality of Patient Care and Hospital Readmission Rates in Jordan.

    Science.gov (United States)

    Alyahya, Mohammad S; Hijazi, Heba H; Alshraideh, Hussam A; Alsharman, Mohammad Aser; Al Abdi, Rabah; Harvey, Heather Lea

    2016-08-31

    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. 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. 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. 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.

  5. Preliminary evidence of association between EFHC2, a gene implicated in fear recognition, and harm avoidance.

    Science.gov (United States)

    Blaya, Carolina; Moorjani, Priya; Salum, Giovanni Abrahão; Gonçalves, Leonardo; Weiss, Lauren A; Leistner-Segal, Sandra; Manfro, Gisele G; Smoller, Jordan W

    2009-03-06

    Genetic variation at the EF-hand domain containing 2 gene (EFHC2) locus has been associated with fear recognition in Turner syndrome. The aim of this study was to examine whether EFHC2 variants are associated with non-syndromic anxiety-related traits [harm avoidance (HA) and behavioral inhibition (BI)] and with panic disorder (PD). Our sample comprised 127 PD patients and 132 controls without psychiatric disorder. We genotyped nine SNPs within the EFHC2 locus and used PLINK to perform association analyses. An intronic SNP (rs1562875) was associated with HA (permuted p=0.031) accounting alone for over 3% of variance in this trait. This same SNP was nominally, but not empirically, associated with BI (r(2)=0.022; nominal p=0.022) and PD (OR=2.64; nominal p=0.009). The same association was found in a subsample of only females. In sum, we observed evidence of association between a variant in EFHC2, a gene previously associated with the processing of fear and social threat, and HA. Larger studies are warranted to confirm this association.

  6. Hospital organization based on intensity of care: potential errors to avoid

    OpenAIRE

    Roberto NardI; Vincenzo Arienti; Carlo Nozzoli; Antonino Mazzone

    2012-01-01

    IntroductionThe extreme variability of clinical severity in medical admitted patients is diluted in a “average” standard of care, that may be stronger than the real needs for someone, but clearly inadequate, sometimes even dangerous, for other ones, critically ill.DiscussionThe model of a differentiated intensity of hospital care can be defined as the organizational model structured to areas/sectors dedicated to patients with homogeneous needs of care. The intermediate care unit (“High depend...

  7. Assessment of access to primary health care among children and adolescents hospitalized due to avoidable conditions

    Directory of Open Access Journals (Sweden)

    Ana Paula Scoleze Ferrer

    Full Text Available Introduction: Hospitalizations for ambulatory care-sensitive conditions (HACSC are considered an indicator of the effectiveness of primary health care (PHC. High rates of HACSC represent problems in the access or the quality of health care. In Brazil, HACSC rates are high and there are few studies on the factors associated with it. Objective: To evaluate the access to PHC offered to children and adolescents hospitalized due to ACSC and analyze the conditioning factors. Method: Cross-sectional study with a quantitative and qualitative approach. Five hundred and one (501 users (guardians/caregivers and 42 professionals of PHC units were interviewed over one year. Quantitative data were obtained using Primary Care Assessment Tool validated in Brazil (PCATool-Brazil, while qualitative data were collected by semi-structured interview. The independent variables were: age, maternal education, family income, type of diagnosis, and model of care offered, and the dependent variables were access and its components (accessibility and use of services. Results: Sixty-five percent (65.2% of hospitalizations were ACSC. From the perspective of both users and professionals, access and its components presented low scores. Age, type of diagnosis, and model of care affected the results. Conclusion: The proportion of HACSC was high in this population. Access to services is inappropriate due to: barriers to access, appreciation of the emergency services, and attitude towards health needs. Professional attitudes and opinions reinforce inadequate ideas of users reflecting on the pattern of service use.

  8. Evidence for inbreeding depression and pre-copulatory, but not post copulatory inbreeding avoidance in the cabbage beetle Colaphellus bowringi.

    Directory of Open Access Journals (Sweden)

    XingPing Liu

    Full Text Available Inbreeding is known to have adverse effects on fitness-related traits in a range of insect species. A series of theoretical and experimental studies have suggested that polyandrous insects could avoid the cost of inbreeding via pre-copulatory mate choice and/or post-copulatory mechanisms. We looked for evidence of pre-copulatory inbreeding avoidance using female mate preference trials, in which females were given the choice of mating with either of two males, a sibling and a non-sibling. We also tested for evidence of post-copulatory inbreeding avoidance by conducting double mating experiments, in which four sibling females were mated with two males sequentially, either two siblings, two non-siblings or a sibling and a non-sibling in either order. We identified substantial inbreeding depression: offspring of females mated to full siblings had lower hatching success, slower development time from egg to adult, lower survival of larval and pupal stages, and lower adult body mass than the offspring of females mated to non-sibling males. We also found evidence of pre-copulatory inbreeding avoidance, as females preferred to mate with non-sibling males. However, we did not find any evidence of post-copulatory inbreeding avoidance: egg hatching success of females mating to both sibling and non-sibling males were consistent with sperm being used without bias in relation to mate relatedness. Our results suggest that this cabbage beetle has evolved a pre-copulatory mechanism to avoid matings between close relative, but that polyandry is apparently not an inbreeding avoidance mechanism in C. bowringi.

  9. Spider fearful individuals attend to threat, then quickly avoid it: Evidence from eye movements

    NARCIS (Netherlands)

    Rinck, M.; Becker, E.S.

    2006-01-01

    According to cognitive models of anxiety, anxiety patients exhibit an early reflexive attentional bias toward threat stimuli, which may be followed by intentional avoidance of these stimuli. To determine the time course of attentional vigilance and avoidance, the authors conducted an eye-tracking st

  10. Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service.

    Science.gov (United States)

    Dwyer, Trudy; Craswell, Alison; Rossi, Dolene; Holzberger, Darren

    2017-01-13

    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

  11. A multilevel analysis on the relationship between neighbourhood poverty and public hospital utilization: is the high Indigenous morbidity avoidable?

    Directory of Open Access Journals (Sweden)

    Guthridge Steven L

    2011-09-01

    Full Text Available Abstract Background The estimated life expectancy at birth for Indigenous Australians is 10-11 years less than the general Australian population. The mean family income for Indigenous people is also significantly lower than for non-Indigenous people. In this paper we examine poverty or socioeconomic disadvantage as an explanation for the Indigenous health gap in hospital morbidity in Australia. Methods We utilised a cross-sectional and ecological design using the Northern Territory public hospitalisation data from 1 July 2004 to 30 June 2008 and socio-economic indexes for areas (SEIFA from the 2006 census. Multilevel logistic regression models were used to estimate odds ratios and confidence intervals. Both total and potentially avoidable hospitalisations were investigated. Results This study indicated that lifting SEIFA scores for family income and education/occupation by two quintile categories for low socio-economic Indigenous groups was sufficient to overcome the excess hospital utilisation among the Indigenous population compared with the non-Indigenous population. The results support a reframing of the Indigenous health gap as being a consequence of poverty and not simplistically of ethnicity. Conclusions Socio-economic disadvantage is a likely explanation for a substantial proportion of the hospital morbidity gap between Indigenous and non-Indigenous populations. Efforts to improve Indigenous health outcomes should recognise poverty as an underlying determinant of the health gap.

  12. Validity of Diagnostic Evidence for Deceased Cases in Hospitals

    Institute of Scientific and Technical Information of China (English)

    XIA WAN; LI-JUN WANG; JUN-FANG WANG; AI-PING CHEN; GONG-HUAN YANG

    2008-01-01

    Objective To determine the validity of the diagnostic evidence for deceased cases in hospitals. Methods All information collected from medical records of the deceased cases in tertiary care health facilities was input into our database. Four diagnosis levels were determined based on level of diagnostic evidence: level I was based on autopsy, pathology or operative exploration, level Ⅱ on physical and laboratory tests plus expert clinical judgment, level Ⅲ on expert clinical judgment, level Ⅳ on postmortem assumptions. After the diagnostic evidence of each deceased case was reviewed by a panel of three experts, the diagnostic level of each diagnosis was determined. Results Among the 2102 medical cases for verbal autopsy study, only 26 (1.24%) afforded diagnostic evidence for level Ⅲ. Among the level Ⅲ evidence-based cases of death, the major causes of death were cardiovascular diseases, respiratory diseases, and gastroenterological diseases. According to some special symptoms and medical histories, these cases could be diagnosed by comprehensive clinical judgment. Only one case met the criteria for level Ⅳ. Conclusion Level Ⅰ diagnostic evidence is hard to attain in China because of the traditional concept and economic restriction. The causes for 2101 deaths can be validated by level Ⅱ or Ⅲ diagnostic evidence.

  13. Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines.

    Science.gov (United States)

    Osborne, Andrew; Taylor, Louise; Reuber, Markus; Grünewald, Richard A; Parkinson, Martin; Dickson, Jon M

    2015-01-01

    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.

  14. [Analysis of the influence of the process of care in primary health care on avoidable hospitalizations for heart failure].

    Science.gov (United States)

    del Saz Moreno, Vicente; Alberquilla Menéndez-Asenjo, Ángel; Camacho Hernández, Ana M; Lora Pablos, David; Enríquez de Salamanca Lorente, Rafael; Magán Tapia, Purificación

    2016-02-01

    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.

  15. Avoidable iatrogenic complications of urethral catheterization and inadequate intern training in a tertiary-care teaching hospital.

    Science.gov (United States)

    Thomas, Arun Z; Giri, Subhasis K; Meagher, David; Creagh, Tom

    2009-10-01

    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. Male UC-related morbidities were retrospectively identified from our computerized inpatient urology consultation system over a 1-year period from July 2006 to June 2007. Relevant medical records were also reviewed. An anonymous questionnaire was used for the subjective assessment of interns about their training on UC. The primary outcome measures were the prevalence of urethral trauma secondary to UC by a non-urological team member in non-urological departments, risk factors and intern-perceived adequacy of practical and theoretical training on UC during their intern year, and finally the supervision of interns during first UC. Of 864 urological consultations, 51 (6%) were related to complications arising from male UC during the 1-year period. The most common indication for UC was monitoring urinary output for acute medical illness (34/51, 67%). The most common complication was urethral trauma (35/51, 67%). The balloon was accidentally inflated in the urethra in six patients (12%). Of the 51 cases of UC-related morbidity, 38 (74%) resulted from interns performing UC, and of these 28 (73%) occurred during the first 6 months of internship. Overall, 76% of interns felt that their practical training was none or inadequate; 52% (26/50) did not receive any supervision during their first UC. UC-related iatrogenic morbidity is not uncommon even in a tertiary-care teaching hospital. This study identified that interns receive inadequate training on UC. Finally, most of the complications are potentially avoidable and can be prevented by adopting a proper technique of catheterization. Adequate training and supervision of medical students and interns can achieve this.

  16. Inbreeding avoidance in spiders: evidence for rescue effect in fecundity of female spiders with outbreeding opportunity

    DEFF Research Database (Denmark)

    Bilde, T.; Maklakov, A.A.; Schilling, Nadia

    2007-01-01

    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...

  17. [Management of avoidable acute transfers from an intermediate care geriatric facility to acute hospitals: critical aspects of an intervention protocol].

    Science.gov (United States)

    Colprim, Daniel; Casco, Mónica; Malumbres, Jennifer; Rodríguez, Ginés; Inzitari, Marco

    The unplanned transfers (UT) from post-acute intermediate care facilities, are associated with adverse outcomes for patients, and a significant cost to the system. We present a practical protocol and the design of an intervention study aimed at reducing avoidable UT from a geriatric post-acute rehabilitation setting to acute care hospitals. A quasi-experimental non randomized study. The intervention consists in: 1) protocol for early detection of symptoms in order to conduct a pro-active management of decompensation; 2) an advanced care planning structured protocol for the acute decompensations. We will compare the intervention group with a parallel and a historical cohort for demographic, functional, cognitive, comorbidity and social variables. number of UT to acute care hospitals. This is a quasi-experimental study, focused on everyday care practice that intends to assess the impact of multi-disciplinary and multi-factorial intervention to reduce UT from a post-acute rehabilitation unit. We expect that the project results will be useful for future randomized and controlled studies. Copyright © 2016 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Do People Avoid Morally Relevant Information? Evidence from the Refugee Crisis

    NARCIS (Netherlands)

    Freddi, Eleonora

    2017-01-01

    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

  19. Trait Anxiety and Economic Risk Avoidance Are Not Necessarily Associated: Evidence from the Framing Effect.

    Science.gov (United States)

    Gu, Ruolei; Wu, Runguo; Broster, Lucas S; Jiang, Yang; Xu, Rui; Yang, Qiwei; Xu, Pengfei; Luo, Yue-Jia

    2017-01-01

    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.

  20. Trait Anxiety and Economic Risk Avoidance Are Not Necessarily Associated: Evidence from the Framing Effect

    Science.gov (United States)

    Gu, Ruolei; Wu, Runguo; Broster, Lucas S.; Jiang, Yang; Xu, Rui; Yang, Qiwei; Xu, Pengfei; Luo, Yue-Jia

    2017-01-01

    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. PMID:28197116

  1. No evidence for spectral jamming avoidance in echolocation behavior of foraging pipistrelle bats

    OpenAIRE

    Simone Götze; Jens C Koblitz; Annette Denzinger; Hans-Ulrich Schnitzler

    2016-01-01

    Frequency shifts in signals of bats flying near conspecifics have been interpreted as a spectral jamming avoidance response (JAR). However, several prerequisites supporting a JAR hypothesis have not been controlled for in previous studies. We recorded flight and echolocation behavior of foraging Pipistrellus pipistrellus while flying alone and with a conspecific and tested whether frequency changes were due to a spectral JAR with an increased frequency difference, or whether changes could be ...

  2. Attachment Avoidance Is Significantly Related to Attentional Preference for Infant Faces: Evidence from Eye Movement Data

    Science.gov (United States)

    Jia, Yuncheng; Cheng, Gang; Zhang, Dajun; Ta, Na; Xia, Mu; Ding, Fangyuan

    2017-01-01

    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. PMID:28184210

  3. Evidence of inbreeding depression but not inbreeding avoidance in a natural house sparrow population.

    Science.gov (United States)

    Billing, Anna M; Lee, Aline M; Skjelseth, Sigrun; Borg, Asa A; Hale, Matthew C; Slate, Jon; Pärn, Henrik; Ringsby, Thor H; Saether, Bernt-Erik; Jensen, Henrik

    2012-03-01

    Inbreeding is common in small and threatened populations and often has a negative effect on individual fitness and genetic diversity. Thus, inbreeding can be an important factor affecting the persistence of small populations. In this study, we investigated the effects of inbreeding on fitness in a small, wild population of house sparrows (Passer domesticus) on the island of Aldra, Norway. The population was founded in 1998 by four individuals (one female and three males). After the founder event, the adult population rapidly increased to about 30 individuals in 2001. At the same time, the mean inbreeding coefficient among adults increased from 0 to 0.04 by 2001 and thereafter fluctuated between 0.06 and 0.10, indicating a highly inbred population. We found a negative effect of inbreeding on lifetime reproductive success, which seemed to be mainly due to an effect of inbreeding on annual reproductive success. This resulted in selection against inbred females. However, the negative effect of inbreeding was less strong in males, suggesting that selection against inbred individuals is at least partly sex specific. To examine whether individuals avoided breeding with close relatives, we compared observed inbreeding and kinship coefficients in the population with those obtained from simulations of random mating. We found no significant differences between the two, indicating weak or absent inbreeding avoidance. We conclude that there was inbreeding depression in our population. Despite this, birds did not seem to actively avoid mating with close relatives, perhaps as a consequence of constraints on mating possibilities in such a small population.

  4. Can Self-Control Explain Avoiding Free Money? Evidence from Interest-Free Student Loans.

    Science.gov (United States)

    Cadena, Brian C; Keys, Benjamin J

    2013-10-01

    This paper uses insights from behavioral economics to explain a particularly surprising borrowing phenomenon: One in six undergraduate students offered interest-free loans turn them down. Models of impulse control predict that students may optimally reject subsidized loans to avoid excessive consumption during school. Using the National Postsecondary Student Aid Study (NPSAS), we investigate students' take-up decisions and identify a group of students for whom the loans create an especially tempting liquidity increase. Students who would receive the loan in cash are significantly more likely to turn it down, suggesting that consumers choose to limit their liquidity in economically meaningful situations.

  5. Evidence of SV40 infections in hospitalized children

    Science.gov (United States)

    Butel, J. S.; Jafar, S.; Wong, C.; Arrington, A. S.; Opekun, A. R.; Finegold, M. J.; Adam, E.

    1999-01-01

    Simian virus 40 (SV40) is known to have contaminated poliovirus vaccines used between 1955 and 1963. Accumulating reports have described the presence of SV40 DNA in human tumors and normal tissues, although the significance of human infections by SV40 is unknown. We investigated whether unselected hospitalized children had evidence of SV40 infections and whether any clinical correlations were apparent. Serum samples were examined for SV40 neutralizing antibody using a specific plaque reduction test; of 337 samples tested, 20 (5.9%) had antibody to SV40. Seropositivity increased with age and was significantly associated with kidney transplants (6 of 15 [40%] positive, P infections in children born after 1980. We conclude that SV40 causes natural infections in humans.

  6. Evidence of SV40 infections in hospitalized children

    Science.gov (United States)

    Butel, J. S.; Jafar, S.; Wong, C.; Arrington, A. S.; Opekun, A. R.; Finegold, M. J.; Adam, E.

    1999-01-01

    Simian virus 40 (SV40) is known to have contaminated poliovirus vaccines used between 1955 and 1963. Accumulating reports have described the presence of SV40 DNA in human tumors and normal tissues, although the significance of human infections by SV40 is unknown. We investigated whether unselected hospitalized children had evidence of SV40 infections and whether any clinical correlations were apparent. Serum samples were examined for SV40 neutralizing antibody using a specific plaque reduction test; of 337 samples tested, 20 (5.9%) had antibody to SV40. Seropositivity increased with age and was significantly associated with kidney transplants (6 of 15 [40%] positive, P children born after 1980. We conclude that SV40 causes natural infections in humans.

  7. No evidence for spectral jamming avoidance in echolocation behavior of foraging pipistrelle bats.

    Science.gov (United States)

    Götze, Simone; Koblitz, Jens C; Denzinger, Annette; Schnitzler, Hans-Ulrich

    2016-08-09

    Frequency shifts in signals of bats flying near conspecifics have been interpreted as a spectral jamming avoidance response (JAR). However, several prerequisites supporting a JAR hypothesis have not been controlled for in previous studies. We recorded flight and echolocation behavior of foraging Pipistrellus pipistrellus while flying alone and with a conspecific and tested whether frequency changes were due to a spectral JAR with an increased frequency difference, or whether changes could be explained by other reactions. P. pipistrellus reacted to conspecifics with a reduction of sound duration and often also pulse interval, accompanied by an increase in terminal frequency. This reaction is typical of behavioral situations where targets of interest have captured the bat's attention and initiated a more detailed exploration. All observed frequency changes were predicted by the attention reaction alone, and do not support the JAR hypothesis of increased frequency separation. Reaction distances of 1-11 m suggest that the attention response may be elicited either by detection of the conspecific by short range active echolocation or by long range passive acoustic detection of echolocation calls.

  8. Experimental evidence of threat-sensitive collective avoidance responses in a large wild-caught herring school.

    Directory of Open Access Journals (Sweden)

    Guillaume Rieucau

    Full Text Available Aggregation is commonly thought to improve animals' security. Within aquatic ecosystems, group-living prey can learn about immediate threats using cues perceived directly from predators, or from collective behaviours, for example, by reacting to the escape behaviours of companions. Combining cues from different modalities may improve the accuracy of prey antipredatory decisions. In this study, we explored the sensory modalities that mediate collective antipredatory responses of herring (Clupea harengus when in a large school (approximately 60,000 individuals. By conducting a simulated predator encounter experiment in a semi-controlled environment (a sea cage, we tested the hypothesis that the collective responses of herring are threat-sensitive. We investigated whether cues from potential threats obtained visually or from the perception of water displacement, used independently or in an additive way, affected the strength of the collective avoidance reactions. We modified the sensory nature of the simulated threat by exposing the herring to 4 predator models differing in shape and transparency. The collective vertical avoidance response was observed and quantified using active acoustics. The combination of sensory cues elicited the strongest avoidance reactions, suggesting that collective antipredator responses in herring are mediated by the sensory modalities involved during threat detection in an additive fashion. Thus, this study provides evidence for magnitude-graded threat responses in a large school of wild-caught herring which is consistent with the "threat-sensitive hypothesis".

  9. Experimental evidence of threat-sensitive collective avoidance responses in a large wild-caught herring school.

    Science.gov (United States)

    Rieucau, Guillaume; Boswell, Kevin M; De Robertis, Alex; Macaulay, Gavin J; Handegard, Nils Olav

    2014-01-01

    Aggregation is commonly thought to improve animals' security. Within aquatic ecosystems, group-living prey can learn about immediate threats using cues perceived directly from predators, or from collective behaviours, for example, by reacting to the escape behaviours of companions. Combining cues from different modalities may improve the accuracy of prey antipredatory decisions. In this study, we explored the sensory modalities that mediate collective antipredatory responses of herring (Clupea harengus) when in a large school (approximately 60,000 individuals). By conducting a simulated predator encounter experiment in a semi-controlled environment (a sea cage), we tested the hypothesis that the collective responses of herring are threat-sensitive. We investigated whether cues from potential threats obtained visually or from the perception of water displacement, used independently or in an additive way, affected the strength of the collective avoidance reactions. We modified the sensory nature of the simulated threat by exposing the herring to 4 predator models differing in shape and transparency. The collective vertical avoidance response was observed and quantified using active acoustics. The combination of sensory cues elicited the strongest avoidance reactions, suggesting that collective antipredator responses in herring are mediated by the sensory modalities involved during threat detection in an additive fashion. Thus, this study provides evidence for magnitude-graded threat responses in a large school of wild-caught herring which is consistent with the "threat-sensitive hypothesis".

  10. Reward devaluation: Dot-probe meta-analytic evidence of avoidance of positive information in depressed persons.

    Science.gov (United States)

    Winer, E Samuel; Salem, Taban

    2016-01-01

    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.

  11. Estimating cigarette tax avoidance and evasion: evidence from a national sample of littered packs

    Science.gov (United States)

    Barker, Dianne C; Wang, Shu; Merriman, David; Crosby, Andrew; Resnick, Elissa A; Chaloupka, Frank J

    2016-01-01

    Introduction 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. Methods 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. Results 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. Discussion 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. PMID:27697946

  12. Estimating cigarette tax avoidance and evasion: evidence from a national sample of littered packs.

    Science.gov (United States)

    Barker, Dianne C; Wang, Shu; Merriman, David; Crosby, Andrew; Resnick, Elissa A; Chaloupka, Frank J

    2016-10-01

    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/.

  13. Avoidance of Bereavement-Related Stimuli in Chinese Individuals Experiencing Prolonged Grief: Evidence from a Dot-Probe Task

    Directory of Open Access Journals (Sweden)

    Meng Yu

    2017-07-01

    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.

  14. Mechanical prophylaxis of venous thromboembolism in ill hospitalized medical patients: evidence and guidelines

    Directory of Open Access Journals (Sweden)

    Luca Masotti

    2012-07-01

    Full Text Available Venous thromboembolism (VTE represents one of the leading causes of mortality and morbidity in ill medical patients. Avoiding VTE is therefore of utmost importance in clinical practice. VTE prophylaxis can be assured by pharmacological strategies, such as heparinoids, unfractioned heparin, low molecular weight heparins, fondaparinux or oral anticoagulants and, when these are contraindicated, by mechanical measures, such as graduated compression stockings (GCS and/ or intermittent pneumatic compression (ICP. However, due to the lack of solid literature evidence, VTE mechanical prophylaxis is not standardized in hospitalized ill medical patients. Much recently, findings from randomized clinical trials on VTE prophylaxis in ill medical patients, such as CLOTS I in patients with stroke and LIFENOX in patients with other kind of medical diseases, seem to increase doubts and reduce certainness in this context and recommendations from guidelines don’t help in reducing confusion. Therefore the aim of this review is to focus on mechanical prophylaxis of VTE in hospitalized ill medical patients.http://dx.doi.org/10.7175/rhc.v3i3.202

  15. Identification of important and potentially avoidable risk factors in a prospective audit study of neonatal deaths in a paediatric hospital in Vietnam

    DEFF Research Database (Denmark)

    Kruse, Alexandra Y; Phuong, Cam N; Ho, Binh T T

    2014-01-01

    (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...

  16. Payment schemes and cost efficiency: evidence from Swiss public hospitals.

    Science.gov (United States)

    Meyer, Stefan

    2015-03-01

    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.

  17. Measuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns

    Science.gov (United States)

    Doyle, Joseph; Graves, John; Gruber, Jonathan

    2014-01-01

    Medicare spending exceeds 4% of GDP in the US each year, and there are concerns that moral hazard problems have led to overspending. This paper considers whether hospitals that treat patients more aggressively and receive higher payments from Medicare improve health outcomes for their patients. An innovation is a new lens to compare hospital performance for emergency patients: plausibly exogenous variation in ambulance-company assignment among patients who live near one another. Using Medicare data from 2002–2010, we show that ambulance company assignment importantly affects hospital choice for patients in the same ZIP code. Using data for New York State from 2000–2006 that matches exact patient addresses to hospital discharge records, we show that patients who live very near each other but on either side of ambulance service area boundaries go to different types of hospitals. Both identification strategies show that higher-cost hospitals achieve better patient outcomes for a variety of emergency conditions. Using our Medicare sample, the estimates imply that a one standard deviation increase in Medicare reimbursement leads to a 4 percentage point reduction in mortality (10% compared to the mean). Taking into account one-year spending after the health shock, the implied cost per at least one year of life saved is approximately $80,000. These results are found across different types of hospitals and patients, as well across both identification strategies. PMID:25750459

  18. Evidence-based obstetrics in four hospitals in China: An observational study to explore clinical practice, women's preferences and provider's views

    Directory of Open Access Journals (Sweden)

    Liang Ji

    2001-05-01

    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.

  19. An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: a systematic review

    Science.gov (United States)

    Mileski, Michael; Topinka, Joseph Baar; Lee, Kimberly; Brooks, Matthew; McNeil, Christopher; Jackson, Jenna

    2017-01-01

    Objectives 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. Problem The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. Setting 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. Results The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. Conclusion 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. PMID:28182162

  20. Evidence-informed obstetric practice during normal birth in China: trends and influences in four hospitals

    Directory of Open Access Journals (Sweden)

    Liang Ji

    2006-03-01

    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.

  1. Lean healthcare in developing countries: evidence from Brazilian hospitals.

    Science.gov (United States)

    Costa, Luana Bonome Message; Filho, Moacir Godinho; Rentes, Antonio Freitas; Bertani, Thiago Moreno; Mardegan, Ronaldo

    2017-01-01

    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.

  2. Strengthening the evidence-policy interface for patient safety: enhancing global health through hospital partnerships.

    Science.gov (United States)

    Syed, Shamsuzzoha B; Dadwal, Viva; Storr, Julie; Riley, Pamela; Rutter, Paul; Hightower, Joyce D; Gooden, Rachel; Kelley, Edward; Pittet, Didier

    2013-10-16

    Strengthening the evidence-policy interface is a well-recognized health system challenge in both the developed and developing world. Brokerage inherent in hospital-to-hospital partnerships can boost relationships between "evidence" and "policy" communities and move developing countries towards evidence based patient safety policy. In particular, we use the experience of a global hospital partnership programme focused on patient safety in the African Region to explore how hospital partnerships can be instrumental in advancing responsive decision-making, and the translation of patient safety evidence into health policy and planning. A co-developed approach to evidence-policy strengthening with seven components is described, with reflections from early implementation. This rapidly expanding field of enquiry is ripe for shared learning across continents, in keeping with the principles and spirit of health systems development in a globalized world.

  3. Mandatory Quality Disclosure and Quality Supply : Evidence from German Hospitals

    NARCIS (Netherlands)

    Filistrucchi, L.; Ozbugday, F.C.

    2012-01-01

    Abstract: Using a newly constructed dataset on German hospitals, which includes 24 process and outcome indicators of clinical quality, we test whether quality has increased in various clinical areas since the introduction of mandatory quality reports and the online publication of part of the

  4. Exclusive contracts in the hospital setting: a two-edged sword: part 2: pros and cons, avoidance strategies, and negotiating tips.

    Science.gov (United States)

    Portman, Robert M

    2007-06-01

    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.

  5. Lost in transformation? -Reviving ethics of care in hospital cultures of evidence-based healthcare

    DEFF Research Database (Denmark)

    Norlyk, Annelise; Haahr, Anita; Dreyer, Pia

    2017-01-01

    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’. Key words: nursing practice, evidence-based practice, nursing theory, nursing theorists, ethics of care, hospital culture, patient......Drawing on our 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 is to analyse and discuss if and how it is possible to include patients...

  6. Understanding patients' behavioral intentions: evidence from Iran's private hospitals industry.

    Science.gov (United States)

    Zarei, Ehsan; Arab, Mohammad; Tabatabaei, Seyed Mahmoud Ghazi; Rashidian, Arash; Forushani, Abbas Rahimi; Khabiri, Roghayeh

    2014-01-01

    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.

  7. Rural hospital web-based, evidence-based practice professional development: challenges and opportunities.

    Science.gov (United States)

    Oman, Kathleen S; Fink, Regina M; Krugman, Mary; Goode, Colleen J; Traditi, Lisa K

    2013-01-01

    To provide quality patient care and achieve positive patient outcomes, it is widely recognized that organizations must develop a supportive environment that encourages individuals to practice from a research- and evidence-based framework. This article describes a Web-based professional educational program designed to teach principles of evidence-based practice to nurses in rural hospitals. Nurses working in staff development will find this useful for designing educational programs for staff in rural hospitals.

  8. Do follow-on therapeutic substitutes induce price competition between hospital medicines? Evidence from the Danish hospital sector.

    Science.gov (United States)

    Hostenkamp, Gisela

    2013-06-01

    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. New follow-on drugs and their incumbent therapeutic competitors were identified from Danish sales and product registration data on hospital pharmaceuticals using medically relevant criteria. We examined whether follow-on drugs adopt lower prices than their incumbent competitors, and whether incumbent competitors react to entry of follow-ons through price adjustments using a random intercept panel model. We found no evidence that follow-on drugs adopt lower prices than their incumbent competitors. Furthermore, potentially due to low sample size, we found no evidence that prices for incumbent pioneer products were significantly reduced as a reaction to competition from follow-on drugs. 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. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  9. QTL mapping provides evidence for lack of association of the avoidance of leaf rust in Hordeum chilense with stomata density

    NARCIS (Netherlands)

    Vaz Patto, M.C.; Rubiales, D.; Martin, A.; Hernandez, P.; Lindhout, W.H.; Niks, R.E.; Stam, P.

    2003-01-01

    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 s

  10. An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: a systematic review

    Directory of Open Access Journals (Sweden)

    Mileski M

    2017-01-01

    Full Text Available Michael Mileski, Joseph Baar Topinka, Kimberly Lee, Matthew Brooks, Christopher McNeil, Jenna Jackson School of Health Administration, Texas State University, San Marcos, TX, USA Objectives: 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. Problem: The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. Setting: 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. Results: The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. Conclusion: 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. Keywords: readmissions, skilled nursing, quality improvement, hospital, finance, Medicare, transfers

  11. Transforming a hospital nursing research fellowship into an evidence-based practice fellowship.

    Science.gov (United States)

    Gattuso, Jami S; Hinds, Pamela S; Beaumont, Cynthia; Funk, Adam J; Green, Jo; Max, Anita; Russell, Philisa; Windsor, Kelley

    2007-12-01

    An established hospital-based nursing research fellowship program was transformed into an evidence-based practice fellowship despite its previous high satisfaction ratings from nursing leaders and nurse fellow participants. The faculty for the fellowship program determined that the long-term outcomes of the research program were insufficient in light of the hospital resources committed to the fellowship program. An evidence-based practice approach was then created in anticipation that greater short-term and more sustained longer-term benefits for the hospital would be realized. The transformation of the fellowship and the short-term outcomes are described.

  12. Evidence of an emerging digital divide among hospitals that care for the poor.

    Science.gov (United States)

    Jha, Ashish K; DesRoches, Catherine M; Shields, Alexandra E; Miralles, Paola D; Zheng, Jie; Rosenbaum, Sara; Campbell, Eric G

    2009-01-01

    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.

  13. A norm utilisation for scarce hospital resources: Evidence from operating rooms in a Dutch university hospital

    NARCIS (Netherlands)

    van Houdenhoven, Mark; Hans, Elias W.; Klein, Jan; Wullink, Gerhard; Kazemier, Geert

    2007-01-01

    Background: Utilisation of operating rooms is high on the agenda of hospital managers and researchers. Many efforts in the area of maximising the utilisation have been focussed on finding the holy grail of 100% utilisation. The utilisation that can be realised, however, depends on the patient mix an

  14. The hospital library as a "magnet force" for a research and evidence-based nursing culture: A case study of two magnet hospitals in one health system.

    Science.gov (United States)

    Rourke, Diane Ream

    2007-01-01

    When Baptist Hospital of Miami, then South Miami Hospital, became Magnet award-winning hospitals, their libraries' challenges increased. Could their librarians ease the transition of research and evidence-based practice into the "real world" of nursing? Did library services have a role in the ongoing Magnet re-credentialing process? This case study defines hospital library magnet force strategies that worked in the quest for this prestigious award for nursing excellence at two hospitals at Baptist Health South Florida.

  15. Standoffish perhaps, but successful as well: evidence that avoidant attachment can be beneficial in professional tennis and computer science.

    Science.gov (United States)

    Ein-Dor, Tsachi; Reizer, Abira; Shaver, Phillip R; Dotan, Eyal

    2012-06-01

    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.

  16. Closing the quality gap: promoting evidence-based breastfeeding care in the hospital.

    Science.gov (United States)

    Bartick, Melissa; Stuebe, Alison; Shealy, Katherine R; Walker, Marsha; Grummer-Strawn, Laurence M

    2009-10-01

    Evidence shows that hospital-based practices affect breastfeeding duration and exclusivity throughout the first year of life. However, a 2007 CDC survey of US maternity facilities documented poor adherence with evidence-based practice. Of a possible score of 100 points, the average hospital scored only 63 with great regional disparities. Inappropriate provision and promotion of infant formula were common, despite evidence that such practices reduce breastfeeding success. Twenty-four percent of facilities reported regularly giving non-breast milk supplements to more than half of all healthy, full-term infants. Metrics available for measuring quality of breastfeeding care, range from comprehensive Baby-Friendly Hospital Certification to compliance with individual steps such as the rate of in-hospital exclusive breastfeeding. Other approaches to improving quality of breastfeeding care include (1) education of hospital decision-makers (eg, through publications, seminars, professional organization statements, benchmark reports to hospitals, and national grassroots campaigns), (2) recognition of excellence, such as through Baby-Friendly hospital designation, (3) oversight by accrediting organizations such as the Joint Commission or state hospital authorities, (4) public reporting of indicators of the quality of breastfeeding care, (5) pay-for-performance incentives, in which Medicaid or other third-party payers provide additional financial compensation to individual hospitals that meet certain quality standards, and (6) regional collaboratives, in which staff from different hospitals work together to learn from each other and meet quality improvement goals at their home institutions. Such efforts, as well as strong central leadership, could affect both initiation and duration of breastfeeding, with substantial, lasting benefits for maternal and child health.

  17. Are some areas more equal than others? Socioeconomic inequality in potentially avoidable emergency hospital admissions within English local authority areas

    Science.gov (United States)

    Asaria, Miqdad; Barratt, Helen; Raine, Rosalind; Cookson, Richard

    2016-01-01

    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

  18. Rethinking the role of worry in generalized anxiety disorder: evidence supporting a model of emotional contrast avoidance.

    Science.gov (United States)

    Llera, Sandra J; Newman, Michelle G

    2014-05-01

    The Contrast Avoidance model (Newman & Llera, 2011) proposes that individuals with generalized anxiety disorder (GAD) are hypersensitive to sharp upward shifts in negative emotion that typically accompany negative events, and use worry to maintain sustained intrapersonal negativity in an attempt to avoid these shifts. Although research shows that worry increases negative emotionality and mutes further emotional reactivity to a stressor when compared to the worry period (e.g., Llera & Newman, 2010), no study has tracked changes in negative emotionality from baseline to worry inductions followed by a range of emotional exposures. Further, no study has yet assessed participants' subjective appraisals of prior worry on helping to cope with such exposures. The present study tested the main tenets of the Contrast Avoidance model by randomly assigning participants with GAD (n=48) and nonanxious controls (n=47) to experience worry, relaxation, and neutral inductions prior to sequential exposure to fearful, sad, and humorous film clips. Both physiological (nonspecific skin conductance responses [NS-SCRs]) and self-reported emotional changes were observed. Results indicated that worry boosted negative emotionality from baseline, which was sustained across negative exposures, whereas low negative emotionality during relaxation and neutral inductions allowed for sharp increases in response to exposures. Furthermore, GAD participants found worry to be more helpful than other conditions in coping with exposures, whereas control participants reported the opposite pattern. Results provide preliminary support for the Contrast Avoidance model. This suggests that treatment should focus on underlying avoidance patterns before attempting to reduce worry behavior.

  19. Home or hospital for people with dementia and one or more other multimorbidities: What is the potential to reduce avoidable emergency admissions? The HOMEWARD Project Protocol

    Science.gov (United States)

    Voss, S; Black, S; Brandling, J; Buswell, M; Cheston, R; Cullum, S; Kirby, K; Purdy, S; Solway, C; Taylor, H; Benger, J

    2017-01-01

    Introduction Older people with multimorbidities frequently access 999 ambulance services. When multimorbidities include dementia, the risk of ambulance use, accident and emergency (A&E) attendance and hospital admission are all increased, even when a condition is treatable in the community. People with dementia tend to do poorly in the acute hospital setting and hospital admission can result in adverse outcomes. This study aims to provide an evidence-based understanding of how older people living with dementia and other multimorbidities are using emergency ambulance services. It will also provide evidence of how paramedics make decisions about taking this group of patients to hospital, and what resources would allow them to make more person-focused decisions to enable optimal patient care. Methods and analysis Phase 1: retrospective data analysis: quantitative analysis of ambulance service data will investigate: how often paramedics are called to older people with dementia; the amount of time paramedics spend on scene and the frequency with which these patients are transported to hospital. Phase 2: observational case studies: detailed case studies will be compiled using qualitative methods, including non-participant observation of paramedic decision-making, to understand why older people with multimorbidities including dementia are conveyed to A&E when they could be treated at home or in the community. Phase 3: needs analysis: nominal groups with paramedics will investigate and prioritise the resources that would allow emergency, urgent and out of hours care to be effectively delivered to these patients at home or in a community setting. Ethics and dissemination Approval for the study has been obtained from the Health Research Authority (HRA) with National Health Service (NHS) Research Ethics Committee approval for phase 2 (16/NW/0803). The dissemination strategy will include publishing findings in appropriate journals, at conferences and in newsletters. We will

  20. Risks in the hospital account receivable management and its avoidance%论医院应收账款管理存在的风险及规避

    Institute of Scientific and Technical Information of China (English)

    丁楠楠

    2015-01-01

    This paper discusses the risks, its inducements and avoidance in the hospital accounts receivable management. We argue that arrears and bad debts of accounts receivable should be strictly controlled and management of accounts receivable be strengthened to ensure normal fund operation and effective prevention of ifnancial risks.%介绍了医院应收账款风险形成的诱因,探讨了应收账款在管理中存在的风险及规避方法。认为应严格控制应收账款所产生的拖欠和坏账,加强应收账款的全程管理,保证医院资金的正常运转,以有效防范财务风险。

  1. Hospital innovativeness and organizational performance: evidence from English public acute care.

    Science.gov (United States)

    Salge, Torsten Oliver; Vera, Antonio

    2009-01-01

    Hospitals around the world dedicate increasing attention and resources to innovation. However, surprisingly little is known about the nature of hospital innovativeness and its relationship with organizational performance. Given both the specific characteristics of the hospital sector and the rather mixed evidence from other industries, a positive innovation-performance link should not be taken for granted but requires empirical examination. The purposes of this study were to introduce a perspective of hospitals as vital generators of innovation, to unpack the concept of innovativeness, to propose a measurement model for hospital innovativeness, and to empirically investigate the innovativeness-performance relationship. We conducted a large-scale empirical study among the entire population of public hospital organizations that are part of the English National Health Service (n = 173) and analyzed the data using exploratory factor and regression analyses. Our analyses suggest a significant positive relationship between science- and practice-based innovativeness and clinical performance but provide less unambiguous support for the existence of such a relationship between innovativeness and administrative performance. In particular, we find that higher levels of innovativeness are rather associated with superior quality of care than with measurable bottom-line financial benefits. Hospitals investing in innovation-generating activities might find their efforts well rewarded in terms of tangible clinical performance improvements. However, to achieve measurable financial benefits, numerous hospitals have yet to discover and capture the commercial value of some of their innovations-a challenging task that requires a holistic innovation management and an effective network of complementary partners.

  2. The importance of working capital management for hospital profitability: evidence from bond-issuing, not-for-profit U.S. hospitals.

    Science.gov (United States)

    Rauscher, Simone; Wheeler, John R C

    2012-01-01

    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

  3. Evidence-based medicine and hospital reform: tracing origins back to Florence Nightingale.

    Science.gov (United States)

    Aravind, Maya; Chung, Kevin C

    2010-01-01

    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.

  4. Home or hospital for people with dementia and one or more other multimorbidities: What is the potential to reduce avoidable emergency admissions? The HOMEWARD Project Protocol.

    Science.gov (United States)

    Voss, S; Black, S; Brandling, J; Buswell, M; Cheston, R; Cullum, S; Kirby, K; Purdy, S; Solway, C; Taylor, H; Benger, J

    2017-04-03

    Older people with multimorbidities frequently access 999 ambulance services. When multimorbidities include dementia, the risk of ambulance use, accident and emergency (A&E) attendance and hospital admission are all increased, even when a condition is treatable in the community. People with dementia tend to do poorly in the acute hospital setting and hospital admission can result in adverse outcomes. This study aims to provide an evidence-based understanding of how older people living with dementia and other multimorbidities are using emergency ambulance services. It will also provide evidence of how paramedics make decisions about taking this group of patients to hospital, and what resources would allow them to make more person-focused decisions to enable optimal patient care. METHODS AND ANALYSIS: Phase 1: retrospective data analysis: quantitative analysis of ambulance service data will investigate: how often paramedics are called to older people with dementia; the amount of time paramedics spend on scene and the frequency with which these patients are transported to hospital. Phase 2: observational case studies: detailed case studies will be compiled using qualitative methods, including non-participant observation of paramedic decision-making, to understand why older people with multimorbidities including dementia are conveyed to A&E when they could be treated at home or in the community. Phase 3: needs analysis: nominal groups with paramedics will investigate and prioritise the resources that would allow emergency, urgent and out of hours care to be effectively delivered to these patients at home or in a community setting. Approval for the study has been obtained from the Health Research Authority (HRA) with National Health Service (NHS) Research Ethics Committee approval for phase 2 (16/NW/0803). The dissemination strategy will include publishing findings in appropriate journals, at conferences and in newsletters. We will pay particular attention to

  5. First evidence of a prospective relation between avoidance of internal states and borderline personality disorder features in adolescents.

    Science.gov (United States)

    Sharp, Carla; Kalpakci, Allison; Mellick, William; Venta, Amanda; Temple, Jeff R

    2015-03-01

    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.

  6. Development of evidence-based remote telemetry policy guidelines for a multifacility hospital system.

    Science.gov (United States)

    George, Karen J; Walsh-Irwin, Colleen; Queen, Caleb; Heuvel, Kimberly Vander; Hawkins, Carrie; Roberts, Susan

    2015-01-01

    Over 10 years ago, the standards for cardiac monitoring were set forth by the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young. The standards were endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. The American Heart Association printed the standards as an American Heart Association Scientific Statement. The standards provided direction related to remote telemetry monitoring to acute care hospitals. Since the standards were published, remote monitoring of cardiac patients has increased dramatically prompting research and literature related to appropriate utilization. Appropriate and safe telemetry monitoring requires clearly written evidence-based facility policies. This article describes the process whereby a team of Veterans Hospital Administration nurses from across the country reviewed 70 remote telemetry policies representing 75 Veterans Hospital Administration hospitals for clarity, consistency, and congruency to existing levels of evidence found in the literature. This article describes the processes, successes, and challenges of compiling an evidence-based remote telemetry policy guideline.

  7. CogChamps - a model of implementing evidence-based care in hospitals: study protocol.

    Science.gov (United States)

    Travers, Catherine; Graham, Frederick; Henderson, Amanda; Beattie, Elizabeth

    2017-03-14

    Delirium and dementia (cognitive impairment; CI), are common in older hospital patients, and both are associated with serious adverse outcomes. Despite delirium often being preventable, it is frequently not recognized in hospital settings, which may be because hospital nurses have not received adequate education or training in recognizing or caring for those with CI. However, the most effective way of increasing nurses' awareness about delirium and dementia, and initiating regular patient screening and monitoring to guide best practices for these patients in hospital settings is not known. Hence this current project, conducted in 2015-2017, aims to redress this situation by implementing a multi-component non-pharmacological evidence-based intervention for patients with CI, through educating and mentoring hospital nurses to change their practice. The development of the practice change component is informed by recent findings from implementation science that focuses on facilitation as the active ingredient in knowledge uptake and utilization. This component focuses on educating and empowering experienced nurses to become Cognition Champions (CogChamps) across six wards in a large Australian tertiary referral hospital. The CogChamps will, in turn, educate other nursing team members to more effectively care for patients with CI. The hospital leadership team are supportive of the project and are directly involved in selecting the CogChamps. CogChamps will be provided with comprehensive education in evidence-based delirium assessment, prevention and management, and practice change management skills. They will receive continuing support from research and education staff about raising awareness, upskilling other staff in delirium assessment and in the adoption of best practices for preventing and managing delirium. Both qualitative and quantitative data are being collected at multiple time-points to evaluate process, impact and outcome, and to provide clarity regarding the

  8. Evidence-based organization and patient safety strategies in European hospitals

    Science.gov (United States)

    Sunol, Rosa; Wagner, Cordula; Arah, Onyebuchi A.; Shaw, Charles D.; Kristensen, Solvejg; Thompson, Caroline A.; Dersarkissian, Maral; Bartels, Paul D.; Pfaff, Holger; Secanell, Mariona; Mora, Nuria; Vlcek, Frantisek; Kutaj-Wasikowska, Halina; Kutryba, Basia; Michel, Philippe; Groene, Oliver; Klazinga, N.; Kringos, D.S.; Lombarts, M.J.M.H.; Plochg, T.; Lopez, M.A.; Vallejo, P.; Saillour-Glenisson, F.; Car, M.; Jones, S.; Klaus, E.; Bottaro, S.; Garel, P.; Saluvan, M.; Bruneau, C.; Depaigne-Loth, A.; Hammer, A.; Ommen, O.; Pfaff, H.; Botje, D.; Escoval, A.; Lívio, A.; Eiras, M.; Franca, M.; Leite, I.; Almeman, F.; Kus, H.; Ozturk, K.; Mannion, R.; Wang, A.; Thompson, A.

    2014-01-01

    Objective To explore how European hospitals have implemented patient safety strategies (PSS) and evidence-based organization of care pathway (EBOP) recommendations and examine the extent to which implementation varies between countries and hospitals. Design Mixed-method multilevel cross-sectional design in seven countries as part of the European Union-funded project ‘Deepening our Understanding of Quality improvement in Europe’ (DUQuE). Setting and participants Seventy-four acute care hospitals with 292 departments managing acute myocardial infarction (AMI), hip fracture, stroke, and obstetric deliveries. Main outcome measure Five multi-item composite measures—one generic measure for PSS and four pathway-specific measures for EBOP. Results Potassium chloride had only been removed from general medication stocks in 9.4–30.5% of different pathways wards and patients were adequately identified with wristband in 43.0–59.7%. Although 86.3% of areas treating AMI patients had immediate access to a specialist physician, only 56.0% had arrangements for patients to receive thrombolysis within 30 min of arrival at the hospital. A substantial amount of the total variance observed was due to between-hospital differences in the same country for PSS (65.9%). In EBOP, between-country differences play also an important role (10.1% in AMI to 57.1% in hip fracture). Conclusions There were substantial gaps between evidence and practice of PSS and EBOP in a sample of European hospitals and variations due to country differences are more important in EBOP than in PSS, but less important than within-country variations. Agencies supporting the implementation of PSS and EBOP should closely re-examine the effectiveness of their current strategies. PMID:24578501

  9. Nurses' information retrieval skills in psychiatric hospitals - are the requirements for evidence-based practice fulfilled?

    Science.gov (United States)

    Koivunen, Marita; Välimäki, Maritta; Hätönen, Heli

    2010-01-01

    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.

  10. Types of internal facilitation activities in hospitals implementing evidence-based interventions.

    Science.gov (United States)

    Baloh, Jure; Zhu, Xi; Ward, Marcia M

    2017-01-25

    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.

  11. Methylphenidate poisoning: an evidence-based consensus guideline for out-of-hospital management.

    Science.gov (United States)

    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

    2007-01-01

    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

  12. No evidence of purported lunar effect on hospital admission rates or birth rates.

    Science.gov (United States)

    Margot, Jean-Luc

    2015-01-01

    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.

  13. Can Payers Use Prices to Improve Quality? Evidence from English Hospitals.

    Science.gov (United States)

    Allen, Thomas; Fichera, Eleonora; Sutton, Matt

    2016-01-01

    In most activity-based financing systems, payers set prices reactively based on historical averages of hospital reported costs. If hospitals respond to prices, payers might set prices proactively to affect the volume of particular treatments or clinical practice. We evaluate the effects of a unique initiative in England in which the price offered to hospitals for discharging patients on the same day as a particular procedure was increased by 24%, while the price for inpatient treatment remained unchanged. Using national hospital records for 205,784 patients admitted for the incentivised procedure and 838,369 patients admitted for a range of non-incentivised procedures between 1 December 2007 and 31 March 2011, we consider whether this price change had the intended effect and/or produced unintended effects. We find that the price change led to an almost six percentage point increase in the daycase rate and an 11 percentage point increase in the planned daycase rate. Patients benefited from a lower proportion of procedures reverted to open surgery during a planned laparoscopic procedure and from a reduction in long stays. There was no evidence that readmission and death rates were affected. The results suggest that payers can set prices proactively to incentivise hospitals to improve quality.

  14. Treatment of avoidant/restrictive food intake disorder in a cohort of young patients in a partial hospitalization program for eating disorders.

    Science.gov (United States)

    Ornstein, Rollyn M; Essayli, Jamal H; Nicely, Terri A; Masciulli, Emily; Lane-Loney, Susan

    2017-09-01

    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.

  15. FACTORS AFFECTING IMPLEMENTATION OF EVIDENCE BASED PRACTICE AMONG PHYSIOTHERAPISTS IN MOI TEACHING REFFERAL HOSPITAL KENYA

    Directory of Open Access Journals (Sweden)

    Naomi Wanjiru

    2016-06-01

    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.

  16. Hospitals

    Data.gov (United States)

    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...

  17. How clinicians make (or avoid) moral judgments of patients: implications of the evidence for relationships and research

    Science.gov (United States)

    2010-01-01

    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

  18. Visual art in hospitals: case studies and review of the evidence.

    Science.gov (United States)

    Lankston, Louise; Cusack, Pearce; Fremantle, Chris; Isles, Chris

    2010-12-01

    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.

  19. Visual art in hospitals: case studies and review of the evidence

    Science.gov (United States)

    Lankston, Louise; Cusack, Pearce; Fremantle, Chris; Isles, Chris

    2010-01-01

    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

  20. How Do Hospitals Respond to Market Entry? Evidence from a Deregulated Market for Cardiac Revascularization.

    Science.gov (United States)

    Li, Suhui; Dor, Avi

    2015-08-01

    Regulatory entry barriers to hospital service markets, namely Certificate of Need (CON) regulations, are enforced in many US states. Policy makers in other states are considering reinstating CON policies in tandem with service expansions mandated under the Affordable Care Act. Although previous studies examined the volume effects of CON, demand responses to actual entry into local hospital markets are not well understood. In this paper, we empirically examine the demand-augmenting, demand-redistribution, and risk-allocation effects of hospital entry by studying the cardiac revascularization markets in Pennsylvania, a state in which dynamic market entry occurred after repeal of CON in 1996. Results from interrupted time-series analyses indicate demand-augmenting effects for coronary artery bypass graft (CABG) and business-stealing effects for percutaneous coronary intervention (PCI) procedures: high entrant market share mitigated the declining incidence of CABG, but it had no significant effect on the rising trend in PCI use, among patients with coronary artery disease. We further find evidence that entry by new cardiac surgery centers tended to sort high-severity patients into the more invasive CABG procedure and low-severity patients into the less invasive PCI procedures. These findings underscore the importance of considering market-level strategic responses by hospitals when regulatory barriers are rescinded.

  1. Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector.

    Science.gov (United States)

    Croes, R R; Krabbe-Alkemade, Y J F M; Mikkers, M C

    2017-01-03

    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.

  2. Cost of Hospitalization and Length of Stay in People with Down Syndrome: Evidence from a National Hospital Discharge Claims Database

    Science.gov (United States)

    Hung, Wen-Jiu; Lin, Lan-Ping; Wu, Chia-Ling; Lin, Jin-Ding

    2011-01-01

    The present paper aims to describe the hospitalization profiles which include medical expenses and length of stays, and to determine their possible influencing factors of hospital admission on persons with Down syndrome in Taiwan. We employed a population-based, retrospective analyses used national health insurance hospital discharge data of the…

  3. Cost of Hospitalization and Length of Stay in People with Down Syndrome: Evidence from a National Hospital Discharge Claims Database

    Science.gov (United States)

    Hung, Wen-Jiu; Lin, Lan-Ping; Wu, Chia-Ling; Lin, Jin-Ding

    2011-01-01

    The present paper aims to describe the hospitalization profiles which include medical expenses and length of stays, and to determine their possible influencing factors of hospital admission on persons with Down syndrome in Taiwan. We employed a population-based, retrospective analyses used national health insurance hospital discharge data of the…

  4. No Evidence of Purported Lunar Effect on Hospital Admission Rates or Birth Rates

    Science.gov (United States)

    Margot, Jean-Luc

    2015-01-01

    Background 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. Purpose 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. Approach 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. Findings 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. Conclusions 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. PMID:25756232

  5. Evidence-based health policy-making, hospital funding and health insurance.

    Science.gov (United States)

    Palmer, G R

    2000-02-01

    An important goal of health services research is to improve the efficiency and effectiveness of health services through a quantitative and evidence-based approach. There are many limitations to the use of evidence in health policy-making, such as differences in what counts as evidence between the various disciplines involved, and a heavy reliance on theory in social science disciplines. Community and interest group values, ideological positions and political assessments inevitably intrude into government health policy-making. The importance of these factors is accentuated by the current absence of evidence on the impact of policy options for improving the health status of the community, and ensuring that efficiency and equity objectives for health services are also met. Analysis of recent hospital funding and private health insurance initiatives shows the limited role of evidence in the making of these decisions. Decision-making about health policy might be improved in the future by initiatives such as greater exposure of health professionals to educational inputs with a policy focus; increased contribution of doctors to health services research via special postgraduate programs; and establishing a national, multidisciplinary centre for health policy research and evaluation.

  6. Avoid Logs to Avoid Ticks

    Institute of Scientific and Technical Information of China (English)

    莫文佳

    2004-01-01

    扁虱是莱姆关节炎的罪魁祸首。研究人员为了弄明白何处扁虱最猖獗, 不惜以身作饵,他们发现:The ticks were all over the log surface。因此告诫人 们:Avoid sitting on logs。

  7. Hospital Market Structure and the Behavior of Not-for-Profit Hospitals: Evidence from Responses to California's Disproportionate Share Program

    OpenAIRE

    Mark Duggan

    2000-01-01

    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...

  8. Evidence-based interventions to reduce adverse events in hospitals: a systematic review of systematic reviews

    Science.gov (United States)

    Zegers, Marieke; Hesselink, Gijs; Geense, Wytske; Vincent, Charles; Wollersheim, Hub

    2016-01-01

    Objective To provide an overview of effective interventions aimed at reducing rates of adverse events in hospitals. Design Systematic review of systematic reviews. Data sources PubMed, CINAHL, PsycINFO, the Cochrane Library and EMBASE were searched for systematic reviews published until October 2015. Study selection English-language systematic reviews of interventions aimed at reducing adverse events in hospitals, including studies with an experimental design and reporting adverse event rates, were included. Two reviewers independently assessed each study's quality and extracted data on the study population, study design, intervention characteristics and adverse patient outcomes. Results Sixty systematic reviews with moderate to high quality were included. Statistically significant pooled effect sizes were found for 14 types of interventions, including: (1) multicomponent interventions to prevent delirium; (2) rapid response teams to reduce cardiopulmonary arrest and mortality rates; (3) pharmacist interventions to reduce adverse drug events; (4) exercises and multicomponent interventions to prevent falls; and (5) care bundle interventions, checklists and reminders to reduce infections. Most (82%) of the significant effect sizes were based on 5 or fewer primary studies with an experimental study design. Conclusions The evidence for patient-safety interventions implemented in hospitals worldwide is weak. The findings address the need to invest in high-quality research standards in order to identify interventions that have a real impact on patient safety. Interventions to prevent delirium, cardiopulmonary arrest and mortality, adverse drug events, infections and falls are most effective and should therefore be prioritised by clinicians. PMID:27687901

  9. Selective information seeking: can consumers' avoidance of evidence-based information on colorectal cancer screening be explained by the theory of cognitive dissonance?

    Directory of Open Access Journals (Sweden)

    Mühlhauser, Ingrid

    2007-08-01

    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.

  10. Selective information seeking: can consumers' avoidance of evidence-based information on colorectal cancer screening be explained by the theory of cognitive dissonance?

    Science.gov (United States)

    Steckelberg, Anke; Kasper, Jürgen; Mühlhauser, Ingrid

    2007-08-27

    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.

  11. The Case for Using Evidence Based Guidelines in Setting Hospital and Public Health Policy

    Directory of Open Access Journals (Sweden)

    Ross Hutchison Francis

    2016-03-01

    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.

  12. hospital

    African Journals Online (AJOL)

    Pattern of congenital orthopaedic malformations in an African teaching hospital ... malformation in this environment while congenital hip dislocation (CDH) is rare when .... malformations of radial dysplasia and other congenital malformations.

  13. Do follow-on therapeutic substitutes induce price competition between hospital medicines? Evidence from the Danish hospital sector

    DEFF Research Database (Denmark)

    Hostenkamp, Gisela

    2013-01-01

    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...... follow-on drugs and their incumbent therapeutic competitors were identified from Danish sales and product registration data on hospital pharmaceuticals using medically relevant criteria. We examined whether follow-on drugs adopt lower prices than their incumbent competitors, and whether incumbent......’ 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....

  14. Do follow-on therapeutic substitutes induce price competition between hospital medicines? Evidence from the Danish hospital sector

    DEFF Research Database (Denmark)

    Hostenkamp, Gisela

    2013-01-01

    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....

  15. Insurance Expansion and Hospital Emergency Department Access: Evidence From the Affordable Care Act.

    Science.gov (United States)

    Garthwaite, Craig; Gross, Tal; Notowidigdo, Matthew; Graves, John A

    2017-02-07

    Little is known about whether insurance expansion affects the location and type of emergency department (ED) use. Understanding these changes can inform state-level decisions about the Medicaid expansion under the Patient Protection and Affordable Care Act (ACA). To investigate the effect of the 2014 ACA Medicaid expansion on the location, insurance status, and type of ED visits. Quasi-experimental observational study from 2012 to 2014. 126 investor-owned, hospital-based EDs. Uninsured and Medicaid-insured adults aged 18 to 64 years. ACA expansion of Medicaid in January 2014. Number of ED visits overall, type of visit (for example, nondiscretionary or nonemergency), and average travel time to the ED. Interrupted time-series analyses comparing changes from the end of 2013 to end of 2014 for patients from Medicaid expansion versus nonexpansion states were done. There were 1.06 million ED visits among patients from 17 Medicaid expansion states, and 7.87 million ED visits among patients from 19 nonexpansion states. The EDs treating patients from Medicaid expansion states saw an overall 47.1% decrease in uninsured visits (95% CI, -65.0% to -29.3%) and a 125.7% (CI, 89.2% to 162.6%) increase in Medicaid visits after 12 months of ACA expansion. Average travel time for nondiscretionary conditions requiring immediate medical care decreased by 0.9 minutes (-6.2% [CI, -8.9% to -3.5%]) among all Medicaid patients from expansion states. We found little evidence of similar changes among patients from nonexpansion states. Results reflect shifts in ED care at investor-owned facilities, which limits generalizability to other hospital types. Meaningful changes in insurance status and location and type of ED visits in the first year of ACA Medicaid expansion were found, suggesting that expansion provides patients with a greater choice of hospital facilities. Robert Wood Johnson Foundation.

  16. Patient hospital choice for hip replacement: empirical evidence from the Netherlands

    NARCIS (Netherlands)

    Beukers, P.D.C.; Kemp, R.G.M.; Varkevisser, M.

    2014-01-01

    In the Dutch health care system, hospitals are expected to compete. A necessary condition for competition among hospitals is that patients do not automatically choose the nearest hospital, but are—at least to some extent—sensitive to differences in hospital quality. In this study, an analysis is

  17. Ownership and technical efficiency of hospitals: evidence from Ghana using data envelopment analysis

    Science.gov (United States)

    2014-01-01

    Background 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. Methods 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. Results 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. Conclusions It would be

  18. Ownership and technical efficiency of hospitals: evidence from Ghana using data envelopment analysis.

    Science.gov (United States)

    Jehu-Appiah, Caroline; Sekidde, Serufusa; Adjuik, Martin; Akazili, James; Almeida, Selassi D; Nyonator, Frank; Baltussen, Rob; Asbu, Eyob Zere; Kirigia, Joses Muthuri

    2014-04-08

    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

  19. Achieving Adherence to Evidence-Based Practices: Are Health IT and Hospital-Physician Integration Complementary or Substitutive Strategies?

    Science.gov (United States)

    Everson, Jordan; Lee, Shoou-Yih Daniel; Adler-Milstein, Julia

    2016-12-01

    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.

  20. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.

    Science.gov (United States)

    Loveday, H P; Wilson, J A; Pratt, R J; Golsorkhi, M; Tingle, A; Bak, A; Browne, J; Prieto, J; Wilcox, M; UK Department of Health

    2014-01-01

    National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were originally commissioned by the Department of Health and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were first published in January 2001(1) and updated in 2007.(2) A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective for the prevention of HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. The Department of Health commissioned a review of new evidence and we have updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the epic2 guidelines published in 2007 remain robust, relevant and appropriate, but some guideline recommendations required adjustments to enhance clarity and a number of new recommendations were required. These have been clearly identified in the text. In addition, the synopses of evidence underpinning the guideline recommendations have been updated. These guidelines (epic3) provide comprehensive recommendations for preventing HCAI in hospital and other acute care settings based on the best currently available evidence. National evidence-based guidelines are broad principles of best practice that need to be integrated into local practice guidelines and audited to reduce variation in practice and maintain patient safety. Clinically effective infection prevention and control practice is an essential feature of patient protection. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and

  1. Three-year follow-up of implementation of evidence-based transfusion practice in a tertiary hospital

    DEFF Research Database (Denmark)

    Nørgaard, Astrid; Stensballe, J; de Lichtenberg, T H

    2017-01-01

    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...... 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....... The implementation process was monitored by transfusion quality and utilization data over a 3-year period with totally 166 341 admissions in 98 960 mixed, adult medical and surgical patients. RESULTS: At the hospital level, transfusion above the upper guideline limit decreased from 23 to 10% (P

  2. Hospital doctors' self-rated skills in and use of evidence-based medicine - a questionnaire survey

    DEFF Research Database (Denmark)

    Oliveri, Roberto S; Gluud, Christian; Wille-Jørgensen, Peer A

    2004-01-01

    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...

  3. Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence.

    Science.gov (United States)

    Keers, Richard N; Williams, Steven D; Cooke, Jonathan; Ashcroft, Darren M

    2013-11-01

    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

  4. Delayed Administration and Contraindicated Drugs Place Hospitalized Parkinson's Disease Patients at Risk; Doxorubicin Liposomal Mix-up; Avoid Mix-ups Between Hydroxyprogesterone and Medroxyprogesterone.

    Science.gov (United States)

    Cohen, Michael R; Smetzer, Judy L

    2015-07-01

    These medication errors have occurred in health care facilities at least once. They will happen again-perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site (www.ismp.org), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org. ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

  5. Occupational therapy practice in acute physical hospital settings: Evidence from a scoping review.

    Science.gov (United States)

    Britton, Lauren; Rosenwax, Lorna; McNamara, Beverley

    2015-12-01

    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.

  6. [What evidence for chest physiotherapy in infants hospitalized for acute viral bronchiolitis?].

    Science.gov (United States)

    Bailleux, S; Lopes, D; Geoffroy, A; Josse, N; Labrune, P; Gajdos, V

    2011-04-01

    This article updates the respiratory physiotherapy technique used in France, and the rationale for its use. This paper reports the results of a recent randomized clinical trial that did not show any efficiency of respiratory physiotherapy (using increased expiratory acceleration) in infants hospitalized for a first episode of bronchiolitis. Further trials are necessary for evaluating this technique in infants who are not hospitalized.

  7. Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers

    DEFF Research Database (Denmark)

    Qin, Ping; Nordentoft, Merete

    2005-01-01

    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......BACKGROUND: Persons with a history of admission to a psychiatric hospital are at high risk for suicide, but little is known about how this is influenced by factors related to psychiatric hospitalization. OBJECTIVE: To explore suicide risk according to time since admission, diagnosis, length...... of hospital treatment, and number of prior hospitalizations. DESIGN: Nested case-control design. SETTING: Individual data are drawn from various Danish longitudinal registers. PARTICIPANTS: All 13 681 male and 7488 female suicides committed in Denmark from January 1, 1981, to December 31, 1997, and 423 128...

  8. Gearing service quality into public and private hospitals in small islands: empirical evidence from Cyprus.

    Science.gov (United States)

    Arasli, Huseyin; Ekiz, Erdogan Haktan; Katircioglu, Salih Turan

    2008-01-01

    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.

  9. Hospital expenditure as a major driver of nurse labour force participation: evidence from a 10-year period in Canada.

    Science.gov (United States)

    Vujicic, Marko; Onate, Kanecy; Laporte, Audrey; Deber, Raisa

    2011-05-01

    This paper examines trends in the nursing labour market in Canada over a period of dramatic fluctuations in hospital expenditures. We add to previous analysis that covered the period 1991-1996 and use Census data from 2001 to examine the relationship between hospital expenditure and nurse labour force participation. We find that shifts in labour force participation over the period 1991-2001 had a significant impact on the nursing supply in Canada. Individuals who were trained in nursing but were working outside the profession in 1996 because of budgetary reductions and layoffs in hospitals had largely been reabsorbed back into nursing jobs by 2001. Our analysis provides further empirical evidence that the labour force participation among individuals trained in nursing is driven to a large extent by demand-side factors.

  10. 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

    Science.gov (United States)

    Spais, George S.; Vasileiou, Konstantinos Z.

    2008-01-01

    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…

  11. The Economic Crisis and Acute Myocardial Infarction: New Evidence Using Hospital-Level Data

    Science.gov (United States)

    Maggioni, Aldo Pietro

    2015-01-01

    Objective This research sought to assess whether and to what extent the ongoing economic crisis in Italy impacted hospitalizations, in-hospital mortality and expenditures associated with acute myocardial infarction (AMI). Methods The data were obtained from the hospital discharge database of the Italian Health Ministry and aggregated at the hospital level. Each hospital (n = 549) was observed for 4 years and was geographically located within a “Sistema Locale del Lavoro” (SLL, i.e., clusters of neighboring towns with a common economic structure). For each SLL, the intensity of the crisis was determined, defined as the 2012–2008 increase in the area-specific unemployment rate. A difference-in-differences (DiD) approach was employed to compare the increases in AMI-related outcomes across different quintiles of crisis intensity. Results Hospitals located in areas with the highest intensity of crisis (in the fifth quintile) had an increase of approximately 30 AMI cases annually (approximately 13%) compared with hospitals in area with lower crisis intensities (pcrisis. Policies aimed to contrast unemployment in the community by keeping and reintegrating workers in jobs could also have positive impacts on adverse health outcomes, especially in areas of high crisis intensity. PMID:26574745

  12. In-Hospital Cardiology Consultation and Evidence-Based Care for Nursing Home Residents with Heart Failure

    Science.gov (United States)

    Aronow, Wilbert S.; Rich, Michael W.; Goodlin, Sarah J.; Birkner, Thomas; Zhang, Yan; Feller, Margaret A.; Aban, Inmaculada B.; Jones, Linda G.; Bearden, Donna M.; Allman, Richard M.; Ahmed, Ali

    2013-01-01

    Objectives To determine the association between cardiology consultation and evidence-based care for nursing home (NH) residents with heart failure (HF). Participants Hospitalized NH residents (n= 646) discharged from 106 Alabama hospitals with a primary discharge diagnosis of HF during 1998–2001. Design Observational. Measurements of Evidence-Based Care Pre-admission estimation of left ventricular ejection fraction (LVEF) for patients with known HF (n=494), in-hospital LVEF estimation for HF patients without known LVEF (n=452), and discharge prescriptions of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs-or-ARBs) to systolic HF (LVEF ACEIs-or-ARBs was defined as lack of prior allergy or adverse effect, serum creatinine 100 mm Hg. Results Pre-admission LVEF was estimated in 38% and 12% of patients receiving and not receiving cardiology consultation, respectively (adjusted odds ratio {AOR}, 3.49; 95% CI, 2.16–5.66; p ACEIs-or-ARBs were prescribed to 62% and 82% of patients receiving and not receiving cardiology consultation, respectively (AOR, 0.24; 95% CI, 0.07–0.81; p=0.022). Conclusion In-hospital cardiology consultation was associated with significantly higher odds of LVEF estimation among NH residents with HF. However, it did not translate into higher odds of discharge prescriptions for ACEIs-or-ARBs to NH resident with systolic HF who were eligible for the receipt of these drugs. PMID:21982687

  13. A new marketing mix model to rescue the hospitality industry: Evidence from Egypt after the Arab Spring

    Directory of Open Access Journals (Sweden)

    Doaa Salman

    2017-06-01

    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.

  14. Not-for-profit hospital CEO performance and pay: some evidence from Connecticut.

    Science.gov (United States)

    Kramer, Jeffrey; Santerre, Rexford E

    2010-01-01

    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.

  15. Teachers Avoiding Learners' Avoidance: Is It Possible?

    Science.gov (United States)

    Tadayyon, Maedeh; Zarrinabadi, Nourollah; Ketabi, Saeed

    2016-01-01

    Dealing with learners who prefer to take the back seat and avoid classroom participation can be every teacher's nightmare. This lack of participation may cause teacher frustration, and possibly the only way to reduce this lack of participation is to access the concept of avoidance strategy. Avoidance strategy is the abandonment of a classroom task…

  16. Efficacy of Evidence Based Care on Care Quality of Mother and Infant in 3 Teaching Hospitals: A Protocol

    Directory of Open Access Journals (Sweden)

    Davoodi R

    2014-04-01

    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.

  17. Service Quality Assessment of Hospitals in Asian Context: An Empirical Evidence From Pakistan.

    Science.gov (United States)

    Shafiq, Muhammad; Naeem, Muhammad Azhar; Munawar, Zartasha; Fatima, Iram

    2017-01-01

    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.

  18. Efficacy and safety of haloperidol for in-hospital delirium prevention and treatment: A systematic review of current evidence.

    Science.gov (United States)

    Schrijver, E J M; de Graaf, K; de Vries, O J; Maier, A B; Nanayakkara, P W B

    2016-01-01

    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.

  19. Medical device-related hospital-acquired pressure ulcers: development of an evidence-based position statement.

    Science.gov (United States)

    Pittman, Joyce; Beeson, Terrie; Kitterman, Jessica; Lancaster, Shelley; Shelly, Anita

    2015-01-01

    Hospital-acquired pressure ulcers (HAPUs) are a problem in the acute care setting causing pain, loss of function, infection, extended hospital stay, and increased costs. In spite of best practice strategies, occurrences of pressure ulcers continue. Many of these HAPUs are related to a medical device. Correct assessment and reporting of device-related HAPUs were identified as an important issue in our organization. Following the Iowa Model for Evidence-Based Practice to Promote Quality Care, a task force was created, a thorough review of current evidence and clinical practice recommendations was performed, and a definition for medical device-related HAPU and an evidence-based position statement were developed. Content of the statement was reviewed by experts and appropriate revisions were made. This position statement provides guidance and structure to accurately identify and report device-related HAPU across our 18 healthcare facilities. Through the intentional focus on pressure ulcer prevention and evidence-based practice in our organization and the use of this position statement, identification and reporting of device-related HAPUs have improved with a decrease in overall HAPU rates of 33% from 2011 and 2012. This article describes the development and implementation of this device-related HAPU position statement within our organization.

  20. Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers

    DEFF Research Database (Denmark)

    Qin, Ping; Nordentoft, Merete

    2005-01-01

    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......BACKGROUND: Persons with a history of admission to a psychiatric hospital are at high risk for suicide, but little is known about how this is influenced by factors related to psychiatric hospitalization. OBJECTIVE: To explore suicide risk according to time since admission, diagnosis, length...

  1. Accounting for quality in the measurement of hospital performance: evidence from Costa Rica.

    Science.gov (United States)

    Arocena, Pablo; García-Prado, Ariadna

    2007-07-01

    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.

  2. Workplace change and the internal labour market: evidence from the NSW hospital industry.

    Science.gov (United States)

    de Ruyter, Alex

    2002-01-01

    After a decade of labour market reform and workplace change, increasing attention has focussed on public sector industries. In this paper, domestic and maintenance occupations in the hospital industry are examined, as previous work has focussed on nursing, with other occupations being largely ignored. Grimshaw and Rubery's (1998) model of internal labour markets is adopted as the preferred theoretical approach. This model, in acknowledging external factors, the role of workers, and custom and norms within the firm, provides a basis from which to examine labour use practices within the hospital industry.

  3. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis

    NARCIS (Netherlands)

    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.

    2016-01-01

    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:

  4. Current evidence on hospital antimicrobial stewardship objectives : A systematic review and meta-analysis

    NARCIS (Netherlands)

    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.

    2016-01-01

    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:

  5. Historical evidence for the origin of teaching hospital, medical school and the rise of academic medicine.

    Science.gov (United States)

    Modanlou, H D

    2011-04-01

    Historical progression and the development of current teaching hospitals, medical schools and biomedical research originated from the people of many civilizations and cultures. Greeks, Indians, Syriacs, Persians and Jews, assembled first in Gondi-Shapur during the Sasanian empire in Persia, and later in Baghdad during the Golden Age of Islam, ushering the birth of current academic medicine.

  6. Compliance with Evidence-Based Guidelines in Acute Pancreatitis: an Audit of Practices in University of Toronto Hospitals.

    Science.gov (United States)

    Greenberg, J A; Hsu, J; Bawazeer, M; Marshall, J; Friedrich, J O; Nathens, A; Coburn, N; Huang, H; McLeod, R S

    2016-02-01

    Despite existing evidence-based practice guidelines for the management of acute pancreatitis, clinical compliance with recommendations is poor. We conducted a retrospective review of 248 patients admitted between 2010 and 2012 with acute pancreatitis at eight University of Toronto affiliated hospitals. We included all patients admitted to ICU (52) and 25 ward patients from each site (196). Management was compared with the most current evidence used in the Best Practice in General Surgery Management of Acute Pancreatitis Guideline. Fifty-six patients (22.6 %) had only serum lipase tested for biochemical diagnosis. Admission ultrasound was performed in 174 (70.2 %) patients, with 69 (27.8 %) undergoing ultrasound and CT. Of non-ICU patients, 158 (80.6 %) were maintained nil per os, and only 18 (34.6 %) ICU patients received enteral nutrition, commencing an average 7.5 days post-admission. Fifty (25.5 %) non-ICU patients and 25 (48.1 %) ICU patients received prophylactic antibiotics. Only 24 patients (22.6 %) with gallstone pancreatitis underwent index admission cholecystectomy. ERCP with sphincterotomy was under-utilized among patients with biliary obstruction (16 [31 %]) and candidates for prophylactic sphincterotomy (18 [22 %]). Discrepancies exist between the most current evidence and clinical practice within the University of Toronto hospitals. A guideline, knowledge translation strategy, and assessment of barriers to clinical uptake are required to change current clinical practice.

  7. What works in delivering dementia education or training to hospital staff? A critical synthesis of the evidence.

    Science.gov (United States)

    Surr, Claire A; Gates, Cara

    2017-08-12

    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

  8. The relationship between hospital market competition, evidence-based performance measures, and mortality for chronic heart failure.

    Science.gov (United States)

    Maeda, Jared Lane K; Lo Sasso, Anthony T

    2012-01-01

    Using data from the Joint Commission's ORYX initiative and the Medicare Provider Analysis and Review file from 2003 to 2006, this study employed a fixed-effects approach to examine the relationship between hospital market competition, evidence-based performance measures, and short-term mortality at seven days, 30 days, 90 days, and one year for patients with chronic heart failure. We found that, on average, higher adherence with most of the Joint Commission's heart failure performance measures was not associated with lower mortality; the level of market competition also was not associated with any differences in mortality. However, higher adherence with the discharge instructions and left ventricular function assessment indicators at the 80th and 90th percentiles of the mortality distribution was associated with incrementally lower mortality rates. These findings suggest that targeting evidence-based processes of care might have a stronger impact in improving patient outcomes.

  9. PHYSICAL EVIDENCE AND QUALITY SERVICE DELIVERY IN PUBLIC HOSPITALS IN GHANA

    Directory of Open Access Journals (Sweden)

    Edem Max Azila-Gbettor

    2013-09-01

    Full Text Available This study examines the value of physical environment in the delivering of quality healthcare or service in public hospitals in Ghana. Twelve set of self-administered questions were designed using Baker’s (1987 typology of servicescape. A descriptive univariate analysis was applied for the study. Based on 233 usable questionnaires retrieved from respondents, the study indicates a strong link between physical environment and quality healthcare delivery and the choice of healthcare facility. It is there by recommended that improvement in quality service delivery may be better served and improved by improving the servicescape/physical element in the services mix.

  10. Feasibility Study on an Evidence-Based Decision-Support System for Hospital Site Selection for an Aging Population

    Directory of Open Access Journals (Sweden)

    Jung In Kim

    2015-03-01

    Full Text Available An aging population has significant, dynamic and complex healthcare needs. Meeting such needs in a sustainable manner requires the capability to prioritize and project multiple relevant criteria (e.g., dynamic population health, treatment preferences, resources, technological changes and location of facilities. Most current decision-making processes for urban hospital site selection rely on a combination of experience and statistical data, yet they lack robustness and trending capabilities. This leads to tremendous efficiency implications, as it is not uncommon for hospitals to have a lifespan of more than 100 years after they are built. Our research team has developed an evidence-based decision-support system, enhanced with a Geographic Information System (GIS, that has the potential to overcome these limitations. This paper presents a feasibility demonstration of our framework through a retrospective case study of hospital site selection in Dallas, Texas, demonstrating its positive value in providing a foundation for informed healthcare resource allocation in the context of an aging population.

  11. Competition and quality indicators in the health care sector : Empirical evidence from the Dutch hospital sector

    NARCIS (Netherlands)

    Croes, Ramsis; Krabbe, Yvonne; Mikkers, Misja

    2017-01-01

    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

  12. Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector

    NARCIS (Netherlands)

    Croes, R.R.; Krabbe-Alkemade, Y.J.F.M.; Mikkers, M.C.

    2017-01-01

    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

  13. Immunological evidence of monoclonal gammopathy in North India: a hospital based study

    Directory of Open Access Journals (Sweden)

    Kalpana Singh

    2010-08-01

    Full Text Available Kalpana Singh1, Bhawna Singh2, Sarika Arora2, Alpana Saxena11Department of Biochemistry, Maulana Azad Medical College and LN Hospital, New Delhi, India; 2Department of Biochemistry, GB Pant Hospital, New Delhi, IndiaBackground: Monoclonal gammopathy of unknown significance (MGUS is a condition in which a paraprotein is found in the blood during standard laboratory tests. It is age-related and characterized by accumulation of bone marrow plasma cells derived from a single abnormal clone. The aim of this study was to investigate the pattern of MGUS in North Indian urban population.Methods: Serum and urine samples were collected from 320 suspected cases of gammopathy, were analyzed by sensitive immunological technique based protein electrophoresis followed by immunofixation for detection and type of monoclonal/polyclonal gammopathies. Twenty-five healthy subjects were included as controls.Results: Gammopathies were observed in 38 (11.88% patients. Out of these 7.5% were ¬monoclonal and 4.3% were polyclonal. Overall age of presentation of these monoclonal ¬gammopathies in both sexes was between 21 and 76 years. Gender-related ratio (men:women for these gammopathies was 1:1.18. Predominant heavy chain isotype was IgG (62.5% followed by IgA (37.5%. Among light chains, kappa (κ and lambda (λ chains appeared in 91.6% and 8.4% gammopathies respectively. Paraprotein fractions obtained were IgGκ (58.3%, IgGλ (4.16%, IgAκ (33.3%, and IgAλ (4.16% with 25% samples being positive for Bence Jones proteinuria.Conclusions: Clinical laboratories play an important role in confirming the immunological diagnosis of gammopathies. Determination of nature of paraproteinemia and its associated diseases calls for more extensive studies in India.Keywords: monoclonal gammopathy, immunoelectrophoresis, multiple myeloma, bence jones protein, immunoglobulins

  14. Delirium in Hospitalized Patients: Implications of Current Evidence on Clinical Practice and Future Avenues for Research—A Systematic Evidence Review

    Science.gov (United States)

    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.

    2013-01-01

    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

  15. 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

    Directory of Open Access Journals (Sweden)

    Rosana Rosseto de Oliveira

    2012-02-01

    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

  16. Characteristics and evidence of nursing scientific production for medication errors at the hospital environment

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    Lolita Dopico da Silva

    2012-06-01

    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.

  17. Hospital cluster of HBV infection: molecular evidence of patient-to-patient transmission through lancing device.

    Directory of Open Access Journals (Sweden)

    Simone Lanini

    Full Text Available INTRODUCTION: In western countries the transmission of hepatitis B virus (HBV transmission through multi-patients lancing devices has been inferred since early '90s, however no study has ever provided biological evidence which directly link these device with HBV cross-infection. Here we present results of an outbreak investigation which could associate, by molecular techniques, the use of lancing device on multiple patients with HBV transmission in an Italian oncohematology unit. METHODS: The outbreak investigation was designed as a retrospective cohort study to identify all potential cases. All cases identified were eventually confirmed through molecular epidemiology techniques. Audit of personnel including extensive review of infection control measures and reviewing personnel's tests for HBV was done identify transmission route. RESULTS: Between 4 May 2006 and 21 February 2007, six incident cases of HBV infection were reported among 162 patients admitted in the oncohematology. The subsequent molecular instigation proved that 3 out 6 incident cases and one prevalent cases (already infected with HBV at the admission represented a monophyletic cluster of infection. The eventual environmental investigation found that an identical HBV viral strain was present on a multi-patients lancing device in use in the unit and the inferential analysis showed a statistically significant association between undergoing lancing procedures and the infection. DISCUSSION: This investigation provide molecular evidence to link a HBV infection cluster to multi-patients lancing device and highlights that patients undergoing capillary blood sampling by non-disposable lancing device may face an unacceptable increased risk of HBV infection. Therefore we believe that multi-patients lancing devices should be banned from healthcare settings and replace with disposable safety lancets that permanently retract to prevent the use of the same device on multiple patients. The use

  18. Evidence-based training as primary prevention of hand eczema in a population of hospital cleaning workers

    DEFF Research Database (Denmark)

    Clemmensen, Kim K B; Randbøll, Ingelise; Ryborg, Malene F.

    2015-01-01

    , of these 86 (82%) were included. At follow-up after 3 months there was a shift towards fewer daily hand washings and hand disinfections (p ...BACKGROUND: Skin disorders accounted for one third of all recognised occupational diseases in Denmark in 2010. Wet work is a risk factor for the development of occupational hand eczema. The consequences of occupational hand eczema include sick leave, loss of job and impaired quality of life....... 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...

  19. Evident?

    DEFF Research Database (Denmark)

    Plant, Peter

    2012-01-01

    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...

  20. Hospital Utilization and Universal Health Insurance Coverage: Evidence from the Massachusetts Health Care Reform Act.

    Science.gov (United States)

    Cseh, Attila; Koford, Brandon C; Phelps, Ryan T

    2015-12-01

    The Affordable Care Act is currently in the roll-out phase. To gauge the likely implications of the national policy we analyze how the Massachusetts Health Care Reform Act impacted various hospitalization outcomes in each of the 25 major diagnostic categories (MDC). We utilize a difference-in-difference approach to identify the impact of the Massachusetts reform on insurance coverage and patient outcomes. This identification is achieved using six years of data from the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project. We report MDC-specific estimates of the impact of the reform on insurance coverage and type as well as length of stay, number of diagnoses, and number of procedures. The requirement of universal insurance coverage increased the probability of being covered by insurance. This increase was in part a result of an increase in the probability of being covered by Medicaid. The percentage of admissions covered by private insurance fell. The number of diagnoses rose as a result of the law in the vast majority of diagnostic categories. Our results related to length of stay suggest that looking at aggregate results hides a wealth of information. The most disparate outcomes were pregnancy related. The length of stay for new-born babies and neonates rose dramatically. In aggregate, this increase serves to mute decreases across other diagnoses. Also, the number of procedures fell within the MDCs for pregnancy and child birth and that for new-born babies and neonates. The Massachusetts Health Care Reform appears to have been effective at increasing insurance take-up rates. These increases may have come at the cost of lower private insurance coverage. The number of diagnoses per admission was increased by the policy across nearly all MDCs. Understanding the changes in length of stay as a result of the Massachusetts reform, and perhaps the Affordable Care Act, requires MDC-specific analysis. It appears that the most important distinction

  1. Barriers to Implementation of Evidence Based Practice in Zahedan Teaching Hospitals, Iran, 2014

    Directory of Open Access Journals (Sweden)

    Mohammad Khammarnia

    2015-01-01

    Full Text Available This study aimed to determine the barriers to implementation of EBP among nurses. This cross-sectional study was conducted in Zahedan City, South East of Iran, in 2014. The questionnaire of barriers to implementation of EBP consists of 27 statements which was distributed among 280 nurses. More than half of the participants agreed that 56% and 57% of barriers to implementation of evidence based practice are related to organizational and individual aspects, respectively. Participants identified barriers at organizational level included the lack of human resources (78.3%, lack of internet access at work (72.2%, and heavy workload (70.0%. Barrier at individual level included lack of time to read literature (83.7%, lack of ability to work with computer (68.8%, and insufficient proficiency in English language (62.0%. Age, educational level, job experience, and employment status were associated with organizational barriers to implementation of EBP. At the individual level only education was associated with barriers to implementation of EBP. Barriers to implementation of EBP occur at both individual and organizational levels. The indicator of quality in nursing practice is EBP. Hence, familiarity with EBP is recommended for Iranian nurses. In addition, knowledge of barriers will help health care system and policy makers to provide a culture of EBP.

  2. Disability among attendees with schizophrenia in a Nigerian hospital: further evidence for integrated rehabilitative treatment designs

    Directory of Open Access Journals (Sweden)

    Andrew Toyin Olagunju

    2016-12-01

    Full Text Available Evidence-based rehabilitative treatment is constrained due to limited knowledge about disability and its related factors among individuals with schizophrenia across West Africa. This study aims to investigate the pattern of disability, and the associated factors among individuals with schizophrenia. One hundred consecutively recruited consenting participants were subjected to designed questionnaire to inquire about their demographic and illness-related variables. This was followed by the administration of Structured Clinical Interview for DSM-IV-TR Axis I Disorders and Brief Psychiatric Rating Scale to confirm the diagnosis of schizophrenia and rate severity of symptoms respectively in them. In addition, the World Health Organisation Disability Assessment Scale II (WHODAS-II was used to assess for disability in all participants. Different degrees of disability based on WHODAS- II mean score of 27.02±3.49 were noted among individuals with schizophrenia, and affectation of domains of disability like self care, getting along with others, life activities and participation in the society among others were observed. In addition, high level of disability was significantly associated with younger adults in the age group 18-44 years (P=0.007, unemployment status (P=0.003, remittance source of income (P=0.034 and ethnicity (P=0.017; conversely, less number of children (P=0.033, less amount spent on treatment (P<0.001 and lower BPRS score (P<0.001 correlated negatively with high level of disability. In spite of clinical stability following treatment, individuals with schizophrenia were disabled to varied degrees, and socioeconomic as well as illness-related factors constituted important correlates. Integration of rehabilitation along with social intervention into treatment design to reduce disability is implied, and further research is also warranted.

  3. Disability among Attendees with Schizophrenia in a Nigerian Hospital: Further Evidence for Integrated Rehabilitative Treatment Designs.

    Science.gov (United States)

    Olagunju, Andrew Toyin; Adegbaju, Dapo Adebowale; Uwakwe, Richard

    2016-11-23

    Evidence-based rehabilitative treatment is constrained due to limited knowledge about disability and its related factors among individuals with schizophrenia across West Africa. This study aims to investigate the pattern of disability, and the associated factors among individuals with schizophrenia. One hundred consecutively recruited consenting participants were subjected to designed questionnaire to inquire about their demographic and illness-related variables. This was followed by the administration of Structured Clinical Interview for DSM-IV-TR Axis I Disorders and Brief Psychiatric Rating Scale to confirm the diagnosis of schizophrenia and rate severity of symptoms respectively in them. In addition, the World Health Organisation Disability Assessment Scale II (WHODAS-II) was used to assess for disability in all participants. Different degrees of disability based on WHODAS-II mean score of 27.02±3.49 were noted among individuals with schizophrenia, and affectation of domains of disability like self care, getting along with others, life activities and participation in the society among others were observed. In addition, high level of disability was significantly associated with younger adults in the age group 18-44 years (P=0.007), unemployment status (P=0.003), remittance source of income (P=0.034) and ethnicity (P=0.017); conversely, less number of children (P=0.033), less amount spent on treatment (Pdisability. In spite of clinical stability following treatment, individuals with schizophrenia were disabled to varied degrees, and socioeconomic as well as illness-related factors constituted important correlates. Integration of rehabilitation along with social intervention into treatment design to reduce disability is implied, and further research is also warranted.

  4. Avoiding health information.

    Science.gov (United States)

    Barbour, Joshua B; Rintamaki, Lance S; Ramsey, Jason A; Brashers, Dale E

    2012-01-01

    This study investigated why and how individuals avoid health information to support the development of models of uncertainty and information management and offer insights for those dealing with the information and uncertainty inherent to health and illness. Participants from student (n = 507) and community (n = 418) samples reported that they avoided health information to (a) maintain hope or deniability, (b) resist overexposure, (c) accept limits of action, (d) manage flawed information, (e) maintain boundaries, and (f) continue with life/activities. They also reported strategies for avoiding information, including removing or ignoring stimuli (e.g., avoiding people who might provide health advice) and controlling conversations (e.g., withholding information, changing the subject). Results suggest a link between previous experience with serious illness and health information avoidance. Building on uncertainty management theory, this study demonstrated that health information avoidance is situational, relatively common, not necessarily unhealthy, and may be used to accomplish multiple communication goals.

  5. Cognitive avoidance in phobia

    NARCIS (Netherlands)

    Brosschot, J.F.; Kindt, M.

    1998-01-01

    Investigated the stage in which the bias changed into avoidance and whether cognitive avoidance of threat is restricted to information that refers to the anxiety response as opposed to the threatening stimulus. Therefore, 37 spider phobics (mean age 31 yrs) and 34 controls (mean age 38 yrs) were

  6. Developing evidence-based clinical practice guidelines in hospitals in Australia, Indonesia, Malaysia, the Philippines and Thailand: values, requirements and barriers

    Directory of Open Access Journals (Sweden)

    Turner Tari J

    2009-12-01

    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

  7. Performing well in financial management and quality of care: evidence from hospital process measures for treatment of cardiovascular disease.

    Science.gov (United States)

    Dong, Gang Nathan

    2015-02-01

    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.

  8. "Whether something cool is good enough": The role of evidence, sales representatives and nurses' expertise in hospital purchasing decisions.

    Science.gov (United States)

    Grundy, Quinn

    2016-09-01

    The emphasis on "value" within healthcare institutions has achieved unprecedented priority, particularly around the purchase of medical products and equipment. Health systems and institutions are implementing formal decision-making processes involving clinicians and supply chain professionals to rationalize purchasing and promote cost-effective investment. One particular form of this process is the "Value Analysis" process. Drawing from fieldwork (100 h), interviews (n = 51) and focus groups (n = 4) conducted from January 2012 to October 2014 at 4 acute care hospitals in the western United States, I analyze the ways that committee members constructed and evaluated a case for a product's value. Participants (n = 72) were a purposive sample including nurses, administrators, supply chain and industry professionals. Interpretive phenomenology served as the analytic approach to generating iterative themes. While trying to be evidence-based, Value Analysis committees lacked data related to a product's price or efficacy and relied heavily on local knowledge and expertise. Sales representatives were an integral part of the process, creating interest in the product and providing product information. As vehicles for cost-savings and quality improvement, purchasing committees need unique support that emphasizes local contexts and expertise, while maintaining rigor and minimizing bias. Drawing from participants' experiences, and principles of health technology assessment and economic evaluation, a guiding framework is proposed to support this decision-making.

  9. Bird Avoidance Model

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This is an unpublished report on the bird avoidance model to predict bird strike hazards with low flying aircraft. Included is peak periods for different species of...

  10. Avoiding Computer Viruses.

    Science.gov (United States)

    Rowe, Joyce; And Others

    1989-01-01

    The threat of computer sabotage is a real concern to business teachers and others responsible for academic computer facilities. Teachers can minimize the possibility. Eight suggestions for avoiding computer viruses are given. (JOW)

  11. Avoid Mosquito Bites

    Science.gov (United States)

    ... Submit What's this? Submit Button Past Emails Avoid Mosquito Bites Language: English (US) Español (Spanish) Recommend on ... finding a travel medicine clinic near you. Prevent Mosquito Bites While Traveling Mosquito bites are bothersome enough, ...

  12. Color-avoiding percolation

    CERN Document Server

    Krause, Sebastian M; Zlatić, Vinko

    2016-01-01

    Many real world networks have groups of similar nodes which are vulnerable to the same failure or adversary. Nodes can be colored in such a way that colors encode the shared vulnerabilities. Using multiple paths to avoid these vulnerabilities can greatly improve network robustness. Color-avoiding percolation provides a theoretical framework for analyzing this scenario, focusing on the maximal set of nodes which can be connected via multiple color-avoiding paths. In this paper we extend the basic theory of color-avoiding percolation that was published in [Krause et. al., Phys. Rev. X 6 (2016) 041022]. We explicitly account for the fact that the same particular link can be part of different paths avoiding different colors. This fact was previously accounted for with a heuristic approximation. We compare this approximation with a new, more exact theory and show that the new theory is substantially more accurate for many avoided colors. Further, we formulate our new theory with differentiated node functions, as s...

  13. Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm Results in Higher Hospital Expenses than Open Surgical Repair: Evidence from a Tertiary Hospital in Brazil.

    Science.gov (United States)

    Teivelis, Marcelo Passos; Malheiro, Daniel Tavares; Hampe, Marcio; Dalio, Marcelo Bellini; Wolosker, Nelson

    2016-10-01

    Endovascular aneurysm repair (EVAR) has become the preferred approach for the treatment of infrarenal abdominal aortic aneurysm (IRAAA) in detriment of open surgical repair (OSR). EVAR results in lower mortality rates within 30 days, but rates tend to be the same after longer periods. Moreover, reduced use of hospital resources with EVAR does not necessarily offset the costs of the endoprosthesis. We aimed, in this study, to estimate hospital expenses after OSR or EVAR, including early and late readmissions. Retrospective analysis of hospital expenses (2005-2012) with elective IRAAA surgeries performed in a tertiary hospital, including 127 patients divided into 2 groups, EVAR (n = 102) and OSR (n = 25). One perioperative death occurred in each group. EVAR interventions lasted 145 vs. 210 min of OSR (P hospitalization time differed significantly for EVAR (4 days) and OSR (8 days; P expenses with EVAR were US $53,080.95 and US $56,289.49, respectively. The median and mean expenses with OSR were US $37,116.04 and US $68,788.54, respectively. Early readmissions reached 11.2%. None of the OSR patients required late reinterventions, but 10 (9.9%) EVAR patients did, one of whom died. EVAR resulted in higher expenses with the exclusion of one outlier. Late reinterventions, with elevated costs, were only required by EVAR patients. Thus, when patients are eligible to undergo either intervention, OSR seems to have lower costs and better long-term results. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. A pragmatic study exploring the prevention of delirium among hospitalized older hip fracture patients: Applying evidence to routine clinical practice using clinical decision support

    Directory of Open Access Journals (Sweden)

    Schmaltz Heidi N

    2010-10-01

    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

  15. Correlates among cognitive beliefs, EBP implementation, organizational culture, cohesion and job satisfaction in evidence-based practice mentors from a community hospital system.

    Science.gov (United States)

    Melnyk, Bernadette Mazurek; Fineout-Overholt, Ellen; Giggleman, Martha; Cruz, Ron

    2010-01-01

    Evidence from research and outcomes management projects strongly supports the use of evidence-based practice (EBP) in improving quality of health care and patient outcomes as well as reducing hospital costs. In addition, published anecdotal reports have indicated that clinicians who use an evidence-based approach to care and practice in cultures that support EBP feel more empowered and satisfied in their roles. However, research is lacking that has specifically examined the relationships among beliefs about and implementation of EBP by hospital staff, organizational culture for EBP, group cohesion and job satisfaction. Therefore, the purpose of this descriptive correlational study was to examine the relationships among these variables in 58 health professionals, prior to their participation in a 12-month EBP mentorship program as part of implementing the Advancing Research and Clinical practice through close Collaboration (ARCC) Model in a community hospital system. Findings indicated that participants' EBP beliefs were significantly correlated with perceived organizational culture for EBP, the extent to which they implemented EBP, group cohesion, and job satisfaction. Organizational culture for EBP was significantly and positively related to EBP beliefs and EBP implementation. Findings support the need for hospitals to establish cultures that support EBP and to implement strategies to strengthen individuals' cognitive beliefs about the value of EBP and their ability to implement it for the ultimate purpose of improving quality of care and enhancing job satisfaction.

  16. Legionnaire's disease avoidance planning.

    Science.gov (United States)

    Broadbent, Clive

    2007-09-01

    Hospital-acquired infection is the cause of about 5,000 deaths a year in the UK. In New Zealand, there are more than three times as many such deaths as from the annual road toll. The costs in loss of income, in pain and suffering and in direct costs to hospitals are staggering.

  17. Public hospital quality report awareness: evidence from National and Californian Internet searches and social media mentions, 2012.

    Science.gov (United States)

    Huesch, Marco D; Currid-Halkett, Elizabeth; Doctor, Jason N

    2014-03-11

    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

  18. Banking deregulation and corporate tax avoidance

    Directory of Open Access Journals (Sweden)

    Bill B. Francis

    2017-06-01

    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.

  19. Helping Students Avoid Plagiarism.

    Science.gov (United States)

    Wilhoit, Stephen

    1994-01-01

    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…

  20. Cachexia & debility diagnoses in hospitalized children and adolescents with complex chronic conditions: evidence from the Kids’ Inpatient Database

    Directory of Open Access Journals (Sweden)

    Bryce A Van Doren

    2015-02-01

    Full Text Available Objective: To characterize the frequency, cost, and hospital-reported outcomes of cachexia and debility in children and adolescents with complex chronic conditions (CCCs. Methods: We identified children and adolescents (aged ≤20 years with CCCs, cachexia, and debility in the Kids’ Inpatient Database [Healthcare Cost and Utilization Project, Agency for Healthcare Research & Quality]. We then compared the characteristics of patients and hospitalizations, including cost and duration of stay, for CCCs with and without cachexia and/ or debility. We examined factors that predict risk of inpatient mortality in children and adolescents with CCCs using a logistic regression model. We examined factors that impact duration of stay and cost in children and adolescents with CCCs using negative binomial regression models. All costs are reported in US dollars in 2014 using Consumer Price Index inflation adjustment. Results: We estimated the incidence of hospitalization of cachexia in children and adolescents with CCCs at 1,395 discharges during the sample period, which ranged from 277 discharges in 2003 to 473 discharges in 2012. We estimated the incidence of hospitalization due to debility in children and adolescents with CCCs at 421 discharges during the sample period, which ranged from 39 discharges in 2003 to 217 discharges in 2012. Cachexia was associated with a 60% increase in the risk of inpatient mortality, whereas debility was associated with a 40% decrease in the risk of mortality. Cachexia and debility increased duration of stay in hospital (17% and 39% longer stays, respectively. Median cost of hospitalization was $15,441.59 and $23,796.16 for children and adolescents with cachexia and debility, respectively. Conclusions: Incidence of hospitalization for cachexia in children and adolescents with CCCs is less than that for adults but the frequency of cachexia diagnoses increased over time. Estimates of the incidence of hospitalization with

  1. Nurse staffing and system integration and change indicators in acute care hospitals: evidence from a balanced scorecard.

    Science.gov (United States)

    McGillis Hall, Linda; Peterson, Jessica; Baker, G Ross; Brown, Adalsteinn D; Pink, George H; McKillop, Ian; Daniel, Imtiaz; Pedersen, Cheryl

    2008-01-01

    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.

  2. On partitions avoiding right crossings

    CERN Document Server

    Yan, Sherry H F

    2011-01-01

    Recently, Chen et al. derived the generating function for partitions avoiding right nestings and posed the problem of finding the generating function for partitions avoiding right crossings. In this paper, we derive the generating function for partitions avoiding right crossings via an intermediate structure of partial matchings avoiding 2-right crossings and right nestings. We show that there is a bijection between partial matchings avoiding 2-right crossing and right nestings and partitions avoiding right crossings.

  3. Salmonella enterica serovar Oranienburg outbreak in a veterinary medical teaching hospital with evidence of nosocomial and on-farm transmission.

    Science.gov (United States)

    Cummings, Kevin J; Rodriguez-Rivera, Lorraine D; Mitchell, Katharyn J; Hoelzer, Karin; Wiedmann, Martin; McDonough, Patrick L; Altier, Craig; Warnick, Lorin D; Perkins, Gillian A

    2014-07-01

    Nosocomial salmonellosis continues to pose an important threat to veterinary medical teaching hospitals. The objectives of this study were to describe an outbreak of salmonellosis caused by Salmonella enterica serovar Oranienburg within our hospital and to highlight its unique features, which can be used to help mitigate or prevent nosocomial outbreaks in the future. We retrospectively analyzed data from patients that were fecal culture-positive for Salmonella Oranienburg between January 1, 2006, and June 1, 2011, including historical, clinical, and pulsed-field gel electrophoresis (PFGE) data. Salmonella Oranienburg was identified in 20 horses, five alpacas, and three cows during this time frame, with dates of admission spanning the period from August, 2006, through January, 2008. We consider most of these patients to have become infected through either nosocomial or on-farm transmission, as evidenced by molecular subtyping results and supportive epidemiologic data. Interpretation of PFGE results in this outbreak was challenging because of the identification of several closely related Salmonella Oranienburg subtypes. Furthermore, a high percentage of cases were fecal culture-positive for Salmonella Oranienburg within 24 h of admission. These patients initially appeared to represent new introductions of Salmonella into the hospital, but closer inspection of their medical records revealed epidemiologic links to the hospital following the index case. Cessation of this outbreak was observed following efforts to further heighten biosecurity efforts, with no known cases or positive environmental samples after January, 2008. This study demonstrates that a Salmonella-positive culture result within 24 h of admission does not exclude the hospital as the source of infection, and it underscores the important role played by veterinary medical teaching hospitals as nodes of Salmonella infection that can promote transmission outside of the hospital setting.

  4. The impact of therapeutic procedure innovation on hospital patient longevity: evidence from Western Australia, 2000-2007.

    Science.gov (United States)

    Lichtenberg, Frank R

    2013-01-01

    Assessing the benefits of medical innovation--its impact on health outcomes--is as important as assessing the costs-its impact on health expenditure. Most formal studies have focused on the expenditure impacts of medical technology, partly because costs are more easily identified and quantified than are benefits. Moreover, most quantitative research relating to the impact of broad categories of technology on health outcomes has focused on pharmaceuticals. This is the first study that investigates the benefits and costs of another broad category of medical innovation--inpatient therapeutic procedure innovation-using data on over one million hospital discharges. We investigate the effect of therapeutic procedure innovation in general on the longevity of Western Australia (WA) hospital patients with a variety of medical conditions. We can measure survival for a period as long as 8 years after admission. We know the date each procedure was added to the Medicare Benefits Schedule (MBS). First, we perform an analysis using cross-sectional patient-level data, controlling for the patient's age, sex, Diagnosis Related Group (DRG, over 600 categories), Aboriginal status, marital status, insurance coverage (whether or not the patient had private insurance), postcode (over 400 postcodes), year of hospital admission, and number of procedures performed. The estimates indicate that therapeutic procedure innovation increased the life expectancy of WA hospital patients (whose mean life expectancy was about 10 years) by almost 3 months between 2000 and 2007. Estimates based on longitudinal DRG-level data also indicate that therapeutic procedure innovation increased the life expectancy of WA hospital patients, but the implied increase may be smaller-about 2 months. In either case, therapeutic procedure innovation in WA hospitals appears to have been remarkably cost-effective, because it increased the cost of medical procedures by a negligible amount. Copyright © 2012 Elsevier Ltd

  5. The challenges for scientists in avoiding plagiarism.

    Science.gov (United States)

    Fisher, E R; Partin, K M

    2014-01-01

    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.

  6. Does autonomization of public hospitals and exposure to market pressure complement or debilitate social health insurance systems? Evidence from a low-income country.

    Science.gov (United States)

    Sepehri, Ardeshir

    2014-01-01

    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.

  7. Methylphenidate intoxications in children and adults: exposure circumstances and evidence-based dose threshold for pre-hospital triage

    NARCIS (Netherlands)

    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

    2015-01-01

    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

  8. Methylphenidate intoxications in children and adults : Exposure circumstances and evidence-based dose threshold for pre-hospital triage

    NARCIS (Netherlands)

    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

    2015-01-01

    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

  9. Inpatient hospital costs and length of stay for the treatment of affective and somatoform disorders – evidence from Germany

    Science.gov (United States)

    Romeyke, Tobias; Scheuer, Hans Christoph; Stummer, Harald

    2014-01-01

    Introduction Diagnosis related costs analyses are the subject of science and research and are of great relevance and importance for decision makers in the hospital and for funding bodies, but also for international health policy. Up to now, standardized costs analyses with valid costs data have not been available for inpatient care of patients with affective and somatoform disorders. Background This clinical picture presents a major challenge for the provision of outpatient and inpatient care. An interdisciplinary approach in an inpatient setting can be beneficial for already “chronified” patients with severe forms of progression. Because of its structural and procedural demands, this type of care is associated with a greater expenditure of resources. Methods Costs data from the years 2008 to 2012 were analyzed for a total of 17,424 hospitalized patients in more than 200 different hospitals in Germany. The study compared the costs of treating patients with the main diagnosis affective and somatoform disorders using standardized interdisciplinary therapy, with the costs of conventional therapy. Results Interdisciplinary patient care is characterized by a high proportion of the costs derived from the structural and procedural implementation and the medical and nursing care. For interdisciplinary therapy with a mean period of hospitalization of 15.2 days, over 60% of the total costs were incurred by the personnel and material costs of the medical and non-medical infrastructure. The outlay is considerably greater than would be incurred by a conventional therapeutic approach without interdisciplinary therapy. Discussion and conclusion For the first time, detailed diagnosis-related costs data are published which were generated by consistent, standardized cost unit accounting. An interdisciplinary, holistic approach to the clinical picture results in a significant increase in costs for the hospitals. PMID:25506252

  10. Predicting attention and avoidance: when do avoiders attend?

    Science.gov (United States)

    Klein, Rupert; Knäuper, Bärbel

    2009-09-01

    Three avoidance measures, the Miller Behavioural Style Scale (MBSS), Index of Self-Regulation of Emotion (ISE) and Mainz Coping Inventory (MCI), were compared in their ability to predict attention and avoidance of threats in the emotional Stroop task. It was also examined if the avoidance mechanism of individuals who would normally avoid threat-indicating words becomes disrupted under conditions of dopamine reduction. Results show that only the ISE predicted attention/avoidance of threat-indicating words. In addition, the avoidance mechanism, as measured by the ISE and MCI, was not activated when regular smokers abstained from smoking.

  11. Avoidable waste management costs

    Energy Technology Data Exchange (ETDEWEB)

    Hsu, K.; Burns, M.; Priebe, S.; Robinson, P.

    1995-01-01

    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.

  12. Can a simulation-based training program impact the use of evidence based routine practices at birth? Results of a hospital-based cluster randomized trial in Mexico

    Science.gov (United States)

    Fritz, Jimena; Walker, Dilys M.; Cohen, Susanna; Angeles, Gustavo; Lamadrid-Figueroa, Hector

    2017-01-01

    Background 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. Objective 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. Methods 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. Results 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. Conclusions The intervention has an

  13. The emergency room at the Rotunda Hospital: evidence of an improving service over the past 3 years.

    LENUS (Irish Health Repository)

    Talukdar, S

    2014-12-01

    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.

  14. Systematic review of statistics on causes of deaths in hospitals: strengthening the evidence for policy-makers.

    Science.gov (United States)

    Rampatige, Rasika; Mikkelsen, Lene; Hernandez, Bernardo; Riley, Ian; Lopez, Alan D

    2014-11-01

    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.

  15. Can the UroLift prostatic implant device treat the symptoms of benign prostatic hypertrophy, avoid sexual dysfunction and reduce hospital TURP waiting times? A single centre, single surgeon experience and review of the literature.

    Science.gov (United States)

    Bardoli, Antonio D; Taylor, Will St J; Mahmalji, Wasim

    2017-09-01

    BPH associated with LUTS and sexual dysfunction is common. We performed UroLift on 11 patients, average age 71 years (range 56-90). IPSS improved by an average of 9 points post-procedure. Pre-operatively their post-void residuals were 306.3 ml (range 120-499 ml SD [120.6]) and their QMAX was 7 ml/s (range 4-14 SD [2.8] ml/s). Post-procedure the post-void residual decreased by 35.4% at 4 months (mean difference - 106.3 ml). QMAX improved by an average of 1.7 ml/s, which was not statistically significant. No patients suffered any sexual dysfunction side effects and all patients were satisfied with their result. Hospital stay and theatre time were significantly reduced. Average length of stay was just 10.6 (6-18) hours and average theatre time just 18.7 (12-30) min. This is significantly faster than other surgery for LUTS. We therefore feel that there are significant benefits for both the patients, who are able to go home much faster, and also the hospital, who are able to perform far more surgeries for their patients. Patients also do not require an inpatient bed so patients should not be cancelled on the day of theatre.

  16. Inpatient hospital costs and length of stay for the treatment of affective and somatoform disorders – evidence from Germany

    Directory of Open Access Journals (Sweden)

    Romeyke T

    2014-12-01

    Full Text Available Tobias Romeyke,1,2 Hans Christoph Scheuer,2 Harald Stummer1 1Department of Public Health and Health Technology Assessment: Division for Organizational Behaviour Research and Workplace Health Promotion, University for Health Sciences, Medical Informatics and Technology, Vienna, Austria; 2Department of Acute Internal and Integrative Medicine and Pain Management, Waldhausklinik Deuringen, Germany Introduction: Diagnosis related costs analyses are the subject of science and research and are of great relevance and importance for decision makers in the hospital and for funding bodies, but also for international health policy. Up to now, standardized costs analyses with valid costs data have not been available for inpatient care of patients with affective and somatoform disorders. Background: This clinical picture presents a major challenge for the provision of outpatient and inpatient care. An interdisciplinary approach in an inpatient setting can be beneficial for already "chronified" patients with severe forms of progression. Because of its structural and procedural demands, this type of care is associated with a greater expenditure of resources. Methods: Costs data from the years 2008 to 2012 were analyzed for a total of 17,424 hospitalized patients in more than 200 different hospitals in Germany. The study compared the costs of treating patients with the main diagnosis affective and somatoform disorders using standardized interdisciplinary therapy, with the costs of conventional therapy. Results: Interdisciplinary patient care is characterized by a high proportion of the costs derived from the structural and procedural implementation and the medical and nursing care. For interdisciplinary therapy with a mean period of hospitalization of 15.2 days, over 60% of the total costs were incurred by the personnel and material costs of the medical and non-medical infrastructure. The outlay is considerably greater than would be incurred by a conventional

  17. Unrecognized hospital trauma as a source of complex psychiatric symptoms: a systematic case study with implications for children's rights and evidence-based practice.

    Science.gov (United States)

    Raby, Carly; Edwards, David

    2011-09-01

    This article describes the psychological assessment and treatment of Paul (12). For several years, he had received numerous diagnoses from a range of specialists and been unsuccessfully treated for epilepsy and obsessive-compulsive disorder. Treatment was based on a formulation-driven transdiagnostic approach. Soon it was clear that the correct diagnosis was posttraumatic stress disorder (PTSD) precipitated by an event in hospital when Paul was 6. Two sessions of Children's Accelerated Trauma Treatment (CATT) led to rapid resolution of the main symptoms and gains were consolidated and maintained in further treatment and follow-up sessions. The case material is used to examine why the correct case formulation had been missed, evidence for the efficacy of CATT, and implications for evidence-based practice and children's rights.

  18. Does hospital ownership influence hospital referral region health rankings in the United States.

    Science.gov (United States)

    Hamadi, Hanadi; Apatu, Emma; Spaulding, Aaron

    2017-07-21

    Extensive evidence demonstrates that a hospital's organizational ownership structure impacts its overall performance, but little is known concerning the influence of hospital structure on the health of its community. This paper explores the association between US hospital referral region (HRR) health rankings and hospital ownership and performance. Data from the 2016 Commonwealth Fund Scorecard on Local Health System Performance, the American Hospital Association dataset, and the Hospital Value-Based Purchasing dataset are utilized to conduct a cross-sectional analysis of 36 quality measures across 306 HRRs. Multivariate regression analysis was used to estimate the association among hospital ownership, system performance measures-access and affordability, prevention and treatment, avoidable hospital use and cost, and healthy lives-and performance as measured by value-based purchasing total performance scores. We found that indicators of access and affordability, as well as prevention and treatment, were significantly associated across all 3 hospitals' organizational structures. Hospital referral regions with a greater number of not-for-profit hospitals demonstrated greater indications of access and affordability, as well as better prevention and treatment rankings than for-profit and government hospitals. Hospital referral regions with a greater number of government, nonfederal hospitals had worse scores for healthy lives. Furthermore, the greater the total performance scores score, the better the HRR score on prevention and treatment rankings. The greater the per capita income, the better the score across all 4 dimensions. As such, this inquiry supports the assertion that performance of a local health system is dependent on its community's resources of health care delivery entities and their structure. Copyright © 2017 John Wiley & Sons, Ltd.

  19. Avoidance Strategies in Intimate Relationships.

    Science.gov (United States)

    Belk, Sharyn S.; And Others

    Avoidance strategies involve the tactics and techniques people use when they don't wish to be influenced by others. To investigate the types of avoidance strategies men and women use to deal with an unwelcome persuasion attempt from an intimate partner, undergraduates wrote essays describing how they avoided such attempts. A 24-strategy coding…

  20. The relative effectiveness of practice change interventions in overcoming common barriers to change: a survey of 14 hospitals with experience implementing evidence-based guidelines.

    Science.gov (United States)

    Simpson, Fiona; Doig, Gordon S

    2007-10-01

    Changing practice to reflect current best evidence can be costly and time-consuming. The purpose of this survey was to determine the optimal combination of practice change interventions needed to overcome barriers to practice change commonly encountered in the intensive care unit (ICU). A survey instrument delivered by mail with email follow-up reminders. Fourteen hospitals throughout Australia and New Zealand. Individuals responsible for implementing an evidence-based guideline for nutritional support in the ICU. Practice change interventions were ranked in order of effectiveness and barriers to change were ranked in order of how frequently they were encountered. A response rate of 100% was achieved. Interventions traditionally regarded as strong (academic detailing, active reminders) were ranked higher than those traditionally regarded as moderate (audit and feedback), or weak (posters, mouse mats). The high ranks of the site initiation visit (educational outreach, modest) and in-servicing (didactic lectures, weak) were unexpected, as was the relatively low rank of educationally influential, peer-nominated opinion leaders. Four hospitals reported the same doctor-related barrier as 'most common' and the remaining 10 hospitals reported three different doctor-related barriers, two nursing-related barriers and three organizational barriers as most common. When designing a multifaceted, multi-centre change strategy, the selection of individual practice change interventions should be based on: (1) an assessment of available resources; (2) recognition of the importance of different types of barriers to different sites; (3) the potential for combinations of interventions to have a synergistic effect on practice change, and (4) the potential for combinations of interventions to actually reduce workload.

  1. Evaluating the feasibility and effect of using a hospital-wide coordinated approach to introduce evidence-based changes for pain management.

    Science.gov (United States)

    Williams, Anne M; Toye, Christine; Deas, Kathleen; Fairclough, Denise; Curro, Kathryn; Oldham, Lynn

    2012-12-01

    This action research project explored the feasibility and effect of implementing a hospital-wide coordinated approach to improve the management of pain. The project used a previously developed model to introduce three evidence-based changes in pain management. Part of this model included the introduction of 30 pain resource nurses (PRNs) to act as clinical champions for pain at a local level. Both quantitative and qualitative measures were used to assess the feasibility and effect of the changes introduced. Quantitative data were gathered through a hospital-wide document review and assessment of the knowledge and attitude of the PRNs at two time points: time 1 before the introduction of the PRNs and time 2 near completion of the project (11 months later). A statistically significant improvement in the documentation of pain scores on admission and each nursing shift was apparent. However, no difference was found in the percentage of patients who had been prescribed opioids for regular pain relief that had also been prescribed and dispensed a laxative/aperient. Neither were any statistically significant decreases in patient pain scores observed. An assessment of the knowledge and attitudes of the PRNs showed an improvement from time 1 to time 2 that was statistically significant. The qualitative data revealed that despite the barriers encountered, the role was satisfying for the PRNs and valued by other hospital staff. Overall, the results revealed that the new model of change incorporating PRNs was a useful and effective method for introducing and sustaining evidence-based organizational change. Copyright © 2012 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  2. Gender differences in presentation, management, and in-hospital outcomes for patients with AMI in a lower-middle income country: evidence from Egypt.

    Directory of Open Access Journals (Sweden)

    Neel M Butala

    Full Text Available BACKGROUND: Many studies in high-income countries have investigated gender differences in the care and outcomes of patients hospitalized with acute myocardial infarction (AMI. However, little evidence exists on gender differences among patients with AMI in lower-middle-income countries, where the proportion deaths stemming from cardiovascular disease is projected to increase dramatically. This study examines gender differences in patients in the lower-middle-income country of Egypt to determine if female patients with AMI have a different presentation, management, or outcome compared with men. METHODS AND FINDINGS: Using registry data collected over 18 months from 5 Egyptian hospitals, we considered 1204 patients (253 females, 951 males with a confirmed diagnosis of AMI. We examined gender differences in initial presentation, clinical management, and in-hospital outcomes using t-tests and χ(2 tests. Additionally, we explored gender differences in in-hospital death using multivariate logistic regression to adjust for age and other differences in initial presentation. We found that women were older than men, had higher BMI, and were more likely to have hypertension, diabetes mellitus, dyslipidemia, heart failure, and atrial fibrillation. Women were less likely to receive aspirin upon admission (p<0.01 or aspirin or statins at discharge (p = 0.001 and p<0.05, respectively, although the magnitude of these differences was small. While unadjusted in-hospital mortality was significantly higher for women (OR: 2.10; 95% CI: 1.54 to 2.87, this difference did not persist in the fully adjusted model (OR: 1.18; 95% CI: 0.55 to 2.55. CONCLUSIONS: We found that female patients had a different profile than men at the time of presentation. Clinical management of men and women with AMI was similar, though there are small but significant differences in some areas. These gender differences did not translate into differences in in-hospital outcome, but

  3. A psychological perspective on tax avoidance: Deferential avoidance vs. defiant avoidance

    National Research Council Canada - National Science Library

    Minjo Kang

    2016-01-01

      Is a taxpayer's act of tax avoidance deemed compliant or non-compliant? Academic researchers, investigating tax compliance behaviour, address the term tax avoidance differently for a variety of purposes...

  4. Audit and Feedback-Focused approach to Evidence-based Care in Treating patients with pneumonia in hospital (AFFECT Study)

    Science.gov (United States)

    Halpape, Katelyn; Sulz, Linda; Schuster, Brenda; Taylor, Ron

    2014-01-01

    Background: Pneumonia is the eighth leading cause of death in Canada. Use of guideline-concordant therapy tempers the development of resistance, decreases health care costs, and reduces morbidity and mortality. Objectives: The purpose of this study was to optimize the treatment of patients with pneumonia under hospitalist care by focusing on best practice and local antibiogram data. The objectives were to collaborate with a hospitalist representative to optimize in-hospital treatment of patients with community-acquired, hospital-acquired, and health care–associated pneumonia; to complete a baseline audit to determine the proportion of antibiotic orders adhering to the strategy; to present the strategy and baseline audit findings to the hospitalists; to perform a post-intervention audit, with comparison to baseline, and to present results to the hospitalists; to expedite de-escalation to a narrower-spectrum antibiotic; to expedite parenteral-to-oral step-down therapy and promote appropriate duration of therapy; and to determine if a pneumonia scoring system was used. Methods: An audit and feedback intervention focusing on pre- and post-intervention retrospective chart audits was completed. Review of pneumonia guidelines and the local antibiogram assisted in identifying the study strategy. A presentation to the hospitalists outlined antimicrobial stewardship principles and described the findings of the baseline audit. Pre- and post-intervention audit results were compared. Results: Local best-practice treatment algorithms were developed for community-acquired pneumonia and for hospital-acquired and health care–associated pneumonia. The pre-intervention audit covered the period December 2011 to January 2012, with subsequent education and audit results presented to the hospitalists in November 2012. The post-intervention audit covered the period December 2012 to January 2013. Adherence to the treatment algorithms increased from 10% (2/21) in the pre

  5. How do nonprofit hospitals manage earnings?

    Science.gov (United States)

    Leone, Andrew J; Van Horn, R Lawrence

    2005-07-01

    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.

  6. Neuroimaging the temporal dynamics of human avoidance to sustained threat.

    Science.gov (United States)

    Schlund, Michael W; Hudgins, Caleb D; Magee, Sandy; Dymond, Simon

    2013-11-15

    Many forms of human psychopathology are characterized by sustained negative emotional responses to threat and chronic behavioral avoidance, implicating avoidance as a potential transdiagnostic factor. Evidence from both nonhuman neurophysiological and human neuroimaging studies suggests a distributed frontal-limbic-striatal brain network supports avoidance. However, our understanding of the temporal dynamics of the network to sustained threat that prompts sustained avoidance is limited. To address this issue, 17 adults were given extensive training on a modified free-operant avoidance task in which button pressing avoided money loss during a sustained threat period. Subsequently, subjects underwent functional magnetic resonance imaging while completing the avoidance task. In our regions of interest, we observed phasic, rather than sustained, activation during sustained threat in dorsolateral and inferior frontal regions, anterior and dorsal cingulate, ventral striatum and regions associated with emotion, including the amygdala, insula, substantia nigra and bed nucleus of the stria terminalis complex. Moreover, trait levels of experiential avoidance were negatively correlated with insula, hippocampal and amygdala activation. These findings suggest knowledge that one can consistently avoid aversive outcomes is not associated with decreased threat-related responses and that individuals with greater experiential avoidance exhibit reduced reactivity to initial threat. Implications for understanding brain mechanisms supporting human avoidance and psychological theories of avoidance are discussed.

  7. Airborne Collision Avoidance System X

    Science.gov (United States)

    2015-06-01

    avoidance system on behalf of the Federal Aviation Adminis- tration (FAA). The current Traffic Alert and Collision Avoidance System II (TCAS II...transformations to the National Airspace System are being imple- mented through the FAA’s Next-Genera- tion Air Transportation System (NextGen). With the goal...weighted states to provide a single, optimal action. If a collision avoidance This work is sponsored by the Federal Aviation Administration under Air

  8. Stimulus conflict triggers behavioral avoidance.

    Science.gov (United States)

    Dignath, David; Eder, Andreas B

    2015-12-01

    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.

  9. Association of Evidence-Based Care Processes With Mortality in Staphylococcus aureus Bacteremia at Veterans Health Administration Hospitals, 2003-2014.

    Science.gov (United States)

    Goto, Michihiko; Schweizer, Marin L; Vaughan-Sarrazin, Mary S; Perencevich, Eli N; Livorsi, Daniel J; Diekema, Daniel J; Richardson, Kelly K; Beck, Brice F; Alexander, Bruce; Ohl, Michael E

    2017-09-05

    Staphylococcus aureus bacteremia is common and frequently associated with poor outcomes. Evidence indicates that specific care processes are associated with improved outcomes for patients with S aureus bacteremia, including appropriate antibiotic prescribing, use of echocardiography to identify endocarditis, and consultation with infectious diseases (ID) specialists. Whether use of these care processes has increased in routine care for S aureus bacteremia or whether use of these processes has led to large-scale improvements in survival is unknown. To examine the association of evidence-based care processes in routine care for S aureus bacteremia with mortality. This retrospective observational cohort study examined all patients admitted to Veterans Health Administration (VHA) acute care hospitals who had a first episode of S aureus bacteremia from January 1, 2003, through December 31, 2014. Use of appropriate antibiotic therapy, echocardiography, and ID consultation. Thirty-day all-cause mortality. Analyses included 36 868 patients in 124 hospitals (mean [SD] age, 66.4 [12.5] years; 36 036 [97.7%] male), including 19 325 (52.4%) with infection due to methicillin-resistant S aureus and 17 543 (47.6%) with infection due to methicillin-susceptible S aureus. Risk-adjusted mortality decreased from 23.5% (95% CI, 23.3%-23.8%) in 2003 to 18.2% (95% CI, 17.9%-18.5%) in 2014. The number of patients who received appropriate antibiotic 10 therapy Rates of appropriate antibiotic prescribing increased from 2467 (66.4%) to 1991 (78.9%), echocardiography from 1256 (33.8%) to 1837 (72.8%), and ID consultation from 1390 (37.4%) to 1717 (68.0%). After adjustment for patient characteristics, cohort year, and other care processes, receipt of care processes was associated with lower mortality, with adjusted odds ratios of 0.74 (95% CI, 0.68-0.79) for appropriate antibiotics, 0.73 (95% CI, 0.68-0.78) for echocardiography, and 0.61 (95% CI, 0.56-0.65) for ID consultation. Mortality

  10. Evidence based practice of nurses working in university hospitals in the French speaking part of Switzerland: a descriptive and correlational study

    Science.gov (United States)

    Gentizon, Jenny; Borrero, Patricia; Vincent-Suter, Sonja; Ballabeni, Pierluigi; Morin, Diane; Eicher, Manuela

    2016-12-01

    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.

  11. Characteristics of multiple-diseased elderly in Swedish hospital care and clinical guidelines: Do they make evidence-based priority setting a “mission impossible”?

    Directory of Open Access Journals (Sweden)

    Carlsson, Per

    2009-02-01

    Full Text Available In Sweden, an expected growing gap between available resources and greater potential for medical treatment has brought evidence-based guidelines and priority setting into focus. There are problems, however, in areas where the evidence base is weak and underlying ethical values are controversial. Based on a specified definition of multiple-diseased elderly patients, the aims of this study are: (i to describe and quantify inpatient care utilisation and patient characteristics, particularly regarding cardiovascular disease and co-morbidity; and (ii to question the applicability of evidence-based guidelines for these patients with regard to the reported characteristics (i.e. age and co-morbidity, and to suggest some possible strategies in order to tackle the described problem and the probable presence of ageism. We used data from three sources: (a a literature review, (b a register study, based on a unique population-based register of inpatient care in Sweden, and (c a national cost per patient database. The results show that elderly patients with multiple co-morbidities constitute a large and growing population in Swedish inpatient hospital care. They have multiple and complex needs and a large majority have a cardiovascular disease. There is a relationship between reported characteristics, i.e. age and co-morbidity, and limited applicability of evidence-based guidelines, and this can cause an under-use as well as an over-use of medical interventions. As future clinical studies will be rare due to methodological and financial factors, we consider it necessary to condense existing practical-clinical experiences of individual experts into consensus-based guidelines concerning elderly with multi-morbidity. In such priority setting, it will be important to consider co-morbidity and different degrees of frailty.

  12. Chemical avoidance responses of fishes.

    Science.gov (United States)

    Tierney, Keith B

    2016-05-01

    The hydrosphere is a repository for all of our waste and mistakes, be they sewage, garbage, process-affected waters, runoff, and gases. For fish living in environments receiving undesirable inputs, moving away seems an obvious way to avoid harm. While this should occur, there are numerous examples where it will not. The inability to avoid harmful environments may lead to sensory impairments that in turn limit the ability to avoid other dangers or locate benefits. For avoidance to occur, the danger must first be perceived, which may not happen if the fish is 'blinded' in some capacity. Second, the danger must be recognized for what it is, which may also not happen if the fish is cognitively confused or impaired. Third, it is possible that the fish may not be able to leave the area, or worse, learns to prefer a toxic environment. Concerning generating regulations around avoidance, there are two possibilities: that an avoidance threshold be used to set guidelines for effluent release with the intention of driving fishes away; the second is to set a contaminant concentration that would not affect the avoidance or attraction responses to other cues. With the complexities of the modern world in which we release diverse pollutants, from light to municipal effluents full of 1000s of chemicals, to the diversity present in ecosystems, it is impossible to have avoidance data on every stimulus-species combination. Nevertheless, we may be able to use existing avoidance response data to predict the likelihood of avoidance of untested stimuli. Where we cannot, this review includes a framework that can be used to direct new research. This review is intended to collate existing avoidance response data, provide a framework for making decisions in the absence of data, and suggest studies that would facilitate the prediction of risk to fish health in environments receiving intentional and unintentional human-based chemical inputs.

  13. Cigarette tax avoidance and evasion.

    Science.gov (United States)

    Stehr, Mark

    2005-03-01

    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.

  14. Enhancing Medicares Hospital Acquired Conditions Policy

    Data.gov (United States)

    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...

  15. Enhancing Medicares Hospital Acquired Conditions Policy

    Data.gov (United States)

    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...

  16. Ground Collision Avoidance System (Igcas)

    Science.gov (United States)

    Skoog, Mark A (Inventor); Prosser, Kevin (Inventor); Hook, Loyd (Inventor)

    2017-01-01

    The present invention is a system and method for aircraft ground collision avoidance (iGCAS) comprising a modular array of software, including a sense own state module configured to gather data to compute trajectory, a sense terrain module including a digital terrain map (DTM) and map manger routine to store and retrieve terrain elevations, a predict collision threat module configured to generate an elevation profile corresponding to the terrain under the trajectory computed by said sense own state module, a predict avoidance trajectory module configured to simulate avoidance maneuvers ahead of the aircraft, a determine need to avoid module configured to determine which avoidance maneuver should be used, when it should be initiated, and when it should be terminated, a notify Module configured to display each maneuver's viability to the pilot by a colored GUI, a pilot controls module configured to turn the system on and off, and an avoid module configured to define how an aircraft will perform avoidance maneuvers through 3-dimensional space.

  17. Pattern Avoidance in Ternary Trees

    CERN Document Server

    Gabriel, Nathan; Pudwell, Lara; Tay, Samuel

    2011-01-01

    This paper considers the enumeration of ternary trees (i.e. rooted ordered trees in which each vertex has 0 or 3 children) avoiding a contiguous ternary tree pattern. We begin by finding recurrence relations for several simple tree patterns; then, for more complex trees, we compute generating functions by extending a known algorithm for pattern-avoiding binary trees. Next, we present an alternate one-dimensional notation for trees which we use to find bijections that explain why certain pairs of tree patterns yield the same avoidance generating function. Finally, we compare our bijections to known "replacement rules" for binary trees and generalize these bijections to a larger class of trees.

  18. Things to Avoid When Breastfeeding

    Science.gov (United States)

    ... need to avoid fish that are high in mercury, namely, shark, swordfish, king mackerel, and tilefish. When you do eat fish, it’s important to eat varieties that contain less mercury, such as canned light tuna, shrimp, salmon, pollock, ...

  19. Neuromorphic UAS Collision Avoidance Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Using biologically-inspired neuromorphic optic flow algorithms is a novel approach in collision avoidance for UAS. Traditional computer vision algorithms rely on...

  20. Avoiding Gluten Cross-Contamination

    Science.gov (United States)

    ... Toddler For Preschooler For Gradeschooler For Teen Avoiding Gluten Cross-Contamination Reviewed by Sharon Denny, MS, RDN ... can be a virtual mine field. That's because gluten (a protein in grains such as wheat, rye ...

  1. Robot Avoids Collisions With Obstacles

    Science.gov (United States)

    Cheung, Edward; Rosinski, Doug; Wegerif, Dan

    1993-01-01

    Developmental robot equipped with infrared sensors and control system acting in concert to enable manipulator arm to move around obstacles. Robot avoids collisions with other objects, even when moving in unpredictable ways. Control system requires no prior knowledge of environment.

  2. How to avoid exercise injuries

    Science.gov (United States)

    ... gov/ency/patientinstructions/000859.htm How to avoid exercise injuries To use the sharing features on this ... injury and stay safe during exercise. What Causes Exercise Injuries? Some of the most common causes of ...

  3. Postcopulatory inbreeding avoidance in guppies

    National Research Council Canada - National Science Library

    Fitzpatrick, J. L; Evans, J. P

    2014-01-01

    .... Here, we examine the potential for paternity biases to favour unrelated males when their sperm compete for fertilizations though postcopulatory inbreeding avoidance mechanisms in the guppy, P oecilia reticulata...

  4. Vision-based obstacle avoidance

    Science.gov (United States)

    Galbraith, John

    2006-07-18

    A method for allowing a robot to avoid objects along a programmed path: first, a field of view for an electronic imager of the robot is established along a path where the electronic imager obtains the object location information within the field of view; second, a population coded control signal is then derived from the object location information and is transmitted to the robot; finally, the robot then responds to the control signal and avoids the detected object.

  5. Nutritional implications of patient-provider interactions in hospital settings: evidence from a within-subject assessment of mealtime exchanges and food intake in elderly patients.

    Science.gov (United States)

    Dubé, L; Paquet, C; Ma, Z; McKenzie, D St-Arnaud; Kergoat, M-J; Ferland, G

    2007-05-01

    To examine the nutritional implications of the interactions taking place between patients and care providers during mealtimes in hospital settings. Specifically, we tested research propositions that the amount and nature of interpersonal behaviours exchanged between patients and providers impact patients' food intake. These propositions were derived from prior evidence of social influences on eating behaviour and a well-established framework that identifies two fundamental modalities of human interaction: striving for mastery and power (agency) and efforts to promote union with others (communion). In a within-subject naturalistic study, participants were observed on multiple meals (n=1477, 46.2 meals/participant on average), during which participants' and providers' agency- and communion-related behaviours and patients' protein and energy intake were recorded. Meal-level frequency and complementarity of patients' and providers' behaviours were computed to test research propositions. Dining room of a geriatric rehabilitation unit. Thirty-two elderly patients (21 females, mean age:78.8, 95% CI: 76.4, 81.1). Meal-level frequency of patient-provider exchanges (P=0.016) and patients' agency-related behaviours (P=0.029), as well as mutual reciprocation of patients' and providers' communion-related behaviours (P=0.015) on a given meal were positively linked to protein intake. Higher energy intake was found during meals where patients expressed more agency-related behaviours (P=0.029). Results present evidence that the amount and nature of patient-provider interpersonal exchanges on a given meal influence the nutritional quality of food intake in hospitalized elderly. They provide insights into how to improve the design and delivery of routine care to this malnutrition-prone population. This study was supported by the Canadian Institutes of Health Research (Operating grant to Laurette Dubé, Doctoral Fellowship to Catherine Paquet) the Fonds de la Recherche en santé du Qu

  6. 住院患儿营养风险筛查的证据报告%Evidence Report of Nutritional Risk Screening of Hospitalized Children

    Institute of Scientific and Technical Information of China (English)

    张慧文; 顾莺

    2016-01-01

    Objective To explore the best evidence of nutritional risk screening of hospitalized children. Methods We conducted literature review in Cochrane Library, JBI library, Canadian Clinical Practice Guidelines Online, EBM reviews, Nursing consult, PubMed, Embase, Sinomed and CNKI for literatures on basic guideline, systematic reviews and diagnostic studies of nutritional risk screening of hospitalized children and the studies were critically appraised by two reviewers. Then the data of included studies were extracted. Results Seven studies were included with 1 study of basic guideline, 2 studies on systematic review and 4 diagnostic studies. It is supposed to conduct nutritional risk screening based on evidence requirement. With sensitivity of 80% and specificity of 49%, Screening Tool for Risk on Nutritional status and Growth, (STRONGkids) was suitable for screening children with high risk but The Paediatric Yorkhill Malnutrition Score (PYMS) was with low sensitivity when used in screening children with low risk. Conclusion With high sensitivity, STRONGkids is a suitable tool for screening nutritional risk of hospitalized children in clinic.%目的:评价总结住院患儿营养风险筛查最佳证据。方法计算机检索 Cochrane图书馆、JBI循证卫生保健国际合作中心图书馆、加拿大临床实践指南数据库、美国指南网、EBM reviews、Nursing consult、PubMed、Embase、中国生物医学文献数据库及中国知网内关于住院患儿营养风险筛查的所有指南、系统评价及诊断性研究。由2名研究者分别对文献质量进行评价和资料提取并对符合质量标准的文献进行证据提取。结果共纳入7篇文献,其中以专家共识为基础指南1篇,系统评价2篇和诊断性研究4篇。建议医疗机构根据证据要求对住院患儿进行营养风险筛查。营养状态和生长发育风险筛查工具更容易实施,其敏感度为80%,特异度为49%,且其筛选高风险

  7. Approach/avoidance in dreams.

    Science.gov (United States)

    Malcolm-Smith, Susan; Koopowitz, Sheri; Pantelis, Eleni; Solms, Mark

    2012-03-01

    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.

  8. Granting silence to avoid wireless collisions

    KAUST Repository

    Choi, Jung Il

    2010-10-01

    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.

  9. Motive to Avoid Success, Locus of Control, and Reinforcement Avoidance.

    Science.gov (United States)

    Katovsky, Walter

    Subjects were four groups of 12 college women, high or low in motive to avoid success (MAS) and locus of control (LC), were reinforced for response A on a fixed partial reinforcement schedule on three concept learning tasks, one task consisting of combined reward and punishment, another of reward only, and one of punishment only. Response B was…

  10. Benzodiazepines and amphetamine on avoidance behaviour in mice.

    Science.gov (United States)

    Sansone, M

    1975-11-01

    Six benzodiazepine derivatives, given alone or in combination with amphetamine, were tested in mice subjected to five 100-trial avoidance sessions in the shuttle-box. All derivatives, execpt bromazepam, showed some facilitating effects on avoidance responding when given alone. Facilitation was particularly evident following the administration of chlordiazepoxide (2.5 mg/kg), medazepam (10 mg/kg) and nitrazepam (0.25, 0.5 and 1 mg/kg). Favourable effects were obtained by combining each benzodiazepine compound with amphetamine. The levels of avoidance respinses were usually higher under benzodiazepine-amphetamine combinations than under benzodiazepines alone.

  11. Avoiding unfavourable outcomes in liposuction.

    Science.gov (United States)

    Khanna, Atul; Filobbos, George

    2013-05-01

    The origin of liposuction can be traced to an adverse event by Dujarrier in 1921 when he used a uterine curette to remove fat from the knees of a ballerina ending in an amputation secondary to damage of the femoral artery. The history of liposuction since then has been one of avoiding complications and optimising outcome. After this adverse event, liposuction was abandoned until the 1960's when Schrudde revived the practice using small stab incisions and sharp curettage with the secondary suction to aspirate the freed tissue. This technique was associated with a high incidence of complications especially seroma and skin necrosis. Illouz then replaced the curette with a blunt cannula connected to vacuum pump thus avoiding the complications of a sharp curette. Despite the presence of various techniques for liposuction, suction assisted liposuction (SAL) is still the standard technique of liposuction. This article aims to discuss literature regarding the various aspects of liposuction (SAL) and to highlight the salient points in the literature and in the senior author's experience in order to avoid unfavourable outcomes in liposuction. A literature review on avoiding complication is in liposuction including some of the seminal papers on liposuction. Liposuction is generally a safe procedure with reproducible outcome. Just like any surgical procedure it should be treated with the utmost care. Illouz published 10 commandments for liposuction in 1989 and we review these commandments to demonstrate how liposuction has evolved.

  12. Avoiding unfavourable outcomes in liposuction

    Directory of Open Access Journals (Sweden)

    Atul Khanna

    2013-01-01

    Full Text Available The origin of liposuction can be traced to an adverse event by Dujarrier in 1921 when he used a uterine curette to remove fat from the knees of a ballerina ending in an amputation secondary to damage of the femoral artery. The history of liposuction since then has been one of avoiding complications and optimising outcome. After this adverse event, liposuction was abandoned until the 1960′s when Schrudde revived the practice using small stab incisions and sharp curettage with the secondary suction to aspirate the freed tissue. This technique was associated with a high incidence of complications especially seroma and skin necrosis. Illouz then replaced the curette with a blunt cannula connected to vacuum pump thus avoiding the complications of a sharp curette. Despite the presence of various techniques for liposuction, suction assisted liposuction (SAL is still the standard technique of liposuction. This article aims to discuss literature regarding the various aspects of liposuction (SAL and to highlight the salient points in the literature and in the senior author′s experience in order to avoid unfavourable outcomes in liposuction. A literature review on avoiding complication is in liposuction including some of the seminal papers on liposuction. Liposuction is generally a safe procedure with reproducible outcome. Just like any surgical procedure it should be treated with the utmost care. Illouz published 10 commandments for liposuction in 1989 and we review these commandments to demonstrate how liposuction has evolved.

  13. Avoidance: grammatical or semantic causes?

    NARCIS (Netherlands)

    Hulstijn, J.H.; Marchena, E.

    1989-01-01

    This article follows up on a study by Dagut and Laufer (1985), who found that Hebrew learners of English avoid phrasal verbs, such as ‘let down’, while preferring one-word verbs, such as ‘;disappoint’, since phrasal verbs do not exist in Hebrew. A corollary derived from Dagut and Laufer's study is t

  14. Avoidance: grammatical or semantic causes?

    NARCIS (Netherlands)

    Hulstijn, J.H.; Marchena, E.

    1989-01-01

    This article follows up on a study by Dagut and Laufer (1985), who found that Hebrew learners of English avoid phrasal verbs, such as ‘let down’, while preferring one-word verbs, such as ‘;disappoint’, since phrasal verbs do not exist in Hebrew. A corollary derived from Dagut and Laufer's study is t

  15. Avoiding plagiarism in academic writing.

    Science.gov (United States)

    Anderson, Irene

    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.

  16. Rapid avoidance acquisition in Wistar-Kyoto rats.

    Science.gov (United States)

    Servatius, R J; Jiao, X; Beck, K D; Pang, K C H; Minor, T R

    2008-10-10

    The relationship between trait stress-sensitivity, avoidance acquisition and perseveration of avoidance was examined using male Wistar-Kyoto (WKY) and Sprague-Dawley (SD) rats. Behavior in an open field was measured prior to escape/avoidance (E/A) acquisition and extinction. E/A was assessed in a discrete trial lever-press protocol. The signal-shock interval was 60s with subsequent shocks delivered every 3s until a lever-press occurred. A 3-min flashing light safety signal was delivered contingent upon a lever-press (or failure to respond in 5 min). WKY rats displayed phenotypic low open field activity, but were clearly superior to SD rats in E/A performance. As avoidance responses were acquired and reached asymptotic performance, SD rats exhibited "warm up", that is, SD rats rarely made avoidance responses on the initial trial of a session, even though later trials were consistently accompanied with avoidance responses. In contrast, WKY rats did not show the "warm up" pattern and avoided on nearly all trials of a session including the initial trial. In addition to the superior acquisition of E/A, WKY rats demonstrated several other avoidance features that were different from SD rats. Although the rates of nonreinforced intertrial responses (ITRs) were relatively low and selective to the early safety period, WKY displayed more ITRs than SD rats. With removal of the shocks extinction was delayed in WKY rats, likely reflecting their nearly perfect avoidance performance. Even after extensive extinction, first trial avoidance and ITRs were evident in WKY rats. Thus, WKY rats have a unique combination of trait behavioral inhibition (low open field activity and stress sensitivity) and superior avoidance acquisition and response perseveration making this strain a good model to understand anxiety disorders.

  17. Is there an improvement of antibiotic use in China? Evidence from the usage analysis of combination antibiotic therapy for type I incisions in 244 hospitals.

    Science.gov (United States)

    Zhou, Wen-Juan; Luo, Zhen-Ni; Tang, Chang-Min; Zou, Xiao-Xu; Zhao, Lu; Fang, Peng-Qian

    2016-10-01

    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% (Pantibiotic therapy for type I incisions was also decreased. Region and bed size were the main determinants on surgical prophylaxis for type I incision. This national analysis of hospitals on antibiotic use and stewardship allows relevant comparisons for bench marking. More efforts addressing the root cause of antibiotics abuse would continue to improve the rational use of antibiotics in China.

  18. Evidence of a broken healthcare delivery system in korea: unnecessary hospital outpatient utilization among patients with a single chronic disease without complications.

    Science.gov (United States)

    Lee, Jin Yong; Jo, Min-Woo; Yoo, Weon-Seob; Kim, Hyun Joo; Eun, Sang Jun

    2014-12-01

    This study aims to estimate the volume of unnecessarily utilized hospital outpatient services in Korea and quantify the total cost resulting from the inappropriate utilization. The analysis included a sample of 27,320,505 outpatient claims from the 2009 National Inpatient Sample database. Using the Charlson Comorbidity Index (CCI), patients were considered to have received 'unnecessary hospital outpatient utilization' if they had a CCI score of 0 and were concurrently admitted to hospital for treatment of a single chronic disease - hypertension (HTN), diabetes mellitus (DM), or hyperlipidemia (HL) - without complication. Overall, 85% of patients received unnecessary hospital services. Also hospitals were taking away 18.7% of HTN patients, 18.6% of DM and 31.6% of HL from clinics. Healthcare expenditures from unnecessary hospital outpatient utilization were estimated at: HTN (94,058 thousands USD, 38.6% of total expenditure); DM (17,795 thousands USD, 40.6%) and HL (62,876 thousands USD, 49.1%). If 100% of patients who received unnecessary hospital outpatient services were redirected to clinics, the estimated savings would be 104,226 thousands USD. This research proves that approximately 85% of hospital outpatient utilizations are unnecessary and that a significant amount of money is wasted on unnecessary healthcare services; thus burdening the National Health Insurance Service (NHIS) and patients.

  19. Falls after Discharge from Hospital: Is There a Gap between Older Peoples' Knowledge about Falls Prevention Strategies and the Research Evidence?

    Science.gov (United States)

    Hill, Anne-Marie; Hoffmann, Tammy; Beer, Christopher; McPhail, Steven; Hill, Keith D.; Oliver, David; Brauer, Sandra G.; Haines, Terry P.

    2011-01-01

    Purpose: The aim of this study was to examine whether older people are prepared to engage in appropriate falls prevention strategies after discharge from hospital. Design and Methods: We used a semi-structured interview to survey older patients about to be discharged from hospital and examined their knowledge regarding falls prevention strategies…

  20. Environmental sustainability in hospitals - a systematic review and research agenda.

    Science.gov (United States)

    McGain, Forbes; Naylor, Chris

    2014-10-01

    Hospitals are significant contributors to natural resource depletion and environmental change. Our objective was to establish the extent to which hospital environmental sustainability has been studied and the key issues that emerge for policy, practice and research. The PubMed, Engineering Village, Cochrane and King's Fund databases were searched for articles relating to hospital environmental sustainability published in English between 1 January 1990 and 1 October 2013. Further studies were found by review of reference lists. One hundred ninety-three relevant articles were found and 76 were selected for inclusion in the review. Common research themes were identified: hospital design, direct energy consumption, water, procurement, waste, travel and psychology and behaviour. Some countries (particularly the United Kingdom) have begun to invest systematically in understanding the environmental effects of hospitals. We found large variability in the extent of the evidence base according to topic. Research regarding the architectural fabric of hospital buildings is at a relatively mature stage. Similarly, there is a developed research base regarding devices and technologies used within hospitals to reduce the environmental effects of direct hospital energy and water use. Less is known about the clinical, psychological and social factors that influence how health care professionals use resources, travel to/from hospital, and interact with the buildings and technologies available. A significant part of the environmental footprint of hospitals relates to clinical practice, e.g. decisions regarding the use of pharmaceuticals and medical devices. Medical 'cradle to grave' life cycle assessment studies have been published to understand the full financial and environmental costs of hospital activities. The effects of preventive or demand management measures which avoid unnecessary hospital procedures are likely to be much greater than incremental changes to how hospital

  1. FacilitiesHospitals_HOSPITAL

    Data.gov (United States)

    Vermont Center for Geographic Information — This data layer contains point locations of all major community, regional, comprehensive health, and healthcare provider hospitals in the state of Vermont. The...

  2. Hospitals; hospitals13

    Data.gov (United States)

    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....

  3. Obstacle Avoidance Through Visual Teleoperation

    Directory of Open Access Journals (Sweden)

    Muhammad Usman Keerio

    2009-01-01

    Full Text Available This paper presents a novel controlling approach forHumanoid Robot to work safely in critical situations like badlight environment using Visual Teleoperation. In this regardmodeling environments for Humanoid Teleoperation Systemis developed. Here virtual reality modeling environmentincludes development of virtual Humanoid BHR-2, andvirtual objects like table etc. The main goal of this work is toenhance our visual teleoperation system for BHR-2 in orderto avoid any collision during real time operation. SoftwareMaya is used for modeling and simulations. Maya plug-insin VC++ provides efficient modeling rule, real timeinteraction, and time saving rendering approach in a virtualenvironment. In this paper the validity of proposed scheme isshown by conducting experiments using offline step overtrajectory to avoid obstacle in bad light environment.

  4. Consumer Privacy and Marketing Avoidance

    OpenAIRE

    Il-Horn Hann; Kai-Lung Hui; Sang-Yong Tom Lee; Ivan Png

    2005-01-01

    We introduce consumer avoidance into analytical marketing research. We show that consumer efforts to conceal themselves and to deflect marketing have a crucial impact on sellers¡¯ marketing strategy. Under reasonable conditions, seller marketing is a strategic complement with consumer concealment. Hence, consumer measures to conceal themselves from marketing will increase its cost-effectiveness and lead sellers to market more. Policies that encourage consumers to conceal their identities woul...

  5. The Ethic of Hospitality

    OpenAIRE

    Christopher Muller

    2013-01-01

    The idea of hospitality is evident in several types of human behavior including obligatory duties, commercial activity, and prosocial action. These are intertwined and revolve around the commitment to caring for others whether they are relatives, guests, or strangers. This article explores the ethic of hospitality in its various forms.

  6. The Ethic of Hospitality

    Directory of Open Access Journals (Sweden)

    Christopher Muller

    2013-04-01

    Full Text Available The idea of hospitality is evident in several types of human behavior including obligatory duties, commercial activity, and prosocial action. These are intertwined and revolve around the commitment to caring for others whether they are relatives, guests, or strangers. This article explores the ethic of hospitality in its various forms.

  7. Education and smoking: were Vietnam war draft avoiders also more likely to avoid smoking?

    Science.gov (United States)

    Grimard, Franque; Parent, Daniel

    2007-09-01

    We use the Vietnam war draft avoidance behavior documented by Card and Lemieux [Card, D., Lemieux, T., May 2001. Did draft avoidance raise college attendance during the Vietnam war? American Economic Review 91 (2), 97-102] as a quasi experiment to infer causation from education to smoking and find strong evidence that education, whether measured in years of completed schooling or in educational attainment categories, reduces the probability of smoking at the time of the interview, more particularly the probability of smoking regularly. However, while we find that more education substantially increases the probability of never smoking, our instrumental procedure yields imprecise estimates of the effect of education on smoking cessation. Potential mechanisms linking education and smoking are also explored.

  8. Avoidable attendance at accident and emergency by the elderly in Hong Kong.

    OpenAIRE

    Lau, E M; Woo, J; Chan, J. T.

    1997-01-01

    Twenty per cent of Accident and Emergency department attendance by the elderly in a regional hospital in Hong Kong were deemed 'avoidable' by the attending doctors. The 'avoidable' attendants were younger and physically more independent than the appropriate attendants, and more of them were illiterate. Half of them attended the Accident and Emergency department for somatic complaints. Strategies to reduce these 'avoidable' attendances should be formulated.

  9. Nutrition support in hospitals

    DEFF Research Database (Denmark)

    Kondrup, Jens

    2005-01-01

    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....

  10. Potential Nematode Alarm Pheromone Induces Acute Avoidance in Caenorhabditis elegans.

    Science.gov (United States)

    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

    2017-07-01

    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.

  11. The national database of hospital-based cancer registries: a nationwide infrastructure to support evidence-based cancer care and cancer control policy in Japan.

    Science.gov (United States)

    Higashi, Takahiro; Nakamura, Fumiaki; Shibata, Akiko; Emori, Yoshiko; Nishimoto, Hiroshi

    2014-01-01

    Monitoring the current status of cancer care is essential for effective cancer control and high-quality cancer care. To address the information needs of patients and physicians in Japan, hospital-based cancer registries are operated in 397 hospitals designated as cancer care hospitals by the national government. These hospitals collect information on all cancer cases encountered in each hospital according to precisely defined coding rules. The Center for Cancer Control and Information Services at the National Cancer Center supports the management of the hospital-based cancer registry by providing training for tumor registrars and by developing and maintaining the standard software and continuing communication, which includes mailing lists, a customizable web site and site visits. Data from the cancer care hospitals are submitted annually to the Center, compiled, and distributed as the National Cancer Statistics Report. The report reveals the national profiles of patient characteristics, route to discovery, stage distribution, and first-course treatments of the five major cancers in Japan. A system designed to follow up on patient survival will soon be established. Findings from the analyses will reveal characteristics of designated cancer care hospitals nationwide and will show how characteristics of patients with cancer in Japan differ from those of patients with cancer in other countries. The database will provide an infrastructure for future clinical and health services research and will support quality measurement and improvement of cancer care. Researchers and policy-makers in Japan are encouraged to take advantage of this powerful tool to enhance cancer control and their clinical practice.

  12. Honey bees selectively avoid difficult choices.

    Science.gov (United States)

    Perry, Clint J; Barron, Andrew B

    2013-11-19

    Human decision-making strategies are strongly influenced by an awareness of certainty or uncertainty (a form of metacognition) to increase the chances of making a right choice. Humans seek more information and defer choosing when they realize they have insufficient information to make an accurate decision, but whether animals are aware of uncertainty is currently highly contentious. To explore this issue, we examined how honey bees (Apis mellifera) responded to a visual discrimination task that varied in difficulty between trials. Free-flying bees were rewarded for a correct choice, punished for an incorrect choice, or could avoid choosing by exiting the trial (opting out). Bees opted out more often on difficult trials, and opting out improved their proportion of successful trials. Bees could also transfer the concept of opting out to a novel task. Our data show that bees selectively avoid difficult tasks they lack the information to solve. This finding has been considered as evidence that nonhuman animals can assess the certainty of a predicted outcome, and bees' performance was comparable to that of primates in a similar paradigm. We discuss whether these behavioral results prove bees react to uncertainty or whether associative mechanisms can explain such findings. To better frame metacognition as an issue for neurobiological investigation, we propose a neurobiological hypothesis of uncertainty monitoring based on the known circuitry of the honey bee brain.

  13. How to Avoid Middle Income Traps : Evidence from Malaysia

    OpenAIRE

    Flaaen, Aaron; Ghani, Ejaz; Mishra, Saurabh

    2013-01-01

    Malaysia's structural transformation from low to middle income is a success story, making it one of the most prominent manufacturing exporters'in the world. However, like many other middle income economies, it is squeezed by the competition from low-wage economies on the one hand, and more innovative advanced economies on the other. What can Malaysia do? Does Malaysia need a new growth strategy? This paper emphasizes the need for broad structural transformation; that is, moving to higher prod...

  14. Learning to Avoid Risky Actions

    OpenAIRE

    Malfaz, María; Miguel A. Salichs

    2011-01-01

    When a reinforcement learning agent executes actions that can cause frequent damage to itself, it can learn, by using Q-learning, that these actions must not be executed again. However, there are other actions that do not cause damage frequently but only once in a while, for example, risky actions such as parachuting. These actions may imply punishment to the agent and, depending on its personality, it would be better to avoid them. Nevertheless, using the standard Q-learning algorithm, the a...

  15. Jam avoidance with autonomous systems

    CERN Document Server

    Tordeux, Antoine

    2016-01-01

    Many car-following models are developed for jam avoidance in highways. Two mechanisms are used to improve the stability: feedback control with autonomous models and increasing of the interaction within cooperative ones. In this paper, we compare the linear autonomous and collective optimal velocity (OV) models. We observe that the stability is significantly increased by adding predecessors in interaction with collective models. Yet autonomous and collective approaches are close when the speed difference term is taking into account. Within the linear OV models tested, the autonomous models including speed difference are sufficient to maximise the stability.

  16. An observational study: associations between nurse-reported hospital characteristics and estimated 30-day survival probabilities

    OpenAIRE

    Tvedt, Christine Raaen; Sjetne, Ingeborg Strømseng; Helgeland, Jon; Bukholm, Geir

    2014-01-01

    Background There is a growing body of evidence for associations between the work environment and patient outcomes. A good work environment may maximise healthcare workers’ efforts to avoid failures and to facilitate quality care that is focused on patient safety. Several studies use nurse-reported quality measures, but it is uncertain whether these outcomes are correlated with clinical outcomes. The aim of this study was to determine the correlations between hospital-aggregated, nurse-assesse...

  17. Secondary Physical Education Avoidance and Gender: Problems and Antidotes

    Science.gov (United States)

    Ryan, Thomas; Poirier, Yves

    2012-01-01

    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…

  18. Hospital Compare

    Data.gov (United States)

    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...

  19. HCAHPS - Hospital

    Data.gov (United States)

    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...

  20. Norovirus - hospital

    Science.gov (United States)

    Gastroenteritis - norovirus; Colitis - norovirus; Hospital acquired infection - norovirus ... fluids ( dehydration ). Anyone can become infected with norovirus. Hospital patients who are very old, very young, or ...

  1. Autonomous hazard detection and avoidance

    Science.gov (United States)

    Pien, Homer

    1992-01-01

    During GFY 91, Draper Laboratory was awarded a task by NASA-JSC under contract number NAS9-18426 to study and evaluate the potential for achieving safe autonomous landings on Mars using an on-board autonomous hazard detection and avoidance (AHDA) system. This report describes the results of that study. The AHDA task had four objectives: to demonstrate, via a closed-loop simulation, the ability to autonomously select safe landing sites and the ability to maneuver to the selected site; to identify key issues in the development of AHDA systems; to produce strawman designs for AHDA sensors and algorithms; and to perform initial trade studies leading to better understanding of the effect of sensor/terrain/viewing parameters on AHDA algorithm performance. This report summarizes the progress made during the first year, with primary emphasis on describing the tools developed for simulating a closed-loop AHDA landing. Some cursory performance evaluation results are also presented.

  2. The Effects of Temporary Services and Contracting Out on Low-Skilled Workers: Evidence from Auto Suppliers, Hospitals, and Public Schools. Staff Working Paper.

    Science.gov (United States)

    Erickcek, George; Houseman, Susan; Kalleberg, Arne

    A study examined why employers use temporary agency and contract company workers and implications of these practices for wages, benefits, and working conditions of workers in low-skilled labor markets. Case studies in manufacturing (automotive supply), services (hospitals), and public sector (primary and secondary schools) industries defined the…

  3. The Effects of Temporary Services and Contracting Out on Low-Skilled Workers: Evidence from Auto Suppliers, Hospitals, and Public Schools. Staff Working Paper.

    Science.gov (United States)

    Erickcek, George; Houseman, Susan; Kalleberg, Arne

    A study examined why employers use temporary agency and contract company workers and implications of these practices for wages, benefits, and working conditions of workers in low-skilled labor markets. Case studies in manufacturing (automotive supply), services (hospitals), and public sector (primary and secondary schools) industries defined the…

  4. How Do Patients Perceive and Expect Quality of Surgery, Diagnostics, and Emergency Services in Tertiary Care Hospitals? An Evidence of Gap Analysis From Pakistan

    Science.gov (United States)

    Fatima, Iram; Humayun, Ayesha; Anwar, Muhammad Imran; Iftikhar, Adil; Aslam, Muhammad; Shafiq, Muhammad

    2017-01-01

    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 quality were independent of sex. Educational status showed significant difference in expectation and perception in responsiveness (p service quality: p 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 quality assurance policy. PMID:28804582

  5. Seasonality in hospital admissions of Crimean-Congo hemorrhagic fever and its dependence on ambient temperature—empirical evidence from Pakistan

    Science.gov (United States)

    Abbas, Tariq; Xu, Zhiwei; Younus, Muhammad; Qayyum, Abdul; Riaz, Muhammad T.

    2017-04-01

    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.

  6. How Do Patients Perceive and Expect Quality of Surgery, Diagnostics, and Emergency Services in Tertiary Care Hospitals? An Evidence of Gap Analysis From Pakistan

    Directory of Open Access Journals (Sweden)

    Iram Fatima

    2017-07-01

    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

  7. Environmental triggers and avoidance in the management of asthma

    Science.gov (United States)

    Gautier, Clarisse; Charpin, Denis

    2017-01-01

    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 hospitalizations. Since avoidance is not easy to achieve, clean air policies remain the most effective strategy. Indoor air is also affected by air pollutants, such as cigarette smoke and

  8. Evidence and evidence gaps – an introduction

    Science.gov (United States)

    Dreier, Gabriele; Löhler, Jan

    2016-01-01

    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

  9. The application of hospitality elements in hospitals.

    Science.gov (United States)

    Wu, Ziqi; Robson, Stephani; Hollis, Brooke

    2013-01-01

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

  10. Out-of-Pocket and Informal Payment Before and After the Health Transformation Plan in Iran: Evidence from Hospitals Located in Kurdistan, Iran.

    Science.gov (United States)

    Piroozi, Bakhtiar; Rashidian, Arash; Moradi, Ghobad; Takian, Amirhossein; Ghasri, Hooman; Ghadimi, Tayyeb

    2017-02-11

    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 (PHTP, and 0.0%, 7.1%, and 10.0% after the first phase. Contrary to the time before the HTP, no informal payment was reported after the third phase. It seems that the implementation of the HTP has reduced the OOP payments for inpatient services and eradicated informal payments to physician in

  11. The effectiveness of mindfulness based programs in reducing stress experienced by nurses in adult hospital settings: a systematic review of quantitative evidence protocol.

    Science.gov (United States)

    Botha, Elmarie; Gwin, Teri; Purpora, Christina

    2015-10-01

    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

  12. Allergen avoidance: does it work?

    Science.gov (United States)

    Woodcock, A; Custovic, A

    2000-01-01

    The first recorded example of allergen avoidance in the treatment of allergic disorders dates from the 16th century. The Italian physician Gerolamo Cardano (1501-1576) was invited to Scotland by John Hamilton, Archbishop of St Andrews (and brother of the Regent), to give advice on the treatment of his asthma. Cardano recommended that the Archbishop should get rid of his feather bedding, which was followed by a 'miraculous' remission of otherwise troublesome symptoms. The first controlled attempts to treat asthma by environmental manipulation date to the beginning of 20th century. In 1925, the Leopold brothers treated patients with asthma and other allergic disorders by moving them into a dust free room. Storm van Leeuwen created a 'climate' chamber in The Netherlands in 1927 and demonstrated that asthmatic patients improved when moved from their homes into the chamber. One year later, Dekker observed that measures aimed at reducing the amount of dust in bedrooms had a beneficial effect on asthma symptoms in patients allergic to house dust. Van Leeuwen wrote: 'In our endeavours to find the cause of the attack ... we utilised the known fact that the environment of the asthmatic patient is, as a rule, of primary importance in determining the intensity and frequency of his attacks'. Nowadays, more than ever, it is essential to address the environmental influences on the increasing prevalence of asthma and allergic disorders.

  13. Obstacle avoidance sonar for submarines

    Science.gov (United States)

    Dugas, Albert C.; Webman, Kenneth M.

    2002-05-01

    The Advanced Mine Detection Sonar (AMDS) system was designed to operate in poor environments with high biological and/or shallow-water boundary conditions. It provides increased capability for active detection of volume, close-tethered, and bottom mines, as well as submarine and surface target active/passive detection for ASW and collision avoidance. It also provides bottom topography mapping capability for precise submarine navigation in uncharted littoral waters. It accomplishes this by using advanced processing techniques with extremely narrow beamwidths. The receive array consists of 36 modules arranged in a 15-ft-diameter semicircle at the bottom of the submarine sonar dome to form a chin-mounted array. Each module consists of 40 piezoelectric rubber elements. The modules provide the necessary signal conditioning to the element data prior to signal transmission (uplink) through the hull. The elements are amplified, filtered, converted to digital signals by an A/D converter, and multiplexed prior to uplink to the inboard receiver. Each module also has a downlink over which it receives synchronization and mode/gain control. Uplink and downlink transmission is done using fiberoptic telemetry. AMDS was installed on the USS Asheville. The high-frequency chin array for Virginia class submarines is based on the Asheville design.

  14. Is Walk Score associated with hospital admissions from chronic diseases? Evidence from a cross-sectional study in a high socioeconomic status Australian city-state.

    Science.gov (United States)

    Mazumdar, Soumya; Learnihan, Vincent; Cochrane, Thomas; Phung, Hai; O'Connor, Bridget; Davey, Rachel

    2016-12-08

    To explore patterns of non-communicable diseases (NCDs) in the Australian Capital Territory (ACT).To ascertain the effect of the neighbourhood built environmental features and especially walkability on health outcomes, specifically for hospital admissions from NCDs. A cross-sectional analysis of public hospital episode data (2007-2013). Hospitalisations from the ACT, Australia at very small geographic areas. Secondary data on 75 290 unique hospital episodes representing 39 851 patients who were admitted to ACT hospitals from 2007 to 2013. No restrictions on age, sex or ethnicity. Geographic Information System derived or compatible measures of general practitioner access, neighbourhood socioeconomic status, alcohol access, exposure to traffic and Walk Score walkability. Hospitalisations of circulatory diseases, specific endocrine, nutritional and metabolic diseases, respiratory diseases and specific cancers. Geographic clusters with significant high and low risks of NCDs were found that displayed an overall geographic pattern of high risk in the outlying suburbs of the territory. Significant relationships between neighbourhood walkability as measured by Walk Score and the likelihood of hospitalisation with a primary diagnosis of myocardial infarction (heart attack) were found. A possible relationship was also found with the likelihood of being hospitalised with 4 major lifestyle-related cancers. Our research augments the growing literature underscoring the relationships between the built environment and health outcomes. In addition, it supports the importance of walkable neighbourhoods, as measured by Walk Score, for improved health. 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/.

  15. Environmental triggers and avoidance in the management of asthma

    Directory of Open Access Journals (Sweden)

    Gautier C

    2017-03-01

    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

  16. What is the empirical evidence that hospitals with higher-risk adjusted mortality rates provide poorer quality care? A systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Mohammed Mohammed A

    2007-06-01

    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.

  17. From Evidence to Clinical Practice: Positive Effect of Implementing a Protein-Enriched Hospital Menu in Conjunction With Individualized Dietary Counseling.

    Science.gov (United States)

    Munk, Tina; Bruun, Nina; Nielsen, Michael A; Thomsen, Thordis

    2017-06-01

    The aim of this study was to investigate if a protein-enriched menu in conjunction with individualized dietary counseling would increase energy and protein intake in hospitalized patients at nutrition risk compared with providing the protein-enriched menu as a stand-alone intervention. Data from medical and surgical hospitalized patients were prospectively collected and compared with a historical intervention group (HIG). Primary outcome was the number of patients achieving >75% of energy and protein requirements. Secondary outcomes included mean energy and protein intake (adjusted for body weight [ABW]), readmission rate, and the number of patients with a baseline intake 75% of energy requirements ( P = .04); 90% in the IG vs 66% in the HIG reached >75% of protein requirements ( p = ABW, 31 kcal kg(-1) vs 25 kcal kg(-1) ( P < .01) and 1.2 g protein kg(-1) vs 0.9 g protein kg(-1) ( P < .001). More than 85% of the patients with a baseline <50% of the EP requirement achieved ≥75% of the energy and protein requirement. No difference between readmission rates was found. Providing a protein-enriched menu in conjunction with individualized dietary counseling significantly increased protein and energy intake in hospitalized patients at nutrition risk.

  18. Inbreeding avoidance through non-random mating in sticklebacks.

    Science.gov (United States)

    Frommen, Joachim G; Bakker, Theo C M

    2006-06-22

    Negative effects of inbreeding are well documented in a wide range of animal taxa. Hatching success and survival of inbred offspring is reduced in many species and inbred progeny are often less attractive to potential mates. Thus, individuals should avoid mating with close kin. However, experimental evidence for inbreeding avoidance through non-random mating in vertebrates is scarce. Here, we show that gravid female three-spined sticklebacks (Gasterosteus aculeatus) when given the choice between a courting familiar brother and a courting unfamiliar non-sib prefer to mate with the non-sib and thus avoid the disadvantages of incest. We controlled for differences in males' body size and red intensity of nuptial coloration. Thus, females adjust their courting behaviour to the risk of inbreeding.

  19. Avoidance processes mediate the relationship between rumination and symptoms of complicated grief and depression following loss.

    Science.gov (United States)

    Eisma, Maarten C; Stroebe, Margaret S; Schut, Henk A W; Stroebe, Wolfgang; Boelen, Paul A; van den Bout, Jan

    2013-11-01

    Ruminative coping has been associated with negative outcomes in bereavement. Rather than assuming it to be a problematic confrontation process, researchers have recently suggested rumination to be maladaptive through its links with avoidance processes. The main aim of this study was to examine, for the first time, whether the relationship between ruminative coping and symptoms of complicated grief and depression is mediated by avoidance processes (suppression, memory/experiential avoidance, behavioral avoidance, loss-reality avoidance). A sample of 282 adults (88% female, 12% male), bereaved on average 18 months previously, filled out three questionnaires at 6-month intervals. We assessed symptom levels, grief rumination, and trait rumination at baseline; avoidance processes after 6 months; and symptom levels after 12 months. When controlling for initial symptom levels, experiential avoidance mediated the link between grief rumination and complicated grief, and experiential avoidance and behavioral avoidance mediated the link between grief rumination and depression. Post hoc analyses showed suppression may also mediate the link between grief rumination and symptoms of complicated grief, but not depression. Loss-reality avoidance was no significant mediator of these relationships. This study provides initial evidence that rumination during bereavement increases and perpetuates symptoms of psychopathology, because it is linked with specific avoidance processes. Bereaved individuals with problematic grief and (chronic) rumination may benefit from therapy focused on countering avoidance tendencies.

  20. Influence of socioeconomic factors on hospital readmissions for heart failure and acute myocardial infarction in patients 65 years and older: evidence from a systematic review

    Directory of Open Access Journals (Sweden)

    Damiani G

    2015-01-01

    Full Text Available Gianfranco Damiani,1 Eleonora Salvatori,1 Giulia Silvestrini,1 Ivana Ivanova,2 Luka Bojovic,3 Lanfranco Iodice,1 Walter Ricciardi1 1Department of Public Health, Università Cattolica Sacro Cuore, Rome, Italy; 2ERAWEB Project, Faculty of Medicine, Saints Cyril and Methodius University of Skopje, Skopje, Macedonia; 3ERAWEB Project, Faculty of Medicine, University of Nis, Nis, Serbia Purpose: Cardiovascular diseases are the leading cause of death and disability worldwide. Among these diseases, heart failure (HF and acute myocardial infarction (AMI are the most common causes of hospitalization. Therefore, readmission for HF and AMI is receiving increasing attention. Several socioeconomic factors could affect readmissions in this target group, and thus, a systematic review was conducted to identify the effect of socioeconomic factors on the risk for readmission in people aged 65 years and older with HF or AMI.Methods: The search was carried out by querying an electronic database and hand searching. Studies with an association between the risk for readmission and at least one socioeconomic factor in patients aged 65 years or older who are affected by HF or AMI were included. A quality assessment was conducted independently by two reviewers. The agreement was quantified by Cohen’s Kappa statistic. The outcomes of studies were categorized in the short-term and the long-term, according to the follow-up period of readmission. A positive association was reported if an increase in the risk for readmission among disadvantaged patients was found. A cumulative effect of socioeconomic factors was computed by considering the association for each study and the number of available studies.Results: A total of eleven articles were included in the review. They were mainly published in the United States. All the articles analyzed patients who were hospitalized for HF, and four of them also analyzed patients with AMI. Seven studies (63.6% were found for the short

  1. Avoidance of activity and disability in patients with osteoarthritis of the knee - The mediating role of muscle strength

    NARCIS (Netherlands)

    Steultjens, MPM; Dekker, J; Bijlsma, JWJ

    2002-01-01

    Objective. Avoidance of activity is hypothesized to lead to muscle weakness and consequently, to physical disability. This study was undertaken to validate the avoidance model by providing evidence for the mediating role of muscle weakness in the relationship between avoidance of activity and physic

  2. Avoidance of activity and disability in patients with osteoarthritis of the knee: the mediating role of muscle strength.

    NARCIS (Netherlands)

    Steultjens, M.P.M.; Dekker, J.; Bijlsma, J.W.J.

    2002-01-01

    OBJECTIVE: Avoidance of activity is hypothesized to lead to muscle weakness and consequently, to physical disability. This study was undertaken to validate the avoidance model by providing evidence for the mediating role of muscle weakness in the relationship between avoidance of activity and physic

  3. The amygdala: securing pleasure and avoiding pain

    Directory of Open Access Journals (Sweden)

    Anushka B P Fernando

    2013-12-01

    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.

  4. The amygdala: securing pleasure and avoiding pain

    Science.gov (United States)

    Fernando, Anushka B. P.; Murray, Jennifer E.; Milton, Amy L.

    2013-01-01

    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. PMID:24367307

  5. Success of commonly used operating room management tools in reducing tardiness of first case of the day starts: evidence from German hospitals.

    Science.gov (United States)

    Ernst, Christian; Szczesny, Andrea; Soderstrom, Naomi; Siegmund, Frank; Schleppers, Alexander

    2012-09-01

    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 tardiness of first 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.

  6. hospital's perspective

    African Journals Online (AJOL)

    Cost effectiveness of autologous blood transfusion - A developing country hospital's ... 4Military Hospital, Lagos. Summary. An autologous blood donation program was set up at. National .... risk of infection for autologous patients was 5.06.

  7. 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

    Directory of Open Access Journals (Sweden)

    Shau Wen-Yi

    2012-02-01

    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.

  8. Hospitals, providers collaborate on transitions.

    Science.gov (United States)

    2012-01-01

    Baystate Health, a three-hospital system with headquarters in Springfield, MA, is partnering with post-acute providers to improve transitions as patients move through the continuum of care. A multidisciplinary post-acute performance team partnered with post-acute providers to determine why patients are readmitted to the hospital and to work on ways to avoid readmissions. Facilities share information with the hospitals how they operate and what they need to ensure patients receive the care they need. The health system's director of post-acute services holds regular meetings with providers to brainstorm on improving patient care.

  9. Detection And Avoidance Of Obstacles By Helicopters

    Science.gov (United States)

    Cheng, Victor H. L.; Sridhar, Banavar

    1992-01-01

    Report discusses problems relevant to control subsystems enabling helicopters on nap-of-the-Earth flight paths to detect and avoid obstacles automatically. Indicates similarities between this and obstacle-avoidance problem of industrial mobile robots. Two approaches extend two-dimensional obstacle-avoidance concept to three dimensions. First involves direct search of three-dimensional range-map data for indications of openings between obstacles. Second involves compression of data into two-dimensional map for path search.

  10. Mobile Robot Collision Avoidance in Human Environments

    OpenAIRE

    Lingqi Zeng; Gary M. Bone

    2013-01-01

    Collision avoidance is a fundamental requirement for mobile robots. Avoiding moving obstacles (also termed dynamic obstacles) with unpredictable direction changes, such as humans, is more challenging than avoiding moving obstacles whose motion can be predicted. Precise information on the future moving directions of humans is unobtainable for use in navigation algorithms. Furthermore, humans should be able to pursue their activities unhindered and without worrying about the robots around them....

  11. Insurance status of patients admitted to specialty cardiac and competing general hospitals: are accusations of cherry picking justified?

    Science.gov (United States)

    Cram, Peter; Pham, Hoangmai H; Bayman, Levent; Vaughan-Sarrazin, Mary S

    2008-05-01

    There has been widespread concern that procedurally oriented specialty hospitals select well-insured patients for admission, while avoiding the underinsured, but data are limited. To determine if specialty cardiac hospitals admit a higher proportion of well-insured patients than general hospitals and/or preferentially transfer patients with less generous insurance to other acute care hospitals. A retrospective study of patients admitted to specialty cardiac and general hospitals with acute myocardial infarction (AMI; N = 41,863), congestive heart failure (CHF; N = 51,696), percutaneous coronary intervention (PCI; N = 73,966), and coronary artery bypass grafting (CABG; N = 33,327) using 2000-2004 all-payor data from Arizona, California, and Texas. Proportion of all admissions in specialty and general hospitals with more generous insurance (Medicare or private insurance), interhospital transfer patterns of patients with less generous insurance by specialty and general hospitals. Specialty hospitals admitted a higher proportion of patients with more generous insurance for both the medical cohort (AMI and CHF) (92.4% vs. 89.0%; P hospital, odds of admission to specialty hospitals were significantly higher for patients with more generous insurance compared to patients with less generous insurance for the medical cohort [odds ratio (OR), 1.16; 95% confidence interval (CI), 1.07-1.27; P hospitals were more or less likely to transfer patients with more or less generous insurance to another hospital. The analysis was limited to 3 states and we were unable to track the care of patients after transfer. Patients with more generous insurance are significantly more likely to gain admission to specialty hospitals. Alternatively, we found no evidence that specialty hospitals preferentially transfer patients with less generous insurance who are admitted. Overall, these findings suggest that specialty hospitals may contribute to segregation of the healthcare system along

  12. Antihypertensive medications and risk of death and hospitalizations in US hemodialysis patients: Evidence from a cohort study to inform hypertension treatment practices.

    Science.gov (United States)

    Shafi, Tariq; Sozio, Stephen M; Luly, Jason; Bandeen-Roche, Karen J; St Peter, Wendy L; Ephraim, Patti L; McDermott, Aidan; Herzog, Charles A; Crews, Deidra C; Scialla, Julia J; Tangri, Navdeep; Miskulin, Dana C; Michels, Wieneke M; Jaar, Bernard G; Zager, Philip G; Meyer, Klemens B; Wu, Albert W; Boulware, L Ebony

    2017-02-01

    Antihypertensive medications are commonly prescribed to hemodialysis patients but the optimal regimens to prevent morbidity and mortality are unknown. The goal of our study was to compare the association of routinely prescribed antihypertensive regimens with outcomes in US hemodialysis patients.We used 2 datasets for our analysis. Our primary cohort (US Renal Data System [USRDS]) included adult patients initiating in-center hemodialysis from July 1, 2006 to June 30, 2008 (n = 33,005) with follow-up through December 31, 2009. Our secondary cohort included adult patients from Dialysis Clinic, Inc. (DCI), a national not-for-profit dialysis provider, initiating in-center hemodialysis from January 1, 2003 to June 30, 2008 (n = 11,291) with follow-up through December 31, 2008. We linked the USRDS cohort with Medicare part D prescriptions-fill data and the DCI cohort with USRDS data. Unique aspect of USRDS cohort was pharmacy prescription-fill data and for DCI cohort was detailed clinical data, including blood pressure, weight, and ultrafiltration. We classified prescribed antihypertensives into the following mutually exclusive regimens: β-blockers, renin-angiotensin system blocking drugs-containing regimens without a β-blocker (RAS), β-blocker + RAS, and others. We used marginal structural models accounting for time-updated comorbidities to quantify each regimen's association with mortality (both cohorts) and cardiovascular hospitalization (DCI-Medicare Subcohort).In the USRDS and DCI cohorts there were 9655 (29%) and 3200 (28%) deaths, respectively. In both cohorts, RAS compared to β-blockers regimens were associated with lower risk of death; (hazard ratio [HR]) (95% confidence interval [CI]) for all-cause mortality, (0.90 [0.82-0.97] in USRDS and 0.87 [0.76-0.98] in DCI) and cardiovascular mortality (0.84 [0.75-0.95] in USRDS and 0.88 [0.71-1.07] in DCI). There was no association between antihypertensive regimens and the risk of cardiovascular

  13. Hospitality within hospital meals –

    DEFF Research Database (Denmark)

    Justesen, Lise; Gyimóthy, Szilvia; Mikkelsen, Bent Egberg

    2016-01-01

    Hospital meals and their role in nutritional care have been studied primarily from a life and natural science perspective. This article takes a different approach and explores the idea of hospitality inspired by Jacques Derrida’s work on the ontology of hospitality. By drawing on ethnographic...... fieldwork in a Danish hospital, hospitality practices were studied using a socio-material assemblage approach. The study showed that rethinking the meal event could change the wards into temporary “pop-up-restaurants,” transcending the hospital context and providing a scene for shifting host...... and management involved in hospital food service and in nutritional care to work more systematically with the environment for improved hospital meal experiences in the future...

  14. Early discharge hospital at home.

    Science.gov (United States)

    Gonçalves-Bradley, Daniela C; Iliffe, Steve; Doll, Helen A; Broad, Joanna; Gladman, John; Langhorne, Peter; Richards, Suzanne H; Shepperd, Sasha

    2017-06-26

    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

  15. Avoidable deaths in Greenland 1968-1985

    DEFF Research Database (Denmark)

    Bjerregaard, Peter; Juel, K

    1990-01-01

    The concept of avoidable deaths suggests that certain deaths ought not occur in a given society because it is possible to prevent or treat the disease or condition. A list of avoidable deaths is time and community specific as it reflects the socioeconomic conditions, professional medical capacity...

  16. 47 CFR 74.604 - Interference avoidance.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 4 2010-10-01 2010-10-01 false Interference avoidance. 74.604 Section 74.604 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES EXPERIMENTAL RADIO... Stations § 74.604 Interference avoidance. (a) (b) Where two or more licensees are assigned a common...

  17. Human Hippocampus Arbitrates Approach-Avoidance Conflict

    Science.gov (United States)

    Bach, Dominik R.; Guitart-Masip, Marc; Packard, Pau A.; Miró, Júlia; Falip, Mercè; Fuentemilla, Lluís; Dolan, Raymond J.

    2014-01-01

    Summary Animal models of human anxiety often invoke a conflict between approach and avoidance [1, 2]. In these, a key behavioral assay comprises passive avoidance of potential threat and inhibition, both thought to be controlled by ventral hippocampus [2–6]. Efforts to translate these approaches to clinical contexts [7, 8] are hampered by the fact that it is not known whether humans manifest analogous approach-avoidance dispositions and, if so, whether they share a homologous neurobiological substrate [9]. Here, we developed a paradigm to investigate the role of human hippocampus in arbitrating an approach-avoidance conflict under varying levels of potential threat. Across four experiments, subjects showed analogous behavior by adapting both passive avoidance behavior and behavioral inhibition to threat level. Using functional magnetic resonance imaging (fMRI), we observe that threat level engages the anterior hippocampus, the human homolog of rodent ventral hippocampus [10]. Testing patients with selective hippocampal lesions, we demonstrate a causal role for the hippocampus with patients showing reduced passive avoidance behavior and inhibition across all threat levels. Our data provide the first human assay for approach-avoidance conflict akin to that of animal anxiety models. The findings bridge rodent and human research on passive avoidance and behavioral inhibition and furnish a framework for addressing the neuronal underpinnings of human anxiety disorders, where our data indicate a major role for the hippocampus. PMID:24560572

  18. Association of ozone and particulate air pollution with out-of-hospital cardiac arrest in Helsinki, Finland: evidence for two different etiologies.

    Science.gov (United States)

    Rosenthal, Frank S; Kuisma, Markku; Lanki, Timo; Hussein, Tareq; Boyd, James; Halonen, Jaana I; Pekkanen, Juha

    2013-01-01

    Out-of-hospital cardiac arrest (OHCA) has been previously associated with exposure to particulate air pollution. However, there is uncertainty about the agents and mechanisms that are involved. We aimed to determine the association of gases and particulates with OHCA, and differences in pollutant effects on OHCAs due to acute myocardial infarction (AMI) vs those due to other causes. Helsinki Emergency Medical Services provided data on OHCAs of cardiac origin (OHCA_Cardiac). Hospital and autopsy reports determined whether OHCAs were due to AMI (OHCA_MI) or other cardiac causes (OHCA_Other). Pollutant data was obtained from central ambient monitors. A case-crossover analysis determined odds ratios (ORs) for hourly lagged exposures (Lag 0-3) and daily lagged exposures (Lag 0d-3d), expressed per interquartile range of pollutant level. For OHCA_Cardiac, elevated ORs were found for PM(2.5) (Lag 0, 1.07; 95% confidence interval (CI): 1.01-1.13) and ozone (O(3)) (Lag 2d, 1.18; CI: 1.03-1.35). For OHCA_MI, elevated ORs were found for PM(2.5) (Lag 0, 1.14; CI: 1.03-1.27; Lag 0d, 1.17; CI: 1.03-1.33), accumulation mode particulate (Acc) (Lag 0d, 1.19; CI: 1.04-1.35), NO (Lag 0d, 1.07; CI: 1.01-1.13), and ultrafine particulate (Lag 0d, 1.27; CI: 1.05-1.54). For OHCA_Other, elevated ORs were found only for O(3) (Lag 1d, 1.26; CI: 1.07-1.48; Lag 2d, 1.30; CI: 1.11-1.53). Results from two-pollutant models, with one of the pollutants either PM(2.5) or O(3), suggested that associations were primarily due to effects of PM(2.5) and O(3), rather than other pollutants. The results suggest that air pollution triggers OHCA via two distinct modes: one associated with particulates leading to AMI and one associated with O(3) involving etiologies other than AMI, for example, arrhythmias or respiratory insufficiency.

  19. Management of HIV-related stigma and adherence to HAART: evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA 2003).

    Science.gov (United States)

    Peretti-Watel, P; Spire, B; Pierret, J; Lert, F; Obadia, Y

    2006-04-01

    This study investigated patterns of HIV disclosure to significant others (parents, siblings, children, other relatives, friends and colleagues) and describe them in terms of socio-demographic background and other characteristics, including experiences of AIDS-related discrimination. It also assessed the relationship between disclosure patterns and adherence to HAART. We used a cross-sectional survey conducted among a national representative sample of 2,932 HIV-infected people recruited in French hospitals. HIV disclosure patterns were both selective and cumulative: disclosure was more frequent for friends and siblings, while concealment prevailed concerning children, other relatives, and colleagues; but patients who disclosed their seropositivity to one significant other were also more likely to disclose it to other significant others. Patients reporting experiences of discrimination from sexual partners were less likely to be highly adherent, and we also found a significant relationship between uncontrolled disclosure and non-adherence. Patients who have opted for concealment probably consider non-adherence and uncontrolled disclosure as competing risks, but among them a significant minority loses on both counts. Counselling provided to HIV-infected people should not separate the adherence and disclosure issues, and adherence interventions should seek to help patients to manage concurrently disclosure/concealment of their seropositivity and its consequences.

  20. Hepatitis C as a risk factor for diabetes type 2: lack of evidence in a hospital in central-west Brazil

    Directory of Open Access Journals (Sweden)

    Luce Marina Freires Corrêa da Costa

    2008-02-01

    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.

  1. Getting evidence-based pressure ulcer prevention into practice: a multi-faceted unit-tailored intervention in a hospital setting.

    Science.gov (United States)

    Sving, Eva; Högman, Marieann; Mamhidir, Anna-Greta; Gunningberg, Lena

    2016-10-01

    The aim of the study was to evaluate whether a multi-faceted, unit-tailored intervention using evidenced-based pressure ulcer prevention affects (i) the performance of pressure ulcer prevention, (ii) the prevalence of pressure ulcers and (iii) knowledge and attitudes concerning pressure ulcer prevention among registered and assistant nurses. A quasi-experimental, clustered pre- and post-test design was used. Five units at a hospital setting were included. The intervention was based on the PARIHS framework and included a multi-professional team, training and repeated quality measurements. An established methodology was used to evaluate the prevalence and prevention of pressure ulcers. Nurses' knowledge and attitudes were evaluated using a validated questionnaire. A total of 506 patients were included, of whom 105 patients had a risk to develop pressure ulcer. More patients were provided pressure ulcer prevention care (P = 0·001) and more prevention care was given to each patient (P = 0·021) after the intervention. Corresponding results were shown in the group of patients assessed as being at risk for developing pressure ulcers. Nurses' knowledge about pressure ulcer prevention increased (P pressure ulcer prevention remained high between pre- and post-test surveys. This multi-faceted unit-tailored intervention affected pressure ulcer prevention. Facilitation and repeated quality measurement together with constructed feedback of results seemed to be the most important factor for pressure ulcer prevention.

  2. Speech intelligibility in hospitals.

    Science.gov (United States)

    Ryherd, Erica E; Moeller, Michael; Hsu, Timothy

    2013-07-01

    Effective communication between staff members is key to patient safety in hospitals. A variety of patient care activities including admittance, evaluation, and treatment rely on oral communication. Surprisingly, published information on speech intelligibility in hospitals is extremely limited. In this study, speech intelligibility measurements and occupant evaluations were conducted in 20 units of five different U.S. hospitals. A variety of unit types and locations were studied. Results show that overall, no unit had "good" intelligibility based on the speech intelligibility index (SII > 0.75) and several locations found to have "poor" intelligibility (SII speech intelligibility across a variety of hospitals and unit types, offers some evidence of the positive impact of absorption on intelligibility, and identifies areas for future research.

  3. Hospitality Industry

    Directory of Open Access Journals (Sweden)

    Marian Ionel

    2017-03-01

    Full Text Available Development of accommodation, as basic services offered to tourists, led to the creation of a genuine hospitality industry. Currently, the hospitality industry is no longer just the accommodation service itself but also requires an atmosphere that ensures leisure tourists in the hotel. Thus, hospitable unit manager offers its service in addition to accommodation and catering services, leisure services, treatment services, business services required.. The existence of factors such as revenue growth, increasing leisure time, the development of transport services, the emergence of new tourist attractions have caused increasing international flows of tourists, with consequent development of units hospitable, and therefore a strong hospitality industry. In Romania, after 1990, the tourism sector experienced a true expansion, both through the development of the hotel sector, but also by developing rural hospitality units.

  4. Neural Correlates of Attentional Flexibility during Approach and Avoidance Motivation

    Science.gov (United States)

    Calcott, Rebecca D.; Berkman, Elliot T.

    2015-01-01

    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

  5. Neural Correlates of Attentional Flexibility during Approach and Avoidance Motivation.

    Directory of Open Access Journals (Sweden)

    Rebecca D Calcott

    Full Text Available 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.

  6. Neural Correlates of Attentional Flexibility during Approach and Avoidance Motivation.

    Science.gov (United States)

    Calcott, Rebecca D; Berkman, Elliot T

    2015-01-01

    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.

  7. Cost-outcome analysis of joint replacement: evidence from a Spanish public hospital Análisis coste-resultado del remplazo de articulaciones: Evidencia de un hospital público español

    Directory of Open Access Journals (Sweden)

    José Luis Navarro Espigares

    2008-08-01

    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

  8. Application of Evidence-based Management of High Value Consumables in Hospital%浅谈循证管理在医院高值耗材管理中的运用

    Institute of Scientific and Technical Information of China (English)

    顾天红; 杨俊

    2012-01-01

    The status of high value consumables management in hospital is analyzed, and how to use evidence-based management to improve the management level of high value medical consumables in hospital is explained. The usage safety and quality control of high value medical consumables are ensured by tracking, the medical care quality is improved, and the doctor-patient relationship is harmonious.[Chinese Medical Equipment Journal,2012,33(5):124,129]%介绍了医院高值医用耗材管理的现状,阐述了医院如何运用循证管理来提高高值医用耗材的管理水平,通过对高值医用耗材的全程跟踪,保证高值医用耗材的使用安全和质量控制,提高了医疗质量,和谐了医患关系.

  9. Medical compliance to evidence-based clinical guidelines on secondary prevention of coronary heart disease in a hospital from Lima, Peru: a retrospective study

    Directory of Open Access Journals (Sweden)

    Zaira Castañeda-Amado

    2017-06-01

    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

  10. Asthma and pneumonia among children less than five years with acute respiratory symptoms in Mulago Hospital, Uganda: evidence of under-diagnosis of asthma.

    Directory of Open Access Journals (Sweden)

    Rebecca Nantanda

    Full Text Available BACKGROUND: Pneumonia is considered the major cause of mortality among children with acute respiratory disease in low-income countries but may be over-diagnosed at the cost of under-diagnosing asthma. We report the magnitude of asthma and pneumonia among "under-fives" with cough and difficulty breathing, based on stringent clinical criteria. We also describe the treatment for children with acute respiratory symptoms in Mulago Hospital. METHODS: We enrolled 614 children aged 2-59 months with cough and difficulty breathing. Interviews, physical examination, blood and radiological investigations were done. We defined asthma according to Global Initiative for Asthma guidelines. Pneumonia was defined according to World Health Organization guidelines, which were modified by including fever and white cell count, C-reactive protein, blood culture and chest x-ray. Children with asthma or bronchiolitis were collectively referred to as "asthma syndrome" due to challenges of differentiating the two conditions in young children. Three pediatricians reviewed each participant's case report post hoc and made a diagnosis according to the study criteria. RESULTS: Of the 614 children, 41.2% (95% CI: 37.3-45.2 had asthma syndrome, 27.2% (95% CI: 23.7-30.9 had bacterial pneumonia, 26.5% (95% CI: 23.1-30.2 had viral pneumonia, while 5.1% (95% CI: 3.5-7.1 had other diagnoses including tuberculosis. Only 9.5% of the children with asthma syndrome had been previously diagnosed as asthma. Of the 253 children with asthma syndrome, 95.3% (95% CI: 91.9-97.5 had a prescription for antibiotics, 87.7% (95% CI: 83.1-91.5 for bronchodilators and 43.1% (95% CI: 36.9-49.4 for steroids. CONCLUSION: Although reports indicate that acute respiratory symptoms in children are predominantly due to pneumonia, asthma syndrome contributes a significant proportion. Antibiotics are used irrationally due to misdiagnosis of asthma as pneumonia. There is need for better diagnostic tools for

  11. Asthma and pneumonia among children less than five years with acute respiratory symptoms in Mulago Hospital, Uganda: evidence of under-diagnosis of asthma.

    Science.gov (United States)

    Nantanda, Rebecca; Tumwine, James K; Ndeezi, Grace; Ostergaard, Marianne S

    2013-01-01

    Pneumonia is considered the major cause of mortality among children with acute respiratory disease in low-income countries but may be over-diagnosed at the cost of under-diagnosing asthma. We report the magnitude of asthma and pneumonia among "under-fives" with cough and difficulty breathing, based on stringent clinical criteria. We also describe the treatment for children with acute respiratory symptoms in Mulago Hospital. We enrolled 614 children aged 2-59 months with cough and difficulty breathing. Interviews, physical examination, blood and radiological investigations were done. We defined asthma according to Global Initiative for Asthma guidelines. Pneumonia was defined according to World Health Organization guidelines, which were modified by including fever and white cell count, C-reactive protein, blood culture and chest x-ray. Children with asthma or bronchiolitis were collectively referred to as "asthma syndrome" due to challenges of differentiating the two conditions in young children. Three pediatricians reviewed each participant's case report post hoc and made a diagnosis according to the study criteria. Of the 614 children, 41.2% (95% CI: 37.3-45.2) had asthma syndrome, 27.2% (95% CI: 23.7-30.9) had bacterial pneumonia, 26.5% (95% CI: 23.1-30.2) had viral pneumonia, while 5.1% (95% CI: 3.5-7.1) had other diagnoses including tuberculosis. Only 9.5% of the children with asthma syndrome had been previously diagnosed as asthma. Of the 253 children with asthma syndrome, 95.3% (95% CI: 91.9-97.5) had a prescription for antibiotics, 87.7% (95% CI: 83.1-91.5) for bronchodilators and 43.1% (95% CI: 36.9-49.4) for steroids. Although reports indicate that acute respiratory symptoms in children are predominantly due to pneumonia, asthma syndrome contributes a significant proportion. Antibiotics are used irrationally due to misdiagnosis of asthma as pneumonia. There is need for better diagnostic tools for childhood asthma and pneumonia in Uganda.

  12. USAID IT Reform Cost Savings/Avoidance

    Data.gov (United States)

    US Agency for International Development — The Office of the Chief Information Officer in the Management Bureau of USAID launched initiatives designed for IT cost savings and avoidance. This dataset includes...

  13. Food Waste Avoidance Actions in Food Retailing

    DEFF Research Database (Denmark)

    Kulikovskaja, Viktorija; Aschemann-Witzel, Jessica

    2017-01-01

    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...

  14. GSA IT Reform Cost Savings/Avoidance

    Data.gov (United States)

    General Services Administration — GSA IT provides data related to Agency IT initiatives that save or avoid expenditures. This data is provided as a requirement of OMB's Integrated Data Collection...

  15. Toddlers at the Table: Avoiding Power Struggles

    Science.gov (United States)

    ... new food being offered. Avoid the Junk Food Trap Toddlers need to eat healthy to get the ... Nemours Foundation, iStock, Getty Images, Corbis, Veer, Science Photo Library, Science Source Images, Shutterstock, and Clipart.com

  16. Your Adolescent: Anxiety and Avoidant Disorders

    Science.gov (United States)

    ... other times, it develops into panic attacks and phobias. Identifying the Signs Anxiety disorders vary from teenager ... may begin to avoid normal activities and routines. Phobias Many fears of younger children are mild, passing, ...

  17. Avoid the Consequences of High Blood Pressure

    Science.gov (United States)

    ... Thromboembolism Aortic Aneurysm More Avoid the Consequences of High Blood Pressure Infographic Updated:Oct 31,2016 View a downloadable version of this infographic High Blood Pressure • Home • Get the Facts About HBP • Know Your ...

  18. Active Collision Avoidance for Planetary Landers Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Advancements in radar technology have resulted in commercial, automotive collision avoidance radars. These radar systems typically use 37GHz or 77GHz interferometry...

  19. 6 Tips to Avoid Medication Mistakes

    Science.gov (United States)

    ... For Consumers Consumer Updates 6 Tips to Avoid Medication Mistakes Share Tweet Linkedin Pin it More sharing ... dietary supplements you use. back to top Computerized Medication Box FDA has cleared for marketing the Electronic ...

  20. Harm Avoidance and Self-Directedness characterize fibromyalgic patients and the symptom severity

    Directory of Open Access Journals (Sweden)

    Paolo eLeombruni

    2016-04-01

    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.

  1. The vigilance-avoidance model of avoidant recognition: An ERP study under threat priming.

    Science.gov (United States)

    Zhai, Jing; Chen, Xu; Ma, Jianling; Yang, Qingqing; Liu, Ying

    2016-12-30

    Our study examined attachment-related electrophysiological differences in recognition using event-related potentials (ERPs) measured during a study-test paradigm after threat priming. We identified ERP correlates of recognition by comparing the ERPs of attachment-related positive and negative images between avoidant and secure attachment orientations. Our results revealed that the distribution of early old/new effects was broader in avoidant individuals than in secure individuals, and an early parietal old/new effect was observed in avoidant individuals, which reflected their implicit memory. The late old/new effect was found only in secure individuals when evoked by negative pictures, and was not observed in avoidant individuals. The results suggest that avoidant individuals adopt the "vigilance-avoidance" dual-process model to recognize both positive and negative attachment-related stimuli and carry out preferential familiarity matching at the automatic level and avoidant retrieval at the controlled-processing level.

  2. Information Dilemmas and Blame-Avoidance Strategies

    DEFF Research Database (Denmark)

    Erik, Baekkeskov; Rubin, Olivier

    2016-01-01

    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...... in place public health specialists and institutions as responsible for H1N1 information and responses, thereby insulating the top-tier leadership....

  3. The "ick" Factor Matters: Disgust Prospectively Predicts Avoidance in Chemotherapy Patients.

    Science.gov (United States)

    Reynolds, Lisa M; Bissett, Ian P; Porter, David; Consedine, Nathan S

    2016-12-01

    Chemotherapy can be physically and psychologically demanding. Avoidance and withdrawal are common among patients coping with these demands. This report compares established emotional predictors of avoidance during chemotherapy (embarrassment; distress) with an emotion (disgust) that has been unstudied in this context. This report outlines secondary analyses of an RCT where 68 cancer patients undergoing chemotherapy were randomized to mindfulness or relaxation interventions. Self-reported baseline disgust (DS-R), embarrassment (SES-SF), and distress (Distress Thermometer) were used to prospectively predict multiple classes of avoidance post-intervention and at 3 months follow-up. Measures assessed social avoidance, cognitive and emotional avoidance (IES Avoidance), as well as information seeking and treatment adherence (General Adherence Scale). Repeated-measures ANOVAs evaluated possible longitudinal changes in disgust and forward entry regression models contrasted the ability of the affective variables to predict avoidance. Although disgust did not change over time or vary between groups, greater disgust predicted greater social, cognitive, and emotional avoidance, as well as greater information seeking. Social avoidance was predicted by trait embarrassment and distress predicted non-adherence. This report represents the first investigation of disgust's ability to prospectively predict avoidance in people undergoing chemotherapy. Compared to embarrassment and distress, disgust was a more consistent predictor across avoidance domains and its predictive ability was evident across a longer period of time. Findings highlight disgust's role as an indicator of likely avoidance in this health context. Early identification of cancer patients at risk of deleterious avoidance may enable timely interventions and has important clinical implications (ACTRN12613000238774).

  4. Mobile Robot Collision Avoidance in Human Environments

    Directory of Open Access Journals (Sweden)

    Lingqi Zeng

    2013-01-01

    Full Text Available Collision avoidance is a fundamental requirement for mobile robots. Avoiding moving obstacles (also termed dynamic obstacles with unpredictable direction changes, such as humans, is more challenging than avoiding moving obstacles whose motion can be predicted. Precise information on the future moving directions of humans is unobtainable for use in navigation algorithms. Furthermore, humans should be able to pursue their activities unhindered and without worrying about the robots around them. In this paper, both active and critical regions are used to deal with the uncertainty of human motion. A procedure is introduced to calculate the region sizes based on worst‐case avoidance conditions. Next, a novel virtual force field‐based mobile robot navigation algorithm (termed QVFF is presented. This algorithm may be used with both holonomic and nonholonomic robots. It incorporates improved virtual force functions for avoiding moving obstacles and its stability is proven using a piecewise continuous Lyapunov function. Simulation and experimental results are provided for a human walking towards the robot and blocking the path to a goal location. Next, the proposed algorithm is compared with five state‐of‐the‐art navigation algorithms for an environment with one human walking with an unpredictable change in direction. Finally, avoidance results are presented for an environment containing three walking humans. The QVFF algorithm consistently generated collision‐free paths to the goal.

  5. Towards better patient care: drugs to avoid.

    Science.gov (United States)

    2013-04-01

    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

  6. ADVERTISING AVOIDANCE PADA IKLAN DI MEDIA TELEVISI

    Directory of Open Access Journals (Sweden)

    Indah Dwi Pratama

    2016-01-01

    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

  7. Basic nursing care to prevent nonventilator hospital-acquired pneumonia.

    Science.gov (United States)

    Quinn, Barbara; Baker, Dian L; Cohen, Shannon; Stewart, Jennifer L; Lima, Christine A; Parise, Carol

    2014-01-01

    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

  8. Hospital Inspections

    Data.gov (United States)

    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...

  9. Hospital Inspections

    Data.gov (United States)

    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...

  10. Hospital marketing.

    Science.gov (United States)

    Carter, Tony

    2003-01-01

    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.

  11. Low-Cost Avoidance Behaviors Are Resistant To Fear Extinction In Humans

    Directory of Open Access Journals (Sweden)

    Bram eVervliet

    2015-12-01

    Full Text Available Elevated levels of fear and avoidance are core symptoms across the anxiety disorders. It has long been known that fear serves to motivate avoidance. Consequently, fear extinction has been the primary focus in pre-clinical anxiety research for decades, under the implicit assumption that removing the motivator of avoidance (fear would automatically mitigate the avoidance behaviors as well. Although this assumption has intuitive appeal, it has received little scientific scrutiny. The scarce evidence from animal studies is mixed, while the assumption remains untested in humans. The current study applied an avoidance conditioning protocol in humans to investigate the effects of fear extinction on the persistence of low-cost avoidance. Online danger-safety ratings and skin conductance responses documented the dynamics of conditioned fear across avoidance and extinction phases. Anxiety- and avoidance-related questionnaires explored individual differences in rates of avoidance. Participants first learned to click a button during a predictive danger signal, in order to cancel an upcoming aversive electrical shock (avoidance conditioning. Next, fear extinction was induced by presenting the signal in the absence of shocks while button-clicks were prevented (by removing the button in Experiment 1, or by instructing not to click the button in Experiment 2. Most importantly, post-extinction availaibility of the button caused a significant return of avoidant button-clicks. In addition, trait-anxiety levels correlated positively with rates of avoidance during a predictive safety signal, and with the rate of pre- to post-extinction decrease during this signal. Fear measures gradually decreased during avoidance conditioning, as participants learned that button-clicks effectively canceled the shock. Preventing button-clicks elicited a sharp increase in fear, which subsequently extinguished. Fear remained low during avoidance testing, but danger-safety ratings

  12. Low-Cost Avoidance Behaviors are Resistant to Fear Extinction in Humans.

    Science.gov (United States)

    Vervliet, Bram; Indekeu, Ellen

    2015-01-01

    Elevated levels of fear and avoidance are core symptoms across the anxiety disorders. It has long been known that fear serves to motivate avoidance. Consequently, fear extinction has been the primary focus in pre-clinical anxiety research for decades, under the implicit assumption that removing the motivator of avoidance (fear) would automatically mitigate the avoidance behaviors as well. Although this assumption has intuitive appeal, it has received little scientific scrutiny. The scarce evidence from animal studies is mixed, while the assumption remains untested in humans. The current study applied an avoidance conditioning protocol in humans to investigate the effects of fear extinction on the persistence of low-cost avoidance. Online danger-safety ratings and skin conductance responses documented the dynamics of conditioned fear across avoidance and extinction phases. Anxiety- and avoidance-related questionnaires explored individual differences in rates of avoidance. Participants first learned to click a button during a predictive danger signal, in order to cancel an upcoming aversive electrical shock (avoidance conditioning). Next, fear extinction was induced by presenting the signal in the absence of shocks while button-clicks were prevented (by removing the button in Experiment 1, or by instructing not to click the button in Experiment 2). Most importantly, post-extinction availability of the button caused a significant return of avoidant button-clicks. In addition, trait-anxiety levels correlated positively with rates of avoidance during a predictive safety signal, and with the rate of pre- to post-extinction decrease during this signal. Fear measures gradually decreased during avoidance conditioning, as participants learned that button-clicks effectively canceled the shock. Preventing button-clicks elicited a sharp increase in fear, which subsequently extinguished. Fear remained low during avoidance testing, but danger-safety ratings increased again when

  13. A Systematic Review of Carrion Eaters' Adaptations to Avoid Sickness.

    Science.gov (United States)

    Blumstein, Daniel T; Rangchi, Tiana N; Briggs, Tiandra; De Andrade, Fabrine Souza; Natterson-Horowtiz, Barbara

    2017-02-13

    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.

  14. Is avoiding an aversive outcome rewarding? Neural substrates of avoidance learning in the human brain.

    Science.gov (United States)

    Kim, Hackjin; Shimojo, Shinsuke; O'Doherty, John P

    2006-07-01

    Avoidance learning poses a challenge for reinforcement-based theories of instrumental conditioning, because once an aversive outcome is successfully avoided an individual may no longer experience extrinsic reinforcement for their behavior. One possible account for this is to propose that avoiding an aversive outcome is in itself a reward, and thus avoidance behavior is positively reinforced on each trial when the aversive outcome is successfully avoided. In the present study we aimed to test this possibility by determining whether avoidance of an aversive outcome recruits the same neural circuitry as that elicited by a reward itself. We scanned 16 human participants with functional MRI while they performed an instrumental choice task, in which on each trial they chose from one of two actions in order to either win money or else avoid losing money. Neural activity in a region previously implicated in encoding stimulus reward value, the medial orbitofrontal cortex, was found to increase, not only following receipt of reward, but also following successful avoidance of an aversive outcome. This neural signal may itself act as an intrinsic reward, thereby serving to reinforce actions during instrumental avoidance.

  15. Approach avoidance training in the eating domain: testing the effectiveness across three single session studies.

    Science.gov (United States)

    Becker, Daniela; Jostmann, Nils B; Wiers, Reinout W; Holland, Rob W

    2015-02-01

    Dual-process models propose that impulsive behavior plays a key role in the development and maintenance of maladaptive eating patterns. Research outside the eating domain suggests that approach avoidance training, a paradigm which aims to modify automatic behavioral dispositions toward critical stimuli, is an effective tool to weaken unhealthy impulses. The present research tested the effectiveness of approach avoidance training in the eating domain. We conducted three single session studies with varying methodologies in a normal-weight female student population (total N = 258), in which one group was always trained to avoid pictures of unhealthy food and to approach pictures of healthy food or neutral objects. We found no conclusive evidence that approach avoidance training can change participants' implicit and explicit food preferences and eating behavior. We discuss the potential and the limitations of approach avoidance training in the eating domain and provide suggestions for future research avenues. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Avoiding barriers in control of mowing robot

    Institute of Scientific and Technical Information of China (English)

    QIU Bai-jing; QIAN Guo-hong; XIANG Zhong-ping; LI Zuo-peng

    2006-01-01

    Due to complicated barriers,it is difficult to track the path of the mowing robot and to avoid barriers.In order to solve the problem,a method based on distance-measuring sensors and fuzzy control inputs was proposed.Its track was composed of beelines and was easy to tail.The fuzzy control inputs were based on the front barrier distance and the difference between the left and right barrier distance measured by ultrasonic sensors;the output was the direction angle.The infrared sensors around the robot improved its safety in avoiding barriers.The result of the method was feasible,agile,and stable.The distance between the robot and the barriers could be changed by altering the inputs and outputs of fuzzy control and the length of the beelines.The disposed sensors can fulfill the need of the robot in avoiding barriers.

  17. Cod avoidance by area regulations in Kattegat

    DEFF Research Database (Denmark)

    Eliasen, Søren Qvist

    2014-01-01

    presents two initiatives for cod avoidance in Kattegat; a fisher initiative sharing information about cod bycatch which could lead to real time closures in areas with high bycatch of juveniles, for vessels with low cod quota to avoid catch of all cod, and a Danish Swedish Government initiative of permanent......The article examines the experiences of two initiatives of cod avoidance by area regulations in the Kattegat in the light of the upcoming discard ban in EU fisheries. The first section highlights elements of the discard ban in the reformed EU Common Fisheries Policy (CFP). The second section...... and temporary area closures in Kattegat. The third section discusses the lessons learned in the light of implementation of the discard ban. The fourth section sums up the lessons learned; Regional measures of implementation of the discard ban should include all vessels with quota in the region to be regarded...

  18. Chloroplast avoidance movement reduces photodamage in plants.

    Science.gov (United States)

    Kasahara, Masahiro; Kagawa, Takatoshi; Oikawa, Kazusato; Suetsugu, Noriyuki; Miyao, Mitsue; Wada, Masamitsu

    When plants are exposed to light levels higher than those required for photosynthesis, reactive oxygen species are generated in the chloroplasts and cause photodamage. This can occur even under natural growth conditions. To mitigate photodamage, plants have developed several protective mechanisms. One is chloroplast avoidance movement, in which chloroplasts move from the cell surface to the side walls of cells under high light conditions, although experimental support is still awaited. Here, using different classes of mutant defective in chloroplast avoidance movement, we show that these mutants are more susceptible to damage in high light than wild-type plants. Damage of the photosynthetic apparatus and subsequent bleaching of leaf colour and necrosis occur faster under high light conditions in the mutants than in wild-type plants. We conclude that chloroplast avoidance movement actually decreases the amount of light absorption by chloroplasts, and might therefore be important to the survival of plants under natural growth conditions.

  19. Engaging Math-Avoidant College Students

    Directory of Open Access Journals (Sweden)

    M. Paul Latiolais

    2009-07-01

    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.

  20. Learning processes underlying avoidance of negative outcomes.

    Science.gov (United States)

    Andreatta, Marta; Michelmann, Sebastian; Pauli, Paul; Hewig, Johannes

    2017-04-01

    Successful avoidance of a threatening event may negatively reinforce the behavior due to activation of brain structures involved in reward processing. Here, we further investigated the learning-related properties of avoidance using feedback-related negativity (FRN). The FRN is modulated by violations of an intended outcome (prediction error, PE), that is, the bigger the difference between intended and actual outcome, the larger the FRN amplitude is. Twenty-eight participants underwent an operant conditioning paradigm, in which a behavior (button press) allowed them to avoid a painful electric shock. During two learning blocks, participants could avoid an electric shock in 80% of the trials by pressing one button (avoidance button), or by not pressing another button (punishment button). After learning, participants underwent two test blocks, which were identical to the learning ones except that no shocks were delivered. Participants pressed the avoidance button more often than the punishment button. Importantly, response frequency increased throughout the learning blocks but it did not decrease during the test blocks, indicating impaired extinction and/or habit formation. In line with a PE account, FRN amplitude to negative feedback after correct responses (i.e., unexpected punishment) was significantly larger than to positive feedback (i.e., expected omission of punishment), and it increased throughout the blocks. Highly anxious individuals showed equal FRN amplitudes to negative and positive feedback, suggesting impaired discrimination. These results confirm the role of negative reinforcement in motivating behavior and learning, and reveal important differences between high and low anxious individuals in the processing of prediction errors.

  1. Telerobotics with whole arm collision avoidance

    Energy Technology Data Exchange (ETDEWEB)

    Wilhelmsen, K.; Strenn, S.

    1993-09-01

    The complexity of teleorbotic operations in a cluttered environment is exacerbated by the need to present collision information to the operator in an understandable fashion. In addition to preventing movements which will cause collisions, a system providing some form of virtual force reflection (VFR) is desirable. With this goal in mind, Lawrence Livermore National Laboratory (LLNL) has installed a kinematically master/slave system and developed a whole arm collision avoidance system which interacts directly with the telerobotic controller. LLNL has also provided a structure to allow for automated upgrades of workcell models and provide collision avoidance even in a dynamically changing workcell.

  2. Are flying wildlife attracted to (or do they avoid) wind turbines?

    Energy Technology Data Exchange (ETDEWEB)

    Larkin, Ronald [Univ. of Illinois, Urbana, IL (United States). Board of Trustees

    2010-03-31

    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).

  3. [Femoral venous catheterization. Does it really need to be avoided?].

    Science.gov (United States)

    Lorente, L; León, C

    2009-12-01

    The guidelines to prevent central venous catheter related bloodstream infections (CVCBSI) of the Centers for Disease Control and Prevention (CDC) of 2002, Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias/ Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEMICYUC/SEIMC) of 2004, and the recently published guidelines of the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA(IDSA) of 2008 have recommended using the subclavian vein and avoiding the use of the femoral vein. They also recommend considering the use of antiseptic- or antimicrobial-impregnated CVCs for hospital units or groups of patients with a high incidence of CVCBSI. When implementing these guidelines, two questions could be asked: 1) Could the abuse of the subclavian vein and avoiding the use of the femoral vein imply a decrease in the incidence of CVCBSI, but an increase in the rate of mechanical complications as pneumothorax and/or hemothorax? 2) Couldn't antimicrobial-impregnated CVCs be used to prevent CVCBSI when the femoral venous access is used?

  4. Personality characteristics in MS patients: The role of avoidant personality.

    Science.gov (United States)

    Mohamadi, Amin; Davoodi-Makinejad, Mahsa; Azimi, Amirreza; Nafissi, Shahriar

    2016-05-01

    Quality of life (QOL) is markedly affected by multiple sclerosis (MS). Particular personality characteristics (PC) of MS patients can affect their QOL. We designed the present study to determine the role of various PCs on QOL in MS patients accounting for other clinical factors. QOL, PC, physical disability, and mental status were recorded in 83 MS patients referred to two academic hospitals of Tehran University of Medical Sciences in 2011-2012. The mean age of enrolled patients was 31.54±7.38 (range: 14-50) years and 74 (89.2%) were female. Mean disease duration was 4.55±4.70 years. Seventy-seven patients (92.8%) had relapsing-remitting disease, five (6%) had primary progressive, and one showed a secondary progressive course. Correlation between total QOL scores in MS patients and disease duration, cognitive impairment, and physical disability was significant (all ppersonality was the most frequent PC (43.4%) in our patients. Only avoidant personality had a significant negative correlation with all components of QOL (Beta: 0.33, ppersonality, physical disability, and mental status were found to be three predictors of QOL with all its components. Avoidant personality appears to be an important predictor of poor QOL in MS patients. In addition, avoidant coping strategies appear to be associated with adverse response to stressful events in these patients. These findings suggest the need for psychological intervention for improving the coping strategies and QOL in MS patients. Copyright © 2016 Elsevier B.V. All rights reserved.

  5. Development of a Measure of Experiential Avoidance: The Multidimensional Experiential Avoidance Questionnaire

    Science.gov (United States)

    Gamez, Wakiza; Chmielewski, Michael; Kotov, Roman; Ruggero, Camilo; Watson, David

    2011-01-01

    Experiential avoidance (EA) has been conceptualized as the tendency to avoid negative internal experiences and is an important concept in numerous conceptualizations of psychopathology as well as theories of psychotherapy. Existing measures of EA have either been narrowly defined or demonstrated unsatisfactory internal consistency and/or evidence…

  6. Myopic Regret Avoidance: Feedback Avoidance and Learning in Repeated Decision Making

    Science.gov (United States)

    Reb, Jochen; Connolly, Terry

    2009-01-01

    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…

  7. Avoided by association: acquisition, extinction, and renewal of avoidance tendencies toward conditioned fear stimuli

    NARCIS (Netherlands)

    A.M. Krypotos; M. Effting; I. Arnaudova; M. Kindt; T. Beckers

    2013-01-01

    Traditional theoretical models hold that avoidance reflects the interplay of Pavlovian and instrumental learning. Here we suggest that avoidance tendencies to intrinsically neutral cues may be established by mere Pavlovian association. Following fear conditioning, in which pictures of one object wer

  8. Reasonable Avoidability, Responsibility and Lifestyle Diseases

    DEFF Research Database (Denmark)

    Andersen, Martin Marchman

    2012-01-01

    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 ...

  9. Oscillations in two-person avoidance control

    CERN Document Server

    Kish, Lazar

    2016-01-01

    Social interaction dynamics are a special type of group interactions that play a large part in our everyday lives. They dictate how and with whom a certain individual will interact. One of such interactions can be termed "avoidance control". This everyday situation occurs when two fast-walking persons suddenly realize that they are on a frontal collision course and begin maneuvering to avoid collision. If the two walkers' initial maneuverings are in the same direction that can lead to oscillations that lengthen time required to reach a stable avoidance trajectory. We introduce a dynamical model with a feedback loop to understand the origin and properties of this oscillation. For the emergence of the oscillatory behavior, two conditions must be satisfied: i) the persons must initiate the avoidance maneuver in the same direction; ii) the time delays in the feedback loop must reverse the phase of the players' positions at the oscillation frequency. The oscillation can be terminated at any time if one of the walk...

  10. Avoidable costs of comprehensive case management.

    Science.gov (United States)

    Issel, L M; Anderson, R A

    1999-01-01

    Comprehensive case management has become an industry standard and its pervasiveness raises questions about the ubiquitous need for this service. Analyzed from the perspective of transaction cost analysis and access, we argue that in some cases comprehensive case management is an avoidable cost incurred because of system problems that limit access to otherwise eligible clients. Implications are discussed.

  11. Doppler micro sense and avoid radar

    Science.gov (United States)

    Gorwara, Ashok; Molchanov, Pavlo; Asmolova, Olga

    2015-10-01

    There is a need for small Sense and Avoid (SAA) systems for small and micro Unmanned Aerial Systems (UAS) to avoid collisions with obstacles and other aircraft. The proposed SAA systems will give drones the ability to "see" close up and give them the agility to maneuver through tight areas. Doppler radar is proposed for use in this sense and avoid system because in contrast to optical or infrared (IR) systems Doppler can work in more harsh conditions such as at dusk, and in rain and snow. And in contrast to ultrasound based systems, Doppler can better sense small sized obstacles such as wires and it can provide a sensing range from a few inches to several miles. An SAA systems comprised of Doppler radar modules and an array of directional antennas that are distributed around the perimeter of the drone can cover the entire sky. These modules are designed so that they can provide the direction to the obstacle and simultaneously generate an alarm signal if the obstacle enters within the SAA system's adjustable "Protection Border". The alarm signal alerts the drone's autopilot to automatically initiate an avoidance maneuver. A series of Doppler radar modules with different ranges, angles of view and transmitting power have been designed for drones of different sizes and applications. The proposed Doppler radar micro SAA system has simple circuitry, works from a 5 volt source and has low power consumption. It is light weight, inexpensive and it can be used for a variety of small unmanned aircraft.

  12. Organising European technical documentation to avoid duplication.

    Science.gov (United States)

    Donawa, Maria

    2006-04-01

    The development of comprehensive accurate and well-organised technical documentation that demonstrates compliance with regulatory requirements is a resource-intensive, but critically important activity for medical device manufacturers. This article discusses guidance documents and method of organising technical documentation that may help avoid costly and time-consuming duplication.

  13. Reducing avoidable pressure ulcers in the community.

    Science.gov (United States)

    Parnham, Alison; Pankhurst, Sarah; Dabell, Wendy

    2015-02-27

    The elimination of avoidable pressure ulcers remains a challenge in healthcare provision, represents an increasing financial burden on resources and continues to affect patients' quality of life. Many pressure ulcers are deemed to be avoidable and there are several factors that can influence this, including the development of a care delivery system and a service delivery strategy that incorporate a comprehensive structure, a meticulous process and measurable outcomes. Nottingham CityCare developed a strategy to reduce avoidable pressure ulcers. The implementation of the strategy in an inner city community setting is discussed. The importance of eliminating pressure ulcers is explored, and the barriers to care delivery are reviewed, demonstrating how a new culture in clinical practice can ensure the elimination of avoidable pressure ulcers. The challenges within the implementation process are reflected on and the implementation of the SSKIN (Surface, Skin inspection, Keep your patient moving, Incontinence and moisture, Nutrition and hydration) phenomenon is reviewed in relation to care delivery, record-keeping and evaluation.

  14. Avoidance Motivation and Conservation of Energy

    NARCIS (Netherlands)

    Roskes, Marieke; Elliot, Andrew J.; Nijstad, Bernard A.; De Dreu, Carsten K. W.

    2013-01-01

    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

  15. Avoidance Motivation and Conservation of Energy

    NARCIS (Netherlands)

    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

  16. Simple Obstacle Avoidance Algorithm for Rehabilitation Robots

    NARCIS (Netherlands)

    Stuyt, F.H.A.; Römer, G.R.B.; Stuyt, H.J.A.

    2007-01-01

    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 fo

  17. An Examination of Avoided Costs in Utah

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark; Wiser, Ryan

    2005-01-07

    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.

  18. Rewarding peak avoidance: the Dutch 'Spitsmijden' projects

    NARCIS (Netherlands)

    Knockaert, J.; Bakens, J.; Ettema, D.F.; Verhoef, E.

    2011-01-01

    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

  19. Obesity and Healthcare Avoidance: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Robert D McGuigan

    2015-03-01

    Full Text Available This review addresses the issue of health care avoidance and obesity. English language journal articles published between 1990 and 2012 that addressed the review question|“is being overweight or obese an unrecognized factor in healthcare avoidance?” were located using major databases. A modified JADAD scoring system was then used to assess papers. Ten papers were identified which directly addressed the review question. A positive relationship exists between obesity and healthcare avoidance. The major contributory factors were being female, have a diagnosed mental health problem and perceived or actual bias and discrimination by health professionals. The review also highlights the importance of the relationship between healthcare professionals and their patients, and the physical environment in which interactions occur as these may contribute to avoidance behaviors. Concern about obesity is rising and while there has been much discussion about strategies to reduce obesity this review highlights the need for thinking more broadly about the way in which overweight and obese individuals interact with preventative health strategies.

  20. Proactive strategies to avoid infectious disease.

    Science.gov (United States)

    Stevenson, Richard J; Case, Trevor I; Oaten, Megan J

    2011-12-12

    Infectious disease exerts a large selective pressure on all organisms. One response to this has been for animals to evolve energetically costly immune systems to counter infection, while another--the focus of this theme issue--has been the evolution of proactive strategies primarily to avoid infection. These strategies can be grouped into three types, all of which demonstrate varying levels of interaction with the immune system. The first concerns maternal strategies that function to promote the immunocompetence of their offspring. The second type of strategy influences mate selection, guiding the selection of a healthy mate and one who differs maximally from the self in their complement of antigen-coding genes. The third strategy involves two classes of behaviour. One relates to the capacity of the organisms to learn associations between cues indicative of pathogen threat and immune responses. The other relates to prevention and even treatment of infection through behaviours such as avoidance, grooming, quarantine, medicine and care of the sick. In humans, disease avoidance is based upon cognition and especially the emotion of disgust. Human disease avoidance is not without its costs. There is a propensity to reject healthy individuals who just appear sick--stigmatization--and the system may malfunction, resulting in various forms of psychopathology. Pathogen threat also appears to have been a highly significant and unrecognized force in shaping human culture so as to minimize infection threats. This cultural shaping process--moralization--can be co-opted to promote human health.

  1. Detect and Avoid (DAA) Automation Maneuver Study

    Science.gov (United States)

    2017-02-01

    Participation was limited to military rated pilots and civilian pilots with full Instrument Flight Rules ( IFR ) ratings. Recent experience (within the last two...Avoidance IFR = Instrument Flight Rules IRB = Institutional Review Board VSCS = Vigilant Spirit Control Station TSD = Tactical Situation Display

  2. HOW TO AVOID SEXIST LANGUAGE IN ENGLISH

    Institute of Scientific and Technical Information of China (English)

    HuZhiqing

    2004-01-01

    Use of Sexist language is one of the serious yet often-neglected mistakes in the English writing and speaking of Chineselearners of English. Sexist language in English can be classifiedinto two categories : ambiguity of referent and stereotyping. Thispaper focuses on some common sexist language in the Englishwriting and speaking of Chinese learners of English and givessome suggestions about how to avoid them.

  3. The Netherlands Bird Avoidance Model, Final Report

    NARCIS (Netherlands)

    Shamoun-Baranes, J.; Bouten, W.; Sierdsema, H.; van Belle, J.; van Gasteren, J.R.; van Loon, E.E.

    2006-01-01

    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

  4. Pathological Demand Avoidance: Exploring the Behavioural Profile

    Science.gov (United States)

    O'Nions, Elizabeth; Viding, Essi; Greven, Corina U; Ronald, Angelica; Happé, Francesca

    2014-01-01

    "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…

  5. [Avoidance of patient-prosthesis mismatch].

    Science.gov (United States)

    Sakamoto, Y; Hashimoto, K

    2006-04-01

    To minimize the incidence of patient-prosthesis mismatch (PPM), we have routinely adopted aortic root enlargement to avoid PPM for patients with small aortic annulus. The aim of this study was to review our strategy of avoiding PPM. The Carpentier-Edwards Perimount (CEP) valves were implanted in 53 patients who were mostly aged over 65 and the St. Jude Medical (SJM) mechanical valves were used in 128 patients aged under 65. A standard 21-mm SJM valve was used in only 3 patients and no 19-mm valves were employed. However, 19-mm CEP valves were used in 12 patients with a small body surface area (1.43 +/- 0.14 m2). Of these, 26 patients (14.4%) who had a small aortic annulus and 24 patients aged under 65 underwent aortic root enlargement. No patient receiving an SJM valve had an projected indexed effective orifice area (EOAI) small annulus, the first choice for avoiding PPM is aortic annular enlargement, which may be avoided by high performance mechanical valves with larger EOA.

  6. Teaching Preschool Children to Avoid Poison Hazards

    Science.gov (United States)

    Dancho, Kelly A.; Thompson, Rachel H.; Rhoades, Melissa M.

    2008-01-01

    We evaluated the effectiveness of group safety training and in situ feedback and response interruption to teach preschool children to avoid consuming potentially hazardous substances. Three children ingested ambiguous substances during a baited baseline assessment condition and continued to ingest these substances following group safety training.…

  7. Hydrofluoric acid on dentin should be avoided.

    NARCIS (Netherlands)

    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

    2010-01-01

    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. M

  8. Do hospital mergers reduce costs?

    Science.gov (United States)

    Schmitt, Matt

    2017-03-01

    Proponents of hospital consolidation claim that mergers lead to significant cost savings, but there is little systematic evidence backing these claims. For a large sample of hospital mergers between 2000 and 2010, I estimate difference-in-differences models that compare cost trends at acquired hospitals to cost trends at hospitals whose ownership did not change. I find evidence of economically and statistically significant cost reductions at acquired hospitals. On average, acquired hospitals realize cost savings between 4 and 7 percent in the years following the acquisition. These results are robust to a variety of different control strategies, and do not appear to be easily explained by post-merger changes in service and/or patient mix. I then explore several extensions of the results to examine (a) whether the acquiring hospital/system realizes cost savings post-merger and (b) if cost savings depend on the size of the acquirer and/or the geographic overlap of the merging hospitals. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Segmentation in local hospital markets.

    Science.gov (United States)

    Dranove, D; White, W D; Wu, L

    1993-01-01

    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.

  10. Measuring Patients’ Attachment Avoidance in Psychotherapy: Development of the Attachment Avoidance in Therapy Scale (AATS

    Directory of Open Access Journals (Sweden)

    András Láng

    2012-11-01

    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.

  11. Bursting neurons and ultrasound avoidance in crickets.

    Science.gov (United States)

    Marsat, Gary; Pollack, Gerald S

    2012-01-01

    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.

  12. Bursting neurons and ultrasound avoidance in crickets

    Directory of Open Access Journals (Sweden)

    Gary eMarsat

    2012-07-01

    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.

  13. Internet connectivity for hospitals and hospital libraries: strategies.

    Science.gov (United States)

    Fuller, S S

    1995-01-01

    Access to Internet resources and communications has rapidly become a necessity in many hospitals nationally. The results of a Pacific Northwest pilot Intenet connections project provides important evidence of the value of librarians in establishing such connections in their institutions The pilot project has resulted in a wealth of information regarding approaches to promoting the utility of the Internet to health professionals in hospitals. Roles that librarians are playing in support of such connections include facilitator, negotiator, provider, publisher, integrator, and educator.

  14. Internet connectivity for hospitals and hospital libraries: strategies.

    OpenAIRE

    Fuller, S S

    1995-01-01

    Access to Internet resources and communications has rapidly become a necessity in many hospitals nationally. The results of a Pacific Northwest pilot Intenet connections project provides important evidence of the value of librarians in establishing such connections in their institutions The pilot project has resulted in a wealth of information regarding approaches to promoting the utility of the Internet to health professionals in hospitals. Roles that librarians are playing in support of suc...

  15. The economics of pressure relieving surfaces: an illustrative case study of the impact of high-specification surfaces on hospital finances.

    Science.gov (United States)

    Trueman, Paul; Whitehead, Sarah J

    2010-02-01

    Pressure ulcers are associated with a significant economic burden that, in many cases, is recognised as being avoidable. The effectiveness of pressure relieving surfaces is well documented and acknowledged in clinical guidelines on the prevention and management of pressure ulcers. Whilst pressure relieving surfaces are more expensive than traditional hospital mattresses, judicious use, targeted to patients most at risk, can help to reduce the incidence and costs of pressure ulcers in hospital settings. This review paper includes a summary of pivotal clinical evidence on pressure relieving surfaces as well as a suggested approach for modelling their financial impact on hospital budgets. Simple financial modelling suggests that pressure relieving surfaces could lead to financial savings for a hospital when used appropriately.

  16. 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

    Directory of Open Access Journals (Sweden)

    Mario da Silva Oliveira

    2015-04-01

    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

  17. [Leadership in the hospital].

    Science.gov (United States)

    Schrappe, Matthias

    2009-01-01

    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.

  18. Academic Hospitality

    Science.gov (United States)

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    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…

  19. Hospitality Management.

    Science.gov (United States)

    College of the Canyons, Valencia, CA.

    A project was conducted at College of the Canyons (Valencia, California) to initiate a new 2-year hospitality program with career options in hotel or restaurant management. A mail and telephone survey of area employers in the restaurant and hotel field demonstrated a need for, interest in, and willingness to provide internships for such a program.…

  20. The role of fear-avoidance cognitions and behaviors in patients with chronic tinnitus.

    Science.gov (United States)

    Kleinstäuber, Maria; Jasper, Kristine; Schweda, Isabell; Hiller, Wolfgang; Andersson, Gerhard; Weise, Cornelia

    2013-01-01

    The current study investigated the role of fear-avoidance-a concept from chronic pain research-in chronic tinnitus. A self-report measure the "Tinnitus Fear-Avoidance Cognitions and Behaviors Scale (T-FAS)" was developed and validated. Furthermore, the role of fear-avoidance behavior as mediator of the relationship between anxiety sensitivity and tinnitus handicap was investigated. From a clinical setting, N = 373 patients with chronic tinnitus completed questionnaires assessing tinnitus handicap (Tinnitus Handicap Inventory), anxiety, depression (Hospital Anxiety and Depression Scale), anxiety sensitivity (Anxiety Sensitivity Index-3), personality factors (Big Five Inventory-10), and fear-avoidance. To analyze the psychometric properties, principal component analysis with parallel component extraction and correlational analyses were used. To examine a possible mediating effect, hierarchical regression analysis was applied. The principal component analysis resulted in a three-factor solution: Fear-avoidance Cognitions, Tinnitus-related Fear-Avoidance Behavior, and Ear-related Fear-Avoidance Behavior. Internal consistency was satisfactory for the total scale and all subscales. High correlations between tinnitus-related handicap scales, depressive and anxiety symptoms, and the T-FAS were found, whereas associations with personality factors were low. Moreover, results indicate a significant partial mediation of fear-avoidance behaviors in the relationship between anxiety sensitivity and the cognitive dimension of tinnitus handicap. Results show that fear-avoidance behavior plays an important role in tinnitus handicap. More attention should be paid to this concept in research and clinical practice of psychotherapy for chronic tinnitus.

  1. Tomographic patient registration and conformal avoidance tomotherapy

    Science.gov (United States)

    Aldridge, Jennifer Stacy

    Development of tomotherapy has led to the emergence of several processes, providing the basis for many unique investigative opportunities. These processes include setup verification, tomographic verification, megavoltage dose reconstruction, and conformal avoidance tomotherapy. Setup verification and conformal avoidance tomotherapy, in particular, are two closely intertwined matters. In order to avoid critical structures located within or adjacent to indistinct tumor regions, accurate patient positioning from fraction to fraction must be ensured. With tomographic patient registration, a higher level of assurance is offered than with traditional positioning methods. Translational and rotational offsets are calculated directly from projection data using cross- correlation or fast Fourier transforms. Experiments assessing the algorithm's ability to calculate individual offsets were conducted using the University of Wisconsin's Tomotherapy Benchtop. These experiments indicate statistical errors within +/-1 mm for offsets up to approximately 20 mm, with maximum offset errors of about +/-2 mm for displacements up to 35 mm. The angular offset component is within +/-2°. To evaluate the registration process as a whole, experimental results from a few multi-parameter examples are also analyzed. With the development of tomographic patient registration in projection space, efforts to promote further sparing of critical structures are justified. Conformal avoidance tomotherapy has as its objective to treat an indistinct tumor region while conformally avoiding any normal critical structures in that region. To demonstrate the advantages of conformal avoidance tomotherapy, conventional and tomotherapy treatments are contrasted for both nasopharyngeal and breast carcinoma cases. For initial research efforts, computed tomography data sets of a human male and female were obtained via the ``Visible Human Project''. Since these data sets are on the order of hundreds of megabytes, both

  2. [Flexibility and safety in hospitals].

    Science.gov (United States)

    Fara, G M; Barni, M

    2011-01-01

    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.

  3. Construction dispute research conceptualisation, avoidance and resolution

    CERN Document Server

    2014-01-01

    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...

  4. How to avoid deferred-compensation troubles.

    Science.gov (United States)

    Freeman, Todd I

    2005-06-01

    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.

  5. Optical Flow based Robot Obstacle Avoidance

    Directory of Open Access Journals (Sweden)

    Kahlouche Souhila

    2008-11-01

    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.

  6. Information Dilemmas and Blame-Avoidance Strategies

    DEFF Research Database (Denmark)

    Erik, Baekkeskov; Rubin, Olivier

    2016-01-01

    China and other authoritarian states notoriously keep mum about disasters. Yet two recent but dissimilar Chinese responses to infectious disease epidemics show that authoritarian crisis management can shift from secrecy to openness. China maintained prolonged secrecy during 2003 SARS, yet was ope...... in place public health specialists and institutions as responsible for H1N1 information and responses, thereby insulating the top-tier leadership.......China and other authoritarian states notoriously keep mum about disasters. Yet two recent but dissimilar Chinese responses to infectious disease epidemics show that authoritarian crisis management can shift from secrecy to openness. China maintained prolonged secrecy during 2003 SARS, yet was open...... 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...

  7. Empathy and avoidance in treating patients living with HIV/AIDS (PLWHA) among service providers in China

    OpenAIRE

    Lin, Chunqing; Li, Li; WAN, Dai; Wu, Zunyou; Yan, Zhihua

    2012-01-01

    This study aims to investigate health care providers’ empathy levels and its association with avoidance in providing service to patients living with HIV/AIDS (PLWHA) in China. A total of 1760 health service providers were randomly sampled from 40 county hospitals in two provinces of China. Using a self-administered questionnaire, participants’ demographic characteristics, work history, empathy level, and avoidance attitudes toward PLWHA were collected in a cross-sectional survey. Empathy was ...

  8. Acute carbon dioxide avoidance in Caenorhabditis elegans

    OpenAIRE

    Hallem, Elissa A.; Sternberg, Paul W.

    2008-01-01

    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....

  9. Potentially Avoidable Peripartum Hysterectomies in Denmark

    DEFF Research Database (Denmark)

    Colmorn, Lotte Berdiin; Krebs, Lone; Langhoff-Roos, Jens

    2016-01-01

    to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations......OBJECTIVE: To audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means. MATERIAL AND METHODS: We developed a structured audit form based on explicit criteria for the minimal mandatory management...

  10. Robot maps, robot moves, robot avoids

    OpenAIRE

    Farrugia, Claire

    2014-01-01

    Robotics is a cornerstone for this century’s innovations. From robot nurses to your own personal assistant, most robots need to know: ‘where is it?’ ‘Where should it go?’ And ‘how to get there?’ Without answers to these questions a robot cannot do much. http://www.um.edu.mt/think/robot-maps-robot-moves-robot-avoids/

  11. Robot maps, robot moves, robot avoids

    OpenAIRE

    Farrugia, Claire; Duca, Edward

    2014-01-01

    Robotics is a cornerstone for this century’s innovations. From robot nurses to your own personal assistant, most robots need to know: ‘where is it?’ ‘Where should it go?’ And ‘how to get there?’ Without answers to these questions a robot cannot do much. http://www.um.edu.mt/think/robot-maps-robot-moves-robot-avoids/

  12. [Mortality by avoidable causes in preschool children].

    Science.gov (United States)

    Lurán, Albenia; López, Elizabeth; Pinilla, Consuelo; Sierra, Pedro

    2009-03-01

    The infant-mortality rate in children aged less than five is an indicator of the general state of health of a population and directly reflects the quality of life and the level of socio-economic development of a country. Avoidable mortality was assessed in preschool children as a reflection of Colombia quality of life and socio-economic development. Mortality trends were analyzed in preschool children aged less than five throughout Colombia during a 20-year period from 1985-2004, and focused on mortality causes that were considered avoidable. This was a descriptive, retrospective study; the sources of information were Departamento Administrativo Nacional de Estadística records of deaths and population projections 1985-2004. Mortality rate due to avoidable causes was the statistical indicator. In children aged less than one, the reducible mortality due to "early diagnosis and medical treatment" occupied the first place amongst causes for every year of the study period and accounted for more than 50% of recorded deaths. In children aged 1 to 4, the category "other important reducible causes" was associated with 40% of recorded deaths-deaths due mainly to respiratory diseases. Over the 20-year period, the avoidable mortality rate decreased by 34% in children aged less than one, in children 1-4, it decreased by 23%. Although the infant-mortality rate in preschool children was reduced, the decrease was small, from 80% to 77%. The situation requires more analysis with respect to strategies in public health, particularly concerning preventable diseases of the infancy.

  13. Potentially avoidable peripartum hysterectomies in Denmark

    DEFF Research Database (Denmark)

    Colmorn, Lotte Berdiin; Krebs, Lone; Langhoff-Roos, Jens

    2016-01-01

    to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations......Objective: To audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means. Material and Methods: We developed a structured audit form based on explicit criteria for the minimal mandatory management...

  14. Tax avoidance: Definition and prevention issues

    Directory of Open Access Journals (Sweden)

    Anđelković Mileva

    2014-01-01

    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.

  15. Airborne Collision Detection and Avoidance for Small UAS Sense and Avoid Systems

    Science.gov (United States)

    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

  16. Knowing and Avoiding Plagiarism During Scientific Writing

    Science.gov (United States)

    Kumar, P Mohan; Priya, N Swapna; Musalaiah, SVVS; Nagasree, M

    2014-01-01

    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

  17. Acute carbon dioxide avoidance in Caenorhabditis elegans.

    Science.gov (United States)

    Hallem, Elissa A; Sternberg, Paul W

    2008-06-10

    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.

  18. Urban water restrictions: Attitudes and avoidance

    Science.gov (United States)

    Cooper, Bethany; Burton, Michael; Crase, Lin

    2011-12-01

    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.

  19. Knowing and avoiding plagiarism during scientific writing.

    Science.gov (United States)

    Kumar, P Mohan; Priya, N Swapna; Musalaiah, Svvs; Nagasree, M

    2014-09-01

    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.

  20. Traffic jam driving with NMV avoidance

    Science.gov (United States)

    Milanés, Vicente; Alonso, Luciano; Villagrá, Jorge; Godoy, Jorge; de Pedro, Teresa; Oria, Juan P.

    2012-08-01

    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.

  1. How does a cyclist avoid obstacles?

    Science.gov (United States)

    Miyadait, Masayuki; Uetake, Teruo; Shimoda, Masahiro

    2012-12-01

    The purpose of this research is to examine the ways bicycles swerve off sidewalks onto roads under various conditions. Seven students, five males and two females participated in an experiment on a road with a 100-cm wide sidewalk. Footage of each participant on a bicycle evading obstacles such as a utility pole and pedestrian were taken with a video camera, while a front-wheel view of the path taken by the bicycle was recorded simultaneously with a digital camera. Twelve experimental conditions were used for each participant, consisting of all the combinations of (1) three obstacle types, (2) the side (left or right) to which the bicycle went to avoid the obstacle, and (3) two weather conditions. Based on the two recorded scenes, the path was then analyzed from the viewpoint of how the bicycle swerved to avoid hitting the obstacle. We found that the conditions of riding a bicycle with an umbrella caused a larger swerve to avoid the obstacle than those conditions when the rider did not have an umbrella. In particular, the condition in which the obstacle was a pedestrian who also had an umbrella caused the largest swerve. Furthermore, the distance required to become aligned with the sidewalk when the obstacle was a pedestrian walking toward the cyclist was longer than that for other obstacles. The swerve width data showed interesting results, including a tendency for swerve width to be wider when the obstacle was a utility pole compared with other obstacles.

  2. Cigarette tax avoidance and evasion: findings from the International Tobacco Control Policy Evaluation Project

    Science.gov (United States)

    Guindon, G. Emmanuel; Driezen, Pete; Chaloupka, Frank J.; Fong, Geoffrey T.

    2014-01-01

    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

  3. Cigarette tax avoidance and evasion: findings from the International Tobacco Control Policy Evaluation (ITC) Project.

    Science.gov (United States)

    Guindon, G Emmanuel; Driezen, Pete; Chaloupka, Frank J; Fong, Geoffrey T

    2014-03-01

    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.

  4. Rapid Assessment of Avoidable Blindness in India.

    Directory of Open Access Journals (Sweden)

    John Neena

    Full Text Available BACKGROUND: Rapid assessment of avoidable blindness provides valid estimates in a short period of time to assess the magnitude and causes of avoidable blindness. The study determined magnitude and causes of avoidable blindness in India in 2007 among the 50+ population. METHODS AND FINDINGS: Sixteen randomly selected districts where blindness surveys were undertaken 7 to 10 years earlier were identified for a follow up survey. Stratified cluster sampling was used and 25 clusters (20 rural and 5 urban were randomly picked in each district.. After a random start, 100 individuals aged 50+ were enumerated and examined sequentially in each cluster. All those with presenting vision = 50 years were enumerated, and 94.7% examined. Based on presenting vision,, 4.4% (95% Confidence Interval[CI]: 4.1,4.8 were severely visually impaired (vision<6/60 to 3/60 in the better eye and 3.6% (95% CI: 3.3,3.9 were blind (vision<3/60 in the better eye. Prevalence of low vision (<6/18 to 6/60 in the better eye was 16.8% (95% CI: 16.0,17.5. Prevalence of blindness and severe visual impairment (<6/60 in the better eye was higher among rural residents (8.2%; 95% CI: 7.9,8.6 compared to urban (7.1%; 95% CI: 5.0, 9.2, among females (9.2%; 95% CI: 8.6,9.8 compared to males (6.5%; 95% CI: 6.0,7.1 and people above 70 years (20.6%; 95% CI: 19.1,22.0 compared to people aged 50-54 years (1.3%; 95% CI: 1.1,1.6. Of all blindness, 88.2% was avoidable. of which 81.9% was due to cataract and 7.1% to uncorrected refractive errors/uncorrected aphakia. CONCLUSIONS: Cataract and refractive errors are major causes of blindness and low vision and control strategies should prioritize them. Most blindness and low vision burden is avoidable.

  5. See-and-Avoid Collision Avoidance Using ADS-B Signal and Radar Sensing Project

    Data.gov (United States)

    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...

  6. Evidence-based Evaluation on Index System of Job Satisfaction of China Hospital Employees%我国医院员工满意度评价指标体系的循证评价

    Institute of Scientific and Technical Information of China (English)

    许星莹; 杜杏斯

    2015-01-01

    Objective:Evidence-based evaluation on job satisfaction for hospital index system in China offers the ref-erence for the construction of evaluation index system of China medical workers’ job satisfaction. Method:The computer searches the Bio-medical Science Databases,Chinese Periodic Full-Text Database,China Science &Technology Periodical Full-Text Database,Chinese Medical Dissertation Full-Text Database,the authority websites and the related medical treat-ment websites,etc.;collects completely the relevant articles on satisfaction with Chinese hospitals,job satisfaction,index, index system,etc. . Result:Among the relevant 54 articles,32 are in Grade C,15,Grade D,and 7,Grade E. There are many common measures in the index systems of job satisfaction but there are some differences. For example,there is not a rela-tively unified evaluation index system and there are fewer indexes of the second grade. And it is a common sense that the same indexes do not have a unified name,which reflects the lack of standardization in statistical terms of job satisfaction e-valuation index. Conclusion:The scientificity of the imperfect evaluation index system of medical workers’ job satisfaction can be improved with the principles and methods of evidence-based medical analysis.%目的:循证评价我国医院员工满意度评价指标体系,为我国医院员工满意度指标评价体系的构建提供借鉴。方法计算机检索中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库、中国医药学位论文全文数据库和官方及医疗相关网站等,全面收集有关我国医院满意度、员工满意度、指标、指标体系等方面相关文献。结果共纳入文献54篇,其中C级32篇,D级15篇,E级7篇。我国各医院员工满意度的评价指标体系虽有很多共性指标,但仍存在差异,还没有形成一套相对统一的评价指标体系;二级指标较少;同一指标名称不统一的现象

  7. Engaging Chicago hospitals in the baby-friendly hospital initiative.

    Science.gov (United States)

    Schoenfelder, Samantha L; Wych, Sadie; Willows, Catherine A; Harrington, Joseph; Christoffel, Katherine Kaufer; Becker, Adam B

    2013-11-01

    Breastfeeding is now widely recognized as a vital obesity prevention strategy and hospitals play a primary role in promoting, supporting and helping mothers to initiate and maintain breastfeeding. The Baby-Friendly Hospital Initiative (BFHI) provides an evidence-based model that hospitals can use to plan and implement breastfeeding quality improvement (QI) projects. Funding under Communities Putting Prevention to Work (CPPW), administered by the CDC, brought together key Chicago partners to provide individualized support and technical assistance with breastfeeding QI projects to the 19 maternity hospitals in Chicago. A community organizing approach was taken to mobilize hospital interest in breastfeeding QI projects, leading to successes, e.g. 12/19 (63 %) Chicago hospitals registered with Baby-Friendly USA, Inc. (BFUSA) to pursue official Baby-Friendly designation. Key factors that fostered this success included: involving all levels of hospital staff, financial incentives, and ongoing tailored technical assistance. To assist other communities in similar work, this article discusses the approach the project took to mobilize hospitals to improve breastfeeding support practices based on the BFHI, as well as successes and lessons learned.

  8. Avoiding unseen obstacles: Subcortical vision is not sufficient to maintain normal obstacle avoidance behaviour during reaching.

    Science.gov (United States)

    Ross, Alasdair I; Schenk, Thomas; Billino, Jutta; Macleod, Mary J; Hesse, Constanze

    2016-10-03

    Previous research found that a patient with cortical blindness (homonymous hemianopia) was able to successfully avoid an obstacle placed in his blind field, despite reporting no conscious awareness of it [Striemer, C. L., Chapman, C. S., & Goodale, M. A., 2009, PNAS, 106(37), 15996-16001]. This finding led to the suggestion that dorsal stream areas, that are assumed to mediate obstacle avoidance behaviour, may obtain their visual input primarily from subcortical pathways. Hence, it was suggested that normal obstacle avoidance behaviour can proceed without input from the primary visual cortex. Here we tried to replicate this finding in a group of patients (N = 6) that suffered from highly circumscribed lesions in the occipital lobe (including V1) that spared the subcortical structures that have been associated with action-blindsight. We also tested if obstacle avoidance behaviour differs depending on whether obstacles are placed only in the blind field or in both the blind and intact visual field of the patients simultaneously. As expected, all patients successfully avoided obstacles placed in their intact visual field. However, none of them showed reliable avoidance behaviour - as indicated by adjustments in the hand trajectory in response to obstacle position - for obstacles placed in their blind visual field. The effects were not dependent on whether one or two obstacles were present. These findings suggest that behaviour in complex visuomotor tasks relies on visual input from occipital areas.

  9. The influence of mastery-avoidance goals on performance improvement

    NARCIS (Netherlands)

    Van Yperen, Nico W.; Elliot, Andrew J.; Anseel, Frederik

    2009-01-01

    Two experiments focused on examining the influence of mastery-avoidance goals on performance improvement, and more specifically, on mastery-avoidance goals grounded in an intrapersonal standard. That is, herein, mastery-avoidance goals entail striving to avoid doing worse than one has done before. B

  10. Decision Making and the Avoidance of Cognitive Demand

    Science.gov (United States)

    Kool, Wouter; McGuire, Joseph T.; Rosen, Zev B.; Botvinick, Matthew M.

    2010-01-01

    Behavioral and economic theories have long maintained that actions are chosen so as to minimize demands for exertion or work, a principle sometimes referred to as the “law of less work.” The data supporting this idea pertain almost entirely to demands for physical effort. However, the same minimization principle has often been assumed also to apply to cognitive demand. We set out to evaluate the validity of this assumption. In six behavioral experiments, participants chose freely between courses of action associated with different levels of demand for controlled information processing. Together, the results of these experiments revealed a bias in favor of the less demanding course of action. The bias was obtained across a range of choice settings and demand manipulations, and was not wholly attributable to strategic avoidance of errors, minimization of time on task, or maximization of the rate of goal achievement. Remarkably, the effect also did not depend on awareness of the demand manipulation. Consistent with a motivational account, avoidance of demand displayed sensitivity to task incentives and co-varied with individual differences in the efficacy of executive control. The findings reported, together with convergent neuroscientific evidence, lend support to the idea that anticipated cognitive demand plays a significant role in behavioral decision-making. PMID:20853993

  11. Convective Weather Avoidance with Uncertain Weather Forecasts

    Science.gov (United States)

    Karahan, Sinan; Windhorst, Robert D.

    2009-01-01

    Convective weather events have a disruptive impact on air traffic both in terminal area and in en-route airspaces. In order to make sure that the national air transportation system is safe and efficient, it is essential to respond to convective weather events effectively. Traffic flow control initiatives in response to convective weather include ground delay, airborne delay, miles-in-trail restrictions as well as tactical and strategic rerouting. The rerouting initiatives can potentially increase traffic density and complexity in regions neighboring the convective weather activity. There is a need to perform rerouting in an intelligent and efficient way such that the disruptive effects of rerouting are minimized. An important area of research is to study the interaction of in-flight rerouting with traffic congestion or complexity and developing methods that quantitatively measure this interaction. Furthermore, it is necessary to find rerouting solutions that account for uncertainties in weather forecasts. These are important steps toward managing complexity during rerouting operations, and the paper is motivated by these research questions. An automated system is developed for rerouting air traffic in order to avoid convective weather regions during the 20- minute - 2-hour time horizon. Such a system is envisioned to work in concert with separation assurance (0 - 20-minute time horizon), and longer term air traffic management (2-hours and beyond) to provide a more comprehensive solution to complexity and safety management. In this study, weather is dynamic and uncertain; it is represented as regions of airspace that pilots are likely to avoid. Algorithms are implemented in an air traffic simulation environment to support the research study. The algorithms used are deterministic but periodically revise reroutes to account for weather forecast updates. In contrast to previous studies, in this study convective weather is represented as regions of airspace that pilots

  12. The global cost of eliminating avoidable blindness

    Directory of Open Access Journals (Sweden)

    Kirsten L Armstrong

    2012-01-01

    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.

  13. Wireless vehicular networks for car collision avoidance

    CERN Document Server

    2013-01-01

    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.

  14. Contact Dermatitis, Patch Testing, and Allergen Avoidance.

    Science.gov (United States)

    Burkemper, Nicole M

    2015-01-01

    In patients presenting with a complaint of rash, contact dermatitis is often the underlying diagnosis making it an entity with which health care providers should be familiar. Contact dermatitis can be divided into irritant contact dermatitis and allergic contact dermatitis. In a patient suspected of having allergic contact dermatitis, patch testing can be done to identify specific allergens. Education focused on allergen avoidance and safe products is an integral part of treatment for the contact dermatitis patient. Knowledge of the most common allergens is helpful for clinicians to be able to provide this education.

  15. Conflict Avoidance by Descent Behind the Intruder

    Directory of Open Access Journals (Sweden)

    Tone Magister

    2004-03-01

    Full Text Available The paramount priorities for safe implementation of a singlepilot manned cockpit concept and the futuristic concept of asingle pilot acting as a supervisor for a fully automated aircraftflying on incessantly self-optimised trajectories are eliminationsof the risk of mid-air collisions and of conflicts resulting fromthe lack of safe airborne separations. Avoidance procedureswith initiation of descent behind the intruder for conflict resolutionbetween a pair of aircraft where one of them is in the vicinityof the top of its descent represents merely one little piece ofthis giant puzzle.

  16. Avoiding Lawsuits for Wage and Hour Violations.

    Science.gov (United States)

    Silberman, Cherie L

    2016-01-01

    Due to the highly technical language in the wage and hour laws and regulations, employers often find that they have unknowingly violated the Fair Labor Standards Act (FLSA). This can occur because employers have improperly classified an employee as exempt or because employers do not realize that certain time should be paid in full. Improperly classifying employees as exempt or failing to compensate nonexempt employees for all time worked can lead to costly lawsuits, audits, or enforcement actions by the Wage and Hour Division of the Department of Labor. This article discusses the most common FLSA exemptions and provides best practices to avoid liability under the FLSA.

  17. The International Double Taxation – Avoiding Methods

    Directory of Open Access Journals (Sweden)

    Nicoleta Barbuta-Misu

    2009-06-01

    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.

  18. CORPORATE SOCIAL RESPONSIBILITY VERSUS TAX AVOIDANCE PRACTICES

    Directory of Open Access Journals (Sweden)

    Stoian Ciprian-Dumitru

    2012-07-01

    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 stakeholders’ 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 paper’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 “Stop Tax Haven Abuse Bill”. 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

  19. Avoidable cancers in the Nordic countries. Occupation

    DEFF Research Database (Denmark)

    Dreyer, L; Andersen, A; Pukkala, E

    1997-01-01

    to be identified. The tissues affected are mainly the epithelial lining of the respiratory organs (nasal cavity, paranasal sinuses, larynx and lung), and urinary tract (renal parenchyma, renal pelvis and urinary bladder), the mesothelial linings, the bone marrow and the liver. During the period 1970-84, almost 4...... 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...

  20. Guide to the collision avoidance rules

    CERN Document Server

    Cockcroft, A N

    2004-01-01

    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

  1. Avoiding plagiarism: guidance for nursing students.

    Science.gov (United States)

    Price, Bob

    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.

  2. Reproducibility Issues: Avoiding Pitfalls in Animal Inflammation Models.

    Science.gov (United States)

    Laman, Jon D; Kooistra, Susanne M; Clausen, Björn E

    2017-01-01

    In light of an enhanced awareness of ethical questions and ever increasing costs when working with animals in biomedical research, there is a dedicated and sometimes fierce debate concerning the (lack of) reproducibility of animal models and their relevance for human inflammatory diseases. Despite evident advancements in searching for alternatives, that is, replacing, reducing, and refining animal experiments-the three R's of Russel and Burch (1959)-understanding the complex interactions of the cells of the immune system, the nervous system and the affected tissue/organ during inflammation critically relies on in vivo models. Consequently, scientific advancement and ultimately novel therapeutic interventions depend on improving the reproducibility of animal inflammation models. As a prelude to the remaining hands-on protocols described in this volume, here, we summarize potential pitfalls of preclinical animal research and provide resources and background reading on how to avoid them.

  3. Interventions in Early Mathematics: Avoiding Pollution and Dilution.

    Science.gov (United States)

    Sarama, Julie; Clements, Douglas H

    2017-01-01

    Although specific interventions in early mathematics have been successful, few have been brought to scale successfully, especially across the challenging diversity of populations and contexts in the early childhood system in the United States. In this chapter, we analyze a theoretically based scale-up model for early mathematics that was designed to avoid the pollution and dilution that often plagues efforts to achieve broad success. We elaborate the theoretical framework by noting the junctures that are susceptible to dilution or pollution. Then we expatiate the model's guidelines to describe specifically how they were designed and implemented to mitigate pollution and dilution. Finally, we provide evidence regarding the success of these efforts. © 2017 Elsevier Inc. All rights reserved.

  4. How to avoid a HIPAA horror story.

    Science.gov (United States)

    Withrow, Scott C

    2010-08-01

    The Health Information Technology for Economic and Clinical Health Act of 2009 significantly expands the financial risk of violations of the Health Insurance Portability and Accountability Act (HIPAA) and extends HIPAA procedures and penalties to business associates. Hospitals, physicians, and their business associates should ensure that HIPAA privacy and security provisions are adopted. Compliance efforts should focus on high-risk areas, including information access management, access control, and impermissible disclosures of protected health information.

  5. Underactuated spacecraft formation reconfiguration with collision avoidance

    Science.gov (United States)

    Huang, Xu; Yan, Ye; Zhou, Yang

    2017-02-01

    Underactuated collision-free controllers are proposed in this paper for multiple spacecraft formation reconfiguration in circular orbits with the loss of either the radial or in-track thrust. A nonlinear dynamical model of underactuated formation flying is introduced, which is then linearized about circular orbits for controllability and feasibility analyses on underactuated formation reconfiguration. By using the inherent dynamics coupling of system states, reduced-order sliding mode controllers are then designed for either case to indirectly stabilize the system trajectories to the desired formations. In consideration of the collision-avoidance requirement, the artificial potential function method is then employed to design novel underactuated collision-avoidance maneuvers. Rigorous proof substantiates the capabilities of such maneuvers in preventing collisions even in the absence of radial or in-track thrust. Furthermore, a Lyapunov-based analysis ensures the asymptotic stability of the overall closed-loop system. Numerical simulations are performed in a J2-perturbed environment to verify the validity of the proposed underactuated control schemes for collision-free reconfiguration.

  6. Shape optimization of self-avoiding curves

    Science.gov (United States)

    Walker, Shawn W.

    2016-04-01

    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.

  7. Collision avoidance for CTV: Requirements and capabilities

    Science.gov (United States)

    Nosek, Thomas P.

    Cargo transfer vehicle (CTV) operations near Space Station Freedom will require positive collision avoidance maneuver (CAM) capability to preclude any change of collision, even in the event of CTV failures. The requirements for CAM are discussed, and the CAM design approach and design of the Orbiting Maneuvering Vehicle (OMV) are reviewed; this design met requirements for OMV operation near the Space Station, provided a redundant collision avoidance maneuver capability. Significant portions of the OMV CAM design should be applicable to CTV. The key features of the OMV design are summarized and related to the CTV mission design to that of OMV's. CAM is a defined sequence of events executed by the CTV to place the vehicle in a safe position relative to a target such as the Space Station. CAM can be performed through software commands to the propulsion system, or through commands pre-stored in hardware. Various techniques for triggering CAM are considered, and the risks associated with CAM enable and execution in phases are considered. OMV CAM design features both hardware and software CAM capability, with analyses conducted to assess the ability to meet the collision-free requirement during all phases of the mission.

  8. Avoiding versus seeking: the relationship of information seeking to avoidance, blunting, coping, dissonance, and related concepts*

    Science.gov (United States)

    Case, Donald O.; Andrews, James E.; Johnson, J. David; Allard, Suzanne L.

    2005-01-01

    Question: How have theorists and empirical researchers treated the human tendency to avoid discomforting information? Data Sources: A historical review (1890–2004) of theory literature in communication and information studies, coupled with searches of recent studies on uptake of genetic testing and on coping strategies of cancer patients, was performed. Study Selection: The authors' review of the recent literature included searches of the MEDLINE, PsychInfo, and CINAHL databases between 1992 and summer of 2004 and selective, manual searches of earlier literature. Search strategies included the following subject headings and key words: MeSH headings: Genetic Screening/psychology, Decision Making, Neoplasms/diagnosis/genetics/psychology; CINAHL headings: Genetic Screening, Genetic Counseling, Anxiety, Decision Making, Decision Making/Patient; additional key words: avoidance, worry, monitoring, blunting, cancer. The “Related Articles” function in MEDLINE was used to perform additional “citation pearl” searching. Main Results: The assumption that individuals actively seek information underlies much of psychological theory and communication practice, as well as most models of the information-seeking process. However, much research has also noted that sometimes people avoid information, if paying attention to it will cause mental discomfort or dissonance. Cancer information in general and genetic screening for cancer in particular are discussed as examples to illustrate this pattern. Conclusion: That some patients avoid knowledge of imminent disease makes avoidance behavior an important area for social and psychological research, particularly with regard to genetic testing. PMID:16059425

  9. Avoiding versus seeking: the relationship of information seeking to avoidance, blunting, coping, dissonance, and related concepts.

    Science.gov (United States)

    Case, Donald O; Andrews, James E; Johnson, J David; Allard, Suzanne L

    2005-07-01

    How have theorists and empirical researchers treated the human tendency to avoid discomforting information? A historical review (1890-2004) of theory literature in communication and information studies, coupled with searches of recent studies on uptake of genetic testing and on coping strategies of cancer patients, was performed. The authors' review of the recent literature included searches of the MEDLINE, PsychInfo, and CINAHL databases between 1992 and summer of 2004 and selective, manual searches of earlier literature. Search strategies included the following subject headings and key words: MeSH headings: Genetic Screening/psychology, Decision Making, Neoplasms/diagnosis/genetics/psychology; CINAHL headings: Genetic Screening, Genetic Counseling, Anxiety, Decision Making, Decision Making/Patient; additional key words: avoidance, worry, monitoring, blunting, cancer. The "Related Articles" function in MEDLINE was used to perform additional "citation pearl" searching. The assumption that individuals actively seek information underlies much of psychological theory and communication practice, as well as most models of the information-seeking process. However, much research has also noted that sometimes people avoid information, if paying attention to it will cause mental discomfort or dissonance. Cancer information in general and genetic screening for cancer in particular are discussed as examples to illustrate this pattern. That some patients avoid knowledge of imminent disease makes avoidance behavior an important area for social and psychological research, particularly with regard to genetic testing.

  10. Exaggerated acquisition and resistance to extinction of avoidance behavior in treated heroin-dependent males

    Science.gov (United States)

    Sheynin, Jony; Moustafa, Ahmed A.; Beck, Kevin D.; Servatius, Richard J.; Casbolt, Peter A.; Haber, Paul; Elsayed, Mahmoud; Hogarth, Lee; Myers, Catherine E.

    2015-01-01

    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

  11. Harm Avoidance and Self-Directedness Characterize Fibromyalgic Patients and the Symptom Severity

    Science.gov (United States)

    Leombruni, Paolo; Zizzi, Francesca; Miniotti, Marco; Colonna, Fabrizio; Castelli, Lorys; Fusaro, Enrico; Torta, Riccardo

    2016-01-01

    Objective: Evidence in the literature suggests peculiar personality traits for fibromyalgic (FM) 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, the Temperament and Character Inventory, the Fibromyalgia Impact Questionnaire and the Short-Form-36 Health Survey. 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 Cluster1 (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 Cluster2 (n = 46). Conclusion: This study confirms the presence of certain personality traits in the FM population. In particular, high levels of HA and low levels of SD 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. PMID:27199814

  12. Foodborne listeriosis acquired in hospitals.

    Science.gov (United States)

    Silk, Benjamin J; McCoy, Morgan H; Iwamoto, Martha; Griffin, Patricia M

    2014-08-15

    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.

  13. Trade-offs between predator avoidance and electric shock avoidance in hermit crabs demonstrate a non-reflexive response to noxious stimuli consistent with prediction of pain.

    Science.gov (United States)

    Magee, Barry; Elwood, Robert W

    2016-09-01

    Arthropods have long been thought to respond to noxious stimuli by reflex reaction. One way of testing if this is true is to provide the animal with a way to avoid the stimulus but to vary the potential cost of avoidance. If avoidance varies with potential cost then a decision making process is evident and the behaviour is not a mere reflex. Here we examine the responses of hermit crabs to electric shock within their shell when also exposed to predator or non-predator odours or to no odour. The electric shocks start with low voltage but increase in voltage with each repetition to determine how odour affects the voltage at which the shell is abandoned. There was no treatment effect on the voltage at which hermit crabs left their shells, however, those exposed to predator odours were less likely to evacuate their shells compared with no odour or low concentrations of non-predator odour. However, highly concentrated non-predator also inhibited evacuation. The data show that these crabs trade-off avoidance of electric shock with predator avoidance. They are thus not responding purely by reflex and the data are thus consistent with predictions of pain but do not prove pain.

  14. Functional textiles in hospital interiors

    DEFF Research Database (Denmark)

    Mogensen, Jeppe

    This PhD thesis explores the possibilities and design qualities of using functional textiles in the interior of hospital environments, and is the result of a three years collaboration between Aalborg University, Department of Civil Engineering, and VIA University College, VIA Design. The project...... is overall related to the construction of new Danish hospitals, where the design concept healing architecture is introduced in a national context, representing the vision of a promoted healing process of hospitalised patients, supported by design related influence. Past research studies provides evidence...... that the physical environments affect the patients’ level of stress and influence their process of recovery and healing. However, although research in this field of hospital design has increased substantially in recent years, knowledge on the use of new materials and textiles in hospital interiors is still rather...

  15. Non-Contiguous Pattern Avoidance in Binary Trees

    CERN Document Server

    Dairyko, Michael; Tyner, Samantha; Wynn, Casey

    2012-01-01

    In this paper we consider the enumeration of binary trees avoiding non-contiguous binary tree patterns. We begin by computing closed formulas for the number of trees avoiding a single binary tree pattern with 4 or fewer leaves and compare these results to analogous work for contiguous tree patterns. Next, we give an explicit generating function that counts binary trees avoiding a single non-contiguous tree pattern according to number of leaves. In addition, we enumerate binary trees that simultaneously avoid more than one tree pattern. Finally, we explore connections between pattern-avoiding trees and pattern-avoiding permutations.

  16. Avoiding accidental exposure to intravenous cytotoxic drugs.

    Science.gov (United States)

    Meade, Elizabeth

    Many cytotoxic drugs have been shown to be mutagenic, teratogenic and carcinogenic with second malignancies known to be associated with several specific cancer drugs. Occupational exposure to cytotoxic drugs presents a signification danger to healthcare staff and unwarranted handling of these drugs should be avoided. Guidelines have been established for the safe handling of hazardous drugs but not all professionals are adhering to these recommendations. Recent environmental studies have demonstrated measurable drug contamination on surfaces even when recommended guidelines are followed. It is therefore imperative that healthcare workers are aware of the potential hazards of antineoplastic agents and employ the recommended precautions to minimise exposure. This article outlines the potential risks associated with exposure to cytotoxic drugs for healthcare staff. The safe-handling precautions required in the storage, preparation, transport, administration and waste disposal of cytotoxic drugs are presented.

  17. DENIS Galaxies in the Zone of Avoidance

    CERN Document Server

    Schröder, A; Mamon, G A; Ruphy, S; Paris-Meudon, Obs.

    1997-01-01

    We investigated the potential of using DENIS for studies of galaxies behind the obscuration layer of our Milky Way, and mapping the Galactic extinction. As a pilot study, we examined DENIS I-, J-, and K-band images of heavily obscured galaxies from a deep optical (B_J-band) galaxy survey in the Zone of Avoidance. We tried to uncover additional galaxies at latitudes where the Milky Way remains fully opaque, i.e. we conducted a `blind' search at |b| 4-5 mag. Furthermore, we determined the I, J and K magnitudes of galaxies in the low-latitude, nearby, rich cluster Abell 3627 and compared the resulting colour-colour diagram with that of an unobscured cluster.

  18. Avoiding sexual harassment liability in veterinary practices.

    Science.gov (United States)

    Lacroix, C A; Wilson, J F

    1996-05-15

    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.

  19. Avoidable cancers in the Nordic countries. Radiation

    DEFF Research Database (Denmark)

    Winther, J F; Ulbak, Kaare; Dreyer, L;

    1997-01-01

    Exposure to solar and ionizing radiation increases the risk for cancer in humans. Some 5% of solar radiation is within the ultraviolet spectrum and may cause both malignant melanoma and non-melanocytic skin cancer; the latter is regarded as a benign disease and is accordingly not included in our......, it was estimated that the exposure of the Nordic populations to natural sources of ionizing radiation other than radon and to medical sources will each give rise to an annual total of 2120 cancers at various sites. For all types of ionizing radiation, the annual total will be 4420 cancer cases, or 3.9% of all...... estimation of avoidable cancers. Under the assumption that the rate of occurrence of malignant melanoma of the buttocks of both men and women and of the scalp of women would apply to all parts of the body in people completely unexposed to solar radiation, it was estimated that approximately 95% of all...

  20. Avoiding Quantum Chaos in Quantum Computation

    CERN Document Server

    Berman, G P; Izrailev, F M; Tsifrinovich, V I

    2001-01-01

    We study a one-dimensional chain of nuclear $1/2-$spins in an external time-dependent magnetic field. This model is considered as a possible candidate for experimental realization of quantum computation. According to the general theory of interacting particles, one of the most dangerous effects is quantum chaos which can destroy the stability of quantum operations. According to the standard viewpoint, the threshold for the onset of quantum chaos due to an interaction between spins (qubits) strongly decreases with an increase of the number of qubits. Contrary to this opinion, we show that the presence of a magnetic field gradient helps to avoid quantum chaos which turns out to disappear with an increase of the number of qubits. We give analytical estimates which explain this effect, together with numerical data supporting

  1. Tax Anti-avoidance Through Transfer Pricing

    DEFF Research Database (Denmark)

    Rossing, Christian Plesner; Riise Johansen, Thomas; Pearson, Thomas C.

    2016-01-01

    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......-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...

  2. Collision Avoidance of Trains Using Arm7

    Directory of Open Access Journals (Sweden)

    Dr. K. R. R. Mohan Rao

    2015-11-01

    Full Text Available Railways are the popular mode of Transport in almost all major cities of the World. Railways are the most widely used and comfortable modes of transportation system. The major cause for railway accidents is collision of trains on the same track. The main aim of this anti collision system is to identify collision points and to report these error cases to main control room nearer to the station as well as grid control station. Majority of accidents occurred due to improper communication among the network between drivers and control room, due to wrong signaling, worst atmospheric condition, immediate change of route. The train driver doesn’t get proper information in time leading to hazardous situations. So this system by using zigbee protocol provides communication in between trains, which provide information or track id of one train to another train to avoid collision.

  3. Avoidable deaths in Greenland 1968-1985

    DEFF Research Database (Denmark)

    Bjerregaard, Peter; Juel, K

    1990-01-01

    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....

  4. Tax Anti-avoidance Through Transfer Pricing

    DEFF Research Database (Denmark)

    Rossing, Christian Plesner; Riise Johansen, Thomas; Pearson, Thomas C.

    2016-01-01

    -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...

  5. Experiential Avoidance and Technological Addictions in Adolescents.

    Science.gov (United States)

    García-Oliva, Carlos; Piqueras, José A

    2016-06-01

    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.

  6. Experiential Avoidance and Technological Addictions in Adolescents

    Science.gov (United States)

    García-Oliva, Carlos; Piqueras, José A.

    2016-01-01

    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

  7. Do more hospital beds lead to higher hospitalization rates? a spatial examination of Roemer's Law.

    Science.gov (United States)

    Delamater, Paul L; Messina, Joseph P; Grady, Sue C; WinklerPrins, Vince; Shortridge, Ashton M

    2013-01-01

    Roemer's Law, a widely cited principle in health care policy, states that hospital beds that are built tend to be used. This simple but powerful expression has been invoked to justify Certificate of Need regulation of hospital beds in an effort to contain health care costs. Despite its influence, a surprisingly small body of empirical evidence supports its content. Furthermore, known geographic factors influencing health services use and the spatial structure of the relationship between hospital bed availability and hospitalization rates have not been sufficiently explored in past examinations of Roemer's Law. We pose the question, "Accounting for space in health care access and use, is there an observable association between the availability of hospital beds and hospital utilization?" We employ an ecological research design based upon the Anderson behavioral model of health care utilization. This conceptual model is implemented in an explicitly spatial context. The effect of hospital bed availability on the utilization of hospital services is evaluated, accounting for spatial structure and controlling for other known determinants of hospital utilization. The stability of this relationship is explored by testing across numerous geographic scales of analysis. The case study comprises an entire state system of hospitals and population, evaluating over one million inpatient admissions. We find compelling evidence that a positive, statistically significant relationship exists between hospital bed availability and inpatient hospitalization rates. Additionally, the observed relationship is invariant with changes in the geographic scale of analysis. This study provides evidence for the effects of Roemer's Law, thus suggesting that variations in hospitalization rates have origins in the availability of hospital beds. This relationship is found to be robust across geographic scales of analysis. These findings suggest continued regulation of hospital bed supply to assist in

  8. Comparison of work-related fear-avoidance beliefs across different anatomical locations with musculoskeletal pain

    Directory of Open Access Journals (Sweden)

    Simon CB

    2011-09-01

    Full Text Available Corey B Simon¹, Sandra E Stryker², Steven Z George³1Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA; 2Life’s Work Physical Therapy, Portland, Oregon, USA; 3Department of Physical Therapy and Center for Pain Research and Behavioral Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USABackground: The influence of work-related fear-avoidance on pain and function has been consistently reported for patients with musculoskeletal low back pain. Emerging evidence suggests similar influences exist for other anatomical locations of musculoskeletal pain, such as the cervical spine and extremities. However, research is limited in comparing work-related fear-avoidance and associations with clinical outcomes across different anatomical locations. The purpose of this study was to examine the associations between work-related fear-avoidance, gender, and clinical outcomes across four different musculoskeletal pain locations for patients being treated in an outpatient physical therapy setting.Methods: This study was a secondary analysis of data obtained prospectively from a cohort of 313 participants receiving physical therapy from an outpatient clinic.Results: No interaction was found between gender and anatomical location of musculoskeletal pain on work-related fear-avoidance scores. Work-related fear-avoidance scores were higher in the cervical group versus the lower extremity group; however, there were no other differences across anatomical locations. Work-related fear-avoidance influenced intake pain intensity in patients with spine pain but not extremity pain. Conversely, work-related fear-avoidance influenced intake function for participants with extremity pain but not spine pain. Similar results were observed for change scores, with higher work-related fear-avoidance being associated with more, not less, change in pain

  9. Avoidable readmission in Hong Kong - system, clinician, patient or social factor?

    Directory of Open Access Journals (Sweden)

    Cheung Annie WL

    2010-11-01

    Full Text Available Abstract Background Studies that identify reasons for readmissions are gaining importance in the light of the changing demographics worldwide which has led to greater demand for hospital beds. It is essential to profile the prevalence of avoidable readmissions and understand its drivers so as to develop possible interventions for reducing readmissions that are preventable. The aim of this study is to identify the magnitude of avoidable readmissions, its contributing factors and costs in Hong Kong. Methods This was a retrospective analysis of 332,453 inpatient admissions in the Medical specialty in public hospital system in Hong Kong in year 2007. A stratified random sample of patients with unplanned readmission within 30 days after discharge was selected for medical record reviews. Eight physicians reviewed patients' medical records and classified whether a readmission was avoidable according to an assessment checklist. The results were correlated with hospital inpatient data. Results It was found that 40.8% of the 603 unplanned readmissions were judged avoidable by the reviewers. Avoidable readmissions were due to: clinician factor (42.3% including low threshold for admission and premature discharge etc.; patient factor (including medical and health factor (41.9% such as relapse or progress of previous complaint, and compliance problems etc., followed by system factor (14.6% including inadequate discharge planning, inadequate palliative care/terminal care, etc., and social factor (1.2% such as carer system, lack of support and community services. After adjusting for patients' age, gender, principal diagnosis at previous discharge and readmission hospitals, the risk factors for avoidable readmissions in the total population i.e. all acute care admissions irrespective of whether there was a readmission or not, included patients with a longer length of stay, and with higher number of hospitalizations and attendance in public outpatient clinics and

  10. Non-avoidance behaviour in enchytraeids to boric acid is related to the GABAergic mechanism.

    Science.gov (United States)

    Bicho, Rita C; Gomes, Susana I L; Soares, Amadeu M V M; Amorim, Mónica J B

    2015-05-01

    Soil invertebrates, e.g. enchytraeids, are known to be able to avoid unfavourable conditions, which gives them an important ecological advantage. These organisms possess chemoreceptors that can detect stressors, which in turn activate responses such as avoidance behaviour. We studied the avoidance behaviour in response to boric acid (BA) using enchytraeids. Results showed not only no avoidance, but that increasing concentrations seemed to have an "attraction" effect. To study the underlying mechanism, a selection of genes targeting for neurotransmission pathways (acetylcholinesterase (AChE) and gamma-aminobutyric acid receptor (GABAr)) were quantified via quantitative real-time polymerase chain reaction (qPCR). Evidences were that BA is neurotoxic via the GABAergic system mechanism where it acts as a GABA-associated protein receptor (GABAAR) antagonist possibly causing anaesthetic effects. This is the first time that (non)avoidance behaviour in invertebrates was studied in relation with the GABAergic system. We strongly recommend the combination of such gene and/or functional assay studies with the avoidance behaviour test as it can bring many advantages and important interpretation lines for ecotoxicity with minor effort.

  11. Is all motivation good for learning? Dissociable influences of approach and avoidance motivation in declarative memory.

    Science.gov (United States)

    Murty, Vishnu P; LaBar, Kevin S; Hamilton, Derek A; Adcock, R Alison

    2011-01-01

    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.

  12. Readmissions at a public safety net hospital.

    Directory of Open Access Journals (Sweden)

    Eri Shimizu

    Full Text Available OBJECTIVE: We aimed to determine factors related to avoidability of 30-day readmissions at our public, safety net hospital in the United States (US. METHODS: We prospectively reviewed medical records of adult internal medicine patients with scheduled and unscheduled 30-day readmissions. We also interviewed patients if they were available. An independent panel used pre-specified, objective criteria to adjudicate potential avoidability. RESULTS: Of 153 readmissions evaluated, 68% were unscheduled. Among these, 67% were unavoidable, primarily due to disease progression and development of new diagnoses. Scheduled readmissions accounted for 32% of readmissions and most (69% were clinically appropriate and unavoidable. The scheduled but avoidable readmissions (31% were attributed largely to limited resources in our healthcare system. CONCLUSIONS: Most readmissions at our public, safety net hospital were unavoidable, even among our unscheduled readmissions. Surprisingly, one-third of our overall readmissions were scheduled, the majority reflecting appropriate management strategies designed to reduce unnecessary hospital days. The scheduled but avoidable readmissions were due to constrained access to non-emergent, expensive procedures that are typically not reimbursed given our system's payor mix, a problem which likely plague other safety net systems. These findings suggest that readmissions do not necessarily reflect inadequate medical care, may reflect resource constraints that are unlikely to be addressable in systems caring for a large burden of uninsured patients, and merit individualized review.

  13. An ideal hospital.

    Science.gov (United States)

    Chandrasiri, Singithi Sidney

    2017-07-03

    Purpose The purpose of this paper is to explore a novel overarching strategy in tackling the key issues raised by the recent inquiry into bullying, harassment and discrimination in surgical practice and surgical training in Australian and New Zealand hospitals. Design/methodology/approach The approach taken is an analysis of the available evidence-based literature to inform the proposed viewpoint. The theoretical subject scope presented is a discussion of how and why the various strategies put forward in this paper should be integrated into and led from an overarching workforce engagement platform. Findings The key themes isolated from the Inquiry into Australian and New Zealand surgical practice ranged from abuse of power by those in leadership positions, gender inequity in the surgical workforce, opaque and corrupt complaints handling processes, excessive surgical trainee working hours to bystander silence secondary to a fear of reprisal. A workforce engagement perspective has elicited the potential to counter various impacts, that of clinical ineffectiveness, substandard quality and safety, inefficient medical workforce management outcomes, adverse economic implications and the operational profitability of a hospital. Generic strategies grounded in evidence-based literature were able to then be aligned with specific action areas to provide a new leadership framework for addressing these impacts. Originality/value To the author's knowledge, this is one of the first responses providing a framework on how medical managers and hospital executives can begin to lead a comprehensive and practical strategy for changing the existing culture of bullying, harassment and discrimination in surgical practice by using a staff engagement framework.

  14. Pregnant Women Should Avoid Zika-Hit Texas Town: CDC

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_162573.html Pregnant Women Should Avoid Zika-Hit Texas Town: CDC ... 15, 2016 THURSDAY, Dec. 15, 2016 (HealthDay News) -- Pregnant women should avoid traveling to a south Texas ...

  15. US Forest Service Aerial Fire Retardant Hydrographic Avoidance Areas: Aquatic

    Data.gov (United States)

    US Forest Service, Department of Agriculture — A map services on the www depicting aerial retardant avoidance areas for hydrographic feature data. Aerial retardant avoidance area for hydrographic feature data are...

  16. Tax avoidance - a view from the dark side

    National Research Council Canada - National Science Library

    Bloom, David

    2016-01-01

    In discussion of tax avoidance in Australia and the United Kingdom, attempts are generally made to define tax avoidance by distinguishing it from other tax activities - often with positive or negative connotations...

  17. Avoidable 30-Day Readmissions Among Patients With Stroke and Other Cerebrovascular Disease

    Science.gov (United States)

    Nahab, Fadi; Takesaka, Jennifer; Mailyan, Eugene; Judd, Lilith; Culler, Steven; Webb, Adam; Frankel, Michael; Choi, Dennis; Helmers, Sandra

    2012-01-01

    Background: There are limited data on factors associated with 30-day readmissions and the frequency of avoidable readmissions among patients with stroke and other cerebrovascular disease. Methods: University HealthSystem Consortium (UHC) database records were used to identify patients discharged with a diagnosis of stroke or other cerebrovascular disease at a university hospital from January 1, 2007 to December 31, 2009 and readmitted within 30 days to the index hospital. Logistic regression models were used to identify patient and clinical characteristics associated with 30-day readmission. Two neurologists performed chart reviews on readmissions to identify avoidable cases. Results: Of 2706 patients discharged during the study period, 174 patients had 178 readmissions (6.4%) within 30 days. The only factor associated with 30-day readmission was the index length of stay >10 days (vs <5 days; odds ratio [OR] 2.3, 95% CI [1.4, 3.7]). Of 174 patients readmitted within 30 days (median time to readmission 10 days), 92 (53%) were considered avoidable readmissions including 38 (41%) readmitted for elective procedures within 30 days of discharge, 27 (29%) readmitted after inadequate outpatient care coordination, 15 (16%) readmitted after incomplete initial evaluations, 8 (9%) readmitted due to delayed palliative care consultation, and 4 (4%) readmitted after being discharged with inadequate discharge instructions. Only 5% of the readmitted patients had outpatient follow-up recommended within 1 week. Conclusions: More than half of the 30-day readmissions were considered avoidable. Coordinated timing of elective procedures and earlier outpatient follow-up may prevent the majority of avoidable readmissions among patients with stroke and other cerebrovascular disease. PMID:23983857

  18. Stigma Related Avoidance in People Living with Severe Mental Illness (SMI): Findings of an Integrative Review.

    Science.gov (United States)

    Abiri, Sadat; Oakley, Linda Denise; Hitchcock, Mary E; Hall, Amanda

    2016-04-01

    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.

  19. Avoidance of contaminated sediments by an amphipod (Melita plumulosa), A harpacticoid copepod (Nitocra spinipes), and a snail (Phallomedusa solida).

    Science.gov (United States)

    Ward, Daniel J; Simpson, Stuart L; Jolley, Dianne F

    2013-03-01

    The distribution of contaminants is seldom homogeneous in aquatic systems. In the present study, the avoidance response of Melita plumulosa, Nitocra spinipes, and Phallomedusa solida when exposed to contaminated sediments was investigated. Test vessels were designed to allow the congruent placement of two sediments and assessment of the movement of organisms between the sediments. When exposed to reference sediment, each species dispersed evenly between test chambers regardless of differences in sediment particle size. In the presence of contaminated sediment, the magnitude and rate of avoidance varied. Avoidance assays showed that test species avoided contaminated sediment as early as 6, 6, and 24 h following exposure for N. spinipes, P. solida, and M. plumulosa, respectively. The 48-h avoidance response of M. plumulosa for nine contaminated sediments of varying toxicity showed that avoidance was generally greater for sediments which elicited greater 10-d lethality to this species. The study demonstrated that each of these species has the ability to respond to chemical cues in the environment to inhabit sediment that provides the best opportunity for survival. The avoidance response for each species indicates the potential for developing rapid screening methods to assess sediment quality. Evidence suggests that avoidance was related to sediment toxicity and that static 10-d toxicity methods are likely to overestimate toxicity for species, which would avoid contamination in heterogeneous field settings.

  20. Differences in spontaneously avoiding or approaching mice reflect differences in CB1-mediated signaling of dorsal striatal transmission.

    Directory of Open Access Journals (Sweden)

    Daniela Laricchiuta

    Full Text Available Approach or avoidance behaviors are accompanied by perceptual vigilance for, affective reactivity to and behavioral predisposition towards rewarding or punitive stimuli, respectively. We detected three subpopulations of C57BL/6J mice that responded with avoiding, balancing or approaching behaviors not induced by any experimental manipulation but spontaneously displayed in an approach/avoidance conflict task. Although the detailed neuronal mechanisms underlying the balancing between approach and avoidance are not fully clarified, there is growing evidence that endocannabinoid system (ECS plays a critical role in the control of these balancing actions. The sensitivity of dorsal striatal synapses to the activation of cannabinoid CB1 receptors was investigated in the subpopulations of spontaneously avoiding, balancing or approaching mice. Avoiding animals displayed decreased control of CB1 receptors on GABAergic striatal transmission and in parallel increase of behavioral inhibition. Conversely, approaching animals exhibited increased control of CB1 receptors and in parallel increase of explorative behavior. Balancing animals reacted with balanced responses between approach and avoidance patterns. Treating avoiding animals with URB597 (fatty acid amide hydrolase inhibitor or approaching animals with AM251 (CB1 receptor inverse agonist reverted their respective behavioral and electrophysiological patterns. Therefore, enhanced or reduced CB1-mediated control on dorsal striatal transmission represents the synaptic hallmark of the approach or avoidance behavior, respectively. Thus, the opposite spontaneous responses to conflicting stimuli are modulated by a different involvement of endocannabinoid signaling of dorsal striatal neurons in the range of temperamental traits related to individual differences.

  1. Performance of humans in concurrent avoidance/positive-reinforcement schedules

    OpenAIRE

    Ruddle, H. V.; Bradshaw, C M; Szabadi, E; Foster, T M

    1982-01-01

    Performance maintained under concurrent schedules consisting of a variable-interval avoidance component and a variable-interval positive-reinforcement component was studied in three human subjects using points exchangeable for money as the reinforcer. The rate of responding in the avoidance component increased, and the rate of responding in the positive-reinforcement component declined, as a function of the frequency of point-losses avoided in the avoidance component. The performance of all t...

  2. Risks in hospitals. Assessment and Management

    Directory of Open Access Journals (Sweden)

    Bradea Ioana-Alexandra

    2014-12-01

    Full Text Available In a complex world, characterized by a multitude of risks, managers need to manage the risks they encounter, in an efficient way and in the shortest time possible. In the current economic crisis, the concept of hospital risk management, as the process in which is identified, analyzed, reduced, or avoided a risk that may affect the hospital, gained great importance. The Romanian health system, distinguished by: lack of transparency, poor funding, the loss of the valuable medical staff, lack of hospitals in villages and small towns, inability to engage patients due to the old and poor equipment, lack of research and problems in information privacy and cyber-security, requires an appropriate management, enabling risk managers to take decisions in order to avoid the occurrence of risks. Important for the functioning of every hospital is the perception of patients and their degree of satisfaction, regarding the quality of services, which depend largely on the quality of human resources. But what are the human resources weaknesses and risks from the patient point of view? What are the risk indicators which must be monitored to avoid risks? And also, which is the most useful method for measurement and assessment of risk?

  3. Landslide disaster avoidance: learning from Leyte

    Science.gov (United States)

    Davies, T. R.

    2006-12-01

    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

  4. Social anxiety predicts avoidance behaviour in virtual encounters

    NARCIS (Netherlands)

    Rinck, M.; Rörtgen, T.; Lange, W.G.; Dotsch, R.; Wigboldus, D.H.J.; Becker, E.S.

    2010-01-01

    Avoidant behaviour is critical in social anxiety and social phobia, being a major factor in the maintenance of anxiety. However, almost all previous studies of social avoidance were restricted to using self-reports for the study of intentional aspects of avoidance. In contrast, the current study use

  5. Effects of vasopressin on active and passive avoidance behavior

    NARCIS (Netherlands)

    Bohus, B.; Ader, R.; Wied, D. de

    1972-01-01

    Male rats were trained in an active avoidance and/or a “step-through” type of passive avoidance situation. Lysine vasopressin administration resulted in resistance to extinction of active avoidance behavior if it was injected 1 hr prior to the third and final acquisition session; peptide treatment 6

  6. 34 CFR 75.611 - Avoidance of flood hazards.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Avoidance of flood hazards. 75.611 Section 75.611... by a Grantee? Construction § 75.611 Avoidance of flood hazards. In planning the construction, a...) Evaluate flood hazards in connection with the construction; and (b) As far as practicable, avoid...

  7. Effects of optimism on creativity under approach and avoidance motivation

    NARCIS (Netherlands)

    Icekson, Tamar; Roskes, Marieke; Moran, Simone

    2014-01-01

    Focusing on avoiding failure or negative outcomes (avoidance motivation) can undermine creativity, due to cognitive (e.g., threat appraisals), affective (e.g., anxiety), and volitional processes (e.g., low intrinsic motivation). This can be problematic for people who are avoidance motivated by

  8. Avoidance learning : a review of theoretical models and recent developments

    NARCIS (Netherlands)

    Krypotos, Angelos-Miltiadis; Effting, Marieke; Kindt, Merel; Beckers, Tom

    2015-01-01

    Avoidance is a key characteristic of adaptive and maladaptive fear. Here, we review past and contemporary theories of avoidance learning. Based on the theories, experimental findings and clinical observations reviewed, we distill key principles of how adaptive and maladaptive avoidance behavior is

  9. 14 CFR 121.356 - Collision avoidance system.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Collision avoidance system. 121.356 Section... Collision avoidance system. Effective January 1, 2005, any airplane you operate under this part must be equipped and operated according to the following table: Collision Avoidance Systems If you operate...

  10. Effects of optimism on creativity under approach and avoidance motivation

    NARCIS (Netherlands)

    Icekson, Tamar; Roskes, Marieke; Moran, Simone

    2014-01-01

    Focusing on avoiding failure or negative outcomes (avoidance motivation) can undermine creativity, due to cognitive (e.g., threat appraisals), affective (e.g., anxiety), and volitional processes (e.g., low intrinsic motivation). This can be problematic for people who are avoidance motivated by natur

  11. 14 CFR 129.18 - Collision avoidance system.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Collision avoidance system. 129.18 Section... § 129.18 Collision avoidance system. Effective January 1, 2005, any airplane you, as a foreign air... Avoidance Systems If you operate in the United States any . . . Then you must operate that airplane with:...

  12. 14 CFR 437.65 - Collision avoidance analysis.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Collision avoidance analysis. 437.65..., DEPARTMENT OF TRANSPORTATION LICENSING EXPERIMENTAL PERMITS Safety Requirements § 437.65 Collision avoidance... permittee must obtain a collision avoidance analysis from United States Strategic Command. (b) The...

  13. 14 CFR 417.231 - Collision avoidance analysis.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Collision avoidance analysis. 417.231..., DEPARTMENT OF TRANSPORTATION LICENSING LAUNCH SAFETY Flight Safety Analysis § 417.231 Collision avoidance analysis. (a) General. A flight safety analysis must include a collision avoidance analysis...

  14. Avoidance learning : a review of theoretical models and recent developments

    NARCIS (Netherlands)

    Krypotos, Angelos-Miltiadis; Effting, Marieke; Kindt, Merel; Beckers, Tom

    2015-01-01

    Avoidance is a key characteristic of adaptive and maladaptive fear. Here, we review past and contemporary theories of avoidance learning. Based on the theories, experimental findings and clinical observations reviewed, we distill key principles of how adaptive and maladaptive avoidance behavior is a

  15. 50 CFR 600.510 - Gear avoidance and disposal.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false Gear avoidance and disposal. 600.510 Section 600.510 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND... Gear avoidance and disposal. (a) Vessel and gear avoidance. (1) FFV's arriving on fishing grounds...

  16. 78 FR 35262 - Detection and Avoidance of Counterfeit Electronic Parts

    Science.gov (United States)

    2013-06-12

    ... Defense Acquisition Regulations System Detection and Avoidance of Counterfeit Electronic Parts AGENCY... and the private sector regarding the electronic parts detection and avoidance coverage proposed to be... about the requirements for detection and avoidance of counterfeit electronic parts in DoD contracts....

  17. 47 CFR 51.609 - Determination of avoided retail costs.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Determination of avoided retail costs. 51.609... (CONTINUED) INTERCONNECTION Resale § 51.609 Determination of avoided retail costs. (a) Except as provided in § 51.611, the amount of avoided retail costs shall be determined on the basis of a cost study...

  18. Fatal distraction: finance versus vigilance in U.S. hospitals.

    Science.gov (United States)

    Schiff, G D

    2000-01-01

    Three decades ago, a now classic study on the sale of human blood defied conventional economic wisdom by demonstrating that a marketplace system for blood distribution was less efficient, less safe, and more costly. Emerging data, including the article by Thomas and colleagues in this issue, suggest the same may be true for hospitals. For-profit hospitals in Utah and Colorado had higher preventable adverse event rates than matched nonprofits. The author explores possible explanations, including the role of nursing care. While some claimed that a for-profit marketplace would stimulate efforts for improved quality, evidence is accumulating that report cards and profit-driven competition have failed to deliver on their promises. More promising is a series of not-for-profit initiatives to reduce errors that redirects our attention to patients and their need for better quality care. Rather than allowing competition to lower costs and avoid sick patients to distract us, our energies need to focus on better quality alternatives.

  19. Can low metallicity binaries avoid merging?

    CERN Document Server

    de Mink, S E; Pols, O R

    2007-01-01

    Rapid mass transfer in a binary system can drive the accreting star out of thermal equilibrium, causing it to expand. This can lead to a contact system, strong mass loss from the system and possibly merging of the two stars. In low metallicity stars the timescale for heat transport is shorter due to the lower opacity. The accreting star can therefore restore thermal equilibrium more quickly and possibly avoid contact. We investigate the effect of accretion onto main sequence stars with radiative envelopes with different metallicities. We find that a low metallicity (Z<0.001), 4 solar mass star can endure a 10 to 30 times higher accretion rate before it reaches a certain radius than a star at solar metallicity. This could imply that up to two times fewer systems come into contact during rapid mass transfer when we compare low metallicity. This factor is uncertain due to the unknown distribution of binary parameters and the dependence of the mass transfer timescale on metallicity. In a forthcoming paper we w...

  20. Avoiding spurious breaks in binned luminosity functions

    CERN Document Server

    Cara, Mihai

    2008-01-01

    We show that using either the method of Page & Carrera or the well-known $1/V_a$ method to construct the binned luminosity function (LF) of a flux limited sample of Active Galactic Nuclei (AGN) can produce an artificial flattening (or steepening in the case of negative evolution) of the binned LF for bins intersected by the flux cutoff of the sample. This effect is more pronounced for samples with steep and strongly evolving parent LFs but is still present even for non-evolving LFs. As a result of this distortion of the true LF, fitting a model LF to binned data may lead to errors in the estimation of the parameters and may even prompt the erroneous use of broken power law functions. We compute the expected positions of apparent breaks in the binned LF. We show that these spurious breaks in the binned LFs can be avoided if the binning is done in the flux--redshift plane instead of the typically used luminosity--redshift plane. Binning in the flux--redshift plane can be used in conjunction with the binning...